Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
The emergency department (ED) and HIV specialty clinics are primary sources of care for persons infected with HIV. HIV disease may be complicated by vague and complex symptomatology, and determining the degree of illness at triage is often difficult. The goals of this project were to characterize the ED presentation of HIV-related conditions, to develop a clinical decision rule to triage HIV-infected patients, and to validate the rule in clinical practice. ⋯ The Clinical Triage Instrument was not sufficiently accurate for clinical use. Until accurate and reliable triage methods are developed, all patients infected with HIV who present to the ED for care should receive timely evaluation and care.
-
Ethnic and racial differences in the provision of emergency department (ED) analgesia for long-bone fractures have recently been reported in two large cities. The authors sought to determine, in a third city, whether nonwhite patients with long-bone fractures were less likely to receive analgesics than white patients with similar injuries. ⋯ In contrast to two recently reported studies, at this urban trauma center and teaching hospital ED, there was no difference in the administration of analgesics to white and nonwhite patients with long-bone fractures.
-
New diagnostic and treatment options for emergency department (ED) patients with congestive heart failure (CHF) may facilitate the ED discharge of some patients. However, some patients require admission to exclude concurrent acute coronary syndrome (ACS) as the precipitant of CHF. The objective of this study was to identify the incidence, clinical characteristics, and hospital course of CHF patients who present to the ED with and without concurrent ACS. ⋯ The incidence of ACS in ED CHF patients with chest pain was 32%. Patients with CHF complicated by ACS had more prolonged hospital stays, required higher levels of care, and had a higher incidence of death than those patients without ACS. Strategies tailored to early identification and management of these patients would be desirable.
-
Comparative Study
Assessment of stroke index using impedance cardiography: comparison with traditional vital signs for detection of moderate acute blood loss in healthy volunteers.
Impedance cardiography has been used to detect early hemorrhagic shock, but, to the best of the authors' knowledge, no previous study has looked at the test characteristics of bioimpedance-derived hemodynamic parameters for the detection of a measured loss of blood volume. The authors set out to investigate the effect of controlled hemorrhage on stroke index (SI) using impedance cardiography, and to evaluate the performance of this test for moderate blood loss in comparison with the performance of traditional vital signs. ⋯ Moderate blood loss was associated with a decline in mean SI that was clearly detectable with impedance cardiography. However, as a test for moderate blood loss in this controlled setting, neither SI nor triangle up SI performed better than traditional vital signs.
-
The use of ocular ultrasonography for the evaluation of emergency patients has recently been described in the emergency medicine (EM) literature. There are a number of potential uses that may greatly aid the emergency physician (EP) and avoid lengthy consultation or other diagnostic tests. ⋯ Emergency bedside ultrasound is highly accurate for ruling out and diagnosing ocular pathology in patients presenting to the emergency department. Further, it accurately differentiates between pathology that needs immediate ophthalmologic consultation and that which can be followed up on an outpatient basis.