European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Review Case Reports
A meta-analysis on the utility of peripheral venous blood gas analyses in exacerbations of chronic obstructive pulmonary disease in the emergency department.
The objective of this case-based review is to identify and summarize the relevant evidence for the clinical utility of peripheral venous blood gas (pVBG) analyses in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in the emergency department. Relevant studies were identified using the Cochrane Library, Medline, Embase, and CINAHL databases and by hand searching of references of published articles. Included studies were prospective trials comparing arterial and pVBG results in patients with COPD or respiratory distress that reported at least average differences and/or limits of agreement between the two results in English. ⋯ No studies investigated the role of pVBG analysis in treatment alteration or clinical outcomes. Available evidence suggests that there is good agreement for pH and HCO3 values between arterial and pVBG results in patients with COPD, but not for pO2 or pCO2. Widespread clinical use is limited because of the lack of validation studies on clinical outcomes.
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Emergency service workers continuously face situations where they are in charge of the lives of others, and this can be a risk factor for their mental health. This study aims to determine the psychological impact of exposure to current death and physical injury events in the context of motor vehicle accidents among emergency personnel and which variables better predict posttraumatic stress disorder. Participants were National Institute of Medical Emergency workers (nurses and medical doctors; n= 59) in the north of Portugal. ⋯ Participants reported high exposure to events evaluated as traumatic, but low prevalence of PTSD. When the relation between exposure, time in emergency, sex, distress symptoms, peritraumatic dissociation, and PTSD symptoms was examined, peritraumatic dissociation and distress were the only predictors of PTSD symptoms, but beyond their contribution direct coping explains PTSD variance. In conclusion, taking into account the contribution of distress and peritraumatic dissociation to predict psychopathological symptoms, and the contribution of coping to lower PTSD scores, education and training should help the professionals deal with these reactions and improve coping, and organizations should support professionals in the most disturbing situations.
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The primary purpose of this prospective cohort study was to characterize the use of the Emergency Department (ED) in patients with chronic obstructive pulmonary disease (COPD) exacerbations and determine the factors affecting the revisit of COPD patients. This is a prospective cohort study on ambulatory patients with exacerbated chronic bronchitis in an ED setting. Patients included in the study were above 18 years of age, had a previous diagnosis of COPD, and presented to the ED for the treatment of COPD exacerbation. ⋯ Home oxygen therapy, intensive care admission, previous intubation, increased cough, and the number of ED visits in the previous year were associated with increased risk of revisit in the univariate analysis. Increased cough (odds ratio: 0.232; 95% confidence interval: 0.063-0.853) and the number of ED visits in the previous year (odds ratio: 1.166; 95% confidence interval: 1.005-1.353) were still significant after multivariate analysis. In conclusion, the number of ED visits previous year and increased cough can predict the revisit of a COPD exacerbated patient within 14 days of an ED visit.
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Comparative Study
Comparison of CT head interpretation between emergency physicians and neuroradiologists.
Cranial computed tomography (CT) of the head is widely used in the emergency department 24 h a day. We compared the accuracy of CT head interpretation between staff emergency physicians (EPs) and neuroradiologists. We conducted a health records review of patients who required head CT in the emergency department. ⋯ The weighted kappa for agreement was 0.83 (95% confidence interval 0.76-0.90). None of these patients had adverse outcomes related to EP misinterpretation of the CT head. In conclusion, clinically important findings on CT head are not commonly missed by our EPs and patients rarely have inappropriate disposition.