European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Observational Study
Is severe hypercalcemia immediately life-threatening?
Severe hypercalcemia is often considered an emergency because of a potential risk of cardiac arrest or coma. However, there is little evidence to support this. The aim of our study was to assess whether severe hypercalcemia (Ca>4 mmol/l or 16 mg/dl) was associated with immediately life-threatening cardiac arrhythmias or neurological complications in patients admitted to the Emergency Department (ED). ⋯ We found no cases of immediately life-threatening cardiac arrhythmias or neurological complications associated with hypercalcemia above 4 mmol/l over a 5-year period in a large tertiary ED.
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Hospitals play a pivotal role as basic healthcare providers during mass casualty incidents (MCIs). Radiological studies and emergency laboratory test are of high importance for the management of hospital patients. However, it is known that during these events, they can generate significant bottlenecks. Appropriate request of such tests is of utmost importance to not generate delays in the patient flow. The aim of this paper is to describe a software designed to increase the realism of hospital-based MCI training through a realistic reproduction of radiology and laboratory departments. ⋯ The tool not only increased the simulation realism by adding the radiology and laboratory departments but also provided valuable data that could be used for educational and organizational purposes.
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Observational Study
Lactate - Arterial and Venous Agreement in Sepsis: a prospective observational study.
Sepsis is a common condition in the emergency department (ED). Lactate measurement is an important part of management: arterial lactate (A-LACT) measurement is the gold standard. There is increasing use of peripheral venous lactate (PV-LACT); however, there is little research supporting the interchangeability of the two measures.If PV-LACT has good agreement with A-LACT, it would significantly reduce patient discomfort and the risks of arterial sampling for a large group of acutely unwell patients, while allowing faster and wider screening, with potential reduced costs to the healthcare system. ⋯ This study is the largest comparing the two measurements, and shows good clinical agreement. We recommend using PV-LACT in the routine screening of septic patients. A PV-LACT less than 2 mmol/l is predictive of an A-LACT less than 2 mmol/l.
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Improved physiologic status can be seen as a surrogate measure of improved outcome and a field-friendly prognostic model such as the Mainz Emergency Evaluation Score (MEES) could quantify the effect on physiological response. We aim to examine the dynamic physiological profile as measured by this score on patients managed by physician-manned helicopter emergency medical services and how this profile was related to on-scene time expenditure and critical care interventions. ⋯ Restoring deranged physiology remains a mantra for all critical care practitioners. We have shown that this is also possible in the prehospital context, even when prolonging on-scene time, and after initiating advanced procedures.
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The role of emergency physicians is to identify patients in need of immediate treatment, but also to identify symptoms indicative of serious, if not immediately life-threatening conditions. ⋯ A small percentage of patients discharged with NSAP from Swedish EDs are diagnosed with a malignancy within a year. Patients aged 60 years or older and with comorbidities were over-represented in terms of developing malignancies after discharge. Emergency physicians should be aware of the fact that diffuse abdominal symptoms in elderly patients could be the first sign of an underlying malignancy and more liberally refer such patients for follow-up in primary care.