European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Optimizing emergency care for the aging population is an important future challenge, as the proportion of older patients at the emergency department (ED) rapidly increases. Older patients, particularly those who are frail, have a high risk of adverse outcomes after an ED visit, such as functional decline, institutionalization, and death. The ED can have a key position in identifying frail older patients who benefit most from comprehensive geriatric care [including delirium preventive measures, early evaluation of after-discharge care, and a comprehensive geriatric assessment (CGA)]. ⋯ Therefore, quick and easy-to-use instruments are needed to identify older patients at risk for adverse outcomes. This narrative review outlines the importance and complexity of frailty assessment at the ED. It aligns the available screening instruments, including clinical judgment as frailty assessment, and summarizes arguments for and against frailty assessment at the ED.
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Multicenter Study Observational Study
Association between mean arterial pressure and survival in patients after cardiac arrest with vasopressor support: a retrospective study.
Mortality among patients admitted to the ICU after cardiac arrest is high. Hemodynamic management in the phase of postresuscitation care is recommended by international guidelines, but the optimal mean arterial pressure (MAP) range in postcardiac arrest patients with vasopressor support is still unclear. ⋯ This study suggests that maintaining a mean arterial pressure of equal or greater than 65 mmHg may be a reasonable target in postcardiac arrest patients admitted to the ICU with vasopressor support. However, further prospective randomized trials are needed to determine the optimal mean arterial pressure targets in this patient population.
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Early identification of the cause of shock is associated with better prognosis. ⋯ This study suggested that echoSHOCK significantly increased the ability to determine the cause of undifferentiated shock in the ED.
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Multicenter Study
Association of frailty on treatment outcomes among patients with suspected infection treated at emergency departments.
The clinical frailty scale (CFS) score has been validated as a predictor of adverse outcomes in community-dwelling older people. Older people are at a higher risk of sepsis and have a higher mortality rate. However, the association of frailty on outcomes in patients with sepsis has not been completely examined. ⋯ This study reported that in patients with suspected sepsis in the emergency department, frailty may be associated with poor prognosis and length of hospital stay.