European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The diagnosis of patients with acute dyspnoea is challenging, as clinical history and physical examination are often nondiagnostic and inaccurate. Consequently, clinicians often rely on the results of chest radiography (CXR) to determine the initial intervention and guide further treatment. ⋯ US-JVD is a sensitive test for identifying pulmonary oedema on CXR in dyspnoeic patients with suspected congestive heart failure.
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The interobserver variability of capillary refill time (CRT) has been questioned. Earlier studies of interobserver variability of CRT have been on a large number of patients but with few observers. The objective of our study was to investigate how a large group of nurses and nurse assistants would grade CRT. ⋯ This is the largest interobserver study of CRT when looking at the number of observers. We found an only moderate agreement for the exact value of CRT and a moderate agreement for normality. We believe that CRT should be used with caution in clinical practice.
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Comparative Study
How different are older people discharged from emergency departments compared with those admitted to hospital?
To compare the characteristics of older people presenting to the emergency department (ED) and admitted to hospital with those discharged directly from the ED and identify factors independently associated with hospital admission. ⋯ In this elderly population, health-related variables were the only independent factors associated with hospital admission. Approximately 30% of patients discharged home from ED had similar risk profiles to admitted patients.
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This study aimed to estimate the city-wide prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in patients (≥18 years old) presenting with skin and soft tissue infections (SSTIs) to the emergency departments (EDs) of a Canadian Academic Health Care Center. Secondary objectives were to identify demographic and clinical variables associated with MRSA, and determine MRSA antimicrobial susceptibilities and genotypes. ⋯ Community-acquired -MRSA is a significant pathogen of SSTIs in EDs of a Canadian teaching center. MRSA should be considered when initiating empiric antibiotic therapy, particularly in patients with risk factors.
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This study evaluates the effects of an educational intervention and the use of a preprinted form on the adequacy of documentation of procedural sedation in an adult emergency department. ⋯ Baseline documentation was poor and improved slightly after both the educational interventions. Use of a preprinted form was associated with no medical records being classified as having poor documentation; however, uptake of the form use was low. Emergency departments should develop and consider mandatory use of such an aid together with training staff in the use of the aid and the important implications of adequate procedural documentation.