J Emerg Med
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Decreased consciousness is a common reason for presentation to the emergency department (ED) and admission to acute hospital beds. In trauma, a Glasgow Coma Scale score (GCS) of 8 or less indicates a need for endotracheal intubation. Some advocate a similar approach for other causes of decreased consciousness, however, the loss of airway reflexes and risk of aspiration cannot be reliably predicted using the GCS alone. ⋯ This study suggests that it can be safe to observe poisoned patients with decreased consciousness, even if they have a GCS of 8 or less, in the ED.
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Multicenter Study Comparative Study
Emergency department children are not as sick as adults: implications for critical care skills retention in an exclusively pediatric emergency medicine practice.
We wished to compare the acuity of adults vs. children using a representative sample drawn from a geographically isolated region. We retrospectively analyzed Emergency Department (ED) patient logs, billing records, and trauma data from two hospitals serving a geographically isolated region (Santa Barbara, California), and compared the following measures of acuity by age, triage category, rates of admission, billing levels of service, procedures (ED intubation, cardiopulmonary resuscitation, and invasive line placement), and trauma team activations. We analyzed 88,864 patients treated at the two EDs over an 18-month period, of whom 15,589 (17.5%) were children (< 18 years of age). ⋯ No age-based differences were noted in the rates of highest-level trauma team activation or admission directly to the operating room. ED children have overall lower acuity than ED adults-by many measures, several-fold less. These findings may have important implications for ongoing skills retention and proficiency in critical care for practitioners whose ED practice is restricted to representative samples of children.
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Review Case Reports
Does early intensive lowering of blood pressure reduce hematoma volume and improve clinical outcome after acute cerebral hemorrhage?
Intracerebral hemorrhage (ICH) is a poorly understood condition with devastating results. Despite the personal and social impact of ICH, modern medicine can offer little hope. Surgery is the longest-standing therapy, but with no demonstrated evidence of positive effect. Reduction of the early hypertension seen with ICH is believed to limit hematoma growth and improve clinical outcome. The effectiveness and safety of an early, aggressive blood-pressure-lowering strategy for ICH patients has only recently been examined in randomized controlled trials. ⋯ There is currently insufficient evidence to support the routine practice of lowering blood pressure of patients suffering an acute intracerebral hemorrhage.
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Case Reports
Methicillin-resistant Staphylococcus aureus sepsis presenting with septic pulmonary emboli.
Septic pulmonary emboli are the result of infections that typically originate from an extrapulmonary source. Septic pulmonary embolus is a rare disorder that classically presents with fever, respiratory symptoms, and lung infiltrates. ⋯ Septic pulmonary embolus is a rare finding that is most commonly seen in patients who are immunocompromised. The patient fully recovered after aggressive antibiotic therapy.