J Emerg Med
-
Case Reports
A case report of a severe musculoskeletal injury in a wheelchair user caused by an incorrect wheelchair ramp design.
The Americans with Disabilities Act (ADA) gives all Americans with disabilities a chance to achieve the same quality of life that individuals without disabilities enjoy. In this case report, we will be discussing the consequences of having inaccessible ramps to persons with disabilities that can result in severe musculoskeletal injuries in a wheelchair user. While going down an inaccessible ramp in the garage of a hospital, a wheelchair tipped over, causing a fracture to the user's right femur. ⋯ This led to the redesign and construction of safe ramps for individuals using wheelchairs as well as for pedestrians using canes, within 1 month after the patient's injury, making it safe for wheelchair users as well as pedestrians using the parking facilities. The ADA specifies guidelines for safe ramps for patients with disabilities. It is important to ensure that hospital ramps comply with these guidelines.
-
The King LT (King Systems Corporation, Noblesville, IN) is a rescue airway device that is gaining favor in the pre-hospital setting. Unlike other rescue airway devices, such as intubating laryngeal mask airways, the King LT does not allow for the placement of an endotracheal tube through the device. Emergency physicians who receive patients with the King LT in place will be presented with the challenge of converting to a definitive airway. ⋯ We cannot recommend using the gum elastic bougie as an aid to convert the King LT to an endotracheal intubation based on our experience with a non-embalmed cadaver.
-
Review Case Reports
Cerebral venous sinus thrombosis in the emergency department: retrospective analysis of 17 cases and review of the literature.
Cerebral venous sinus thrombosis (CVST) is a rare but serious cause of neurologic impairment. Due to its relative rarity, there is limited research that describes the incidence and clinical features of CVST in the emergency department (ED). ⋯ CVST is rare, but it can have significant associated morbidity and mortality. Whereas the clinical outcome and functional outcomes of treated patients can vary, prompt recognition of the disease is important.
-
Multicenter Study
Standardization of severe sepsis management: a survey of methodologies in academic and community settings.
Evidence-based therapies for severe sepsis include early antibiotics, early goal-directed therapy, corticosteroids, recombinant human activated protein C, glucose control, and lung protective strategies. ⋯ Implementation of a sepsis management protocol incorporating evidence-based therapies can be accomplished in both academic and community hospitals, with minimal additional staffing. The presence of a protocol champion and education program is crucial to success, and may result in improved patient outcome.
-
Multicenter Study
Multicenter survey of emergency physician management and referral for hyperglycemia.
The Emergency Department (ED), with its high-risk and often disenfranchised patient population, presents a novel opportunity to identify patients as having undiagnosed or uncontrolled diabetes. ⋯ Emergency Physicians support improved recognition of and referral for hyperglycemia, based on glucose values collected during usual ED care. We plan to develop tools to interpret random ED glucose values in the context of undiagnosed and uncontrolled diabetes.