J Emerg Med
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Observational Study
Use of the Broselow Tape in a Mexican Emergency Department.
The Broselow tape is one method for rapid weight estimation in pediatric patients undergoing resuscitation, but it does not perform equally in all populations. To date, we are unaware of any study evaluating its use in a Latin American population. ⋯ The Broselow tape-estimated weight was different from the scale weight by more than 10% in a substantial percentage of Mexican children. Nevertheless, the mean percentage difference was <3%, and Broselow tape color zone estimation was accurate in the majority of subjects, suggesting its use would result in clinically appropriate dosing and equipment estimations. Further research is needed to validate its use in this clinical setting.
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Uncontrolled hypertension is a primary risk factor for development of cardiovascular complications. ⋯ We found a point prevalence of subclinical heart disease of 39% in this urban ED population, using LBE. Real-time identification of subclinical heart disease at early stages in the ED in conjunction with abnormal renal function can help emergency physicians identify those patients in need of more aggressive therapy and urgent follow-up.
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Research suggests that older age can influence perception, assessment, and treatment of acute pain, resulting in inadequate pain control for geriatric patients. ⋯ Trauma patients ≥ 65 years of age are less likely to receive analgesia than the younger cohort in our ED and waited longer to get it.
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Emergency physicians regularly encounter agitated patients. In extremely agitated and violent patients, the onset of many traditional medications is relatively slow and often requires additional medication. Ketamine is frequently used in emergency departments (EDs) for procedural sedation and intubation, but has recently been suggested as a treatment for acute agitation. ⋯ We found ketamine was used rarely, but had few major adverse effects on vital signs even in a population with 21.9% alcohol intoxication. However, a high proportion (62.5%) of patients required additional pharmacologic treatment for agitation, implying that administering ketamine is useful only for initial control of severe agitation.
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Despite numerous calls for hospitals to employ quality improvement (QI) interventions to improve emergency department (ED) performance, their impact has not been explored in multi-site investigations. ⋯ Employing QI interventions was associated with better PCI scores. More research is needed to explore the direction of this relationship, but results suggest that hospitals should consider adopting patient flow strategies, electronic dashboards, and five-level triage systems to improve PCI scores.