J Emerg Med
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Observational Study
Comparison of 1-Day Emergency Department Observation and Inpatient Ward for 1-Day Admissions in Syncope Patients.
In an era of increasing health care costs, the need for hospitalization is being scrutinized. In particular, 1-day hospitalizations are thought to be especially costly and unnecessary, and, increasingly, emergency department observation units (EDOUs) are being used as alternatives. ⋯ EDOU patients were less likely than patients admitted to the hospital to be discharged with an etiology of their syncope. Future EDOU protocols can benefit from set admission criteria and standardized evaluation protocols to facilitate maximal use of EDOU for syncope.
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Emergency physicians make treatment decisions in patients who present to the emergency department (ED) with acute venous thromboembolism (VTE). They also encounter patients on target-specific oral anticoagulants (TSOACs) who require urgent intervention. New approvals and increasing prescriptions for TSOACs (e.g., apixaban, dabigatran, edoxaban, and rivaroxaban) for the management of several thromboembolic disorders warrant an evaluation of the impact of these agents in the ED setting. ⋯ Familiarity with TSOACs will better position emergency physicians to provide state-of-the art care to their patients with VTE and help them manage potentially complicated circumstances related to the chronic use of these drugs.
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Respiratory distress and tachycardia are common presenting complaints in infants and young children, and evaluation typically focuses on respiratory infections. Tachydysrhythmias causing heart failure are rare and can be difficult to diagnose in young children, but are reversible if recognized and treated early. ⋯ We discuss a 7-week-old female infant who presented with respiratory distress and persistent tachycardia. Evaluation revealed severe cardiac dysfunction with an underlying atrial flutter discovered on electrocardiography after adenosine administration. Rate control by synchronized electrocardioversion resulted in resolution of symptoms and restoration of cardiac function, confirming the diagnosis of atrial flutter-induced cardiomyopathy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Persistent or inappropriate tachycardia in a young child should not be dismissed and underlying dysrhythmia should be considered.