Curēus
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High-flow nasal cannula (HFNC) is an open oxygen delivery system, which provides heated and humidified oxygen at a high flow (up to 60 L/min). This effect can improve mucociliary function, airway clearance, and level of comfort to the patient. It can provide controlled and adequate fraction of inspired oxygen (FiO2) between 21% and 100%. ⋯ HFNC can potentially be an alternative to non-invasive positive-pressure ventilation in terms of initial oxygen therapy in patients with ACPE. There is a need for larger prospective studies to evaluate and develop guidelines to consider the use of HFNC in patients with ACPE. We also highlight the fact that if there is no improvement in arterial blood gas parameters after HFNC therapy, initiation of invasive ventilation should not be delayed.
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Background Emergency department overutilization is a known contributor to the high per-capita healthcare cost in the United States. There is a knowledge gap regarding the substitution effect of walk-in clinic availability in primary care provider (PCP) offices and emergency department utilization (EDU). This study evaluates associations between PCP availability and EDU and analyzes the potential cost savings for health systems. ⋯ Conclusion Extended walk-in availability in primary care offices provides non-ED capacity for low acuity management and might mitigate low acuity ED utilization while providing more cost-effective care. This study supports similarly described pre-hospital diversions in reducing ED over-utilization by increasing access to care. Higher levels of evidence are needed to establish causality.
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Background Tracheal intubation carries an elevated risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to the generation of aerosols containing high concentrations of the virus. An airway box was designed to mitigate the exposure of healthcare professionals performing intubations. Aim We evaluated usability and sustainability in the routine practice of the "airway box" as a protective device during high-risk airway procedures. Materials and methods After institutional review board approval, clinicians were educated on using the device through simulation, intranet learning modules, and emailed resources. ⋯ Conclusion Intubation boxes may effectively mitigate high-risk viral exposure during airway procedures. Survey responses show that devices were easy to use and did not significantly affect visualization of the airway. Similar to mask use, enclosure devices in clinical practice could become a vital part of medical protective equipment even after the SARS-CoV-2 pandemic if they are effectively implemented.
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Introduction Canadian emergency departments (EDs) are struggling under the weight of increased use by a growing population of elderly patients; those who lack proper housing; and those who lack family physicians to provide primary care. The Canadian Foundation for Healthcare Improvement projected a possible ED service utilization increase in Canada at a rate of 40% over three decades. This calls for local-level information on the time trends to understand demographic and temporal variations in the different geographical locations in the country. This study sought to identify and quantify acuity level-based per capita ED visit annual time trends for the 10-year period of 2006-2015 (by age, gender, and housing status). The aim is to provide detailed information on the time trends for demographically targeted ED planning locally. ⋯ The highest annual homeless increment rate was shown for <30-year-old group high acuity CTAS-2 level visits (219/year, CI:193-246, per 100,000). Conclusion Neither the city population increase nor increased homeless visits contributed to ED visit annual per capita incremental trends in the city of Halifax. The increasing trend was chiefly driven by high-acuity-level visits by >50-year-old patients. Our findings suggest one way to make this escalating ED visit rates stable in the future is by maintaining the declining semi-urgent and non-urgent visit trends at the same rates estimated within the years 2012-2015. These findings highlight the potential directions for ED services planning to keep up with the growing demand for high-acuity-level ED services by the aging population.
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As coronavirus disease 2019 (COVID-19) became a public health emergency of international concern, countries across the globe began to instate strict social distancing restrictions or "lockdowns". During these times emergency departments in the United Kingdom (UK) recorded a significant drop in patients attending when compared to the same months of previous years. Attendances related to musculoskeletal (MSK) trauma also saw a significant drop in numbers Objective: The purpose of this retrospective audit was to investigate patterns of injuries attending during the pandemic and more specifically during times of lockdown. ⋯ Attendances in the emergency department were greatly reduced during the COVID-19 pandemic, especially during the first lockdown. The rates of fractures and soft tissue injuries within the minors' area of the emergency department were also reduced but not at the same rate as the overall attendance. A large number of fractures and soft tissue injuries still presented to the emergency department despite reduced national activity. These attendances may be as a result of the increased rate of Do It Yourself (DIY)-related injuries and altered patient/social behaviour due to lockdown, social distancing, and seasons/weather. Further research would be required to investigate the changing patterns of behaviour especially as we enter a second wave of cases.