Emergency medicine journal : EMJ
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To evaluate the performance of a simple screening tool for chest radiography for identification of community-acquired pneumonia (CAP) among emergency department (ED) patients who present with respiratory-related complaints. Our screening tool is a modification of a previously published guideline, which relied only on the presence of vital-sign abnormality (97% sensitivity, 19% specificity). We included respiratory symptoms to improve the specificity, defining our screening tool as the presence of any one respiratory symptom (cough, chest pain or shortness of breath) and any abnormality of the vital signs (temperature >38 degrees C, heart rate >100 beats/min, respiration rate >20 breaths/min, or pulse oximetry <95%). ⋯ A simple screening tool with high sensitivity and specificity was used in an urban inner city ED to decide on the requirement for chest radiographs for patients with respiratory symptoms for identification of CAP. Validation studies are required to determine the utility of this screening tool for improving time to diagnosis and treatment.
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Case Reports
The use of a cardiac output monitor to guide the initial fluid resuscitation in a patient with burns.
A case of initial resuscitation of a patient with severe burns is described. Such patients can have hypotension and reduced organ perfusion for a number of reasons, and can remain in the emergency department for many hours while awaiting transfer to specialist centres. ⋯ The case demonstrates that relying on fluid regimes alone can lead to insufficient resuscitation. We suggest that using technologies such as those mentioned in this article, which have the potential to be used in the emergency department, could improve the initial resuscitation of patients with burns.
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Procedural sedation (PS) is common in the emergency department (ED) and ideally patients should have no recall of the procedure. ⋯ Recall following PS in ED is uncommon. There is no association of recall with drugs used or the presence of a grimace/groan. There is high patient satisfaction with PS in the ED.