Articles: hospital-emergency-service.
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Frailty is a risk factor for presentation to the ED, in-hospital mortality, prolonged hospital stays and functional decline at discharge. Profiling the prevalence and level of frailty within the acute hospital setting is vital to ensure evidence-based practice and service development within the construct of frailty. The aim of this cross-sectional study was to establish the prevalence of frailty and co-morbidities among older adults in an acute hospital setting. ⋯ There is a high prevalence of frailty and co-morbidity among older adults who present to the ED and require inpatient care. This may contribute to increased waiting times, lengths of stay, and the need for specialist intervention. With an increased focus on the integration of care for older adults across care transitions, there is a clear need for expansion of frailty-based services, staff training in frailty care and multidisciplinary team resources across the hospital and community setting.
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Pediatric emergency care · Dec 2024
Case ReportsPoint-of-Care Ultrasound Evaluation of Pediatric Osteomyelitis in the Emergency Department: A Case Series.
Musculoskeletal and soft tissue complaints commonly present to the pediatric emergency department and literature supports the use point-of-care ultrasound (POCUS) in the diagnosis of these complaints. The diagnosis of osteomyelitis typically involves laboratory testing with inflammatory biomarkers, imaging with x-ray, and often magnetic resonance imaging with test results often not immediately available. We report a case series of children initially evaluated with POCUS for osteomyelitis. The POCUS may expedite diagnosis and treatment when used as the initial test in children with suspected osteomyelitis in the emergency department.
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Each year millions of children seek care in emergency departments, many of whom are from marginalized and minoritized groups who lack access to primary and preventive care. Law enforcement personnel are also commonly present in pediatric and adult emergency departments serving in a range of roles. Therefore, pediatric emergency departments sit at the nexus of the health system and the legal system for many vulnerable youth and families. ⋯ Pediatric clinicians, highly trained professionals in the medical and social care of youth and children, are often unaware of legal rules and procedures that guide law enforcement interaction with youth. This lack of knowledge may result in unknowing and unwitting violations of patients' rights while also compromising the quality of health care provided. Therefore, it is imperative that clinicians are educated on their roles and their institutions' roles in safeguarding patients' privacy and autonomy while still promoting effective collaboration with law enforcement.
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Randomized Controlled Trial
Magnesium Sulfate Versus Lidocaine as an Adjunct for Renal Colic in the Emergency Department: A Randomized, Double-Blind Controlled Trial.
We wished to determine whether the addition of magnesium sulfate (MgSO4) or lidocaine to diclofenac could improve the analgesic efficacy in emergency department (ED) patients with acute renal colic. ⋯ Adding intravenous MgSO4, but not lidocaine, to IM diclofenac offered superior pain relief but at levels below accepted thresholds for clinical importance.
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Hidden infections and late diagnoses are currently the main challenges of the HIV pandemic. Emergency departments (EDs) are one of the health care system's key resources addressing these challenges. In 2020, the Spanish Society of Emergency Medicine (SEMES) published recommendations for ordering HIV serology testing for patients with certain health conditions, and in 2021 SEMES launched the "Leave Your Mark" (Deja tu Huella - DTH) program to facilitate implementing the recommendations during emergency care. ⋯ One out of every 5 new HIV diagnoses in Spain is now made in an ED, but there is still room for improvement. To that end, this paper contributes 7 concrete proposals: 1) update the DTH program's criteria for ordering serology by including unexplained thrombocytopenia, fever with no focus of infection, and former residence in a country with endemic HIV infection; 2) include serology for hepatitis C virus infection at the time HIV testing is ordered; 3) reinforce the importance of obtaining the patient's informed consent for testing, meeting the obligation to respect the individual's rights; 4) implement educational programs; 5) develop decision-making tools (forms for ordering tests, alerts in patients' histories); 6) involve nurses in the DTH process and value their contributions; and 7) monitor quality markers to evaluate implementation of the program in all participating hospitals. The ultimate goal is to improve the DTH program and ensure its sustainability over time.