Articles: emergency-department.
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Pediatric emergency care · Dec 2013
ReviewShake, rattle, and roll: an update on pediatric seizures.
Seizure is a common presenting complaint for patients in the pediatric emergency department (PED) setting. In some cases, protocols are in place on how to manage this group of patients, for example, a patient with a simple febrile seizure already back to baseline or a patient with known epilepsy already back to baseline. However, many scenarios present dilemmas for physicians in the PED, specifically patients with status epilepticus (SE). ⋯ Current practices are constantly changing because new medications arise, and more information is gathered regarding existing medications and guidelines. Here we will review the basics about first-time afebrile seizures presenting to the PED and common treatments specific to seizure types. We will then review SE management basics and medical therapy, including both older and newer agents and their routes of administration for both the prehospital and the hospital setting.
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Alcohol use in college-age individuals is associated with increased injury risk. Many college drinkers end up in the emergency department (ED) as a result of their drinking, providing a unique opportunity to intervene. ⋯ Seven studies were identified that measured the outcomes of ED interventions for alcohol use in the college-age population. The studied interventions showed promise but had variable success. More research is needed to establish short- and long-term efficacy, specifically in high-risk underage college students.
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Review Meta Analysis
The Diagnosis of Acute Mesenteric Ischemia: A Systematic Review and Meta-analysis.
Acute mesenteric ischemia is an infrequent cause of abdominal pain in emergency department (ED) patients; however, mortality for this condition is high. Rapid diagnosis and surgery are key to survival, but presenting signs are often vague or variable, and there is no pathognomonic laboratory screening test. A systematic review and meta-analysis of the available literature was performed to determine diagnostic test characteristics of patient symptoms, objective signs, laboratory studies, and diagnostic modalities to help rule in or out the diagnosis of acute mesenteric ischemia in the ED. ⋯ The quality of the overall literature base for mesenteric ischemia is varied. Signs, symptoms, and laboratory testing are insufficiently diagnostic for the condition. Only CT angiography had adequate accuracy to establish the diagnosis of acute mesenteric ischemia in lieu of laparotomy.
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Pediatric patients, who accounted for 17.4% of US emergency department (ED) visits in 2010, present unique challenges that can impede an ED's ability to provide optimal care. To meet the growing demand for comprehensive, high-quality care, health care systems are incorporating quality improvement (QI) methods to reduce costs and variations in care and to improve access, safety, and ultimately the outcomes of medical care. This overview of QI initiatives within the field of pediatric emergency medicine explores how proven QI strategies are being integrated into efforts that target the care of children within the broader emergency care community. ⋯ Professional societies supporting education, such as the American Academy of Pediatrics, have made several strides to cultivate new health leaders that will use QI methodology to improve outcomes in pediatric emergency care. In addition to educational pursuits, professional societies and QI organizations (eg, Children's Hospital Association) offer stable infrastructures from which QI initiatives, either disease specific or broadly targeted, can be implemented as large-scale QI initiatives (eg, quality collaboratives). This overview also provides examples of how QI methodology has been integrated into research strategies and describes how the pediatric emergency medicine community can spread innovation and best practices into the larger emergency care community.
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Cardiac arrest is a common presentation to the emergency care system. The decision to terminate CPR is often challenging to heath care providers. An accurate, early predictor of the outcome of resuscitation is needed. The purpose of this systematic review is to evaluate the prognostic value of ETCO2 during cardiac arrest and to explore whether ETCO2 values could be utilised as a tool to predict the outcome of resuscitation. ⋯ ETCO2 values during CPR do correlate with the likelihood of ROSC and survival and therefore have prognostic value. Although certain ETCO2 cut-off values appears to be a strong predictor of mortality, the utility of ETCO2 cut-off values during CPR to accurately predict the outcome of resuscitation is not fully established. Therefore, ETCO2 values cannot be used as a mortality predictor in isolation.