Articles: emergency-department.
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Pediatric emergency care · Mar 2014
ReviewThe use of alternate light sources in the clinical evaluation of child abuse and sexual assault.
Alternate light sources are devices that produce visible and invisible light at specific wavelengths to allow for enhanced visualization of fluorescent substances. These devices (which include Wood's lamp and blue light) are often used in forensics for evidence collection and can be quite useful to physicians in the medical evaluation of suspected physical or sexual assault. An understanding of the proper applications, as well as the limitations, of each alternate light source is imperative to correctly performing and interpreting medical evaluations in the emergency department. This review discusses the evidence from prospective trials in children and adults on the ability of specific alternate light sources to identify evidence of physical or sexual assault and also highlights some promising new technological adjuncts to alternate light sources that may allow for accurate dating of bruising.
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Shared decision making (SDM) is a process whereby patients and clinicians work together to make informed medical decisions that incorporate patient values. Recent data suggest that, for patients with low pretest probability of pulmonary embolism (PE), doubling the standard d-dimer cutoff may reduce the need for imaging with minimal increase in missed PE diagnoses. We used an SDM approach to determine patient preferences regarding this diagnostic approach. ⋯ When presented with a hypothetical scenario, more than one-third of patients deferred imaging for PE based on low clinical probability and a d-dimer less than twice the normal threshold. An SDM approach is acceptable to patients and may decrease imaging for PE.
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Observational Study
Addition of a lateral view improves adequate visualization of the abdominal aorta during clinician performed ultrasound.
Full visualization of the abdominal aorta using the standard midline view is often inadequate for the detection of abdominal aortic aneurysm. We evaluated whether the addition of a lateral midaxillary right upper quadrant view could improve visualization of the abdominal aorta. ⋯ Combining a lateral view to the standard midline approach improves adequate visualization of the abdominal aorta by approximately 28%. Further study is required to determine if the lateral view is equivalent for detecting abdominal aortic aneurysm.
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Ulus Travma Acil Cer · Mar 2014
Are neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as effective as Fournier's gangrene severity index for predicting the number of debridements in Fourner's gangrene?
Fournier's gangrene (FG) is a rapidly progressive and necrotizing infection of the subcutaneous and fascial tissues with a high mortality rate. In the present study, we aimed to investigate prognostic factors and analyze the outcomes of 68 patients in a tertiary reference hospital. ⋯ The FGSI scoring system was not found to be valuable in determining prognosis. However, NLR and PLR were valuable, and previous use of NLR and PLR for determining Fournier's gangrene prognosis could not be found in the English literature.
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Observational Study
Requirement for a structured algorithm in cardiac arrest following major trauma:Epidemiology, management errors, and preventability of traumatic deaths in Berlin.
Despite continuous innovation in trauma care, fatal trauma remains a significant medical and socioeconomic problem. Traumatic cardiac arrest (tCA) is still considered a hopeless situation, whereas management errors and preventability of death are neglected. We analyzed clinical and autopsy data from tCA patients in an emergency-physician-based rescue system in order to reveal epidemiologic data and current problems in the successful treatment of tCA. ⋯ Trauma CPR is beyond routine with the need for a tCPR-algorithm, including chest/pericardial decompression, external pelvic stabilization and external bleeding control. The prehospital trauma management has the highest potential to improve tCPR and survival. Therefore, we suggested a pilot prehospital tCPR-algorithm.