Articles: emergency-department.
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Observational Study
Door-in-Door-Out Times at Referring Hospitals and Outcomes of Hemorrhagic Stroke.
Interhospital transfer is often required in the care of patients with hemorrhagic stroke. Guidelines recommend a door-in-door-out (DIDO) time of ≤120 minutes at the transferring emergency department (ED); however, it is unknown whether DIDO times are related to clinical outcomes of hemorrhagic stroke. ⋯ These findings suggest that EDs currently expedite the transfer of the sickest patients; however, prospective studies and more granular data are needed to understand the impact of early treatment and timing of transfer for patients with hemorrhagic stroke.
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Physicians often cite time as a limitation to performing a focused cardiac ultrasound (FoCUS) exam. The primary outcome of this study was to determine the amount of time to complete a quality FoCUS exam. Secondary outcomes evaluated time differences between different training levels. ⋯ Our study shows EM physicians take approximately 3.4 min to complete a quality FoCUS exam and residents took 45 s longer compared to attendings. For resident physicians, the amount of time it takes to complete a quality FoCUS exam decreases over the course of residency training. Our findings suggest the amount of time to complete a quality FoCUS exam should not be a limitation to perform a FoCUS exam.
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Early recognition of sepsis is essential for timely initiation of adequate care. However, this is challenging as signs and symptoms may be absent or nonspecific. The cascade of events leading to organ failure in sepsis is characterized by immune-metabolic alterations. Volatile organic compounds (VOCs) are metabolic byproducts released in expired air. We hypothesize that measuring the VOC profile using electronic nose technology (eNose) could improve early recognition of sepsis. ⋯ The study is embedded in the Acutelines data-biobank (www.acutelines.nl), registered in Clinicaltrials.gov (NCT04615065).
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Randomized Controlled Trial Multicenter Study
Association of early doses of diuretics and nitrates in acute heart failure with 30 days outcomes: ancillary analysis of ELISABETH study.
The optimal dose of diuretics and nitrates for acute heart failure treatment remains uncertain. This study aimed to assess the association between intravenous nitrates and loop diuretics doses within the initial 4 h of emergency department presentation and the number of days alive and out of hospital (NDAOH) through 30 days. ⋯ In this ancillary analysis, there was no significant association between different doses of diuretics and nitrates with the NDAOH at 30 days. Point estimates and CIs may suggest that the optimal doses are less than 60 mg of diuretics, and more than 16 mg of nitrates in the first 4 h.
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Case Reports
Point-of-Care Ultrasound Diagnosis of Pyocele: A Rare Complication of Testicular Infection.
Epididymo-orchitis is one of the common causes of acute scrotal pain that requires an accurate diagnosis as delayed management can result in complications such as pyocele, abscess, or testicular infarction. Point-of-care ultrasound (PoCUS) has emerged as a valuable diagnostic tool in the management of testicular emergencies in the emergency department (ED) including testicular infections CASE REPORT: Here we report a case of an elderly man who presented to the ED with a complaint of right-sided testicular pain and swelling. ⋯ WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case underscores the important role of PoCUS in the timely and accurate diagnosis of pyocele. The prompt identification of pyocele enabled early referral to urology services, highlighting the significance of integrating PoCUS into the management of testicular emergencies in the ED.