Articles: emergency-department.
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Ankle injuries are one of the most common presentations in the ED. Although fractures can be ruled out using the Ottawa Ankle Rules, the specificity is low, which means many patients may still receive unnecessary radiographs. Even once fractures are ruled out, assessment of ankle stability is recommended to rule out ruptures, but the anterior drawer test has only moderate sensitivity and low specificity and should be performed only after swelling has receded. Ultrasound could be a reliable, cheap and radiation free alternative to diagnose fractures and ligamentous injuries. The purpose of this systematic review was to investigate the accuracy of ultrasound in diagnosing ankle injuries. ⋯ CRD42020215258.
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A person's place of residence is a strong risk factor for important diagnosed chronic diseases such as diabetes. It is unclear whether neighborhood-level risk factors also predict the probability of undiagnosed disease. The objective of this study was to identify neighborhood-level variables associated with severe hyperglycemia among emergency department (ED) patients without a history of diabetes. ⋯ Many geospatial exposures were associated with uncontrolled hyperglycemia, even after controlling for individual-level risk factors. The most strongly associated neighborhood-level variables included lower markers of educational attainment, higher percentage of households where limited English is spoken, lower rates of white-collar employment, and higher rates of Medicaid insurance. Including these geospatial factors in risk assessment models may help identify important subgroups of patients with undiagnosed disease.
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The objective of this study is to evaluate the impact of the introduction of an education program familiarizing staff with the effective and appropriate use of Laceraine application to children's lacerations requiring repair at The Prince Charles Hospital Children's Emergency Department (TPCH-CED), Brisbane. ⋯ There was a significant change in practice with greater use of topical anesthetic (Laceraine) for the management of laceration repair of children, as expected, after the focused education program on its correct use. As emergency departments continue to be overwhelmed with increasing attendances and long patient wait times, a simple small intervention, such as that described, has potential to improve flow through the children's emergency department. Future research should focus on a randomized control trial to determine the contribution of the use of a topical agent, as opposed to injectable local anesthetic and/or full procedural sedation to determine the contribution to the impact of this simple change of practice on patient flow and satisfaction.
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Emerg Med Australas · Aug 2023
Comment Observational StudyImpact of time of intensive care unit transfer and outcomes in patients with septic shock: An observational study.
To evaluate the association between time from ED presentation to intensive care unit (ICU) transfer on mortality in patients presenting with septic shock. ⋯ In patients presenting to the ED with septic shock, ED-to-ICU time less than 4 h was not associated with altered 90-day mortality, although this should be interpreted with caution due to study limitations.
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Emerg Med Australas · Aug 2023
Triage to electrocardiogram sign-off time in patients with acute coronary syndrome at a metropolitan Sydney hospital.
To compare the time from triage to ECG sign-off in patients with acute coronary syndrome, before and after the introduction of an electronic medical record-integrated ECG workflow system (Epiphany). Additionally, to assess for any correlation between patient characteristics and ECG sign-off times. ⋯ The introduction of the Epiphany system has significantly reduced the triage to ECG sign-off time in the ED. Despite this, there remains a large proportion of patients with acute coronary syndrome who do not have an ECG signed-off within the guideline-recommended 10 min.