Articles: emergency-department.
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Pediatric asthma is a significant cause of emergency department visits and hospital admissions. While most patients respond well to standard pharmacologic treatments, those with more severe disease frequently require noninvasive respiratory support (NRS) and adjunct therapies, or admission to an intensive care unit-a condition termed critical asthma. NRS modalities include high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and noninvasive ventilation (NIV) to deliver standard air-oxygen mixtures or helium-oxygen (heliox). ⋯ Despite the growing use of NRS, robust evidence supporting its efficacy in pediatric critical asthma is limited, with few published clinical trials and a heavy reliance on observational studies to inform clinical practice. This narrative review explores the current evidence, physiological rationale, practical considerations, and future research directions for the use of NRS in pediatric critical asthma. The goal is to provide clinicians with a comprehensive overview of the benefits and limitations of NRS modalities to better inform therapeutic decisions and improve patient outcomes.
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The role of video laryngoscopy in critically ill patients requiring emergency tracheal intubation remains controversial. This systematic review and meta-analysis aimed to evaluate whether video laryngoscopy could improve the clinical outcomes of emergency tracheal intubation. ⋯ CRD 42023461887.
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The objective was to systematically review all studies focusing on barriers, facilitators, and tools currently available for shared decision making (SDM) in emergency departments (EDs). ⋯ Circumstances in EDs are generally less favorable for SDM. However, PtDAs for conditions seen in EDs are helpful in overcoming barriers to SDM and are welcomed by patients. Even in EDs, SDM is feasible and supported by an increasing number of tools for patients and physicians.
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Diagnosing patients presenting to the emergency department with self-limited episodes of isolated dizziness (the episodic vestibular syndrome) requires a broad differential diagnosis that includes posterior circulation transient ischemic attack. Because these patients are, by definition, asymptomatic without new neurologic findings on examination, the diagnosis, largely based on history and epidemiologic context, can be challenging. ⋯ We present ways of distinguishing posterior circulation transient ischemic attack from vestibular migraine, the most common cause of episodic vestibular syndrome. We also present a diagnostic algorithm that may help clinicians to work their way through the differential diagnosis.
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Emerg Med Australas · Oct 2024
ReviewPractical strategies for caring for patients with functional neurological disorder in the ED.
Functional Neurological Disorder (FND) presents unique challenges in the emergency department (ED), where patients often arrive with varied and vague symptoms that can be difficult to address. This article provides practical strategies for effectively managing and supporting FND patients in the ED, emphasizing a compassionate, systematic approach, tailored treatments, appropriate use of investigations, and ensuring continuity of care. Key principles include clear communication of the diagnosis, preventing iatrogenic harm, and facilitating appropriate referrals for follow-up care. ⋯ A low threshold for investigating potential comorbid neurological conditions should be maintained when patients present to ED, especially in cases of unclear diagnoses or acute presentations, while avoiding repetitive testing that may reinforce illness behaviour. Managing FND in the ED requires a patient-centered, multidisciplinary approach. By adopting these strategies, health professionals can improve outcomes and support patients in managing their condition effectively.