Articles: emergency-services.
-
Ulus Travma Acil Cerrahi Derg · Jan 2025
Predicting mortality in penetrating thoracic trauma in the emergency department: The prognostic value of the glucose-to-potassium ratio.
Penetrating thoracic injuries are critical conditions that significantly influence the clinical outcomes of trauma patients in the emergency department (ED). This study evaluates the prognostic value of the glucose-to-potassium ratio (GPR) in predicting mortality among patients presenting to the ED with isolated penetrating thoracic injuries caused by stabbings. ⋯ Our findings indicate that the GPR is a valuable prognostic marker for mortality in patients with stabbing-induced penetrating thoracic injuries presenting to the ED. This highlights its potential utility in early risk stratification within this patient population.
-
Behavioral health visits to emergency departments have increased, increasing the risk of patient violent agitation that may require restraints to control. Our objective was to determine whether using the Behavioral Activity Rating Scale and treatment recommendations matched to patient scores would affect the number of patients who required physical restraints during their stay in the emergency department. ⋯ Early recognition of patient agitation is essential in appropriate treatment of that agitation. The Behavioral Activity Rating Scale assessment is an effective tool to quantify a patient's agitation level. When coupled with treatment recommendations or protocols, it may decrease restraint use in the emergency department.
-
Trauma-informed care has been posited as a framework for creating ideal and safe environments for patients to participate in treatment. However, there are limited studies that demonstrate the impact of a focused trauma-informed care training on ED staff. We implemented a 4-hour trauma-informed care training in a general emergency department. We aimed to measure changes in knowledge, opinions, self-rated competency, barriers, and recent practices before and after implementing trauma-informed care training. We hypothesized that the training would result in significant self-reported improvement in all domains. ⋯ Trauma-informed care training is an effective means to improving ED staff self-perceived competence and practice of trauma-informed care even among those with high self-perceived knowledge and opinions of trauma-informed care before the training. Future study should explore the patient-level impact of trauma-informed care training, as well as how to continue to reduce barriers to system-wide implementation of trauma-informed care practices.
-
Review Meta Analysis
Risk-stratification tools for emergency department patients with syncope: A systematic review and meta-analysis of direct evidence for SAEM GRACE.
Approximately 10% of patients with syncope have serious or life-threatening causes that may not be apparent during the initial emergency department (ED) assessment. Consequently, researchers have developed clinical decision rules (CDRs) to predict adverse outcomes and risk stratify ED syncope patients. This systematic review and meta-analysis (SRMA) aims to cohere and synthesize the best current evidence regarding the methodological quality and predictive accuracy of CDRs for developing an evidence-based ED syncope management guideline. ⋯ Most CDRs for ED adult syncope management have low-quality evidence for routine clinical practice use. Only three CDRs (SFSR, CSRS, OESIL) are validated by more than two studies, with significant overlap in operating characteristics.
-
Randomized Controlled Trial Comparative Study
Handheld ultrasound versus standard machines for placement of peripheral IV catheters: A randomized, non-inferiority study.
Ultrasound guided IV catheter (USGIV) access occurs frequently in Emergency Departments (EDs). This task is often performed using large, expensive, cart-based ultrasound systems (CBUS) which are frequently needed for other ED ultrasound functions and can be cumbersome to use and store. Handheld ultrasounds (HHUs) may be able to meet this need, but it is unknown if they function interchangeably with CBUS for USGIV placement. We performed a prospective, randomized, noninferiority study to compare the success rate of HHUs to CBUSs for placing USGIVs. ⋯ HHU was noninferior to CBUS for successful USGIV placement. There was no difference in the rate of first attempt success at placement or USGIV survival to a patient's ED disposition between groups. No significant additional training was required for ED providers of all levels to use the HHUs.