Articles: emergency-services.
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The burden of acute bacterial skin and skin structure infections (ABSSSI) continue to plague the healthcare system. One approach to managing moderate-to-severe ABSSSI in low-risk patients involves use of a single dose lipoglycopeptide (LGP), dalbavancin or oritavancin, in the emergency department (ED) and discharge to home with follow-up care. Limited ED studies indicate decreased hospital stays, ED revisits, readmissions, and healthcare costs, as well as improved patient satisfaction with use of these antibiotics. ⋯ Moreover, there is lack of research on the impact of LGPs on organizational productivity, patient quality of life, and utility in indications beyond ABSSSI. This review focuses on the role of long-acting LGPs in the ED setting for select patients presenting with ABSSSI, aiming to avoid hospitalizations, expedite patient discharge, and prevent readmissions while acknowledging potential limitations of therapy. Additionally, it provides insights into strategies and considerations specifically relevant to implementing this therapeutic approach in the ED.
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Multicenter Study
Dispatch Categories as Indicators of Out-of-Hospital Time Critical Interventions and Associated Emergency Department Outcomes.
Emergency medical services (EMS) systems increasingly grapple with rising call volumes and workforce shortages, forcing systems to decide which responses may be delayed. Limited research has linked dispatch codes, on-scene findings, and emergency department (ED) outcomes. This study evaluated the association between dispatch categorizations and time-critical EMS responses defined by prehospital interventions and ED outcomes. Secondarily, we proposed a framework for identifying dispatch categorizations that are safe or unsafe to hold in queue. ⋯ In general, Determinant levels aligned with time-critical responses; however, a notable minority of lower acuity Determinant level Protocols met criteria for unsafe to hold. This suggests a more nuanced approach to dispatch prioritization, considering both Protocol and Determinant level factors.
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Rib fractures are frequently diagnosed and treated in the emergency department (ED). Thoracic trauma has serious morbidity and mortality, particularly in older adults, with complications including pulmonary contusions, hemorrhage, pneumonia, or death. Bedside ED-performed ultrasound-guided anesthesia is gaining in popularity, and early and adequate pain control has shown improved patient outcomes with rare complications. ⋯ Thoracic nerve blocks (e.g., ESP, SANB, ICNB) can be performed safely by appropriately trained emergency physicians, provide excellent anesthesia for rib fractures and thoracic trauma, and should be strongly considered for improved patient-centered outcomes. Furthermore, performing regional nerve blocks in the emergency department can reduce complications including adverse effects from opioids or other delirium-inducing medications.
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Multicenter Study Observational Study
End-Tidal Oxygen as an Effective Noninvasive Measure of Preoxygenation during Rapid Sequence Intubation in the Emergency Department.
Preoxygenation is intended to extend the duration of apnea until desaturation occurs. End-tidal oxygen (ETO2) is the standard for measuring preoxygenation, however, peripheral capillary oxygen saturation (SpO2) is used more commonly within the emergency department. ⋯ Preoxygenation success was similar when measured by strict ETO2 and SpO2 criteria. ETO2 is more sensitive to periods of apnea than SpO2 and may serve as an early indicator of an imminent desaturation event.
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Singapore medical journal · Jan 2025
Multicenter StudyGastrointestinal transit time of radiopaque ingested foreign bodies in children: experience of two paediatric tertiary centres.
Foreign body (FB) ingestion is a common paediatric emergency. While guidelines exist for urgent intervention, less is known of the natural progress of FBs passing through the gastrointestinal tract (GIT). We reviewed these FB transit times in an outpatient cohort. ⋯ This study provides insight into the transit times of FB ingested by children, which helps medical professionals to decide on the optimal time for follow-up visits and provide appropriate counsel to caregivers.