Articles: emergency-services.
-
Observational Study
Usefulness of mid-regional pro-adrenomedullin for stratifying risk in emergency department patients with solid tumors attended for febrile neutropenia secondary to chemotherapy.
To analyze the usefulness of mean mid-regional pro-adrenomedullin (MR-proADM) level to stratify risk in emergency department patients with solid tumors attended for febrile neutropenia after chemotherapy. To compare risk prediction with MR-proADM to that of conventional biomarkers and scores on the Multinational Association for Supportive Care in Cancer (MASCC) score. ⋯ Risk stratification in cancer patients with febrile neutropenia is essential for decision-making in the ED. MR-proADM was the best predictor of serious complications in these patients, and combining it with any of the other variables did not improve prediction.
-
Case Reports
Rectus sheath nerve block for analgesia & incarcerated hernia reduction in the emergency department.
Patients who present to the emergency department (ED) with incarcerated or strangulated ventral hernias are often in significant pain. Furthermore, even with procedural sedation, reduction itself also causes substantial pain. Hernias that cannot be reduced at the bedside with intravenous opioids or procedural sedation will require emergent surgery, which contributes to morbidity and mortality, especially in high-risk populations. ⋯ Ultrasound can visualize and diagnose an incarcerated hernia, and a bilateral rectus sheath block can be performed in the ED to anesthetize the peritoneal wall, paralyze abdominal musculature, and achieve nearly painless hernia reduction.
-
Scand J Prim Health Care · Dec 2024
Changes in location and number of nurse consultations as the supply of general practitioners decreases in primary health care: six-year register-based follow-up cohort study in the city of Vantaa, Finland.
To investigate whether the location and the number of nurse consultations have changed in response to the continuously decreasing number of GP consultations in the fourth-largest city in Finland. It has been suggested that nurse consultations are replacing GP consultations. ⋯ It appears that in primary health care, medical consultations have shifted from GPs to nurses with lower education levels, and from care during office-hours to emergency care.
-
Emerg Med Australas · Dec 2024
Recommendations for developing a comprehensive point-of-care ultrasound (POCUS) program in the emergency department: an Emergency Medicine Ultrasound Group advocacy statement.
Point-of-care ultrasound (POCUS) use is widespread in EDs and throughout those practising medicine. Between institutions and specialities, there is widespread variety and training. With this comes the risk of patient harm and backlash to a clinically useful modality. Our objective is to form a statement that encompasses current published and unpublished guidance for creating and maintaining robust POCUS programs in EDs. ⋯ These recommendations complement existing guidelines and are not intended to replace them; however, we hope to promote discussion and provide reference support for those developing POCUS programs. Implementing a comprehensive and robust ED POCUS program will ensure safe, effective and standardised high-quality POCUS use, with the aim of improving patient care across Australia and New Zealand. Patient safety will be enhanced through effective risk management and quality assurance and there will be consistency in POCUS education, training and credentialing across institutions.
-
Existing screening tools for sepsis in children are limited by suboptimal sensitivity. Our objective was to develop a new, more sensitive screening tool for pediatric septic shock by enhancing 2 aspects of the 4-point Liverpool quick Sequential Organ Failure Assessment (LqSOFA) tool. ⋯ The qPS4, with 2 enhancements to the LqSOFA, demonstrated overall improved sensitivity and specificity for pediatric septic shock.