Articles: emergency-services.
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Multicenter Study Observational Study
Characteristics of emergency department patients with confirmed diagnoses of chronic obstructive pulmonary disease vs patients with respiratory symptoms and a suspected diagnosis.
To describe differences in patient characteristics and case management between patients attended in emergency departments (EDs) with confirmed diagnoses of chronic obstructive pulmonary disease (COPD) vs those with respiratory symptoms in whom COPD is suspected. ⋯ Clinical characteristics and management of emergency care differ between patients with confirmed vs suspected COPD. Patients with suspected COPD had more limited access to certain diagnostic, therapeutic, and follow-up resources.
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Emergency tracheal intubation is associated with a risk of clinical adverse events, including the risk of first-attempt failure. Induction agents usually include a sedative and a neuromuscular blocking agent (i.e., paralytic). Whether the order of administration (i.e., sedative vs. paralytic given first) is associated with first-attempt failure or adverse events is unknown. ⋯ In this Bayesian analysis a paralytic-first drug sequence was associated with reduced first-attempt failure during emergency tracheal intubation.
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Multicenter Study
Emergency centre thoracotomy for penetrating trauma: Insights from 2 South African district-level emergency centres.
Trauma is a major contributor to global disease burden, disproportionally affecting low- and middle-income countries, especially in the African Region. Emergency centre thoracotomy (ECT) is a potentially life-saving procedure for a sub-group of trauma patients in extremis. Most literature regarding ECT originated in high-income countries. This study aimed to describe patient, procedure and outcome characteristics of ECTs performed at two facilities in a resource-limited setting in South Africa. ⋯ The performance of ECT in this resource-limited district-level setting, followed by stabilisation and transfer of patients to tertiary hospitals seems to result in comparable or better survival rates than reported in international literature. Further research is needed to better describe the performance and outcomes of EC thoracotomies in a resource-limited setting. This study setting, with high incidence of trauma and ECT performed, provides an excellent opportunity for further research. Prospective studies may demonstrate correlations between specific patient and procedural characteristics and outcomes and may guide the development of local guidelines.
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To evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) because of the COVID-19 pandemic. ⋯ Respiratory testing and associated costs increased during the COVID-19 pandemic and were sustained despite decreasing incidence of disease. These findings highlight a need for further efforts to clarify indications for viral testing in the ED and efforts to reduce low-value testing.
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Caring for older adults in the Emergency Department demands compassion, expertise, and adaptability to address the intricate medical and emotional needs of this vulnerable population. Key geriatric emergency medicine articles from 2023 highlight the evolving landscape of this field: updates to the Beers Criteria for potentially inappropriate medications, medications most implicated in causing delirium, geriatric trauma centers, behavioral problems in persons with dementia, geriatric syndrome detection, and emergency department (ED) process outcomes in geriatric EDs. As healthcare organizations shift to focus on the larger continuum of care that extends beyond the ED visit, we also highlight a novel program from the Veterans Affairs bringing former military medics to the home to improve outcomes after ED discharge. This review highlights practice-changing updates to improve the management of older adults in the ED.