Articles: emergency-services.
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Observational Study
The effect of intravenous ondansetron on QT interval in the emergency department.
Ondansetron, a 5HT3 receptor antagonist, is commonly used in emergency departments to treat nausea and vomiting. In 2011, the Food and Drug Administration (FDA) issued a warning that this medicine may cause QT prolongation, potentially leading to deadly arrhythmias. The objective of this study was to characterize the QT interval prolongation associated with ondansetron use in the Emergency Department. ⋯ In this study, QT prolongation due to ondansetron administration was below the 'important' value according to the recommendations of the ICH. No cases of cardiac arrhythmia were reported in any of the partients. Thus, routine ECG monitoring in patients given ondansetron due to the risk of QTc prolongation does not seem cost-effective when evaluated together with additional factors such as its negative impact on emergency patient flow, waste of personnel and time, and increase in healthcare costs. In the absence of a known risk of cardiac arrhythmia, IV administration of 4 mg and 8 mg of ondansetron doses no risk of QT prolongation in the emergency population.
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Observational Study
Evaluation of use and identification of predictive factors for nonuse of peripheral venous catheters in the emergency department.
The placement of peripheral venous catheters (PVC) is a frequent procedure in the emergency department (ED), which exposes patients to complications (hematoma, fluid leakage, phlebitis, edema, infection), increases hemolysis of blood samples, is time-consuming and costly. The main aim of this study is to analyze the rate of PVC nonuse in the ED and to identify predictive factors of their nonuse. This prospective single-center observational study was conducted in the ED of the Saint-Antoine Hospital in Paris, France between February and March 2022. ⋯ PVC were not used in 23.7% of cases. Predictors of nonuse were the prescribing physician's expectation of nonuse and the reason for prescribing "just in case". A PVC should probably not be prescribed if the prescribing physician thinks it will not be used or prescribes it "just in case".
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The use of acute hospital-level care at home (hospital-at-home) for patients who are chronically ill has led to decreased medical costs, amount of sedentary time, and hospital admissions. Our large integrated healthcare system identified the need to develop a mechanism through which to decrease emergency department (ED) visits in this patient population by creating a home acute care program called Urgent Dispatch. The primary objective of this study was to determine the medical condition for referral and seven and 30-day ED visit rates. ⋯ A home-based care model of healthcare delivery for patients with chronic medical conditions can provide effective care, with 80.2 % of patients avoiding an ED visit within seven days and 68.2 % avoiding an ED visit within 30 days.
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Cauda equina syndrome (CES) may have significant individual consequences if diagnostic delays occur. Our aim was to evaluate the presenting subjective and objective features of patients with suspected CES in comparison to those with radiologically confirmed cauda equina compression (CEC).. ⋯ This study suggests that in those presenting with CES symptoms, the presence of both bilateral leg pain and absent ankle reflexes pose an acceptable diagnostic tool to predict a large acute disc herniation on MRI scan..
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Individuals with chronic obstructive pulmonary disease (COPD) constitute a significant portion of patients who present to the emergency department with dyspnea. However, there is no ideal method for predicting mortality or making hospitalization decisions in the emergency department (ED). In this regard, objective findings are needed for these patients. Since there are no objective findings regarding the hospitalization decision, there may be an increase in the re-admission rate of patients who needed hospitalization but were decided to be discharged. Side-stream end-tidal carbon dioxide (EtCO2) measurements offer a non-invasive, easy-to-interpret, quickly accessible, and reproducible method that can be applied at the bedside. ⋯ It was observed that both the pretreatment alpha angle values and the posttreatment alpha angle variables were statistically significant in predicting the readmission of the patients within 30 days (p = 0.001, p = 0.003) CONCLUSION: The results of this study show that alpha angle values measured for patients with COPD who present to the ED with the complaint of dyspnea may be used to predict readmission.