Articles: emergency-services.
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Scand J Trauma Resus · Sep 2024
Workplace violence against healthcare workers in the emergency department - a 10-year retrospective single-center cohort study.
Medical staff are regularly confronted with workplace violence (WPV), which poses a threat to the safety of both staff and patients. Structured de-escalation training (DET) for Emergency Department (ED) staff has been shown to positively affect the reporting of WPV incidents and possibly reduce its impact. This study aimed to describe the development of incidence rates, causes, means, targets, locations, responses, and the time of WPV events. Additionally, it explored the effect of the staff trained in DET on the objective and subjective severity of the respective WPV events. ⋯ The findings underline the relevance of WPV events in the high-risk environment of an ED. The analyzed data suggest that DET significantly fostered the awareness of WPV. While most events can be addressed with verbal interventions, WPV remains a concern that needs to be addressed through organizational measures and further research.
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Observational Study
Prognostic Significance of Lactate Clearance in Cardiogenic Pulmonary Edema in the Emergency Department.
Background and Objectives: Acute cardiorespiratory failure disrupts the delicate balance of energy supply, demand, and consumption, with elevated lactate levels and decreased blood pH serving as crucial indicators. Acute cardiogenic pulmonary edema (ACPO), a common cause of acute respiratory failure, poses a substantial mortality risk. Lactate, a byproduct of pyruvate reduction, is a pertinent marker in perfusion assessment. ⋯ Conclusions: This study pioneers the exploration of lactate clearance in patients with acute cardiogenic pulmonary edema. LC below 14.29% signifies a poor prognosis, emphasizing its potential as an early treatment initiation marker. While acknowledging this study's limitations, we advocate for further multicenter research to refine the understanding of lactate clearance in this context.
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Scand J Trauma Resus · Sep 2024
Observational StudyThromboelastography as an early prediction method for hypofibrinogenemia in emergency department patients with primary postpartum hemorrhage.
Timely and accurate assessment of coagulopathy is crucial for the management of primary postpartum hemorrhage (PPH). Thromboelastography (TEG) provides a comprehensive assessment of coagulation status and is useful for guiding the treatment of hemorrhagic events in various diseases. This study aimed to evaluate the role of TEG in predicting hypofibrinogenemia in emergency department (ED) patients with primary PPH. ⋯ Point-of-care TEG could be a valuable tool for the early identification of hypofibrinogenemia in ED patients with primary PPH.
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Data suggest patients suffering acute coronary occlusion myocardial infarction (OMI) benefit from prompt primary percutaneous intervention (PPCI). Many emergency medical services (EMS) activate catheterization labs to reduce time to PPCI, but suffer a high burden of inappropriate activations. Artificial intelligence (AI) algorithms show promise to improve electrocardiogram (ECG) interpretation. The primary objective was to evaluate the potential of AI to reduce false positive activations without missing OMI. ⋯ In this single-center retrospective study, an AI-driven algorithm reduced false positive diagnoses of OMI compared to EMS clinician gestalt. Compared to AI (which missed no OMI), STEMI criteria also reduced false positives but missed 6 true OMI. External validation of these findings in prospective cohorts is indicated.
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Pediatric emergency care · Sep 2024
Point-of-Care Ultrasound Diagnosis of Early Pyomyositis in a Pediatric Patient: A Case Report.
Skin and soft tissue infections are common in the pediatric emergency department. Because pyomyositis occurs deep to the fascial plane, it is often difficult to appreciate on physical examination. ⋯ This case report describes a child who presented to the pediatric emergency department with leg pain and redness, initially concerning for an abscess based on clinical findings. Point-of-care ultrasound diagnosed early pyomyositis, prompting early involvement of the pediatric surgical service and urgent computed tomography imaging, which confirmed the diagnosis.