scholarly journals Fahr Disease: A Rare Cause of First-Time Seizure in the Emergency Department

Cureus ◽  
2021 ◽  
Author(s):  
Faleh M Aldawsari ◽  
Turki B Alotaibi ◽  
Omran S Hashim ◽  
Zainab A Bu Hamad ◽  
Maha R Eisaa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Fahr Disease ◽  
First Time

Insertion of Peripheral Intravenous Cannulae in the Emergency Department: Factors Associated with First-time Insertion Success

2015 ◽  
Vol 17 (2) ◽  
pp. 182-190 ◽  
Author(s):  
Peter J. Carr ◽  
James C.R. Rippey ◽  
Charley A. Budgeon ◽  
Marie L. Cooke ◽  
Niall Higgins ◽  
...  
Keyword(s):  
Emergency Department ◽  
Factors Associated ◽  
First Time

Why Is My Child Shaking All Over?

2020 ◽  
pp. 131-140
Author(s):  
Katherine Battisti
Keyword(s):  
Emergency Department ◽  
Pediatric Patients ◽  
Febrile Seizures ◽  
Physical Exam ◽  
Common Reason ◽  
Laboratory Evaluation ◽  
First Time

Seizures are a common reason for pediatric patients to present to the emergency department for evaluation. Differentiating between the different categories of seizures is essential when determining the approach to evaluation and management of these patients. These categories include simple and complex febrile seizures, first time non-febrile seizures, and known epilepsy. There are no universal guidelines so understanding these categories can help the emergency provider obtain appropriate laboratory evaluation, neuroimaging, and possibly electroencephalogram as indicated. Management of pediatric seizures and special considerations are discussed, taking into consideration key history and physical exam findings.

scholarly journals Association between QTc prolongation and mortality in patients with suspected poisoning in the emergency department: a transnational propensity score matched cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020036 ◽  
Author(s):  
Camilla Schade Hansen ◽  
Anton Pottegård ◽  
Ulf Ekelund ◽  
Helene Kildegaard Jensen ◽  
Jakob Lundager Forberg ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Cohort Study ◽  
Propensity Score ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
First Time

ObjectivesPoisoning is a frequent cause of admission to the emergency department (ED) and may involve drugs known to prolong the QT interval. This study aims to describe the prevalence of QTc prolongation among ED patients with suspected poisoning and to calculate the absolute and relative risk of mortality or cardiac arrest associated with a prolonged QTc interval.MethodsWe performed a register-based cohort study, including all adult first-time contacts with suspected poisoning to the ED of two Swedish hospitals (January 2010–December 2014) and two Danish hospitals (March 2013–April 2014). We used propensity score matching to calculate HRs for all-cause mortality or cardiac arrest (combined endpoint) within 30 days after contact comparing patients with a prolonged QTc interval (≥450 ms men, ≥460 ms women) with patients with a QTc interval of <440 ms.ResultsAmong all first-time contacts with suspected poisoning that had an ECG recorded within 4 hours after arrival (n=3869), QTc prolongation occurred in 6.5%. The overall mortality after a 30-day follow-up period was 0.8% (95% CI 0.6 to 1.2), with an absolute risk of mortality or cardiac arrest in patients with QTc prolongation of 3.2% (95% CI 1.4 to 6.1). A prolonged QTc interval on arrival was associated with a HR of 3.6 (95% CI 1.0 to 12.2).ConclusionIn the ED, a prolonged QTc interval in patients arriving with suspected poisoning seems to be associated with a threefold increased risk of 30-day all-cause mortality or cardiac arrest.

Utility of the DIVA Score for Experienced Emergency Department Technicians

2019 ◽  
Vol 24 (4) ◽  
pp. 38-44
Author(s):  
Haroon Shaukat ◽  
Beemnet Neway ◽  
Kristen Breslin ◽  
Ar'Reon Watson ◽  
Kelly Poe ◽  
...  
Keyword(s):  
Emergency Department ◽  
Early Identification ◽  
Difficult Patients ◽  
Alternative Technology ◽  
First Time

Highlights The DIVA score may be generalizable to IVs placed by experienced EDTs. Higher odds of first-time success in difficult patients with ≥5 years EDT experience. Early identification of difficult access may allow for aid of alternative technology. Likely first study to evaluate EDTs IV skills in patients with varying DIVA scores.

Frequency of Emergency Department Visits for Sickle Cell Disease Vaso-Occlusive Crisis and Its Contribution to Hospital Admission Rates

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5569-5569
Author(s):  
Patrick Loeffler ◽  
Taylor Mueller ◽  
Abdullah Kutlar ◽  
Robert Gibson ◽  
LaShon Sturgis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sickle Cell Disease ◽  
Hospital Admission ◽  
Admission Rate ◽  
Cell Disease ◽  
Admission Rates ◽  
Time Period ◽  
Number Of Visits ◽  
The Difference ◽  
First Time

Abstract Background: Patients with sickle cell disease (SCD) vaso-occlusive crisis (VOC) frequently seek care in the emergency department (ED). To improve and increase consistency of care patients with uncomplicated VOC, are treated in the Emergency Department Observation Unit (EDOU) where they are treated with an individualized protocol-based pathway. EDOUs have been shown to be effective in meeting treatment guidelines and reducing hospital admission. Objective: This study examines the admission rates of individuals with SCD stratified by frequency of presentation at the EDOU. Methods: A retrospective review of an ED database was completed to explore the relationship between EDOU utilization and admission rate for patients with uncomplicated VOC. All patient records meeting pathway inclusion criteria for uncomplicated VOC during the time period September 2013 through May 2015 were included in the study. Visits were first associated with individual patients. Then, based on the number of visits per time period, patients were categorized as high users, moderate users, or low users. Categorization was done using the number of visits during the first, 12-month period (9/11/13 - 9/10/14), or the second, nine-month period (9/10/14 - 5/31/15). Adaptations to the categorization scheme for the nine-month time period were as follows. Low users were patients that had no more than one visit in either the first or second time period; moderate users were patients with two or three visits in the first time period or two visits in the second; high users were patients with four or more visits in the first time period, or three or more visits in the second time period. Admission rates were calculated as percentages of visits to the EDOU. Rates of admission for high, middle, and low users were compared using an unpaired, one-tailed Student's t-test. This study was approved by expedited review by the institution's Institutional Review Board (IRB). Results: A total of 727 visits for 154 patients were included in the analysis. High users (n=44) had a total of 539 visits and an average patient admission rate of 22% (n=118). Moderate users (n=49) had a total of 108 visits and an admission rate of 31% (n=33). Low users (N=61) had a total of 80 visits and an admission rate of 36% (n=29). The difference between the number of high user admissions and low user admissions was significant (p<0.01) as was the difference between the number of moderate-user visits and the number of high-user visits (p=0.04). The difference between the number of moderate and low user admissions was not significant (p=0.14). Conclusion: This study found that the difference in the number of admissions between high and low users and between high and moderate users was significant. The findings provide support for the value of the EDOU in reducing unnecessary hospital admissions. These findings also raise important questions regarding the phenotypic expression of pain in SCD and the availability of care. Although the criteria for categorization of patients in this study was limited and the time periods unequal the results suggest different patterns of personal response to pain and treatment seeking. It is unknown how these groups may be different in regards to access to care, treatment preferences, self-care practices, or severity of disease. It can be hypothesized from these results that there may be two different patterns of care seeking with some patients only using the EDOU when crisis is severe (low users) and other patients (high users) using the EDOU as part of their regular pain treatment strategy. To address these questions it is necessary to further examine the differences between these groups to look for explanations that can address increased utilization of the EDOU among some patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals The effectiveness of clinical risk factors on determining delayed traumatic intracranial pathology in the treatment of mild head trauma

2019 ◽  
pp. 102490791986951
Author(s):  
Ekrem Taha Sert ◽  
Hüseyin Mutlu ◽  
Kamil Kokulu
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Computerized Tomography ◽  
Head Trauma ◽  
Hospital Admissions ◽  
Clinical Risk Factors ◽  
Clinical Risk ◽  
Anticoagulant Drug ◽  
Abnormal Head ◽  
First Time

Background: Currently, a large burden of hospital admissions is related to minor head trauma and its related imaging studies. One of the challenging issues for emergency physicians is head computed tomography scan. Objective: The aim of this study was to determine whether there are clinical risk factors that may reveal the intracranial pathology occurring after discharge in adult patients who underwent computerized tomography because of mild/minor head traumas. We aimed to evaluate the prevalence of abnormal computerized tomography in these patients. Methods: Between January 2013 and December 2017 medical records and imaging findings of patients over 18 years of age who had undergone computerized tomography examination in the emergency department of our hospital were evaluated retrospectively. Patients were divided into groups according to age, sex, symptoms and physical examination findings. The relationship between these findings and abnormal computerized tomography findings was evaluated statistically. Results: A total of 619 patients who were admitted to the emergency department for the second time because of the same head trauma and underwent control head computerized tomography were included in the study. Abnormal head computerized tomography findings were found in 7.6% (47) of the patients. Clinical risk factors; Glasgow Coma Scale score, vomiting, loss of consciousness, dangerous trauma mechanism and anticoagulant drug use were significantly correlated with the presence of pathology on head CT( p<0.05). Conclusion: Patients who are readmitted to the emergency department due to worsening symptoms after the injury and who undergo control head computerized tomography have the risk of traumatic brain injury as much as those who are admitted for the first time. A very early computerized tomography may cause to miss an evolving bleeding. The presence of one or more of the identified risk factors will help clinicians to decide which patient requires computerized tomography.

scholarly journals Disparities in Outcomes Among Patients Diagnosed With Cancer in Proximity to an Emergency Department Visit

2022 ◽  
Author(s):  
Nicholas Pettit ◽  
Elisa Sarmiento ◽  
Jeffrey Kline
Keyword(s):  
Emergency Department ◽  
Low Income ◽  
Control Analysis ◽  
Adjusted Risk ◽  
Risk Of Death ◽  
Department Of Health ◽  
Prostate Cancers ◽  
Poor Outcomes ◽  
Case Control Analysis ◽  
First Time

Abstract A suspected diagnosis of cancer in the emergency department (ED) may be associated with poor outcomes, related to health disparities, however data are limited. This study is a case-control analysis of the Indiana State Department of Health Cancer Registry, and the Indiana Network for Patient Care. First time cancer diagnoses appearing in the registry between January 2013 and December 2017 were included. Cases were patients who had an ED visit in the 6 months before their cancer diagnosis; controls had no recent ED visits. The primary outcome was mortality, comparing ED-associated mortality to non-ED-associated. 134,761 first-time cancer patients were identified, including 15,432 (11.5%) cases. The mean age was same at 65, more of the cases were Black than the controls (12.4% vs 7.4%, P<.0001) and more were low income (36.4%. vs 29.3%). The top 3 ED-associated cancer diagnoses were lung (18.4%), breast (8.9%), and colorectal cancers (8.9%), whereas the controls were breast (17%), lung (14.9%), and prostate cancers (10.1%). Cases observed an over three-fold higher mortality, with cumulative death rate of 32.9% for cases vs 9.0% for controls (P<.0001). Regression analysis predicting mortality, controlling for many confounders produced an odds ratio of 4.12 (95% CI 3.72-4.56 for cases). This study found that an ED visit within 6 months prior to the first time of ICD-coded cancer is associated with Black race, low income and an overall three-fold increased adjusted risk of death. The mortality rates for ED-associated cancers are uniformly worse for all cancer types. These data suggest that additional work is needed to reduce disparities among ED-associated cancer diagnoses.

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