1,081 results on '"Emergency Treatment standards"'
Search Results
2. Trends in emergency ophthalmic care during COVID-19: A comparative analysis.
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Robles-Holmes H, Sridhar J, Al-Khersan H, Patel M, Hwang J, Hucko L, and Cavuoto KM
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- Adult, COVID-19 prevention & control, COVID-19 transmission, Emergency Treatment standards, Eye Diseases epidemiology, Female, Humans, Male, Middle Aged, Ophthalmology statistics & numerical data, Emergency Treatment statistics & numerical data, Eye Diseases therapy, Ophthalmology methods, Patient Acceptance of Health Care statistics & numerical data
- Abstract
Competing Interests: Declaration of Competing Interest No conflicting relationships exist for Dr. Cavuoto, Dr. Al-khersan, student Dr. Robles-Holmes, student Dr. Patel, student Dr. Hwang, or student Dr. Hucko. Dr. Sridhar is a consultant for Alcon, Dorc, and Regeneron.
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- 2022
- Full Text
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3. Acute Ischemic Priapism: An AUA/SMSNA Guideline.
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Bivalacqua TJ, Allen BK, Brock G, Broderick GA, Kohler TS, Mulhall JP, Oristaglio J, Rahimi LL, Rogers ZR, Terlecki RP, Trost L, Yafi FA, and Bennett NE Jr
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- Acute Disease therapy, Adult, Combined Modality Therapy methods, Combined Modality Therapy standards, Emergency Treatment methods, Erectile Dysfunction etiology, Erectile Dysfunction physiopathology, Humans, Ischemia etiology, Ischemia physiopathology, Male, North America, Penile Erection physiology, Penis diagnostic imaging, Penis drug effects, Penis physiopathology, Penis surgery, Phenylephrine administration & dosage, Priapism diagnosis, Priapism etiology, Priapism physiopathology, Societies, Medical standards, Time Factors, Ultrasonography, Doppler, Urology methods, Emergency Treatment standards, Erectile Dysfunction prevention & control, Ischemia therapy, Priapism therapy, Urology standards
- Abstract
Purpose: Priapism is a persistent penile erection that continues hours beyond, or is unrelated to, sexual stimulation and results in a prolonged and uncontrolled erection. Given its time-dependent and progressive nature, priapism is a situation that both urologists and emergency medicine practitioners must be familiar with and comfortable managing. Acute ischemic priapism, characterized by little or no cavernous blood flow and abnormal cavernous blood gases (ie, hypoxic, hypercarbic, acidotic) represents a medical emergency and may lead to cavernosal fibrosis and subsequent erectile dysfunction., Materials and Methods: A comprehensive search of the literature was performed by Emergency Care Research Institute for articles published between January 1, 1960 and May 1, 2020. Searches identified 2948 potentially relevant articles, and 2516 of these were excluded at the title or abstract level for not meeting inclusion criteria for any key question. Full texts for the remaining 432 articles were reviewed, and ultimately 137 unique articles were included in the report., Results: This Guideline was developed to inform clinicians on the proper diagnosis and surgical and non-surgical treatment of patients with acute ischemic priapism. This Guideline addresses the role of imaging, adjunctive laboratory testing, early involvement of urologists when presenting to the emergency room, discussion of conservative therapies, enhanced data for patient counseling on risks of erectile dysfunction and surgical complications, specific recommendations on intracavernosal phenylephrine with or without irrigation, the inclusion of novel surgical techniques (eg, tunneling), and early penile prosthesis placement., Conclusions: All patients with priapism should be evaluated emergently to identify the sub-type of priapism (acute ischemic versus non-ischemic) and those with an acute ischemic event should be provided early intervention. Treatment of the acute ischemic patient must be based on patient objectives, available resources, and clinician experience. As such, a single pathway for managing the condition is oversimplified and no longer appropriate. Using a diversified approach, some men may be treated with intracavernosal injections of phenylephrine alone, others with aspiration/irrigation or distal shunting, and some may undergo non-emergent placement of a penile prosthesis.
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- 2021
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4. Emergency clinicians' knowledge, preparedness and experiences of managing COVID-19 during the 2020 global pandemic in Australian healthcare settings.
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Li C, Sotomayor-Castillo C, Nahidi S, Kuznetsov S, Considine J, Curtis K, Fry M, Morgan D, Walker T, Burgess A, Carver H, Doyle B, Tran V, Varshney K, and Shaban RZ
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- Adult, Australia, COVID-19 epidemiology, Cross-Sectional Studies, Emergency Medical Services standards, Emergency Treatment standards, Female, Humans, Male, Middle Aged, Personal Protective Equipment statistics & numerical data, Attitude of Health Personnel, COVID-19 prevention & control, Clinical Competence statistics & numerical data, Emergency Service, Hospital organization & administration, Health Knowledge, Attitudes, Practice, Infection Control organization & administration
- Abstract
Background: Emergency clinicians have a crucial role during public health emergencies and have been at the frontline during the COVID-19 pandemic. This study examined the knowledge, preparedness and experiences of Australian emergency nurses, emergency physicians and paramedics in managing COVID-19., Methods: A voluntary cross-sectional study of members of the College of Emergency Nursing Australasia, the Australasian College for Emergency Medicine, and the Australasian College of Paramedicine was conducted using an online survey (June-September 2020)., Results: Of the 159 emergency nurses, 110 emergency physicians and 161 paramedics, 67.3-78% from each group indicated that their current knowledge of COVID-19 was 'good to very good'. The most frequently accessed source of COVID-19 information was from state department of health websites. Most of the respondents in each group (77.6-86.4%) received COVID-19 specific training and education, including personal protective equipment (PPE) usage. One-third of paramedics reported that their workload 'had lessened' while 36.4-40% of emergency nurses and physicians stated that their workload had 'considerably increased'. Common concerns raised included disease transmission to family, public complacency, and PPE availability., Conclusions: Extensive training and education and adequate support helped prepare emergency clinicians to manage COVID-19 patients. Challenges included inconsistent and rapidly changing communications and availability of PPE., (Copyright © 2021 College of Emergency Nursing Australasia. All rights reserved.)
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- 2021
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5. Use of Involuntary Emergency Treatment by Physicians and Law Enforcement for Persons With High-Risk Drug Use or Alcohol Dependence.
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Coffey KE, Aitelli A, Milligan M, Niemierko A, Broom T, and Shih HA
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- Adult, Cohort Studies, Female, Humans, Male, Massachusetts, Middle Aged, Pilot Projects, Practice Guidelines as Topic, Alcoholism therapy, Dangerous Behavior, Emergency Treatment standards, Involuntary Commitment legislation & jurisprudence, Involuntary Commitment standards, Law Enforcement methods, Substance-Related Disorders therapy, Volition
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- 2021
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6. Feasibility of task-sharing with community health workers for the identification, emergency management and referral of women with pre-eclampsia, in Mozambique.
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Sevene E, Boene H, Vidler M, Valá A, Macuacua S, Augusto O, Fernandes Q, Bique C, Macete E, Sidat M, von Dadelszen P, and Munguambe K
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- Adult, Clinical Competence, Disease Management, Feasibility Studies, Female, Humans, Maternal Mortality, Mozambique, Patient Acceptance of Health Care, Pregnancy, Prenatal Care, Referral and Consultation, Community Health Services standards, Community Health Workers psychology, Emergency Treatment standards, Health Knowledge, Attitudes, Practice, Pre-Eclampsia diagnosis, Pre-Eclampsia therapy
- Abstract
Background: Maternal mortality is an important public health problem in low-income countries. Delays in reaching health facilities and insufficient health care professionals call for innovative community-level solutions. There is limited evidence on the role of community health workers in the management of pregnancy complications. This study aimed to describe the feasibility of task-sharing the initial screening and initiation of obstetric emergency care for pre-eclampsia/eclampsia from the primary healthcare providers to community health workers in Mozambique and document healthcare facility preparedness to respond to referrals., Method: The study took place in Maputo and Gaza Provinces in southern Mozambique and aimed to inform the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomized controlled trial. This was a mixed-methods study. The quantitative data was collected through self-administered questionnaires completed by community health workers and a health facility survey; this data was analysed using Stata v13. The qualitative data was collected through focus group discussions and in-depth interviews with various community groups, health care providers, and policymakers. All discussions were audio-recorded and transcribed verbatim prior to thematic analysis using QSR NVivo 10. Data collection was complemented by reviewing existing documents regarding maternal health and community health worker policies, guidelines, reports and manuals., Results: Community health workers in Mozambique were trained to identify the basic danger signs of pregnancy; however, they have not been trained to manage obstetric emergencies. Furthermore, barriers at health facilities were identified, including lack of equipment, shortage of supervisors, and irregular drug availability. All primary and the majority of secondary-level facilities (57%) do not provide blood transfusions or have surgical capacity, and thus such cases must be referred to the tertiary-level. Although most healthcare facilities (96%) had access to an ambulance for referrals, no transport was available from the community to the healthcare facility., Conclusions: This study showed that task-sharing for screening and pre-referral management of pre-eclampsia and eclampsia were deemed feasible and acceptable at the community-level, but an effort should be in place to address challenges at the health system level.
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- 2021
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7. Safety of emergency, elective and day case operating during the winter period at East Suffolk and North Essex NHS Foundation Trust: lessons from the outcomes of 4,254 surgical patients from the first COVID-19 wave.
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Parikh S, Cooper L, Matthews W, Khan M, Syed S, Vasudevan SP, Brosnan C, Barr L, and Loeffler M
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- Ambulatory Surgical Procedures standards, Ambulatory Surgical Procedures statistics & numerical data, COVID-19 complications, COVID-19 diagnosis, COVID-19 transmission, COVID-19 Testing standards, COVID-19 Testing statistics & numerical data, Elective Surgical Procedures standards, Elective Surgical Procedures statistics & numerical data, Emergency Service, Hospital standards, Emergency Service, Hospital statistics & numerical data, Emergency Treatment standards, Emergency Treatment statistics & numerical data, England epidemiology, Female, Hospital Mortality, Humans, Incidence, Infection Control standards, Infection Control statistics & numerical data, Length of Stay statistics & numerical data, Male, Pandemics prevention & control, Pandemics statistics & numerical data, Patient Admission standards, Patient Admission statistics & numerical data, Retrospective Studies, SARS-CoV-2 isolation & purification, State Medicine standards, State Medicine statistics & numerical data, Ambulatory Surgical Procedures mortality, COVID-19 epidemiology, Elective Surgical Procedures mortality, Emergency Treatment mortality
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Background: There is limited evidence on perioperative outcomes of surgical patients during the COVID-19 pandemic to inform continued operating into the winter period., Methods: We retrospectively analysed the rate of 30-day COVID-19 transmission and mortality of all surgical patients in the three hospitals in our trust in the East of England during the first lockdown in March 2020. All patients who underwent a swab were swabbed on or 24 hours prior to admission., Results: There were 4,254 patients and an overall 30-day mortality of 0.99%. The excess surgical mortality in our region was 0.29%. There were 39 patients who were COVID-19 positive within 30 days of admission, 12 of whom died. All 12 were emergency admissions with a length of stay longer than 24 hours. There were three deaths among those who underwent day case surgery, one of whom was COVID-19 negative, and the other two were not swabbed but not suspected to have COVID-19. There were two COVID-19 positive elective cases and none in day case elective or emergency surgery. There were no COVID-19 positive deaths in elective or day case surgery., Conclusions: There was a low rate of COVID-19 transmission and mortality in elective and day case operations. Our data have allowed us to guide patients in the consent process and provided the evidence base to restart elective and day case operating with precautions and regular review. A number of regions will be similarly affected and should perform a review of their data for the winter period and beyond.
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- 2021
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8. Adapting an emergency general surgery service in response to the COVID-19 pandemic.
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Hickland P, Clements JM, Convie LJ, McKay D, and McElvanna K
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- Adult, Aged, Ambulatory Surgical Procedures statistics & numerical data, COVID-19 diagnosis, COVID-19 epidemiology, COVID-19 transmission, Conservative Treatment statistics & numerical data, Emergency Service, Hospital standards, Emergency Service, Hospital statistics & numerical data, Emergency Treatment methods, Emergency Treatment standards, Female, Follow-Up Studies, General Surgery standards, General Surgery statistics & numerical data, Hospital Mortality, Humans, Infection Control organization & administration, Infection Control standards, Male, Middle Aged, Pandemics prevention & control, Patient Readmission statistics & numerical data, Patient Safety standards, Prospective Studies, Referral and Consultation organization & administration, Referral and Consultation standards, Referral and Consultation statistics & numerical data, Retrospective Studies, SARS-CoV-2 isolation & purification, Surgery Department, Hospital standards, Surgery Department, Hospital statistics & numerical data, COVID-19 prevention & control, Emergency Service, Hospital organization & administration, Emergency Treatment statistics & numerical data, General Surgery organization & administration, Surgery Department, Hospital organization & administration
- Abstract
Introduction: In response to the COVID-19 pandemic, our emergency general surgery (EGS) service underwent significant restructuring, including establishing an enhanced ambulatory service and undertaking nonoperative management of selected pathologies. The aim of this study was to compare the activity of our EGS service before and after these changes., Methods: Patients referred by the emergency department were identified prospectively over a 4-week period beginning from the date our EGS service was reconfigured (COVID) and compared with patients identified retrospectively from the same period the previous year (Pre-COVID), and followed up for 30 days. Data were extracted from handover documents and electronic care records. The primary outcomes were the rate of admission, ambulation and discharge., Results: There were 281 and 283 patients during the Pre-COVID and COVID periods respectively. Admission rate decreased from 78.7% to 41.7%, while there were increased rates of ambulation from 7.1% to 17.3% and discharge from 6% to 22.6% (all p <0.001). For inpatients, mean duration of admission decreased (6.9 to 4.8 days), and there were fewer operative or endoscopic interventions (78 to 40). There were increased ambulatory investigations (11 to 39) and telephone reviews (0 to 39), while early computed tomography scan was increasingly used to facilitate discharge (5% vs 34.7%). There were no differences in 30-day readmission or mortality., Conclusions: Restructuring of our EGS service in response to COVID-19 facilitated an increased use of ambulatory services and imaging, achieving a decrease of 952 inpatient bed days in this critical period, while maintaining patient safety.
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- 2021
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9. Implementation of a school emergency asthma bag.
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Chavasse RJPG, Coffey T, Brown-Bampoe O, Adebayo I, and Kumar V
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- Administration, Inhalation, Child, Consent Forms, Emergency Treatment standards, Health Plan Implementation, Humans, Nebulizers and Vaporizers, Practice Guidelines as Topic, Quality Improvement, School Health Services legislation & jurisprudence, School Health Services standards, United Kingdom, Adrenergic beta-Agonists administration & dosage, Asthma drug therapy, Emergency Treatment instrumentation, School Health Services organization & administration
- Abstract
Competing Interests: Competing interests: None declared.
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- 2021
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10. Using performance frontiers to differentiate elective and capacity-based surgical services.
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Ranney SE, Tsai MH, Breidenstein MW, Sexton KW, and Malhotra AK
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- Efficiency, Organizational standards, Efficiency, Organizational statistics & numerical data, Elective Surgical Procedures statistics & numerical data, Emergency Treatment statistics & numerical data, Humans, Operating Rooms organization & administration, Operating Rooms statistics & numerical data, Trauma Centers organization & administration, Trauma Centers standards, Trauma Centers statistics & numerical data, Workload standards, Workload statistics & numerical data, Benchmarking methods, Elective Surgical Procedures standards, Emergency Treatment standards, Operating Rooms standards, Wounds and Injuries surgery
- Abstract
Background: Acute care surgery (ACS) model of care delivery has many benefits. However, since the ACS surgeon has limited control over the volume, timing, and complexity of cases, traditional metrics of operating room (OR) efficiency almost always measure ACS service as "inefficient." The current study examines an alternative method-performance fronts-of evaluating changes in efficiency and tests the following hypotheses: (1) in an institution with a robust ACS service, performance front methodology is superior to traditional metrics in evaluating OR throughput/efficiency, and (2) introduction of an ACS service with block time allocation will improve OR throughput/efficiency., Methods: Operating room metrics 1-year pre-ACS implementation and post-ACS implementation were collected. Overall OR efficiency was calculated by mean case volumes for the entire OR and ACS and general surgery (GS) services individually. Detailed analysis of these two specific services was performed by gathering median monthly minutes-in block, out of block, after hours, and opportunity unused. The two services were examined using a traditional measure of efficiency and the "fronts" method. Services were compared with each other and also pre-ACS implementation and post-ACS implementation., Results: Overall OR case volumes increased by 5% (999 ± 50 to 1,043 ± 46: p < 0.05) with almost all of the increase coming through ACS (27 ± 4 to 68 ± 16: p < 0.05). By traditional metrics, ACS had significantly worse median efficiency versus GS in both periods: pre (0.67 [0.66-0.71] vs. 0.80 [0.78-0.81]) and post (0.75 [0.53-0.77] vs. 0.83 [0.84-0.85]) (p < 0.05). As compared with the pre, GS efficiency improved significantly in post (p < 0.05), but ACS efficiency remained unchanged (p > 0.05). The alternative fronts chart demonstrated the more accurate picture with improved efficiency observed for GS, ACS, and combined., Conclusion: In an institution with a busy ACS service, the alternative fronts methodology offers a more accurate evaluation of OR efficiency. The provision of an OR for the ACS service improves overall throughput/efficiency., (Copyright © 2021 American Association for the Surgery of Trauma.)
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- 2021
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11. Decision to delivery interval and associated factors for emergency cesarean section: a cross-sectional study.
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Kitaw TM, Limenh SK, Chekole FA, Getie SA, Gemeda BN, and Engda AS
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- Adult, Cesarean Section standards, Cross-Sectional Studies, Emergency Treatment standards, Ethiopia epidemiology, Female, Guideline Adherence statistics & numerical data, Hospitals, Public standards, Hospitals, Public statistics & numerical data, Hospitals, Urban standards, Hospitals, Urban statistics & numerical data, Humans, Infant, Newborn, Maternal Death prevention & control, Obstetric Labor Complications diagnosis, Obstetric Labor Complications mortality, Perinatal Care standards, Perinatal Death prevention & control, Practice Guidelines as Topic, Pregnancy, Quality of Health Care standards, Time Factors, Time-to-Treatment statistics & numerical data, Young Adult, Cesarean Section statistics & numerical data, Clinical Decision-Making, Emergency Treatment statistics & numerical data, Obstetric Labor Complications surgery, Perinatal Care statistics & numerical data
- Abstract
Background: Emergency cesarean section is a commonly performed surgical procedure in pregnant women with life-threatening conditions of the mother and/or fetus. According to the Royal College of Obstetricians and Gynecologists and the American College of Obstetricians and Gynecologists, decision to delivery interval for emergency cesarean sections should be within 30 min. It is an indicator of quality of care in maternity service, and if prolonged, it constitutes a third-degree delay. This study aimed to assess the decision to delivery interval and associated factors for emergency cesarean section in Bahir Dar City Public Hospitals, Ethiopia., Method: An institution-based cross-sectional study was conducted at Bahir Dar City Public Hospitals from February to May 2020. Study participants were selected using a systematic random sampling technique. A combination of observations and interviews was used to collect the data. Data entry and analysis were performed using Epi-data version 3.1 and SPSS version 25, respectively. Statistical significance was set at p < 0.05., Result: Decision-to-delivery interval below 30 min was observed in 20.3% [95% CI = 15.90-24.70%] of emergency cesarean section. The results showed that referral status [AOR = 2.5, 95% CI = 1.26-5.00], time of day of emergency cesarean section [AOR = 2.5, 95%CI = 1.26-4.92], status of surgeons [AOR = 2.95, 95%CI = 1.30-6.70], type of anesthesia [AOR = 4, 95% CI = 1.60-10.00] and transfer time [AOR = 5.26, 95% CI = 2.65-10.46] were factors significantly associated with the decision to delivery interval., Conclusion: Decision-to-delivery intervals were not achieved within the recommended time interval. Therefore, to address institutional delays in emergency cesarean section, providers and facilities should be better prepared in advance and ready for rapid emergency action.
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- 2021
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12. Clinical guideline for retained button batteries.
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Houston R, Powell S, Jaffray B, and Ball S
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- Child, Preschool, Humans, Infant, Infant, Newborn, Otolaryngology, Practice Guidelines as Topic, State Medicine, United Kingdom, Emergency Treatment standards, Foreign Bodies surgery, Pediatric Emergency Medicine standards
- Abstract
Objective: To design a clinical guideline for the emergency management of retained button batteries (RBBs) through analysis of UK National Health Service hospital guidelines and published literature., Method: 49 acute hospitals were contacted, and their guidelines were analysed. A consensus guideline was then created with multidisciplinary input. The final guideline was independently peer reviewed by the British Association of Otorhinolaryngology and Head and Neck Surgery (ENT UK) clinical guidelines committee., Results: 40 (82%) trusts responded. 28 had a guideline for the management of a RBB in the aerodigestive tract. Significant variation between guidelines assessment, investigation and management of a RBB was identified., Conclusion: A single-page guideline was designed to improve frontline healthcare professional's immediate investigation and management of a RBB on presentation to emergency care. This has been published by ENT UK as a clinical guideline., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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13. The laparoscopy in emergency general surgery (LEGS) study: a questionnaire survey of UK practice.
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Heywood N, Parmar KL, Stott M, Sodde P, Doherty DT, Lim J, and Sharma A
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- Consensus, Consultants statistics & numerical data, Emergency Treatment standards, Humans, Laparoscopy standards, Practice Guidelines as Topic, Practice Patterns, Physicians' standards, Surgeons statistics & numerical data, Surveys and Questionnaires statistics & numerical data, United Kingdom, Emergency Treatment statistics & numerical data, Laparoscopy statistics & numerical data, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Introduction: Recent consensus guidelines suggest that the laparoscopic approach may be a useful, safe and feasible approach in emergency general surgery. Despite this, the UK National Emergency Laparotomy Audit (NELA) suggests the rate of laparoscopy is low (9% fully laparoscopic) and slow to increase over time. A European survey found uptake to be variable. This UK survey was therefore undertaken to establish current UK practice and to determine factors affecting implementation., Materials and Methods: A questionnaire survey of currently practising UK consultant general surgeons was carried out by the North West Surgical Research Collaborative, using a secure web-based database maintained by the North West Surgical Trials Centre., Results: A total of 151 completed questionnaires were returned from 22 UK centres; 18% of respondents were unaware that laparoscopic cases should be reported to NELA. Appendicectomy (97%) and cholecystectomy (87%) were routinely performed laparoscopically. Laparoscopy was infrequently used in perforation, ischaemia or obstructed hernias. There appears to be equipoise regarding laparoscopic compared with open surgery in small-bowel obstruction among all subspecialty emergency general surgeons, in perforated peptic ulcer among upper gastrointestinal surgeons and in Hinchey III diverticulitis among colorectal surgeons., Conclusion: Uptake of laparoscopy in UK emergency general surgery is influenced by surgeon preference, subspecialty, patient and operative factors. Further research into outcomes may help to identify areas of greatest potential benefit. The rate of laparoscopy reported by NELA may be an underestimate due to the 18% of surgeons unaware that laparoscopic cases should be reported, which may affect the validity of analyses performed from this dataset.
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- 2021
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14. A cohort study examining urgent and emergency treatment for decompensated severe aortic stenosis.
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Ali N, Patel P, Wahab A, Das A, Blackman DJ, Cunnington MS, and Malkin CJ
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- Aged, Aortic Valve diagnostic imaging, Aortic Valve Stenosis diagnosis, Female, Humans, Male, Retrospective Studies, Risk Factors, Severity of Illness Index, Time Factors, Tomography, X-Ray Computed, Ambulatory Care standards, Aortic Valve surgery, Aortic Valve Stenosis surgery, Emergencies, Emergency Treatment standards, Practice Guidelines as Topic, Transcatheter Aortic Valve Replacement methods
- Abstract
Aims: We compared strategies in the treatment of decompensated severe aortic stenosis. The hypothesis was that undertaking urgent or emergency transcatheter aortic valve implantation (TAVI) directly in such patients is safer and more effective than urgent or emergency balloon aortic valvuloplasty (BAV) followed by elective TAVI or surgical aortic valve replacement (SAVR)., Methods: This was a single-centre retrospective study including all consecutive patients who underwent urgent or emergency BAV or TAVI for decompensated severe aortic stenosis between September 2014 and February 2018. Primary endpoints were 30-day and 1-year mortality., Results: Fifty-two patients underwent urgent or emergency BAV and 87 underwent TAVI. Baseline characteristics of the two groups were well matched. Significant differences were noted between the two groups in 30-day all-cause mortality (88.5% BAV patients alive at 30 days, 97.7% TAVI patients; P < 0.05) and 1-year all-cause mortality (44.2% BAV patients alive at 1 year, 88.5% TAVI patients; P < 0.001). At 1 year, the estimated hazard ratio for patients undergoing BAV was 11.2 (95% confidence interval: 4.67-26.9; P < 0.001) when adjusted for potential confounding variables. Patients in the BAV group who successfully underwent subsequent TAVI or SAVR all survived for 365 days, but there was no significant 1-year mortality difference compared with those who underwent urgent or emergency TAVI (100 vs. 88.5%; P > 0.155)., Conclusion: Our results suggest treatment of decompensated severe aortic stenosis with urgent or emergency TAVI may be associated with improved survival outcomes when compared with a strategy of performing BAV as a bridge to subsequent TAVI or SAVR., (Copyright © 2020 Italian Federation of Cardiology - I.F.C. All rights reserved.)
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- 2021
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15. Effect of Implementing the Out-of-Hospital Traumatic Brain Injury Treatment Guidelines: The Excellence in Prehospital Injury Care for Children Study (EPIC4Kids).
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Gaither JB, Spaite DW, Bobrow BJ, Keim SM, Barnhart BJ, Chikani V, Sherrill D, Denninghoff KR, Mullins T, Adelson PD, Rice AD, Viscusi C, and Hu C
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- Adolescent, Brain Injuries, Traumatic mortality, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Injury Severity Score, Male, Positive-Pressure Respiration, Risk Factors, Survival Analysis, Trauma Centers, Brain Injuries, Traumatic therapy, Emergency Treatment standards, Practice Guidelines as Topic
- Abstract
Study Objective: We evaluate the effect of implementing the out-of-hospital pediatric traumatic brain injury guidelines on outcomes in children with major traumatic brain injury., Methods: The Excellence in Prehospital Injury Care for Children study is the preplanned secondary analysis of the Excellence in Prehospital Injury Care study, a multisystem, intention-to-treat study using a before-after controlled design. This subanalysis included children younger than 18 years who were transported to Level I trauma centers by participating out-of-hospital agencies between January 1, 2007, and June 30, 2015, throughout Arizona. The primary and secondary outcomes were survival to hospital discharge or admission for children with major traumatic brain injury and in 3 subgroups, defined a priori as those with moderate, severe, and critical traumatic brain injury. Outcomes in the preimplementation and postimplementation cohorts were compared with logistic regression, adjusting for risk factors and confounders., Results: There were 2,801 subjects, 2,041 in preimplementation and 760 in postimplementation. The primary analysis (postimplementation versus preimplementation) yielded an adjusted odds ratio of 1.16 (95% confidence interval 0.70 to 1.92) for survival to hospital discharge and 2.41 (95% confidence interval 1.17 to 5.21) for survival to hospital admission. In the severe traumatic brain injury cohort (Regional Severity Score-Head 3 or 4), but not the moderate or critical subgroups, survival to discharge significantly improved after guideline implementation (adjusted odds ratio = 8.42; 95% confidence interval 1.01 to 100+). The improvement in survival to discharge among patients with severe traumatic brain injury who received positive-pressure ventilation did not reach significance (adjusted odds ratio = 9.13; 95% confidence interval 0.79 to 100+)., Conclusion: Implementation of the pediatric out-of-hospital traumatic brain injury guidelines was not associated with improved survival when the entire spectrum of severity was analyzed as a whole (moderate, severe, and critical). However, both adjusted survival to hospital admission and discharge improved in children with severe traumatic brain injury, indicating a potential severity-based interventional opportunity for guideline effectiveness. These findings support the widespread implementation of the out-of-hospital pediatric traumatic brain injury guidelines., (Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)
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- 2021
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16. Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms.
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Upchurch GR Jr, Escobar GA, Azizzadeh A, Beck AW, Conrad MF, Matsumura JS, Murad MH, Perry RJ, Singh MJ, Veeraswamy RK, and Wang GJ
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- Aftercare methods, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic surgery, Aortic Aneurysm, Thoracic diagnosis, Clinical Decision-Making, Elective Surgical Procedures adverse effects, Elective Surgical Procedures instrumentation, Elective Surgical Procedures methods, Elective Surgical Procedures standards, Emergency Treatment adverse effects, Emergency Treatment instrumentation, Emergency Treatment methods, Emergency Treatment standards, Endoleak diagnosis, Endoleak etiology, Endovascular Procedures adverse effects, Endovascular Procedures instrumentation, Endovascular Procedures methods, Humans, Tomography, X-Ray Computed standards, Treatment Outcome, Aftercare standards, Aortic Aneurysm, Thoracic surgery, Endovascular Procedures standards, Societies, Medical standards, Specialties, Surgical standards
- Abstract
Thoracic aortic diseases, including disease of the descending thoracic aorta (DTA), are significant causes of death in the United States. Open repair of the DTA is a physiologically impactful operation with relatively high rates of mortality, paraplegia, and renal failure. Thoracic endovascular aortic repair (TEVAR) has revolutionized treatment of the DTA and has largely supplanted open repair because of lower morbidity and mortality. These Society for Vascular Surgery Practice Guidelines are applicable to the use of TEVAR for descending thoracic aortic aneurysm (TAA) as well as for other rarer pathologic processes of the DTA. Management of aortic dissections and traumatic injuries will be discussed in separate Society for Vascular Surgery documents. In general, there is a lack of high-quality evidence across all TAA diseases, highlighting the need for better comparative effectiveness research. Yet, large single-center experiences, administrative databases, and meta-analyses have consistently reported beneficial effects of TEVAR over open repair, especially in the setting of rupture. Many of the strongest recommendations from this guideline focus on imaging before, during, or after TEVAR and include the following: In patients considered at high risk for symptomatic TAA or acute aortic syndrome, we recommend urgent imaging, usually computed tomography angiography (CTA) because of its speed and ease of use for preoperative planning. Level of recommendation: Grade 1 (Strong), Quality of Evidence: B (Moderate). If TEVAR is being considered, we recommend fine-cut (≤0.25 mm) CTA of the entire aorta as well as of the iliac and femoral arteries. CTA of the head and neck is also needed to determine the anatomy of the vertebral arteries. Level of recommendation: Grade 1 (Strong), Quality of Evidence: A (High). We recommend routine use of three-dimensional centerline reconstruction software for accurate case planning and execution in TEVAR. Level of recommendation: Grade 1 (Strong), Quality of Evidence: B (Moderate). We recommend contrast-enhanced computed tomography scanning at 1 month and 12 months after TEVAR and then yearly for life, with consideration of more frequent imaging if an endoleak or other abnormality of concern is detected at 1 month. Level of recommendation: Grade 1 (Strong), Quality of Evidence: B (Moderate). Finally, based on our review, in patients who could undergo either technique (within the criteria of the device's instructions for use), we recommend TEVAR as the preferred approach to treat elective DTA aneurysms, given its reduced morbidity and length of stay as well as short-term mortality. Level of recommendation: Grade 1 (Strong), Quality of Evidence: A (High). Given the benefits of TEVAR, treatment using a minimally invasive approach is largely based on anatomic eligibility rather than on patient-specific factors, as is the case in open TAA repair. Thus, for isolated lesions of the DTA, TEVAR should be the primary method of repair in both the elective and emergent setting based on improved short-term and midterm mortality as well as decreased morbidity., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2021
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17. Perception survey of crisis and emergency risk communication in an acute hospital in the management of COVID-19 pandemic in Singapore.
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Ow Yong LM, Xin X, Wee JML, Poopalalingam R, Kwek KYC, and Thumboo J
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- Centers for Disease Control and Prevention, U.S., Humans, Information Dissemination methods, Pandemics prevention & control, Singapore, United States, COVID-19 therapy, Communicable Disease Control standards, Emergency Medical Service Communication Systems standards, Emergency Service, Hospital organization & administration, Emergency Treatment standards
- Abstract
Background: Emergency risk communication is a critical component in emergency planning and response. It has been recognised as significant for planning for and responding to public health emergencies. While there is a growing body of guidelines and frameworks on emergency risk communication, it remains a relatively new field. There has also been limited attention on how emergency risk communication is being performed in public health organisations, such as acute hospitals, and what the associated challenges are. This article seeks to examine the perception of crisis and emergency risk communication in an acute hospital in response to COVID-19 pandemic in Singapore and to identify its associated enablers and barriers., Methods: A 13-item Crisis and Emergency Risk Communication (CERC) Survey, based on the US Centers for Disease and Control (CDC) CERC framework, was developed and administered to hospital staff during February 24-28, 2020. The survey also included an open-ended question to solicit feedback on areas of CERC in need of improvement. Chi-square test was used for analysis of survey data. Thematic analysis was performed on qualitative feedback., Results: Of the 1154 participants who responded to the survey, most (94.1%) reported that regular hospital updates on COVID-19 were understandable and actionable. Many (92.5%) stated that accurate, concise and timely information helped to keep them safe. A majority (92.3%) of them were clear about the hospital's response to the COVID-19 situation, and 79.4% of the respondents reported that the hospital had been able to understand their challenges and address their concerns. Sociodemographic characteristics, such as occupation, age, marital status, work experience, gender, and staff's primary work location influenced the responses to hospital CERC. Local leaders within the hospital would need support to better communicate and translate hospital updates in response to COVID-19 to actionable plans for their staff. Better communication in executing resource utilization plans, expressing more empathy and care for their staff, and enhancing communication channels, such as through the use of secure text messaging rather than emails would be important., Conclusion: CERC is relevant and important in the hospital setting to managing COVID-19 and should be considered concurrently with hospital emergency response domains.
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- 2020
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18. Management of cardiovascular emergencies during the COVID-19 pandemic.
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Choudhary R, Gautam D, Mathur R, and Choudhary D
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- Aged, Angioplasty standards, Angioplasty statistics & numerical data, Betacoronavirus pathogenicity, COVID-19, Cardiovascular Diseases diagnosis, Coronavirus Infections epidemiology, Coronavirus Infections transmission, Coronavirus Infections virology, Emergencies, Emergency Service, Hospital standards, Emergency Treatment standards, Emergency Treatment statistics & numerical data, Female, Health Services Accessibility organization & administration, Health Services Accessibility standards, Humans, India epidemiology, Male, Middle Aged, Pneumonia, Viral epidemiology, Pneumonia, Viral transmission, Pneumonia, Viral virology, Practice Guidelines as Topic, Retrospective Studies, SARS-CoV-2, Thrombectomy standards, Thrombectomy statistics & numerical data, Cardiovascular Diseases therapy, Communicable Disease Control standards, Coronavirus Infections prevention & control, Emergency Service, Hospital organization & administration, Pandemics prevention & control, Patient Admission standards, Pneumonia, Viral prevention & control
- Abstract
Background: It has been reported that patients attending the emergency department with other pathologies may not have received optimal medical care due to the lockdown measures in the early phase of the COVID-19 pandemic., Methods: This was a retrospective study of patients presenting with cardiovascular emergencies to four tertiary regional emergency departments in western India during the government implementation of complete lockdown., Results: 25.0% of patients during the lockdown period and 17.4% of patients during the pre-lockdown period presented outside the window period (presentation after 12 hours of symptom onset) compared with only 6% during the pre-COVID period. In the pre-COVID period, 46.9% of patients with ST elevation myocardial infarction underwent emergent catheterisation, while in the pre-lockdown and lockdown periods, these values were 26.1% and 18.8%, respectively. The proportion of patients treated with intravenous thrombolytic therapy increased from 18.4% in the pre-COVID period to 32.3% in the post-lockdown period. Inhospital mortality for acute coronary syndrome (ACS) increased from 2.69% in the pre-COVID period to 7.27% in the post-lockdown period. There was also a significant decline in emergency admissions for non-ACS conditions, such as acute decompensated heart failure and high degree or complete atrioventricular block., Conclusion: The COVID-19 pandemic has led to delays in patients seeking care for cardiac problems and also affected the use of optimum therapy in our institutions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2020
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19. Patient safety incidents and medication errors during a clinical trial: experience from a pre-hospital randomized controlled trial of emergency medication administration.
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England E, Deakin CD, Nolan JP, Lall R, Quinn T, Gates S, Miller J, O'Shea L, Pocock H, Rees N, Scomparin C, and Perkins GD
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- Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation standards, Documentation standards, Epinephrine administration & dosage, Humans, Research Design, Emergency Medical Services standards, Emergency Treatment standards, Medication Errors statistics & numerical data, Out-of-Hospital Cardiac Arrest therapy
- Abstract
Aim: To assess and evaluate patient safety incidents and in particular, medication errors, during a large multi-center pre-hospital trial of emergency therapy (PARAMEDIC2), in order to inform and improve future pre-hospital medicines trials., Methods: The PARAMEDIC2 trial was undertaken across five NHS Ambulance Services in England and Wales with randomisation between December 2014 and October 2017. Patients with an out -of-hospital cardiac arrest unresponsive to initial resuscitation were randomly assigned to 1 mg intravenous adrenaline or matching placebo. Records were reviewed to identify trial medication errors involving documentation and/or clinical protocol errors occurring in trial participants. Causes of medication errors, including root cause analysis where available, were reviewed to identify patterns and themes contributing to these errors., Results: Eight thousand sixteen patients were enrolled, of whom 4902 received trial medication. A total of 331 patient safety incidents was reported, involving 295 patients, representing an overall rate of 3.6% of these, 166 (50.2%) were documentation errors while 165 (49.8%) were clinical protocol/medication errors. An overall rate of 0-4.5% was reported across all five ambulance services, with a mean of 2.0%. These errors had no impact on patient care or the trial and were all resolved CONCLUSION: The overall medication error rate of 1.8% primarily consisted of administration of open-label adrenaline and confusion with trial medication packs. A similar number of patients had documentation errors. This study is the first to provide data on patient safety incidents relating to medication errors encountered during a pre-hospital trial of emergency medication administration and will provide supporting data for planning future trials in this area.
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- 2020
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20. Set up of a dedicated COVID-19 surgical pathway and operating room for surgical emergencies.
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Fransvea P, Sganga G, Cozza V, Di Grezia M, Fico V, Tirelli F, Pepe G, and La Greca A
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- Betacoronavirus pathogenicity, COVID-19, Coronavirus Infections epidemiology, Coronavirus Infections prevention & control, Coronavirus Infections transmission, Critical Pathways standards, Humans, Infection Control standards, Infectious Disease Transmission, Patient-to-Professional prevention & control, Italy epidemiology, Operating Rooms standards, Pandemics prevention & control, Personal Protective Equipment standards, Pneumonia, Viral epidemiology, Pneumonia, Viral prevention & control, Pneumonia, Viral transmission, SARS-CoV-2, Surgical Procedures, Operative standards, Workflow, Coronavirus Infections surgery, Critical Pathways organization & administration, Emergency Treatment standards, Infection Control organization & administration, Operating Rooms organization & administration, Pneumonia, Viral surgery
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- 2020
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21. Evaluation and treatment of thoracic outlet syndrome during the global pandemic due to SARS-CoV-2 and COVID-19.
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Ohman JW, Annest SJ, Azizzadeh A, Burt BM, Caputo FJ, Chan C, Donahue DM, Freischlag JA, Gelabert HA, Humphries MD, Illig KA, Lee JT, Lum YW, Meyer RD, Pearl GJ, Ransom EF, Sanders RJ, Teijink JAW, Vaccaro PS, van Sambeek MRHM, Vemuri C, and Thompson RW
- Subjects
- COVID-19, Consensus, Coronavirus Infections epidemiology, Coronavirus Infections transmission, Coronavirus Infections virology, Decompression, Surgical standards, Elective Surgical Procedures methods, Elective Surgical Procedures standards, Emergency Treatment methods, Emergency Treatment standards, Humans, Infection Control standards, Interdisciplinary Communication, Limb Salvage methods, Limb Salvage standards, Patient Selection, Pneumonia, Viral epidemiology, Pneumonia, Viral transmission, Pneumonia, Viral virology, SARS-CoV-2, Telemedicine standards, Thoracic Outlet Syndrome etiology, Thoracic Outlet Syndrome therapy, Thrombolytic Therapy methods, Thrombolytic Therapy standards, Time-to-Treatment standards, Betacoronavirus pathogenicity, Coronavirus Infections prevention & control, Pandemics prevention & control, Pneumonia, Viral prevention & control, Practice Guidelines as Topic, Thoracic Outlet Syndrome diagnosis, Triage standards
- Abstract
The global SARS-CoV-2/COVID-19 pandemic has required a reduction in nonemergency treatment for a variety of disorders. This report summarizes conclusions of an international multidisciplinary consensus group assembled to address evaluation and treatment of patients with thoracic outlet syndrome (TOS), a group of conditions characterized by extrinsic compression of the neurovascular structures serving the upper extremity. The following recommendations were developed in relation to the three defined types of TOS (neurogenic, venous, and arterial) and three phases of pandemic response (preparatory, urgent with limited resources, and emergency with complete diversion of resources). • In-person evaluation and treatment for neurogenic TOS (interventional or surgical) are generally postponed during all pandemic phases, with telephone/telemedicine visits and at-home physical therapy exercises recommended when feasible. • Venous TOS presenting with acute upper extremity deep venous thrombosis (Paget-Schroetter syndrome) is managed primarily with anticoagulation, with percutaneous interventions for venous TOS (thrombolysis) considered in early phases (I and II) and surgical treatment delayed until pandemic conditions resolve. Catheter-based interventions may also be considered for selected patients with central subclavian vein obstruction and threatened hemodialysis access in all pandemic phases, with definitive surgical treatment postponed. • Evaluation and surgical treatment for arterial TOS should be reserved for limb-threatening situations, such as acute upper extremity ischemia or acute digital embolization, in all phases of pandemic response. In late pandemic phases, surgery should be restricted to thrombolysis or brachial artery thromboembolectomy, with more definitive treatment delayed until pandemic conditions resolve., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2020
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22. Assessing Operating Room Preparedness for COVID-19 Patients Through In Situ Simulations.
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Tong QJ, Chai JX, Tan LH, Prit S, Ong LT, Wu MYL, and Ng LXL
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- COVID-19, Civil Defense standards, Coronavirus Infections epidemiology, Coronavirus Infections prevention & control, Emergency Treatment methods, Emergency Treatment standards, Humans, Operating Rooms standards, Pandemics prevention & control, Pneumonia, Viral epidemiology, Pneumonia, Viral prevention & control, SARS-CoV-2, Betacoronavirus, Civil Defense methods, Computer Simulation standards, Coronavirus Infections surgery, Operating Rooms methods, Pneumonia, Viral surgery
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- 2020
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23. Emergency tracheostomy during COVID 19 pandemic in a head and neck surgical oncology unit.
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George CK, Varghese BT, Divya GM, Janardhan D, and Thomas S
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- Airway Obstruction diagnosis, Airway Obstruction etiology, Betacoronavirus isolation & purification, Betacoronavirus pathogenicity, COVID-19, COVID-19 Testing, Clinical Laboratory Techniques standards, Conservative Treatment standards, Coronavirus Infections diagnosis, Coronavirus Infections epidemiology, Coronavirus Infections transmission, Emergency Treatment instrumentation, Emergency Treatment standards, Glucocorticoids administration & dosage, Head and Neck Neoplasms therapy, Humans, India epidemiology, Infection Control instrumentation, Infection Control standards, Infectious Disease Transmission, Patient-to-Professional prevention & control, Infectious Disease Transmission, Professional-to-Patient prevention & control, Male, Operating Rooms standards, Personal Protective Equipment standards, Pneumonia, Viral diagnosis, Pneumonia, Viral epidemiology, Pneumonia, Viral transmission, Preoperative Care standards, SARS-CoV-2, Severity of Illness Index, Surgical Oncology standards, Time Factors, Time-to-Treatment standards, Tracheostomy instrumentation, Airway Obstruction therapy, Coronavirus Infections prevention & control, Emergency Treatment methods, Head and Neck Neoplasms complications, Pandemics prevention & control, Pneumonia, Viral prevention & control, Tracheostomy standards
- Abstract
Competing Interests: Declaration of Competing Interest All authors declared that there is no conflict of interest.
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- 2020
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24. Feedback to Prepare EMS Teams to Manage Infected Patients with COVID-19: A Case Series.
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Ghazali DA, Ouersighni A, Gay M, Audebault V, Pavlovsky T, and Casalino E
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- Aged, Betacoronavirus, COVID-19, Coronavirus Infections epidemiology, Disaster Planning, Emergency Medical Services standards, Emergency Treatment standards, Female, France epidemiology, Humans, Male, Pandemics, Personal Protective Equipment, Planning Techniques, Pneumonia, Viral epidemiology, SARS-CoV-2, Coronavirus Infections diagnosis, Coronavirus Infections transmission, Emergency Medical Services organization & administration, Infectious Disease Transmission, Patient-to-Professional prevention & control, Pneumonia, Viral diagnosis, Pneumonia, Viral transmission
- Abstract
Coronavirus Disease 2019 (COVID-19), a new respiratory disease, is spreading globally. In France, Emergency Medical Service (EMS) teams are mobile medicalized resuscitation teams composed of emergency physician, nurse or anesthesiologist nurse, ambulance driver, and resident. Four types of clinical cases are presented here because they have led these EMS teams to change practices in their management of patients suspected of COVID-19 infection: cardiac arrest, hypoxia on an acute pneumonia, acute chronic obstructive pulmonary disease (COPD) exacerbation with respiratory and hemodynamic disorders, and upper function disorders in a patient in a long-term care facility. The last case raised the question of COVID-19 cases with atypical forms in elderly subjects. Providers were contaminated during the management of these patients. These cases highlighted the need to review the way these EMS teams are responding to the COVID-19 pandemic, in view of heightening potential for early identification of suspicious cases, and of reinforcing the application of staff protection equipment to limit risk of contamination.
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- 2020
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25. Strategies and recommendations for the safe implementation of vascular surgery during the pandemic period of novel coronavirus pneumonia.
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Li W, Chen X, and Feng H
- Subjects
- Betacoronavirus pathogenicity, COVID-19, Coronavirus Infections epidemiology, Coronavirus Infections transmission, Coronavirus Infections virology, Health Services Accessibility organization & administration, Health Services Accessibility standards, Humans, Infection Control organization & administration, Pneumonia, Viral epidemiology, Pneumonia, Viral transmission, Pneumonia, Viral virology, Practice Guidelines as Topic, SARS-CoV-2, Societies, Medical standards, United States epidemiology, Vascular Surgical Procedures standards, Coronavirus Infections prevention & control, Critical Illness therapy, Emergency Treatment standards, Infection Control standards, Pandemics prevention & control, Pneumonia, Viral prevention & control, Vascular Surgical Procedures organization & administration
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- 2020
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26. Pattern of vascular disease in Lombardy, Italy, during the first month of the COVID-19 outbreak.
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Melissano G, Mascia D, Baccellieri D, Kahlberg A, Bertoglio L, Rinaldi E, and Chiesa R
- Subjects
- Age Factors, Aged, Aged, 80 and over, COVID-19, Coronavirus Infections epidemiology, Coronavirus Infections transmission, Coronavirus Infections virology, Elective Surgical Procedures standards, Emergencies epidemiology, Emergency Treatment standards, Female, Humans, Incidence, Infection Control standards, Italy epidemiology, Male, Middle Aged, Pneumonia, Viral epidemiology, Pneumonia, Viral transmission, Pneumonia, Viral virology, Regional Health Planning standards, SARS-CoV-2, Vascular Diseases surgery, Vascular Surgical Procedures standards, Betacoronavirus pathogenicity, Coronavirus Infections prevention & control, Emergency Treatment statistics & numerical data, Pandemics prevention & control, Pneumonia, Viral prevention & control, Vascular Diseases epidemiology, Vascular Surgical Procedures statistics & numerical data
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- 2020
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27. Effectiveness of a video lesson for the correct use in an emergency of the automated external defibrillator (AED).
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Rubbi I, Lapucci G, Bondi B, Monti A, Cortini C, Cremonini V, Nanni E, Pasquinelli G, and Ferri P
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- Adult, Female, Humans, Male, Prospective Studies, Retrospective Studies, Young Adult, Cardiopulmonary Resuscitation education, Defibrillators, Emergency Treatment standards, Out-of-Hospital Cardiac Arrest therapy, Video Recording
- Abstract
Background and Aim of the Work: Every year around 275 thousand people in Europe and 420 thousand in the United States are affected by sudden cardiac arrest. Early electrical defibrillation before the arrival of emergency services can improve survival. Training the population to use the AED is essential. The training method currently in use is the BLSD course, which limits training to a population cohort and may not be enough to meet the requirements of the proposed Law no. 1839/2019. This study aims to verify the effectiveness of an online course that illustrates the practical use of the AED to a population of laypeople., Methods: An observational study was conducted to compare a lay population undergoing the view of a video spot and a cohort of people who had participated in BLSD Category A courses. The performances of the two groups were measured immediately after the course and 6 months later., Results: Overall, the video lesson reported positive results. Six months later the skills were partially retained. The cohort that followed the video lesson showed significant deterioration in the ability to correctly position the pads and in safety., Conclusions: Although improved through significant reinforcements, the video spot represents a valid alternative training method for spreading defibrillation with public access and could facilitate the culture of defibrillation as required by the new Italian law proposal.
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- 2020
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28. American College of Sports Medicine Expert Consensus Statement to Update Recommendations for Screening, Staffing, and Emergency Policies to Prevent Cardiovascular Events at Health Fitness Facilities.
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Thompson PD, Baggish AL, Franklin B, Jaworski C, and Riebe D
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- Consensus, Defibrillators, Humans, Mass Screening standards, United States, Cardiovascular Diseases prevention & control, Death, Sudden, Cardiac prevention & control, Emergency Treatment standards, Fitness Centers standards, Personnel Staffing and Scheduling standards, Sports Medicine standards
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- 2020
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29. Assessing healthcare service quality using routinely collected data: Linking information systems in emergency care.
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Dormann H, Eder PA, Gimpel H, Meindl O, Rashid A, and Regal C
- Subjects
- Humans, Outcome and Process Assessment, Health Care, Quality Indicators, Health Care standards, Emergency Medical Services standards, Emergency Service, Hospital standards, Emergency Treatment standards, Total Quality Management organization & administration
- Abstract
Emergency departments need to continuously calculate quality indicators in order to perform structural improvements, improvements in the daily routine, and ad-hoc improvements in everyday life. However, many different actors across multiple disciplines collaborate to provide emergency care. Hence, patient-related data is stored in several information systems, which in turn makes the calculation of quality indicators more difficult. To address this issue, we aim to link and use routinely collected data of the different actors within the emergency care continuum. In order to assess the feasibility of linking and using routinely collected data for quality indicators and whether this approach adds value to the assessment of emergency care quality, we conducted a single case study in a German academic teaching hospital. We analyzed the available data of the existing information systems in the emergency continuum and linked and pre-processed the data. Based on this, we then calculated four quality indicators (Left Without Been Seen, Unplanned Reattendance, Diagnostic Efficiency, and Overload Closure). Lessons learned from the calculation and results of the discussions with staff members that had multiple years of work experience in the emergency department provide a better understanding of the quality of the emergency department, the related challenges during the calculation, and the added value of linking routinely collected data.
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- 2020
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30. Working toward Equity in Emergencies (WE) through Stop the Bleed: A pilot collaborative health program with the Somali community in Seattle.
- Author
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Stadeli KM, Abdullahi D, Ali A, Conrick KM, Paulsen M, Bulger EM, Vavilala MS, Mohamed FB, Ali A, and Ibrahim A
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- Adolescent, Adult, Aged, Aged, 80 and over, Cultural Characteristics, Female, Health Promotion, Humans, Male, Middle Aged, Pilot Projects, Program Evaluation, Self Efficacy, Somalia ethnology, Trust, Washington, Emergency Treatment standards, Health Education, Hemorrhage ethnology, Hemorrhage prevention & control
- Abstract
Background: We developed a culturally-adapted program (WE Stop the Bleed) to increase bleeding control knowledge and self-efficacy among Somali individuals, and to build trust between Somali individuals and first responders., Methods: WE Stop the Bleed was piloted in the Seattle Somali community with first responders as skills coaches. The program included: 1) adapted ACS Stop the Bleed program; 2) cultural exchange. We evaluated knowledge, self-efficacy, and trust between Somali participants and first responders using a pre/post survey., Results: Attendance exceeded a priori goals (27 community participants, 13 first responders). 96% of participants would recommend the training. Knowledge and self-efficacy improved pre/post (62%-72%, 65%-93% respectively). First responders indicated increased comfort with Somali individuals, and participants reported positive changes in perceptions of first responders., Conclusions: WE Stop the Bleed is a feasible and acceptable program to increase bleeding control knowledge and self-efficacy among participants and build trust between participants and first responders., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2020
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31. Prehospital Medical Response to Active Shooter Incidents-The Rescue Task Force Concept.
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Weinman S
- Subjects
- Advisory Committees, Humans, Law Enforcement, Mass Casualty Incidents, Emergency Medical Services organization & administration, Emergency Nursing, Emergency Treatment standards, Firearms, Wounds, Gunshot therapy
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- 2020
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32. Validation of an evaluation instrument for responders in tactical casualty care simulations.
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Usero-Pérez MDC, Jiménez-Rodríguez ML, González-Aguña A, González-Alonso V, Orbañanos-Peiro L, Santamaría-García JM, and Gómez-González JL
- Subjects
- Adult, Female, Hemorrhage, Humans, Male, Mass Casualty Incidents, Reproducibility of Results, Tourniquets, Emergency Medical Services standards, Emergency Treatment standards
- Abstract
Objective: to construct and validate a tool for the evaluation of responders in tactical casualty care simulations., Method: three rubrics for the application of a tourniquet, an emergency bandage and haemostatic agents recommended by the Hartford Consensus were developed and validated. Validity and reliability were studied. Validation was performed by 4 experts in the field and 36 nursing participants who were selected through convenience sampling. Three rubrics with 8 items were evaluated (except for the application of an emergency bandage, for which 7 items were evaluated). Each simulation was evaluated by 3 experts., Results: an excellent score was obtained for the correlation index for the 3 simulations and 2 levels that were evaluated (competent and expert). The mean score for the application of a tourniquet was 0.897, the mean score for the application of an emergency bandage was 0.982, and the mean score for the application of topical haemostats was 0.805., Conclusion: this instrument for the evaluation of nurses in tactical casualty care simulations is considered useful, valid and reliable for training in a prehospital setting for both professionals who lack experience in tactical casualty care and those who are considered to be experts.
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- 2020
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33. Emergency management of iatrogenic arterial injuries with a low-profile balloon-expandable stent-graft: Preliminary results.
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Ruffino MA, Fronda M, Varello S, Discalzi A, Mancini A, Muratore P, Rossato D, Bergamasco L, Righi D, and Fonio P
- Subjects
- Aged, Aged, 80 and over, Aneurysm, False epidemiology, Aneurysm, False therapy, Balloon Occlusion methods, Endovascular Procedures methods, Female, Hemorrhage epidemiology, Hemorrhage therapy, Humans, Male, Middle Aged, Retrospective Studies, Stents adverse effects, Treatment Outcome, Vascular Fistula epidemiology, Vascular Fistula therapy, Vascular Patency, Embolization, Therapeutic methods, Emergency Treatment standards, Iatrogenic Disease epidemiology, Vascular System Injuries therapy
- Abstract
Endovascular treatment of arterial injuries with stent-graft is a reliable alternative approach in patients not suitable for embolization or at high risk for surgery. The aim of our study was to evaluate the efficacy and the safety of the BeGraft stent-graft, a low-profile balloon expandable covered stent, for emergency endovascular treatment of iatrogenic arterial injuries.Between August 2015 and September 2018, 34 consecutive patients (mean age 71 ± 12 years, 9 females) underwent implantation of BeGraft stent-grafts for iatrogenic arterial injuries (22 active bleedings, 11 pseudoaneurysms, and 1 enteric-iliac fistula). The primary endpoints were technical and clinical success and rates of major and minor complications. The secondary endpoint was the patency of the device during the follow-up. Imaging follow-up was performed by duplex ultrasound and/or computed tomography angiography (according to lesion site/target vessel), at 1-6-12-15 and 24 months.In all 34 patients (100%), the lesion or the defect was effectively excluded with a cumulative amount of 42 stent-grafts. The clinical success was documented in 30/34 patients (88.2%). Neither device- or procedure-related deaths, or major complications occurred. A minor complication was reported in 1 patient (2.9%), successfully treated during the same procedure. Thirty (88.2%) patients were available for a mean follow-up time of 390 ± 168 days (minimum 184, maximum 770), with no observed loss of patency, yielding a 100% Kaplan-Meier cumulative survival patency function. The percentage of patent patients was 30/30 at 6 months, 22/22 at 12 months, and 5/5 at 15 months.Endovascular treatment of iatrogenic arterial injuries with the BeGraft stent-graft is minimally invasive and effective, with good patency rate at midterm follow-up.
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- 2020
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34. Timing of Performing Endoscopic Retrograde Cholangiopancreatography and Inpatient Mortality in Acute Cholangitis: A Systematic Review and Meta-Analysis.
- Author
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Du L, Cen M, Zheng X, Luo L, Siddiqui A, and Kim JJ
- Subjects
- Acute Disease mortality, Acute Disease therapy, Cholangiopancreatography, Endoscopic Retrograde standards, Cholangitis mortality, Emergency Treatment standards, Gastroenterology standards, Humans, Observational Studies as Topic, Practice Guidelines as Topic, Societies, Medical standards, Time Factors, Treatment Outcome, Cholangiopancreatography, Endoscopic Retrograde statistics & numerical data, Cholangitis surgery, Emergency Treatment statistics & numerical data, Hospital Mortality, Time-to-Treatment statistics & numerical data
- Abstract
Objectives: Although early biliary drainage improves outcomes in patients with acute cholangitis, the optimal time to perform endoscopic retrograde cholangiopancreatography (ERCP) is controversial. Our aim was to evaluate the impact of timing of ERCP on mortality in hospitalized patients with acute cholangitis., Methods: We searched PubMed, EMBASE, and The Cochrane Library (until February 2019) for studies evaluating the impact of timing of ERCP (<24, <48, and <72 hours from hospitalization) on outcomes in patients with acute cholangitis. The primary outcome was in-hospital mortality., Results: Fourteen observational studies, including 84,063 patients (mean age = 66 ± 18), met the study criteria. The overall pooled in-hospital mortality with acute cholangitis was 1.9% (95% confidence interval [CI] 1.8%-7.6%), which increased to 4.3% (95% CI 1.8%-8.7%) when administrative database studies were excluded. In 9 studies, ERCP performed <24 compared with ≥24 hours decreased in-hospital mortality (odds ratio [OR] = 0.81, 95% CI 0.73-0.90; I = 0%). In 8 studies, ERCP performed <48 compared with ≥48 hours decreased in-hospital mortality (OR = 0.57, 95% CI 0.51-0.63; I = 0%). In 4 studies, ERCP performed <72 compared with ≥72 hours decreased in-hospital mortality (OR = 0.32, 95% CI 0.15-0.68; I = 0%). Furthermore, hospital stay was reduced in patients receiving ERCP <24 compared with ≥24 hours (mean difference [MD] = 3.2 days, 95% CI 2.3-4.1; I = 78%), <48 compared with ≥48 hours (MD = 3.6 days, 95% CI 2.1-5.1; I = 98%), and <72 compared with ≥72 hours (MD = 4.1 days, 95% CI 0.9-7.3; I = 63%)., Discussion: In observational studies, earlier ERCP performed in patients with acute cholangitis, even urgently performed <24 hours from presentation, was associated with reduced mortality. A randomized trial evaluating the impact of urgent ERCP on outcomes is needed.
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- 2020
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35. [Update polytrauma and computed tomography in ongoing resuscitation : ABCDE and "diagnose first what kills first"].
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Gäble A, Hebebrand J, Armbruster M, Mück F, Berndt M, Kumle B, Fink U, and Wirth S
- Subjects
- Emergency Treatment standards, Humans, Injury Severity Score, Multiple Trauma etiology, Multiple Trauma mortality, Radiation Dosage, Resuscitation, Emergency Treatment methods, Multiple Trauma diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Clinical Issue: The mean number of trauma room admissions and applied CT dose increase as the severity of injuries decreases. Therefore, appropriateness of established procedures should be re-evaluated., Standard Radiological Methods: Considering severely injured patients with an Injury Severity Score (ISS) ≥16, whole body CT (WB-CT) compared to selective CT decreased mortality by about 25%. Thus, the ISS is a good indicator for the severity of injuries. However, since ISS can only be determined after diagnosis, it does not help with the primary assessment., Methodological Innovation and Evaluation: In addition to the currently used very fast WB-CT protocol with the highest diagnostic precision, a second protocol should be established applying a substantially lower dose. Under ongoing resuscitation, WB-CT often makes a substantial contribution towards targeted therapy or to justifying the discontinuation of resuscitation measures. The WB-CT findings should be performed several times and, at least in the acute emergency situation, it should follow the ABCDE scheme as close as possible., Practical Recommendations: In the trauma room it should be initially decided whether the classification as polytrauma is to be maintained. If yes, every institution should provide a dose-reduced WB-CT protocol in addition to the maximum variant used so far. Dose-reduced WB-CT seems to be appropriate for stable and oriented patients, who receive a CT primarily because of the trauma mechanism. Even under resuscitation conditions, WB-CT is easy to perform and medically as well as ethically of high value. The reporting and communication should be structured according to "diagnose first what kills first".
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- 2020
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36. How to Stop the Bleed: First Care Provider Model for Developing Public Trauma Response Beyond Basic Hemorrhage Control.
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Bobko JP, Badin DJ, Danishgar L, Bayhan K, Thompson KJ, Harris WJ, Baldridge RT, and Fortuna GR Jr
- Subjects
- Consensus, Education, Humans, Emergency Medical Services methods, Emergency Responders, Emergency Treatment standards, Hemorrhage therapy, Mass Casualty Incidents
- Abstract
Introduction: Since 2013, the First Care Provider (FCP) model has successfully educated the non-medical population on how to recognize life-threatening injuries and perform interventions recommended by the Committee for Tactical Emergency Casualty Care (C-TECC) and the Hartford Consensus in the disaster setting. Recent programs, such as the federal "Stop The Bleed" campaign, have placed the emphasis of public training on hemorrhage control. However, recent attacks demonstrate that access to wounded, recognition of injury, and rapid evacuation are equally as important as hemorrhage control in minimizing mortality. To date, no training programs have produced a validated study with regard to training a community population in these necessary principles of disaster response., Methods: In our study, we created a reproducible community training model for implementation into prehospital systems. Two matched demographic groups were chosen and divided into "trained" and "untrained" groups. The trained group was taught the FCP curriculum, which the Department of Homeland Security recognizes as a Stop the Bleed program, while the untrained group received no instruction. Both groups then participated in a simulated mass casualty event, which required evaluation of multiple victims with varying degree of injury, particularly a patient with an arterial bleed and a patient with an airway obstruction., Results: The objective measures in comparing the two groups were the time elapse until their first action was taken (T1A) and time to their solution of the simulation (TtS). We compared their times using one-sided t-test to demonstrate their responses were not due to chance alone. At the arterial bleed simulation, the T1A for the trained and untrained groups, respectively, were 34.75 seconds and 111 seconds (p-value = .1064), while the TtS were 3 minutes and 33 seconds in the trained group and eight minutes in the untrained groups (physiologic cutoff) (p-value = .0014). At the airway obstruction simulation, the T1A for the trained and untrained groups, respectively, were 20.5 seconds and 43 seconds (p-value = .1064), while the TtS were 32.6 seconds in the trained group and 7 minutes and 3 seconds in the untrained group (p-value = .0087). Simulation values for recently graduated nursing students and a local fire department engine company (emergency medical services [EMS]) were also given for reference. The trained group's results mirrored times of EMS., Conclusion: This study demonstrates an effective training model to civilian trauma response, while adhering to established recommendations. We offer our model as a potential solution for accomplishing the Stop The Bleed mission while advancing the potential of public disaster response.
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- 2020
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37. Interim monitoring of nonrandomized prospective studies that invoke propensity scoring for decision making.
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DeSantis SM, Swartz MD, Greene TJ, Fox EE, Holcomb JB, and Wade CE
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- Heart Arrest therapy, Humans, Patient Selection, Practice Guidelines as Topic, Prospective Studies, Research Design standards, Stroke therapy, Treatment Outcome, Wounds and Injuries therapy, Clinical Decision-Making, Emergency Treatment standards, Observational Studies as Topic standards, Propensity Score
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- 2020
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38. 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.
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Soar J, Maconochie I, Wyckoff MH, Olasveengen TM, Singletary EM, Greif R, Aickin R, Bhanji F, Donnino MW, Mancini ME, Wyllie JP, Zideman D, Andersen LW, Atkins DL, Aziz K, Bendall J, Berg KM, Berry DC, Bigham BL, Bingham R, Couto TB, Böttiger BW, Borra V, Bray JE, Breckwoldt J, Brooks SC, Buick J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Couper K, Dainty KN, Dawson JA, de Almeida MF, de Caen AR, Deakin CD, Drennan IR, Duff JP, Epstein JL, Escalante R, Gazmuri RJ, Gilfoyle E, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Holmberg MJ, Hood N, Hosono S, Hsieh MJ, Isayama T, Iwami T, Jensen JL, Kapadia V, Kim HS, Kleinman ME, Kudenchuk PJ, Lang E, Lavonas E, Liley H, Lim SH, Lockey A, Lofgren B, Ma MH, Markenson D, Meaney PA, Meyran D, Mildenhall L, Monsieurs KG, Montgomery W, Morley PT, Morrison LJ, Nadkarni VM, Nation K, Neumar RW, Ng KC, Nicholson T, Nikolaou N, Nishiyama C, Nuthall G, Ohshimo S, Okamoto D, O'Neil B, Yong-Kwang Ong G, Paiva EF, Parr M, Pellegrino JL, Perkins GD, Perlman J, Rabi Y, Reis A, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Schexnayder SM, Scholefield BR, Shimizu N, Skrifvars MB, Smyth MA, Stanton D, Swain J, Szyld E, Tijssen J, Travers A, Trevisanuto D, Vaillancourt C, Van de Voorde P, Velaphi S, Wang TL, Weiner G, Welsford M, Woodin JA, Yeung J, Nolan JP, and Hazinski MF
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- Child, Emergency Service, Hospital standards, Humans, Out-of-Hospital Cardiac Arrest therapy, Cardiopulmonary Resuscitation standards, Emergency Medical Services standards, Emergency Treatment standards, Hypothermia, Induced standards
- Abstract
The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.
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- 2019
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39. 2019 American Heart Association Focused Update on Systems of Care: Dispatcher-Assisted Cardiopulmonary Resuscitation and Cardiac Arrest Centers: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
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Panchal AR, Berg KM, Cabañas JG, Kurz MC, Link MS, Del Rios M, Hirsch KG, Chan PS, Hazinski MF, Morley PT, Donnino MW, and Kudenchuk PJ
- Subjects
- American Heart Association, Emergency Treatment standards, Humans, Out-of-Hospital Cardiac Arrest mortality, United States, Cardiopulmonary Resuscitation standards, Emergency Medical Services standards, Emergency Service, Hospital standards, Out-of-Hospital Cardiac Arrest therapy
- Abstract
Survival after out-of-hospital cardiac arrest requires an integrated system of care (chain of survival) between the community elements responding to an event and the healthcare professionals who continue to care for and transport the patient for appropriate interventions. As a result of the dynamic nature of the prehospital setting, coordination and communication can be challenging, and identification of methods to optimize care is essential. This 2019 focused update to the American Heart Association systems of care guidelines summarizes the most recent published evidence for and recommendations on the use of dispatcher-assisted cardiopulmonary resuscitation and cardiac arrest centers. This article includes the revised recommendations that emergency dispatch centers should offer and instruct bystanders in cardiopulmonary resuscitation during out-of-hospital cardiac arrest and that a regionalized approach to post-cardiac arrest care may be reasonable when comprehensive postarrest care is not available at local facilities.
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- 2019
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40. 2019 American Heart Association Focused Update on Neonatal Resuscitation: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
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Escobedo MB, Aziz K, Kapadia VS, Lee HC, Niermeyer S, Schmölzer GM, Szyld E, Weiner GM, Wyckoff MH, Yamada NK, and Zaichkin JG
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- American Heart Association, Emergency Service, Hospital standards, Emergency Treatment standards, Humans, Out-of-Hospital Cardiac Arrest mortality, United States, Cardiopulmonary Resuscitation standards, Emergency Medical Services standards, Guidelines as Topic, Out-of-Hospital Cardiac Arrest therapy
- Abstract
This 2019 focused update to the American Heart Association neonatal resuscitation guidelines is based on 2 evidence reviews recently completed under the direction of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. The International Liaison Committee on Resuscitation Expert Systematic Reviewer and content experts performed comprehensive reviews of the scientific literature on the appropriate initial oxygen concentration for use during neonatal resuscitation in 2 groups: term and late-preterm newborns (≥35 weeks of gestation) and preterm newborns (<35 weeks of gestation). This article summarizes those evidence reviews and presents recommendations. The recommendations for neonatal resuscitation are as follows: In term and late-preterm newborns (≥35 weeks of gestation) receiving respiratory support at birth, the initial use of 21% oxygen is reasonable. One hundred percent oxygen should not be used to initiate resuscitation because it is associated with excess mortality. In preterm newborns (<35 weeks of gestation) receiving respiratory support at birth, it may be reasonable to begin with 21% to 30% oxygen and to base subsequent oxygen titration on oxygen saturation targets. These guidelines require no change in the Neonatal Resuscitation Algorithm-2015 Update.
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- 2019
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41. National quality improvement programmes need time and resources to have an impact.
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Cook R, Lamont T, and Martin R
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- Acute Disease, Cluster Analysis, Critical Pathways, Humans, Program Evaluation, Quality Improvement standards, Abdominal Pain surgery, Digestive System Surgical Procedures standards, Emergency Treatment standards, Quality Improvement organization & administration
- Abstract
The studyPeden CJ, Stephens T, Martin G et al. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial. Lancet 2019;393:2213-21.This project was funded by the NIHR Health Services and Delivery Research Programme (project number 12/5005/10).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000789/national-quality-improvement-programmes-need-time-and-resources-to-have-impact., Competing Interests: Competing interests The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: none Further details of The BMJ policy on financial interests is here: https://www.bmj.com/about-bmj/resources-authors/forms-policies-and-checklists/declaration-competing-interests, (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
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- 2019
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42. A Comparison of Emergency Preparedness Between High School Coaches and Club Sport Coaches.
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Post EG, Schaefer DA, Biese KM, Cadmus-Bertram LA, Watson AM, McGuine TA, Brooks MA, and Bell DR
- Subjects
- Adult, Cross-Sectional Studies, Female, Humans, Male, Professional Competence, Surveys and Questionnaires, United States, Universities, Athletic Injuries therapy, Cardiopulmonary Resuscitation instrumentation, Cardiopulmonary Resuscitation methods, Defibrillators supply & distribution, Emergency Treatment methods, Emergency Treatment standards, Mentoring methods, Mentoring organization & administration, Mentoring standards, Youth Sports injuries
- Abstract
Context: Recent studies suggested that a large population of high school-aged athletes participate on club sport teams. Despite attempts to document emergency preparedness in high school athletics, the adherence to emergency and medical coverage standards among club sport teams is unknown., Objective: To determine if differences in emergency preparedness and training existed between coaches of high school teams and coaches of high school-aged club teams., Design: Cross-sectional survey., Setting: Online questionnaire., Patients or Other Participants: A total of 769 coaches (females = 266, 34.6%) completed an anonymous online questionnaire regarding their emergency preparedness and training., Main Outcome Measure(s): The questionnaire consisted of (1) demographics and team information, (2) emergency preparedness factors (automated external defibrillator [AED] availability, emergency action plan [EAP] awareness, medical coverage), and (3) emergency training requirements (cardiopulmonary resuscitation/AED, first aid)., Results: High school coaches were more likely than club sport coaches to be aware of the EAP for their practice venue (83.9% versus 54.4%, P < .001), but most coaches in both categories had not practiced their EAP in the past 12 months (70.0% versus 68.9%, P = .54). High school coaches were more likely to be made aware of the EAP during competitions (47.5% versus 37.1%, P = .02), but the majority of coaches in both categories indicated that they were never made aware of EAPs. High school coaches were more likely than club coaches to (1) have an AED available at practice (87.9% versus 58.8%, P < .001), (2) report that athletic trainers were responsible for medical care at practices (31.2% versus 8.8%, P < .001) and competitions (57.9% versus 31.2%, P < .001), and (3) be required to have cardiopulmonary resuscitation, AED, or first-aid training ( P < .001)., Conclusions: High school coaches displayed much greater levels of emergency preparedness and training than coaches of high school-aged club teams. Significant attention and effort may be needed to address the lack of emergency preparedness and training observed in club coaches.
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- 2019
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43. Efficacy of Prehospital Criteria in Identifying Trauma Patients Susceptible to Undertriage.
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Smith SG, Dewey EN, Eastes LE, and Schreiber MA
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- Adult, Emergency Medical Services statistics & numerical data, Emergency Treatment statistics & numerical data, Female, Humans, Male, Middle Aged, Multivariate Analysis, Retrospective Studies, Emergency Medical Services standards, Emergency Treatment standards, Trauma Severity Indices, Triage standards, Wounds and Injuries diagnosis, Wounds and Injuries therapy
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- 2019
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44. Patient satisfaction with peri-operative anesthesia care and associated factors at two National Referral Hospitals: a cross sectional study in Eritrea.
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Andemeskel YM, Elsholz T, Gebreyohannes G, and Tesfamariam EH
- Subjects
- Adult, Anesthesia psychology, Cross-Sectional Studies, Elective Surgical Procedures statistics & numerical data, Emergency Treatment psychology, Emergency Treatment standards, Eritrea, Female, Hospitalization, Humans, Male, Middle Aged, Professional-Patient Relations, Referral and Consultation statistics & numerical data, Surveys and Questionnaires, Young Adult, Anesthesia standards, Patient Satisfaction statistics & numerical data, Perioperative Care standards
- Abstract
Background: Measuring patient satisfaction has become an important parameter of the continuous quality assessment and improvement in anaesthesia services. The aim of this study was to assess the level of patient satisfaction with perioperative anaesthesia care and to determine the factors that influence satisfaction., Method: This study is an cross sectional design, conducted on 470 patients who underwent different types of surgeries at two National Referral Hospitals in Asmara, Eritrea between January and March of 2018. Patients were interviewed 24 h after the operation using a Tigrigna translated Leiden Perioperative Care Patient Satisfaction questionnaire (LPPSq). Descriptive and inferential analysis were made using SPSS (version 22). Statistical significance level was set at P < 0.05., Results: The overall satisfaction score was 68.8%. Less fear and concern was observed among patients with satisfaction scores of 87.5%. Staff-patient relationship satisfaction score was 75%. Patients were least satisfied with information provision (45%). Multivariable analysis revealed that satisfaction of patients who did surgery at Halibet hospital is significantly higher (p < 0.001) than those patients who did at Orotta hospital. Moreover, those patients who did elective surgery had higher level of satisfaction that those who did emergency surgery (p < 0.001)., Conclusion: Moderate level of satisfaction was observed among the patients. Generally, the study emphasized that the information provision about anesthesia and surgery was low. Patients described better staff-patient relationship and low fear and concern related to anesthesia and surgery was observed.
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- 2019
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45. Impact of New Guidelines of Unscheduled and Scheduled Sedation for Cardiologists: JACC Council Perspectives.
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Fisher JD, Welt FG, Villines TC, Truesdell AG, Young MN, Lakkireddy D, and Lee BK
- Subjects
- Cardiology standards, Humans, Conscious Sedation standards, Deep Sedation standards, Emergency Treatment standards, Heart Diseases therapy, Practice Guidelines as Topic
- Abstract
Until 2019, guidelines for procedural sedation emphasized a detailed process most applicable for elective procedures scheduled well in advance. These guidelines provided by the American Society of Anesthesiologists were adopted by many specialties and institutions, and they have historically served the medical field well. However, cardiologists and other specialists often encounter urgent situations that demand unscheduled sedation. Physicians have been concerned about performing procedures in a fashion that "departs from the guidelines." In response, the American College of Emergency Physicians (ACEP) has developed a set of guidelines for patients requiring urgent unscheduled sedation. Many of the recommendations made within the novel ACEP guidelines are appropriate for cardiology, but there remain fundamental differences between trauma and other emergencies encountered in the emergency department and urgent cardiac procedures. This paper examines the differences between the American Society of Anesthesiologists and ACEP guidelines and provides some points to consider regarding best practices for cardiologists., (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2019
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46. The REDS score: a new scoring system to risk-stratify emergency department suspected sepsis: a derivation and validation study.
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Sivayoham N, Blake LA, Tharimoopantavida SE, Chughtai S, Hussain AN, Cecconi M, and Rhodes A
- Subjects
- Adult, Aged, Decision Support Techniques, Emergency Service, Hospital standards, Female, Humans, Male, Middle Aged, Prognosis, Severity of Illness Index, Emergency Treatment standards, Hospital Mortality, Risk Assessment standards, Sepsis mortality
- Abstract
Objective: To derive and validate a new clinical prediction rule to risk-stratify emergency department (ED) patients admitted with suspected sepsis., Design: Retrospective prognostic study of prospectively collected data., Setting: ED., Participants: Patients aged ≥18 years who met two Systemic Inflammatory Response Syndrome criteria or one Red Flag sepsis criteria on arrival, received intravenous antibiotics for a suspected infection and admitted., Primary Outcome Measure: In-hospital all-cause mortality., Method: The data were divided into derivation and validation cohorts. The simplified-Mortality in Severe Sepsis in the ED score and quick-SOFA scores, refractory hypotension and lactate were collectively termed 'component scores' and cumulatively termed the 'Risk-stratification of ED suspected Sepsis (REDS) score'. Each patient in the derivation cohort received a score (0-3) for each component score. The REDS score ranged from 0 to 12. The component scores were subject to univariate and multivariate logistic regression analyses. The receiver operator characteristic (ROC) curves for the REDS and the components scores were constructed and their cut-off points identified. Scores above the cut-off points were deemed high-risk. The area under the ROC (AUROC) curves and sensitivity for mortality of the high-risk category of the REDS score and component scores were compared. The REDS score was internally validated., Results: 2115 patients of whom 282 (13.3%) died in hospital. Derivation cohort: 1078 patients with 140 deaths (13%). The AUROC curve with 95% CI, cut-off point and sensitivity for mortality (95% CI) of the high-risk category of the REDS score were: derivation: 0.78 (0.75 to 0.80); ≥3; 85.0 (78 to 90.5)., Validation: 0.74 (0.71 to 0.76); ≥3; 84.5 (77.5 to 90.0). The AUROC curve and the sensitivity for mortality of the REDS score was better than that of the component scores. Specificity and mortality rates for REDS scores of ≥3, ≥5 and ≥7 were 54.8%, 88.8% and 96.9% and 21.8%, 36.0% and 49.1%, respectively., Conclusion: The REDS score is a simple and objective score to risk-stratify ED patients with suspected sepsis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2019
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47. Identification of Emergency Care-Sensitive Conditions and Characteristics of Emergency Department Utilization.
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Vashi AA, Urech T, Carr B, Greene L, Warsavage T Jr, Hsia R, and Asch SM
- Subjects
- Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Young Adult, Emergency Medical Services standards, Emergency Medical Services statistics & numerical data, Emergency Service, Hospital statistics & numerical data, Emergency Treatment standards, Emergency Treatment statistics & numerical data, Quality of Health Care standards, Quality of Health Care statistics & numerical data
- Abstract
Importance: Monitoring emergency care quality requires understanding which conditions benefit most from timely, quality emergency care., Objectives: To identify a set of emergency care-sensitive conditions (ECSCs) that are treated in most emergency departments (EDs), are associated with a spectrum of adult age groups, and represent common reasons for seeking emergency care and to provide benchmark national estimates of ECSC acute care utilization., Design, Setting, and Participants: A modified Delphi method was used to identify ECSCs. In a cross-sectional analysis, ECSC-associated visits by adults (aged ≥18 years) were identified based on International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes and analyzed with nationally representative data from the 2016 US Nationwide Emergency Department Sample. Data analysis was conducted from January 2018 to December 2018., Main Outcomes and Measures: Identification of ECSCs and ECSC-associated ED utilization patterns, length of stay, and charges., Results: An expert panel rated 51 condition groups as emergency care sensitive. Emergency care-sensitive conditions represented 16 033 359 of 114 323 044 ED visits (14.0%) in 2016. On average, 8 535 261 of 17 886 220 ED admissions (47.7%) were attributed to ECSCs. The most common ECSC ED visits were for sepsis (1 716 004 [10.7%]), chronic obstructive pulmonary disease (1 273 319 [7.9%]), pneumonia (1 263 971 [7.9%]), asthma (970 829 [6.1%]), and heart failure (911 602 [5.7%]) but varied by age group. Median (interquartile range) length of stay for ECSC ED admissions was longer than non-ECSC ED admissions (3.2 [1.7-5.8] days vs 2.7 [1.4-4.9] days; P < .001). In 2016, median (interquartile range) ED charges per visit for ECSCs were $2736 ($1684-$4605) compared with $2179 ($1118-$4359) per visit for non-ECSC ED visits (P < .001)., Conclusions and Relevance: This comprehensive list of ECSCs can be used to guide indicator development for pre-ED, intra-ED, and post-ED care and overall assessment of the adult, non-mental health, acute care system. Health care utilization and costs among patients with ECSCs are substantial and warrant future study of validation, variations in care, and outcomes associated with ECSCs.
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- 2019
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48. Opportunities for achieving resuscitation goals during the inter-emergency department transfer of severe sepsis patients by emergency medical services: A case series.
- Author
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Froehlich A, Tegtmeier RJ, Faine BA, Reece J, Ahmed A, and Mohr NM
- Subjects
- Adolescent, Adult, Aged, Cohort Studies, Emergency Medical Services standards, Emergency Medical Services statistics & numerical data, Emergency Service, Hospital standards, Emergency Service, Hospital statistics & numerical data, Emergency Treatment standards, Emergency Treatment statistics & numerical data, Female, Humans, Male, Middle Aged, Midwestern United States, Patient Transfer statistics & numerical data, Resuscitation statistics & numerical data, Retrospective Studies, Young Adult, Anti-Bacterial Agents therapeutic use, Goals, Patient Transfer standards, Resuscitation standards, Sepsis drug therapy
- Abstract
Purpose: This study aimed to describe the care provide by Emergency Medical Services (EMS) to severe sepsis patients being transferred between acute care hospitals and identify how that care contributes to sepsis care goals., Methods: This was a single-center retrospective cohort study conducted at a 60,000-visit Midwestern academic emergency department, using run reports from 13 ambulance services transferring from 9 hospitals., Results: 39 patients were included in the final cohort, transferred by 13 ambulance services from 9 hospitals. Included patients were adults with severe sepsis transferred by ambulance between 2009 and 2014. Thirty-nine patients were included in this cohort. 41% (n = 12) of patients received an adequate fluid bolus of 30 mL/kg (median 42.9 mL/kg crystalloid fluid, IQR 8.0 mL/kg) prior to tertiary care arrival. Seventeen percent (n = 2) of patients completed the adequate bolus during transfer time. Broad-spectrum antibiotics were initiated during transfer in 2 patients., Conclusions: EMS sepsis care during transfer was limited. EMS crews primarily continued treatments previously initiated and did not take additional steps toward resuscitation targets. Data suggests the inter-emergency department transfer period may provide an opportunity to continue working toward treatment targets, though the time is currently underutilized., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
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49. Creating Model Stop the Bleed Training Programs at Three Distinct Institutions.
- Author
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Fridling JIG, Shapiro DS, and Jacobs LM Jr
- Subjects
- Allied Health Personnel education, Education, Medical methods, Education, Nursing methods, First Aid, Humans, Mass Casualty Incidents, Program Development, United States, Volunteers education, Emergency Medicine education, Emergency Treatment standards, Hemorrhage prevention & control, Hemostatic Techniques standards
- Published
- 2019
50. Developing and validating an instrument to assess non-hospital health centers' preparedness to provide initial emergency care: a study protocol.
- Author
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Amir Behghadami M, Janati A, Sadeghi-Bazargani H, Gholizadeh M, Rahmani F, and Arab-Zozani M
- Subjects
- Clinical Protocols, Feasibility Studies, Humans, Interviews as Topic, Iran, Pilot Projects, Qualitative Research, Quality Assurance, Health Care, Reproducibility of Results, Systematic Reviews as Topic, Community Health Centers organization & administration, Emergency Treatment methods, Emergency Treatment standards, Health Services Accessibility organization & administration
- Abstract
Introduction: Basic emergency management in urban and rural areas is a critical challenge. This paper presents the protocol for developing, validating and piloting an instrument to assess the preparedness of non-hospital health centres which deliver initial emergency care., Methods and Analysis: This study will be designed based on a sequential exploratory mixed method in two phases, in each of which there are three steps. In the first step of phase I, an extensive systematic review will be conducted. In the second step, through focus group discussions (FGDs), the experts' views on the definition of domains and items of the instrument will be compiled. In addition, semistructured interviews with the target group will be performed. Then, qualitative framework analysis will be performed. In the last step of phase I, the results of both steps will be triangulated by a panel of experts to define the domains and items to be included in the instrument. Phase II will include content validity, feasibility and reliability of the instrument. Content validity of the instrument will be assessed using modified Kappa coefficient based on clarity and relevance criteria. Feasibility of the instrument will be assessed through its implementation in 10 non-hospital health centres in Tabriz, which will be selected randomly. Reliability will be assessed in a pilot on 30 non-hospital health centres through using stratified random sampling method. Reliability of the instrument will be assessed through measuring internal consistency, test-retest reliability and inter-rater agreement. The main statistical methods for assessing reliability will include Cronbach's alpha, intraclass correlation coefficient and Kendall's tau-b. All the statistical analyses will be performed using Stata V.14., Ethics and Dissemination: This study is approved by Tabriz University of Medical Sciences Research Ethics Committee (IR.TBZMED.REC.1397.145). The results of the study will be presented at national scientific conferences and published in peer-reviewed journals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
- Full Text
- View/download PDF
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