Keatlaretse Siamisang, J. Tlhakanelo, Bonolo Mhaladi
Introduction: Emergency medicine is a critical component of quality public health service. In fact length of stay and waiting times in the Emergency department are key indicators of quality. The aim of this study was to determine waiting times and determinants of prolonged length of stay (LOS) in the Princess Marina Hospital Emergency Department. Methods: This was a retrospective observational study. It was done at Princess Marina, a referral hospital in Gaborone, Botswana. Triage forms of patients who presented between 19/11/ 2018 and 18/12/2018 were reviewed. Data from patient files was used to determine time duration from triage to being reviewed by a doctor, time duration from review by emergency doctor to patients’ disposition and the time duration from patient’s triage to disposition (length of stay). Prolonged length of stay was defined as duration > 6 hours. Results: A total of 1052 files repre- senting patients seen over a 1-month period were reviewed. 72.5% of the patients had a prolonged length of stay. The median emergency doctor waiting time was 4.5 hours (IQR 1.6 - 8.3 hours) and the maximum was 27.1 hours. The median length of stay in the emergency department was 9.6 hours (IQR 5.8 - 14.6 hours) and the maximum was 45.9 hours. Patient’s age (AOR 1.01), mental status (AOR 0.61), admission to internal medicine service (AOR 5.12) and pediatrics admissions (AOR 0.11) were significant predictors of prolonged length of stay in the emergency department. Conclusion: Princess Marina Hospital emergency department waiting times and length of stay are long. Age, normal mental status and internal medicine admission were independent predictors of prolonged stay (>6 hours). Admission to the pediatrics service was associated with shorter length of stay. There is a need for interventions to address the long waiting times and length of stay. Interventions should particularly focus on the identified predictors.
{"title":"Emergency Department Waiting Times and Determinants of Prolonged Length of Stay in a Botswana Referral Hospital","authors":"Keatlaretse Siamisang, J. Tlhakanelo, Bonolo Mhaladi","doi":"10.4236/ojem.2020.83007","DOIUrl":"https://doi.org/10.4236/ojem.2020.83007","url":null,"abstract":"Introduction: Emergency medicine is a critical component of quality public health \u0000service. In fact length of stay and waiting times in the Emergency department \u0000are key indicators of quality. The aim of this study was to determine waiting times and determinants of prolonged length \u0000of stay (LOS) in the Princess Marina Hospital Emergency Department. Methods: This was a retrospective observational study. It was done at Princess \u0000Marina, a referral hospital in Gaborone, \u0000Botswana. Triage forms of patients who presented between 19/11/ 2018 and 18/12/2018 were \u0000reviewed. Data from patient files was used to determine time duration from \u0000triage to being reviewed by a doctor, time duration from review by emergency \u0000doctor to patients’ disposition and the time duration \u0000from patient’s triage to disposition (length of stay). Prolonged length of stay was defined as duration > 6 hours. Results: A total of 1052 files repre- senting patients seen over a 1-month period were \u0000reviewed. 72.5% of the patients had a prolonged length of stay. The median \u0000emergency doctor waiting time was 4.5 hours (IQR 1.6 - 8.3 hours) and the \u0000maximum was 27.1 hours. The median length of stay in the emergency department \u0000was 9.6 hours (IQR 5.8 - 14.6 hours) and the maximum was 45.9 hours. Patient’s age (AOR 1.01), mental status \u0000(AOR 0.61), admission to internal medicine service (AOR 5.12) and pediatrics admissions (AOR 0.11) were \u0000significant predictors of prolonged length \u0000of stay in the emergency department. Conclusion: Princess Marina Hospital emergency department waiting times and length of stay are long. Age, normal mental \u0000status and internal medicine admission were independent predictors of prolonged \u0000stay (>6 hours). Admission to the pediatrics service was associated with \u0000shorter length of stay. There is a need for interventions to address the long waiting times and length of stay. \u0000Interventions should particularly focus on the identified predictors.","PeriodicalId":57857,"journal":{"name":"急诊医学(英文)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43781979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Sethuraman, Salzali Mohd, S. Govindaraju, W. Tiau, N. Farouk, H. Hassan
Background: Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potassium level below 2.5 mmol/L [1]. Patient with hypokalemia can present with wide range of presentation including musculoskeletal complaints from numbness to acute paralysis. Severe hypokalemia has tendency to progress to intestinal paralysis and respiratory failure. In some cases of hypokalemia, cardiovascular system can also be affected causing cardiac arrhythmias and heart failure [2]. Aim: This case report is to highlight that severe hypokalaemia can present with ECG changes mimicking acute coronary syndrome (ACS) which was fully resolved with correction of potassium level. Methods: We report a case of 84 years old Chinese man with underlying triple vessel disease presented with generalised body weakness for 2 days. ECG on arrival noted changes suggestive of ACS with ST segment depression in lead V4-V6 with first degree heart block, however patient had no ischemic symptoms and the potassium level was severe low at 1.6 mmol/L (3.5 - 5.1 mmol/L). He was correctly not treated for ACS. Outcomes: Repeated ECG post fast intravenous potassium correction noted complete resolution of the ST segment depression and first degree heart block. Patient discharged well from hospital four days later with potassium level of 3.8 mmol/L. Conclusions: Severe hypokalemia with asymptomatic ECG of ACS changes can safely be treated as a single entity clinical emergency with good resolution and no complication after normalizing potassium level.
{"title":"Severe Hypokalemia ECG Changes Mimicking Those of Acute Coronary Syndrome (ACS) in Patient with Underlying Ischaemic Heart Disease: A Case Review","authors":"C. Sethuraman, Salzali Mohd, S. Govindaraju, W. Tiau, N. Farouk, H. Hassan","doi":"10.4236/ojem.2020.82006","DOIUrl":"https://doi.org/10.4236/ojem.2020.82006","url":null,"abstract":"Background: Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potassium level below 2.5 mmol/L [1]. Patient with hypokalemia can present with wide range of presentation including musculoskeletal complaints from numbness to acute paralysis. Severe hypokalemia has tendency to progress to intestinal paralysis and respiratory failure. In some cases of hypokalemia, cardiovascular system can also be affected causing cardiac arrhythmias and heart failure [2]. Aim: This case report is to highlight that severe hypokalaemia can present with ECG changes mimicking acute coronary syndrome (ACS) which was fully resolved with correction of potassium level. Methods: We report a case of 84 years old Chinese man with underlying triple vessel disease presented with generalised body weakness for 2 days. ECG on arrival noted changes suggestive of ACS with ST segment depression in lead V4-V6 with first degree heart block, however patient had no ischemic symptoms and the potassium level was severe low at 1.6 mmol/L (3.5 - 5.1 mmol/L). He was correctly not treated for ACS. Outcomes: Repeated ECG post fast intravenous potassium correction noted complete resolution of the ST segment depression and first degree heart block. Patient discharged well from hospital four days later with potassium level of 3.8 mmol/L. Conclusions: Severe hypokalemia with asymptomatic ECG of ACS changes can safely be treated as a single entity clinical emergency with good resolution and no complication after normalizing potassium level.","PeriodicalId":57857,"journal":{"name":"急诊医学(英文)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49599319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Podvorica, Besnik Rrmoku, Albulena Metaj, Hasan Gashi
Background: Emergency Clinic (EC) and Central Intensive Care (CIC) are high-stress environments that directly affect the health status of nurses. Methods: The aim of this study was to assess the level of stress at nurses working in the Emergency Clinic and nurses working in the Central Intensive Care. The study included 90 nurses, 45 nurses working in Emergency Clinic and 45 nurses working in Central Intensive Care. The study applied the Emergency Nurse Stress Questionnaire as an instrument to gather the data. This questionnaire was adopted from the Operational Police Stress Questionnaire in order to serve for the function and aim of the present study. Results: Nurses’ cohort-age ranged from 20 to 62 years. The largest proportion of respondents 40 (44.4%) was in the 20 - 30 age group, 58 (64.4%) were married, 60 (66.6%) hold bachelor degree and (33.3%) were with secondary school educational level. In terms of work-related fatigue, significant difference was found in working hours, participants reported that there was a significant difference in fatigue between 12 hours shift nurses (61 ± 10.5) compared to 8 hours nurses (41 ± 23.6) with P < 0.001. Results indicated that a vast majority of participants reported moderate to high levels of stress (81% of participants). There was no significant difference in the level of stress between the two groups of participants. There were also no significant differences compared to their demographic characteristics. Conclusion: These findings emphasize the role of using and assuring adequate strategies for ensuring quality management and finding ways of facilitating the increase in the number of nursing staff in these two departments because workplace overload and fatigue are potential factors that increase nurses’ stress levels.
{"title":"Level of Stress at Nurses Working in Emergency Clinic and Central Intensive Care: University Clinical Centre of Kosovo","authors":"E. Podvorica, Besnik Rrmoku, Albulena Metaj, Hasan Gashi","doi":"10.4236/ojem.2020.82005","DOIUrl":"https://doi.org/10.4236/ojem.2020.82005","url":null,"abstract":"Background: Emergency Clinic (EC) and Central Intensive Care (CIC) are high-stress environments that directly affect the health status of nurses. Methods: The aim of this study was to assess the level of stress at nurses working in the Emergency Clinic and nurses working in the Central Intensive Care. The study included 90 nurses, 45 nurses working in Emergency Clinic and 45 nurses working in Central Intensive Care. The study applied the Emergency Nurse Stress Questionnaire as an instrument to gather the data. This questionnaire was adopted from the Operational Police Stress Questionnaire in order to serve for the function and aim of the present study. Results: Nurses’ cohort-age ranged from 20 to 62 years. The largest proportion of respondents 40 (44.4%) was in the 20 - 30 age group, 58 (64.4%) were married, 60 (66.6%) hold bachelor degree and (33.3%) were with secondary school educational level. In terms of work-related fatigue, significant difference was found in working hours, participants reported that there was a significant difference in fatigue between 12 hours shift nurses (61 ± 10.5) compared to 8 hours nurses (41 ± 23.6) with P < 0.001. Results indicated that a vast majority of participants reported moderate to high levels of stress (81% of participants). There was no significant difference in the level of stress between the two groups of participants. There were also no significant differences compared to their demographic characteristics. Conclusion: These findings emphasize the role of using and assuring adequate strategies for ensuring quality management and finding ways of facilitating the increase in the number of nursing staff in these two departments because workplace overload and fatigue are potential factors that increase nurses’ stress levels.","PeriodicalId":57857,"journal":{"name":"急诊医学(英文)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46053311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Isichei, A. Ale, M. Misauno, P. Brown, N. Soulakis
United States Consumer Product Safety Commission (CPSC) reported a 700% increase in Emergency Department (ED) visits for injuries attributed to unpowered scooter use from January through October 2000. Our objective is to investigate injuries associated with the use of unpowered scooters among adolescents from the age of >9 years to 20 years in the National Electronic Injury Surveillance Study (NEISS) data set from 2007-2017. We analyzed unpowered scooter-related injuries in the NEISS data set using variables: SCOOTER, INJURED, AFTER, OFF, AT and IN; the product code for injuries related to unpowered scooters is 1329, and age ≥9 years and 9 - 19 - <99 years. Distribution by race: White 39.65%, Not Specified (NS) 38.94%, Black/African American 13.98% and Others (Asian, American Indians, Alaskan natives, Native Hawaiians, and Pacific Islanders) 7.43%. Body parts injured: head 16.19%, followed by face 8.49%, finger 8.30%, lower trunk 8.30%, ankle 5.60%, upper trunk 5.35%, internal injuries 0.99% and others 14.28%. Most of the injuries were mild: Treated and Discharged 89.80%, Hospitalized 7.68%, and Death in ED 0.05%. The locations of injuries were: Occurred at Home 43.47%, UNK 29.78%, Sports 12.63%, Public 6.49%, School 5.35%, and Street 2.22%. Injury trend: a rise until 2010, a decline until 2015 and, then a sharp rise through 2017. Injuries from the use of unpowered scooters are a rising threat that should be given attention. Outcome: Most of the injuries 69.80% were mild treated and discharged, 7.68% were hospitalized, while death in ED was 0.05%. Whereas: Transfer to referral hospital was about the same as in adults. Although most of these injuries were minor, head injuries could lead to more serious problems, and severe injuries could be life-threatening.
{"title":"Unpowered Scooter-Related Injuries among Adolescents and Adults in the United States 2007-2017","authors":"M. Isichei, A. Ale, M. Misauno, P. Brown, N. Soulakis","doi":"10.4236/ojem.2020.81002","DOIUrl":"https://doi.org/10.4236/ojem.2020.81002","url":null,"abstract":"United States Consumer Product Safety Commission (CPSC) reported a 700% increase in Emergency Department (ED) visits for injuries attributed to unpowered scooter use from January through October 2000. Our objective is to investigate injuries associated with the use of unpowered scooters among adolescents from the age of >9 years to 20 years in the National Electronic Injury Surveillance Study (NEISS) data set from 2007-2017. We analyzed unpowered scooter-related injuries in the NEISS data set using variables: SCOOTER, INJURED, AFTER, OFF, AT and IN; the product code for injuries related to unpowered scooters is 1329, and age ≥9 years and 9 - 19 - <99 years. Distribution by race: White 39.65%, Not Specified (NS) 38.94%, Black/African American 13.98% and Others (Asian, American Indians, Alaskan natives, Native Hawaiians, and Pacific Islanders) 7.43%. Body parts injured: head 16.19%, followed by face 8.49%, finger 8.30%, lower trunk 8.30%, ankle 5.60%, upper trunk 5.35%, internal injuries 0.99% and others 14.28%. Most of the injuries were mild: Treated and Discharged 89.80%, Hospitalized 7.68%, and Death in ED 0.05%. The locations of injuries were: Occurred at Home 43.47%, UNK 29.78%, Sports 12.63%, Public 6.49%, School 5.35%, and Street 2.22%. Injury trend: a rise until 2010, a decline until 2015 and, then a sharp rise through 2017. Injuries from the use of unpowered scooters are a rising threat that should be given attention. Outcome: Most of the injuries 69.80% were mild treated and discharged, 7.68% were hospitalized, while death in ED was 0.05%. Whereas: Transfer to referral hospital was about the same as in adults. Although most of these injuries were minor, head injuries could lead to more serious problems, and severe injuries could be life-threatening.","PeriodicalId":57857,"journal":{"name":"急诊医学(英文)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45459691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Interfacility transfers (IFT) of acute ischemic stroke (AIS) may not always lead to a better prognosis. Methods: Retrospective cohort study included AIS patients at an emergency department (ED) with telestroke. Multiple linear regression for departure time from ED (DT), quantile regression for length of in-hospital stay (LOS), and Kaplan-Meier estimator with Cox proportional hazards model for one-year survival (SV) were performed. Results: 192 patients included were categorised according to IFT. Mechanical thrombectomy was performed in 50% who had been transferred. Differences were found in DT, discharge disposition and LOS. An inverse relationship existed between DT and NIHSS. The strongest predictor of LOS was TACS (β = 3.14 [0.03 - 8.49]; p = 0.005). SV was related to IFT (HR 4.68 [1.37 - 16.07]; p = 0.014), age (HR 1.1 [1.04 - 1.17]), BI < 60 (HR 2.7 [1.02 - 7.1]), TACS (HR 9.82 [1.08 - 88.95]) and NIHSS ≥ 6 (HR 2.85 [1.05 - 7.74]). Conclusions: Shared decision-making with a stroke unit through telemedicine enabled a standardised clinical management in a non-metropolitan setting. Several improvement opportunities were identified: multimodal computed tomography availability before transfer, as well as optimization of response time and training in neurosonology of emergency physicians.
{"title":"A Real-World Perspective on Interfacility Transfers of Acute Ischemic Stroke from a Semi-Rural Center","authors":"L. Llauger, E. Puyuelo, F. Sanchez-Mendez","doi":"10.4236/ojem.2020.81001","DOIUrl":"https://doi.org/10.4236/ojem.2020.81001","url":null,"abstract":"Introduction: Interfacility transfers (IFT) of acute ischemic stroke (AIS) may not always lead to a better prognosis. Methods: Retrospective cohort study included AIS patients at an emergency department (ED) with telestroke. Multiple linear regression for departure time from ED (DT), quantile regression for length of in-hospital stay (LOS), and Kaplan-Meier estimator with Cox proportional hazards model for one-year survival (SV) were performed. Results: 192 patients included were categorised according to IFT. Mechanical thrombectomy was performed in 50% who had been transferred. Differences were found in DT, discharge disposition and LOS. An inverse relationship existed between DT and NIHSS. The strongest predictor of LOS was TACS (β = 3.14 [0.03 - 8.49]; p = 0.005). SV was related to IFT (HR 4.68 [1.37 - 16.07]; p = 0.014), age (HR 1.1 [1.04 - 1.17]), BI < 60 (HR 2.7 [1.02 - 7.1]), TACS (HR 9.82 [1.08 - 88.95]) and NIHSS ≥ 6 (HR 2.85 [1.05 - 7.74]). Conclusions: Shared decision-making with a stroke unit through telemedicine enabled a standardised clinical management in a non-metropolitan setting. Several improvement opportunities were identified: multimodal computed tomography availability before transfer, as well as optimization of response time and training in neurosonology of emergency physicians.","PeriodicalId":57857,"journal":{"name":"急诊医学(英文)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70627665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The use of opioid analgesics has created an opioid addiction epidemic in the United States and around the world. One of the main responsibilities of the emergency department is to address acute pain. In this paper we examine the use of low dose ketamine as a safe substitute for opioid analgesics. Types of pain are identified using prior established taxonomy, followed by discussing types of management and treatments. The opioid epidemic and its societal implications are considered. We also examine the side effects of ketamine and the use of ketamine as an adjunct to analgesics used for pain control. Recommendations and considerations for the use of ketamine are suggested, and a low dose ketamine administration sample hospital policy is reviewed.
{"title":"Low Dose Ketamine Used for Acute Pain Management in the Emergency Department","authors":"Catherine Kestenian, R. Gantioque, Eric Snyder","doi":"10.4236/ojem.2020.81003","DOIUrl":"https://doi.org/10.4236/ojem.2020.81003","url":null,"abstract":"The use of opioid analgesics has created an opioid addiction epidemic in the United States and around the world. One of the main responsibilities of the emergency department is to address acute pain. In this paper we examine the use of low dose ketamine as a safe substitute for opioid analgesics. Types of pain are identified using prior established taxonomy, followed by discussing types of management and treatments. The opioid epidemic and its societal implications are considered. We also examine the side effects of ketamine and the use of ketamine as an adjunct to analgesics used for pain control. Recommendations and considerations for the use of ketamine are suggested, and a low dose ketamine administration sample hospital policy is reviewed.","PeriodicalId":57857,"journal":{"name":"急诊医学(英文)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70627671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Mccoy, R. Eisenstein, Channing Hui, G. Corcoran, C. Kilker, P. Ohman-Strickland, M. Merlin, Clifton R. Lacy
Introduction: Our aim was to determine what patient volume, if any, in-laboratory testing provides results faster than Point-of-Care-Testing (POCT). Methods: To evaluate POCT effectiveness during high volume situations, POCT was compared to in-laboratory testing during busy periods with large numbers of patients. Our setting was an urban level 1 trauma center with an academic emergency medicine department (ED) and annual patient volume of 70,000. Patients seen requiring laboratory testing during peak volume between 11 a.m. and 7 p.m. were enrolled over a five-week period. One tube of blood was sent to the laboratory and the other tube was run in the ED using POCT. Turnaround time was recorded as time from when the tube was received to when the result was available. We also completed a time-motion study to assess the number of POCT machines that would be needed to process the entire average hourly hospital laboratory volume. Results: We collected 539 hematology and chemistry specimens. The POCT group was significantly faster than in-laboratory testing, with mean POCT [complete blood count (CBC) and chemistry] 3.5 minutes compared to in-laboratory CBC test time of 30.9 minutes and chemistry test time of 55 minutes. As the volume of samples peaked, there was a slight but insignificant decrease in POCT turnaround time. If POCT was used to process the entire average hospital laboratory volume which approached 54 samples an hour, 3 POCT machines would be necessary to maintain turnaround times. Conclusion: Even during ED high volume situations, POCT provided results significantly faster than in-laboratory testing.
{"title":"Point-of-Care Testing vs. Laboratory Testing during High Patient Volume Situations","authors":"J. Mccoy, R. Eisenstein, Channing Hui, G. Corcoran, C. Kilker, P. Ohman-Strickland, M. Merlin, Clifton R. Lacy","doi":"10.4236/ojem.2019.74006","DOIUrl":"https://doi.org/10.4236/ojem.2019.74006","url":null,"abstract":"Introduction: Our aim was to determine what patient volume, if any, in-laboratory testing provides results faster than Point-of-Care-Testing (POCT). Methods: To evaluate POCT effectiveness during high volume situations, POCT was compared to in-laboratory testing during busy periods with large numbers of patients. Our setting was an urban level 1 trauma center with an academic emergency medicine department (ED) and annual patient volume of 70,000. Patients seen requiring laboratory testing during peak volume between 11 a.m. and 7 p.m. were enrolled over a five-week period. One tube of blood was sent to the laboratory and the other tube was run in the ED using POCT. Turnaround time was recorded as time from when the tube was received to when the result was available. We also completed a time-motion study to assess the number of POCT machines that would be needed to process the entire average hourly hospital laboratory volume. Results: We collected 539 hematology and chemistry specimens. The POCT group was significantly faster than in-laboratory testing, with mean POCT [complete blood count (CBC) and chemistry] 3.5 minutes compared to in-laboratory CBC test time of 30.9 minutes and chemistry test time of 55 minutes. As the volume of samples peaked, there was a slight but insignificant decrease in POCT turnaround time. If POCT was used to process the entire average hospital laboratory volume which approached 54 samples an hour, 3 POCT machines would be necessary to maintain turnaround times. Conclusion: Even during ED high volume situations, POCT provided results significantly faster than in-laboratory testing.","PeriodicalId":57857,"journal":{"name":"急诊医学(英文)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49143989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Growing evidence has made it obvious that early intervention in patients with Achilles tendon rupture extensively affects the prognosis. This requires the use of easily accessible imaging modalities such as ultrasound in establishing accurate diagnosis of tendinopathies so that early therapeutic decisions can be made. Ultrasound allows for assessment of tendons in a dynamic real time setting. Physicians can interact with patients and receive feedback regarding the symptomatic area, and assessing the tendon from different angles while under stress. It also offers a faster method to diagnose Achilles tendon rupture and therefore provide early intervention. Furthermore, ultrasound is a safe, non-invasive, and a patient friendly method that has become less expensive, portable, and a faster imaging modality to diagnose tendinopathies. In this paper, we review the application of ultrasound in diagnosing Achilles tendon rupture and comparing it with other imaging modalities, after thoroughly studying the current literature.
{"title":"Analyzing the Use of Ultrasound: Achilles Tendon Rupture","authors":"M. Atta, S. Jafari, Kareen Moore","doi":"10.4236/OJEM.2019.73005","DOIUrl":"https://doi.org/10.4236/OJEM.2019.73005","url":null,"abstract":"Growing evidence has made it obvious that early intervention in patients with Achilles tendon rupture extensively affects the prognosis. This requires the use of easily accessible imaging modalities such as ultrasound in establishing accurate diagnosis of tendinopathies so that early therapeutic decisions can be made. Ultrasound allows for assessment of tendons in a dynamic real time setting. Physicians can interact with patients and receive feedback regarding the symptomatic area, and assessing the tendon from different angles while under stress. It also offers a faster method to diagnose Achilles tendon rupture and therefore provide early intervention. Furthermore, ultrasound is a safe, non-invasive, and a patient friendly method that has become less expensive, portable, and a faster imaging modality to diagnose tendinopathies. In this paper, we review the application of ultrasound in diagnosing Achilles tendon rupture and comparing it with other imaging modalities, after thoroughly studying the current literature.","PeriodicalId":57857,"journal":{"name":"急诊医学(英文)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47921278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seval Komut, B. Sönmez, A. K. Erenler, Erdal Komut
Objective: We aimed to investigate the clinical and demographical characteristics of patients admitted to the Emergency Department (ED) due to maxillofacial trauma (MFT). Methods: This sectional and retrospective study was conducted in Ankara Numune Education and Research Hospital ED between 1st March 2010 and 31st March 2017. Into the study, patients with MFT older than 15 years of age were included. Characteristics of patients were recorded. Patients’ characteristics were compared according to presence of fractures. Results: Mean age of the patients was 41.1 ± 18.0 years and a statistically significant relationship was determined between age and presence of fracture (p > 0.05). Of the patients, 74.5% was male and fracture presence was significantly more in males than females (p 0.05). Conclusion: The MFT is a pathology that either leads to its own, or can lead to life-threatening consequences as a result of additional organ injuries. The physician evaluating the patient should determine the MFT and additional pathologies and ensure that the interventions start as soon as possible.
{"title":"Clinical and Demograhical Characteristics of Patients with Maxillofacial Trauma in the Emergency Department","authors":"Seval Komut, B. Sönmez, A. K. Erenler, Erdal Komut","doi":"10.4236/OJEM.2019.72004","DOIUrl":"https://doi.org/10.4236/OJEM.2019.72004","url":null,"abstract":"Objective: We aimed to investigate the clinical and demographical characteristics of patients admitted to the Emergency Department (ED) due to maxillofacial trauma (MFT). Methods: This sectional and retrospective study was conducted in Ankara Numune Education and Research Hospital ED between 1st March 2010 and 31st March 2017. Into the study, patients with MFT older than 15 years of age were included. Characteristics of patients were recorded. Patients’ characteristics were compared according to presence of fractures. Results: Mean age of the patients was 41.1 ± 18.0 years and a statistically significant relationship was determined between age and presence of fracture (p > 0.05). Of the patients, 74.5% was male and fracture presence was significantly more in males than females (p 0.05). Conclusion: The MFT is a pathology that either leads to its own, or can lead to life-threatening consequences as a result of additional organ injuries. The physician evaluating the patient should determine the MFT and additional pathologies and ensure that the interventions start as soon as possible.","PeriodicalId":57857,"journal":{"name":"急诊医学(英文)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49552955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A serious concern among post-9/11 Iraq and Afghanistan veterans (IAV) are health conditions from military and environmental exposure while serving. Many veterans are becoming suddenly ill and experiencing symptoms that have been associated with exposure to burning trash or “burn pits” set up to destroy waste produced by the military. IAVs are exhibiting respiratory conditions and other numerous health issues from exposure to burn pits during deployments. From the US military operations to the Middle East, 70% of the military personnel reported respiratory illnesses, with 17% experiencing symptoms serious enough to require medical care. Despite growing concerns, little research has been conducted on the health conditions of returning veterans. Many veterans have difficulty gaining appropriate access to care, unable to travel long distances to Veterans health facility, or have to deal with long wait times to see a provider. As a result, many veterans utilize civilian emergency rooms and healthcare facilities. Most healthcare facilities are not familiar with military-related health conditions. To address and prevent delays in care, it is helpful to have a veteran-specific screener questionnaire at the point of healthcare access. Getting a better understanding of the background and history of veterans can aid in accurately triaging this community and lead to better health care outcomes. Collecting and maintaining data regarding health issues that can arise from burn pit exposures can help direct the care of this specific community of veterans. In seeking to improve the understanding of IAV health issues from exposure to burn pits, the aim of this article is to help educate and raise awareness, and assist health care professionals to better triage and direct the care or resources necessary to help this underserved and at-risk community of our veterans.
{"title":"Critical Analysis of the Healthcare Response to Burn-Pit-Related Illnesses for Post-9/11 Iraq and Afghanistan Veterans","authors":"Peter J. Lim, A. Tayyeb","doi":"10.4236/OJEM.2019.72003","DOIUrl":"https://doi.org/10.4236/OJEM.2019.72003","url":null,"abstract":"A serious concern among post-9/11 Iraq and Afghanistan veterans (IAV) are health conditions from military and environmental exposure while serving. Many veterans are becoming suddenly ill and experiencing symptoms that have been associated with exposure to burning trash or “burn pits” set up to destroy waste produced by the military. IAVs are exhibiting respiratory conditions and other numerous health issues from exposure to burn pits during deployments. From the US military operations to the Middle East, 70% of the military personnel reported respiratory illnesses, with 17% experiencing symptoms serious enough to require medical care. Despite growing concerns, little research has been conducted on the health conditions of returning veterans. Many veterans have difficulty gaining appropriate access to care, unable to travel long distances to Veterans health facility, or have to deal with long wait times to see a provider. As a result, many veterans utilize civilian emergency rooms and healthcare facilities. Most healthcare facilities are not familiar with military-related health conditions. To address and prevent delays in care, it is helpful to have a veteran-specific screener questionnaire at the point of healthcare access. Getting a better understanding of the background and history of veterans can aid in accurately triaging this community and lead to better health care outcomes. Collecting and maintaining data regarding health issues that can arise from burn pit exposures can help direct the care of this specific community of veterans. In seeking to improve the understanding of IAV health issues from exposure to burn pits, the aim of this article is to help educate and raise awareness, and assist health care professionals to better triage and direct the care or resources necessary to help this underserved and at-risk community of our veterans.","PeriodicalId":57857,"journal":{"name":"急诊医学(英文)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42036310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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