Emergency
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Which Chest Pain Patients Require Further Testing, Intervention, or Discharge?
Hospitals in Kaiser Permanente’s Southern California region have implemented a new approach to help identify which patients who present with chest pain require further testing or intervention and which can be discharged safely. The core of this approach is use of the HEART score, a tool developed in the Netherlands to help physicians risk-stratify such patients quickly.
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Offering Patients Hospital Care at Home
There is growing interest in an approach that delivers hospital-level care to appropriate patients in their homes. Generally, such programs identify potential candidates for the approach upon their presentation to the ED. Depending on the program, emergency physicians and/or hospitalists determine whether patients should be offered the option of receiving care for their acute condition at home. Investigators have found the approach can deliver equal or superior outcomes to similar hospitalized patients at considerably lower cost, although reimbursement remains a major obstacle.
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Chronic Abdominal Pain Disorders: Chronic Pancreatitis and Cyclic Vomiting Syndrome
It is important for emergency providers to understand the pathophysiology and management of chronic abdominal pain disorders. This article will review two common chronic abdominal pain disorders encountered in the ED: chronic pancreatitis and cyclic vomiting syndrome.
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Are In-hospital Deaths Related to Community-acquired Pneumonia Preventable?
This secondary analysis of data from five tertiary care centers found that among patients hospitalized for community-acquired pneumonia, very few deaths potentially were related to a lapse in in-hospital quality of pneumonia care.
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Neighborhood Socioeconomic Status Associated With Infection Risk, But Not Sepsis
Based on a large, national, prospective cohort study, lower neighborhood socioeconomic status was associated with a higher incidence of hospitalizations for infection (but not sepsis) at presentation.
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Post-intensive Care Syndrome: What Happens After the ICU?
The number of ICU patients admitted annually continues to grow, with most recent estimates reaching 5.7 million. As there are growing numbers of critically ill patients, sepsis survivorship also has grown as a substantial public health concern, with a significant number of survivors diagnosed with post-intensive care syndrome (PICS). It is important to go beyond saving lives in the ICU and devote additional time and attention to preventing and treating the psychiatric, cognitive, and physical sequalae of ICU illness in the follow-up setting.
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Pediatric Abdominal Ultrasound: A Comprehensive Guide to Making the Diagnosis — Part II
Ultrasound is evolving rapidly as the ideal imaging modality for many common pediatric complaints. In the second part of this series, the authors discuss point-of-care use of ultrasound for concerns regarding the kidneys, ovaries, testicles, gallbladder, and small bowel obstruction. The ability to make critical diagnoses safely and rapidly with ultrasound is an invaluable clinical tool to facilitate and improve pediatric care.
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Is Intoxicated Patient ‘Just Another Drunk,’ or Someone With Unsuspected Critical Illness?
About 1% of patients who arrived to the ED for uncomplicated alcohol intoxication required critical care resources during their encounter, according to a recent study.
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EP’s Independent Contractor Status Doesn’t Always Limit Hospital Malpractice Exposure
Often, hospitals and EPs are named jointly in malpractice litigation. The EP defendant’s status, as either a hospital employee or independent contractor, can determine whether the hospital is liable.
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Beware Exposure if ‘Bouncebacks’ Don’t Return to Same ED
Most EDs track return visits — cases in which patients come back with new or worsening symptoms. But what if that patient goes to a different ED? Investigators recently examined this question.