Πέμπτη 31 Αυγούστου 2017
Does the applied polytrauma definition notably influence outcome and patient population? – a retrospective analysis
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Psychiatric Emergencies for Clinicians: Emergency Department Management of Cocaine-Related Presentations
Source:The Journal of Emergency Medicine
Author(s): Jagoda Pasic, Paul Zarkowski, Kimberly Nordstrom, Michael P. Wilson
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EMS Artwork: London Ambulance Service Incident Response Unit personnel
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Paramedic - Superior Ambulance
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Paramedic Firefighter - Metro Paramedic Services, Inc.
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Inside EMS Podcast: Why did you become a caregiver?
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Τετάρτη 30 Αυγούστου 2017
Paramedics, Full Time, Part Time, PRN - Second Alarmers Rescue Squad
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EMT, Full Time, Part Time, and PRN - Second Alarmers Rescue Squad
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Yuneec International announces availability of Yuneec H520 Commercial UAV
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HeartRescue expands effort to reduce sudden cardiac arrest deaths
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Harvey victims use social media when 911 fails
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Risk factors for acute kidney injury in patients with burn injury: A meta-analysis and systematic review
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Comparison of fetomaternal outcome between 47 deliveries following successful external cephalic version for breech presentation and 7456 deliveries following spontaneous cephalic presentation
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Report reveals high level of drug use in athletics
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The effect of peer support groups on family adaptation from the perspective of wives of war veterans with posttraumatic stress disorder
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New ransomware strain targeting healthcare
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Feasibility and safety of intact cord resuscitation in newborn infants with congenital diaphragmatic hernia (CDH)
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Impact of age on extracorporeal membrane oxygenation survival of patients with cardiac failure
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Early versus late canalicular laceration repair outcomes
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The use of aortic balloon occlusion in traumatic shock: First report from the ABO trauma registry
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Might statin use lower the risk of death from prostate cancer?
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Emergency department provider perspectives on benzodiazepine-opioid co-prescribing: A qualitative study
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The management of small area burns and unexpected illness after burn in children under five years of age - A costing study in the English healthcare setting
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Development and validation of a tool to identify patients with type 2 diabetes at high risk of hypoglycemia-related emergency department or hospital use
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The neurobiology of brain recovery from traumatic stress: A Longitudinal DTI Study
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Bacterial and fungal infections in acute-on-chronic liver failure: Prevalence, characteristics and impact on prognosis
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Impact of systemic inflammatory response syndrome and surgical Apgar score on post-operative acute kidney injury
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Childhood bruising distribution observed from eight mechanisms of unintentional injury
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Treatment of unstable thoracolumbar fractures: Does fracture level fixation accelerate the bone healing?
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Asian dust exposure triggers acute myocardial infarction
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Exploring the relationship between general practice characteristics and attendance at Walk-in Centres, Minor Injuries Units and Emergency Departments in England 2009/10–2012/2013: a longitudinal study
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Patient physiological status during emergency care and rapid response team or cardiac arrest team activation during early hospital admission
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Diagnosis and treatment of upper airway oedema caused by acute angio-oedema in the emergency department: a French consensus statement
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Disaster preparedness and response improvement: comparison of the 2010 Haiti earthquake-related diagnoses with baseline medical data
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OBESICA study: relationship between BMI and acute heart failure outcome
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TIER competency-based training course for the first receivers of CBRN casualties: a European perspective
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Drug safety at admission to emergency department: an innovative model for PRIOritizing patients for MEdication Reconciliation (PRIOMER)
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Prognosis of overt disseminated intravascular coagulation in patients admitted to a medical emergency department
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Hospital preparedness and response in CBRN emergencies: TIER assessment tool
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Anticoagulation therapy among patients presenting to the emergency department with symptomatic atrial fibrillation – the FinFib2 study
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Usefulness of a multiplying factor in predicting the final number of victims during a mass casualty incident
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Large arterial occlusive strokes as a medical emergency: need to accurately predict clot location
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Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock.
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Interventions to Improve Hand Hygiene Compliance in the ICU: A Systematic Review.
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Antifungal Prevention of Systemic Candidiasis in Immunocompetent ICU Adults: Systematic Review and Meta-Analysis of Clinical Trials.
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Effects of High-Flow Nasal Cannula on the Work of Breathing in Patients Recovering From Acute Respiratory Failure.
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Valproic Acid Combined With Postcardiac Arrest Hypothermic-Targeted Temperature Management Prevents Delayed Seizures and Improves Survival in a Rat Cardiac Arrest Model.
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Heparin-Free Prolonged Intermittent Hemodialysis Using Calcium-Free Citrate Dialysate in Critically Ill Patients.
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"It Was the Only Thing I Could Hold Onto, But[horizontal ellipsis]": Receiving a Letter of Condolence After Loss of a Loved One in the ICU: A Qualitative Study of Bereaved Relatives' Experience.
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Nebulized Versus IV Amikacin as Adjunctive Antibiotic for Hospital and Ventilator-Acquired Pneumonia Postcardiac Surgeries: A Randomized Controlled Trial.
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Daily volume of cases in emergency call centers: construction and validation of a predictive model
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Τρίτη 29 Αυγούστου 2017
Rate-control with beta-blockers versus calcium-channel blockers in the emergency setting: predictors of medication class choice and associated hospitalization
Abstract
Objectives
Rate-control is an important component of the management of patients with atrial fibrillation (AF). Previous studies of emergency department (ED) rate-control have been limited by relatively small sample sizes. We examined the use of beta-blockers (BB) versus non-dihydropyridine calcium channel blockers (CCB) in ED patients from 24 sites, and the associated hospital admission rates.
Methods
In this pre-planned sub-study, we examined chart data on AF patients who visited one of 24 hospital EDs in Ontario, Canada, between April 2008 and March 2009. We describe the proportion of patients who received either a BB or a CCB, had a heart rate < 110 beats/minute 2 hours later, and any complications. We used hierarchical logistic regression modeling to determine the predictors of BB versus CCB use, and to assess the between-hospital variation in use of BB versus CCB. Solely in patients who had no rhythm control attempts, we examined the difference in the probability of hospital admission after propensity score matching patients by medication class.
Results
Of the 1639 patients who received either a BB (n=429) or a CCB (n=1210), 70.9% of the patients who received a BB had successful rate-control, versus 66.1% for a CCB. Complications were rare (2.4%), and the large majority were hypotension (2.0%). In adjusted analyses, predictors of receiving a BB (compared to a CCB) included already being on a BB, being sent in from a doctor's office, or being seen at a teaching hospital. In contrast, patients with evidence of heart failure, prior use of a CCB, a higher presenting heart rate, a successful pharmacological cardioversion (versus no attempt), or who were seen at the highest AF volume EDs were significantly less likely to receive a BB, compared to a CCB. Systematic between-hospital differences accounted for 8% of the variation in BB versus CCB use. Hospital characteristics accounted for the large majority of that variation: after accounting for patient characteristics the between-hospital variation decreased by a relative 2.8%. By further adjusting for hospital characteristics, it decreased by a relative 74.7%. Among propensity-score matched patients with no rhythm-control attempts, more CCB patients were admitted (51.6%) compared to BB patients (40.0%) (difference of 11.6%; 95% CI, 7.9-16.2).
Conclusions
In this study of 24 EDs, CCBs were used more frequently for rate-control than BBs, and complications were rare and easily managed using both agents. Variation between hospitals in BB versus CCB use was predominantly due to hospital characteristics such as teaching status and AF volumes, rather than different case-mix. Among patients who did not receive attempts at rhythm control, use of a BB for rate control was associated with a lower rate of hospitalization.
This article is protected by copyright. All rights reserved.
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The 2017 Academic Emergency Medicine Consensus Conference: Catalyzing System Change through Healthcare Simulation: Systems, Competency, and Outcomes
Abstract
Over the past decade, emergency medicine took a lead role in healthcare simulation in part due to its demands for successful interprofessional and multidisciplinary collaboration, along with educational needs in a diverse array of cognitive and procedural skills. Simulation-based methodologies have the capacity to support training and research platforms that model micro-, meso- and macro- systems of healthcare. To fully capitalize on the potential of simulation-based research to improve emergency healthcare delivery will require the application of rigorous methods from engineering, social science, and basic science disciplines. The Academic Emergency Medicine (AEM) Consensus Conference, “Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcome” was conceived to foster discussion among experts in emergency medicine, engineering, and social sciences, focusing on key barriers and opportunities in simulation-based research. This executive summary describes the overall rationale for the conference, conference planning, consensus-building approaches, and outlines the focus of the eight breakout sessions. The consensus outcomes from each breakout session are summarized in Proceedings papers published in this issue of Academic Emergency Medicine. Each paper provides an overview of methodological and knowledge gaps in simulation research and identifies future research targets aimed at improving the safety and quality of healthcare.
This article is protected by copyright. All rights reserved.
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Innovation Zone - Mercury Medical Small Adult CPR2 Bag
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Innovation Zone - Mercury Medical Small Adult CPR2 Bag
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Innovation Zone - Mercury Medical Small Adult CPR2 Bag
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EMCrit Wee – Central Line MicroSkills – Dilation
The next in the microskill series
EMCrit by Scott Weingart.
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How to remove the most common uniform stains
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Innovation Zone - Mercury Medical Small Adult CPR2 Bag
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EMCrit Wee – Central Line MicroSkills – Dilation
The next in the microskill series
EMCrit by Scott Weingart.
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Golfers, staff save man in cardiac arrest
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EM Nerd-The Case of the Liberated Radicals
A recent publication in the NEJM by Hofmann et al (1) serves as a nice reminder that so many of our therapeutic staples while based on sound physiological reasoning fail to translate into clinically important realities when empirically tested. This mammoth undertaking, entitled the DETO2X trial, randomized 6629 adult patients (>30 years old) presenting to […]
EMCrit by Rory Spiegel.
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EM Nerd-The Case of the Liberated Radicals
A recent publication in the NEJM by Hofmann et al (1) serves as a nice reminder that so many of our therapeutic staples while based on sound physiological reasoning fail to translate into clinically important realities when empirically tested. This mammoth undertaking, entitled the DETO2X trial, randomized 6629 adult patients (>30 years old) presenting to […]
EMCrit by Rory Spiegel.
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NHTSA to host webinar on patient, EMS provider safety
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Prognostic value of admission red blood cell distribution width in acute pancreatitis: A systematic review
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Gilead to buy Kite for promising cancer therapies in $12 billion deal
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Medical treatment may prevent, alleviate mitral valve damage after a heart attack
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Providers still largely in the dark about MACRA as reporting deadline nears
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Unsuspected critical illness among emergency department patients presenting for acute alcohol intoxication
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Early Detection of brain death using the Bispectral Index (BIS) in patients treated by extracorporeal cardiopulmonary resuscitation (E-CPR) for refractory cardiac arrest
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The efficacy of mini-c-arm fluoroscopy for the closed reduction of distal radius fractures in adults: A randomized controlled trial
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Time trends and predictors of acute gastroenteritis in the United States: results from National Health and Nutrition Examination Survey 2005-2014
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King-Devick test identifies real-time concussion and asymptomatic concussion in youth athletes
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Dehydroepiandrosterone sulfate and dehydroepiandrosterone sulfate/cortisol ratio in cirrhotic patients with septic shock: Another sign of hepatoadrenal syndrome?
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Burns in a major burns center in East China from 2005 to 2014: Incidence and outcome
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Impact of rapid response car system on extracorporeal life support in out-of-hospital cardiac arrest: A retrospective cohort study
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US FDA steps up scrutiny of stem-cell therapies
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Traumatic lower extremity and lumbosacral peripheral nerve injuries in adults: Electrodiagnostic studies and patients symptoms
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Using external lumbar CSF drainage to treat communicating external hydrocephalus in adult patients after acute traumatic or non-traumatic brain injury
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Small intestinal angioectasia: Characterization, risk factors, and rebleeding
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Differences and similarities in risk factors for post-operative acute kidney injury between younger and older adults undergoing cardiac surgery
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N-acetylcysteine and prednisolone treatment improved serum biochemistries in suspected flupirtine cases of severe idiosyncratic liver injury
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Trauma mechanisms and injury patterns in pediatric burn patients
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Risk stratification for return emergency department visits among high-risk patients
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Δευτέρα 28 Αυγούστου 2017
Bringing a 'Yes, and' mindset to EMS
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Basil A. Pruitt Jr. MD and the US Army Institute for Surgical Research: Five Decades of Science, Clinical Care, Mentorship, and Leadership.
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Lead Paramedic (Full Time) - Constellis, LLC
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Paramedic (Part Time) - Constellis, LLC
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Training: How to use the 2016 Emergency Response Guidebook
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Training: How to use the 2016 Emergency Response Guidebook
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Training: How to use the 2016 Emergency Response Guidebook
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Searching for mortality predictors in trauma patients: a challenging task
Abstract
Background
We aimed to study the value of new physiological variables compared with ISS and GCS as predictors for trauma mortality in a high-income developing country having a young population.
Methods
Data of 1008 consecutive trauma patients who were included in Al-Ain City Road Traffic Collision Registry were analyzed. Demography of patients, systolic blood pressure, heart rate, shock index, shock index age (SIA), blood pressure age index (BPAI), Glasgow Coma Scale (GCS), injury severity score (ISS), and in-hospital mortality were analyzed. Univariate analysis was used to compare those who died with those who survived. Significant factors were then entered into a backward logistic regression model to define factors predicting mortality.
Results
80.3% of the patients were males. The median (range) age of patients was 26 (1–78) years. Significant factors that predicted mortality were GCS (p < 0.0001), SIA (p = 0.003), ISS (p = 0.007), and BPAI (p = 0.022).
Conclusions
The physiological variables including GCS and shock index age were better predictors for trauma mortality comparted with ISS in our young population. A large global multi-centric study could possibly define an accurate global formula that uses both anatomical and physiological variables for predicting trauma mortality.
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Training: How to use the 2016 Emergency Response Guidebook
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Top EMS Game Changers – #8: Specialty centers
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Top EMS Game Changers – #8: Specialty centers
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Mannequin-based telesimulation: Increasing access to simulation-based education
The 2017 Academic Emergency Medicine Consensus Conference, “Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes,” highlights how simulation can improve the delivery of health care across larger systems; however, how can systems change when valuable educational interventions reach only limited populations? Studies have demonstrated the benefit of simulation education1,2 but have questioned the use of simulation in a system with limited financial resources.3 Most academic medical centers have mannequin-based simulation technology;4 yet, it is unclear from the literature how many community hospitals, especially in rural areas, have a simulation center or mannequins.
This article is protected by copyright. All rights reserved.
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“What do people do if they don't have insurance?”: ED to ED Referrals
Abstract
Objective
Up to 20% of patients seen in public emergency departments (EDs) have already been seen for the same complaint at another ED, but little is known about the origin or impact of these duplicate ED visits. The goals of this investigation were to explore (1) whether patients making a repeat ED visit are self-referred or indirectly referred from the other ED; and (2) gather the perspective of affected patients on the health, social, and financial consequences of these duplicate ED visits.
Methods
This mixed-methods study conducted over a 10-week period during 2016 in a large public hospital ED in Texas prospectively surveyed patients seen in another ED for the same chief complaint. Selected patients presenting with fractures were then enrolled for semi-structured qualitative interviews, which were audiotaped, transcribed, and independently coded by two team members until thematic saturation was reached.
Results
143 patients were identified as being recently seen at another local ED for the same chief complaint prior to presenting to the public hospital; 94% were uninsured and 61% presented with fractures. 27% required admission at the public ED and 95% of those discharged required further outpatient follow-up. 51 patients completed a survey and qualitative interviews were conducted with 23 fracture patients. 53% of patients reported that staff at the first hospital told them to go the public hospital ED, and 23% reported referral from a follow-up physician associated with the first hospital. 73% reported receiving the same tests at both EDs. Interview themes identified multiple healthcare visits for the same injury, concern about complications, disrespectful treatment at the first ED, delayed care, problems accessing needed follow-up care without insurance, loss of work, and financial strain.
Conclusions
The majority of patients presenting to a public hospital ED after treatment for the same complaint in another local ED were indirectly referred to the public ED without transferring paperwork or records, incurring duplicate testing and patient anxiety.
This article is protected by copyright. All rights reserved.
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PulmCrit- Brain death, mimics, and flow scans
As with many uncommon situations that are unique to critical illness, we cannot always rely on specialist consultation. Critical care practitioners must develop a firm grasp of this diagnosis. This post will explore some diagnostic conundrums in brain death diagnosis. The radionuclide flow scan is emphasized because it is the most commonly used tool to sort out difficult cases.
EMCrit by Josh Farkas.
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PulmCrit- Brain death, mimics, and flow scans
As with many uncommon situations that are unique to critical illness, we cannot always rely on specialist consultation. Critical care practitioners must develop a firm grasp of this diagnosis. This post will explore some diagnostic conundrums in brain death diagnosis. The radionuclide flow scan is emphasized because it is the most commonly used tool to sort out difficult cases.
EMCrit by Josh Farkas.
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Mechanisms, treatment, and patient outcome of iatrogenic injury to the brachial plexus – A retrospective single-center study
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MGMA: Medical practices focused on customer service, revenue cycle training
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Adequate interval for the monitoring of vital signs during endotracheal intubation
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Aetna violated HIPAA when envelope windows exposed HIV medication use, attorneys say
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Hip osteoarthritis as a predictor of the fracture pattern in proximal femur fractures
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Ambulatory hemodynamic monitoring strategy for heart failure management reduces utilization of emergency room services
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Markers of acute kidney injury in patients with sepsis: The role of soluble thrombomodulin
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Enteral nutrition as stress ulcer prophylaxis in critically ill patients: A randomized controlled exploratory study
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Association between strained capacity and mortality among patients admitted to intensive care: A path-analysis modeling strategy
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Safety threats during the care of infants with hypoglycemic seizures in the emergency department: A multicenter, simulation-based prospective cohort study
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Improving trend in ventricular fibrillation/pulseless ventricular tachycardia out-of-hospital cardiac arrest in Rochester Minnesota: A 26-year observational study from 1991 to 2016
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Effectiveness of endoscopic treatments for colonic diverticular bleeding
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FDA clears Novo Nordisk's diabetes drug to treat heart diseases
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Patients discharged from the intensive care unit on a dopamine infusion: A retrospective, observational study
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Heart rate variability associated with posttraumatic stress disorder in victims’ families of sewol ferry disaster
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Non-medical use of psychoactive prescription drugs is associated with fatal poisoning
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Brain ischemia: CT and MRI techniques in acute ischemic stroke
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The pediatric submersion score predicts children at low risk for injury following submersions
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RCR audit of compliance with UK guidelines for the prevention and detection of acute kidney injury in adult patients undergoing iodinated contrast media injections for CT
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Inferior vena cava filters in stable patients with acute pulmonary embolism who receive thrombolytic therapy
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Κυριακή 27 Αυγούστου 2017
Clinical Care Specialist (Paramedic/EMT-CC) - Call9
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Σάββατο 26 Αυγούστου 2017
Laceration Management
Source:The Journal of Emergency Medicine
Author(s): Scott L. Mankowitz
BackgroundTraumatic lacerations to the skin represent a fairly common reason for seeking emergency department care. Although the incidence of lacerations has decreased over the past decades, traumatic cutaneous lacerations remain a common reason for patients to seek emergency department care.ObjectiveInnovations in laceration management have the potential to improve patient experience with this common presentation.DiscussionStudies have confirmed that delays in wound closure rarely confer increased rates of infection, although comorbidities such as diabetes, chronic renal failure, obesity, human immunodeficiency virus, smoking, and cancer should be considered. Antibiotics should be reserved for high-risk wounds, such as those with comorbidities, gross contamination, involvement of deeper structures, stellate wounds, and selected bite wounds. Topical anesthetics, which are painless to apply, have a role in select populations. In most studies, absorbable sutures perform similarly to nonabsorbable sutures and do not require revisit for removal. Novel atraumatic closure devices and expanded use of tissue adhesives for wounds under tension further erode the primacy of regular sutures in wound closure. Maintaining a moist wound environment with occlusive dressings is more important than previously thought. Most topical wound agents are of limited benefit.ConclusionsRecent innovations in wound closure are allowing emergency physicians to shift toward painless, atraumatic, and rapid closure of lacerations.
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Extracorporeal Circulatory Support in Acute Coronary Syndromes: A Systematic Review and Meta-Analysis.
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Delirium and Catatonia in Critically Ill Patients: The Delirium and Catatonia Prospective Cohort Investigation.
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Παρασκευή 25 Αυγούστου 2017
Early post-traumatic seizures are associated with valproic acid plasma concentrations and UGT1A6/CYP2C9 genetic polymorphisms in patients with severe traumatic brain injury
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The Cause of the Aimless Convoy
Never has a biomarker with so much evidence demonstrating its disutility, enjoyed such a long reign of prosperity as BNP and its natriuretic analogs. And while evidence discrediting BNP’s use for the diagnosis and inpatient management of acute exacerbations of heart failure (HF) is well documented, its utility to guide outpatient therapy in patients […]
EMCrit by Rory Spiegel.
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The Cause of the Aimless Convoy
Never has a biomarker with so much evidence demonstrating its disutility, enjoyed such a long reign of prosperity as BNP and its natriuretic analogs. And while evidence discrediting BNP’s use for the diagnosis and inpatient management of acute exacerbations of heart failure (HF) is well documented, its utility to guide outpatient therapy in patients […]
EMCrit by Rory Spiegel.
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Paramedics roll child down sidewalk to ER after ambulance breaks down
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Paramedic Fulltime - City of Croswell EMS
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Commissioners order audit of Pa. 911 center
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The accuracy of acuity scoring tools to predict 24-hour mortality in traumatic brain injury patients: A guide to triage criteria
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Elders may face hearing challenges at doctor's offices
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Violent behavior by emergency department patients with an involuntary hold status
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Last 'bare county' in US gets insurer
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Potential drug–drug interactions among critically ill pediatric patients in a tertiary pulmonary center
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Improving discharge care: The potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before-after pilot study
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Endocrinopathies and renal outcomes in lithium therapy: Impact of lithium toxicity
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Dual antiplatelet therapy and the severity risk of lower intestinal bleeding
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Performance of serum creatinine and kidney injury biomarkers for diagnosing histologic acute tubular injury
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The value of arterial blood gas parameters for prediction of mortality in survivors of out-of-hospital cardiac arrest
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Controlled trial to improve resident sign-out in a medical intensive care unit
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Long-term outcomes after acute myocardial infarction in countries with different socioeconomic environments: An international prospective cohort study
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Novartis picks retail expert for new role of digital chief
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Economic implications of unintentional carbon monoxide poisoning in the United States and the cost and benefit of CO detectors
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Cerebral oximetry versus end tidal CO2 in predicting ROSC after cardiac arrest
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Effectiveness and safety of polygeline in patients with hypovolemia due to trauma
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Evaluation of negative pressure wound therapy to closed laparotomy incisions in acute care surgery
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Aspiration pneumonia in patients with carbon monoxide poisoning who had loss of consciousness: Prevalence, outcomes, and risk factors
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Collaborative care from the emergency department for injured patients with prescription drug misuse: An open feasibility study
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Massive transfusion practice in non-trauma related hemorrhagic shock
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Πέμπτη 24 Αυγούστου 2017
Human Neutrophil Elastase Mediates Fibrinolysis Shutdown Through Competitive Degradation of Plasminogen and Generation of Angiostatin.
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Multi-institutional analysis of neutrophil to lymphocyte ratio (NLR) in patients with severe hemorrhage: A new mortality predictor value.
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Characterization of hypoalbuminemia following temporary abdominal closure.
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Severe Burnout Is Common Among Critical Care Physician Assistants.
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The Epidemiology of Chronic Critical Illness After Severe Traumatic Injury at Two-Level One Trauma Centers.
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Inside EMS Podcast: Giving volunteer EMTs meaningful incentives
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App boosts communications for emergency medical services
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ESO announces addition of SafetyPAD to its product portfolio
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Uncomplicated
Source:The Journal of Emergency Medicine
Author(s): Meghan G. Liroff
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Safety Threats During the Care of Infants with Hypoglycemic Seizures in the Emergency Department: A Multicenter, Simulation-Based Prospective Cohort Study
Source:The Journal of Emergency Medicine
Author(s): Barbara M. Walsh, Sandeep Gangadharan, Travis Whitfill, Marcie Gawel, David Kessler, Robert A. Dudas, Jessica Katznelson, Megan Lavoie, Khoon-Yen Tay, Melinda Hamilton, Linda L. Brown, Vinay Nadkarni, Marc Auerbach
BackgroundErrors in the timely diagnosis and treatment of infants with hypoglycemic seizures can lead to significant patient harm. It is challenging to precisely measure medical errors that occur during high-stakes/low-frequency events. Simulation can be used to assess risk and identify errors.ObjectiveWe hypothesized that general emergency departments (GEDs) would have higher rates of deviations from best practices (errors) compared to pediatric emergency departments (PEDs) when managing an infant with hypoglycemic seizures.MethodsThis multicenter simulation-based prospective cohort study was conducted in GEDs and PEDs. In situ simulation was used to measure deviations from best practices during management of an infant with hypoglycemic seizures by inter-professional teams. Seven variables were measured: five nonpharmacologic (i.e., delays in airway assessment, checking dextrose, starting infusion, verbalizing disposition) and two pharmacologic (incorrect dextrose dose and incorrect dextrose concentration). The primary aim was to describe and compare the frequency and types of errors between GEDs and PEDs.ResultsFifty-eight teams from 30 hospitals (22 GEDs, 8 PEDs) were enrolled. Pharmacologic errors occurred more often in GEDs compared to PEDs (p = 0.043), while nonpharmacologic errors were uncommon in both groups. Errors more frequent in GEDs related to incorrect dextrose concentration (60% vs. 88%; p = 0.025), incorrect dose (20% vs. 56%; p = 0.033), and failure to start maintenance dextrose (33% vs. 65%; p = 0.040).ConclusionsDuring the simulated care of an infant with hypoglycemic seizures, errors were more frequent in GEDs compared to PEDs. Decreasing annual pediatric patient volume was the best predictor of errors on regression analysis.
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Tanzania to use drone network to deliver critical medicines
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6-year-old pulls drowning toddler twin cousins from pool
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Acute unilateral hip pain in fibrodysplasia ossificans progressiva (FOP)
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After solar eclipse, Americans' eyes seem mostly none the worse
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Epidemiology from tweets: Estimating misuse of prescription opioids in the USA from social media
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CMS targets providers that have high error rates in new claims processing, fraud reviews
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Pulmonary CTA in sickle cell patients: Quantitative assessment of enhancement quality
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A walking program plus high intensity breathing exercise may enhance quality of life in individuals with heart failure - A preliminary report
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Knowledge and practice for pressure injury prevention among care managers in a home care setting: A cross-sectional study
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Thoracic epidural anesthesia reversed myocardial fibrosis in patients with heart failure caused by dilated cardiomyopathy
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Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study
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Risk factors for the occurrence of epistaxis: Prospective study
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Correlation of venous lactate and time of death in emergency department patients with noncritical lactate levels and mortality from trauma
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Hyperlactatemia, lactate kinetics and prediction of citrate accumulation in critically ill patients undergoing continuous renal replacement therapy with regional citrate anticoagulation
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Using unproven methods to tackle cancer could be deadly
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Patient navigation for patients frequently visiting the emergency department: a randomized, controlled trial
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Anterior cruciate ligament injury/reinjury in alpine ski racing: A narrative review
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Critical care polyneuropathy in burn injuries: an integrative review
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Early surgical intervention for acute ulcerative colitis is associated with improved postoperative outcomes
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Identifying emergency department patients at low risk for a variceal source of upper gastrointestinal hemorrhage
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The time-sensitive challenge of diagnosing spinal epidural abscess in the emergency department
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The association between intensive care unit-acquired hypernatraemia and mortality in critically ill patients with cerebrovascular diseases: A single-centre cohort study in Japan
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Maintaining immobilisation devices on trauma patients during CT: a feasibility study
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Identifying pre-hospital factors associated with outcome for major trauma patients in a regional trauma network: an exploratory study
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Τετάρτη 23 Αυγούστου 2017
Acute Limb Ischemia
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Penetrating Vascular Injury
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Cerebral Venous Thrombosis
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Extracranial Cervical Artery Dissections
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Subarachnoid Hemorrhage
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Vascular Access Complications
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Deep Venous Thrombosis
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Pulsara releases version 6.2, debuting 'Flexible Teams' feature
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Registered Nurse - Falck Northern California
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Paramedic - Falck Northern California
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Top EMS Game Changers – #9: ePCRs
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A New Rule for Terminating Resuscitation of Out-of-Hospital Cardiac Arrest Patients in Japan: A Prospective Study
Source:The Journal of Emergency Medicine
Author(s): SOS–KANTO 2012 Study GroupSadakiInokuchiMDYoshihiroMasuiMDKunihisaMiuraMDHaruhikoTsutsumiMDKiyotsuguTakumaMDIshiharaAtsushiMDMinoruNakanoMDHiroshiTanakaMDKeiichiIkegamiMDTakaoAraiMDArinoYaguchiMDNobuyaKitamuraMDShigetoOdaMDKenjiKobayashiMDTakayukiSudaMDKazuyukiOnoMDNaotoMorimuraMDRyosukeFuruyaMDYuichiKoidoMDFumiakiIwaseMDKenNagaoMDShigeruKanesakaMDYasuseiOkadaMDKyokoUnemotoMDTomohitoSadahiroMDMasayukiIyanagaMDAsakiMuraokaMDMunehiroHayashiMDShinichiIshimatsuMDYasufumiMiyakeMDHideoYokokawaMDYasuakiKoyamaMDAsukaTsuchiyaMDTetsuyaKashiyamaMDMunetakaHayashiMDKiyohiroOshimaMDKazuyaKiyotaMDYuichiHamabeMDHiroyukiYokotaMDShingoHoriMDShinInabaMDTetsuyaSakamotoMDNaoshigeHaradaMDAkioKimuraMDMasayukiKanaiMDYasuhiroOtomoMDManabuSugitaMDKosakuKinoshitaMDTakatoshiSakuraiMDMitsuhideKitanoMDKiyoshiMatsudaMDKotaroTanakaMDKatsunoriYoshiharaMDKikuoYohMDJunichiSuzukiMDHiroshiToyodaMDKunihiroMashikoMDNaokiShimizuMDTakashiMugurumaMDTadanagaShimadaMDYoshiroKobeMDTomohisaShokoMDKazuyaNakanishiMDTakashiShigaMDTakefumiYamamotoMDKazuhikoSekineMDShinichiIzukaMD
BackgroundThe American Heart Association and European Resuscitation Council guidelines for cardiopulmonary resuscitation present rules for termination of resuscitation (TOR) in cases of out-of-hospital cardiac arrest (OHCA). In Japan, only doctors are legally allowed TOR in OHCA cases.ObjectiveThis study aimed to develop a new TOR rule that suits the actual situations of the Japanese emergency medical services system.MethodsFive different combinations of the TOR rule criteria were compared regarding specificity and positive predictive value (PPV) for 1-month survival with unfavorable neurologic outcomes. The criteria were unwitnessed by emergency medical service personnel, unwitnessed by bystanders, initial unshockable rhythm in the field, initial asystole in the field, no shock delivered, no prehospital return of spontaneous circulation, unshockable rhythm at hospital arrival, and asystole at hospital arrival.ResultsA total of 13,291 cases were included. The following combination provided the highest specificity and PPV for predicting 1-month unfavorable neurologic outcomes and death: unwitnessed by bystanders, initial asystole in the field, and asystole at hospital arrival. The specificity and PPV for the combination of the three criteria for predicting 1-month unfavorable neurologic outcomes were 0.992 and 0.999, and for predicting death at 1 month after OHCA were 0.986 and 0.998, respectively.ConclusionsOHCA patients fulfilling the criteria unwitnessed by bystanders and asystole in the field and at hospital arrival had universally poor outcomes. Termination of resuscitation after hospital arrival for these patients may decrease unwarranted treatments.
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