Neergaardbird6965

Reason for revisit included natural progression of disease (67.6%), new condition or problem (11.2%), diagnostic error (6.9%), and scheduled or planned readmissions (3.5%). All diagnostic errors had not been previously identified by ED leadership. Of the reviewed cases, most were not preventable (84.0%); however, a number of system-level actions resulted from discussion of the potentially preventable revisits. CONCLUSIONS Seventy-two-hour ED revisits were efficiently and systematically categorized with determination of root causes and preventability. This process resulted in shared provider-level feedback, identifying trends in revisits, and implementation of system-level actions, therefore, encouraging other institutions to adopt a similar process.BACKGROUND Intubated pediatric patients with isolated traumatic brain injury (TBI) are a diagnostic challenge for early detection of altered cerebral physiology instigated by trauma-induced increased intracranial pressure (ICP) while preventing secondary neuronal damage (secondary insult detection) and assessing the effects of increased ICP therapeutic interventions (3% hypertonic saline [HTS]). Invasive brain tissue oxygen monitoring is guiding new intensive care unit TBI management but is not pediatric emergency department (PED) readily accessible. Objective measurements on pediatric isolated TBI-altered bihemispheric cerebral physiology and treatment effects of 3% HTS are currently lacking. Cerebral oximetry can assess increased ICP-induced abnormal bihemispheric cerebral physiology by measuring regional tissue oxygenation (rcSO2) and cerebral blood volume index (CBVI) and the mechanical cerebrospinal fluid removal effects on the increased ICP-induced abnormal bihemispheric cerebral physiology.In the PED i; right) for rcSO2 10 demonstrated the greatest significant positive delta change and required the greatest numbers of 3% HTS infusions. Overall, 3% HTS produced a significant positive 15% change within 2.1 minutes of infusion, whereas heart rate showed no significant change. During trauma neuroresuscitation, especially in intubated isolated TBI patients requiring 3% HTS, cerebral oximetry has shown its functionality as a rapid adjunct neurological, therapeutic assessment tool and should be considered in the initial emergency department pediatric trauma neurological assessment and neuroresuscitation regimen.OBJECTIVE This descriptive study aimed at evaluating the impact of distance between a general and pediatric emergency department (PED) on adults seeking care at PEDs. METHODS The Pediatric Health Information Systems database was used to perform a retrospective study of all adult patients presenting to PEDs from 2005 to 2015. Data regarding age, disposition, pregnancy status, insurance status, median household income, all-patients refined diagnosis-related groups, and procedures were gathered. Distances were categorized as PEDs less than 1 mile and 1 mile from a general facility. Data were analyzed for the entire population, in addition to those 45 years old. RESULTS The majority of patients were discharged from the ED; transfers were more frequent at PEDs 1 mile away from a general facility. Death was rare, with minimal differences noted between interfacility distances (21 0.25% vs 0.24%; 45 0.36% vs 0.32%). Cardiopulmonary resuscitation occurred in 0.25% with no differences based on location. Pregnant women visits and childbirth occur more frequently in PEDs closer to general facilities (4.89% vs 2.85%, P less then 0.05; 0.07% vs 0.03%, P less then 0.05, respectively). Chest pain was seen more frequently at PEDs located farther away from general EDs, the difference more pronounced in those 45 years old (21 5.12% vs 6.3%; 45 6.61% vs 13.17%). CONCLUSIONS Statistically significant differences were seen in the adult population presenting to PEDs based on the interfacility distance between a pediatric and general ED. These data can help PEDs prepare for the adult patients they are more likely to treat.Subgaleal hemorrhage is commonly described in the neonatal population but is a rare injury in young children and adolescents. Though infrequently seen, it can follow blunt head trauma or hair pulling. This case report details a 4-year-old African American boy with massive subgaleal hemorrhage and bilateral periorbital swelling and ecchymosis as a result of hair pulling in the setting of child physical abuse. The patient was evaluated in the emergency department for swelling of his scalp several hours after reportedly bumping his head on a chair. He was discharged home after a head computed tomography only confirmed soft tissue hematoma. The following morning, the findings progressed and he returned to the emergency department. IACS-010759 supplier He was triaged as a trauma and initially evaluated by the emergency physician, pediatric trauma surgeon, and pediatric neurosurgeon. Head computed tomography scan confirmed diffuse scalp edema without skull fracture or intracranial pathology. The child abuse specialty service was consulted for suspected child physical abuse. Their examination revealed numerous scattered bruises on the trunk and thighs, several of which were patterned. Local police investigation resulted in the patient's grandfather confessing to striking the patient with a belt and picking him up from the ground by his hair, the latter of which is a mechanism consistent with the patient's dramatic scalp and facial findings. The authors encourage consultation by a specialist in child abuse pediatrics for subgaleal hemorrhage and/or raccoon eyes in the presence of minor trauma, as well as thorough head-to-toe skin examination for all children presenting with injuries.OBJECTIVE Fractures in children are common and account for 10% to 25% of injuries in children with considerable effects on activity restriction and subsequent high socioeconomically impact. Eighty percent of all fractures in children occur at the upper extremity. The article investigates the epidemiology and fracture pattern of the upper extremity within a pediatric population consulting a tertiary referral hospital in Switzerland. METHODS Study population included all patients younger than 18 years presenting with an upper extremity fracture. Recorded data were age, sex, side, season of the year, mechanism, type of fracture, and applied treatment. RESULTS Fractures of the upper extremities represented 76% with a mean age of 9 years and 7 months. Compared with girls, boys had a risk ratio of 1.35 (1.14-1.6) of having a traumatic injury. The radius, with 298 fractures (37%), was the most injured bone. Overall simple fall from his or her height and soccer represented the main injury mechanisms accounting for 26% and 9%, respectively. Eighty-six percent of fractures were treated by cast with or without closed reduction, 11% (92) by closed reduction and pinning or elastic stable intramedullary, and only 3% of fractures were treated by open reduction and internal fixation. CONCLUSIONS Eighty-six percent of all fractures could be treated by conservative methods. Only 17% need surgical treatments by orthopedic surgeons. This shows how important it is to train residents in pediatrics for the treatment of upper limb fractures in children.BACKGROUND Many instructional classrooms now exist in the online environment, where it is difficult to integrate experiential teaching strategies. Autopsy-based education has been shown to be a valuable teaching tool for pathophysiology in a medical school curriculum. PROBLEM There is a gap in the literature about the use of an autopsy observation in nurse practitioner (NP) education. APPROACH The purpose of this project was to develop and evaluate the effectiveness of an autopsy experience for NP students in an online advanced pathophysiology course. OUTCOMES Based on a review of course evaluations and reflective essays, the majority of students found this to be a valuable learning experience. The main barrier was locating a facility and scheduling the autopsy observation. CONCLUSION The benefits outweigh the barriers to providing experiential learning with an autopsy observation in an online pathophysiology course. As such, it should be considered in similar course offerings.AIM To characterize different patterns of variability of three repeated within-visit blood pressure (BP) readings and to determine the prevalence of specific variation trends in systolic (SBP), diastolic (DBP) blood pressure and pulse pressure (PP). METHODS Data from 53 737 subjects from the National Health and Nutrition Examination Survey were analyzed. In each subject, three consecutive BP measurements were performed with a minimum time-interval of at least 30 s. We propose three patterns of within-visit BP variability (separately for SBP, DBP and PP) (1) increasing trend (BP3 > BP2 > BP1); (2) decreasing trend (BP1 > BP2 > BP3) and (3) no trend (BP3 ≈ BP2 ≈ BP1). A threshold of minimum change (ΔP > 3 mmHg) between BP1-BP2 and BP2-BP3 was also applied as a prerequisite for the definition of these trends. RESULTS An increasing trend was observed among three consecutive measurements of SBP, DBP and PP in 7.4, 10.4 and 10.2%, respectively. When a minimum threshold of 3 mmHg was set the respective increasing trends were observed in 1.8, 2.9 and 4.4%, respectively. There was a higher prevalence of decreasing trend within three consecutive SBP, DBP and PP readings 17, 13.1 and 16.2%, respectively, whereas using a threshold of ΔP >3 mmHg the respective prevalence was 6.3, 4.1 and 7.7%. A maximum absolute difference >10 mmHg within triplicate of SBP/DBP/PP readings was observed in 12.9, 13 and 29.4%, respectively. In the era of personalized medicine, these patterns are well worth further investigation concerning their pathophysiologic and clinical relevance.Onset delay of current antidepressants is always the most significant limitation for the treatment of depression. More attention has been given to the glutamate acid system for developing fast-onset antidepressants. Xenon, acting as a well-known N-methyl-D-aspartate receptors antagonist, has been widely used clinically as anesthetics and was reported to exert antidepressant-like effects in rats under normal condition. The robust and rapid-acting antidepressant- and anxiolytic-like activities of xenon through the use of depression rodent model are still elusive. By using lipopolysaccharide-induced depression mice models, the present study aimed to evaluate the fast-acting antidepressant-like effects of xenon pretreatment. Behavioral tests, mainly including open-field test, novelty-suppressed feeding test, sucrose preference test, tail suspension test, and forced swimming test, were conducted respectively. Our results showed that both xenon gas and xenon-rich saline pretreatment intraperitoneally produced significant antidepressant- and anxiolytic-like activities in mice under normal condition. Further, xenon gas pretreatment (intraperitoneally) rapidly blocked lipopolysaccharide-induced depression- and anxiety-like behaviors of mice. These findings provide direct evidence that xenon could produce fast-onset antidepressant- and anxiolytic-like activities, which highlights the possibility to develop xenon as a promising fast-acting drug for treatment of depression, anxiety, and even other stress-related diseases.