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Challenges in the Diagnosis of Chronic Obstructive Pulmonary Disease
(Source: Current Emergency and Hospital Medicine Reports)
Source: Current Emergency and Hospital Medicine Reports - September 1, 2014 Category: Emergency Medicine Source Type: research

Use of Fibrinolysis in Acute Pulmonary Embolism
Abstract Acute pulmonary embolism (PE) is a serious medical condition frequently diagnosed in the emergency department. It is a diagnosis which can be difficult to make, yet requires prompt treatment because of its high morbidity and mortality. There are various treatment options available that are chosen based on severity of disease (low-risk PE, submassive PE, and massive PE). In this article, we will focus on determining the level of severity of acute pulmonary embolism as well as the recommended treatment for patients within these three categories. Specifically, we will focus on the use of fibrinoly...
Source: Current Emergency and Hospital Medicine Reports - June 1, 2014 Category: Emergency Medicine Source Type: research

Decreasing Heart Failure Revisits
Abstract Heart failure (HF) is a complex medical condition that is associated with a high rate of HF-related revisits (emergency department and HF hospitalization). Heart failure revisits are associated with worse clinical outcomes and are under scrutiny because of rules imposed by the US Patient Protection and Affordable Care Act and the Hospital Value Based Purchasing program. Many program models and individual strategies have been tested as methods to decrease HF revisits. Many models use similar themes; however, interventions are not always well described in the literature, care providers vary and m...
Source: Current Emergency and Hospital Medicine Reports - June 1, 2014 Category: Emergency Medicine Source Type: research

Diagnostic Testing in Acute Aortic Dissection
Abstract Acute aortic dissection (AAD) is the most common catastrophe to involve the aorta, resulting in high morbidity and mortality. Delayed diagnosis can adversely affect patient outcome, therefore a high clinical index of suspicion is the first step. Absence of the classical signs such as pulse defecit and chest radiograph changes should not falsely reassure clinicians. Availability of a biomarker to expedite and improve diagnosis of AAD would greatly benefit emergency department clinicians. Some promising novel biomarkers include calponin and elastin, but their use in everyday practice is still som...
Source: Current Emergency and Hospital Medicine Reports - June 1, 2014 Category: Emergency Medicine Source Type: research

Vasodilators in Acute Heart Failure: Review of the Latest Studies
Abstract Vasodilators play an important role in the management of acute heart failure (HF), particularly when increased afterload is the precipitating cause of decompensation. The time-honored approach to afterload reduction has been largely focused on use of intravenous nitrovasodilators, and, when properly dosed, this class of agents does provide substantial symptom relief for patients with acute hypertensive HF. Despite this, nitrovasodilators have never been shown to diminish mortality or provide any post-discharge outcome benefit leading to an ongoing search for viable and more effective alternativ...
Source: Current Emergency and Hospital Medicine Reports - June 1, 2014 Category: Emergency Medicine Source Type: research

Galectin 3: Newest Marker of HF Outcomes
Abstract Heart failure is an ever-growing health issue in Western society that affects millions of patients each year. This problem is further exacerbated by high mortality and readmission rates post discharge. Despite recent medical advances, 25 % of patients admitted for heart failure are readmitted within 30 days, and 30 % die within a year. Better risk stratification would decrease such outcomes by identifying patients that require closer follow-up or more aggressive treatment. Galectin-3 is a new heart failure biomarker that has shown great prognostic potential and could aid in such risk stratif...
Source: Current Emergency and Hospital Medicine Reports - June 1, 2014 Category: Emergency Medicine Source Type: research

Bioimpedance Vector Analysis (BIVA) for Diagnosis and Management of Acute Heart Failure
This article aims to describe the usefulness of BIVA in the management of AHF patients in the emergency department. (Source: Current Emergency and Hospital Medicine Reports)
Source: Current Emergency and Hospital Medicine Reports - June 1, 2014 Category: Emergency Medicine Source Type: research

Cardiovascular Admissions, Readmissions, and Transitions of Care
Abstract Hospital 30-day readmissions have become a major priority for hospitals, which face penalties for excessive readmissions for acute myocardial infarction (AMI) and heart failure (HF). Thus, it is important for hospitals to understand the transitions of care that occur for both of these conditions, and what tools are available to guide the processes involved. A multi-disciplinary team including Emergency Medical Service providers, Emergency Medicine providers, cardiologists, hospitalists, pharmacists, nurses, case managers, and outpatient physicians can all be involved in the process of safely tr...
Source: Current Emergency and Hospital Medicine Reports - March 1, 2014 Category: Emergency Medicine Source Type: research

Observation Units: Definition, History, Data, Financial Considerations, and Metrics
Abstract Observation units are dedicated units built to provide efficient protocol-based care to patients with well-defined diagnoses or presenting symptoms such as chest pain, asthma, and congestive heart failure. Only approximately one-third of US hospitals currently have an observation unit. The efficiency which results from use of such units may improve bed capacity in individual hospitals and also provide great national cost savings as care is delivered safely in less time with use of fewer resources. Starting a unit can be challenging and there is much to be considered when selecting a medical dir...
Source: Current Emergency and Hospital Medicine Reports - March 1, 2014 Category: Emergency Medicine Source Type: research

Appropriate Use of Telemetry Monitoring in Hospitalized Patients
Abstract Non-intensive telemetry units are overused in hospitalized patients, either inappropriately initiated in low arrhythmia risk patients or continued beyond the recommended duration of monitoring. By far, the largest group of monitored patients is those with chest pain syndromes. The practice guidelines for telemetry monitoring are limited in scope, and chart audits show only moderate adherence by providers; up to 43 % of monitored patients have no indication for monitoring. Review of the available evidence supports the selection of a subset of chest pain patients that have a very low risk of arr...
Source: Current Emergency and Hospital Medicine Reports - March 1, 2014 Category: Emergency Medicine Source Type: research

How to Develop and Validate Institutional ACS Protocols: Guidelines and Transitions of Care in ACS Management
The objective of this article is to review processes for developing and validating institutional protocols that focus on management, communication, and transitions of care for ACS patients. (Source: Current Emergency and Hospital Medicine Reports)
Source: Current Emergency and Hospital Medicine Reports - March 1, 2014 Category: Emergency Medicine Source Type: research

Evidence for Basal–Bolus Insulin Versus Slide Scale Insulin
Abstract Greater understanding of hyperglycemia and its control in non-ICU patients has become ever more urgent given the high and increasing prevalence of diabetes in the general population and, hence, in hospitalized patients. It is well accepted that hyperglycemia in hospitalized patients is common and associated with profound medical consequences, longer lengths of stay, high healthcare costs, and adverse outcomes. It is a marker for poor clinical outcome and mortality. Although evidence that supports intensive glycemic control in critically ill patients is strong, glycemic control is often o...
Source: Current Emergency and Hospital Medicine Reports - March 1, 2014 Category: Emergency Medicine Source Type: research