Referred vs Spontaneous Visits at Pediatric ER: an Outcome Study
Emergency SurgicalSince 80's, admissions in Emergency medical services increase regularly. Children represents 30% of the patients in Emergency medical Service. Only 20% of admissions are hospitalized and only 3 % need emergency care. Consequences are team's exhaustion, a reduction of healthcare quality, a slowdown in emergency care. Investigator decided to realize an epidemiologic prospective study in Emergency medical and surgical Pediatric Service in Strasbourg Teaching Hospital to compare coverage of children who are referred by a liberal doctor with children who are coming by themselves matched with age and complaint. This study will analyze the relevance of complaints and decision-making factors for the liberal doctor to send children in Emergency Medical and Surgical Service. Investigator will talk about the importance of close collaboration between liberal doctor and hospital doctor, as well as patient's information about basic care service on nights and week-ends in order to decrease the number of emergency admission.
DetermInants of Antimicrobial Use aNd De-escalAtion in Critical Care
EmergenciesAppropriate initial antibiotic therapy is crucial in the treatment of severe infections in patients with intensive care. Adequate spectrum and appropriate doses are the keys to achieving the therapeutic goal. Despite broad consensus on the spectrum and timing of antimicrobial therapy, antibiotic use varies according to various parameters including choice, dose, method of administration, duration of antibiotic therapy and de-escalation. an empirical attitude. Therapeutic de-escalation is considered essential for the use of antibiotics and is now clearly established by different consensus. However, routine de-escalation has recently been questioned in a randomized, controlled study that did not demonstrate non-inferiority of de-escalation with an increase in the number of days of antibiotic therapy associated with an increased number of days. superinfection. The components of the de-escalation described in the literature, are based on the reduction of the number of antibiotics, the strict observance of the spectrum of the antibiotic, the reduction of use of the antibiotic, the stopping of any inappropriate antibiotic treatment ( lack of in vitro activity). De-escalation can be considered in different ways; there are significant variations between hospitals, countries, teams. A large European multicenter cohort is needed. The main objective of this study is to describe empiric antibiotic therapy in intensive care and the modalities of de-escalation.
Non Attendance at Scheduled Appointments as a Marker of Mortality and Hospital Admission
Appointments and SchedulesOutpatient Clinics4 moreTo evaluate the association of non attendance at scheduled appointments with visits in the emergency department, hospitalizations and mortality during one year follow up.
Non-Invasive Shock: Differentiating Shock in the Emergency Department
ShockInfection1 moreThe goal of this study is to compare the characteristics of echocardiography and different monitoring devices in shock patients, the relationship of device parameters to biomarkers associated with shock, and determine if these any of these add clinical utility when predicting the cause of shock. We will perform a prospective, observational study of patients found to have shock physiology in the ED and follow them to determine the final shock category and ultimate outcomes.
Anesthesia for Emergency Orthopedic Surgery
AnesthesiaThe aim of this retrospective study is to evaluate the preferred anaesthesia techniques in our clinic for emergency orthopedic surgery at a 1 year period.
Observatory on Emergency Care for Acute Coronary Syndrome in Grand Est of France
Acute Coronary SyndromeThe purpose is to build up a data observatory of individuals with thoracic pain evoking acute coronary syndrome (ACS). The aim is the characterization of this population of patients consulting at emergency department, the evaluation of therapeutic strategies with regard to guidelines and the becoming of patients including severe complications and mortality.
Ultrasound Emergency Diagnosis of Small Bowel Obstruction
Obstruction BowelSmall bowel obstruction (SBO) is a common presentation to the emergency department (ED) and represents 15% of hospital admissions for acute abdominal complaints. Plain radiography, although traditionally recommended as the initial diagnostic imaging modality of choice, has a sensitivity of only 59% to 77%. When clinical and radiographic assessment is indeterminate, computed tomography (CT) becomes the test of choice due to its superior resolution and increased ability to identify both obstruction and its aetiology Aim: this is a prospective study in a sample of patients presenting to the emergency department (ED) with abdominal pain, vomiting, or other symptoms suggestive of a SBO (history of previous surgeries, constipation, abnormal bowel sounds, and abdominal distention). Patients will be evaluated with US prior to x-ray and CT, with possible diagnostic confirms by endoscopy or surgery.
Emergency Department Assessment of Right Ventricular Function and Size in the Post Cardiac Arrest...
Right Ventricular DysfunctionCardiac ArrestThe right side of the heart of often overlooked in patients who are acutely unwell, as the main area of focus when performing echocardiography tends to be the left ventricle. The right ventricle can yield important diagnostic clues that can aid the clinician, particularly in cases where one may suspect elevated right sided pressures, such as those due to a pulmonary embolus. Although it is taught that a dilated right ventricle is associated in patients with pulmonary embolus, but in patients with spontaneous circulation. What is unknown is patients who sustain a cardiac arrest, does the same hold true. There is a paucity of literature surrounding the appearance of the right ventricle in the cardiac arrest patient acutely. This study aims to assess right ventricular size and function in the immediate post cardiac arrest phase.
ED Overcrowding Validation Study
Emergency Department OvercrowdingThe aim of this study is to externally validate a new emergency department overcrowding estimation tool (SONET) developed at John Peter Smith Health Network (JPS).
Current Trend of Epidemiology of Psychiatric Emergency and the Stress of Duty Psychiatric Resident...
Emergent PsychiatricConsultation1 moreAgitation, paranoia, and suicide risk of the psychiatric patients made them difficult to be managed when they visited medical emergency services. The prolonged waiting time at medical emergency services and the stigmatization of psychiatric medicine also made the psychiatric emergency services full of challenges. However, in recent years, the random killings, celebrity suicide and other major social events attracted much attention to the emergency psychiatry. Following the establishment of the National Health Insurance, the law of mandatory admission, and the prevalence change of all psychiatric diseases, we are now dealing with totally different types of emergent psychiatric conditions, i.e., depression and suicide. However, the real epidemiological data need to be updated. Psychiatric emergency is one of the entrances of the psychiatric network. A comprehensive review of the psychiatric emergency would be needed for the base of further research. This study is aimed to investigate the prevalence of psychiatric diagnosis of patients who came to Emergency Department of National Taiwan University Hospital and needed a psychiatric consultation. The epidemiological data will be compared to those collected 30 years ago in the same hospital to examine the 30-year trend. On the other hand, the visiting time and the staying time will be analyzed. The stress of on-duty and the contributing factors will be assessed by a 2-hour in-depth interview with psychiatric residents.