Emergency Department Observation Unit Utilization Among Older Patients With Chest Pain.

Background: Although some emergency department observation units (EDOUs) may exclude patients over 65 years old, our EDOU accepts patients up to 79 years old. We assessed the utilization of our EDOU by older patients (those 65-79 years old).

Methods: We prospectively enrolled emergency department (ED) patients with chest pain.

Mesh pouch pexy in the management of J-pouch prolapse.

J-pouch prolapse is a rare complication after IPAA. To date, limited data exist regarding management of this condition, with most reported cases involving suture pouch pexy. We present our experience and technique with 3 patients who were treated with transabdominal mesh pexy repair.

Prospective evaluation of an ED observation unit protocol for trauma activation patients.

Background: The University of Utah emergency department (ED) observation unit (EDOU) cares for over 2500 patients each year, with a significant portion of these patients being trauma activation patients. We evaluated the safety and efficacy of our EDOU trauma protocol and described patient characteristics and outcomes of trauma patients managed in an EDOU.

Methods: We performed a prospective observational study of all trauma patients admitted to the EDOU over a 1-year period.

EDOU staffing by PAs: what are the effects on patient outcomes?

Objective: An emergency department observation unit (EDOU) opened in April 2006 staffed by physician assistants (PAs) and nurse practitioners (NPs). This study describes the complexity and outcomes of the EDOU patients to determine the effectiveness of staffing by PAs.

Methods: A retrospective chart review was performed of chest pain and trauma patients in the EDOU from April 2006 through May 2007.

Low-risk young adult patients with chest pain may not benefit from routine cardiac stress testing: a Bayesian analysis.

Introduction: Low-risk emergency department (ED) chest pain patients with a nondiagnostic electrocardiogram (ECG) and negative cardiac biomarkers are commonly evaluated with cardiac stress testing to detect undiagnosed coronary artery disease. Provocative testing incurs certain costs and may require additional time investment either in the ED or in an observation setting. Recent research has questioned the utility of provocative testing in young adults with negative cardiac biomarkers and nondiagnostic ECG.

Serial hematocrit testing does not identify major injuries in trauma patients in an observation unit.

Background: Routine serial hematocrit measurements are a component of the trauma evaluation for patients without serious injury identified on initial evaluation. We sought to determine whether serial hematocrit testing was useful in detecting significant intra-abdominal injuries in trauma patients in our observation unit.

Methods: We performed a retrospective chart review of all trauma patients placed in our observation unit over a 14-month period.

Patients with coronary disease fail observation status at higher rates than patients without coronary disease.

Background: Few studies have evaluated emergency department (ED) observation unit chest pain protocols for optimal patient characteristics and admission rates. At our 35 000-visits/y ED, we implemented a chest pain protocol for our observation unit that allowed emergency physicians to admit patients with known coronary artery disease (CAD).

Methods: We performed a retrospective chart review of all observation unit patients admitted under the chest pain protocol from April 1, 2006, to May 31, 2007.

Utility of the emergency department observation unit in ensuring stress testing in low-risk chest pain patients.

Background: Recent research has noted low rates of compliance among ED chest pain patients referred for outpatient stress testing. The practice at our institution, a 39,000 visits per year emergency department (ED), is to place chest pain patients considered low risk for acute coronary syndrome in an observation unit for serial biomarker testing and provocative cardiac testing. Our objective was to determine the rates of positive stress tests among this group and to extrapolate from this the potential missed positive stress tests if these patients were referred instead for outpatient stress testing.

Observation unit admission as an alternative to inpatient admission for trauma activation patients.

Background: At this 35 000 visits/year emergency department (ED) at a level one trauma centre, a trauma protocol was implemented for the ED observation unit. Data on all trauma observation unit admissions were then collected to evaluate for safety, efficiency and admission rates.

Methods: A retrospective chart review was performed of all trauma patients in the observation unit during a 14-month period.

Physician documentation of nonspecific EKG changes predicts hospital admission among observation unit chest pain patients.

Our emergency department (ED) observation unit specifically excludes patients with "significant" electrocardiogram (EKG) findings, but patients may be admitted with "nonspecific" EKG findings. We evaluated whether physician documentation of nonspecific findings predicted eventual admission to an inpatient unit from the observation unit. We reviewed the charts of all chest pain patients admitted to our ED observation unit over a 14-month period.

Appropriately screened geriatric chest pain patients in an observation unit are not admitted at a higher rate than nongeriatric patients.

Objective: Observation units may exclude geriatric patients (defined as age >or=65) due to the high rate of observation failure (admission to an inpatient unit) among these patients. We evaluated whether geriatric patients on a chest pain protocol are admitted to an inpatient unit from an emergency department (ED) observation unit at a higher rate than nongeriatric patients.

Methods: This was a retrospective chart review of all patients placed in the ED observation unit at the University of Utah Medical Center over a 14-month period from April 2006 to June 2007.

Changes in heart rate do not correlate with changes in pain intensity in emergency department patients.

The objective of this study was to determine the correlation, if any, between change in heart rate (HR) and change in pain in Emergency Department (ED) patients. This was a prospective, observational study of a convenience sample of patients presenting to an academic ED with pain. Heart rate and pain intensity (using a 100-mm visual analog scale) were determined at time of triage, 30 min post pain treatment, and at discharge.

Venturi atomizers as potential sources of patient cross-infection.

Venturi-principle atomizers, which rely on compressed air to aerosolize medications, are commonly used in clinical practice to apply topical anesthetics and vasoconstrictors to the mucous membranes of the nose and throat. Unfortunately, the mechanism by which these devices operate leads to aspiration of external contaminants back into the device at the end of the spray cycle. This "flaw" in design may make Venturi-principle atomizers unsafe for clinical practice because of the risk of patient cross-infection.

Solute transport in crystalline rocks at Aspö--I: geological basis and model calibration.

Water-conducting faults and fractures were studied in the granite-hosted Aspö Hard Rock Laboratory (SE Sweden). On a scale of decametres and larger, steeply dipping faults dominate and contain a variety of different fault rocks (mylonites, cataclasites, fault gouges). On a smaller scale, somewhat less regular fracture patterns were found.

The comparative risks of bacterial contamination between a venturi atomizer and a positive displacement atomizer.

Introduction: This laboratory study determined the incidence of internal contamination of Venturi principle atomizers and positive displacement atomizers exposed to high external concentrations of Staphylococcal aureus (Staph).

Methods: Atomizer device nozzle tips were immersed into a Staph solution and I ml of spray was atomized via compressed wall air (Venturi) or hydraulic pump (positive displacement). The Venturi nozzle was then wiped with 70% isopropyl alcohol while the disposable positive displacement nozzle was replaced.

Patient expectations for pain medication delivery.

The purpose of this study was to evaluate emergency department (ED) patient expectations for the delivery of pain medication and correlation of satisfaction with meeting patient needs for pain relief. In this prospective survey of 458 ED patients with pain, the patients reported a mean of 23 minutes as a reasonable wait for pain medication versus 78 minutes for the actual delivery of pain medication. Forty-five percent of patients received pain medication and 70% had their needs for pain relief met.

Visual acuity after topical application of proparacaine.

Study Objective: To determine the effect of topical anesthetics on visual acuity (VA).

Methods: We studied 66 consecutive patients (73 afflicted eyes) who presented to a university hospital emergency department with the complaint of eye pain. VA was measured before and after patients were treated with proparacaine, a topical ocular anesthetic.

Detection of intestinal ischemia in patients with acute small-bowel obstruction due to adhesions or hernia: efficacy of CT.

Objective: The purpose of this study was to determine whether CT can be used to diagnose ischemia of the small intestine in patients with small-bowel obstruction due to adhesions or hernia.

Subjects And Methods: During a 12-month period, 60 patients underwent surgery for complete or high-grade small-bowel obstruction due to adhesions or hernia, and 29 (48%) had evidence of associated intestinal ischemia. All of these patients had been preoperatively diagnosed by CT as having high-grade small-bowel obstruction.

Cardiovascular effects of carbamazepine toxicity.

Study Objective: To evaluate the cardiovascular effects of carbamazepine in patients presenting to the emergency department.

Design: A retrospective case series from February 1, 1985, to July 30, 1993.

Setting: Six urban EDs.

Distinction between postoperative ileus and mechanical small-bowel obstruction: value of CT compared with clinical and other radiographic findings.

Objective: The expeditious diagnosis of complete and partial mechanical small-bowel obstruction, as opposed to paralytic ileus, during the immediate postoperative period may be difficult on the basis of clinical and plain film radiographic findings. For this reason, we prospectively evaluated the use of CT in this setting and compared it with the clinical and plain film evaluations as well as with various contrast examinations.

Subjects And Methods: Thirty-six postoperative patients with signs and symptoms of paralytic ileus or mechanical small-bowel obstruction were examined clinically and had plain abdominal radiographs.

Surgical management of complications of fiberoptic colonoscopy.

A variety of complications are associated with fiberoptic colonoscopy. Life-threatening complications such as perforation and hemorrhage may require surgical intervention. The records of all patients who underwent fiberoptic colonoscopy, with or without biopsy, polypectomy, electrocoagulation, or laser therapy at St.

Demographic and electrocardiographic factors associated with severe tricyclic antidepressant toxicity.

This study was designed to evaluate a historic cohort of pure tricyclic antidepressant overdose patients for factors associated with severe toxicity. Hospitalized tricyclic antidepressant overdose patients were identified by computerized discharge diagnosis (ICD-9 codes). Patients with a serum drug screen positive for tricyclic antidepressants and an emergency department 12-lead electrocardiogram were included in the study.

Intravenous catheter aspiration for obtaining basic analytes during intravenous infusion.

The aspiration of blood through a functioning IV line to obtain samples for laboratory analysis was evaluated. Thirty-eight emergency department patients were studied. Each had an 18-gauge IV catheter placed and then received a 100-mL bolus of either normal saline, lactated Ringer's, or 5% dextrose in water.

Nifedipine for the relief of renal colic: a double-blind, placebo-controlled clinical trial.

Pain from ureteral stones is believed to be due to spasm and hyper-peristalsis of the involved ureter. Nifedipine has been shown to decrease human ureteral spasm in vitro. Conflicting results have been reported concerning the clinical efficacy of nifedipine in relieving acute renal colic.