ABSTRACT
UNLABELLED: The Emergency Severity Index (ESI) is a five-level emergency department triage algorithm that provides stratification of patients on the basis of acuity and resource needs, being ESI-1 the highest acuity and ESI-5 the lesser. The ESI triage system was recently adopted at our Emergency Department. We suspect higher acuity patients are facing inappropriate stratification and thus waiting longer to be managed and stabilized. METHODS: A retrospective review of 100 charts was performed to calculate ESI accuracy by triage nurses and the time waiting to be seen by a physician. RESULTS: 41% of the patients were assigned an ESI level of lesser acuity, while 31.6% received the same score as calculated retrospectively. Retrospective ESI-2 patients that were assigned an ESI-4 upon triage faced inappropriate high median waiting time of 58 minutes. CONCLUSIONS: The ESI assigned upon arrival correlated with the median waiting time, exposing undertriaged patients to longer waiting times.
Subject(s)
Emergencies/nursing , Emergency Service, Hospital , Severity of Illness Index , Triage/standards , Algorithms , Emergency Service, Hospital/statistics & numerical data , Hospitals, University/statistics & numerical data , Humans , Nursing Assessment , Nursing Diagnosis , Puerto Rico , Quality Assurance, Health Care , Retrospective Studies , Sampling Studies , Time Factors , Trauma Severity IndicesABSTRACT
Diaphragmatic eventration or diaphragmatic herniations are congenital defect that involve abnormal development of the diaphragm and stretching of the muscular fibers leading to protrusion of abdominal organs into the thoracic cavity. Left sided defects will lead to stomach contents into the chest cavity while, right sided defects will have bowel or liver in the thoracic cavity. Infants with Congenital diaphragmatic hernia often present with respiratory distress that can be life-threatening unless treated appropriately. Bedside ultrasound in the Emergency Department, performed by the Emergency Physician can be a very useful tool in diagnosing conditions such as this one. We present a case of diaphragmatic eventration in a two month old male sent to Emergency Department (ED) by his primary care physician due to a severe case of bronchiolitis.
Subject(s)
Bronchiolitis/complications , Diaphragmatic Eventration/diagnosis , Emergency Service, Hospital , Point-of-Care Systems , Bronchiolitis/diagnostic imaging , Diaphragmatic Eventration/complications , Diaphragmatic Eventration/diagnostic imaging , Diaphragmatic Eventration/surgery , Humans , Incidental Findings , Infant , Liver/diagnostic imaging , Male , Phrenic Nerve/abnormalities , Radiography , UltrasonographyABSTRACT
A 20 year-old female in her 32nd week of gestation presented to the Emergency Department with dysphonia and dysphagia associated to a recent recurrence of a periapical abscess. Her oral examination showed trismus, elevated tongue and neck swelling. A clinical diagnosis of Ludwig's angina was reached, and empirical antibiotic coverage was started. The decompression and drainage placement was performed successfully under local anesthesia without airway compromise. At the moment, no clear guidelines exist for the acute treatment of Ludwig's angina. Establishment of a secure airway has long been considered the gold standard, yet new literature suggests a more conservative management. Ascertaining an early diagnosis at the Emergency Department, and involvement of Anesthesia, Obstetrics, and, Ear, Nose and Throat specialist services is vital for materno-fetal wellbeing. Careful evaluation of the airway status in addition to prompt antimicrobial therapy with surgical decompression may represent a plausible alternative in pregnant patients.
