Abstract:
STUDY OBJECTIVES:Many patients with community-acquired pneumonia are treated empirically without an aggressive search for causative pathogens, an approach adopted largely because of the costs and difficulties encountered during efforts to identify the causative organisms. Blood and sputum cultures are not sensitive, and the more invasive techniques of bronchoscopy and lung biopsy are generally time consuming and not cost-effective. The technique of nonbronchoscopic bronchoalveolar lavage (BAL) has been shown to accurately diagnose the causes of nosocomial pneumonia. The purpose of this study was to determine whether an emergency department-based BAL protocol would lead to more frequent isolation of pneumonia pathogens and result in more changes to tailored antibiotic therapy in comparison with standard care. METHODS:We studied all adult patients admitted with a diagnosis of pneumonia who were tracheally intubated and who had obtainable familial consent in the ED of an urban county hospital from March 1998 to October 1999. Exclusions included antibiotic use within the past 5 days, pneumothorax, hemoptysis, or persistent hypoxia using 100% oxygen. Patients were randomized to standard care versus standard care plus BAL. Blood culture specimens were drawn from all patients before the initiation of antibiotics. All other diagnostic tests were ordered at the discretion of treating physicians. BAL fluid, sputum, and blood culture specimens were tracked, and patient antibiotic course was followed to assess any change in regimen. RESULTS:Twenty-six of 64 patients evaluated for study participation met all eligibility criteria; 14 patients received standard care, and 12 patients received standard care plus BAL. Pneumonia pathogens were identified in 10 (83.3%) of 12 patients in the BAL group and in 4 (28.6%) of 14 patients in the standard care group (P =.007). Comparing BAL versus non-BAL groups, there was no significant difference in the likelihood of overall antibiotic regimen changes (P =.149), but there was a difference with regard to antibiotic changes made in patients with positive culture test results (P =.026). No major complications occurred with BAL catheterizations. CONCLUSION:ED-based BAL catheterization allows for early identification of pathogens in severe community-acquired pneumonia, which leads to changes in antibiotic therapy.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Rodriguez RM,Fancher ML,Phelps M,Hawkins K,Johnson J,Stacks K,Rossini T,Way M,Holland Ddoi
10.1067/mem.2001.118014subject
Has Abstractpub_date
2001-10-01 00:00:00pages
357-63issue
4eissn
0196-0644issn
1097-6760pii
S0196-0644(01)86193-Xjournal_volume
38pub_type
临床试验,杂志文章,随机对照试验abstract::A case is presented of a vaginal foreign body. A drinking glass was inserted in the vagina of an intoxicated patient by her irate lover. Infection followed. The emergency care is described, including the method of extraction of the object, along with discussion of the principles involved and associated complications. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(81)80287-9
更新日期:1981-09-01 00:00:00
abstract:STUDY OBJECTIVE:We compare the efficacy and safety of intravenous lidocaine with that of hydromorphone for the treatment of acute abdominal pain in the emergency department (ED). METHODS:This was a randomized, double-blind, clinical trial conducted in 2 EDs in the Bronx, NY. Adults weighing 60 to 120 kg were randomize...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2019.01.021
更新日期:2019-08-01 00:00:00
abstract::The hypotension and myocardial depression that result from calcium channel blocker ingestion often are refractory to standard therapeutic modalities. Anecdotal reports on the use of glucagon have failed to show significant hemodynamic improvement. We report the first case of calcium channel blocker overdose that respo...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)80997-7
更新日期:1993-07-01 00:00:00
abstract::Decisions about medical resource triage during disasters require a planned structured approach, with foundational elements of goals, ethical principles, concepts of operations for reactive and proactive triage, and decision tools understood by the physicians and staff before an incident. Though emergency physicians ar...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/j.annemergmed.2011.06.012
更新日期:2012-03-01 00:00:00
abstract::A 24-year-old man was assaulted and sustained a stab wound to the left lower neck. When he arrived at the emergency department, he was hemodynamically stable. Although the wound had penetrated the platysma, on initial evaluation the patient did not appear to have sustained significant injury. Closer examination of the...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82619-8
更新日期:1990-12-01 00:00:00
abstract:STUDY OBJECTIVE:We study the incremental value of the ABCD2 score in predicting short-term risk of ischemic stroke after thorough emergency department (ED) evaluation of transient ischemic attack. METHODS:This was a prospective observational study of consecutive patients presenting to the ED with a transient ischemic ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2010.07.001
更新日期:2011-01-01 00:00:00
abstract:STUDY OBJECTIVE:This study measures the degree to which parents of patients, in the course of evaluation and treatment in a pediatric emergency department (ED), could report what they were waiting for. METHODS:Brief in-person interviews were conducted with parents of nonemergency patients during an ED visit. After the...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2007.09.032
更新日期:2008-04-01 00:00:00
abstract::Communication at discharge is an important part of high-quality emergency department (ED) care. This review describes the existing literature on patient understanding and implementation of discharge instructions, discusses previous interventions aimed at improving the discharge process, and recommends best practices a...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/j.annemergmed.2011.10.023
更新日期:2012-08-01 00:00:00
abstract::We present the cases of three patients with skin blisters following carbon monoxide (CO) poisoning. Their blisters appeared to be related to the severity of the poisoning (HbCO levels of more than 40%). Two of the three patients died despite aggressive initial 100% surface oxygen followed by hyperbaric oxygen therapy....
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(85)80792-7
更新日期:1985-06-01 00:00:00
abstract:STUDY OBJECTIVE:To compare patient and practitioner assessments of pain associated with commonly performed emergency department procedures and use of anesthetics before these procedures. METHODS:This was a prospective, observational, cross-sectional study conducted at a university-based ED with a convenience sample of...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:
更新日期:1999-06-01 00:00:00
abstract::We present the case of a diver who experienced the acute onset of shoulder pain after a rapid ascent. It was determined that the patient had decompression sickness ("the bends") of the right shoulder and pulmonary barotrauma resulting in secondary pneumoperitoneum. He underwent decompression, with prompt resolution of...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(87)80240-8
更新日期:1987-11-01 00:00:00
abstract:STUDY OBJECTIVES:To demonstrate the degree to which pulse oximetry overestimates actual oxyhemoglobin (O2Hb) saturation in patients with carbon monoxide (CO) poisoning. This phenomenon has been reported in fewer than 20 humans in the English medical literature. METHODS:A retrospective chart review of 191 patients eval...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(97)70077-5
更新日期:1997-11-01 00:00:00
abstract::In December 2002, the federal government began a program to immunize approximately 500000 civilian public health and health care workers with smallpox (vaccinia) vaccine as a part of our pre-event defense against bioterrorism. First responders will likely follow, and the general US population might be offered vaccinat...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(03)00629-2
更新日期:2003-11-01 00:00:00
abstract::The Trauma Score (TS) is a physiologic measure of injury severity that correlates with patient outcome. Application of the TS has shown that it is useful for patient triage, for predicting patient outcome, and as a means of normalizing for case mix when comparing prehospital care and transport modalities. Our study ex...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(85)80917-3
更新日期:1985-11-01 00:00:00
abstract::Increasing numbers of patients with diagnosed HIV infection are presenting to inner-city emergency departments. Unfortunately, there is little information available on the characteristics and emergency clinical problems of HIV-infected patients to guide physicians in patient care and strategies for resource use. Preli...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82555-7
更新日期:1990-09-01 00:00:00
abstract::Emergency thoracotomy has become a mainstay in the resuscitation of patients with major thoracic injuries. It also is occasionally useful in several other life-threatening conditions. The specific indications for emergency thoracotomy are reviewed, and expeditious thoracotomy in the emergency department, when necessar...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(81)80057-1
更新日期:1981-05-01 00:00:00
abstract:STUDY OBJECTIVES:To characterize the attendance at and presenters of conferences given to emergency medicine residents and to determine the ability of emergency medicine residents to attend conferences while working in the emergency department and on off-service rotations. DESIGN:Descriptive study of an anonymous mail...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(95)70288-1
更新日期:1995-03-01 00:00:00
abstract::Extraordinary incidents resulting in airborne infectious disease outbreaks could produce patient isolation requirements that exceed most hospitals' capacity. This article investigates expedient methods to establish airborne infection isolation areas using a commercially available portable filtration unit and common ha...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2004.07.451
更新日期:2004-12-01 00:00:00
abstract::In a prospective investigation of isolated simple pneumothorax, the treatment of 35 patients with a total of 37 pneumothoraces was studied. A standardized sequential treatment approach was followed for evacuation of the pneumothorax and maintenance of lung reexpansion. The protocol involved catheter placement using a ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(88)80676-0
更新日期:1988-09-01 00:00:00
abstract::Pulmonary embolism, although uncommon in children, occurs in as many as 104 per 100,000 pediatric patients. Undiagnosed and untreated pulmonary embolism has a high mortality rate; thus, a high index of clinical suspicion and reliable diagnostic modalities are necessary to ensure prompt and accurate diagnosis. We repor...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81131-x
更新日期:1991-01-01 00:00:00
abstract:STUDY OBJECTIVE:We estimate the test characteristics of nasogastric aspiration to diagnose upper gastrointestinal tract hemorrhage in patients without hematemesis. METHODS:In this retrospective cohort study, medical records from patients admitted to 2 urban hospitals between 1997 and 2002 for gastrointestinal tract bl...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2003.09.002
更新日期:2004-04-01 00:00:00
abstract::Barium is a divalent alkaline earth metal used as the insoluble sulfate salt in contrast radiography and soluble acid salts in industry. Barium poisoning results from ingestion or inhalation of the acid salts; the most common poisoning occurs after ingestion of the rodenticide barium carbonate (BaCO3). We report seven...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(05)81393-9
更新日期:1991-10-01 00:00:00
abstract:STUDY OBJECTIVES:To compare three different methods of teaching CPR to parents of infants at high risk for sudden cardiopulmonary arrest and to identify characteristics that predict difficulty in learning CPR. METHODS:We conducted a prospective, multicenter clinical trial of 480 parents and other infant caretakers. Su...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0196-0644(98)70133-7
更新日期:1998-08-01 00:00:00
abstract:STUDY OBJECTIVE:The prevalence of agitation among emergency department (ED) patients is increasing. Physical restraints are routinely used to prevent self-harm and to protect staff, but are associated with serious safety risks. To date, characterization of physical restraint use in the emergency setting has been limite...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2018.06.020
更新日期:2019-02-01 00:00:00
abstract:STUDY OBJECTIVE:The potential of infectious disease spread in diseases such as tuberculosis, infectious disease epidemic such as avian flu and the threat of terrorism with agents capable of airborne transmission have focused attention on the need for increased surge capacity for patient isolation. Total negative pressu...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2007.04.017
更新日期:2008-04-01 00:00:00
abstract::Verapamil is considered by many investigators to be the drug of choice for the acute management of uncomplicated PSVT. Several clinical investigators have demonstrated termination of PSVT in more than 90% of their patients within minutes following IV drug administration. The incidence of reported severe adverse reacti...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(81)80013-3
更新日期:1981-10-01 00:00:00
abstract:STUDY OBJECTIVE:News media are used for community education and notification in exception from informed consent clinical trials, yet their effectiveness as an added safeguard in such research remains unknown. We assessed the number of callers requesting opt-out bracelets after each local media report and described the ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2009.05.028
更新日期:2010-01-01 00:00:00
abstract:STUDY OBJECTIVES:To reappraise Boehler's angle and evaluate factors, including centering of the central beam, sex of subjects, and side of the body, that may affect angle measurement. DESIGN:Retrospective clinical review. SETTING:Emergency department, Level I trauma center. TYPE OF PARTICIPANTS:120 consecutive patie...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81206-5
更新日期:1991-02-01 00:00:00
abstract:STUDY OBJECTIVE:Machine-learning algorithms allow improved prediction of sepsis syndromes in the emergency department (ED), using data from electronic medical records. Transfer learning, a new subfield of machine learning, allows generalizability of an algorithm across clinical sites. We aim to validate the Artificial ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2020.11.007
更新日期:2021-01-15 00:00:00
abstract::We reviewed the patterns of injuries sustained by 12 consecutive fallers and jumpers in whom primary impact was onto the feet. The fall heights ranged from 20 to 100 ft. The 12 patients sustained 49 significant injuries. Skeletal injuries were most frequent and included 15 lower extremity fractures, four pelvic fractu...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80107-6
更新日期:1989-02-01 00:00:00