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1.
Recurso de Internet en Español | LIS - Localizador de Información en Salud, LIS-ES-PROF | ID: lis-LISBR1.1-47024

RESUMEN

Documento técnico que contiene: introducción, herramientas de triaje, identificar el caso en investigación, equipo de protección individual, procedimiento diagnóstico, tratamiento en urgencias, limpieza, desinfección y gestión de residuos del cuarto de aislamiento, traslado del paciente en la urgencia extrahospitalaria, referencias y anexos.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Neumonía Viral , Servicio de Urgencia en Hospital , Servicios Médicos de Urgencia , Equipo de Protección Personal , Administración de Residuos
3.
Rev Med Liege ; 75(2): 83-88, 2020 Feb.
Artículo en Francés | MEDLINE | ID: mdl-32030931

RESUMEN

Facing the aging of primary care practitioners and their still increasing duties, we implemented a new and original solution to maintain the continuity of primary care in the area surrounding of our university hospital. Thereby, we created a new model of nurse telephone triage for the regulation of out-of-hours primary care calls, the SALOMON algorithm ("Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne"). Following the nurse telephone triage and the assessment of the illness severity, the patient is referred to four potential orientations : Emergency Medical Services (EMS), Emergency Department Referred Consultation (EDRC), Primary Care Physician Home visit (PCPH) and Primary Care Physician Delayed visit (PCPD). In this article, we aim to describe the SALOMON model and present a 12-month feasibility study in order to determine the safety of the tool. We can also notice nurse and general practitioner satisfaction about this approach with a positive impact on the global primary care out-of-hour organization. Currently, SALOMON seems to be full of promise. Further investigations on a larger cohort are needed to determine more precisely the reliability of the algorithm.


Asunto(s)
Servicio de Urgencia en Hospital , Atención Secundaria de Salud , Triaje , Urgencias Médicas , Humanos , Reproducibilidad de los Resultados , Teléfono
6.
Lancet ; 395(10221): 339-349, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-32007169

RESUMEN

BACKGROUND: Acute atrial fibrillation is the most common arrythmia treated in the emergency department. Our primary aim was to compare conversion to sinus rhythm between pharmacological cardioversion followed by electrical cardioversion (drug-shock), and electrical cardioversion alone (shock-only). Our secondary aim was to compare the effectiveness of two pad positions for electrical cardioversion. METHODS: We did a partial factorial trial of two protocols for patients with acute atrial fibrillation at 11 academic hospital emergency departments in Canada. We enrolled adult patients with acute atrial fibrillation. Protocol 1 was a randomised, blinded, placebo-controlled comparison of attempted pharmacological cardioversion with intravenous procainamide (15 mg/kg over 30 min) followed by electrical cardioversion if necessary (up to three shocks, each of ≥200 J), and placebo infusion followed by electrical cardioversion. For patients having electrical cardioversion, we used Protocol 2, a randomised, open-label, nested comparison of anteroposterior versus anterolateral pad positions. Patients were randomly assigned (1:1, stratified by study site) for Protocol 1 by on-site research personnel using an online electronic data capture system. Randomisation for Protocol 2 occurred 30 min after drug infusion for patients who had not converted and was stratified by site and Protocol 1 allocation. Patients and all research and emergency department staff were masked to treatment allocation for Protocol 1. The primary outcome was conversion to normal sinus rhythm for at least 30 min at any time after randomisation and up to a point immediately after three shocks. Protocol 1 was analysed by intention to treat and Protocol 2 excluded patients who did not receive electrical cardioversion. This study is registered at ClinicalTrials.gov, number NCT01891058. FINDINGS: Between July 18, 2013, and Oct 17, 2018, we enrolled 396 patients, and none were lost to follow-up. In the drug-shock group (n=204), conversion to sinus rhythm occurred in 196 (96%) patients and in the shock-only group (n=192), conversion occurred in 176 (92%) patients (absolute difference 4%; 95% CI 0-9; p=0·07). The proportion of patients discharged home was 97% (n=198) versus 95% (n=183; p=0·60). 106 (52%) patients in the drug-shock group converted after drug infusion only. No patients had serious adverse events in follow-up. The different pad positions in Protocol 2 (n=244), had similar conversions to sinus rhythm (119 [94%] of 127 in anterolateral group vs 108 [92%] of 117 in anteroposterior group; p=0·68). INTERPRETATION: Both the drug-shock and shock-only strategies were highly effective, rapid, and safe in restoring sinus rhythm for patients in the emergency department with acute atrial fibrillation, avoiding the need for return to hospital. The drug infusion worked for about half of patients and avoided the resource intensive procedural sedation required for electrical cardioversion. We also found no significant difference between the anterolateral and anteroposterior pad positions for electrical cardioversion. Immediate rhythm control for patients in the emergency department with acute atrial fibrillation leads to excellent outcomes. FUNDING: Heart and Stroke Foundation of Canada and the Canadian Institutes of Health Research.


Asunto(s)
Antiarrítmicos/uso terapéutico , Fibrilación Atrial/terapia , Cardioversión Eléctrica , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Protocolos Clínicos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven
11.
Isr Med Assoc J ; 22(1): 5-7, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927797

RESUMEN

BACKGROUND: Many procedures requiring sedation in the pediatric emergency department are performed by consultants from outside the department. This team usually includes orthopedic surgeons and general surgeons. As sedation is now a standard of care in such cases, we evaluated consultants' views on sedation. OBJECTIVES: To evaluate consultants' views on sedation. METHODS: A questionnaire with both open-ended questions and Likert-type scores was distributed to all orthopedic surgeons and general surgeons performing procedures during the study period. The questionnaire was presented at three medical centers. RESULTS: The questionnaire was completed by 31 orthopedic surgeons and 16 general surgeons. Although the vast majority (93-100%) considered sedation important, a high percentage (64-75%) would still perform such procedures without sedation if not readily available. CONCLUSIONS: Sedation is very important for patients and although consultants understand its importance, the emergency department staff must be vigilant in both being available and not allowing procedures to "escape" the use of sedation.


Asunto(s)
Sedación Consciente , Consultores/estadística & datos numéricos , Servicio de Urgencia en Hospital , Actitud del Personal de Salud , Niño , Sedación Consciente/métodos , Sedación Consciente/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Cirujanos Ortopédicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cirujanos/estadística & datos numéricos , Encuestas y Cuestionarios
12.
Isr Med Assoc J ; 22(1): 8-12, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927798

RESUMEN

BACKGROUND: Heart failure centers with specialized nurse-supervised management programs have been proposed to improve prognosis. The Heart Failure Center in Beit Shemesh, Israel, is located within a large primary care facility. The specialist team supervised the managememt of patients both within the frame of the center and while they were hospitalized. OBJECTIVES: To evaluate the health services utilization by heart failure patients treated at a heart failure center and their clinical outcome. METHODS: In this retrospective study, we compared the clinical outcome of patients treated at a heart failure center to patients who received the standard care in 2013-2014. The clinical outcome included primary care visits, emergency room visits, hospitalizations, and death. RESULTS: The study comprised 430 heart failure patients; 82 were treated at the heart failure center and 348 under standard care. At baseline, no significant differences were seen in clinical parameters between the groups. Healthcare utilization was higher among the study group. No significant changes in healthcare utilization were found. During follow-up, patients treated in a heart failure center were more likely to get recommended heart failure medications. Mortality was significantly lower in patients treated in the heart failure center compared with those receiving standard care 3.6% vs. 24%, respectively (P = 0.001), hazard ratio 0.19, 95% confidence interval 0.06-0.62, P = 0.005. CONCLUSIONS: Joint management of heart failure by primary clinics and a specialized community heart failure center reduced mortality. There was no decrease in healthcare utilizations among heart failure center patients, despite the reduction in mortality.


Asunto(s)
Centros Comunitarios de Salud/estadística & datos numéricos , Insuficiencia Cardíaca/terapia , Anciano , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/mortalidad , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Estudios Retrospectivos
13.
Medicine (Baltimore) ; 99(2): e18525, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914025

RESUMEN

Human immunodeficiency virus (HIV) testing is important for prevention and treatment. Ending the HIV epidemic is unattainable if significant proportions of people living with HIV remain undiagnosed, making HIV testing critical for prevention and treatment. The Centers for Disease Control and Prevention (CDC) recommends routine HIV testing for persons aged 13 to 64 years in all health care settings. This study builds on prior research by estimating the extent to which HIV testing occurs during physician office and emergency department (ED) post 2006 CDC recommendations.We performed an unweighted and weighted cross-sectional analysis using pooled data from 2 nationally representative surveys namely National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2009 to 2014. We assessed routine HIV testing trends and predictive factors in physician offices and ED using multi-stage statistical survey procedures in SAS 9.4.HIV testing rates in physician offices increased by 105% (5.6-11.5 per 1000) over the study period. A steeper increase was observed in ED with a 191% (2.3-6.7 per 1000) increase. Odds ratio (OR) for HIV testing in physician offices were highest among ages 20 to 29 ([OR] 7.20, 99% confidence interval [CI: 4.37-11.85]), males (OR 1.34, [CI: 0.91-0.93]), African-Americans (OR 2.97, [CI: 2.05-4.31]), Hispanics (OR 1.80, [CI: 1.17-2.78]), and among visits occurring in the South (OR 2.06, [CI: 1.23-3.44]). In the ED, similar trends of higher testing odds persisted for African Americans (OR 3.44, 99% CI 2.50-4.73), Hispanics (OR 2.23, 99% CI 1.65-3.01), and Northeast (OR 2.24, 99% CI 1.10-4.54).While progress has been made in screening, HIV testing rates remains sub-optimal for ED visits. Populations visiting the ED for routine care may suffer missed opportunities for HIV testing, which delays their entry into HIV medical care. To end the epidemic, new approaches for increasing targeted routine HIV testing for populations attending health care settings is recommended.


Asunto(s)
Epidemias/prevención & control , Infecciones por VIH/epidemiología , VIH/aislamiento & purificación , Tamizaje Masivo/métodos , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Estudios Transversales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/etnología , Infecciones por VIH/prevención & control , Encuestas de Atención de la Salud/métodos , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Consultorios Médicos/estadística & datos numéricos , Pruebas Serológicas/métodos , Pruebas Serológicas/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto Joven
15.
BMJ ; 368: l6831, 2020 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-31941686

RESUMEN

OBJECTIVES: To determine whether patients discharged after hospital admissions for conditions covered by national readmission programs who received care in emergency departments or observation units but were not readmitted within 30 days had an increased risk of death and to evaluate temporal trends in post-discharge acute care utilization in inpatient units, emergency departments, and observation units for these patients. DESIGN: Retrospective cohort study. SETTING: Medicare claims data for 2008-16 in the United States. PARTICIPANTS: Patients aged 65 or older admitted to hospital with heart failure, acute myocardial infarction, or pneumonia-conditions included in the US Hospital Readmissions Reduction Program. MAIN OUTCOME MEASURES: Post-discharge 30 day mortality according to patients' 30 day acute care utilization; acute care utilization in inpatient and observation units and the emergency department during the 30 day and 31-90 day post-discharge period. RESULTS: 3 772 924 hospital admissions for heart failure, 1 570 113 for acute myocardial infarction, and 3 131 162 for pneumonia occurred. The overall post-discharge 30 day mortality was 8.7% for heart failure, 7.3% for acute myocardial infarction, and 8.4% for pneumonia. Risk adjusted mortality increased annually by 0.05% (95% confidence interval 0.02% to 0.08%) for heart failure, decreased by 0.06% (-0.09% to -0.04%) for acute myocardial infarction, and did not significantly change for pneumonia. Specifically, mortality increased for patients with heart failure who did not utilize any post-discharge acute care, increasing at a rate of 0.08% (0.05% to 0.12%) per year, exceeding the overall absolute annual increase in post-discharge mortality in heart failure, without an increase in mortality in observation units or the emergency department. Concurrent with a reduction in 30 day readmission rates, stays for observation and visits to the emergency department increased across all three conditions during and beyond the 30 day post-discharge period. Overall 30 day post-acute care utilization did not change significantly. CONCLUSIONS: The only condition with increasing mortality through the study period was heart failure; the increase preceded the policy and was not present among patients who received emergency department or observation unit care without admission to hospital. During this period, the overall acute care utilization in the 30 days after discharge significantly decreased for heart failure and pneumonia, but not for acute myocardial infarction.


Asunto(s)
Unidades de Observación Clínica/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Insuficiencia Cardíaca , Infarto del Miocardio , Neumonía , Atención Subaguda , Anciano , Anciano de 80 o más Años , Femenino , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Humanos , Revisión de Utilización de Seguros , Masculino , Uso Excesivo de los Servicios de Salud/prevención & control , Medicare/estadística & datos numéricos , Mortalidad , Infarto del Miocardio/mortalidad , Infarto del Miocardio/terapia , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Neumonía/mortalidad , Neumonía/terapia , Estudios Retrospectivos , Atención Subaguda/métodos , Atención Subaguda/organización & administración , Atención Subaguda/tendencias , Estados Unidos/epidemiología
16.
JAMA Netw Open ; 3(1): e1919954, 2020 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-31995214

RESUMEN

Importance: The number of patients presenting to emergency departments (EDs) for psychiatric care continues to increase. Psychiatrists often make a conservative recommendation to admit patients because robust outpatient services for close follow-up are lacking. Objective: To assess whether the availability of a 45-day behavioral health-virtual patient navigation program decreases hospitalization among patients presenting to the ED with a behavioral health crisis or need. Design, Setting, and Participants: This randomized clinical trial enrolled 637 patients who presented to 6 EDs spanning urban and suburban locations within a large integrated health care system in North Carolina from June 12, 2017, through February 14, 2018; patients were followed up for up to 45 days. Eligible patients were aged 18 years or older, with a behavioral health crisis and a completed telepsychiatric ED consultation. The availability of the behavioral health-virtual patient navigation intervention was randomly allocated to specific days (Monday through Friday from 7 am to 7 pm) so that, in a 2-week block, there were 5 intervention days and 5 usual care days; 323 patients presented on days when the program was offered, and 314 presented on usual care days. Data analysis was performed from March 7 through June 13, 2018, using an intention-to-treat approach. Interventions: The behavioral health-virtual patient navigation program included video contact with a patient while in the ED and telephonic outreach 24 to 72 hours after discharge and then at least weekly for up to 45 days. Main Outcomes and Measures: The primary outcome was the conversion of an ED encounter to hospital admission. Secondary outcomes included 45-day follow-up encounters with a self-harm diagnosis and postdischarge acute care use. Results: Among 637 participants, 358 (56.2%) were men, and the mean (SD) age was 39.7 (16.6) years. The conversion rates were 55.1% (178 of 323) in the intervention group vs 63.1% (198 of 314) in the usual care group (odds ratio, 0.74; 95% CI, 0.54-1.02; P = .06). The percentage of patient encounters with follow-up encounters having a self-harm diagnosis was significantly lower in the intervention group compared with the usual care group (36.8% [119 of 323] vs 45.5% [143 of 314]; P = .03). Conclusions and Relevance: Although the primary result did not reach statistical significance, there is a strong signal of potential positive benefit in an area that lacks evidence, suggesting that there should be additional investment and inquiry into virtual behavioral health programs. Trial Registration: ClinicalTrials.gov identifier: NCT03204643.


Asunto(s)
Terapia Conductista/métodos , Servicio de Urgencia en Hospital , Trastornos Mentales/terapia , Admisión del Paciente/estadística & datos numéricos , Telemedicina/organización & administración , Adulto , Medicina de la Conducta/métodos , Femenino , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , North Carolina , Automanejo/educación , Resultado del Tratamiento , Adulto Joven
17.
Medicine (Baltimore) ; 99(1): e18567, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895799

RESUMEN

We investigated the epidemiological and clinical characteristics deaths from road traffic injury (RTI) in Beijing, and provided evidence useful for the prevention of fatal traffic trauma and for the treatment of traffic-related injuries.We retrospectively reviewed death cases provided by the Beijing Red Cross Emergency Center on road traffic injury deaths from 2008 to 2017. We analyzed population characteristics, time distribution, distribution of transportation modes, intervals to death, locations and injured body parts.From 2008 to 2017, there were 3327 deaths from RTI recorded by the Beijing Red Cross Emergency Center, with mainly males among these deaths. The average age at death was 46.19 ±â€Š17.43 years old (46.19, 0.43-100.24). In accidents with more detail recorded, pedestrians and people using nonmotorized transportation modes suffered the most fatalities (664/968, 68.60%). The most commonly injured body parts were the head (2569/3327, 77.22%), followed by the chest (180/3327, 5.41%), abdomen (130/3327, 3.91%), lower extremities (68/3327, 2.04%), pelvis (67/3327, 2.01%), spinal cord (31/3327, 0.93%), and upper extremities (26/3327, 0.78%). Burns accounted for 0.96% (32/3327), and unknown body parts were affected in 11.28% (365/3327). The average time interval from injury to death was 36.90 ±â€Š89.57 h (36.90, 0-720); 46.7% (1554/3327) died within 10 minutes after injury; 9.02% (300/3327) died between 10 min and 1 hour; 30.33% (1009/3327) died between 1 hour and 3 days; 13.95% (464/3327) died between 3 and 30 days.In Beijing, RTI is a significant cause of preventable death, particularly among pedestrians and users of non-motorized vehicles. Head trauma was the most lethal cause of RTI deaths. Our findings suggested that interventions to prevent collisions and reduce injuries, and improved trauma treatment process and trauma rescue system could address a certain proportion of avoidable RTI deaths.


Asunto(s)
Accidentes de Tránsito/mortalidad , Traumatismos Craneocerebrales/mortalidad , Peatones/estadística & datos numéricos , Heridas y Traumatismos/mortalidad , Adulto , Anciano , Beijing/epidemiología , Traumatismos Craneocerebrales/etiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Centros Traumatológicos/estadística & datos numéricos , Heridas y Traumatismos/etiología
18.
Epidemiol Psychiatr Sci ; 29: e95, 2020 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-31987063

RESUMEN

AIMS: Children with autism spectrum disorder (ASD) tend to suffer from various medical comorbidities. We studied the comorbidity burden and health services' utilisation of children with ASD to highlight potential aetiologies and to better understand the medical needs of these children. METHODS: In this nested case-control study, ASD cases and controls - matched by age, sex and ethnicity in a 1:5 ratio - were sampled from all children born between 2009 and 2016 at a tertiary medical centre. Data were obtained from the hospital's electronic database. Comorbid diagnoses were classified according to pathophysiological aetiology and anatomical/systemic classification of disease. Standard univariate and multivariate statistics were used to demonstrate comorbidities and health services' utilisation patterns that are significantly associated with ASD. RESULTS: ASD children had higher rates of comorbidities according to both pathophysiological and anatomical/systemic classifications (p < 0.001). The most marked significant differences were observed for: hearing impairments (OR = 4.728; 95% CI 2.207-10.127) and other auricular conditions (OR = 5.040; 95% CI 1.759-14.438); neurological (OR = 8.198; 95% CI 5.690-11.813) and ophthalmological (OR = 3.381; 95% CI 1.617-7.068) conditions; and ADD/ADHD (OR = 3.246; 95% CI 1.811-5.818). A subgroup analysis revealed a more profound case-control difference in anaemia rates among girls than in boys (OR = 3.25; 95% CI 1.04-10.19 v. OR = 0.74; 95% CI 0.33-1.64 respectively) and an opposite trend (larger differences in males than in females in cardiovascular diseases (OR = 1.99; 95% CI 1.23-3.23 v. OR = 0.76; 95% CI 0.17-3.45, respectively)). In addition, larger case-control differences were seen among Bedouin children than in Jewish children in a number of medical comorbidities (Breslow-Day test for homogeneity of odds ratio p-value <0.05). Finally, we found that children with ASD tended to be referred to the emergency department and to be admitted to the hospital more frequently than children without ASD, even after adjusting for their comorbidity burden (aOR = 1.28; 95% CI 1.08-1.50 and aOR = 1.28; 95% CI 1.11-1.47 for >1 referrals and admissions per year, respectively). CONCLUSIONS: The findings of this study contribute to the overall understanding of comorbid conditions and health services' utilisation for children with ASD. The higher prevalences of comorbidities and healthcare services' utilisation for children with ASD highlight the additional medical burden associated with this condition.


Asunto(s)
Trastorno del Espectro Autista/terapia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Trastorno del Espectro Autista/diagnóstico , Trastorno del Espectro Autista/epidemiología , Estudios de Casos y Controles , Niño , Comorbilidad , Femenino , Humanos , Israel/epidemiología , Masculino , Registros Médicos/estadística & datos numéricos , Prevalencia
19.
Internist (Berl) ; 61(1): 5-12, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31912164

RESUMEN

Cough is one of the most frequent causes for consultation in primary care. The diagnostic characteristics in primary care with a broad spectrum of causes and unspecific symptoms are presented using the example of acute and chronic cough. The understanding of the formation of the cough stimulus and the induction by inflammatory, mechanical and chemical triggers as well as the significance of the stimulus threshold of the cough receptor facilitate the comprehension of the various possible causes of cough. The necessary diagnostic procedures are based on the exclusion of warning symptoms that necessitate emergency inpatient treatment, on the duration of symptoms and the spectrum of causes to be expected from them. Ambiguities often remain even with careful basic diagnostics. Watchful waiting and active surveillance can initially be the most sensible approach but should not be misconstrued as carelessness. It necessitates follow-up controls and increased attention especially in patients with a high-risk constellation (e.g. multimorbidity, immune suppression, heart failure) in order to be able to quickly react to the development of treatable aspects or even dangerous courses of disease.


Asunto(s)
Tos/diagnóstico , Servicio de Urgencia en Hospital , Atención Primaria de Salud , Enfermedad Aguda , Enfermedad Crónica , Humanos , Derivación y Consulta , Espera Vigilante
20.
Rev Med Suisse ; 16(676-7): 59-62, 2020 Jan 15.
Artículo en Francés | MEDLINE | ID: mdl-31961086

RESUMEN

At a time when «â€…Smarter medicine ¼ and «â€…Choosing Wisely ¼ campains become increasingly important, emergency medicine is no exception. Many recent studies lead us to reconsider our practices and to change our work-up and treatement strategies, to ultimately use only the ones with a real clinical benefit for emergency departement patients.


Asunto(s)
Medicina de Emergencia , Medicina de Emergencia/tendencias , Servicio de Urgencia en Hospital , Humanos
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