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To describe characteristics and outcomes of coronavirus disease (COVID-19) patients with new supplemental oxygen requirements discharged from a large public urban emergency department (ED) with supplemental oxygen.

We determine whether the Clinical Frailty Scale applied at emergency department (ED) triage is associated with important service- and patient-related outcomes.

In 2018, the American College of Emergency Physicians (ACEP) began accrediting facilities as “geriatric emergency departments” (EDs) according to adherence to the multiorganizational guidelines published in 2014. The guidelines were developed to help every ED improve its care of older adults. The geriatric ED guideline recommendations span the care continuum from out-of-hospital care, ED staffing, protocols, infrastructure, and transitions to outpatient care. Hospitals interested in making their EDs more geriatric friendly thus face the challenge of adopting, adapting, and implementing extensive guideline recommendations in a cost-effective manner and within the capabilities of their facilities and staff. Because all innovation is at heart local and must function within the constraints of local resources, different hospital systems have developed implementation processes for the geriatric ED guidelines according to their differing institutional capabilities and resources. This article describes 4 geriatric ED models of care to provide practical examples and guidance for institutions considering developing geriatric EDs: a geriatric ED–specific unit, geriatrics practitioner models, geriatric champions, and geriatric-focused observation units. The advantages and limitations of each model are compared and examples of specific institutions and their operational metrics are provided.

We estimate emergency department (ED) use differences across Medicare enrollees of different race/ethnicity who are residing in the same zip codes.

Study objectives: Cardiac preconditioning is associated with improved cardiac function after global ischemia. During global cardiac ischemia, developed pressure and heart rate typically decrease. We have previously suggested that ischemic preconditioning results from norepinephrine release from adrenergic nerve termini in the heart. The study objectives are to assess cardiac function and energy expenditure after cyclic ischemia and β-adrenergic blockade.Methods: Isolated rat hearts (n=12) were subject to 4 cycles of ischemia (5 minutes) followed by reperfusion (5 minutes). Developed pressure and heart rate were assessed using high-resolution time-series analysis, and adenosine triphosphate (ATP) expenditure was calculated.Results: Immediately after the onset of transient ischemia, there was a brief period when developed pressure (Δ +13±3 mm Hg; P<.05 versus baseline) and heart rate (Δ +51±0.12 beats/min) increased. This inotropic and chronotropic reflex occurred within 10 seconds of ischemia. Subsequent cycles of transient ischemia and reperfusion differentially reduced the inotropic (Δ −30±15%; P<.05 fourth versus first cycle) and chronotropic (Δ −53±23%; P<.05 versus baseline) aspects of the reflex, with eventual diminution of both reflexes after 4 cycles. Attenuation of the compensatory reflex resulted in decreased contractile work and energy expenditure during repeated episodes of global ischemia, with a net ATP savings of 4.3 μmol/g wet weight. The inotropic and chronotropic responses during all cycles of ischemia were attenuated by 10 μM propranolol.Conclusion: This study reports a novel, locally mediated adrenergic sympathetic response that results in a desperate energy expenditure during global cardiac ischemia. Ischemic preconditioning curtails this reflex after the onset of global ischemia, and the preconditioning effect may be replicated using β-blockade. Blocking this adrenergic response may prevent energy expenditure on potentially futile cardiac contractile work during prolonged global ischemia and prove beneficial in protecting cardiac function during acute ischemic states, such as coronary syndromes, arrest, shock, and trauma.