Academic Emergency Medicine

Opioid use and misuse have increased greatly in the past 15 years, but opioids remain a mainstay of treatment for acute pain. Many studies, most of which are retrospective and rely on large databases, have evaluated the long-term use of opioids. Questions remain regarding the incidence of recurrent or inappropriate use of opioids after an initial prescription. This article discusses a study by Daoust et al published in Academic Emergency Medicine, August 2019, which attempts to answer those questions. We provide critical analysis of the article, as well as summarize the social media discussion and feedback of a podcast in which the authors discuss their work...

Venous thromboembolism (VTE) occurs in up to 30% of patients with cancer.1,2 Prior guidelines have recommended low molecular weight heparin (LMWH) for 3-6 months as first-line therapy in cancer patients with newly-diagnosed VTE.3-5 Unfortunately, LMWH is associated with poor compliance due to the need for subcutaneous injection.6,7 Direct oral anticoagulants (DOACs) have been increasingly used for the treatment of VTE, are administered orally with no requirement for regular laboratory monitoring, and may have fewer drug-drug interactions as compared with warfarin, despite DOACs possessing a greater cost compared to other therapies...

Dr. Reynolds has no disclosures, other than being a resuscitation science enthusiast, which inherently requires dogged optimism despite sizable numbers needed to treat. Clinicians must continually synthesize, integrate, and revise estimates of treatment effectiveness. The 'number needed to treat' (NNT),1 2 has emerged as a frontrunner among the absolute and relative measures that describe treatment effects.

Spinal precautions are a key component of many emergency medical services (EMS) protocols.1,2 However, there is limited evidence regarding the ability of spinal immobilization (i.e. cervical collars and/or longboards) to improve patient outcomes among those with penetrating trauma, and spinal immobilization may increase complications.3,4 These complications include increased intracranial pressure, local pressure injury, missed penetrating injury, and delay in the successful performance of vital procedures (e...

Antibiotics are prescribed daily in emergency departments (EDs) and urgent care centers (UCCs) for acute respiratory infections (ARIs). Despite recognizing the need for antibiotic stewardship, there continue to be many inappropriate prescriptions for antibiotic non-responsive ARIs. The authors of this study sought to evaluate the comparative effectiveness of two antibiotic stewardship interventions in reducing inappropriate prescriptions. An adapted intervention for ambulatory care settings was compared to an enhanced intervention that incorporated behavioral nudges, audit and feedback and peer comparison data...

OBJECTIVE: We sought to assess the frequency, content, and quality of shared decision-making (SDM) in the Emergency Department (ED), from patients' perspectives. METHODS: Utilizing a cross-sectional, multi-site approach, we administered an instrument, consisting of two validated SDM assessment tools - the CollaboRATE and the SDM-Q-9 - and one newly developed tool, to a sample of ED patients. Our primary outcome was the occurrence of SDM in the clinical encounter, as defined by participants giving "Top Box" scores on the CollaboRATE measure, and the ability of patients to identify the topic of their SDM conversation...

BACKGROUND: Emergency department (ED) patients with uncomplicated atrial fibrillation (AF) of less than 48 hours may be safely managed with rhythm control. Although both chemical-first and electrical-first strategies have been advocated, there are no comparative effectiveness data to guide clinicians. METHODS: At six urban Canadian centers, ED patients ages 18 to 75 with uncomplicated symptomatic AF of less than 48 hours and CHADS2 score of 0 or 1 were randomized using concealed allocation in a 1:1 ratio to one of the following strategies: 1) chemical cardioversion with procainamide infusion, followed by electrical countershock if unsuccessful; or 2) electrical cardioversion, followed by procainamide infusion if unsuccessful...

Fever and infection are common in neutropenic cancer patients. While some become severely ill, most patients have an uneventful course, with 50-60% having no life-threatening complication or fatal infection. Patients with febrile neutropenia have therefore been divided into low-risk and high-risk groups. Those patients at low-risk of complications may benefit from outpatient management. Admission to the hospital has its own risks, including iatrogenic infections and reduced quality of life. This article is protected by copyright...

Rapid sequence intubation (RSI), placing a tube into the trachea facilitated by rapid sedation and paralysis to improve ventilation and oxygenation, is a common procedure in emergent, critical care, and operating room settings. There is great interest in drugs that improve the process. The two most commonly used paralytic agents in the emergency department are succinylcholine (depolarizing) and rocuronium (non-depolarizing). Traditionally succinylcholine has been the preferred muscle relaxant for RSI because of its rapid onset of 40 to 60 seconds and a short duration of action lasting 6 to 10 minutes...

OBJECTIVES: Emergency departments (EDs) frequently care for patients who are homeless or unstably housed. One promising approach taken by the homeless services system is to provide interventions that attempt to prevent homelessness before it occurs. Experts have suggested that health care settings may be ideal locations to identify and intervene with patients at risk for homelessness, yet little is known even about the basic characteristics of patients who might benefit from such interventions...

There are limited prognostic tools to guide clinicians in acute risk-stratification of adult mild TBI patients (mTBI). While the majority of mTBI patients achieve full recovery within 7-14 days, approximately 25-30% remain symptomatic for 3 or more months post-injury.(1;2) Early identification of the subset of mTBI patients at high risk for protracted recovery will: (a) facilitate administering the right discharge instructions and sub-specialty referral to the right at-risk mTBI patients; (b) enable individualized education of patients regarding their expected course of recovery; (c) allow targeted administration of cognitive and behavioral therapy that has been found to be efficacious when implemented during the acute phase of injury; (3,4,5) and (d) enable enrichment of study populations of mTBI clinical trials with patients who are at-risk for protracted recovery and therefore decrease the sample size required for demonstrating therapeutic efficacy...

This is a prospective observational study looking to validate the CriSTAL decision rule, designed to predict the short-term risk of death in an elderly population. They studied two separate cohorts of emergency department patients over the age of 65. The first consisted of 1143 patients from 5 hospitals in Australia, and the second consisted of 349 patients from a single hospital in Ireland. The primary outcome was mortality at 3 months. Although there was a statistical difference in the scores between deceased and surviving patients, it isn't clear that the difference is big enough to be clinically useful...

OBJECTIVES: Nursing evaluations are an important component of residents' professional development as nurses are present for interactions with patients and non-physician providers. Despite this, there has been few prior studies on the benefits, harms, or effectiveness of using nursing evaluations to help guide emergency medicine residents' development. We hypothesized that gender bias exists in nursing evaluations and that female residents, as compared to their male counterparts, would receive more negative feedback on the perception of their interpersonal communication skills...

Since 1989, when the term "oligoanalgesia" was coined, physicians have been encouraged to be more aggressive about treating pain (1). Although pain scores have sometimes been considered the "fifth vital sign," it is not clear if this initiative has resulted in improved pain management or if it has contributed to the opioid epidemic (2). That being said, it is possible that pain scores, like traditional vital signs, may have clinical predictive utility. This article is protected by copyright...

"What do you want to do?" Matt asked. I looked up from the blue, gasping baby to the physician asking the question. "Well, back home I would have intubated her already." "Then you should do that here," he responded. Intubating the newborn was easy, and as the adrenaline rush passed, I looked up and asked the obvious question, "Now what?" "Now you bag her until you think she can be extubated…or you think it's futile." He headed for the door. "I'll be back...

BACKGROUND: Chest pain is a common problem presenting to the Emergency Department (ED). Many decision aids and accelerated diagnostic protocols have been developed to help clinicians differentiate those needing admission from those who can be safely discharged. Some early evidence has suggested that clinician judgement or gestalt alone could be sufficient. OBJECTIVES: Our aim was to externally validate whether emergency physician's gestalt could "rule in" or "rule out" acute coronary syndromes (ACS)...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Pediatric seizures are commonly encountered in Emergency Medical Services (EMS). Evidence is accumulating that the rate of hypoglycemia in this setting is low, challenging the concept of routine prehospital glucose measurement. OBJECTIVE: We studied factors associated with EMS protocol compliance for glucose testing in children <18 years of age with a 911 call for seizure, as well as rates of hypoglycemia in the prehospital setting. METHODS: We performed a retrospective analysis of data from the North Carolina EMS registry from 2013-2014...

No abstract text is available yet for this article.