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ER Dogma

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By David Rhine MD FRCPC. Emergency medicine. Special interest in concussion management.
Justin Morgenstern, Corey Heitz, Chris Bond, William K Milne
This is a prospective observational study looking to validate a previously derived decision rule designed to help safely discharge opioid overdose patients from the emergency department after 1 hour.4 They included a convenience sample of 538 adult patients who had received naloxone pre-hospital and compared the Hospital Observation Upon Reversal (HOUR) rule with clinical judgement. The primary outcome of interest was a broadly defined composite of adverse events. The HOUR rule had a sensitivity of 84.1% (95% CI 76...
February 11, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Kelsey A Miller, Gary Andolfatto, James R Miner, John H Burton, Baruch S Krauss
We update an evidence-based clinical practice guideline for the administration of propofol for emergency department procedural sedation. Both the unique considerations of using this drug in the pediatric population and the substantial new research warrant revision of the 2007 advisory. We discuss the indications, contraindications, personnel requirements, monitoring, dosing, coadministered medications, and adverse events for propofol sedation.
February 4, 2019: Annals of Emergency Medicine
Jessica Laureano-Phillips, Richard D Robinson, Subhash Aryal, Somer Blair, Damalia Wilson, Kellie Boyd, Chet D Schrader, Nestor R Zenarosa, Hao Wang
STUDY OBJECTIVE: The objectives of this systematic review and meta-analysis are to appraise the evidence in regard to the diagnostic accuracy of a low-risk History, ECG, Age, Risk Factors, and Troponin (HEART) score for prediction of major adverse cardiac events in emergency department (ED) patients. These included 4 subgroup analyses: by geographic region, the use of a modified low-risk HEART score (traditional HEART score [0 to 3] in addition to negative troponin results), using conventional versus high-sensitivity troponin assays in the HEART score, and a comparison of different post-ED-discharge patient follow-up intervals...
February 1, 2019: Annals of Emergency Medicine
Jared Baylis, Devin R Harris, Charlie Chen, Daniel K Ting, Kevin Clark, Anthony Kwan, Skye Crawford, David Williscroft
ABSTRACTCLINICIAN'S CAPSULEWhat is known about the topic?Palliative medicine is increasingly encountered in an emergency medicine setting, and emergency medicine residents desire further training in this field.What did this study ask?How many postgraduate emergency medicine programs in Canada have an existing palliative medicine curriculum?What did this study find?A minority (38.5%) of emergency medicine programs report having a formal palliative medicine curriculum, and the contents are variable.Why does this study matter to clinicians?It will be important to define how trainees will achieve competence in palliative medicine in the emergency department...
January 30, 2019: CJEM
Robert Ohle, Sarah McIsaac, Paul Atkinson
No abstract text is available yet for this article.
January 2019: CJEM
A J van Tienhoven, C A J van Beers, C E H Siegert
BACKGROUND: In the Emergency Department, lactate measurement is a useful tool to risk-stratify critically ill patients. However, it is unclear whether arterial or peripheral venous lactate levels can be used interchangeably for this purpose. In this systematic review, we provide an overview of studies investigating the agreement between arterial and peripheral venous lactate levels in the Emergency Department. METHODS: PubMed, Embase, the Cochrane Central Register of Controlled Trials/Wiley, Web of Science/Clarivate Analytics, and references of selected articles were assessed for all studies comparing arterial and peripheral venous lactate levels in adult patients in the emergency department...
January 21, 2019: American Journal of Emergency Medicine
Brit Long, Alex Koyfman, Michael Gottlieb
Syncope accounts for 1-3% of emergency department (ED) visits and 1-6% of hospital admissions. There are numerous etiologies, ranging from relatively benign vasovagal syncope to dangerous dysrhythmias. The ED evaluation and management of syncope is comprised of history, examination, and typically an electrocardiogram, with further investigation dependent upon clinical decision-making and suspected conditions. Previously, pulmonary embolism (PE) was thought to account for a small minority of patients with syncope...
January 27, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Judith Finn, Ian Jacobs, Teresa A Williams, Simon Gates, Gavin D Perkins
BACKGROUND: Adrenaline and vasopressin are widely used to treat people with cardiac arrest, but there is uncertainty about the safety, effectiveness and the optimal dose. OBJECTIVES: To determine whether adrenaline or vasopressin, or both, administered during cardiac arrest, afford any survival benefit. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and DARE from their inception to 8 May 2018, and the International Liaison Committee on Resuscitation 2015 Advanced Life Support Consensus on Science and Treatment Recommendations...
January 17, 2019: Cochrane Database of Systematic Reviews
Darren Shu Jeng Ting, Niru Ghosh, Saurabh Ghosh
No abstract text is available yet for this article.
January 17, 2019: BMJ: British Medical Journal
Brian M Clemency, William Eggleston, Evan W Shaw, Michael Cheung, Nicholas S Pokoj, Michael A Manka, Donald J Giordano, Laura Serafin, Han Yu, Heather A Lindstrom, David Hostler
OBJECTIVE: St. Paul's Early Discharge Rule was derived to determine which patients could be safely discharged from the emergency department after a 1-hour observation period following naloxone administration for opiate overdose. The rule suggested that patients could be safely discharged if they could mobilize as usual and had a normal oxygen saturation, respiratory rate, temperature, heart rate, and Glasgow Coma Scale score. Validation of the St. Paul's Early Discharge Rule is necessary to ensure that these criteria are appropriate to apply to patients presenting after an unintentional presumed opioid overdose in the context of emerging synthetic opioids and expanded naloxone access...
December 28, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
John C Moskop, Joel M Geiderman, Kenneth D Marshall, Jolion McGreevy, Arthur R Derse, Kelly Bookman, Norine McGrath, Kenneth V Iserson
This article revisits the persistent problem of crowding in US hospital emergency departments (EDs). It begins with a brief review of origins of this problem, terms used to refer to ED crowding, proposed definitions and measures of crowding, and causal factors. The article then summarizes recent studies that document adverse moral consequences of ED crowding, including poorer patient outcomes; increased medical errors; compromises in patient physical privacy, confidentiality, and communication; and provider moral distress...
December 19, 2018: Annals of Emergency Medicine
François Mathieu, Michael J Ellis, Charles H Tator
BACKGROUND: Despite concussion now being recognized as a public health priority in Canada, recent studies-including our 2012 survey of Canadian medical schools-have revealed major gaps in concussion education at the undergraduate medical school level. METHODS: We re-surveyed all 17 Canadian medical schools using a questionnaire divided in two categories: (1) concussion-specific education (2) head injury education incorporating a concussion component to determine whether there have been any improvements in concussion education at the medical school level during the last five years...
December 20, 2018: BMC Medical Education
Maria Beatrice Spinola, Alessandro Riccardi, Pierangela Minuto, Paola Campodonico, Giulia Motta, Michele Malerba, Grazia Guiddo, Roberto Lerza
The correlation between direct oral anticoagulants (DOACs) or Vitamin K Antagonist (VKAs) intake and the incidence of intracranial complications after minor head injury (MHI) is still object of debate: preliminary observation seems to demonstrate lower incidence in intracranial bleeding complications (ICH) in patients taking DOACs than VKA. METHODS. This prospective and observational study was performed to clarify the incidence of ICH in patients in DOACs compared to VKAs. Between January 2016 and April 2018 we have recorded in our ED patients with MHI taking oral anticoagulants...
December 4, 2018: American Journal of Emergency Medicine
Caitlin R Dean, Manjeet Shemar, Gillian A U Ostrowski, Rebecca C Painter
No abstract text is available yet for this article.
November 30, 2018: BMJ: British Medical Journal
Christian Backer Mogensen, Malene Bue Vilhelmsen, Johanne Jepsen, Lilian Keene Boye, Maiken Hjuler Persson, Florence Skyum
BACKGROUND: A new generation of ear thermometers with preheated tips and several measurements points should allow a more precise temperature measurement. The aim of the study was to evaluate if the ear temperature measured by this ear thermometer can be used to screen for fever and whether the thermometer is in agreement with the rectal temperature and if age, use of hearing devices or time after admission influences the temperature measurements. METHODS: Open cross-sectional clinical single site study patients, > 18 years old, who were acutely admitted to the short stay unit at the ED...
December 3, 2018: BMC Emergency Medicine
Risa B Burns, C Christopher Smith, Robert H Shmerling, Anjala Tess
Gout is the most common form of inflammatory arthritis. In 2012, the American College of Rheumatology (ACR) issued a guideline, which was followed in 2017 by one from the American College of Physicians (ACP). The guidelines agree on treating acute gout with a corticosteroid, nonsteroidal anti-inflammatory drug, or colchicine and on not initiating long-term urate-lowering therapy (ULT) for most patients after a first gout attack and in those whose attacks are infrequent (<2 per year). However, they differ on treatment of both recurrent gout and problematic gout...
December 4, 2018: Annals of Internal Medicine
Corey Heitz, Justin Morgenstern, Christopher Bond, William K Milne
Ketamine has been studied as an alternative to opioids for acute pain in the emergency department setting. This review compares the effectives of intravenous ketamine at a dose of <0.5mg/kg to opioids for acute pain in adult patients. Measurements were taken within 60 minutes of administration. Ketamine was found to have similar effectiveness to opioids. Increased, but short-lived, side effects were seen with ketamine.
November 27, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Matthew James Reed
Syncope is a common reason for ED attendance and it presents a major management challenge with regard to the appropriate workup and disposition. Nearly 50% of patients are admitted, and for many this is unnecessary; clinical decision rules have not proven to decrease unnecessary admissions. The European Society of Cardiology has recently developed guidance for managing syncope in the ED. This article highlights the key steps in evaluating syncope in the ED, factors involved in determining risk of a cardiac cause, and considerations for admission, observation or discharge...
February 2019: Emergency Medicine Journal: EMJ
Jeremiah S Hinson, Diego A Martinez, Stephanie Cabral, Kevin George, Madeleine Whalen, Bhakti Hansoti, Scott Levin
STUDY OBJECTIVE: Rapid growth in emergency department (ED) triage literature has been accompanied by diversity in study design, methodology, and outcome assessment. We aim to synthesize existing ED triage literature by using a framework that enables performance comparisons and benchmarking across triage systems, with respect to clinical outcomes and reliability. METHODS: PubMed, EMBASE, Scopus, and Web of Science were systematically searched for studies of adult ED triage systems through 2016...
November 20, 2018: Annals of Emergency Medicine
Lorna M Gibson, Laura Paul, Francesca M Chappell, Malcolm Macleod, William N Whiteley, Rustam Al-Shahi Salman, Joanna M Wardlaw, Cathie L M Sudlow
OBJECTIVES: To determine prevalence and types of potentially serious incidental findings on magnetic resonance imaging (MRI) in apparently asymptomatic adults, describe factors associated with potentially serious incidental findings, and summarise information on follow-up and final diagnoses. DESIGN: Systematic review and meta-analyses. DATA SOURCES: Citation searches of relevant articles and authors' files in Medline and Embase (from inception to 25 April 2017)...
November 22, 2018: BMJ: British Medical Journal
2018-11-25 17:02:16
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