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emergency department sedation

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https://www.readbyqxmd.com/read/28645462/analgosedation-practices-and-the-impact-of-sedation-depth-on-clinical-outcomes-among-patients-requiring-mechanical-ventilation-in-the-emergency-department-a-cohort-study
#1
Robert J Stephens, Enyo Ablordeppey, Anne M Drewry, Christopher Palmer, Brian T Wessman, Nicholas M Mohr, Brian W Roberts, Stephen Y Liang, Marin H Kollef, Brian M Fuller
BACKGROUND: Analgesia and sedation are cornerstone therapies for mechanically ventilated patients. Despite data showing that early deep sedation in the intensive care unit influences outcome, this has not been investigated in the emergency department (ED). Therefore, ED-based sedation practices, and their influence on outcome, remain incompletely defined. This study's objectives were to describe ED sedation practices in mechanically ventilated patients, and to test the hypothesis that ED sedation depth is associated with worse outcomes METHODS: This was a cohort study on a prospectively compiled ED registry of adult, mechanically ventilated patients at a single academic medical center...
June 20, 2017: Chest
https://www.readbyqxmd.com/read/28625000/mechanical-restraint-in-an-emergency-department-a-consecutive-series-of-593-cases
#2
Nicolas Beysard, Bertrand Yersin, Pierre-Nicolas Carron
The objective is to describe the characteristics of mechanically restrained patients in the emergency department (ED) of a university hospital and to evaluate the quality of restraint documentation that was filled out according to the dedicated protocol with respect to the law on restraint. All adult patients (≥16 years) who were admitted to the ED from January 2009 to December 2010 and were mechanically restrained were included. We assessed medical and demographic characteristics, the completeness of the dedicated protocol, and the concomitant use of chemical sedation...
June 17, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28621182/-non-intubated-uniportal-video-assisted-thoracic-surgery-vats-lobectomy-as-a-new-procedure-in-our-department
#3
József Furák, Zsolt Szabó, Theodor Horváth, Tibor Géczi, Balázs Pécsy, Tibor Németh, Aurél Ottlakán, Zsolt Molnár, György Lázár
AIM: Due to the emerging experience in VATS (video assisted thoracic surgery) lobectomies, in some centers the so called "non-intubated" VATS lobectomies (NITS - non-intubated thoracic surgery) gained increased authority, during which endotracheal intubation and muscle relaxation of the patient is not carried out, thus surgery is being performed with the patient breathing spontaneously. The recent study deals with our initial experience gained during uniportal NITS VATS lobectomies. PATIENTS AND METHOD: Between 24...
June 2017: Magyar Sebészet
https://www.readbyqxmd.com/read/28616616/lipoprotein-associated-phospholipase-a2-activity-and-its-diagnostic-potential-in-patients-with-acute-coronary-syndrome-and-acute-ischemic-stroke
#4
Sedat Kocak, Birsen Ertekin, Abdullah Sadik Girisgin, Zerrin Defne Dundar, Mehmet Ergin, Idris Mehmetoglu, Said Bodur, Basar Cander
BACKGROUND: The study examined the Lp-PLA2 activity at the patients presented to the emergency department with acute coronary syndrome (ACS) or acute ischemic stroke (AIS), as well as its diagnostic value. METHODS: The prospective study included consecutive male and female patients aged >18 years that presented to the our emergency department with ACS or AIS between November 2009 and January 2010. Blood samples were obtained immediately following diagnosis in the ACS and AIS groups...
June 2017: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28613973/the-association-of-cannabis-use-on-inpatient-psychiatric-hospital-outcomes
#5
Melanie Rylander, Helena R Winston, Haley Medlin, Madelyne Hull, Abraham Nussbaum
BACKGROUND: The associations between cannabis use and psychosis are well documented in numerous studies. There is a need to evaluate the impact of cannabis use on inpatient psychiatric utilization and outcomes. OBJECTIVES: To evaluate the impact of cannabis use on psychiatric hospital outcomes. METHODS: This study was conducted between April 20, 2015 and October 20, 2015. All patients (n = 120) admitted to Denver Health with psychotic symptoms were administered a urine toxicology screening testing for the presence of 11-nor-9-carboxy-Δ(9)-tetrahydrocannabinol (THC-COOH, the active metabolite of cannabis)...
June 14, 2017: American Journal of Drug and Alcohol Abuse
https://www.readbyqxmd.com/read/28606617/management-of-patients-with-predicted-difficult-airways-in-an-academic-emergency-department
#6
John C Sakles, Matthew J K Douglas, Cameron D Hypes, Asad E Patanwala, Jarrod M Mosier
BACKGROUND: Patients with difficult airways are sometimes encountered in the emergency department (ED), however, there is a little data available regarding their management. OBJECTIVES: To determine the incidence, management, and outcomes of patients with predicted difficult airways in the ED. METHODS: Over the 1-year period from July 1, 2015 to June 30, 2016, data were prospectively collected on all patients intubated in an academic ED. After each intubation, the operator completed an airway management data form...
June 9, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28587704/between-and-within-site-variation-in-medication-choices-and-adverse-events-during-procedural-sedation-for-electrical-cardioversion-of-atrial-fibrillation-and-flutter
#7
David Clinkard, Ian Stiell, Eddy Lang, Stuart Rose, Catherine Clement, Robert Brison, Brian H Rowe, Bjug Borgundvaag, Trevor Langhan, Kirk Magee, Rob Stenstrom, Jeffery J Perry, David Birnie, George Wells, Andrew McRae
OBJECTIVES: Although procedural sedation for cardioversion is a common event in emergency departments (EDs), there is limited evidence surrounding medication choices. We sought to evaluate geographic and temporal variation in sedative choice at multiple Canadian sites, and to estimate the risk of adverse events due to sedative choice. METHODS: This is a secondary analysis of one health records review, the Recent Onset Atrial Fibrillation or Flutter-0 (RAFF-0 [n=420, 2008]) and one prospective cohort study, the Recent Onset Atrial Fibrillation or Flutter-1 (RAFF-1 [n=565, 2010 - 2012]) at eight and six Canadian EDs, respectively...
June 7, 2017: CJEM
https://www.readbyqxmd.com/read/28562388/procedural-sedation-in-the-icu-and-emergency-department
#8
Nikhil Chawla, Adjoa Boateng, Ranjit Deshpande
PURPOSE OF REVIEW: Procedures are increasingly being performed in the acute care setting, outside of the operating rooms (OR). This article aims to review the current literature on out-of-OR procedural sedation with a focus on the ICU and emergency department, highlighting the following topics: multidisciplinary team approach, choice of pharmacologic agent, sedation scales, current safety guidelines, anticipating complications, appropriate monitoring and necessary resources. RECENT FINDINGS: Subjective assessment of sedation using sedation scales is controversial...
May 27, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28559128/performance-of-the-modified-richmond-agitation-sedation-scale-in-identifying-delirium-in-older-emergency-department-patients
#9
Florian F Grossmann, Wolfgang Hasemann, Reto W Kressig, Roland Bingisser, Christian H Nickel
BACKGROUND: Delirium in older emergency department (ED) patients is associated with severe negative patient outcomes and its detection is challenging for ED clinicians. ED clinicians need easy tools for delirium detection. We aimed to test the performance criteria of the modified Richmond Agitation Sedation Scale (mRASS) in identifying delirium in older ED patients. METHODS: The mRASS was applied to a sample of consecutive ED patients aged 65 or older by specially trained nurses during an 11-day period in November 2015...
May 22, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28552271/comparing-the-success-rates-of-standard-and-modified-valsalva-maneuvers-to-terminate-psvt-a-randomized-controlled-trial
#10
Şeref Kerem Çorbacıoğlu, Emine Akıncı, Yunsur Çevik, Halit Aytar, Mehmet Veysel Öncül, Sedat Akkan, Hüseyin Uzunosmanoğlu
PURPOSE: The study aimed to detect whether modified Valsalva maneuver (VM) is more effective than the standard VM in terminating paroxysmal supraventricular tachycardia (PSVT). METHODOLOGY: This randomized controlled trial was conducted in the emergency department of a training and research hospital between Dec. 1, 2015 and Dec. 31, 2016. Participants were divided into two groups, randomly assigned standard VM or modified VM, as the first treatment with two-dimensional permutation blocks; in the order of arrival of the patients...
May 22, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28551041/emergency-departments-increasingly-administering-medications-through-the-nose
#11
REVIEW
Deborah L McBride
Administering medications through the nose as an alternative to intramuscular or intravenous injections is increasingly popular in emergency departments and out-of hospital settings because it is simple, fast, and can be used in situations where obtaining intravenous access is difficult or time intensive. This article examines the literature and indications for the out-of-hospital and emergency department administration of five commonly used intranasal medications: midazolam (used to sedate children and treat seizures), fentanyl (for pain relief), naloxone (for opioid overdoses), ketamine (to induce anesthesia) and dexmedetomidine (to sedate and relieve pain in children)...
May 24, 2017: Journal of Pediatric Nursing
https://www.readbyqxmd.com/read/28541419/acute-toxicity-from-intravenous-use-of-the-tricyclic-antidepressant-tianeptine
#12
Sara K Dempsey, Justin L Poklis, Kacie Sweat, Kirk Cumpston, Carl E Wolf
Tianeptine (7-[([3-chloro-6,11]-dihydro-6-methyldibenzo[c,f][1,2]thiazepin-11-yl) amino] heptanoic acid S, S dioxide) is a tricyclic compound prescribed as an antidepressant in European countries, but is not currently approved for use in the United States. There are few published case reports of tianeptine intoxication. Presented is the first case of acute toxicity associated with the intravenous use of tianeptine. A 36-year-old male intentionally injected tianeptine powder intravenously to "help him see into the future"...
May 24, 2017: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/28500785/don-t-label-me-a-qualitative-study-of-patients-perceptions-and-experiences-of-sedation-during-behavioral-emergency-in-the-emergency-department
#13
Celene Y L Yap, Jonathan C Knott, David C M Kong, Marie Gerdtz, Kay Stewart, David McD Taylor
OBJECTIVES: Behavioral emergencies are commonly seen in emergency departments. Acutely agitated patients can be difficult to manage and sedation may be required to decrease dangerous behavior and to ensure the safety of both the patient and staff. While the experience of staff caring for this population has been reported, patients' experiences with their overall management remains unknown. We aimed to describe the perceptions and experiences of patients regarding the use of sedation during acute behavioral emergencies...
May 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28489008/-do-opioids-sedatives-and-proton-pump-inhibitors-increase-the-risk-of-fractures
#14
Gudlaug Thorsdottir, Elisabet Benedikz, Sigridur A Thorgeirsdottir, Magnus Johannsson
INTRODUCTION: A pharmacoepidemiological study was conducted to analyse the relationship between bone fracture and the use of certain drugs. MATERIAL/METHODS: The study includes patients 40 years and older, diagnosed with bone fractures in the Emergency Department of Landspitali University Hospital in Reykjavik, Iceland, during a 10-year period (2002-2011). Also were included those who picked up from a pharmacy 90 DDD or more per year of the drugs included in the study in the capital region of Iceland during same period...
May 2017: Læknablađiđ
https://www.readbyqxmd.com/read/28476551/emergency-department-visits-involving-benzodiazepines-and-non-benzodiazepine-receptor-agonists
#15
Christopher N Kaufmann, Adam P Spira, G Caleb Alexander, Lainie Rutkow, Ramin Mojtabai
OBJECTIVE: Sedative-hypnotic medications (e.g., Benzodiazepines [BZDs] and non-benzodiazepine receptor agonists [nBZRAs]) are associated with adverse events, especially in the elderly, that may require emergency department (ED) treatment. This study assessed outcomes from ED visits attributed to BZDs and/or nBZRAs, and variations in these associations by age group. METHODS: Data came from the 2004-2011 waves of the Drug Abuse Warning Network (DAWN). Visits were categorized as involving: (1) BZDs-only, (2) nBZRAs-only, (3) combination of BZDs and nBZRAs, or (4) any other sedative-hypnotic medication...
April 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28466184/thirty-day-emergency-room-visits-and-hospital-admissions-after-outpatient-non-vascular-image-guided-procedures
#16
Quang Nguyen, Sahil V Mehta, Jieming Fang, Robert Sheiman, Robert Kane, Muneeb Ahmed, Ammar Sarwar, Bettina Siewert, Olga R Brook
PURPOSE: To evaluate the rate of post-procedure emergency department (ED) visits and hospital admissions following outpatient non-vascular image-guided interventions performed under moderate sedation and to identify common and preventable causes of emergency department visits and hospital admissions. MATERIALS AND METHODS: Institutional review board approval was acquired for this HIPAA-compliant retrospective study with waiver of informed consent. 1426 consecutive patients undergoing 1512 outpatient image-guided procedures under moderate sedation from November 2012 to August 2014 were included...
May 2, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/28460809/ultrasound-guided-interscalene-nerve-block-vs-procedural-sedation-by-propofol-and-fentanyl-for-anterior-shoulder-dislocations
#17
Esmaeil Raeyat Doost, Mohammad Mehdi Heiran, Mitra Movahedi, Amirhossein Mirafzal
BACKGROUND: Few studies were performed to compare ultrasound guided brachial plexus block with procedural sedation for reduction of shoulder dislocations in the Emergency Department (ED). This study was done to provide further evidence regarding this comparison. METHODS: This was a randomized clinical trial performed on patients presenting with anterior shoulder dislocations to the emergency department of an academic level 2 trauma center. Exclusion criteria were any contraindications to the drugs used, any patient which may not be potentially assigned into both groups because of an underlying medical condition, presence of neurovascular compromise related to the dislocation, presence of concomitant fractures, and patient refusal to participate in the study...
April 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28457743/the-information-needs-of-patients-receiving-procedural-sedation-in-a-hospital-emergency-department
#18
Sue Revell, Judy Searle, Shona Thompson
This research investigated the information needs of patients receiving ED procedural sedation to determine the best format to consistently deliver key information in a way acceptable to all involved. Of particular interest was the question concerning patients' need for receiving written information. A descriptive exploratory study gathered qualitative data through face-to-face interviews and focus groups involving patients, nurses and medical staff. Individual interviews were conducted with eight adult patients following procedural sedation...
April 27, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28457093/deliberate-self-harm-in-older-adults-a-general-hospital-emergency-department-survey
#19
Irina Briskman, Assaf Shelef, Uri Berger, Yehuda Baruch, Gali Bar, Jack Asherov, Artur Lvovski, Alan Apter, Yoram Barak
BACKGROUND: Deliberate self-harm (DSH) increases the danger of future suicide death and the risk increases with age. Self-harm in older adults is often associated with greater suicidal intent and lethality. OBJECTIVES: To investigate clinical and psychosocial variables of older patients (age ≥ 65 years) assessed due to DSH, compared with younger adults. METHODS: Patients admitted to the Emergency Department following DSH during an 8 year period were included...
March 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28438447/randomized-clinical-trial-of-propofol-versus-alfentanil-for-moderate-procedural-sedation-in-the-emergency-department
#20
James R Miner, Brian E Driver, Johanna C Moore, Erik Faegerstrom, Lauren Klein, Matthew Prekker, Jon B Cole
STUDY OBJECTIVE: To compare the frequency of airway and respiratory adverse events leading to an intervention between moderate sedation using alfentanil or propofol. METHODS: We performed a randomized clinical trial in which adults undergoing moderate sedation in the ED received either alfentanil or propofol. Our primary outcome was the frequency of airway and respiratory adverse events leading to an intervention. Other outcomes included sedation depth, efficacy, sedation time, patient satisfaction, pain, and satisfaction...
April 21, 2017: American Journal of Emergency Medicine
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