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https://www.readbyqxmd.com/read/29310960/cannabinoid-hyperemesis-syndrome-pathophysiology-and-treatment-in-the-emergency-department
#1
John R Richards
BACKGROUND: Cannabinoid hyperemesis syndrome (CHS) is a challenging clinical disorder. CHS patients frequently present to the emergency department and may require treatment for intractable emesis, dehydration, and electrolyte abnormalities. Thought to be a variant of cyclic vomiting syndrome, CHS has become more prevalent with increasing cannabis potency and use, as enabled by various states having legalized the recreational use of cannabis. OBJECTIVE: This aim of this review is to investigate the pathophysiology of CHS and evaluate the published literature on pharmacologic treatment in the emergency department...
January 5, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29306262/considerations-for-physicians-using-ketamine-for-sedation-of-children-in-emergency-departments
#2
Woo Sung Kim, Ji Yeon Ku, Hanbyul Choi, Hyo Jeong Choi, Ho Jung Kim, Bora Lee
OBJECTIVE: Ketamine use in emergency departments (EDs) for procedural sedation and analgesia is becoming increasingly common. However, few studies have examined patient factors related to adverse events associated with ketamine. This study investigated factors for consideration when using ketamine to sedate pediatric ED patients. METHODS: The study included pediatric patients receiving ketamine for laceration repair in the ED. Before sedation, information was collected about upper respiratory tract infection symptoms, allergy history, and fasting time...
December 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29305022/emergency-department-length-of-stay-for-ethanol-intoxication-encounters
#3
Lauren R Klein, Brian E Driver, James R Miner, Marc L Martel, Jon B Cole
BACKGROUND: Emergency Department (ED) encounters for ethanol intoxication are becoming increasingly common. The purpose of this study was to explore factors associated with ED length of stay (LOS) for ethanol intoxication encounters. METHODS: This was a multi-center, retrospective, observational study of patients presenting to the ED for ethanol intoxication. Data were abstracted from the electronic medical record. To explore factors associated with ED LOS, we created a mixed-effects generalized linear model...
December 8, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29295971/special-k-with-no-license-to-kill-accidental-ketamine-overdose-on-induction-of-general-anesthesia
#4
Lindsay L Warner, Nathan Smischney
BACKGROUND Ketamine is used as an induction and sedation agent in emergency departments and operating rooms throughout the country. Despite its widespread clinical use, there are few cases of significant morbidity and mortality attributed to ketamine overdose in the clinical setting. CASE REPORT The anesthesia provider in the room was an oral maxillofacial surgeon who inadvertently took out a more highly concentrated bottle of ketamine that is typically used for pediatric patients. The patient received 950 mg (100 mg/ml concentration) of intravenous ketamine instead of the intended 95 mg (10 mg/ml concentration)...
January 3, 2018: American Journal of Case Reports
https://www.readbyqxmd.com/read/29276277/impact-of-developing-adult-ketamine-order-panels-for-the-emergency-department
#5
Haley Baird, Rachel Rumbarger
Background: Ketamine in adults has been identified as a safe and effective alternative for multiple indications, each with specific evidence-based dosing ranges. Emergency department (ED) providers are tasked with appropriate ordering of ketamine. A multi-institutional retrospective analysis within EDs at a large health system from November 2013 to October 2015 reviewed ED adult ketamine prescribing patterns for procedural sedation (PS), rapid sequence intubation (RSI), and analgesia. Retrospective cohort results revealed 56% (84 of 150) of PS, 64% (16 of 25) of RSI, and 81...
July 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/29249008/secondary-imaging-for-suspected-appendicitis-after-equivocal-ultrasound-time-to-disposition-of-mri-compared-to-ct
#6
James F Martin, David J Mathison, Paul C Mullan, Hansel J Otero
PURPOSE: The purpose of this study was to compare MRI to CT as a secondary imaging modality for children age 5 years and older with suspected appendicitis after an equivocal abdominal ultrasound in terms of (1) the time to ED disposition decision, (2) surgery consultation rate, and (3) imaging test accuracy. METHODS: We retrospectively studied children with suspected appendicitis and equivocal ultrasound results who underwent MR or CT as secondary imaging in a pediatric emergency department over two-consecutive 9-month periods...
December 16, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/29247274/procedural-sedation-and-analgesia-practices-by-emergency-physicians-in-the-netherlands-a-nationwide-survey
#7
Maybritt I Kuypers, Gaël J P Smits, Suzanne C Valkenet, Wendy A M H Thijssen, Frans B Plötz
BACKGROUND: Several efforts have been made to assure and to improve the quality of procedural sedation and analgesia (PSA) performed by emergency physicians (EPs) in The Netherlands. This study investigated the current PSA practice and competences of EPs in both adult and paediatric patients. In particular, if residency and current training, awareness of guidelines is sufficient for registered EPs to adequately perform PSA and if the availability of both adult and paediatric PSA in the ED is adequate...
December 15, 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29244659/intra-articular-patellar-dislocation-a-technique-for-closed-reduction-a-case-report-and-review-of-the-literature
#8
Lachlan Wight, Dugal James
CASE: An 87-year-old man fell onto a flexed knee and sustained a closed intra-articular patellar dislocation. A closed reduction was performed under intravenous sedation by flexing the knee to 90°, applying an anterior drawer force to the tibia, and applying pressure to the inferior pole of the patella. The day after reduction, weight-bearing was begun in a hinged brace set at 0° to 90°. Full function was regained by 6 weeks postreduction. CONCLUSION: Intra-articular patellar dislocation may present as an unusual cause of a locked knee...
December 13, 2017: JBJS Case Connector
https://www.readbyqxmd.com/read/29240569/paediatric-procedural-sedation-and-analgesia-by-emergency-physicians-in-a-country-with-a-recent-establishment-of-emergency-medicine
#9
Maybritt I Kuypers, Gaël J P Smits, Eva P Baerends, Erick Oskam, Eef P J Reijners, Lisette A A Mignot-Evers, Wendy A M H Thijssen, Frans B Plötz, Erik H M Korsten
OBJECTIVES: Paediatric patients receive less procedural sedation and analgesia (PSA) in the emergency department compared with adults, especially in countries where emergency medicine is at an early stage of development. The objectives of this study were to evaluate the adverse events and efficacy of paediatric PSA in a country with a recent establishment of emergency medicine and to describe which factors aided implementation. METHODS: This is a prospective, multicentre, observational study of paediatric patients undergoing PSA by the first trained emergency physicians (EPs) in The Netherlands...
December 13, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/29239751/feasibility-of-single-vs-two-physician-procedural-sedation-in-a-small-community-emergency-department
#10
Clayton P Josephy, David R Vinson
OBJECTIVE: Sedation is commonly required for painful procedures in the emergency department (ED). Some facilities mandate two physicians be present for deep sedation cases. Evidence is lacking, however, that a two-physician approach improves safety outcomes. We report our experience on the feasibility of replacing a two-physician ED procedural sedation policy with a single-physician policy in a small, single-coverage community ED. METHODS: This is a retrospective, before/after, single-center observational study of prospectively collected data from January 2013 through December 2016...
November 3, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29233853/variation-in-pediatric-procedural-sedations-across-children-s-hospital-emergency-departments
#11
Andrew F Miller, Michael C Monuteaux, Florence T Bourgeois, Eric W Fleegler
OBJECTIVES: Describe the trends in pediatric sedation use over time and determine variation in use of procedural sedation across children's hospital emergency departments (EDs). METHODS: We analyzed ED data from 35 hospitals within the Pediatric Health Information System for patients <19 years old who received sedation medications and were discharged from 2009 to 2014. Patients with chronic comorbidities or undergoing intubation were excluded. We determined frequency and trends in use of sedation and compared these between EDs...
January 2018: Hospital Pediatrics
https://www.readbyqxmd.com/read/29227367/practice-patterns-and-outcomes-associated-with-early-sedation-depth-in-mechanically-ventilated-patients-a-systematic-review-and-meta-analysis
#12
Robert J Stephens, Matthew R Dettmer, Brian W Roberts, Enyo Ablordeppey, Susan A Fowler, Marin H Kollef, Brian M Fuller
OBJECTIVES: Emerging data suggest that early deep sedation may negatively impact clinical outcomes. This systematic review and meta-analysis defines and quantifies the impact of deep sedation within 48 hours of initiation of mechanical ventilation, as described in the world's literature. The primary outcome was mortality. Secondary outcomes included hospital and ICU lengths of stay, mechanical ventilation duration, and delirium and tracheostomy frequency. DATA SOURCES: The following data sources were searched: MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews and Effects, Cochrane Database of Systematic Reviews databases, ClinicalTrials...
December 8, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29212133/factors-associated-with-patient-reported-procedural-memory-following-emergency-department-procedural-sedation-with-ketamine-and-propofol-a-prospective-cohort-of-563-patients
#13
Andrew Greer, Greg Treston
OBJECTIVES: To describe the proportion of patients reporting procedural memory following procedural sedation and analgesia (PSA) with ketamine and propofol (KP) administered premixed together (ketofol) or individually (sequential KP) in ED attendees. Identify any clinical or demographic variables associated with procedural memory. METHODS: This was a convenience sample of 563 patients who received KP PSA as per the departmental protocol. A standardised script was used to assess for procedural memory...
December 6, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29198490/overdose-and-adverse-drug-event-experiences-among-adult-patients-in-the-emergency-department
#14
Amy S B Bohnert, Maureen A Walton, Rebecca M Cunningham, Mark A Ilgen, Kristen Barry, Stephen T Chermack, Frederic C Blow
INTRODUCTION: Overdose is a leading cause of injury and death in the United States. Emergency Department (ED) patients have an elevated prevalence of substance use. This study describes overdose/adverse drug event experiences among adult ED patients to inform strategies to address overdose risk. METHODS: Patients seeking care at a large ED in the city of Flint, Michigan participated in a computerized self-assessment during 2011-2013 (n=4571). Overdose was assessed with a broad definition and included occurrences that could be considered adverse drug events...
November 16, 2017: Addictive Behaviors
https://www.readbyqxmd.com/read/29170353/56%C3%A2-manipulation-and-reduction-of-paediatric-forearm-fractures-using-es-ketamine-in-a-paediatric-emergency-department-a-5-year-study
#15
Shirley Mulvaney
BACKGROUND: Forearm fractures are the most common paediatric injury presenting to A+E.1,2 Literature supports safe and effective treatment of these injuries in A+E using a variety of sedation methods, including ketamine.3,4 The Paediatric Orthopaedic Trauma Snapshot (POTS) study showed that only 35% of A+Es nationally allow manipulation of these injuries in the department. METHODS: A retrospective analysis was undertaken of all patients presenting with fractures of the forearm between January 2012 to December 2016 who were treated with reduction and manipulation in the Alder Hey A+E department using Es-ketamine...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29169819/use-of-capnography-to-optimize-procedural-sedation-in-the-emergency-department-pediatric-population
#16
Leonie Rose Bovino, Christina Brainard, Kristen Beaumier, Victoria Concetti, Nicole Lefurge, Emily Mittelstadt, Tabea Wilson, Melissa L Langhan
No abstract text is available yet for this article.
November 20, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29166296/emergency-intubations-in-a-high-volume-pediatric-emergency-department
#17
Jen Heng Pek, Gene Yong-Kwang Ong
INTRODUCTION: Resuscitation of critically ill children can be chaotic, and emergency airway management is often fraught with difficulties. This study aimed to characterize the Singaporean landscape of tracheal intubation in a pediatric emergency unit, placing emphasis on safety outcomes, procedural process of care, and provider training. METHODS: A retrospective review of all cases presented to the KK Women's and Children's Hospital from January 2009 to December 2013 with intubation carried out within the pediatric emergency unit was done...
November 21, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29157794/analgosedative-interventions-after-rapid-sequence-intubation-with-rocuronium-in-the-emergency-department
#18
Emily Kilber, Daniel H Jarrell, John C Sakles, Christopher J Edwards, Asad E Patanwala
OBJECTIVES: The use of etomidate and rocuronium for rapid sequence intubation (RSI) results in a duration of paralysis that exceeds the duration of sedation. The primary objective of this study was to compare the number of analgosedative (AGS) interventions early versus late post-RSI, with this drug combination. The secondary objective was to descriptively assess time to first AGS intervention. METHODS: This was a retrospective cohort study conducted in an academic ED in the United States between January 2015 and June 2016...
November 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29157713/procedural-sedation-in-the-emergency-department
#19
EDITORIAL
(no author information available yet)
No abstract text is available yet for this article.
December 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29132572/secondary-gains-advances-in-neurotrauma-management
#20
REVIEW
Brit Long, Alex Koyfman
Neurotrauma is a leading cause of death and is associated with many secondary injuries. A balance of mean arterial pressure (MAP) and intracranial pressure (ICP) is required to ensure adequate cerebral blood flow and cerebral perfusion pressure. Evaluation and management in the emergency department entails initial stabilization and resuscitation while assessing neurologic status. ICP management follows a tiered approach. Intubation requires consideration of preoxygenation, head of bed elevation, first pass success, and adequate analgesia and sedation...
February 2018: Emergency Medicine Clinics of North America
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