Journal of the American College of Emergency Physicians open
-
J Am Coll Emerg Physicians Open · Dec 2020
Not all HEART scores are created equal: identifying "low-risk" patients at higher risk.
We sought to identify sub-groups of "low-risk" HEART score patients (history, ECG, age, risk factors, and troponin) at elevated risk of acute myocardial infarction or death within 30 days. ⋯ Among "low-risk" suspected acute coronary syndrome encounters, increasing points within each of the 5 categories demonstrated small increases in risk of death or acute myocardial infarction, with the troponin and ECG components representing the largest risk increases.
-
J Am Coll Emerg Physicians Open · Dec 2020
Artificial intelligence in emergency medicine: A scoping review.
Despite the growing investment in and adoption of artificial intelligence (AI) in medicine, the applications of AI in an emergency setting remain unclear. This scoping review seeks to identify available literature regarding the applications of AI in emergency medicine. ⋯ AI-related research is rapidly increasing in emergency medicine. There are several promising AI interventions that can improve emergency care, particularly for acute radiographic imaging and prediction-based diagnoses. Higher quality evidence is needed to further assess both short- and long-term clinical outcomes.
-
J Am Coll Emerg Physicians Open · Dec 2020
Comparison of preadministered and coadministered lidocaine for treating pain and distress associated with intranasal midazolam administration in children: A randomized clinical trial.
Pain and distress associated with intranasal midazolam administration can be decreased by administering lidocaine before intranasal midazolam (preadministered lidocaine) or combining lidocaine with midazolam in a single solution (coadministered lidocaine). We hypothesized coadministered lidocaine is non-inferior to preadministered lidocaine for decreasing pain and distress associated with intranasal midazolam administration. ⋯ Pain and distress associated with intranasal midazolam administration were similar when using coadministered or preadministered lidocaine, but our non-inferiority determination was inconclusive. Administration of intranasal lidocaine by itself was associated with a measurable degree of pain and distress.Keywords: intranasal, midazolam, anxiolysis, sedation, emergency department, emergency medicine, pain, distress, pediatric, lidocaine, laceration.
-
J Am Coll Emerg Physicians Open · Dec 2020
Emergency medical services targeting opioid user disorder: An exploration of current out-of-hospital post-overdose interventions.
The opioid epidemic continues to escalate, and out-of-hospital emergency medical services (EMS) play a vital role in acute overdose reversal, but could serve a broader role post-incident for follow-up, outreach, and referrals. Our objective is to identify the scope and prevalence of community-based, post-opioid overdose EMS programs across the United States. ⋯ Out-of-hospital emergency care has the potential to provide more comprehensive care after drug overdose, but many programs either do not currently have such an intervention in place, or are not disseminating their practices for other agencies to assimilate. EMS protocols and policies that encourage greater adoption of active community paramedicine practices for opioids should be encouraged.
-
J Am Coll Emerg Physicians Open · Dec 2020
System impacts of the COVID-19 pandemic on New York City's emergency medical services.
To describe the impact of the COVID-19 pandemic on New York City's (NYC) 9-1-1 emergency medical services (EMS) system and assess the efficacy of pandemic planning to meet increased demands. ⋯ COVID-19-associated NYC 9-1-1 EMS volume surge was primarily due to respiratory and cardiovascular call-types. As the pandemic stabilized, call volume declined to below pre-pandemic levels. Our results highlight the importance of EMS system-wide pandemic crisis planning.