The American journal of emergency medicine
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We study community-level factors associated with emergency department (ED) admission rates and assessed how they vary across geography. ⋯ In 3031 U.S. counties, the ED admission rate varied from 3.9% to 82.2%. The lowest ED admission rates were concentrated in counties in Kansas, Oregon, and Vermont and the highest ED admission rates were in counties throughout Washington, Wyoming, Texas, and Colorado. The OLS model found several community-level factors that negatively impacted admission rates, specifically hospital market concentration, the rate of hospital beds with urgent care, and the rate of hospital beds. The factors that had a positive impact on the admission rate include the rate of MDs and factors for disadvantage, affluence, and foreign born/Hispanic. However, GWR showed the relationship between the ED admission rate and predictors varied across U.S. counties CONCLUSIONS: The association between healthcare market concentration, healthcare delivery, and socioeconomic factors with ED admissions differed across communities in Medicare beneficiaries. This suggests that policy and interventions to reduce ED admissions need to be tailored to specific community contexts.
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Blood gas analyzers can be alternatives to laboratory autoanalyzers for obtaining test results in just a few minutes. We aimed to find out whether the results from blood gas analyzers are reliable when compared to results of core laboratory autoanalyzers. ⋯ The two types of measurements showed a moderate correlation for sodium and potassium levels and a strong correlation for glucose, hemoglobin, and hematocrit levels, but none of the levels had acceptable agreement limits. Clinicians should be aware of the limitations of blood gas analyzer results.
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Ultrasound-guided nerve blocks (UGNBs) allow emergency physicians an opportunity to provide optimal pain management for acute traumatic conditions. Over the past decade, a growing body of literature has detailed the novel ways clinicians have incorporated UGNBs for analgesia and an alternative to procedural sedation. ⋯ Even with the presumed level of increased safety, we recommend that any clinician who performs ultrasound-guided nerve blocks be aware of complications that could arise during and after the procedure. Peripheral nerve injury (PNI) post block, local anesthetic systemic toxicity (LAST) and the role of single peripheral nerve blocks in patients with a risk for compartment syndrome are common safety issues discussed when performing ultrasound-guided nerve blocks.
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Emergency department (ED) visits for dental pain and low back pain (LBP) are common. Many such patients have severe pain and receive opioids. Increased opioid-related deaths has led to efforts to reduce opioid prescriptions. We compared recent trends in use of analgesics and opioids in the ED and at discharge among patients with dental or LBP. ⋯ Prescription of opioids decreased for ED dental patients. While less likely to receive analgesics and opioids in the ED, patients with dental pain were more likely to be prescribed analgesics and opioids at the time of ED discharge than those with LBP.