The American journal of emergency medicine
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The quick Sepsis-Related Organ Failure Assessment (qSOFA) score was designed to predict mortality among sepsis patients. However, it has never been used to identify prolonged length of hospital stay (pLOS) in geriatric patients with influenza infection. We conducted this study to clarify this issue. ⋯ qSOFA score ≥ 2 is a prompt and simple tool to predict pLOS in geriatric patients with influenza infection.
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Mounting evidence suggests hyperoxia therapy may be harmful. We describe injury characteristics and survival outcomes for pediatric trauma casualties in Iraq and Afghanistan, stratified by partial pressure of arterial oxygen (PaO2). Secondarily, we performed subgroup analyses for severe traumatic brain injury (TBI) and massive transfusion of blood products (MT). ⋯ Hyperoxemia was common among hospitalized, wartime pediatric trauma casualties in Iraq and Afghanistan that underwent ABG analysis. Survival to hospital discharge rates were not significantly different between subjects with hyperoxemia and subjects without hyperoxemia.
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Prescription opioid related deaths have increased dramatically over the past 17 years. Although emergency physicians (EPs) have not been the primary force behind this rise, previous literature have suggested that EPs could improve their opioid prescribing practices. We designed this study to evaluate the trend in emergency department (ED) opioid prescriptions over time during the US opioid epidemic. ⋯ ED physicians are prescribing less opiates, while increasing the amount of non-narcotic analgesic prescriptions. This may be in response to the literature suggesting that prescription opioids play a large role in the opioids crisis. This decrease in opioid prescriptions did not increase the need for repeat ED visits.
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To determine the impact of an emergency medicine clinical pharmacist's (EMCP) intervention on physicians' prescribing of vancomycin loading doses at an institution with limited EMCP services. ⋯ Following an EMCP intervention there was a statistically significant increase in the number of appropriate vancomycin loading dose orders prescribed by emergency medicine physicians. The EMCP's unique skill set and role within the emergency department permitted the EMCP to recognize and resolve a discrepancy in vancomycin prescribing practices. This study further highlights the importance of having dedicated clinical pharmacists in the emergency department and encourages institutions to develop, expand, and maintain EMCP positions.
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Spontaneous lung herniation is a rare finding, most often the result of forceful coughing. Risk factors include obesity, male gender, tobacco use, and steroid use. Surgical repair is recommended due to increasing size of herniation and pain control. Life style modification, such as smoking cessation, is recommended in this patient population.