The American journal of emergency medicine
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Letter Observational Study
Acute pain assessment and management depicted in medical television shows.
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Atrial fibrillation is the most common cardiac dysrhythmia in the United States. Our aim was to determine if a novel protocol for management of atrial fibrillation was feasible to implement in an emergency department (ED). Interviews were conducted with ED physicians and physician assistants to identify themes in relation to the clinical use and impleon of the protocol. ⋯ The Iowa Less Aggressive Protocol is a novel treatment protocol for the ED management of atrial fibrillation that was feasible to implement and use. Providers viewed the protocol favorably and identified areas of improvement for future use.
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The increasing worldwide demand for ambulance transport may worsen patient prognosis due to a prolonged response time and overcrowding in the emergency department. Triage in the prehospital setting may reduce the demand for ambulance transport by advising low-acuity patients seek non-emergency medical care. In Japan, a five-level triage system that allows emergency medical services (EMS) to triage patients has been implemented since 2014. This study aimed to validate the five-level triage system. ⋯ Our study validates the five-level prehospital triage system for patients transported by EMS and demonstrates an association between the triage acuity and ICU admissions.
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Antimalarial medications carry a risk of rare, but serious side effects. Primaquine in particular is known to cause methemoglobinemia and hemolytic anemia. In patients with underlying glucose-6-phosphate dehydrogenase (G6PD) deficiency, these side effects become amplified and can be life-threatening. ⋯ To our knowledge, this case represents a unique presentation of mixed methemoglobinemia and hemolytic toxicity due to an accidental primaquine overdose in a G6PD deficient pediatric patient. Though cases remain relatively rare, pediatric patients represent the vast majority of known primaquine overdoses. Their diagnosis and treatment require maintaining a high index of suspicion and a good working knowledge of antimalarial toxicities and management options.