The American journal of emergency medicine
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To determine the rate at which commercially-insured patients fill prescriptions for naloxone after an opioid-related ED encounter as well as patient characteristics associated with obtaining naloxone. ⋯ Few patients use insurance to obtain naloxone by prescription following opioid-related ED encounters. Clinical and policy interventions should expand distribution of this life-saving medication in the ED.
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Review Case Reports
Acute myocardial infarction from embolization of Lambl's excrescences: A case report.
While coronary artery embolism remains an infrequent cause of myocardial infarction (MI), it may present in patients at otherwise low risk for coronary artery disease. When clinicians apply typical risk stratification in these cases, they may be led away from a full evaluation for acute coronary syndrome (ACS). A diagnosis of MI in an otherwise healthy patient should prompt consideration of embolic sources, including Lambl's excrescences (LEs), and echocardiographic evaluation may be necessary to make a final diagnosis. We present a case of LEs in an otherwise healthy 43-year-old male presenting with chest pain and elevated cardiac enzymes, and also review the cases of this rare event found in the literature.
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Observational Study
Type of bystander and rate of cardiopulmonary resuscitation in nursing home patients suffering out-of-hospital cardiac arrest.
We investigated bystander cardiopulmonary resuscitation (CPR) provision rate and survival outcomes of out-of-hospital cardiac arrest (OHCA) patients in nursing homes by bystander type. ⋯ Although OHCA was detected more often by non-medical staff, they provided bystander CPR less frequently than the medical staff did. To improve survival outcome of nursing home OHCA, bundle interventions including increasing the usage of automated external defibrillators and expanding CPR training for non-medical staff in nursing home are needed.
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This study aimed to determine the association between sarcopenic findings of the psoas muscle and mortality in patients with sepsis; further, it aimed to assess its clinical utility, in addition to the sequential organ failure assessment (SOFA) score, in predicting mortality. ⋯ The results suggested an association of the sarcopenic findings of the psoas muscle on CT imaging with 90-day mortality; however, the modified SOFA had few additional clinical values to that of SOFA in predicting 90-day mortality.
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Alteplase is the standard of care for early pharmacologic thrombolysis after acute ischemic stroke (AIS). Alteplase is also considered a high-alert medication and is fraught with potential for error. We sought to describe the difference in medication error rates in in patients receiving alteplase for acute ischemic stroke from regional hospitals compared to patients receiving alteplase at the Comprehensive Stroke Center. ⋯ The error rate of alteplase infusion for ischemic stroke is high, particularly in patients from referring centers. Errors may be associated with adverse events. Further education and administration safeguards should be implemented to decrease the risk of medication errors.