The American journal of emergency medicine
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Review Meta Analysis
A year ReviewED: Top emergency medicine pharmacotherapy articles of 2021.
This article highlights the most relevant emergency medicine (EM) pharmacotherapy publications indexed in 2021. A modified Delphi approach was utilized for selected journals to identify the most impactful EM pharmacotherapy studies via the GRADE system. ⋯ Articles included in this review highlight acute agitation management, acute appendicitis treatment, sexually transmitted infection updates, optimizing sepsis management and treatment, updates for the ideal thrombolytic agent in acute ischemic stroke and endovascular therapy candidates, indications for tranexamic acid, calicium for out of hospital cardiac arrest, optimial inotrope for cardiogenic shock, awareness during rapid sequence intubation paralysis, comparison of propofol or dexmedetomidine for sedation, treatment of cannabis hyperemsis syndrome, and prophylactic use of diphenhydramine to reduce neuroleptic side effects. Selected articles are summarized to include design, results, limitations, conclusions and impact.
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Acute ataxia is commonly the chief complaint among patients visiting the emergency department (ED). It has multiple causes including infection and immunity-related, metabolic, vascular, and organic causes. Therefore, treating physicians should consider the severity and timing of onset in relation to the initial screening tests when making a differential diagnosis, and must be careful not to miss cases that require urgent treatment, such as stroke and drug-induced ataxia. ⋯ The plasma levels of phenytoin, carbamazepine, and valproic acid were 21.2 μg/mL (normal range: 7-20 μg/mL), 2.1 μg/mL (normal range: 5-10 μg/mL), and 33.5 μg/mL (normal range: 50-100 μg/mL), respectively. She was finally diagnosed with ataxia due to phenytoin toxicity. Her symptoms improved soon after the phenytoin dose was reduced and did not recur during a year of follow-up.
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Racial disparities in emergency medical care are abundant, and processes aimed to increase throughput, such as a rapid triage fast-track (FT) systems, may exacerbate these inequities. A FT strategy may be more susceptible to implicit bias as subjective information is obtained quickly. We aim to determine whether a FT model was associated with greater disparities between Black and White emergency department (ED) patients. ⋯ These results suggest that, after controlling for potential confounders, racial disparities may have been exacerbated in a FT ED triage process. In a FT model utilizing physicians and midlevel providers, this may create tiered levels of care between Black and White patients - an unacceptable side-effect of an effort to increase ED throughput.
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A key component of trauma system evaluation is the Injury Severity Score (ISS). The ISS is dependent on the AIS, and as AIS versions are updated this effects the number of patients within a health system which are considered severely injured (ISS >15). This study aims to analyse the changes comparing AIS1998 and AIS2015, and its impact on injury severity scoring and survival prediction model in a major trauma centre. ⋯ Trauma centres should be aware of the impact of the AIS2015 update on the benchmarking of trauma care, and consider the need for updating the ISS cut off for major trauma definitions.