The American journal of emergency medicine
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Effective pain management results in improved patient satisfaction, reduced anxiety, and improved comfort. However, concern exists regarding the effects of pain medications on cognition and patient ability to consent for procedures, hospital admission, or to refuse recommended medical interventions. ⋯ We found significant variation in DSST scores among ED patients with pain. Treatment of pain with nonsedating analgesic agents was not associated with improved scores on the Digit Symbol Substitution Test among ED patients with acute painful conditions, compared to control subjects.
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For patients with sepsis and septic shock, the initial administration of antibiotics should occur as soon as possible, preferably within one hour of sepsis recognition. While clinicians are focused on providing first-doses of antibiotics quickly upon presentation, re-dosing issues may arise in patients who have an extended emergency department (ED) length of stay (LOS). Limited studies have been conducted that assess the impact of re-dosing delays. The purpose of this study was to assess the association of an extended ED LOS ≥ 6 h with antibiotic re-dosing delays in patients with sepsis and examine outcomes. ⋯ There was no statistically significant difference in the incidence of delays to the second dose of antibiotics among patients with sepsis with an ED LOS of <6 h versus those with an ED LOS of ≥6 h. The high incidence of antibiotic re-dosing delays in both groups, indicates an overall need for improved transitions of care in the ED sepsis population.
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Observational Study
MRSA nasal swab PCR to de-escalate antibiotics in the emergency department.
Methicillin-resistant Staphylococcus aureus (MRSA) nasal swab polymerase chain reaction (PCR) assay has a 96.1-99.2% negative predictive value (NPV) in pneumonia and may be used for early de-escalation of MRSA-active antibiotic agents. Xu (2018), File (2010) [1,2]. ⋯ MRSA PCR nasal swabs in the ED may serve as a useful tool for early MRSA-active antibiotic de-escalation when treating pneumonia.
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Observational Study
Long-term treatment retention of an emergency department initiated medication for opioid use disorder program.
Medication for Opioid Use Disorder (MOUD) has been shown to decrease mortality, reduce overdoses, and increase treatment retention for patients with opioid use disorder (OUD) and has become the state-of-the-art treatment strategy in the emergency department (ED). There is little evidence on long-term (6 and 12 month) treatment retention outcomes for patients enrolled in MOUD from the ED. ⋯ Our ED-initiated MOUD program, in partnership with local addiction medicine services, produced high rates of long-term treatment retention.
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Thrombotic microangiopathies are a diverse group of clinical syndromes characterized by microangiographic hemolytic anemia, thrombocytopenia, and organ dysfunction. We report a unique case of thrombotic microangiopathy in an adult caused by vitamin B12 deficiency that presented with stroke-like symptoms.