The American journal of emergency medicine
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Out-of-pocket payments made by patients transported by Helicopter Emergency Medical Services (HEMS).
Recent news media have reported that Helicopter Emergency Medical Service (HEMS) programs use the practice of balanced billing, resulting in exorbitant charges not covered by insurance companies and financially burdening patients. To date, no study has described the billing practices of HEMS programs. We look to provide transparent billing practices and average patient payment of one midwestern non-profit HEMS program and report the reimbursement data of both federal and private insurance policies for transports. ⋯ The amount charged by this HEMS program and amount patients paid on average for flights was less than has been commonly reported in recent news media. More transparency in costs and payments between non-profit and for-profit HEMS agencies should occur.
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Each dialysis session uses approximately 150 to 200 L of water. The winter storm that swept southwest USA saw an unprecedented disruption of water supplies due to which intermittent hemodialysis could not be performed for end-stage renal disease (ESRD) patients. We present 4 cases when continuous renal replacement therapy (CRRT) was utilized to provide urgent hemodialysis in hemodynamically stable, non-critically ill ESRD patients during this time of water supply crisis. ⋯ We demonstrate limited CRRT as an alternative to safely manage ESRD patients needing urgent hemodialysis in the scenario of a natural disaster resulting in a water outage.
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Letter Case Reports
Amphetamine toxicity masked by concomitant γ-hydroxybutyrate (GHB) ingestion.
We report a case of a young male with amphetamine toxicity initially obscured by concomitant use of gamma-hydroxybutyrate (GHB), and the sympathomimetic symptoms emerged after GHB's effects receded. A 24-year-old unconscious man presented to emergency department showed the following vital signs upon admission: blood pressure 136/58 mmHg; heart rate 79 bpm; SpO2 87% under ambient air; body temperature 36.1 °C; Glasgow Coma Scale score 3. The pupils were not dilated. ⋯ The patient improved later and was extubated at 4 days after the mitigation of pneumonia and discharged uneventfully 8 days later. In our patient, amphetamine intoxication was initially masked by concomitant use of GHB but appeared as GHB's effect attenuated. We wish to remind clinicians of variable clinical presentations of polydrug abuse.
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Case Reports
Factor-guided diagnosis of coagulopathy associated with coumarin-contaminated synthetic cannabinoids: A case report.
Contamination of synthetic cannabinoids with toxic coumarin derivatives known as superwarfarins can induce a persistent coagulopathy. In comparison to warfarin, these derivatives have prolonged half-lives and laboratory assays for detection are not readily available in clinical practice. To our knowledge, factor-guided diagnosis of coagulopathy secondary to coumarin-contaminated synthetic cannabinoids has not been described previously. ⋯ Toxic coumarin derivative assays are not immediately available for reference. Given the patient's confirmed synthetic cannabinoid consumption and the possibility of coagulopathy from coumarin-contamination, factor levels served as a guide for diagnosis and treatment prior to the confirmatory assay. Obtaining factor levels in patients with an unexplained coagulopathy and suspected cannabis or synthetic cannabinoid use may aid clinicians in a more prompt diagnosis and treatment.
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Given the importance of understanding methodical reporting and statistical terminology in ensuring evidence-based decision-making, physicians should possess statistical literacy. The purpose of this study was to distinguish statistical terminology commonly used in emergency medicine methods and describe changes in statistical methods from 2011 to 2021. ⋯ By understanding common statistical terms and trends over time, educational efforts can be targeted to consumers of EM literature. Additionally, this work provides evidence suggesting an overall improvement in processes in statistical methodology, enhancing the quality of research outputs and ultimately allowing better clinical decision-making.