The American journal of emergency medicine
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Falls are a significant issue among older adults, leading to morbidity and mortality. Screening for fall risk in the ED is crucial but challenging due to time limitations and patient conditions. Sarcopenia, characterized by muscle loss, is associated with increased fall risk, and ultrasound has been proposed as a non-invasive tool to measure muscle mass in this context. ⋯ The simpler tool, the STEADI questionnaire, may offer more practicality in screening fall risk compared to complex ultrasound measurements or physical performance tests among the older in ED.
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Posterior hip dislocation is commonly seen in the emergency department and requires urgent reduction to help avoid complications. Many techniques have been described to perform the reduction, all aimed at helping the physician gain a mechanical advantage to overcome the bony anatomy and large muscles groups involved. ⋯ The lift is engaged to create the desired traction, allowing the provider to manipulate the hip with adduction/abduction and/or internal/external rotation to achieve reduction. In addition, our method may also allow the provider to task switch more easily between other requirements, such as procedural sedation and attention to the patient's airway, especially in the single coverage emergency department.
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Case Reports
Successful administration of extended-release buprenorphine in the emergency department.
The ongoing opioid epidemic in the United States has resulted in a substantial increase in overdose deaths and related morbidity and mortality. Given that emergency departments (ED) frequently serve as the initial point of contact for individuals experiencing opioid overdose or seeking treatment for opioid use disorder (OUD), ED clinicians have a pivotal role to play in providing prompt and effective treatment for OUD. While ED clinicians routinely administer sublingual and other transmucosal formulations of buprenorphine, extended-release buprenorphine (BUP-XR) remains underutilized in the ED. ⋯ Our report adds to the existing limited literature on the administration of BUP-XR in the ED and highlights the need for more comprehensive clinician teaching and guidance, as well as the establishment of in-hospital protocols for BUP-XR. Despite these challenges, our case indicates that initiating BUP-XR could be a viable and effective option for ED patients with OUD.
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This study analyzes the trajectory of youth emergency department or inpatient hospital visits for depression or anxiety in Illinois before and during the COVID-19 pandemic. ⋯ llinois youth depression and anxiety hospital visit rates declined significantly after the pandemic shutdown and remained stable into 2023 at levels below 2016-2019 rates. Further progress will require both clinical innovations and effective prevention grounded in a better understanding of the cultural roots of youth mental health.
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Randomized Controlled Trial Multicenter Study Comparative Study
Alfentanil versus fentanyl for emergency department rapid sequence induction with ketamine: A-FAKT, a pilot randomized trial.
Fentanyl is often administered during rapid sequence induction of anesthesia (RSI) in the emergency department (ED) to ameliorate the hypertensive response that may occur. Due to its more rapid onset, the use of alfentanil may be more consistent with both the onset time of the sedative and the commencement of laryngoscopy. As such, we compared the effect of alfentanil and fentanyl on post-induction hemodynamic changes when administered as part of a standardized induction regimen including ketamine and rocuronium in ED RSI. ⋯ Alfentanil and fentanyl produced comparable post-induction hemodynamic changes when used as adjuncts to ketamine in ED RSI. Future studies could consider comparing different dosages of these opioids.