The American journal of emergency medicine
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Observational Study
Optimizing outcomes: A retrospective analysis of discharge safety for elderly mTBI patients on anticoagulation therapy.
Mild traumatic brain injuries (mTBIs) pose a significant risk, particularly in the elderly population on anticoagulation therapy. The safety of discharging these patients from the emergency department (ED) with a negative initial computed tomography (CT) scan has been debated due to the risk of delayed intracranial hemorrhage (d-ICH). ⋯ In elderly patients on anticoagulation with mTBI and a negative initial CT, admission was associated with a higher risk of d-ICH compared to discharge. These findings have implications for clinical decision-making in this high-risk population.
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Review
Osteopathic manipulation and its applicability in the emergency department: A narrative review.
Osteopathic manipulative treatment (OMT), also known as osteopathic manipulative medicine (OMM), is a set of manual techniques, developed by Dr. Andrew Taylor Still, founder of osteopathic medicine, initially limited to osteopathic medicine, for the treatment of painful conditions. This toolset is now used by allopathic physicians, international osteopaths, physical therapists, chiropractors, and other healthcare workers for the treatment of musculoskeletal pain. OMT can be used in the emergency department (ED) for the treatment of musculoskeletal complaints as an adjunct to pharmacologic agents (e.g., NSAIDs), or an alternative to opioids. ⋯ OMT is being used and has great potential in the management of acute and chronic musculoskeletal pain in the ED in addition to, or instead of pharmacologic agents, in particular as an opioid-sparing option.
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Comparative Study
The accuracy of Gemini, GPT-4, and GPT-4o in ECG analysis: A comparison with cardiologists and emergency medicine specialists.
GPT-4, GPT-4o and Gemini advanced, which are among the well-known large language models (LLMs), have the capability to recognize and interpret visual data. When the literature is examined, there are a very limited number of studies examining the ECG performance of GPT-4. However, there is no study in the literature examining the success of Gemini and GPT-4o in ECG evaluation. The aim of our study is to evaluate the performance of GPT-4, GPT-4o, and Gemini in ECG evaluation, assess their usability in the medical field, and compare their accuracy rates in ECG interpretation with those of cardiologists and emergency medicine specialists. ⋯ While GPT-4o shows promise, especially in more challenging ECG questions, and may have potential as an assistant for ECG evaluation, its performance in routine and overall assessments still lags behind human specialists. The limited accuracy and consistency of GPT-4 and Gemini suggest that their current use in clinical ECG interpretation is risky.
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We report the feasibility and recommend the potential efficacy of a bolus intravenous potassium chloride during out-of-hospital cardiac arrest with recurrent ventricular fibrillation following an acute coronary syndrome in a man in his 40's.
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The standard of care for congestive heart failure (CHF) aims to slow disease progression and maximize patient function, however there is an increase in emergency department (ED) revisits and readmissions. Social risk factors play a role in the disease management and prognosis of CHF. There is a gap in the identification of low-risk CHF patient who would be safely discharged using an initial social risk factor stratification. ⋯ This study suggests establishing a social risk profile for patients presenting to the ED with CHF can help formulate a CHF-specific care plan and optimize multidisciplinary management to reduce ED revisits and readmissions.