The American journal of emergency medicine
-
The "72-h rule" allows emergency department (ED) physicians to administer methadone as an induction or bridge while referring to treatment. We aimed to evaluate an ED-based program designed to increase methadone access. ⋯ ED-based methadone "guest dosing," initiation, and bridging with linkage to care can increase access to MOUD. Most patients were seen for "guest dosing," and the majority remained in treatment at 30 days. A small sample was initiated on methadone and discharged from the ED. In this limited group, initial linkage and 30-day retention rates were similar to those of inpatient methadone initiation and ED-based buprenorphine initiation. Further study of ED-based methadone initiation is warranted.
-
Targeted temperature management (TTM) for patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) has not been fully studied. This study aimed to investigate the association between blood glucose levels during TTM and neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients undergoing ECPR. ⋯ During TTM, blood glucose levels of 180 mg/dL or more were significantly more associated with unfavorable outcomes than those of 140-180 mg/dL, in patients on ECPR. Further studies to evaluate more intensive glucose control than the current target of 140-180 mg/dL are required.
-
While lumbar puncture (LP) remains gold standard for assessing intracranial pressure (ICP), LP can be difficult to perform and lead to complications. Noninvasive correlations for elevated ICP via ocular ultrasound (OUS) have shown mixed results. The primary objective of this study is to identify the frequency and test characteristics of the crescent sign on OUS for elevated ICP. Secondary objectives include comparison of test characteristics to optic nerve sheath diameter (ONSD) and optic disc elevation (ODE). ⋯ The crescent sign was observed in 31 % of patients, with moderate sensitivity, specificity, and accuracy for elevated ICP. This study has several limitations and evaluations in the acute care setting are needed.
-
Facial burn injuries can compromise the airways in pediatric patients. Because prompt assessment of airway safety is a must, most assessment algorithms rely mainly on clinical judgment. There is little data on the value or utility of Fiber Optic Laryngoscopy (FOL) as an ancillary test. ⋯ The study findings suggest that the use of FOL examination in pediatric patients with facial burns and clinical signs suggestive of inhalation injury may have value, whereas its routine use presents low sensitivity comparable to reliance on clinical findings alone. Thus, FOL should be used in the patients with clinical signs of inhalation injury.