The American journal of emergency medicine
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The use of ketorolac for analgesia in the emergency department is a common practice for pediatric patients. There is a lack of guidance on optimal dosing to limit the risk of side effects especially in pediatric patients. The standard dosing is weight based with a cap at 30 mg, a dose which is higher than the typical max used for adult patients. The objective of this study is to compare the analgesic effect of intravenous ketorolac at doses of 15 mg versus doses greater than 15 mg. ⋯ This retrospective review demonstrates an association of similar analgesic effects using a capped dose of 15 mg of IV ketorolac as compared to larger doses in pediatric patients admitted to the ED.
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Biased language in provider documentation of marginalized patient populations has been shown to negatively influence patient management. There has been debate over the use of "homeless" as a descriptor of people experiencing homelessness (PEH), as it is a potentially biased term with negative connotations. This study explores the relationship between the use of the word "homeless" in Emergency Department (ED) provider documentation and admission rates, as well as intravenous (IV) vs. oral (PO) opioid administration rates. ⋯ ED physician use of the term "homeless" in medical documentation was associated with a lower likelihood of being admitted to the hospital for certain conditions and more likely to receive PO rather than IV opioids compared with those patients not labeled as "homeless". This study reinforces prior studies in how biased language may alter medical decision making.
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The National Heart, Lung, and Blood Institute (NHLBI) defines acute chest syndrome (ACS) as a new infiltrate on chest x-ray (CXR) and at least 1 of the following: fever (≥38.50C), hypoxia, or respiratory symptoms. NHLBI expert consensus recommends a CXR in patients with sickle cell disease (SCD) who have fever and respiratory symptoms. Past work has shown that physicians fail to recognize ACS in children with SCD who present with fever, leading to varied CXR obtainment criteria. ⋯ Our findings provide strong evidence that a CXR is not necessary in a child with SCD presenting to the ED with fever and no NHLBI-defined respiratory symptoms. This evidence could improve quality of care and decrease unnecessary CXR use in the SCD population.
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Chronic kidney disease (CKD) patients with chest pain (CP) should receive special attention in the emergency department (ED). Evaluating troponin levels is highly confusing. This study aims to compare Cystatin C (CysC) and creatinine on troponin results in CKD patients with CP in ED. ⋯ CysC can be preferable in CKD patients with CP due to the stage change and the decisive effect of CysC on troponin compared to creatinine in patients with and without ACS.
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Optimal timing of adrenaline administration in pediatric out-of-hospital cardiac arrest (OHCA) is unclear. We aimed to evaluate the impact of early versus late adrenaline administration on survival and neurological outcomes at one month in children experiencing OHCA with non-shockable rhythm. ⋯ Early adrenaline administration in pediatric OHCA was not associated with overall one month survival or neurologic outcome.