The American journal of emergency medicine
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Fentanyl use has been linked with an increasing number of opioid-related deaths. The emergency department (ED) is a critical contact point for patients with opioid use disorder (OUD) to access basic healthcare. Little information is known about buprenorphine precipitated opioid withdrawal (BPOW). This study sought to examine the rates of BPOW in patients who used fentanyl and received buprenorphine in the ED. ⋯ We demonstrate that the prevalence of BPOW is low in a cohort of patients who use fentanyl. When precipitated withdrawal does occur, however, it can be severe and require intensive treatment, ICU admission, and prolonged hospital stay.
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Skin and soft tissue infections (SSTIs) are common and contribute significantly to morbidity and healthcare costs in emergency departments (EDs). The rise of antimicrobial resistance, particularly due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA), complicates treatment decisions. Objective physical examination findings suggesting need for empiric MRSA coverage are sometimes ignored. Improving initial antimicrobial selection in the ED, especially regarding MRSA, could enhance antimicrobial stewardship. ⋯ Several factors, not always aligned with clinical guidelines, influenced the decision to initiate MRSA coverage in the ED. Understanding these determinants may improve antimicrobial stewardship and reduce costs. Future research should focus on patient outcomes based on methicillin-sensitive S. aureus (MSSA) versus MRSA coverage decisions and educational initiatives to improve guideline compliance.
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Chlamydia trachomatis is the most prevalent, reportable sexually transmitted infection (STI) in the United States. In 2021, the Centers for Disease Control and Prevention (CDC) updated treatment recommendations from a single azithromycin 1000 mg dose to doxycycline 100 mg twice daily for seven days for the treatment of chlamydia infections. In response to changes in treatment recommendations and addressing patient barriers to treatment, pharmacists at an urban, academic medical center collaborated with the state health department to create doxycycline kits dispensed upon emergency department (ED) discharge. ⋯ Doxycycline discharge kits significantly increased guideline-directed treatment and decreased time-to-treatment for chlamydia in the ED population at an urban academic medical center.
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Physicians often cite time as a limitation to performing a focused cardiac ultrasound (FoCUS) exam. The primary outcome of this study was to determine the amount of time to complete a quality FoCUS exam. Secondary outcomes evaluated time differences between different training levels. ⋯ Our study shows EM physicians take approximately 3.4 min to complete a quality FoCUS exam and residents took 45 s longer compared to attendings. For resident physicians, the amount of time it takes to complete a quality FoCUS exam decreases over the course of residency training. Our findings suggest the amount of time to complete a quality FoCUS exam should not be a limitation to perform a FoCUS exam.
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Recent studies have validated the efficacy of point-of-care ultrasound (POCUS) as an alternative diagnostic imaging approach to computed tomography (CT) for patients with suspected acute diverticulitis. This study aimed to quantify the national impact of this approach in cost savings, ED length-of-stay (LOS), and radiation risk mitigation using a POCUS-first approach for acute diverticulitis in the emergency department (ED). ⋯ Both POCUS-first models can achieve substantial national annual cost savings, ED LOS reduction, and decreases in radiation exposure compared to the traditional CT-first approach. POCUS should be strongly considered as a first-line imaging modality for acute diverticulitis especially among low-risk patients.