The American journal of emergency medicine
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The trauma team leader (TTL) is a "model" of a specifically dedicated team leader in the emergency department (ED), but its benefits are uncertain. The primary objective was to assess the impact of the TTL on 72-hour mortality. Secondary objectives included 24-hour mortality and admission delays from the ED. ⋯ TTL implementation was not associated with changes in mortality or admission delays from the ED. Future studies should assess the potential impact of TTL programs on other patient-centred outcomes using different quality of care indicators.
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The effectiveness of advanced airway management (AAM) for out-of-hospital cardiac arrest (OHCA) has been reported differently in each region; however, no study has accounted for the regional differences in the association between the timing of AAM implementation and neurological outcomes. ⋯ A delay in AAM performance was negatively associated with CPC 1-2 in both shockable and non-shockable cohorts. Moreover, a delay in AAM performance at the prefecture level was negatively associated with CPC 1-2 in the non-shockable cohort.
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Case Reports
Recreational drug toxicity with severe hyperthermia: Rapid onsite treatment and clinical course.
Electronic dance music festivals have gained notoriety in the critical care and emergency medicine fields due to an alarming incidence of hospitalizations and deaths related to the high prevalence of recreational drug use. Recreational drug use toxicity, in part related to sympathomimetic toxidromes, may cause hyponatremia, seizures, rhabdomyolysis, hyperkalemia, acidosis, coagulopathy, circulatory shock, multi-organ failure, and even death. ⋯ Rapid onsite diagnosis and treatment, with attention to the A-B-C's of clinical emergencies, is essential to preserve life. We describe a patient presenting with the highest recorded core temperature in a survivor of psychostimulant drug-induced toxicity, and emphasize management principles of this life-threatening and increasingly prevalent condition.
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Law enforcement officer (LEO) administered naloxone is an effective intervention for treating prehospital opioid overdoses. Our objective is to determine the rate and factors associated with adverse behavioral effects and efficacy following LEO naloxone administration. ⋯ LEO administered naloxone remains an effective intervention for overdose victims, with higher perceived efficacy when opioids are specifically implicated. Combativeness is rare following LEO naloxone administration. Further research is needed to understand a relationship between suspected fentanyl intoxication and post-naloxone behavioral disturbances.
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With respect to reversal of life threatening bleeds associated with the use of oral factor Xa inhibitors, current guidelines provide few recommendations for a preferred reversal agent. When the initial reversal agent fails to achieve the desired hemostatic response, there is little to no recommendations for the use of additional reversal agents. ⋯ An 86-year-old female on apixaban (ELIQUIS) for atrial fibrillation, presented from an outside hospital due to a spontaneous intracranial hemorrhage (sICH). Computed tomography (CT) scan revealed multifocal left sided sICH. Due to use of apixaban in the setting to sICH, patient received andexanet alfa (AA) for reversal. Patient was then transferred and upon arrival to receiving emergency department (ED), repeat CT scans showed an expanding sICH, progression of midline shift, and low-molecular weight heparin levels that were ≥ 2 international units (IU) per milliliter (mL), indicating therapeutic apixaban activity. The patient was subsequently given four-factor prothrombin complex concentrate (4F-PCC). WHY AN EMERGENCY MEDICINE PHYSICIAN SHOULD BE AWARE OF THIS INCLUDE THE FOLLOWING KEY POINTS.