The American journal of emergency medicine
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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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Atrial fibrillation (Afib) with rapid ventricular response (RVR) is acutely treated with intravenous push (IVP) metoprolol (MET) or diltiazem (DIL). In heart failure (HF) patients, diltiazem is not recommended due to negative inotropic effects. Studies comparing the treatment of atrial fibrillation often exclude HF. Hirschy et al. evaluated HF patients with concomitant Afib with RVR who received IVP metoprolol or diltiazem to determine their effectiveness and safety. They found similar safety and effectiveness outcomes between the two groups. ⋯ Acute management of patients with Afib with RVR and HF is challenging. While successful rate control at 30 min was not significantly different between diltiazem and metoprolol, IVP diltiazem reduced HR more quickly and reduced HR by 20% or greater more frequently than IVP metoprolol with no safety outcome differences. Further studies are needed to evaluate diltiazem's safety in patients with Afib and HF.
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Observational Study
Trauma center designation level and survival of patients with chest wall instability.
Chest wall instability is a potentially life-threatening condition that should be evaluated at a trauma center. While patients with chest wall instability are sent to different trauma center levels, the impact of this on outcomes has not been evaluated yet. This study examines survival to hospital discharge of patients with chest wall instability treated at different trauma center levels. ⋯ Survival rates for patients having chest wall instability were similar when transported to level II or level III versus level I centers. This finding can help guide pre-hospital field triage criteria for this specific type of injury and highlights the need for more outcome research in organized trauma systems.