Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial
The effect of triage-applied Ottawa Ankle Rules on the length of stay in a Canadian urgent care department: a randomized controlled trial.
To determine whether triage nurses ordering ankle or foot radiographs according to the Ottawa Ankle Rules (OAR) before physician evaluation decreases the length of stay for patients visiting an urgent care department. ⋯ The use of OAR and the ordering of roentgenograms by triage nurses before physician evaluation for twisting ankle or foot injuries does not decrease the length of stay in an urgent care department.
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To characterize emergency medicine (EM) program directors (PDs) and compare the data, where possible, with those from other related published studies. ⋯ Emergency medicine PDs generally are very satisfied with the position of PD, perhaps because of increased support and resources. Although PD turnover remains an issue, PDs intend to remain in the position for a longer period of time than noted before this study. This may reflect the overall satisfaction with the position as well as the increased resources and support now available to the PD. PDs have greater satisfaction if they have been mentored for the position.
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The goal of this study was to examine how physicians in the emergency department ask questions of patients presenting with chest pain and whether this varies by patient demographics. ⋯ The variability in questions about behavioral factors associated with chest pain etiology as reported by patients may indicate a possible cultural bias by physicians. Differences in risk identification may lead to differences in treatment decisions.
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Delta opioids have been shown to confer ischemic preconditioning and pharmacologic ischemic preconditioning to the myocardium. However, their role in providing extended pharmacologic ischemic preconditioning in hemorrhagic shock has not been explored. The authors examined the effects of 24-hour preinfusions of a selective delta opioid receptor agonist, Deltorphin-Dvariant (Delt-Dvar), on hemodynamic stability and duration of survival in a rat model of severe hemorrhagic shock. ⋯ Twenty-four-hour pretreatment with Delt-Dvar decreases plasma lactate levels and improves hemodynamic stability and survival during hemorrhagic shock. The use of delta-specific opioids may improve survival from hemorrhagic shock and have clinical utility in providing ischemic protection in scenarios of planned ischemia.
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Editorial Comment
Stuck in neutral: continued challenges with healthcare disparities.