Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Review Meta Analysis
Adjuvant anticholinergic therapy for the prevention of akathisia in patients with primary headache in the emergency department: a systematic review.
Adjunct therapy with anticholinergic agents has been proposed to reduce the incidence of extrapyramidal side effects such as akathisia following treatment with neuroleptics or metoclopramide. This systematic review assessed the effectiveness of anticholinergic agents to prevent neuroleptic or metoclopramide-induced akathisia in patients presenting to the emergency department (ED) with benign headache. ⋯ This review found insufficient evidence to recommend the use of diphenhydramine as an adjunct therapy to prevent akathisia in ED patients treated with neuroleptics or metoclopramide for primary headache. This finding relies on the results of two small randomized controlled trials with incomplete outcome reporting. Additional high-quality studies are needed to better understand the clinical efficacy of agents with anticholinergic properties in the ED management of patients with primary headaches.
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Severe hypothermia (core body temperature < 28°C) is life-threatening and predisposes to cardiac arrest. The comparative effectiveness of different active internal rewarming methods in an urban U.S. population is unknown. We aim to compare outcomes between hypothermic emergency department (ED) patients rewarmed conventionally using an intravascular rewarming catheter or warm fluid lavage versus those rewarmed using extracorporeal membrane oxygenation (ECMO). ⋯ Among ED patients with severe hypothermia and cardiac arrest, survival was significantly higher with ECMO versus conventional rewarming. Among all hypothermic patients, ECMO use was associated with faster rewarming than conventional methods.
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Temperature abnormalities in infants may be a sign of a serious infection (SI) and there is literature regarding the workup of the febrile infant to help guide management. The prevalence of SIs in hypothermic infants and the development of established guidelines for this population has not been established. Our primary objective was to determine the prevalence of SI in hypothermic infants who are 60 days old or younger presenting to the emergency department (ED). In addition, we calculated the prevalence of SI by organ system and identified its microorganism. ⋯ The overall prevalence of SI was 4.86% in hypothermic young infants ≤ 60 days old presenting to the ED. Infants ≤ 28 days had a slightly higher prevalence of 5.15%. The most common source for serious bacterial infection was UTI.