Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study Clinical Trial Observational Study
Risk Factors for Sedation-Related Events During Acute Agitation Management in The Emergency Department.
The objective was to describe the incidence, nature, and risk factors for adverse events (AEs) among patients who received parenteral sedation for acute agitation in an emergency department (ED) setting. ⋯ Sedation-related AEs are common, especially respiratory events. Elderly patients, sedation with multiple sedatives within 60 minutes, and alcohol intoxication increased the risk.
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Multicenter Study Comparative Study
Multicenter Comparison of Nonsupine Versus Supine Positioning During Intubation in the Emergency Department: A National Emergency Airway Registry (NEAR) Study.
Head-up positioning for preoxygenation and ramping for morbidly obese patients are well-accepted techniques, but the effect of head-up positioning with full torso elevation for all intubations is controversial. We compared first-pass success, adverse events, and glottic view between supine (SP) and nonsupine (NSP) positioning for emergency department (ED) patients undergoing orotracheal intubation. ⋯ ED providers utilized SP in most ED intubations but were more likely to use NSP for patients who were obese or in whom they predicted a difficult airway. We found no differences in first-pass success between groups but total adverse events were more likely in NSP. A randomized trial comparing patient positioning during intubation in the ED is warranted.
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Randomized Controlled Trial Multicenter Study
A Multicenter Randomized Trial to Evaluate a Chemical-first or Electrical-first Cardioversion Strategy for Patients With Uncomplicated Acute Atrial Fibrillation.
Emergency department (ED) patients with uncomplicated atrial fibrillation (AF) of less than 48 hours may be safely managed with rhythm control. Although both chemical-first and electrical-first strategies have been advocated, there are no comparative effectiveness data to guide clinicians. ⋯ In uncomplicated ED AF patients managed with rhythm control, chemical-first and electrical-first strategies both appear to be successful and well tolerated; however, an electrical-first strategy results in a significantly shorter ED LOS.
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Multicenter Study
The Emergency Department Response to Women Experiencing Intimate Partner Violence: Insights From Interviews With Clinicians in Australia.
Emergency departments (EDs) are essential providers of compassionate, immediate treatment and referral for women experiencing intimate partner violence (IPV). IPV, largely perpetrated by men against women, exerts a substantial burden on the health systems and economies of all nations. There is little known about how staff in Australian EDs respond to the challenges such violence generates. We therefore examined the clinical team response to women experiencing IPV in two large Australian metropolitan hospital EDs. ⋯ Emergency departments can provide caring environments for women experiencing IPV. Effective interprofessional teamwork across nursing, medical, and social work professionals may mitigate the need for formal screening tools. Supportive workforce environments can improve staff understanding, reduce stigma, enhance appropriate treatment, and counsel health professionals experiencing violence. However, staff training and advocacy and referral relationships with local programs require strengthening. A connected multisystems-level response is required to coordinate and resource services for all affected by violence.
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Multicenter Study Observational Study
Benefits of Rhythm Control and Rate Control in Recent-onset Atrial Fibrillation: The HERMES-AF Study.
Although rhythm control has failed to demonstrate long-term benefits over rate control in longstanding episodes of atrial fibrillation (AF), there is little evidence concerning recent-onset ones. We analyzed the benefits of rhythm and rate control in terms of symptoms alleviation and need for hospital admission in patients with recent-onset AF. ⋯ In our study, recent-onset AF patients in whom rhythm control was attempted in the ED had a high rate of symptoms' alleviation and a reduced rate of hospital admissions.