Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Review Meta Analysis
Predicting Geriatric Falls Following an Episode of Emergency Department Care: A Systematic Review.
Falls are the leading cause of traumatic mortality in geriatric adults. Despite recent multispecialty guideline recommendations that advocate for proactive fall prevention protocols in the emergency department (ED), the ability of risk factors or risk stratification instruments to identify subsets of geriatric patients at increased risk for short-term falls is largely unexplored. ⋯ This study demonstrates the paucity of evidence in the literature regarding ED-based screening for risk of future falls among older adults. The screening tools and individual characteristics identified in this study provide an evidentiary basis on which to develop screening protocols for geriatrics adults in the ED to reduce fall risk.
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Fatal opioid overdose in the United States is at epidemic levels. Naloxone, an effective opioid antidote, is commonly administered by advanced emergency medical services (EMS) personnel in the prehospital setting. While states are rapidly moving to increase access to naloxone for community bystanders, the EMS system remains the primary source for out-of-hospital naloxone access. Many communities have limited advanced EMS response capability and therefore may not have prehospital access to the medication indicated for opioid overdose reversal. The goal of this research was to determine the authority of different levels of EMS personnel to administer naloxone for the reversal of opioid overdose in the United States, Guam, and Puerto Rico. ⋯ Naloxone administration is standard for paramedic and intermediate-level EMS personnel, but most states do not allow basic life support (BLS) personnel to administer this medication. Standards consistent with available medical evidence for naloxone administration, dosing, and route of administration should be implemented at each EMS level of certification.
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Review Meta Analysis
Prehospital Noninvasive Ventilation for Acute Respiratory Failure: Systematic Review, Network Meta-analysis, and Individual Patient Data Meta-analysis.
This meta-analysis aimed to determine the effectiveness of prehospital continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP) in acute respiratory failure. ⋯ Prehospital CPAP can reduce mortality and intubation rates compared to standard care, while the effectiveness of prehospital BiPAP is uncertain.
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Review Meta Analysis
Prehospital Noninvasive Ventilation for Acute Respiratory Failure: Systematic Review, Network Meta-analysis, and Individual Patient Data Meta-analysis.
This meta-analysis aimed to determine the effectiveness of prehospital continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP) in acute respiratory failure. ⋯ Prehospital CPAP can reduce mortality and intubation rates compared to standard care, while the effectiveness of prehospital BiPAP is uncertain.
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Review Meta Analysis
Systematic Review and Meta-analysis of Pregnant Patients Investigated for Suspected Pulmonary Embolism in the Emergency Department.
Pregnancy causes a small increase in risk of venous thromboembolism (VTE), but a large increase in concern upon presentation to an emergency department (ED) with symptoms of pulmonary embolism (PE), which may cause physicians to employ a low test threshold. This was a systematic review with the hypothesis that symptomatic pregnant patients in the ED have a low relative risk (RR) for VTE outcome. ⋯ In the ED setting, physicians test for PE in pregnant patients at a low threshold, resulting in a low rate of VTE diagnosis and a RR of VTE that is lower than that for nonpregnant women of childbearing age who are tested for PE in the ED setting.