Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Patient safety interventions for multitasking, multipatient, error-prone work settings such as the emergency department (ED) must improve assorted clinical abilities, specific cognitive strategies, and teamwork functions of the staff to be effective. Multiple encounter simulation scenarios explore and convey this specialized mental work-set through use of multiple high-fidelity medical simulation (SIM) manikins in realistic surroundings. Multipatient scenarios reflect the work situations being targeted yet have the benefit of scripted control and instructor guidance to advance specific educational objectives. ⋯ Widespread and effective training in well-replicated, carefully coordinated representations of complex multipatient work environments may strengthen educational interventions for personnel working in high acuity and work-overloaded settings such as the ED. The use of concurrent patient encounter SIM exercises to elicit calculated stressors and to foster compensatory staff behaviors is an educational advance toward this objective. The authors present SIM methodology using concurrent patient encounters to replicate these environments.
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Acute atrial fibrillation and flutter are very common arrhythmias seen in emergency department (ED) patients, but there is no consensus for their optimal management. The objective of this study was to examine the efficacy and safety of intravenous (IV) procainamide for acute atrial fibrillation or flutter. ⋯ This study of acute atrial fibrillation or flutter patients treated in the ED with IV procainamide suggests that this treatment is safe and effective in this setting. Procainamide should be prospectively compared with other ED strategies.
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Multicenter Study
Barriers to metered-dose inhaler/spacer use in Canadian pediatric emergency departments: a national survey.
Metered-dose inhalers and spacers (MDI+S) are at least as effective as nebulizers for treating children with mild to moderate asthma exacerbations. Despite advantages in terms of efficacy, side effects, and ease of use, MDI+S are not used in many North American pediatric emergency departments (PEDs). ⋯ MDI+S are infrequently used to treat patients with acute asthma in Canadian PEDs, despite the fact that most emergency staff believe they are effective. Important barriers to using MDI+S have been identified in this study and should be used to guide future implementation strategies.