J Emerg Med
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It has been known for many years that interrupting chest compressions during cardiopulmonary resuscitation (CPR) from out-of-hospital cardiac arrest (OHCA) leads directly to negative outcomes. Interruptions in chest compressions occur for a variety of reasons, including provider fatigue and switching of compressors, performance of ventilations, placement of invasive airways, application of CPR devices, pulse and rhythm determinations, vascular access placement, and patient transfer to the ambulance. Despite significant resuscitation guideline changes in the last decade, several studies have shown that chest compressions are still frequently interrupted or poorly executed during OHCA resuscitations. Indeed, the American Heart Association has made great strides to improve outcomes by placing a greater emphasis on uninterrupted chest compressions. As highly trained health care providers, why do we still interrupt chest compressions? And are any of these interruptions truly necessary? ⋯ New and future technologies may provide promising results, but the greatest benefit will always be a well-directed, organized, and proactive team of providers performing excellent-quality and continuous chest compressions during CPR.
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Orally administered anticoagulants that offer alternatives to warfarin have been developed in recent years and are currently available for reduction of stroke risk in patients with non-valvular atrial fibrillation, the prophylaxis of venous thromboembolism after hip or knee replacement surgery, and the treatment and secondary risk reduction of deep vein thrombosis and pulmonary embolism. ⋯ The introduction of alternative oral anticoagulants will require emergency procedures that differ in some respects from those currently in place for warfarin and it will be necessary for Emergency Medicine professionals to become familiar with these procedures. Clinical stabilization of the bleeding or at-risk patient remains the emergency physician's priority.
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Intimate partner violence (IPV) is a widespread, but often unidentified, health concern. Understanding distinguishing characteristics of IPV assaults when compared to non-IPV assaults would advance IPV identification in health care settings. ⋯ For both women and men, victims assaulted at home had an elevated risk for IPV. These findings suggest that directed probing for assault incident characteristics - particularly incident location - may be an efficient, effective complement to current IPV screening practices for the busy ED provider. Incident location can be a cue to deepen inquiry about IPV among assault victims.