J Emerg Med
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Randomized Controlled Trial
Telephoned, Texted, or Typed Out: A Randomized Trial of Physician-Patient Communication After Emergency Department Discharge.
Novel means of emergency department (ED) post-discharge communication-telephone callbacks and text messages-are increasingly being utilized to facilitate patient-oriented outcomes, such as ED revisits, patient adherence, and satisfaction. ⋯ Patients who are contacted for ED follow-up by phone and text, though perhaps not more satisfied, may tend to revisit the ED and contact their PMD or specialty physician less often than patients receiving standard written discharge instructions. However, this pilot study is underpowered, so larger randomized studies are needed to confirm.
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Immune checkpoint inhibitors (ICIs) are a novel class of drugs used in cancer immunotherapy that are becoming more commonly used among advanced-stage cancers. Unfortunately, these therapies are sometimes associated with often subtle, potentially fatal immune-related adverse events (irAEs). ⋯ With the increasing success and popularity of ICIs, emergency physicians will inevitably encounter increasing numbers of patients on these medications as well as the associated side effects. It is important that emergency physicians become aware of these irAEs and improve the detection of these processes to prevent inappropriate discharges, emergency department revisits, and downstream complications.
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Randomized Controlled Trial
Effect of Intranasal Vasoconstrictors on Blood Pressure: A Randomized, Double-Blind, Placebo-Controlled Trial.
Treatment for epistaxis includes application of intranasal vasoconstrictors. These medications have a precaution against use in patients with hypertension. Given that many patients who present with epistaxis are hypertensive, these warnings are commonly overridden by clinical necessity. ⋯ Intranasal vasoconstrictors did not significantly increase blood pressure in patients without a history of hypertension. Our findings reinforce the practice of administering these medications to patients who present to the ED with epistaxis, regardless of high blood pressure.
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Randomized Controlled Trial
End-Tidal Oxygen Saturation with Nasal Cannula During Noninvasive Positive Pressure Ventilation: A Randomized Crossover Trial.
Simultaneous use of nasal cannula (NC) with noninvasive positive pressure ventilation (NIPPV) may help streamline the transition from preoxygenation to intubation with apneic oxygenation in patients with deteriorating respiratory status, but may also compromise preoxygenation by impairing NIPPV mask seal. ⋯ The mean difference confidence interval did not include the noninferiority margin. Hence, NIPPV with NC seems noninferior to NIPPV alone with regard to EtO2. These results indicate that concomitant use of NC with NIPPV may be an appropriate preoxygenation strategy in anticipation of the potential need for transition to intubation.
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Pulmonary embolism (PE) is a disease diagnosed relatively frequently in emergency departments (EDs). Evidence suggests that improved decision making may decrease inappropriate testing, unnecessary radiation exposure, and non-beneficial treatment. Several studies have looked at the utility and safety of age-adjusting the D-dimer levels used to safely rule out PE. ⋯ Age-adjusted D-dimer cutoff values, in combination with a non-high clinical probability, is safe and effective to essentially rule out PE in ED patients.