J Emerg Med
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Patient safety incidents are commonly observed in critical and high demanding care settings, including the emergency department. There is a need to understand what causes patient safety incidents in emergency departments and determine the implications for excellence in practice. ⋯ This review enhances our awareness of contributing factors to patient safety incidents within emergency departments and encourages researchers from different disciplines to investigate the causes of practice errors and formulate safety improvement strategies.
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Multicenter Study Comparative Study
Prospective Evaluation of a Fixed-Dose 4-Factor Prothrombin Complex Concentrate Protocol for Urgent Vitamin K Antagonist Reversal.
Four-factor prothrombin complex concentrate (4F-PCC) is the standard of care for reversal of vitamin K antagonists (VKAs). Research has demonstrated noninferior efficacy with the use of lower, fixed-dose strategies for 4F-PCC dosing. ⋯ The use of a fixed-dose 4F-PCC protocol is safe and effective for the rapid reversal of VKA-associated anticoagulation.
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International medical graduates (IMGs) are medical graduates who have received their degree from international medical schools. IMGs must undertake a 3-step process to apply to the National Residency Matching Program match. ⋯ Third, they must obtain a visa that would enable them to commence their training. In this article, we delve thoroughly into these stepladders to provide IMGs with a clear roadmap of the process as well as contacts to key agencies that may provide more comprehensive assistance.
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Pickleball is a paddle sport that combines many of the elements of tennis, badminton, and ping-pong. It is reported to be one of the faster growing sports in the United States and is popular among older adults. There is limited published information on pickleball-related injuries. ⋯ Based on NEISS data, pickleball-related injuries have been increasing in recent years. Although pickleball-related injuries have many similarities with those associated with other racquet sports, there were various differences (e.g., increasing trend and older patient age) that may need to be considered for the prevention and management of injuries related to the sport.
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Case Reports
High-Dose Insulin for Toxin Induced Cardiogenic Shock: Experience at a New High and Overview of the Evidence.
High-dose insulin therapy is an effective treatment for cardiogenic shock caused by the overdose of particular medications. Other treatment options are usually of limited benefit. Consensus suggests that early initiation improves efficacy. No ceiling effect has been established at doses in the general range of 0.5-10 units/kg/hour. ⋯ A 79-year-old man presented in cardiogenic shock after an intentional overdose of numerous cardioactive medications 10 days after experiencing myocardial infarction. A high-dose insulin infusion was commenced. This was titrated up to a maximum of 20 units/kg/hour (1600 units/hour) and sustained for 32 h (61,334 units total). Minimal adverse events were seen despite this exceptional infusion rate (3 episodes of hypoglycemia and 2 episodes of hypokalemia). Concurrent catecholamine support was used, and cardiovascular function was maintained until all support was withdrawn 5 days after admission. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians are pivotal to the successful initiation/up-titration of high-dose insulin therapy. They must balance the potential for treatment failure with other treatment options, mitigate against adverse events in the initial phase of therapy, and coordinate care between other hospital specialties. This case shows that the relative safety and efficacy was extended to an infusion rate of 20 units/kg/hour, the highest recorded in the published literature. This information may help guide treatment of similar cases in the future.