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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The emergency medicine (EM) workforce has been growing at a rapid rate, fueled by a large increase in the number of EM residency programs and growth in the number of Advanced Practice Providers (APPs). ⋯ Historically, there has been a significant shortage of EPs. We project that this shortage may resolve quickly, and there is the potential for a significant oversupply in the future.
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Choosing Wisely Canada (CWC) guidelines recommend that in the absence of clinical indicators suggestive of serious underlying pathology, physicians should not order radiological imaging for patients presenting with nonspecific low back pain (LBP). ⋯ CWC guidelines did not appear to alter the rate of imaging for patients presenting to the ED with nontraumatic LBP. Future clinical recommendations should consider active knowledge dissemination and education strategies to help facilitate guideline adoption.
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Intussusception can lead to significant morbidity in affected children secondary to tissue ischemia and necrosis. When a child outside of the classic age range presents with symptoms other than intermittent abdominal pain, the diagnosis of intussusception can be difficult and is often delayed. ⋯ We present the case of a three-month-old boy who presented to the emergency department with waxing and waning mental status and seizure-like activity who was ultimately diagnosed with intussusception. The effective use of bedside ultrasonography, by the attending pediatric radiologist, enabled an interdisciplinary team to explore abdominal etiologies in parallel with testing for more commonly seen causes of altered mental status. This led to an expedited diagnosis and successful definitive management. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Intussusception is a common pediatric emergency encountered by emergency physicians where a timely diagnosis can have a profound impact on patient outcomes. Previous case reports highlight how easily intussusception can be overlooked with this atypical neurologic presentation. Furthermore, because patients with profound altered mental status are often too ill to leave the emergency department for diagnostic testing, bedside abdominal ultrasonography may be helpful in these patients.