J Emerg Med
-
Observational Study
Can I Send This Patient With Atrial Fibrillation Home From the Emergency Department?
Atrial fibrillation (AF) is one of the most common dysrhythmias managed in the emergency department (ED) setting. Due to the variety of patient presentations and disease severity, most patients in the United States are admitted to the hospital. ⋯ Based on the available literature, RED-AF, AFFORD, and the AFTER (complex, modified, and pragmatic) scores demonstrate modest predictive discrimination in predicting adverse events, but further validation is recommended.
-
Society allows physicians the privilege and responsibility of caring for patients. Those responsibilities demand that their knowledge and technical expertise meet standards defined and policed by their colleagues, through medical societies or governmental entities. However, the fiduciary duty that patients' interests are held above those of the physicians' is an ethical precept that is tested when society is under threat. ⋯ Despite the conflict between normative and descriptive ethics, in times of disaster, physicians must respond to the call of duty. This duty is contingent on the responsibility being shared with governmental agencies and health care facilities, to mitigate the risks borne by those who answer the call.
-
The reversal of anticoagulant or antiplatelet medications is a priority in the management of patients with severe injury with the goal of minimizing further bleeding without thrombotic complications. There are few studies, however, evaluating the dosing of reversal agents in the setting of trauma specific to patients with extreme obesity. Nevertheless, clinicians must still make decisions, balancing concerns of ongoing bleeding with excessive thrombosis. ⋯ Future studies should make efforts to increase reporting of patients with obesity included in clinical trials along with results stratified by weight class. In the meantime, doses listed in product labels should be used. Desmopressin should be dosed using either ideal body weight or a dose-capping strategy.