J Emerg Med
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Oral endotracheal intubation is a procedure performed by emergency medical services (EMS) providers-who are stationed on ground ambulances, rotor-wing air ambulances (helicopter), and fixed-wing air ambulances (airplane)-for the purpose of securing a patient's airway. ⋯ Our data show that flight crew members-either on fixed-wing or rotor-wing air ambulances-are associated with significantly higher rates of intubation success than ground ambulance providers. There are a number of possible explanations for this trend, including more opportunities to intubate in the air medical setting, increased clinical education focused on airway management in the air medical setting, or assistive technologies being more commonly used in the air medical setting.
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The recent proliferation of electric standing scooters in major urban areas of the United States has been accompanied by injuries of varying severity and nature, representing a growing public health concern. ⋯ Patients presenting with e-scooter injuries have a high likelihood of injury to the radial head, nasal bone, and malleoli. Emergency physicians should be especially vigilant for injuries in these areas at presentation. Visceral injuries are uncommon but may be severe enough to warrant surgery.
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Diquat is an herbicide that may cause rapid and profound systemic toxicity. It can cause multisystem organ failure, primarily via its effects on the gastrointestinal, renal, cardiovascular, and central nervous systems. Case fatality rates as high as 43% have been reported. There is a paucity of pediatric literature on diquat poisoning, and in this article, we will discuss an unfortunate pediatric case that highlights the severity of diquat toxicity. ⋯ We present the case of a child who ingested diquat, which led to multisystem organ failure and death. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinicians should be aware of this herbicide's potential for significant morbidity and mortality, especially in children, in whom small quantities can be lethal. It is important that emergency physicians are aware of the significant toxicity of diquat and provide early gastric decontamination, as it is the only proven therapeutic strategy.
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This study was developed to provide insight into the effects of an i.v. opioid order set on prescribing of i.v. opioids in the emergency department (ED) for nontraumatic, unspecified abdominal pain. Research is needed in this area to catalyze more consistent and evidence-based i.v. opioid prescribing. ⋯ The restriction correlated with a decrease in i.v. opioids. Pain control was not diminished as a result of the restriction. The results of this study may be used to generate hypotheses for comparing different modes of pain management in the ED in this patient population and others. Future studies should continue to evaluate the impact of oral vs. i.v. opioids.
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Early recognition of difficult intravenous (i.v.) access and use of ultrasound-guided techniques prior to multiple attempts are important steps in improving patient care in the emergency department (ED). Success rates for ultrasound-guided peripheral i.v. (PIV) cannulation are affected by depth, size of target vessel, and predictability of anatomy. The great saphenous vein (GSV) in the medial distal thigh may provide an alternative site for ultrasound-guided cannulation in cases of difficult peripheral venous access. ⋯ Ultrasound-guided GSV PIV placement is a feasible alternative in situations of difficult i.v. access. No unforeseen complication or safety issue was identified. Blood products, medications, and contrast medium were successfully administered safely.