J Emerg Med
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Review
Diagnosis and Management of Adrenal Insufficiency and Adrenal Crisis in the Emergency Department.
Adrenal insufficiency can result in significant patient morbidity and mortality, but due to the range of symptoms and variable clinical course and etiologies, it can be a challenging condition to diagnose and manage. ⋯ Emergency clinicians must be prepared to recognize, evaluate, and manage those with known or suspected adrenal insufficiency or adrenal crisis.
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Dexmedetomidine is an alternative agent for procedural sedation in the emergency department thanks to its ability to maintain hemodynamic and respiratory stability. Dexmedetomidine must, however, be combined with a powerful analgesic. ⋯ The combination of dexmedetomidine and ketamine provides conscious sedation, bringing comfort and pain relief to patients in optimal conditions for respiratory and hemodynamic safety. However, sedation and recovery times are longer than with conventional drug combinations. The dexmedetomidine-ketamine combination should therefore be recommended for nonurgent procedures and fragile patients.
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Randomized Controlled Trial
Comparison of Tele-Education and Conventional Cardiopulmonary Resuscitation Training During COVID-19 Pandemic.
Cardiopulmonary resuscitation (CPR) performed by lay rescuers can increase a person's chance of survival. The COVID-19 pandemic enforced prevention policies that encouraged social distancing, which disrupted conventional modes of health care education. Tele-education may benefit CPR training during the pandemic. ⋯ Tele-education offers a pragmatic and reasonably effective alternative to conventional CPR training during the COVID-19 pandemic.
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Trends in Lower Extremity Injuries Presenting to Emergency Departments During the COVID-19 Pandemic.
During the emergence of the SARS-CoV-2 (COVID-19) pandemic, there were substantial changes in U.S. emergency department (ED) volumes and acuity of patient presentation compared with more recent years. ⋯ The COVID-19 pandemic has placed immense stress on both emergency medical services and hospital systems around the United States. While there were decreased rates of ED utilization for LE orthopedic complaints during the first year of the pandemic, there was a concomitant increase in both the number and proportion of these injuries admitted to the hospital from the ED. This places an additional burden on already stressed emergency medicine services and overall hospital systems that could slow down the management of medical emergencies.
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In 2004, 2009, and 2014, we examined the number of endowed faculty positions in academic departments of emergency medicine (ADEMs). ⋯ Forty-six individual ADEMs (46%) reported having at least one endowed faculty position compared with only 30 in 2014 and only 19 in 2009. The total number of endowed faculty positions in ADEMs was 92 in the current study compared with 53 in 2014, 25 in 2009, and only 9 in 2004.