The western journal of emergency medicine
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Multicenter Study Observational Study
Tranexamic Acid in Civilian Trauma Care in the California Prehospital Antifibrinolytic Therapy Study.
Hemorrhage is one of the leading causes of death in trauma victims. Historically, paramedics have not had access to medications that specifically target the reversal of trauma-induced coagulopathies. The California Prehospital Antifibrinolytic Therapy (Cal-PAT) study seeks to evaluate the safety and efficacy of tranexamic acid (TXA) use in the civilian prehospital setting in cases of traumatic hemorrhagic shock. ⋯ Findings from the Cal-PAT study suggest that TXA use in the civilian prehospital setting may safely improve survival outcomes in patients who have sustained traumatic injury with signs of hemorrhagic shock.
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Multicenter Study
Emergency Department Patient Satisfaction with Treatment of Low-risk Pulmonary Embolism.
Many emergency department (ED) patients with acute pulmonary embolism (PE) who meet low-risk criteria may be eligible for a short length of stay (LOS) (<24 hours), with expedited discharge home either directly from the ED or after a brief observation or hospitalization. We describe the association between expedited discharge and site of discharge on care satisfaction and quality of life (QOL) among patients with low-risk PE (PE Severity Index [PESI] Classes I-III). ⋯ ED patients with low-risk PE reported high satisfaction with their care in follow-up surveys. Expedited discharge (<24 hours) and site of discharge were not associated with differences in patient satisfaction.
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Observational Study
Obtaining History with a Language Barrier in the Emergency Department: Perhaps not a Barrier After All.
Patients with limited English proficiency may be at risk for incomplete history collection, potentially a patient safety issue. While federal law requires qualified medical interpreters be provided for these patients, little is known about the quality of information obtained in these encounters. Our study compared the medical histories obtained by physicians in the emergency department (ED) based on whether the patients primarily spoke English or Spanish. ⋯ In this study at a large, urban, academic ED, the medical histories obtained by physicians were similar between English-speaking and Spanish-speaking patients. This suggests that the physicians sought to obtain medical histories at the same level of detail despite the language barrier. One limitation to consider is the Hawthorne effect; however, providers and observers were blinded to the nature of the study in an attempt to minimize the effect.
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Multicenter Study
Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department.
The 72-hour unscheduled return visit (URV) of an emergency department (ED) patient is often used as a key performance indicator in emergency medicine. We sought to determine if URVs with admission to hospital (URVA) represent a distinct subgroup compared to unscheduled return visits with no admission (URVNA). ⋯ We demonstrate that URVA patients comprise a distinct subgroup of 72-hour URV patients. Risk factors for URVA are present at the index visit suggesting that patients at high risk for URVA may be identifiable prior to admission.
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Randomized Controlled Trial
Low-dose Ketamine Does Not Improve Migraine in the Emergency Department: A Randomized Placebo-controlled Trial.
Patients frequently present to the emergency department (ED) with migraine headaches. Although low-dose ketamine demonstrates analgesic efficacy for acute pain complaints in the ED, headaches have historically been excluded from these trials. This study evaluates the efficacy and safety of low-dose ketamine for treatment of acute migraine in the ED. ⋯ We found that 0.2mg/kg IV ketamine did not produce a greater reduction in NRS score compared to placebo for treatment of acute migraine in the ED. Generalized discomfort at 30 minutes was significantly greater in the ketamine group. Overall, ketamine was well tolerated by migraine-suffering subjects. To optimize low-dose ketamine as an acute migraine treatment, future studies should investigate more effective dosing and routes of administration.