Articles: emergency-department.
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Succinylcholine is often used to facilitate neonatal and pediatric rapid sequence intubation in the emergency department, and most relevant literature recommends administering atropine prior to succinylcholine to reduce the risk of bradycardia. Given the potential complications associated with combining these medications, we searched the published literature for evidence supporting this practice. Most studies recommending atropine premedication were undertaken in the operating room setting and pertained to repeated succinylcholine dosing. ⋯ Several authors have called for the practice to cease, but, to date, these calls have gone unheeded. We found no evidence supporting atropine's use in pediatric patients prior to single-dose succinylcholine. Atropine premedication for emergency department rapid sequence intubation is unnecessary and should not be viewed as a "standard of care."
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Evidence suggests that symptom-triggered benzodiazepine treatment for patients with alcohol withdrawal reduces complication rates and emergency department lengths of stay. Our objective was to describe the management of alcohol withdrawal in 2 urban emergency departments. ⋯ There is significant variability in the documentation and treatment of alcohol withdrawal. Lower benzodiazepine doses are associated with higher rate of withdrawal seizures and prolonged emergency department length of stay. A standardized approach using symptom-triggered management is likely to improve outcomes for patients presenting with alcohol withdrawal.
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J Stroke Cerebrovasc Dis · Jan 2005
Painless acute aortic dissection with a left hemiparesis: a case report.
We report a patient with completely painless acute aortic dissection who presented with transient left hemiparesis. A 59-year-old male presented to our Emergency Department with left-sided weakness of sudden onset. We therefore suspected cerebrovascular accident. ⋯ The cycle of symptom appearance and recovery recurred 3 times over a period of a few minutes. The final diagnosis was acute aortic dissection (DeBakey type II Stanford type A). Completely painless acute aortic dissection who presented with only neurologic symptoms, which made the diagnosis of acute aortic dissection extremely difficult.
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Patient satisfaction most be a priority in emergency departments (EDs). The care provided by residents forms much of the patient contact in academic EDs. ⋯ Incentives are a novel idea to improve patient satisfaction, but did not foster overall Press-Ganey score improvement. We did find a trend toward improvement for doctor-patient interaction scores. Confounding variables, such as increasing patient census, could account for inability to demonstrate a positive effect.