Articles: emergency-medicine.
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While several studies have focused on preliminary data and outcomes associated with prehospital buprenorphine administration interventions, to date there has been little discussion of the challenges experienced during the initial implementation of a prehospital buprenorphine protocol. In this case series we examine 3 separate patient encounters with different crews, patients, and receiving emergency medicine (EM) physicians, which highlight initial challenges experienced with implementing the first prehospital buprenorphine program in a rural Appalachian County within South Carolina. In 2 cases we highlight conflicts that may require collegial intervention and education of local receiving EM physicians regarding the new prehospital protocol. In 1 case we describe a patient who was eligible but not enrolled due to a misunderstanding among an Emergency Medical Services (EMS) clinician of how to correctly apply protocol criteria. We discuss the management of each implementation issue and outcomes after follow-up with members of the study team. As these novel programs emerge, understanding the potential challenges and personal biases that may be encountered when implementing a prehospital buprenorphine administration protocol is essential to inform organizations planning to implement similar programs.
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A shortcut review of the literature was conducted to examine the sensitivity and specificity of point-of-care ultrasound (POCUS) in detecting paediatric skull fractures. A total of 162 publications were screened by title and abstract, 13 studies underwent full text review, and after review of bibliographies of meta-analyses and systematic reviews, a total of 6 articles were included. Details about the author, date of publication, country of publication, patient group studied, study type, relevant outcomes (skull fracture), results and study limitations were tabulated. The clinical bottom line is that, in paediatric patients with a minor head injury, POCUS performed by emergency medicine physicians has a sensitivity ranging between 77% and 100% and a specificity between 85% and 100% for skull fracture detection, and its use in clinical decision-making has yet to be validated.
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Identifying frequent users of Emergency Medical Services (EMS) in the post-discharge period can potentially direct interventions to prevent deterioration at home. This study aimed to describe the frequency of post-discharge emergency phone calls within 30 days after common medical and surgical categories of hospital admission. A retrospective cohort study retrieved data from the electronic medical record and the EMS Capital Region Denmark database after approval by the Danish Health Data Authority. ⋯ Patients discharged after medical hospitalization due to AECOPD contacted EMS 15 (95% CI: 13-16) times per 1000 patient days only surpassed by sepsis with 19 calls per 1000 patient days (95% CI: 17-21). Patients undergoing colorectal surgery had an EMS call frequency of 7.5 (95% CI: 6.4-8.7) and highest among types of surgery was hip- and knee replacements with 12 (95% CI: 11-13) calls per 1000 patient days. Patients discharged after hospitalization due to AECOPD and sepsis had a higher 30-day EMS call frequency compared with other medical cohorts, whereas major orthopedic surgery was followed by more EMS calls than admissions for colorectal surgery.
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Fundoscopy is crucial in the emergency department to identify or rule out serious ocular and neurological conditions. Despite its clinical importance, fundoscopy is often omitted due to the technical challenges associated with traditional direct ophthalmoscopy, particularly for non-ophthalmologists. This study examines emergency physicians' practices, confidence levels, and training related to various modalities of fundoscopy including traditional direct ophthalmoscopes, binocular indirect ophthalmoscopes, panoptic ophthalmoscopes, slit lamp fundoscopy and fundus cameras; and explores the potential role of alternative modalities, such as fundus cameras, in Canadian emergency departments. ⋯ Emergency physicians in Canada report low confidence in fundoscopy despite its critical role in identifying vision- or life-threatening conditions. Traditional modalities are widely used but remain challenging for non-ophthalmologists. Fundus cameras, which offer ease of use and higher diagnostic accuracy, are underutilized.