Articles: emergency-medicine.
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Artificial intelligence (AI) in healthcare is the ability of a computer to perform tasks typically associated with clinical care (e.g. medical decision-making and documentation). AI will soon be integrated into an increasing number of healthcare applications, including elements of emergency department (ED) care. Here, we describe the basics of AI, various categories of its functions (including machine learning and natural language processing) and review emerging and potential future use-cases for emergency care. ⋯ AI could also help provide focused summaries of charts, summarize encounters for hand-offs, and create discharge instructions with an appropriate language and reading level. Additional use cases include medical decision making for decision rules, real-time models that predict clinical deterioration or sepsis, and efficient extraction of unstructured data for coding, billing, research, and quality initiatives. We discuss the potential transformative benefits of AI, as well as the concerns regarding its use (e.g. privacy, data accuracy, and the potential for changing the doctor-patient relationship).
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Internal medicine journal · Jul 2024
Meta AnalysisUltrasound for acute pyelonephritis: a systematic review and meta-analysis.
There is little consensus regarding the indications and utility of urinary tract imaging and type of imaging to perform in patients presenting with acute pyelonephritis (APN). ⋯ Patients with APN are commonly investigated with US, but only a small proportion have abnormalities and appear to be associated with changes in clinical management. The use of routine US for APN is therefore questioned. The identification of clinical variables for appropriate selection of patients to investigate with US requires further research.
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Emergency physicians (EPs) navigate high-pressure environments, making rapid decisions amidst ambiguity. Their choices are informed by a complex interplay of experience, information, and external forces. While cognitive shortcuts (heuristics) expedite assessments, there are multiple ways they can be subtly manipulated, potentially leading to reflexive control: external actors steering EPs' decisions for their own benefit. ⋯ Recognizing these dangers empowers EPs to resist reflexive control through (1) critical thinking: examining information for potential biases and prioritizing evidence-based practices, (2) continuous education: learning about cognitive biases and mitigation strategies, and (3) institutional policies: implementing regulations to reduce external influence and to promote transparency. This vulnerability of emergency medicine decision making highlights the need for awareness, education, and robust ethical frameworks. Understanding reflexive control techniques is crucial for safeguarding patient care and promoting independent, ethical decision making in emergency medicine.
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Used as a veterinary sedative and not approved for human use, xylazine has been increasingly linked with opioid overdose deaths in the United States. A growing number of people have been exposed to xylazine in the illicit opioid supply (especially fentanyl) or in other drugs, particularly in some areas of the Northeast. Xylazine is an α-2 adrenergic agonist that decreases sympathetic nervous system activity. ⋯ The significance and clinical effects of xylazine as an adulterant is focused on 4 domains that merit further evaluation: fentanyl-xylazine overdose, xylazine dependence and withdrawal, xylazine-associated dermal manifestations, and xylazine surveillance and detection in clinical and nonclinical settings. This report reflects the Proceedings of the National Institute on Drug Abuse Center for the Clinical Trials Network convening of clinical and scientific experts, federal staff, and other stakeholders to describe emerging best practices for treating people exposed to xylazine-adulterated opioids. Participants identified scientific gaps and opportunities for research to inform clinical practice in emergency departments, hospitals, and addiction medicine settings.
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Prior work has found first-attempt success improves with emergency medicine (EM) postgraduate year (PGY). However, the association between PGY and laryngoscopic view - a key step in successful intubation - is unknown. We examined the relationship among PGY, laryngoscopic view (ie, Cormack-Lehane view), and first-attempt success. ⋯ Compared with PGY 1, PGY 2, 3, and 4 resident physicians obtained similar Cormack-Lehane views but had higher first-attempt success when obtaining a grade 3 or 4 view.