Articles: emergency-services.
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The primary objective was to evaluate the effectiveness of telemedicine for improving clinical follow-up for survivors of sexual assault and intimate partner violence after an emergency department (ED) visit. The Sexual Assault and Partner Abuse Care Program (SAPACP) is an ED-based clinic for survivors of sexual assault/intimate partner violence. Virtual Visit, a telemedicine platform, was introduced at SAPACP in January 2020, allowing patients to attend follow-up virtually. ⋯ The implementation of Virtual Visit led to an immediate 10% increase in the proportion of overall follow-ups, which was sustained over a two-year period, while accounting for pre-Virtual Visit trends. These findings indicate that telemedicine can help improve clinical follow-up among survivors of sexual assault/intimate partner violence.
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Despite research linking chemical and physical restraints to negative outcomes including unplanned intubations and psychological distress, there is little guidance for their use in the care of trauma patients. We used institutional data to describe recent trends in chemical and physical restraint in the emergency department evaluation and treatment of trauma patients and to identify characteristics associated with their use. ⋯ In this institutional study, nearly one-in-twelve trauma patients were restrained during emergency department evaluation and treatment. Restraint utilization increased during the study driven primarily by increases in ketamine and restraints utilized during trauma bay evaluation and resuscitation. Future research should assess the generalizability of these findings. It is important that rigorous guidelines are established to ensure the safe and effective use of restraints in trauma.
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Observational Study
Brief Risk Communication for Emergency Department Patients With Sustained Asymptomatic Hypertension.
Sustained asymptomatic hypertension in ED patients is a powerful predictor of chronic uncontrolled hypertension. In this study, we assess the feasibility of using a storyboard video and communicating real-time cardiovascular imaging results on blood pressure control and primary care engagement. ⋯ The Brief Risk Communication for ED patientswith sustained asymptomatic hypertension study demonstrates the feasibility and acceptability of using a brief video and real-time cardiovascular imaging for risk communication in the emergency department. Future research will build on these findings with a larger, more comprehensive study.
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Droperidol is used commonly to treat agitation in the emergency department (ED), however, data comparing doses are lacking. ⋯ In this large cohort, patients deemed appropriately treated with 5 mg of droperidol required less rescue sedation than patients determined to need 10 mg.
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Gastrointestinal bleeding (GIB) is a common condition in the emergency department (ED) with high incidence and mortality. ⋯ In this manuscript, we present a case series of ED patients with upper GIB in whom emergency physicians (2 fellowship-trained attendings and 2 senior residents facile with point-of-care ultrasound) performed GUS. As a supplement to the clinical examination, this sonographic "lavage" (i.e., using GUS in patients with upper GIB) helped predict aspiration risk, support diagnostic reasoning, and expedite early goal-directed management and appropriate disposition. We also provide a step-by-step tutorial using high-quality media, as well as a novel algorithm for translation of this technique to the bedside for emergency physicians.