Articles: emergency-services.
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Pediatric emergency care · Feb 2025
Oral Ketamine and Midazolam for Procedural Sedation in the Pediatric Emergency Department: A Retrospective Study.
Needle-free procedural sedation (PS) is an attractive option for children presenting to the emergency department (ED) who require a painful procedure, as it avoids inflicting additional pain either with intravenous line placement or intramuscular injection. While use of oral (PO) ketamine has been reported in the literature, limited information is available to guide ED-based use in children. ⋯ PO ketamine with or without midazolam resulted in procedure completion of a variety of procedures in the pediatric ED with minimal AE, no SAE, and without need for additional sedative medications in 86.2% (50). This regimen is an option for needle-free moderate PS in this setting. Further study is needed to clarify the benefit of the addition of midazolam to PO ketamine, rates of AE and SAE, sedation duration, and recovery times.
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Transfer of patients between hospitals is common, costly, and over 20 % are estimated to be avoidable, meaning patients do not receive specialized interventions once transferred. Older adults are more likely to be transferred and may be at increased risk for developing delirium or other complications due to transfer. We aimed to determine the frequency of potentially avoidable transfer (PAT) among older adults; identify conditions most likely to involve a PAT; and describe factors associated with PAT. ⋯ PATs were common in transfers of older adults, particularly among a subset of neurologic, cardiovascular, and injury-related conditions. These conditions may represent ideal targets for intervention to decrease rates of avoidable transfer. Research exploring hospital variation in transfer practices and the impact of PAT on older adults' health outcomes are also needed.
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Pediatric emergency care · Feb 2025
Minor Head Trauma in Children Younger Than 3 Months and Clinical Predictors of Clinically Important Traumatic Brain Injuries.
Major studies have defined clinical rules to regulate the use of computed tomography in children after head trauma. Infants younger than 3 months are considered at higher risk of brain injuries than older children and at the same time at higher risk of radiation-induced damage. Hence, it would be desirable to have clinical decision rules more adapted to this subset of patients. The objectives of this study are to compare the rate of brain injuries in children younger than 3 months or 3 to 24 months and to assess predictors of clinically important traumatic brain injuries (ciTBIs) (the ones causing death, neurosurgical intervention, long intubation, or hospitalization for 2 days or more) in the former group. ⋯ Children younger than 3 months presenting after minor head trauma constitute a relevant population. Available clinical predictors well correlate with ciTBIs in this age group.
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Case Reports
A Novel Use of Terbutaline: Persistent Genital Arousal Disorder in the Emergency Department.
Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing, multifactorial disorder characterized by persistent unwanted physiologic genital arousal in the absence of sexual desire. This poorly understood disorder is thought to be derived from a complex dysregulation of biopsychosocial factors with common underlying neurological dysfunction that has yet to be adequately studied. With frequently evolving diagnostic criteria, lack of a standardized treatment algorithm, and few evidence-based treatment options, this disease is largely unrecognized and difficult to treat once identified. ⋯ A 25-year-old woman presented to the Emergency Department (ED) with persistent and refractory symptoms of genital arousal not responsive to previously documented treatments, and the novel use of a β-adrenergic agent, terbutaline, leading to cessation of symptoms. With her initial presentation, lorazepam, haloperidol, and viscous lidocaine intravaginally provided relief for approximately 24 h until the patient returned. At her subsequent presentation, the patient received additional doses of lorazepam and intravaginal lidocaine, as well as consults with Urology and Obstetrics and Gynecology. Her symptoms eventually ceased by administration of terbutaline. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although presentation of PGAD to the ED is rare, emergency physicians should be prepared with treatment options to assist patients with this distressing diagnosis. This case highlights the novel use of terbutaline, a β-agonist, in cessation of PGAD symptoms when first-line benzodiazepines and antipsychotics fail.
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Multicenter Study
Means to an end: Characteristics and follow-up of emergency department patients with a history of suicide attempt via medication overdose.
Availability and accessibility of a wide range of medications may be a contributing factor to rising medication-related overdose (OD) rates. Treatment for both suicide attempts (SAs) and ODs often occurs in the emergency department (ED), highlighting its potential as a screening and intervention point. The current study aimed to identify sociodemographic and clinical characteristics of individuals who reported SA via medication OD compared to other methods and to examine how these patients' suicide severity and behaviors differed over 12-month post-ED follow-up. ⋯ Among patients presenting to the ED, females, individuals with bipolar disorder, and patients with a college education, respectively, may be at highest risk for SAs via medication OD. Prospectively, medication OD appears to be a frequent method, even among individuals with no prior attempt via OD, as demonstrated by the high percentage of patients who did not have a medication OD at baseline, but reported a medication OD during follow-up.