Annals of emergency medicine
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We characterize the use of analgesics among children of different race and ethnicity who had isolated long bone fractures that were treated in emergency departments (EDs) across the United States. ⋯ No difference in analgesic prescription or opioid analgesic prescription was found between black and Hispanic children compared with non-Hispanic white children with long bone fractures in EDs. There are, however, previously unreported regional differences in analgesic administration.
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We describe discontinuities in antibiotic therapy in patients with community-acquired pneumonia admitted from the emergency department (ED) to an inpatient unit. ⋯ Discontinuous therapy, represented through a delayed first inpatient antibiotic dose, is common in patients with community-acquired pneumonia admitted from the ED. Although the effect on outcome is unknown, theoretical concerns should lead emergency physicians to consider using longer-acting antibiotics to minimize delayed therapy.
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Using nationally representative data, we sought to describe the incidence of emergency department (ED) visits for dental-related complaints for children and adults in the United States. We hypothesized that dental-related ED visits were more likely than other ED visits to have Medicaid or no insurance as the payer. ⋯ EDs are an important point of care for dental-related complaints, particularly for individuals who lack private insurance. ED providers should be equipped to triage, diagnose, provide basic treatment, and ensure appropriate follow-up care for dental problems, which may require enhancement of dental training for emergency medicine providers and improved dental care during and after ED visits.
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Concern about patient safety and failed rapid sequence intubation has led to an increased awareness of potentially difficult laryngoscopy situations and algorithms promoting techniques in awake patients. Given the low overall incidence of failed laryngoscopy, however, prediction of difficult laryngoscopy has poor positive predictive value and uncertain clinical utility, especially in emergency settings. Non-rapid sequence intubation approaches have comparatively lower chances of intubation success, require more time, and are associated with more complications. ⋯ A novel way to conceptualize patient risk and safety issues in rapid sequence intubation is to examine how inherent risk is managed in skydiving. Metaphorical lessons from skydiving that are applicable to rapid sequence intubation include (1) a redundancy of safety; (2) a methodic approach to primary chute deployment; (3) use of backup chutes that are fast, simple, and easy to deploy; (4) attention to monitoring; and (5) equipment vigilance. This article reviews how each of these lessons apply metaphorically to rapid sequence intubation, wherein the primary chute is laryngoscopy, the backup chute is rescue ventilation, and monitoring involves pulse oximetry.