Annals of emergency medicine
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Review
Ondansetron and the Risk of Cardiac Arrhythmias: A Systematic Review and Postmarketing Analysis.
To explore the risk of cardiac arrhythmias associated with ondansetron administration in the context of recent recommendations for identification of high-risk individuals. ⋯ Current evidence does not support routine ECG and electrolyte screening before single oral ondansetron dose administration to individuals without known risk factors. Screening should be targeted to high-risk patients and those receiving ondansetron intravenously.
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The death of a child in the emergency department (ED) is one of the most challenging problems facing ED clinicians. This revised technical report and accompanying policy statement reaffirm principles of patient- and family-centered care. Recent literature is examined regarding family presence, termination of resuscitation, bereavement responsibilities of ED clinicians, support of child fatality review efforts, and other issues inherent in caring for the patient, family, and staff when a child dies in the ED. Appendices are provided that offer an approach to bereavement activities in the ED, carrying out forensic responsibilities while providing compassionate care, communicating the news of the death of a child in the acute setting, providing a closing ritual at the time of terminating resuscitation efforts, and managing the child with a terminal condition who presents near death in the ED.
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Disasters often cause psychological injury, as well as dramatic physical damage. Epidemiologic research has identified a set of disaster experiences and predisposing characteristics that place survivors at risk for post traumatic stress disorder (PTSD), depression, and anxiety. Rapid triage of at-risk survivors could have benefits for individual and population-level outcomes. We examine American Red Cross mental health risk surveillance data collected from October 29 to November 20, 2012, immediately after Hurricane Sandy in 8 lower New York State counties to evaluate the feasibility and utility of collecting these data. ⋯ Aggregated PsySTART data in Superstorm Sandy indicate substantial population-level impact suggestive of risk for disorders that may persist chronically without treatment. Mental health triage has the potential to improve care of individual disaster survivors, as well as inform disaster management, local health providers, and public health officials.
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The risks associated with urgent land-based transport of critically ill patients are not well known and have important implications for patient safety, care delivery, and policy development. We seek to determine the incidence of in-transit critical events and associated patient- and transport-level factors. ⋯ Critical events occurred in approximately 1 in 15 transports and were associated with mechanical ventilation, hemodynamic instability, and transport duration, and were less frequent in neurologic patients. The finding that hypotension is common and predicted by pretransport hemodynamic instability has implications for the preparation and management of this patient group.
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Hospital evacuations have myriad effects on all elements of the health care system. We seek to (1) examine the effect of patient surge on hospitals that received patients from evacuating hospitals in New York City during Hurricane Sandy; (2) describe operational challenges those hospitals faced pre- and poststorm; and (3) examine the coordination efforts to distribute patients to receiving hospitals. ⋯ Our qualitative, event-based research identified key opportunities to improve disaster preparedness. The specific opportunities and this structured postevent approach can serve to guide future disaster planning and analyses.