Annals of emergency medicine
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Observational Study
Ketamine as Rescue Treatment for Difficult-to-Sedate Severe Acute Behavioral Disturbance in the Emergency Department.
We investigate the effectiveness and safety of ketamine to sedate patients with severe acute behavioral disturbance who have failed previous attempts at sedation. ⋯ Ketamine appeared effective and did not cause obvious harm in this small sample and is a potential option for patients who have failed previous attempts at sedation. A dose of 4 to 5 mg/kg is suggested, and doses less than 200 mg are associated with treatment failure.
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We describe emergency department (ED) intubation practices for children younger than 16 years through multicenter prospective surveillance. ⋯ Because we sampled only 10 centers and most of the intubations were by trainees, our results may not be generalizable to the typical ED setting. We found that premedication is now uncommon, etomidate is the predominant induction agent, and rocuronium and video laryngoscopy are used increasingly. First-attempt failure is most common in infants.
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Emergency physicians are using free open access medical education (FOAM) resources at an increasing rate. The extent to which FOAM resources cover the breadth of emergency medicine core content is unknown. We hypothesize that the content of FOAM resources does not provide comprehensive or balanced coverage of the scope of knowledge necessary for emergency medicine providers. Our objective is to quantify emergency medicine core content covered by FOAM resources and identify the predominant FOAM topics. ⋯ The data suggest an imbalanced and incomplete coverage of emergency medicine core content in FOAM. The study is limited by its retrospective design and use of a single referral Web site to obtain available FOAM resources. More comprehensive and balanced coverage of emergency medicine core content is needed if FOAM is to serve as a primary educational resource.
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Case Reports
The Use of Ophthalmic Ultrasonography to Identify Retinal Injuries Associated With Abusive Head Trauma.
Abusive head trauma includes any nonaccidental injury inflicted to a child's head and body. It is often characterized by, but not limited to, the repetitive acceleration-deceleration forces with or without blunt head impact. It has a mortality rate of 30%, and 80% of survivors experience permanent neurologic damage. ⋯ Dilated ophthalmic examinations and autopsy reports confirmed retinoschisis and other forms of retinal hemorrhages that were too numerous to count, multilayered, and extending to the periphery in all 11 patients. One patient did not have a dilated ophthalmic examination; however, traumatic retinoschisis and retinal hemorrhages were confirmed on autopsy. Ocular point-of-care ultrasonography is a promising tool to investigate abusive head trauma through the identification of traumatic retinoschisis and retinal hemorrhages when pupillary dilatation and direct ophthalmic examination is delayed.