Annals of emergency medicine
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Randomized Controlled Trial
Tarp-Assisted Cooling as a Method of Whole-Body Cooling in Hyperthermic Individuals.
We investigated the efficacy of tarp-assisted cooling as a body cooling modality. ⋯ In the absence of a stationary cooling method such as cold-water immersion, tarp-assisted cooling can serve as an alternative, field-expedient method to provide on-site cooling with a satisfactory cooling rate.
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A stable and readily accessible work surface for bedside medical procedures represents a valuable tool for acute care providers. In emergency department (ED) settings, the design and implementation of traditional Mayo stands and related surface devices often limit their availability, portability, and usability, which can lead to suboptimal clinical practice conditions that may affect the safe and effective performance of medical procedures and delivery of patient care. We designed and built a novel, open-source, portable, bedside procedural surface through an iterative development process with use testing in simulated and live clinical environments. ⋯ An iterative, interdisciplinary approach was used to generate, evaluate, revise, and finalize the design specification for a new procedural surface that met all core end-user requirements. The final surface design was evaluated favorably on a validated usability tool against Mayo stands when use tested in simulated and live clinical settings.
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Comparative Study Observational Study
A Prospective Observational Study of Patients Receiving Intravenous and Intramuscular Olanzapine in the Emergency Department.
Parenteral olanzapine is an emerging therapy for a variety of conditions in the emergency department (ED). Intramuscular administration is standard; however, intravenous administration has been proposed as a safe alternative route. We investigate the safety and efficacy of both intramuscular and intravenous olanzapine in the ED when used for a variety of indications. ⋯ These data suggest that, with proper monitoring, administration of olanzapine, both intramuscular and intravenous, is safe for several indications in the ED.
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For an emergency medicine pharmacist to become a well-integrated multidisciplinary team member, his or her services need to be accepted by the emergency department (ED) staff. There have been 2 published studies attesting the value of the emergency medicine pharmacist by ED staff: at an academic medical and trauma center in 2007 and a large academic medical center in 2011. The aim of this study is to determine whether the emergency medicine pharmacist's value, as perceived by ED staff, would be similarly accepted at a smaller community hospital with limited clinical pharmacist services. ⋯ As was previously found in academic settings, an emergency medicine pharmacist is an invaluable addition to the health care team and can be incorporated into an existing pharmacy staffing model at a small, community hospital.
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Accumulating evidence has shown increasing use of observation stays for patients presenting to emergency departments and requiring diagnostic evaluation or time-limited treatment plans, but critics suggest that this expansion arises from hospitals' concerns to maximize revenue and shifts costs to patients. Perspectives of physicians making decisions to admit, observe, or discharge have been absent from the debate. We examine the views of emergency physicians in the United States and England on observation stays, and what influences their decisions to use observation services. ⋯ Observation status increases the options available to admitting physicians in a way that they valued for its potential benefits to patient safety and quality of care, but some of these have been neglected in the literature to date. Reform to observation status should address these important but previously unacknowledged functions.