The American journal of emergency medicine
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Letter Review
Low dose ketamine use in the emergency department, a new direction in pain management.
There is a need for alternative non-opioid analgesics for the treatment of acute, chronic, and refractory pain in the emergency department (ED). Ketamine is a fast acting N-methyl-d-aspartate (NMDA) receptor antagonist that provides safe and effective analgesia. The use of low dose ketamine (LDK) (<1mg/kg) provides sub-dissociative levels of analgesia and has been studied as an alternative and/or adjunct to opioid analgesics. ⋯ Nursing protocols for the administration of LDK have been studied. We believe that LDK has the potential to be a safe and effective alternative and/or adjunct to opioid analgesics in the ED. Additional studies are needed to expand upon and determine the optimal use of LDK in the ED.
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Multicenter Study Comparative Study Observational Study
Early sepsis bundle compliance for non-hypotensive patients with intermediate versus severe hyperlactemia.
To compare the association of 3-h sepsis bundle compliance with hospital mortality in non-hypotensive sepsis patients with intermediate versus severe hyperlactemia. ⋯ We observed a significant interaction between 3-h bundle compliance and initial hyperlactemia. Bundle compliance may be associated with greater mortality benefit for non-hypotensive sepsis patients with less severe hyperlactemia.
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Case Reports
Acute neck pain in the emergency department: Consider longus colli calcific tendinitis vs meningitis.
Presented here is a rare cause of severe neck pain - acute longus colli calcific tendinitis - in a 54year old man who presented to the emergency department. The neck pain is due to inflammation caused by calcium hydroxyapatite crystal deposition in the tendons on the longus colli muscles. This is non-infectious. ⋯ D. physicians can avoid unnecessary invasive interventions, increased costs, and delays that result from incorrect diagnosis and treatment. This is a unique case in which a patient who was afebrile with a normal ESR was worked up for meningitis and an intracranial process, and also empirically treated for meningitis before finally being diagnosed with acute calcific tendinitis of the longus colli muscle in the E. D.
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Seven years after the Affordable Care Act legislated Alternative Payment Models, it is time for Emergency Medicine to find its place within this value-based trend by developing its own Alternative Payment Model.
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Case Reports
The de Winter electrocardiographic pattern of proximal left anterior descending occlusion.
Prompt recognition of electrocardiographic signs of acute left anterior descending (LAD) occlusion is essential for timely restoration of flow. However, some patients may present with atypical electrocardiographic signs, and early diagnosis of these patients may constitute a clinical challenge. ⋯ These cases highlight the importance of recognizing the de Winter electrocardiogram pattern in cases of suspected acute myocardial infarction (AMI). An emergency percutaneous coronary intervention (PCI) should be performed in suspected AMI patients as early as possible.