The American journal of emergency medicine
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Observational Study
Adoption of low tidal volume ventilation in the emergency department: A quality improvement intervention.
Ventilator tidal volumes of >8 mL/kg of predicted body weight (PBW) may increase the risk of lung injury. We sought to evaluate the impact of a quality improvement intervention among intubated Emergency Department (ED) patients to protocolize the prescription of low tidal volume ventilation. ⋯ Pairing a ventilator initiation protocol with focused education and resources for emergency physicians and respiratory therapists was associated with a significant reduction in tidal volume delivered to ED patients.
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In 2018, the FDA approved andexanet alfa for the reversal of life-threatening hemorrhages in patients anticoagulated with apixaban or rivaroxaban. Yet, cost-effective factor Xa inhibitor reversal remains controversial. The objective of this study was to describe real world utilization of andexanet alfa. ⋯ This is the largest series to date describing real-world utilization of andexanet alfa. Our series showed hemostatic efficacy in 90.9% of patients with ICH, and 100% in patients undergoing surgical procedures. There were no thrombotic complications. Yet, larger and comparative studies are needed to clarify the optimal agent and patient selection for reversal of factor Xa inhibitors.
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To determine the impact of an emergency medicine clinical pharmacist's (EMCP) intervention on physicians' prescribing of vancomycin loading doses at an institution with limited EMCP services. ⋯ Following an EMCP intervention there was a statistically significant increase in the number of appropriate vancomycin loading dose orders prescribed by emergency medicine physicians. The EMCP's unique skill set and role within the emergency department permitted the EMCP to recognize and resolve a discrepancy in vancomycin prescribing practices. This study further highlights the importance of having dedicated clinical pharmacists in the emergency department and encourages institutions to develop, expand, and maintain EMCP positions.
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Priapism is defined as a prolonged erection of the penis for at least 4 h without sexual stimulation. It may occur in all age groups. Drugs are the most common cause in adults. ⋯ Approximately 30 cc of dark blood was drained from the corpus cavernosum with an 18 Gauge needle in the emergency department. Cavernous blood aspiration and irrigation resulted in significant recovery and relief. We present this report of priapism associated with pregabalin as it is a rare case with insufficient number of studies in the literature.