The American journal of emergency medicine
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Observational Study
Association between fentanyl treatment for acute pain in the emergency department and opioid use two weeks after discharge.
Analgesia with fentanyl can be associated with hyperalgesia (higher sensitivity to pain) and can contribute to escalating opioid use. Our objective was to assess the relationship between emergency department (ED) acute pain management with fentanyl compared to other opioids, and the quantity of opioids consumed two-week after discharge. We hypothesized that the quantity of opioids consumed would be higher for patients treated with fentanyl compared to those treated with other opioids. ⋯ Patients treated with fentanyl during ED stay did not consume more opioids after ED discharge, compared to those treated with other opioids. If fentanyl does cause more hyperalgesia compared to other opioids, it does not seem to have a significant impact on opioid consumption after ED discharge.
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To verify the role of lactate dehydrogenase to albumin (LDH/ALB) ratio as an independent prognostic factor for mortality due to the lower respiratory tract infection (LRTI) in the emergency department (ED). ⋯ The LDH/ALB ratio may serve as an independent prognostic factor for in-hospital mortality in patients with LRTI.
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Observational Study
The role of brain tomography scan in patients with out-of-hospital cardiac arrest in whom return of spontaneous circulation.
The diagnosis and treatment process after resuscitation of patients with spontaneous return of circulation (ROSC) after cardiac arrest is important. There is no clear recommendation on utilization of computerized tomography (CT) of the brain in patients with ROSC. In this study, it was aimed to diagnosis the pathology detection rates in the brain tomography of out-of-hospital cardiac arrest (OHCA) patients with ROSC after resuscitation in the emergency department and the effect of these pathologies on treatment management. ⋯ We have seen that the data obtained from the CT studied in the early period after the ROSC was achieved, did not change the management of our patients x in the early and late periods after resuscitation. We conclude that it is not necessary to have a brain CT scan in the emergency department in the early period.
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While multiple studies have evaluated physician-related return visits (RVs) to a pediatric emergency department (PED) limited data exists for Advanced Practice Provider (APP)-related RVs, hence our study aimed to evaluate APP-related RVs and their outcomes in a PED. ⋯ APP-related RVs for low acuity medical patients remain low and are associated with good outcomes. Diagnostic errors account for a minority of these RVs. Focused interventions targeting provider errors can further decrease these RVs.