The American journal of emergency medicine
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Multiple myeloma (MM) and its complications carry a high rate of morbidity and mortality. ⋯ An understanding of the complications of MM can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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There have been important updates in the guidelines for the management of agitation in emergency room settings, including psychiatric emergency services. This manuscript provides a synthesis of current recommendations, combined with a detailed breakdown of the neurobiology of agitation, linking these neuroscientific dimensions with the pharmacological profiles of the drugs recommended by practice guidelines (as well as the profiles of other important agents). Since Project BETA (Best Practices in Evaluation and Treatment of Agitation) guidelines were published in 2012 (by the American Association for Emergency Psychiatry), there have been several developments in the standard of care, including an increase in use of ketamine and droperidol. Recommended treatment strategies for clinicians will be presented, including consideration of how to address specific causes of agitation.
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Hypothermia in combination with infection presents a complex challenge in clinical and battlefield medicine. Multifaceted physiological and immunological consequences of hypothermia drastically change the risk, progression, and treatment of a concomitant infection. Managing hypothermia and infection in extreme cold settings is particularly relevant in an era with increased risk of military operations in Polar climates. ⋯ We focus on skin and soft tissue infections and sepsis, which are among the serious infectious complications of hypothermia and battlefield injuries. We also present the challenges associated with treating infections under hypothermic conditions. Finally, we advocate for a renewed focus on identifying causal relationships between hypothermia and infection risk and assessing established infection treatment regiments in hypothermic patients to enhance trauma management and survival outcomes in hypothermia-related injuries.
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Caring for older adults in the Emergency Department demands compassion, expertise, and adaptability to address the intricate medical and emotional needs of this vulnerable population. Key geriatric emergency medicine articles from 2023 highlight the evolving landscape of this field: updates to the Beers Criteria for potentially inappropriate medications, medications most implicated in causing delirium, geriatric trauma centers, behavioral problems in persons with dementia, geriatric syndrome detection, and emergency department (ED) process outcomes in geriatric EDs. As healthcare organizations shift to focus on the larger continuum of care that extends beyond the ED visit, we also highlight a novel program from the Veterans Affairs bringing former military medics to the home to improve outcomes after ED discharge. This review highlights practice-changing updates to improve the management of older adults in the ED.