The American journal of emergency medicine
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Multicenter Study
High- versus low-dose ketamine for analgesia in older adults in the emergency department.
Ketamine is increasingly being utilized in the management of acute pain in the emergency department (ED), including for older adults, a population at increased risk of adverse effects from medications. We aimed to compare the safety and analgesic effects of high-dose (≥0.3mg/kg) to low-dose (<0.3mg/kg) intravenous (IV) ketamine among older ED patients. ⋯ High-dose and low-dose ketamine reduced pain scores in older adults. High-dose ketamine led to a greater reduction in pain scores, and there was no observed difference in adverse effects or the need for rescue analgesia. One-third needed discontinuation of ketamine in both groups.
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Multicenter Study
Factors influencing secondary overtriage in trauma patients undergoing interhospital transfer: A 10-year multi-center study in Hong Kong.
With the development of regionalised trauma networks, interhospital transfer of trauma patients is an inevitable component of the trauma system. However, unnecessary transfer is a common phenomenon, and it is not without risk and cost. A better understanding of secondary overtriage would enable emergency physicians to make better decisions about trauma transfers and allow guidelines to be developed to support this decision making. This study aimed to describe the pattern of secondary overtriage in Hong Kong and identify its associated factors. ⋯ Interhospital transfer is an essential component of the trauma system. However, over one-fifth of the transfers were considered unnecessary in Hong Kong, and this could be considered to be an inefficient use of resources as well as cause inconvenience to patients and their families. We have identified related factors including blunt trauma, AIS <3 scores for head or neck, thorax, abdomen and extremities, and opportunities to establish and improve on transfer protocols. Further research should be aimed to safely reduce interhospital transfers in the future to improve the efficiency of the Hong Kong trauma system.
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Multicenter Study
A nationwide analysis of emergency medicine residents' CT interpretation in trauma: The Tract-EM study.
To evaluate the accuracy and determine the factors influencing trauma CT interpretation proficiency among emergency medicine (EM) residents in Turkey through the TraCT-EM study (Interpretation of Trauma CT by EMergency Physicians). ⋯ The TraCT-EM study highlighted a 65 % accuracy rate for senior EM residents in trauma CT interpretation, with specific predictors of failure identified. These findings suggest a need for tailored radiology education strategies to enhance training and competency in trauma CT interpretation for EM residents. Further optimization of educational programs could address these gaps, ultimately improving patient outcomes in trauma care.
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Multicenter Study Comparative Study
Comparison of initial adenosine dose conversion rate for supraventricular tachycardia in the emergency department.
To evaluate the rate of supraventricular tachycardia (SVT) termination between 6 mg and 12 mg initial adenosine doses. ⋯ A higher rate of SVT termination was observed with an initial adenosine dose of 12 mg in the ED in comparison to the guideline recommended dose of 6 mg. There were no significant differences in adverse effects observed.
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Multicenter Study
Association between multiple intubation attempts and complications during emergency department airway management: A national emergency airway registry study.
Peri-intubation complications are important sequelae of airway management in the emergency department (ED). Our objective was to quantify the increased risk of complications with multiple attempts at emergency airway intubation in the ED. ⋯ We found an independent association between the number of intubation attempts among ED patients undergoing emergency airway intubation and the risk of complications.