The American journal of emergency medicine
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Chronic obstructive pulmonary disease (COPD) is an important comorbidity in heart failure. The MIMO trial showed that patients with acute cardiogenic pulmonary edema (ACPE) treated with midazolam had fewer serious adverse events than those treated with morphine. In this post hoc analysis, we examined whether the presence/ absence of COPD modifies the reduced risk of midazolam over morphine. ⋯ The reduced risk of serious adverse events in the midazolam group compared with morphine is similar in patients with and without COPD.
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In patients who experience a seizure, the seizure duration is a strong indicator of prognosis. Thus, reducing time to antiepileptic medications in patients who are actively seizing is critical. While findings from retrospective studies suggest that the rapid administration of undiluted intravenous (IV) levetiracetam may be safe, some gaps in the literature remain. ⋯ This study found that the rapid administration of undiluted IV levetiracetam in ED patients was associated with few adverse events.
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Hepatobiliary infections are common in the emergency department (ED), and the mortality rate for this condition is high. A suitable bacteremia prediction model would support prompt identification of bacteremia and appropriate management of hepatobiliary infections in the ED. Therefore, we attempted to produce a bacteremia prediction model with both internal and external validation for hepatobiliary infections in the ED. ⋯ A bacteremia prediction model for hepatobiliary infection might be useful to predict the risk of bacteremia. It might also reduce the need for blood culture in low-risk patients.
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Prothrombin/international normalized ratio and activated partial thromboplastin time (PT/INR and aPTT) are frequently ordered in emergency departments (EDs), but rarely affect management. They offer limited utility outside of select indications. Several quality improvement initiatives have shown reduction in ED use of PT/INR and aPTT using multifaceted interventions in well-resourced settings. Successful reduction of these low-value tests has not yet been shown using a single intervention across a large hospital system in a safety net setting. This study aims to determine if an intervention of two BPAs is associated with a reduction in PT/INR and aPTT usage across a large safety net system. ⋯ This BPA intervention reduced PT/INR and aPTT use across 11 EDs in a large, urban, safety net system. Further study is needed in implementation to other non-safety net settings.
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Tumor lysis syndrome (TLS) is an acutely life threatening, must-not miss, oncological emergency that infrequently presents to the emergency department (ED). This diagnosis is typically a complication of chemotherapy, however, TLS can also occur spontaneously as the first presentation of malignancy. ⋯ Further workup revealed the diagnosis of pre-B cell acute lymphoblastic leukemia. This case emphasizes the consideration of TLS as a cause of acute renal failure or severe electrolyte derangements in those who may not have a known diagnosis of malignancy or recent chemotherapy.