The American journal of emergency medicine
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Case Reports
Bottle it up: Prehospital management of an AV fistula bleed using a bottle cap: A case report.
Hemorrhage from arteriovenous fistula sites is a known complication with potentially fatal consequences. The management of AV fistula hemorrhage has historically included direct pressure, tourniquet use, and/or surgical management. We describe a case of a 71-year-old female with hemorrhage from an AV fistula site that was successfully managed in the prehospital setting using a simple bottle cap.
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Antimuscarinic delirium (AD), a potentially life-threatening condition frequently encountered by emergency physicians, results from poisoning with antimuscarinic agents. Treatment with physostigmine and benzodiazepines is the mainstay of pharmacotherapy, and use of dexmedetomidine and non-physostigmine centrally-acting acetylcholinesterase inhibitors (cAChEi) such as rivastigmine has also been described. Unfortunately, these medications are subject to drug shortages which negatively impact the ability to provide appropriate pharmacologic treatment of patients with AD. ⋯ Shortages of agents used in the treatment of AD were common during the study period and affected all agent classes. Shortages were often prolonged and multiple shortages were ongoing at study period end. Multiple concurrent shortages involving different agents occurred, which could hamper substitution as a means of mitigating shortage. Healthcare stakeholders must develop innovative patient- and institution-specific solutions in times of shortage and work to build resilience into the medical product supply chain to minimize future shortages of drugs used for treatment of AD.
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Delay to first antibiotic dose in patients with sepsis has been associated with increased mortality. Second dose antibiotic delay has also been linked to worsened patient outcomes. Optimal methods to decrease second dose delay are currently unclear. The primary objective of this study was to evaluate the association between updating an emergency department (ED) sepsis order set design from one-time doses to scheduled antibiotic frequencies and delay to administration of second piperacillin-tazobactam dose. ⋯ Including scheduled antibiotic frequencies in ED sepsis order sets is a pragmatic mechanism to decrease delays in second antibiotic doses.
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Although noise is known to negatively affect blood pressure (BP) measurements, its impact on different BP measurement methods remains unclear. The aim of this study is to compare the agreement of oscillometric and auscultatory BP measurement methods under in-ambulance noise levels. ⋯ The results of this study demonstrate that noise significantly affects the agreement between oscillometric and auscultatory blood pressure measurement methods.
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We evaluate the impact of the COVID-19 pandemic on care for survivors of sexual assault in three urban Emergency Departments (ED) in the United States. ⋯ The care of survivors in the ED was disrupted by the COVID-19 pandemic. While medical care remained similar, fewer calls to sexual assault advocates, a key component of ED and long-term care of survivors, demonstrate a disruption in their care.