The American journal of emergency medicine
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Observational Study
Effect of a best practice advisory activated "kit in hand" naloxone distribution program in the emergency department.
We implemented a "kit in hand" naloxone distribution program at emergency department (ED) discharge activated by electronic health record Best Practice Advisory (BPA). The purpose of this study was to evaluate naloxone kit distribution before and after implementation. ⋯ Implementation of a BPA-activated kit in hand naloxone distribution program increases the rate of successful naloxone distribution to patients presenting to the ED following unintentional opioid overdose, a subpopulation at very high risk for recurrence of overdose. Opportunities for program improvement were identified as there were instances where kits were intended to be distributed but barriers in the process existed.
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Recent studies have validated the efficacy of point-of-care ultrasound (POCUS) as an alternative diagnostic imaging approach to computed tomography (CT) for patients with suspected acute diverticulitis. This study aimed to quantify the national impact of this approach in cost savings, ED length-of-stay (LOS), and radiation risk mitigation using a POCUS-first approach for acute diverticulitis in the emergency department (ED). ⋯ Both POCUS-first models can achieve substantial national annual cost savings, ED LOS reduction, and decreases in radiation exposure compared to the traditional CT-first approach. POCUS should be strongly considered as a first-line imaging modality for acute diverticulitis especially among low-risk patients.
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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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Randomized Controlled Trial Comparative Study
Comparison of supination/flexion maneuver to hyperpronation maneuver in the reduction of radial head subluxations: A randomized clinical trial.
This randomized controlled trial aimed to compare the effectiveness of supination/flexion (SF) and hyperpronation (HP) maneuvers in the management of radial head subluxation (RHS) in children ≤6 years old presenting to the emergency department. ⋯ gov/ct2/show/NCT05828641).
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Observational Study
Exploring ChatGPT's potential in ECG interpretation and outcome prediction in emergency department.
Approximately 20 % of emergency department (ED) visits involve cardiovascular symptoms. While ECGs are crucial for diagnosing serious conditions, interpretation accuracy varies among emergency physicians. Artificial intelligence (AI), such as ChatGPT, could assist in ECG interpretation by enhancing diagnostic precision. ⋯ ChatGPT demonstrates moderate accuracy in ECG interpretation, yet its current limitations, especially in assessing critical cases, restrict its clinical utility in ED settings. Future research and technological advancements could enhance AI's reliability, potentially positioning it as a valuable support tool for emergency physicians.