Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The objective of this study was to evaluate operational policies that may improve the proportion of eligible stroke patients within a population who would receive intravenous recombinant tissue plasminogen activator (rt-PA) and minimize time to treatment in eligible patients. ⋯ Given the potential societal benefits, continued efforts to deploy telemedicine appear warranted. Aligning the incentives between those who would have to fund the up-front technology investments and those who will benefit over time from reduced ongoing health care expenses will be necessary to fully realize the benefits of telemedicine for stroke care.
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This was a study of longitudinal trends in U.S. drug shortages within the scope of emergency medicine (EM) practice from 2001 to 2014. ⋯ Drug shortages impacting emergency care have grown dramatically since 2008. The majority of shortages are for drugs used for lifesaving interventions or high-acuity conditions. For some, no substitute is available.
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Olanzapine is an atypical antipsychotic with similar pharmacologic properties to droperidol. Due to the current droperidol shortage, the authors' clinical practice has been to substitute olanzapine for droperidol in many situations. At this time, olanzapine is U.S. Food and Drug Administration approved for oral and intramuscular (IM) use only, but due to its increased utility, intravenous (IV) olanzapine was recently approved for use in the study emergency department (ED). ⋯ In this large retrospective review, IV olanzapine appears to be a safe in the management of a variety of ED indications. Hypoxia was common, but serious airway compromise was rare.
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Cardiac arrest is one of the leading causes of death in the United States and is treated by cardiopulmonary resuscitation (CPR). CPR involves both chest compressions and positive pressure ventilations when given by medical providers. Mechanical chest compression devices automate chest compressions and are beginning to be adopted by emergency medical services with the intent of providing high-quality, consistent chest compressions that are not limited by human providers who can become fatigued. Biosignals acquired from cardiac arrest patients have been characterized in their ability to track the effect of CPR on the patient. The authors investigated the feasibility and appropriate response of a biosignal-guided mechanical chest compression device in a swine model of cardiac arrest. ⋯ In this proof-of-concept study, a signal-guided chest compression device was demonstrated to be capable of responding to biosignal input and delivering chest compressions with a broad range of rates and depths.
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The effect of emergency medicine (EM) residents on the clinical efficiency of attending physicians is controversial. The authors hypothesized that implementing a new EM residency program would result in an increase in relative value units (RVUs) generated per hour by attending physicians and decrease staffing requirements. ⋯ The implementation of an EM residency program had a positive effect on the clinical efficiency of attending physicians and decreased staffing requirements.