Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Violence is a critical problem in the emergency department (ED) and patients experiencing mental health crises are at greater violence risk; however, tools appropriate for assessing violence risk in the ED are limited. Our goal was to evaluate the utility of the Fordham Risk Screening Tool (FRST) in reliability assessing violence risk in adult ED patients with acute mental health crises through evaluation of test characteristics compared to a reference standard. ⋯ These findings support the potential utility of the FRST when used to assess violence risk in adult ED patients experiencing a mental health crisis. Future research with more diverse populations and ED settings is warranted.
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Randomized Controlled Trial
Survival by Time-to-Administration of Amiodarone, Lidocaine, or Placebo in Shock-Refractory Out-of-Hospital Cardiac Arrest.
Amiodarone and lidocaine have not been shown to have a clear survival benefit compared to placebo for out-of-hospital cardiac arrest (OHCA). However, randomized trials may have been impacted by delayed administration of the study drugs. We sought to evaluate how timing from emergency medical services (EMS) arrival on scene to drug administration affects the efficacy of amiodarone and lidocaine compared to placebo. ⋯ The early administration of amiodarone, particularly within 8 min, is associated with greater survival to admission, survival to discharge, and functional survival compared to placebo in patients with an initial shockable rhythm.
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The diagnostic strategy for pulmonary embolism (PE) includes a D-dimer test when PE probability is low or intermediate, but false-positive D-dimer results are frequent and can result in an unnecessary computed tomography pulmonary angiogram. The PE rule-out criteria (PERC) rule excludes PE without D-dimer testing when pretest probability is <15%. The aim of this study was to assess the safety of the PERC rule strategy in patients included in the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry. ⋯ A low failure rate of the PERC rule was observed in the RIETE registry, thus supporting its use to safely identify patients with an unlikely probability of PE.