Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial
Randomized placebo-controlled trial of droperidol and ondansetron for adult emergency department patients with nausea.
The objective was to separately compare effectiveness of 1.25 mg of intravenous (IV) droperidol and 8 mg of IV ondansetron with 0.9% saline placebo for adult emergency department (ED) patients with nausea. A novel primary outcome measure, expected to aid clinical interpretation of reported results, was employed. ⋯ For adult ED patients with nausea, superiority was not demonstrated for droperidol or ondansetron over placebo.
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Ketamine has been studied as an alternative to opioids for acute pain in the emergency department setting. This review compares the effectives of intravenous ketamine at a dose of <0.5mg/kg to opioids for acute pain in adult patients. ⋯ Ketamine was found to have similar effectiveness to opioids. Increased, but short-lived, side effects were seen with ketamine.
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Multicenter Study
Variation in Emergency Department Adherence to Treatment Guidelines for Inpatient Pneumonia and Sepsis: A Retrospective Cohort Study.
Evidence-based clinical practice guidelines (CPGs) for the treatment of pneumonia and sepsis have existed for many years with multiple studies suggesting improved patient outcomes. Despite their importance, little is known about variation in emergency department (ED) adherence to these CPGs. Our objectives were to estimate variation in ED adherence across CPGs for pneumonia and sepsis and identify patient, provider, and environmental factors associated with adherence. ⋯ Adherence to ED infectious CPGs for pneumonia and sepsis varies significantly across diseases and types of institutions with significant room for improvement, especially in light of a significant association with in-hospital mortality.
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Multicenter Study
Psychiatric Outcomes of Patients with Severe Agitation Following Administration of Prehospital Ketamine.
Ketamine is an emerging drug used in the management of undifferentiated, severe agitation in the prehospital setting. However, prior work has indicated that ketamine may exacerbate psychotic symptoms in patients with schizophrenia. The objective of this study was to describe psychiatric outcomes in patients who receive prehospital ketamine for severe agitation. ⋯ Administration of prehospital ketamine for severe agitation was not associated with an increase in the rate of psychiatric evaluation in the emergency department or psychiatric inpatient admission when compared with benzodiazepine treatment, regardless of the patient's psychiatric history.