Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The needle-free jet injection system with buffered lidocaine (J tip) has been shown to reduce pain for intravenous (IV) line insertion, but its relationship with successful IV placement has not been well studied. This study aimed to determine if J tip use is associated with improved first-attempt IV placement success in children. ⋯ The use of the J tip did not affect first-attempt success for IV placement in children.
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In a video-based study of rapid sequence intubation (RSI) in a pediatric emergency department (PED), 33% of children experienced oxyhemoglobin desaturation (SpO2 < 90%). To inform targeted improvement interventions, we planned multivariable analyses to identify patient and process variables (including time-based data around performance of key RSI process elements uniquely available from video review) associated with desaturation during pediatric RSI. ⋯ For children 24 months of age or younger undergoing RSI in a PED, respiratory indication for intubation, esophageal intubation, and duration of laryngoscopy (both individual and cumulative) were associated with desaturation; the number of attempts was not. Interventions to limit attempt duration in the youngest children may improve the safety of RSI.
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The objective was to examine whether the emergency department (ED) evaluation of older adult fallers is concordant with the Geriatric Emergency Department Guidelines. ⋯ The current ED evaluation of older adult fallers is discordant with general and ED-specific fall guidelines. Future studies are warranted to investigate ways to successfully implement fall evaluation guidelines.
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To the best of the authors' knowledge, admission of children under observation status in community hospitals has not been examined. The hypothesis of this study was that there has been an increase in observation charge code use over time and variations in the application of observation charge codes across hospital types. ⋯ The application of observation charge codes to Michigan children with observation-prone conditions has increased over time across all hospital types. There is a need to evaluate pediatric observation care in diverse settings to compare the effectiveness of different models.
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The objective was to determine emergency physician (EP) perceptions regarding 1) the extent to which they order medically unnecessary advanced diagnostic imaging, 2) factors that contribute to this behavior, and 3) proposed solutions for curbing this practice. ⋯ Overordering of advanced imaging may be a systemic problem, as many EPs believe a substantial proportion of such studies, including some they personally order, are medically unnecessary. Respondents cited multiple complex factors with several potential high-yield solutions that must be addressed simultaneously to curb overimaging.