J Emerg Med
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Communication is considered a core competency for physicians. However, the Emergency Department setting poses significant and unique communication challenges. ⋯ The majority of respondents are not utilizing communication techniques, despite their own beliefs that the techniques are effective and easy to implement in the Emergency Department. Additional research is needed to determine the effectiveness of these techniques and relevant barriers to their use.
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Syncope in the pediatric population is a common and mostly benign event. There is a subset of patients, however, in whom exertional syncope is the manifestation of a life-threatening cardiac abnormality. ⋯ As a potential precursor of sudden death, exertional syncope in pediatric patients should prompt a thorough evaluation for a cardiac etiology.
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Concerns over adrenal suppression caused by a single dose of etomidate for intubation led to limiting its use in trauma patients in 2006. ⋯ A significant reduction in the use of etomidate in trauma patients was not associated with differences in mortality, ICU days, or hospital LOS, but was associated with an increase in episodes of hypotension within 24h of presentation.
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Pharmacologic management of the agitated emergency department patient is controversial. The combination of olanzapine + benzodiazepines is not recommended by the manufacturer, but a recent report suggested harm only if the patient was intoxicated. Whether this is also true for haloperidol + benzodiazepines is not known. ⋯ In this sample, olanzapine alone or with a benzodiazepine was not associated with more hypotension than haloperidol. However, olanzapine + benzodiazepines were associated with lower oxygen saturations than haloperidol + benzodiazepines in ETOH+ but not ETOH- patients. In patients with known alcohol ingestion, haloperidol, haloperidol + benzodiazepines, or olanzapine alone may be better choices for treatment of agitation.
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Medication errors are a leading cause of increased cost and iatrogenic injury in the pediatric population. In the academic setting, studies have suggested that these increased error rates are related primarily to resident inexperience, thus advocating a higher level of supervision. ⋯ Overall prescription error rates at our institution are comparable to nationally reported error rates in children. Error rates were not associated with newly matriculated residents. These findings dispute previously held opinion that physician level of training is a factor of prescription errors.