J Emerg Med
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Observational Study
Impact of an Opioid Prescribing Guideline in the Acute Care Setting.
Death from opioid abuse is a major public health issue. The death rate associated with opioid overdose nearly quadrupled from 1999 to 2008. Acute care settings are a major source of opioid prescriptions, often for minor conditions and chronic noncancer pain. ⋯ An opioid prescribing guideline significantly decreased the rates at which opioids were prescribed for minor and chronic complaints in an acute care setting.
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Mad honey-related intoxication frequently leads to bradycardia, hypotension, and syncope. Hypothermia is a potentially life-threatening condition if not identified early and treated appropriately. ⋯ Three patients are reviewed. Patient 1 was a 66-year-old man who presented to the emergency department with nausea, vomiting, and faintness beginning 2 h after consuming honey. His temperature was 34°C, his blood pressure was 70/40 mm Hg, and his heart rate was 30 beats/min. Patient 2, a 57-year-old man, presented to the emergency department with headache, feeling cold, and faintness beginning 3 h after consuming honey. His temperature was 35°C, his blood pressure was 60/40 mm Hg, and his heart rate was 46 beats/min. Patient 3 was a 79-year-old woman who presented with nausea, vomiting, and headache 2 h after consuming honey. Her temperature was 35°C, her blood pressure was 70/40 mm Hg, and her heart rate was 40 beats/min. All 3 patients were discharged in good condition after appropriate therapy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Bradycardia and hypotension are frequently encountered in mad honey intoxication. However, intoxication accompanied by hypothermia has attracted little attention to date.
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The U.S. Food and Drug Administration recently approved a four-factor prothrombin complex concentrate (4-PCC) for warfarin reversal. The literature supporting its use over three-factor prothrombin complex concentrate (3-PCC) is limited. ⋯ A higher percentage of patients achieved warfarin reversal with 4-PCC compared to 3-PCC treatment. A prospective randomized control trial is necessary to confirm our results.
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Prehospital tracheal intubation may be performed by novice intubators in cervical immobilized patients. However, most indirect laryngoscopes require special training. The McGrath® Series 5 video laryngoscope is similar to the Macintosh laryngoscope in shape and usage, yet still confers the advantages of having indirect laryngoscopes. ⋯ McGrath® Series 5 video laryngoscope may be better than a standard Macintosh laryngoscope for novice intubators intubating the trachea in cervical immobilization, due to the higher first-attempt success rate, faster intubation time, fewer dental clicks, lower number of intubation attempts, and overall ease of use.
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Guidelines recommend initiation of appropriate antimicrobial therapy within 1 h of severe sepsis diagnosis. Few sepsis bundles exist in the literature emphasizing initiation of specific antibiotic therapy. ⋯ An updated antibiotic-specific sepsis bundle, with antibiotics put in an automated medication cabinet, can result in improvements in the initiation of appropriate initial antibiotic therapy for severe sepsis in the emergency department.