J Emerg Med
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Observational Study
The Impact of Pop-Up Clinical Electronic Health Record Decision Tools on Ordering Pulmonary Embolism Studies in the Emergency Department.
Emergency physicians make time-sensitive care decisions for life threatening diagnoses and utilize evidence-based decision rules and testing with high sensitivity to ensure that critical diagnoses are not missed. Current literature suggests that there is over testing for pulmonary embolism in the emergency department. ⋯ There are many barriers to the implementation of successful EHR alerts. These findings support and validate previous studies that have shown a higher diagnostic yield of CT angiography for pulmonary embolism after implementation of active alerts integrated into the EHR with ordering studies. These tools are effective quality improvement initiatives, and their use should be encouraged.
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Endophthalmitis is an uncommon yet devastating compilation of Fusarium keratitis. Cases of Fusarium keratitis are seen commonly in tropical regions of the world; however, they have been increasing in frequency in the United States. ⋯ We present the case of a 36-year-old man who experienced an ocular lens expulsion secondary to Fusarium endophthalmitis. Why Should an Emergency Physician Be Aware of This?:Fusarium keratitis is becoming more common and can progress to endophthalmitis without proper management. This infection can be difficult to recognize and treat, so early action by the emergency physician could be the difference between vision loss and vision-sparing care.
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Despite increasing trends of nonfatal opioid overdoses in emergency departments (EDs), population-based studies comparing prescription opioid dosing patterns before and after nonfatal opioid overdoses are limited. ⋯ In Tennessee, many patients treated in the ED for an overdose are still prescribed high-dose opioid analgesics after an overdose, highlighting a missed opportunity for intervention and coordination of care between ED and non-ED providers.