Articles: emergency-department.
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Succinylcholine is often used to facilitate neonatal and pediatric rapid sequence intubation in the emergency department, and most relevant literature recommends administering atropine prior to succinylcholine to reduce the risk of bradycardia. Given the potential complications associated with combining these medications, we searched the published literature for evidence supporting this practice. Most studies recommending atropine premedication were undertaken in the operating room setting and pertained to repeated succinylcholine dosing. ⋯ Several authors have called for the practice to cease, but, to date, these calls have gone unheeded. We found no evidence supporting atropine's use in pediatric patients prior to single-dose succinylcholine. Atropine premedication for emergency department rapid sequence intubation is unnecessary and should not be viewed as a "standard of care."
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Difficulty maintaining physician staffing in emergency departments (EDs) prompted the government of Ontario to offer alternate funding arrangements (AFAs) to replace fee-for-service remuneration for physicians working in EDs. ⋯ Emergency department AFAs have been widely adopted in Ontario, but have not been associated with substantial changes in the overall physician workforce in EDs. However, trends toward increased physician numbers were seen in small/rural and teaching hospitals. There was little evidence of any adverse effects on the provision of primary care services by physicians.
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Evidence suggests that symptom-triggered benzodiazepine treatment for patients with alcohol withdrawal reduces complication rates and emergency department lengths of stay. Our objective was to describe the management of alcohol withdrawal in 2 urban emergency departments. ⋯ There is significant variability in the documentation and treatment of alcohol withdrawal. Lower benzodiazepine doses are associated with higher rate of withdrawal seizures and prolonged emergency department length of stay. A standardized approach using symptom-triggered management is likely to improve outcomes for patients presenting with alcohol withdrawal.
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J Stroke Cerebrovasc Dis · Jan 2005
Painless acute aortic dissection with a left hemiparesis: a case report.
We report a patient with completely painless acute aortic dissection who presented with transient left hemiparesis. A 59-year-old male presented to our Emergency Department with left-sided weakness of sudden onset. We therefore suspected cerebrovascular accident. ⋯ The cycle of symptom appearance and recovery recurred 3 times over a period of a few minutes. The final diagnosis was acute aortic dissection (DeBakey type II Stanford type A). Completely painless acute aortic dissection who presented with only neurologic symptoms, which made the diagnosis of acute aortic dissection extremely difficult.