Articles: emergency-department.
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Transcutaneous carbon dioxide (Ptcco2) measurement is a non-invasive surrogate marker for arterial carbon dioxide (Paco2), which requires invasive arterial blood sampling. Use of Ptcco2 has been examined in different clinical settings, however, most existing evidence in the adult emergency department (ED) setting shows insufficient agreement between the measurements. This study assessed the level of agreement between Ptcco2 and Paco2 in undifferentiated adult ED patients across multiple timepoints. ⋯ The level of agreement between Ptcco2 and Paco2 measurements may not be sufficiently precise for the adoption of Ptcco2 monitoring in patients presenting to the ED.
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Opioid use disorder and opioid overdose deaths are a major public health crisis, yet highly effective evidence-based treatments are available that reduce morbidity and mortality. One such treatment, buprenorphine, can be initiated in the emergency department (ED). ⋯ Meeting participants identified research and knowledge gaps in 8 categories, including ED staff and peer-based interventions; out-of-hospital buprenorphine initiation; buprenorphine dosing and formulations; linkage to care; strategies for scaling ED-initiated buprenorphine; the effect of ancillary technology-based interventions; quality measures; and economic considerations. Additional research and implementation strategies are needed to enhance adoption into standard emergency care and improve patient outcomes.
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Pediatric emergency care · Sep 2023
Moral Distress and Its Relating Factors Among Pediatric Emergency Department Nurses: A Cross-Sectional Study.
Emergency services are patient circulation units that require chaos, trauma, and high tension. It was aimed to determine the moral distress levels of pediatric nurses in pediatric emergency and emergency departments and relevant factors. ⋯ It was found in the study that nurses had low levels of moral distress; however, many factors relevant to working conditions were associated with moral distress. The pediatric emergency service nurses were determined to experience a higher moral distress compared with the emergency department nurses serving pediatric patients.
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Pediatric emergency care · Sep 2023
Risk Factors for Failure of Closed Forearm Fracture Reduction in the Pediatric Emergency Department.
This study aimed to explore risk factors for failure of forearm fracture closed reduction in the pediatric emergency department (ED) and to suggest indications for initial surgery. ⋯ Most pediatric forearm fractures can be successfully managed by closed reduction in the ED. Two-bone fractures had the strongest association with reduction failure. Refracture, open fracture, midshaft location, initial radius bone translation of 37% and higher (and not initial angulation), and patient age of 10 years and older are independent risk factors for reduction failure in two-bone fractures. We propose a risk score for reduction failure that can serve as a decision-making tool.
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Pediatric emergency care · Sep 2023
Intranasal Dexmedetomidine Use in Pediatric Patients for Anxiolysis in the Emergency Department.
In recent years, dexmedetomidine has gained traction as a treatment for anxiolysis in the emergency department (ED). When used with an atomizer, it may also be given intranasally for anxiolysis. The primary objective was to determine the level of ED provider satisfaction and comfort with intranasal (IN) dexmedetomidine for anxiolysis in pediatric patients with behavioral agitation and/or acute psychosis. The secondary objectives included determining safety, rates of therapy failure, and ED length of stay compared with oral midazolam. The efficacy of IN dexmedetomidine versus oral midazolam in patients with autism spectrum disorder (ASD) was also evaluated. ⋯ This study demonstrates that IN dexmedetomidine has high levels of provider comfort and satisfaction, moderately high success rate, and a promising safety profile. In addition, IN dexmedetomidine may be superior to oral midazolam in patients with ASD for anxiolysis, but additional studies are needed.