Articles: emergency-medicine.
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While several studies have focused on preliminary data and outcomes associated with prehospital buprenorphine administration interventions, to date there has been little discussion of the challenges experienced during the initial implementation of a prehospital buprenorphine protocol. In this case series we examine 3 separate patient encounters with different crews, patients, and receiving emergency medicine (EM) physicians, which highlight initial challenges experienced with implementing the first prehospital buprenorphine program in a rural Appalachian County within South Carolina. In 2 cases we highlight conflicts that may require collegial intervention and education of local receiving EM physicians regarding the new prehospital protocol. In 1 case we describe a patient who was eligible but not enrolled due to a misunderstanding among an Emergency Medical Services (EMS) clinician of how to correctly apply protocol criteria. We discuss the management of each implementation issue and outcomes after follow-up with members of the study team. As these novel programs emerge, understanding the potential challenges and personal biases that may be encountered when implementing a prehospital buprenorphine administration protocol is essential to inform organizations planning to implement similar programs.
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The Pediatric Emergency Care Applied Research Network (PECARN) derived and externally validated a clinical prediction rule to identify children with blunt torso trauma at low risk for intraabdominal injuries undergoing acute intervention (IAIAI). Little is known about the risk for IAIAI when only one or two prediction rule variables are positive. We sought to determine the risk for IAIAI when either one or two PECARN intraabdominal injury rule variables are positive. ⋯ Few children with blunt torso trauma and one or two PECARN predictor variables present have IAIAI. Those with GCS score <14, however, are at highest risk for IAIAI.
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Cognitive impairment in older adults is underrecognized in emergency departments. Despite emergency nurses' central role in facilitating ED screening for clinical and social needs, little is known about their perspectives on implementing delirium and dementia screenings. Nurses can provide insights to promote the uptake of these screenings. ⋯ Emergency nurses conceptualize screenings in terms of patient safety, which may be the best way to frame initiatives to implement screenings for cognitive impairment. In light of ED crowding and boarding's impacts on patient safety, nurses highlighted screening for cognitive impairment as increasingly relevant. However, they found current working conditions of delivering patient care in waiting rooms and hallways not conducive to implementing screenings. Using the Consolidated Framework for Implementation Research framework helped identify workflow limitations that are barriers to ED screening.