Western Journal of Emergency Medicine最新文献

{"title":"Monitoring the Evolving Match Environment in Emergency Medicine 2023.","authors":"Anthony Sielicki, Brian Milman, Andrew Little, Miriam Kulkarni, James Morris, Laura Hopson, Michael Kiemeney","doi":"10.5811/westjem.18562","DOIUrl":"10.5811/westjem.18562","url":null,"abstract":"<p><strong>Introduction: </strong>The 2023 National Residency Matching Program (NRMP) Match in emergency medicine (EM) left 554 spots and 132 EM programs unfilled. The Council of Residency Directors Match Task Force sought to characterize the programs that did and did not fill, learn more about their Supplemental Offer and Acceptance Program (SOAP) applicants, determine residency programs' needs for future NRMP Matches, and inquire what actions program leaders would like to see to promote a healthy future for training in EM.</p><p><strong>Methods: </strong>We conducted a web-based survey of EM residency program leadership during March and April 2023. We generated descriptive statistics from these survey results. Thematic analysis was used for free-text responses.</p><p><strong>Results: </strong>Of 287 programs, 160 (55.7%) responded to the survey, including 59 of 132 programs (44.7%) that did not fill in the Match. Unfilled programs were overall content with the quality of applicants in the SOAP. Programs expressed varying opinions on why fewer students are choosing EM. While most agreed there are concerns about the workforce (78.1%), even more spread exists on what actions should be taken to help support the future of residency training in EM.</p><p><strong>Conclusion: </strong>Here we present data regarding the 2023 Match environment for EM and describe a residency program-level needs assessment and desire for action. Annual review of the Match data and residency program needs should be continued until we see improvement in the Match environment for EM.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"233-240"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood Pressure Variability and Outcome Predictors for Traumatic Brain Injury Patients with Diffuse Axonal Injury: A Retrospective Cohort Study.","authors":"Christine E Ren, Anastasia Ternovskaia, Fatima Mikdashi, Hassan Syed, Isha Vashee, Vainavi Gambhir, Natalie Chao, Jessica V Downing, David Dreizin, Quincy K Tran","doi":"10.5811/westjem.20346","DOIUrl":"10.5811/westjem.20346","url":null,"abstract":"<p><strong>Background: </strong>Diffuse axonal injury (DAI), a feature seen in severe traumatic brain injury (TBI), is associated with substantial morbidity and mortality. Although blood pressure variability (BPV) has been shown to impact TBI outcomes overall, its relevance in DAI cases remains uncertain. We investigated whether 24-hour post-injury BPV and other clinical factors were linked to patient outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of Level I trauma center-admitted TBI patients with radiographic DAI diagnosis (computed tomography/magnetic resonance imaging). Hospital disposition (home, nursing facility, hospice/death) and Glasgow Coma Scale (GCS) on hospital day 5 (HD5GCS) were outcomes of interest. We assessed associations with clinical factors using ordinal logistic regression.</p><p><strong>Results: </strong>Among 153 patients (mean age 49 ±20 years, 74% male), median admission GCS was 5.0 (3.0-12.5), HD5GCS was 8.0 (6.0-11), and median hospital stay was 25 (15.5-34.5) days. The BPV, measured as successive variation in systolic blood pressure (SBP_SV) and standard deviation in systolic blood pressure (SBP_SD), was not significantly associated with hospital disposition. SBP_SV and SBP_SD were also not associated with our secondary outcome of HD5GCS. Initial international normalized ratio (INR) (Coefficient -3.67, odds ratio [OR] 0.03, 95% confidence interval [CI] 0.00-0.70), cerebral contusion (Coeff -2.39, OR 0.09, 95% CI 0.01-0.75), and HD5GCS (Coeff 0.59, OR 1.80, 95% CI 1.30-2.49) were associated with increased odds of discharge to hospice or death. Administration of blood products (Coeff 1.06, OR 2.89, 95% CI 1.10-7.60), vasopressors (Coeff 1.40, OR 4.05, 95% CI 1.37-11.96), and hyperosmolar therapy (Coeff 1.23, OR 3.41, 95% CI 1.36-8.54), and concurrent intraventricular hemorrhage (Coeff 0.99, OR 2.70, 95% CI 0.86-6.49) were linked to poorer HD5GCS.</p><p><strong>Conclusion: </strong>Blood pressure variability was not correlated with outcomes in patients with diffuse axonal injury. Low Glasgow Coma Score on hospital day 5, high initial INR, and concomitant cerebral contusion were associated with poorer outcomes.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"367-377"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Push and Pull: What Factors Attracted Applicants to Emergency Medicine and What Factors Pushed Them Away Following the 2023 Match.","authors":"Michael Kiemeney, James Morris, Lauren Lamparter, Moshe Weizberg, Andy Little, Brian Milman","doi":"10.5811/westjem.21249","DOIUrl":"10.5811/westjem.21249","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency medicine (EM) historically enjoyed a nearly 100% match rate. A rapid change saw 46% of EM programs with one or more unfilled positions after the 2023 Match. Much has been discussed about potential causes, and characteristics of unfilled programs have been investigated. We surveyed recent applicants to EM to further understand what continues to draw them to EM and what concerns deter them from choosing a career in EM.</p><p><strong>Methods: </strong>A cross-sectional, mixed methods survey was distributed in the summer of 2023 to a convenience sample of respondents via the listservs of national EM resident and student organizations as well as clerkship directors in EM. We did not calculate response rate due to listserv convenience sampling. A total of 213 responses were received, representing 7.7% of the total number of EM applicants (2,765) in 2023. Applicants were asked to rank from 1 to 5 their experiences with EM and the characteristics of the specialty that were important in their career decision. We calculated means and 95% confidence intervals for quantitative results. We performed qualitative analysis of free-text responses to identify themes.</p><p><strong>Results: </strong>Positive factors for applicants were interactions with EM faculty (4.29 on 1-5 scale) and residents (4.42) as well as clinical experiences in third-year (4.53) and fourth-year clerkships (4.62). Applicants continue to be drawn to EM by the variety of pathology encountered (4.66), flexible lifestyle (4.63), and high-acuity patient care (4.43). Most applicants (68.5%) experienced advisement away from EM. Of those who received negative advisement, non-emergency physicians were the most common source (73.3%). Factors negatively influencing a career choice in EM were corporate influence (2.51), ED crowding (2.52), burnout (2.59), presence of advanced practice practitioners (APP) in EM (2.63), and workforce concerns (2.85). Job concerns stemming from the 2021 EM workforce report were identified by respondents as the primary reason for recent Match results.</p><p><strong>Conclusion: </strong>Applicants noted clinical experiences in the emergency department and interactions with EM attendings and residents as positive experiences. High-acuity patient care, variety of pathology, and flexible lifestyle continue to attract applicants. Applicants identified EM workforce concerns as the primary contributor to recent EM Match results. Corporate influence, ED crowding, burnout, and presence of APPs in the ED were also significant issues.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"261-270"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Social Risk Factors and Emergency Department Use: National Health Interview Survey 2016-2018.","authors":"Iraa Guleria, Jennifer A Campbell, Abigail Thorgerson, Sanjay Bhandari, Leonard E Egede","doi":"10.5811/westjem.18616","DOIUrl":"10.5811/westjem.18616","url":null,"abstract":"<p><strong>Background: </strong>Evidence shows that social risks are highly prevalent in the patient population that presents to the emergency department (ED) for care; however, understanding the relationship between social risk factors and ED utilization at the population level remains unknown.</p><p><strong>Methods: </strong>We used the National Health Interview Survey from the 2016-2018 sample adult files. The sample included 82,364 individuals, representing a population size of 238,888,238. The primary independent variables included six social risk factors: economic instability; lack of community; educational deficit; food insecurity; social isolation; and inadequate access to care. The outcome included ED use in the prior year. Covariates included age, race/ethnicity, insurance status, obesity, mental health (depression/anxiety), and comorbidities. We ran logistic regression models to test the relationship between the independent and dependent variables adjusting for covariates.</p><p><strong>Results: </strong>In the study sample, 20% had at least one ED visit in the prior year. In the fully adjusted model, individuals reporting economic instability (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.25-1.42), lack of community (OR 1.10, 95% CI 1.05-1.15), educational deficit (OR 1.12, 95% CI 1.06-1.18), food insecurity (OR 1.77, 95% CI 1.66-1.89), and social isolation (OR 1.32, 95% CI 1.26-1.39) had significantly higher odds of ED use. Inadequate access to care was significantly related to lower odds of ED use (OR 0.75, 95% CI 0.69-0.81).</p><p><strong>Conclusions: </strong>Social risk factors are significantly associated with higher odds of ED use in the United States adult population. Interventions that integrate social and medical needs are greatly needed, as is understanding the role that preventive medicine may play in reducing avoidable ED visits.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"307-314"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-year Results of an Emergency Department Night Shift Buy-out Program.","authors":"Charlotte W Croteau, Joshua N Goldstein, Lauren Nentwich, Ali S Raja, Michael VanRooyen, Joshua J Baugh","doi":"10.5811/westjem.20303","DOIUrl":"10.5811/westjem.20303","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency physicians have the highest rates of burnout among our physician peers, with prior literature suggesting clinician schedules can play a significant role in burnout. We assessed our transition from a tenure- and age-based paradigm to an egalitarian, night shift buy-out program that allows schedule flexibility for physicians at all stages of their careers.</p><p><strong>Methods: </strong>The night shift buy-out program was implemented in the emergency department (ED) of an academic, quaternary-care center that treats approximately 100,000 adult patients annually with 56 faculty emergency physicians. We sought to create a cost-neutral program, carefully balancing incentives between nocturnists and those wanting to reduce allotted night shifts. Ultimately, the program was designed to allow all faculty to buy out of any number of nights for $500 per night shift, with the funds generated used to increase nocturnist salaries. We analyzed two years of the program (July 2022-June 2024) to assess trends in night shift buy-outs, the primary outcome. We also conducted an all-faculty survey after the program's first year to gauge sentiments about the program.</p><p><strong>Results: </strong>Over two years, 22 faculty (42%) fully bought out of nights; an additional 10 (15%) bought out of some nights. By year two, the program could grant all faculty their preferred night-shift allotment. Faculty who bought out fully had worked longer in EM on average, worked fewer clinical hours per year, were more likely to be associate/full professors, and were less likely to be women. Nocturnists had the highest mean clinical hours of the four groups, had the lowest average tenure, and were least likely to be associate/full professors. A total of 86% of faculty responded to the survey, to which more than 80% of those buying out reported that reducing the night-shift burden was either \"very important\" or \"critical for continuing in this job.\"</p><p><strong>Conclusion: </strong>Our academic ED transitioned from a tenure- and age-based, overnight shift paradigm to an egalitarian buy-out program that allows physicians flexibility at all career stages. This approach could improve career satisfaction and reduce burnout among emergency physicians.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"290-294"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Productivity and Efficiency Growth During Emergency Medicine Residency Training.","authors":"Matthew T Singh, David M Austin, Stephanie C Mullennix, Joshua C Reynolds, J Adam Oostema","doi":"10.5811/westjem.21227","DOIUrl":"10.5811/westjem.21227","url":null,"abstract":"<p><strong>Introduction: </strong>Throughout training, an emergency medicine (EM) resident is required to increase efficiency and productivity to ensure safe practice after graduation. Multitasking is one of the 22 Accreditation Council for Graduate Medical Education (ACGME) EM milestones and is often measured through evaluations and observation. Providing quantitative data to both residents and residency administration on patients seen per hour (PPH) and efficiency could improve a resident experience and training in many ways. Our study was designed to analyze various throughput metrics and productivity trends using applied mathematics and a robust dataset. Our goals were to define the curve of resident PPH over time, adjust for relevant confounders, and analyze additional efficiency metrics related to throughput such as door-to-decision time (DTDT).</p><p><strong>Methods: </strong>We used a retrospective, observational design in a single, tertiary-care center emergency department (ED) that sees approximately 110,000 adult patients per year; our study spanned the period July 1, 2019-December 31, 2021. A total of 42 residents from an ACGME-accredited three-year residency were included in the analysis. We excluded patients <18 years of age. Data was collected using a secure data vendor, and we created an exponential regression model to assess resident PPH data. Additional models were created accounting for patient covariates.</p><p><strong>Results: </strong>We analyzed a total of 79,232 patients over 30 months. Using an exponential equation and adjusting for patient covariates, median PPH started at 0.898 and ended at 1.425 PPH. The median PPH by postgraduate (PGY) year were 1.13 for PGY 1; 1.38 for PGY 2; and 1.38 for PGY 3. Median DTDT in minutes was as follows: 185 minutes for PGY 1; 171 for PGY 2; and 166 for PGY 3.</p><p><strong>Conclusion: </strong>Productivity and efficiency metrics such as PPH and DTDT data are an essential part of working in an ED. Our study shows that residents improve with number of patients seen per hour over three years but tend to plateau in their second year. Door-to-decision time continued to improve throughout their three years of training.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"246-253"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modeling Hourly Productivity of Advanced Practice Clinicians in the Emergency Department.","authors":"Bryan A Stenson, Peter S Antkowiak, David T Chiu, Leon D Sanchez, Joshua W Joseph","doi":"10.5811/westjem.21298","DOIUrl":"10.5811/westjem.21298","url":null,"abstract":"<p><strong>Introduction: </strong>Advance practice clinicians (APC) play significant roles in academic and community emergency departments (ED). In attendings and residents, prior research demonstrated that productivity is dynamic and changes throughout a shift in a predictable way. However, this has not been studied in APCs. The primary outcome of this study was to model productivity for APCs in community EDs to determine whether it changes during a shift similar to the way it does for attendings and residents.</p><p><strong>Methods: </strong>This was a retrospective, observational analysis of 10-hour APC shifts at two suburban hospitals, worked by 14 total individuals. We examined the number of patients seen per hour of the shift by experienced APCs who see all acuity and staff all patients with an attending. We used a generalized estimating equation to construct the model of hour-by-hour productivity change.</p><p><strong>Results: </strong>We analyzed 862 shifts over one year across two sites, with three shift start times. Site 1 10 am-8 pm saw an average of 13.31 (95% confidence interval [CI] 13.02-13.63) patients per shift; Site 2 8 am-6 pm saw an average of 12.64 (95% CI 12.32-13.06) patients per shift; Site 2 4 pm-2 am saw an average of 12.53 (95% CI 12.04-12.82) patients per shift. Across all sites and shifts, hour 1 saw the highest number of patients. Each subsequent hour was associated with a small, statistically significant decrease over the previous hours. This was most pronounced in the shift's last two hours.</p><p><strong>Conclusion: </strong>The productivity of APCs demonstrates a similar pattern of hourly declines observed in both resident and attending physicians. This corroborates prior findings that patients per hour is a dynamic variable, decreasing throughout a shift. This provides further external validity to prior research to include both APCs and community EDs. These departments must take this phenomenon into account, as it has scheduling and operational consequences.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"295-300"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procedural Sedation in the Emergency Department - An Observational Study: Does Nil Per Os Status Matter?","authors":"Brendan Peterson, Amy S Nowacki, Alexander Ulintz, Sharon E Mace","doi":"10.5811/westjem.18561","DOIUrl":"10.5811/westjem.18561","url":null,"abstract":"<p><strong>Introduction: </strong>Procedural sedation (PS) is commonly performed in the emergency department (ED). Nil per os (nothing by mouth) (NPO) guidelines extrapolated from standards for patients undergoing elective procedures in the operating room have been applied to ED PS patients. There has been no large study of ED PS patients comparing differences in adverse events and PS success rates based on NPO status.</p><p><strong>Methods: </strong>From a cohort of consecutive ED PS patients of all ages in the 20 EDs of one hospital system-one quaternary ED, four tertiary EDs, six community hospital EDs, one rural ED, two pediatric EDs, and six freestanding EDs in two states in the Midwest and South-we conducted a retrospective analysis on a prospective database over 183 months from April 2000-June 2015. Primary outcome was the incidence of side effects and complications, which comprised the adverse effects. The side effects were nausea, vomiting, itching/rash, emergence reaction, myoclonus, paradoxical reaction, cough, and hiccups. Complications were oxygen desaturation <90%, respiratory depression (respiratory rate <8), apnea, tachypnea, hypotension, hypertension, bradycardia, and tachycardia. Normal vital signs were age dependent. Secondary outcome was successful sedation defined as completion of the procedure. We examined the association between adverse events and successful sedation with NPO status.</p><p><strong>Results: </strong>Of 3,274 visits, exact NPO status was known in 2,643 visits. Comparison of NPO <8 hours in 1,388 patients vs ≥ 8 hours in 1,255 patients revealed side effects 5.5% vs 4.5% (<i>P</i> = 0.28); complications 11.9% vs 17.7% (<i>P</i> < 0.001); adverse events 16.3% vs 21.5% (<i>P</i> < 0.001), interventions 4.1% vs 4.4% (<i>P</i> = 0.73), and procedural completions 94.3% vs 89.7% (<i>P</i> < 0.001). After adjustment for age, sex, transfer status, American Society of Anesthesiology physical status classification, race, primary sedative, multiple sedatives, sedative plus analgesic, and primary analgesic, we found no association between NPO status and side effects (<i>P</i> = 0.68), complications (<i>P</i> = 0.48), or adverse effects (<i>P</i> = 0.26); however, procedural completion rate remained significantly higher for NPO < 8 hours (<i>P</i> = 0.007).</p><p><strong>Conclusion: </strong>A nil per os status ≥8 hours may have similar or worse outcomes than NPO <8 hours, which is contrary to many suggested guidelines. Strict adherence to NPO guidelines in ED procedural sedation patients may not be necessary.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"200-209"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use and Outcomes of Sugammadex for Neurological Examination after Neuromuscular Blockade in the Emergency Department.","authors":"Stephen D Hallisey, Christiana K Prucnal, Annette M Ilg, Raghu R Seethala, Paul S Jansson","doi":"10.5811/westjem.29328","DOIUrl":"10.5811/westjem.29328","url":null,"abstract":"<p><strong>Introduction: </strong>Non-depolarizing agents such as rocuronium and vecuronium are frequently used in the emergency department (ED) to facilitate intubation but may lead to delay in neurologic examination and intervention. Sugammadex is used for reversal of neuromuscular blockade by non-depolarizing agents but its role in the reversal of neuromuscular blockade for neurologic examination in the ED is poorly defined.</p><p><strong>Methods: </strong>This was a multicenter cohort study using retrospective chart review. We reviewed all ED encounters from June 21, 2016-February 9, 2024 of the electronic health record of Mass General Brigham, a large multistate health system, and abstracted all ED administrations of sugammadex to facilitate neurologic examination. We calculated descriptive statistics and assessed outcomes.</p><p><strong>Results: </strong>In 3,080,338 ED visits during the study period, 48 patients received sugammadex to facilitate neurologic examination. Of those patients, 23 (47.9%) underwent a procedure within 24 hours. Three (6.3%) had bradycardia, and one (2.1%) had hypotension following sugammadex administration. A total of 23 patients (47.9%) ultimately died during their admission, and 24 (50%) died within 30 days.</p><p><strong>Conclusion: </strong>Patients who received sugammadex in the ED to facilitate neurologic examination during the study period had rare associated adverse effects, high rates of procedures within 24 hours of administration, and significant in-hospital mortality. Prospective data is needed to assess the impact of sugammadex on decision-making.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"347-352"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Reliable, Valid Procedural Checklist for Assessment of Emergency Medicine Resident Performance of Emergency Cricothyrotomy.","authors":"Dana E Loke, Andrew M Rogers, Morgan L McCarthy, Maren K Leibowitz, Elizabeth T Stulpin, David H Salzman","doi":"10.5811/westjem.20365","DOIUrl":"10.5811/westjem.20365","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency cricothyrotomy is a rare but potentially life-saving procedure performed by emergency physicians. A comprehensive, dichotomous procedural checklist for emergency cricothyrotomy for emergency medicine (EM) resident education does not exist.</p><p><strong>Objectives: </strong>We aimed to develop a checklist containing the critical steps for performing an open emergency cricothyrotomy, to assess performance of EM residents performing an open emergency cricothyrotomy using the checklist on a simulator, and to evaluate the reliability and validity of the checklist for performing the procedure.</p><p><strong>Curricular design: </strong>We developed a preliminary checklist based on literature review and sent it to experts in EM and trauma surgery. A modified Delphi approach was used to revise the checklist and reach consensus on a final version of the checklist. To assess usability of the checklist, we assessed EM residents using a cricothyrotomy task trainer. Scores were determined by the number of correctly performed items. We calculated inter-rater reliability using the Cohen kappa coefficient. Validity was assessed using the Welch <i>t</i>-test to compare the performance of residents who had and had not performed an open emergency cricothyrotomy, and we used analysis of variance to compare performance of postgraduate year (PGY) cohorts.</p><p><strong>Impact/effectiveness: </strong>The final 27-item checklist was developed after three rounds of revisions. Inter-rater reliability was strong overall (κ = 0.812) with individual checklist items ranging from slight to nearly perfect agreement. A total of 56 residents participated, with an average score of 14.3 (52.9%). Performance varied significantly among PGY groups (<i>P</i> < 0.001). Residents who had performed an emergency cricothyrotomy previously performed significantly better than those who had not <i>(P</i> = 0.005). The developed checklist, which can be used in procedural training for open emergency cricothyrotomy, suggests that improved training approaches to teaching and assessing emergency cricothyrotomy are needed given the overall poor performance of this cohort.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"279-284"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}