Western Journal of Emergency Medicine最新文献

{"title":"Introducing the Climate Change Special Issue.","authors":"Gary Gaddis, Shahram Lotfipour","doi":"10.5811/westjem.66424","DOIUrl":"https://doi.org/10.5811/westjem.66424","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1116-1117"},"PeriodicalIF":2.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient vs. Companion Satisfaction in the Emergency Department: Cross-sectional, Telephone-Based Survey.","authors":"Abdo Mghames, Louisa Maria Alam, Hani Tamim, Yara Abou Harb, Eveline Hitti","doi":"10.5811/westjem.47351","DOIUrl":"https://doi.org/10.5811/westjem.47351","url":null,"abstract":"<p><strong>Introduction: </strong>In Lebanon, it is common for multiple family members to accompany patients to the ED. In this cultural context, where family is closely involved with patient care, we sought to identify and compare factors associated with satisfaction among patients and their companions during the same emergency department (ED) visit.</p><p><strong>Methods: </strong>This cross-sectional, telephone-based survey compared factors associated with satisfaction among adult patients and their companions, during the same ED visit, at a tertiary-care center in Beirut, Lebanon. Adult patients presenting to the ED with intermediate- or low-acuity complaints were included in the study. We administered a questionnaire to patients and their companions covering six domains, including demographics, general admission, nursing and medical teams, discharge process, and overall satisfaction. Satisfaction was then categorized into high and low. We conducted an analysis of variables associated with high overall satisfaction for each group.</p><p><strong>Results: </strong>A total of 100 patients and 100 companions completed the survey, with a 45.7% response rate. Among companions, the top three factors associated with high overall satisfaction were: respect of confidentiality and privacy (odds ratio 12.98, 95% CI, 4.79-35.19), length of stay before being seen by triage nurse (9.77, 3.68-25.89), and overall ED length of stay (9.56, 3.7-24.37). Among patients, the top three factors associated with high overall satisfaction were: amount of time the physician spent with the patient (20.26, 7.10-57.82); overall ED length of stay (19.71, 5.44-71.39), and length of stay before being seen by the emergency physician team (13.26, 4.84-36.35). All variables were statistically significant for both patients and companions except for the discharge process, which was only significant for companions.</p><p><strong>Conclusion: </strong>This study suggests that patients and companions may have different experiences of their ED visit, highlighting the top factors associated with satisfaction for each group. Emergency department efforts aimed at enhancing patient experience should also consider processes related to companion experience in cultural contexts where family/relatives play an integral role in patient care.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1172-1179"},"PeriodicalIF":2.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher Intensity Quality Improvement Campaign Yields Greater Reduction in Medical Glove Use: The \"Gloves Off!\" Campaign.","authors":"Lai Heng Foong, Matthew Knox, Arunima Malik, Wendy Hird","doi":"10.5811/westjem.56980","DOIUrl":"https://doi.org/10.5811/westjem.56980","url":null,"abstract":"<p><strong>Introduction: </strong>The healthcare sector contributes 5.4-7.0% of Australia's total carbon dioxide (CO2) emissions. Among the most ubiquitous items used in healthcare organisations, whether it be hospital, clinic, or community health centres, are gloves.</p><p><strong>Methods: </strong>We reviewed two case studies of the \"Gloves Off!\" sustainability initiative to compare reduction in glove use and improvement in hand hygiene practice-one that featured a \"low-intensity\" campaign (Hospital A) and the other a \"high-intensity\" campaign (Hospital B).</p><p><strong>Results: </strong>A comparison of glove use over the year before and after implementation of the Gloves Off! campaign shows that Hospital A achieved a 2.6% reduction (0.4% reduction per patient), while Hospital B achieved an 11.4% reduction in total glove consumption (7.8% reduction in glove use per patient).</p><p><strong>Conclusion: </strong>Sustainability initiatives can be initiated within busy emergency departments with reduced unnecessary use of nonsterile gloves, decreased CO2 emissions, and cost savings.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1167-1171"},"PeriodicalIF":2.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Comparison of the Pericapsular Nerve Group Block Versus the Fascia Iliaca Block for Hip Fractures in the Emergency Department.","authors":"Theresa Kim, Vahe Martikian, Soheil Saadat, Michael Hetzel, Matthew Whited, Ami Kurzweil","doi":"10.5811/westjem.53940","DOIUrl":"https://doi.org/10.5811/westjem.53940","url":null,"abstract":"<p><strong>Introduction: </strong>Hip fractures are a common injury among the elderly and a substantial cause of morbidity and mortality worldwide. Pain management is an essential component of care for patients with hip fractures, particularly for improving patient outcomes. Ultrasound-guided nerve blocks such as the fascia iliaca block (FIB) are evidence-based means of providing perioperative analgesia and reducing opioid use. Newer nerve blocks, such as the pericapsular nerve group (PENG) block, may serve as alternatives to the FIB. The objective of this study was to retrospectively compare pain reduction following the PENG block and FIB in patients with hip fractures treated in our emergency department. Secondary objectives included block-related complications such as local anesthetic systemic toxicity (LAST), greater hospital length of stay, and increase in mortality.</p><p><strong>Methods: </strong>The primary outcome measure was to investigate whether the PENG block is an effective alternative to FIB in achieving analgesia. Secondary objectives include data on rates of LAST, block complications, hospital length of stay, and mortality. We conducted a retrospective chart review on adult patients (≥18 years) with hip fractures who received either a FIB or PENG block between June 2021 and June 2023. Among the participants, pain scores (0-10 scale) were recorded before and after the block. Opioid use 24 hours postblock was also documented. We used generalized estimating equation modeling to compare pre-to-post block pain reduction between the FIB and PENG block groups.</p><p><strong>Results: </strong>A total of 88 participants met inclusion criteria (73 FIB, 15 PENG). The mean (SD) preblock pain scores were 6.5 (2.1) for FIB and 7.9 (1.6) for PENG, improving to 4.4 (2.0) and 4.3 (2.1) postblock, respectively. Generalized estimating equation analysis revealed a statistically significant greater reduction in pain for the PENG group compared to FIB (mean difference = 1.42; 95% CI, 0.21-2.63; P = .02). In this study, there were no cases of local anesthetic systemic toxicity or other block-related complications observed (0%; 95% CI, 0%-3.4%).</p><p><strong>Conclusion: </strong>Patients who received the PENG block achieved a greater reduction in pain scores compared to the FIB in this small retrospective cohort study. These findings suggest that the PENG block may be an effective alternative to FIB for analgesia in this setting. However, larger, prospective studies are needed to confirm these results. Given the study design and baseline differences in pain scores, these findings should be interpreted with caution.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1485-1489"},"PeriodicalIF":2.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Headache Management and Emergency Department Throughput: A Multicenter Retrospective Analysis.","authors":"Aimen Vanood, Billy J Evans, Samantha J Brown, Nicole R Hodgson, Thom Maciulewicz, Anthony Laine Green, Wayne A Martini","doi":"10.5811/westjem.61415","DOIUrl":"https://doi.org/10.5811/westjem.61415","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Headache is a common presentation to the emergency department (ED), requiring both accurate diagnosis and efficient management. Although consensus guidelines exist, real-world treatment practices and their associations with operational outcomes remain variable. We evaluated the association between acute headache management strategies-including medications, diagnostic imaging, and consultations-and ED length of stay (LOS), using both unadjusted and multivariable-adjusted analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a multicenter retrospective observational study using data from 79,527 adult ED encounters for headache across 22 EDs in the southwestern and upper Midwestern United States between 2018 and 2024. The primary outcome was ED LOS. Secondary outcomes included LOS differences associated with medication classes, imaging modalities, procedures, and specialty consultations. Length of stay differences by treatment strategy were compared using Mann-Whitney U testing. We performed multivariable linear regression and quantile regression (median) adjusting for age, sex, Emergency Severity Index level, disposition, imaging, procedures, consultations, site, and year. Encounters were classified by headache type (primary, secondary, or unspecified) using discharge diagnosis codes, and stratified analyses were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Primary headache encounters comprised 19.4% of the cohort (n = 15,413), secondary headache 14.0% (n = 11,147), and unspecified headache 66.6% (n = 52,967). The overall median LOS was 183 minutes (interquartile range [IQR], 119-276). In unadjusted analyses, nonsteroidal anti-inflammatory drug (NSAID) (median 180 vs 185 minutes; P = .42) and triptan administration (177 vs 183 minutes; P = .49) were not associated with longer LOS. In contrast, antiseizure medications (+136 minutes; P &lt; .001), intravenous magnesium (+101 minutes; P &lt; .001), opioids (+89 minutes; P &lt; .001), and benzodiazepines (+72 minutes; P &lt; .001) were associated with the longest LOS. In multivariable-adjusted analysis (R&lt;sup&gt;2&lt;/sup&gt; = .40), antiseizure medications (adjusted coefficient +85.1 min; 95% CI, 76.0-94.3), admission (+71.1 minutes; 95% CI, 68.3-73.8), and magnetic resonance imaging (+125.9 minutes; 95% CI, 119.8-131.9) were most strongly associated with longer LOS. Stratified analyses showed primary headaches had shorter median LOS (153 minutes; IQR, 105-224) than secondary (204 minutes; IQR, 126-317) or unspecified headaches (189 minutes; IQR, 123-282), with consistent medication-LOS associations across subgroups (Kruskal-Wallis H = 1,476.85, P &lt; .001; all pairwise comparisons P &lt; .001 after Bonferroni correction).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this multicenter retrospective study, most pharmacologic and diagnostic interventions-aside from NSAIDs and triptans-were associated with longer ED LOS, even after adjusting for patient and clinical covariates. These associations likely r","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1436-1446"},"PeriodicalIF":2.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Financial Value of Cardiac Point-of-Care Ultrasound During Traumatic Cardiac Arrest.","authors":"Donias Doko, Zachary Boivin, Kevin M Duignan, Nishant Merchant, Trent She","doi":"10.5811/westjem.61896","DOIUrl":"https://doi.org/10.5811/westjem.61896","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic cardiac arrest is associated with poor survival and significant consumption of hospital resources. Determining which patients have survivable injuries allows for judicious use of resources. Our aim was to determine whether cardiac activity on point-of-care ultrasound (POCUS) during traumatic cardiac arrest was associated with increased patient survival and the charges of continued resuscitation in patients that do have cardiac activity on POCUS.</p><p><strong>Methods: </strong>We conducted this single-center retrospective study at an urban, Level I trauma center of consecutive patients arriving in traumatic cardiac arrest from August 2016-December 2023 who had a cardiac POCUS performed during the initial resuscitation efforts. Our primary outcome was to determine whether cardiac activity on POCUS during the arrest was associated with increased patient survival to neurologically intact hospital discharge. Secondary objectives included determining whether there was a correlation between cardiac activity on POCUS during traumatic cardiac arrest and survival to hospital admission. Additionally, we evaluated hospital charges and length of stay associated with continued resuscitation in patients who demonstrated cardiac activity on ultrasound.</p><p><strong>Results: </strong>We identified 134 patients in traumatic cardiac arrest, of whom 74 (55.2%) had a cardiac POCUS performed and met inclusion criteria. A total of 17 patients had cardiac activity noted on the initial POCUS, with two (11%) surviving to hospital discharge (95% CI, 1.3-39.7). The two survivors initially categorized as being in traumatic cardiac arrest were ultimately found to have medical etiologies and not trauma. Of the 57 patients who had no cardiac activity noted on POCUS, none survived to hospital discharge (95% CI, 0-6.3%). More patients survived to hospital admission who had cardiac activity on their initial POCUS compared with those who had no cardiac activity (odds ratio [OR], 49.8; 95% CI, 5.5-446.9; P < .001). More patients survived to hospital discharge as well, but this was not statistically significant (OR, 18.6; 95% CI, 0.84-406.7, P = .06). Traumatic cardiac arrest patients who had present cardiac activity had longer code times prior to terminating efforts (26.6 vs 7.7 minutes, P < .001) and had higher overall charges per patient ($91,321 vs $10,032), P < .001).</p><p><strong>Conclusion: </strong>The absence of cardiac activity on POCUS in patients with traumatic cardiac activity is likely to be fatal. The presence of cardiac activity was associated with increased resuscitation times, charges, and survival to hospital admission but not necessarily to hospital discharge.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1280-1289"},"PeriodicalIF":2.3,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Street Medicine on Emergency Department Use: A Three-Year Evaluation of People Experiencing Homelessness.","authors":"Savannah Vetterly, Amy Wozniak, Theresa Nguyen","doi":"10.5811/westjem.63074","DOIUrl":"https://doi.org/10.5811/westjem.63074","url":null,"abstract":"<p><strong>Introduction: </strong>People experiencing homelessness (PEH) frequently utilize the emergency department (ED) for acute and primary healthcare needs. Loyola Street Medicine is a multidisciplinary team comprised of physicians, students, and other professionals who provide weekly healthcare services to PEH at a train station in Chicago. The objective of the study was to identify the specific patient demographics, chief complaints, and clinical interventions associated with increased odds of these patients reporting that they would have sought care at an ED had Loyola Street Medicine been unavailable.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients seen by Loyola Street Medicine between September 2021 and September 2024, with 2,121 total encounters and a subset of 1,565 with identifying data. The primary outcome measure was whether the patient reported they would have gone to the ED for care, and the secondary outcome measures were patient demographics, chief complaints, and interventions provided. We estimated odds ratios with univariable logistic regression mixed models, with random intercept accounting for multiple patient visits in the subset of patients with identifiers.</p><p><strong>Results: </strong>For 63% of all encounters (N = 1,293), people experiencing homelessness indicated they would have gone to the ED without street medicine, with the most common demographics including Black race (77%), male sex (80%), and a mean age of 46.7 years. Among patients who indicated they would have gone to the ED, the most prevalent chief complaints were wound check (22%), musculoskeletal issues (17%), and podiatry concerns (14%). Black and \"other\" race patients had decreased odds of indicating they would have gone to the ED compared to White patients (0.69 [95% CI, 0.49-0.97], P = .03 and 0.39 [95% CI, 0.22-0.69], P = .001, respectively). Patients with wound-related complaints and those needing wound care as an intervention had greater odds of indicating they would go to the ED versus any other location such as a clinic or a primary care physician (1.46 [95% CI, 1.07-1.99], P = .02 and 1.5 [95% CI, 1.11-2.03], P = .009, respectively).</p><p><strong>Conclusion: </strong>The findings demonstrate that street medicine can play a vital role in addressing the complex needs of people experiencing homelessness. By providing consistent, low-barrier care, street medicine has the potential to reduce nonemergent ED use and improve continuity of care.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1457-1466"},"PeriodicalIF":2.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Live Preferential Music on Pain in the Emergency Care Setting: A Randomized Controlled Trial.","authors":"Jill Sonke, Marie-Carmelle Elie, Diana J Wilkie, Henry W Young, Muhammad Abdul 'Baker' Chowdhury, Meenakshi Puthucode Balakrishnan, Cindy Montero, Joseph Adrian Tyndall","doi":"10.5811/westjem.61331","DOIUrl":"https://doi.org/10.5811/westjem.61331","url":null,"abstract":"<p><strong>Introduction: </strong>Pain is the most prevalent complaint for the more than 155 million patients accessing emergency care in the United States. Appropriate and timely management of pain is a measure of quality emergency care. However, the opioid crisis has created a need for multimodal and alternative approaches to successful pain management. Models for integrating such approaches in emergency departments (ED) are understudied. Therefore, we chose to investigate the impact of live preferential music (LPM) in the management of acute musculoskeletal pain.</p><p><strong>Methods: </strong>This prospective, randomized, double-blind intervention study was designed with block randomization clustered by day of the week to live preferred music versus usual care. To ensure blinding, patients were deceived that the study focus was on pain assessment without disclosure that there was an intervention. A total of 2,262 patients were screened, and 272 patients (94 interventions, 128 usual care controls, and 50 declined-music intervention) were recruited from two free-standing EDs. All subjects received analgesics per prescription, had vital signs measured, and completed baseline and follow-up Pain Intensity Number Scale (0-10) scores via PAINReportIt. We calculated morphine equivalents for pain medications in the ED.</p><p><strong>Results: </strong>The mean age of the 222 patients in the per-protocol analytic sample was 48.3 years (95% confidence interval, 45.9-50.7); 64% were female, 29% Black; and their triage acuity was 4% emergent Emergency Severity Index (ESI) 2, 52% urgent ESI 3, and 44% less urgent ESI 4. There were absolute reductions in current pain intensity from baseline in both the control (-1.21) and intervention (-1.34) groups (difference -0.14, 95% CI, -0.48 to 0.76). However, the difference was not significant in posttest pain intensity when controlling for baseline pain intensity (P = .29). Qualitative analysis reflected patient-reported reduction in the perception of pain as a common theme. Vital signs and morphine equivalents were similar between groups.</p><p><strong>Conclusion: </strong>This study demonstrated that live preferential music interventions are feasible to study rigorously in the ED. Patients were enrolled using deception and were not informed of the study's focus on music or their potential exposure to music. However, they were told initially that they would be part of a pain assessment study. Although significant between-group differences were not observed, the general theme of patient-reported reduction in the perception of pain suggests that a more highly powered study might detect significant effects in pain reduction with LPM. Variation in clinician care strategies and evolving federal guidelines for pain management may have influenced study processes and outcomes.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1189-1198"},"PeriodicalIF":2.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic Effects of Interfacility Dexmedetomidine Infusions During Transport of Patients with Alpha-2-adrenergic Agonist Withdrawal.","authors":"Scott Goldstein, Nathaniel Zahustecher, Derek Isenberg, Eric Rosen, Celine Bennett","doi":"10.5811/westjem.62953","DOIUrl":"https://doi.org/10.5811/westjem.62953","url":null,"abstract":"<p><strong>Background: </strong>In the Philadelphia region, there has been an increase in the potency of illicit opioids as well as the addition of nonopioid adulterants. Currently, medetomidine, a veterinary anesthetic that acts as an alpha-2-adrenergic agonist, is a common adulterant in the illicit opioid supply, causing both unique overdose and withdrawal syndromes. Although opioid withdrawal alone is not deadly, with added adulterants, especially medetomidine, this is no longer the case. Dexmedetomidine is an alpha-2-adrenergic agonist frequently used for sedation in the emergency department and intensive care unit. Dexmedetomidine is also used off-label to treat the life-threatening withdrawal from alpha-2-agonists.</p><p><strong>Objective: </strong>This study describes the dosing and hemodynamic effects associated with the interfacility administration of dexmedetomidine in patients with alpha-2 adrenergic agonist withdrawal. Secondarily, we describe the safety of dexmedetomidine in this patient population.</p><p><strong>Methods: </strong>We conducted a retrospective case review of patients receiving dexmedetomidine infusions in the interfacility setting for presumed alpha-2-adrenergic agonist withdrawal. Demographic data, dosing, and vital signs were analyzed descriptively.</p><p><strong>Results: </strong>Over a six-month period, of 217 cases identified, 182 contained complete hemodynamic data. The average age was 39.5 years, and 67% were male. The average transport time was 15.7 minutes (range, 5-40 minutes). The mean dexmedetomidine infusion rate was 1.32 (0.31) mcg/kg/hr. The average mean arterial pressure decreased from 122.1 mm Hg (21.7) at the time of initial patient contact to 118.3 mm Hg (21.7) (mean difference, 3.80; 95% CI, 1.96-5.64) at final patient interaction. Heart rate also showed a minimal change from 104.9 (23.7) to 103.6 (21.8) beats/min (mean 1.3; 95% CI, -0.48 to 3.08). No cases of severe hypotension or clinically significant bradycardia requiring intervention were documented (one-sided 95% CI, 0-1.7%).</p><p><strong>Conclusion: </strong>In this case series of patients, prehospital dexmedetomidine infusions to treat alpha-2-agonist withdrawal were associated with stable hemodynamics without significant bradycardia or hypotension. These findings support the safety of dexmedetomidine infusions for interfacility transport and provide a rationale for examining whether advanced life support clinicians can safely transport patients receiving dexmedetomidine infusions for this indication.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1327-1330"},"PeriodicalIF":2.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurse and Physician Stakeholder Guidance on Improving Sexually Transmitted Infection Care in a Pediatric Emergency Department.","authors":"Roland C Merchant, Daniela Ramirez-Castillo, Arlet Capeta Romero, Rachel Solnick, Patricia Mae Martinez, Christopher Strother, Melissa A Clark","doi":"10.5811/westjem.61866","DOIUrl":"https://doi.org/10.5811/westjem.61866","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric emergency departments (PEDs) and general EDs in the United States (U.S.) do not consistently deliver sexually transmitted infection (STI) care that aligns with clinical guidelines. To inform the development of an implementation strategy plan aimed to improve STI care in a PED, we interviewed PED nurse and physician stakeholders to identify challenges and corresponding potential solutions aimed to improve STI care in a PED.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with 27 stakeholders consisting of emergency medicine (EM) residents, pediatrics residents, pediatric EM (PEM) fellows, attending pediatric emergency physicians, and PED nurses at an academic urban PED. Using the Tailored Implementation in Chronic Diseases (TICD) framework, we prepared semi-structured interview guides specific to stakeholder roles structured according to the usual six successive workflow stages of STI care in the PED (triage, history-taking, physical examination, testing, treatment, and follow-up). Questions concerned current practices on providing STI care, challenges encountered, and potential solutions. Interviews were transcribed and analyzed using rapid content analysis. Responses were coded independently by two reviewers and categorized by TICD determinant domain.</p><p><strong>Results: </strong>Participants identified multilevel implementation challenges across the stages of STI care in the PED. Structural challenges included lack of privacy and limited private exam rooms, inadequate STI-related workflows, and inadequate waiting areas. Procedural challenges included the following: nonstandardized triage protocols; unclear role delineation; confusing sample collection procedures; insufficient training in STI examination, testing, and treatment procedures; variable documentation practices; and difficulty ensuring follow-up. Suggested solutions included development of role-specific STI protocols, smart phrases for documentation, improved sample-labeling procedures, prepackaged medications for empiric treatment, and embedded referral pathways to an adolescent care clinic.</p><p><strong>Conclusion: </strong>Using the TICD framework, this study identified key challenges, such as gaps in training, protocols and transition of care, and corresponding stakeholder-informed solutions to improve adolescent care for STIs in a pediatric ED setting. These findings can guide efforts to implement evidence-based STI practice guidelines in PEDs and general EDs.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1305-1316"},"PeriodicalIF":2.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}