Western Journal of Emergency Medicine最新文献

{"title":"Compartment Syndrome Following Snake Envenomation in the United States: A Scoping Review of the Clinical Literature.","authors":"John Newman, Colin Therriault, Mia S White, Daniel Nogee, Joseph E Carpenter","doi":"10.5811/westjem.18401","DOIUrl":"10.5811/westjem.18401","url":null,"abstract":"<p><strong>Introduction: </strong>Local tissue destruction following envenomation from North American snakes, particularly those within the Crotalinae subfamily, has the potential to progress to compartment syndrome. The pathophysiology of venom-induced compartment syndrome (VICS) is a debated topic and is distinct from trauma/reperfusion-induced compartment syndrome. Heterogeneity exists in the treatment practices of VICS, particularly regarding the decision to progress to fasciotomy. Associations with functional outcomes and evolution in clinical practice since the introduction of Crotalidae polyvalent immune Fab (FabAV) have not been well defined. Our goal was to identify the potential gaps in the literature regarding this phenomenon, as well as illuminate salient themes in the clinical characteristics and treatment practices of VICS.</p><p><strong>Methods: </strong>We conducted this systematic scoping-style review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Records were included if they contained data surrounding the envenomation and hospital course of one or more patients who were envenomated by a snake species native to North America and were diagnosed with compartment syndrome from 1980-2020.</p><p><strong>Results: </strong>We included 19 papers: 10 single- or two-patient case reports encompassing 12 patients, and nine chart reviews providing summary statistics of the included patients. In case reports, the median compartment pressure when reported was 60 millimeters of mercury (interquartile range 55-68), 66% underwent fasciotomy, and functional outcomes varied. Use of antivenom appeared to be more liberal with FabAV than the earlier antivenin Crotalidae polyvalent. Rapid progression of swelling was the most commonly reported symptom. Among the included retrospective chart reviews, important data such as compartment pressures, consistent laboratory values, and snake species was inconsistently reported.</p><p><strong>Conclusions: </strong>Venom-induced compartment syndrome is relatively rare. Existing papers generally describe good outcomes even in the absence of surgical management. Significant gaps in the literature regarding antivenom dosing practices, serial compartment pressure measurements, and functional outcomes highlight the need for prospective studies and consistent standardized reporting.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 4","pages":"651-660"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724527","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":"Variability in Practice of Buprenorphine Treatment by Emergency Department Operational Characteristics.","authors":"Grant Comstock, Natalia Truszczynski, Sean S Michael, Jason Hoppe","doi":"10.5811/westjem.18019","DOIUrl":"10.5811/westjem.18019","url":null,"abstract":"<p><strong>Introduction: </strong>We sought to describe emergency department (ED) buprenorphine treatment variability among EDs with varying operational characteristics.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of adult patients with opioid use disorder discharged from 12 hospital-based EDs within a large healthcare system as a secondary data analysis of a quality improvement study. Primary outcome of interest was buprenorphine treatment rate. We described treatment rates between EDs, categorized by tertile of operational characteristics including annual census, hospital and intensive care unit (ICU) admission rates, ED length of stay (LOS), and boarding time. Secondary outcomes were ED LOS and 30-day return rates.</p><p><strong>Results: </strong>There were 7,469 unique ED encounters for patients with opioid use disorder between January 2020-May 2021, of whom 759 (10.2%) were treated with buprenorphine. Buprenorphine treatment rates were higher in larger EDs and those with higher hospital and ICU admission rates. Emergency department LOS and 30-day ED return rate did not have consistent associations with buprenorphine treatment.</p><p><strong>Conclusion: </strong>Rates of treatment with ED buprenorphine vary according to the operational characteristics of department. We did not observe a consistent negative relationship between buprenorphine treatment and operational metrics, as many feared. Additional funding and targeted resource allocation should be prioritized by departmental leaders to improve access to this evidence-based and life-saving intervention.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 4","pages":"483-489"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724546","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":"A Measure of the Impact on Real-Time Patient Care of Evidence-based Medicine Logs.","authors":"Jeffrey B Brown, Ajay K Varadhan, Jacob R Albers, Shreyas Kudrimoti, Estelle Cervantes, Phillip Sgobba, Dawn M Yenser, Bryan G Kane","doi":"10.5811/westjem.18082","DOIUrl":"10.5811/westjem.18082","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence-based medicine (EBM) is a critical skill for physicians, and EBM competency has been shown to increase implementation of best medical practices, reduce medical errors, and increase patient-centered care. Like any skill, EBM must be practiced, receiving iterative feedback to improve learners' comprehension. Having residents document patient interactions in logbooks to allow for residency program review, feedback, and documentation of competency has been previously described as a best practice within emergency medicine (EM) to document practice-based learning (PBL) competency. Quantifying how residents use the information they query, locate, evaluate, and apply while providing direct patient care can measure the efficacy of EBM education and provide insight into more efficient ways of providing medical care.</p><p><strong>Methods: </strong>Practice-based learning logs were surveys created to record resident EBM activity on-shift and were placed into our residency management software program. Residents were required to submit 3-5 surveys of EBM activity performed during a 28-day rotation during which additional information was sought. This study included all PBL logs completed by EM residents from June 1, 2013-May 11, 2020. Using qualitative methodology, a codebook was created to analyze residents' free-text responses to the prompt: \"Based on your research, would you have done anything differently?\" The codebook was designed to generate a three-digit code conveying the effect of the researched information on the patient about whom the log was written, as well as whether the information would affect future patient care and whether these decisions were based on scientific evidence.</p><p><strong>Results: </strong>A total of 10,574 logs were included for primary analysis. In total, 1,977 (18.7%) logs indicated that the evidence acquired through research would affect future patient care. Of these, 392 (3.7%) explicitly stated that the EBM activity conducted as part of our project led to real-time changes in patient care in the ED and would change future management of patients as well.</p><p><strong>Conclusion: </strong>We present a proof of concept that PBL log activity can lead to integration of evidence-based medicine into real-time patient care. While a convenience sample, our cohort recorded evidence of both lifelong learning and application to patient care.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 4","pages":"565-573"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724590","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":"End-tidal Carbon Dioxide Trajectory-based Prognostication of Out-of-hospital Cardiac Arrest.","authors":"Chih-Hung Wang, Tsung-Chien Lu, Joyce Tay, Cheng-Yi Wu, Meng-Che Wu, Chun-Yen Huang, Chu-Lin Tsai, Chien-Hua Huang, Matthew Huei-Ming Ma, Wen-Jone Chen","doi":"10.5811/westjem.18403","DOIUrl":"10.5811/westjem.18403","url":null,"abstract":"<p><strong>Background: </strong>During cardiopulmonary resuscitation (CPR), end-tidal carbon dioxide (EtCO₂) is primarily determined by pulmonary blood flow, thereby reflecting the blood flow generated by CPR. We aimed to develop an EtCO₂ trajectory-based prediction model for prognostication at specific time points during CPR in patients with out-of-hospital cardiac arrest (OHCA).</p><p><strong>Methods: </strong>We screened patients receiving CPR between 2015-2021 from a prospectively collected database of a tertiary-care medical center. The primary outcome was survival to hospital discharge. We used group-based trajectory modeling to identify the EtCO₂ trajectories. Multivariable logistic regression analysis was used for model development and internally validated using bootstrapping. We assessed performance of the model using the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>The primary analysis included 542 patients with a median age of 68.0 years. Three distinct EtCO₂ trajectories were identified in patients resuscitated for 20 minutes (min): low (average EtCO₂ 10.0 millimeters of mercury [mm Hg]; intermediate (average EtCO₂ 26.5 mm Hg); and high (average EtCO₂: 51.5 mm Hg). Twenty-min EtCO₂ trajectory was fitted as an ordinal variable (low, intermediate, and high) and positively associated with survival (odds ratio 2.25, 95% confidence interval [CI] 1.07-4.74). When the 20-min EtCO₂ trajectory was combined with other variables, including arrest location and arrest rhythms, the AUC of the 20-min prediction model for survival was 0.89 (95% CI 0.86-0.92). All predictors in the 20-min model remained statistically significant after bootstrapping.</p><p><strong>Conclusion: </strong>Time-specific EtCO₂ trajectory was a significant predictor of OHCA outcomes, which could be combined with other baseline variables for intra-arrest prognostication. For this purpose, the 20-min survival model achieved excellent discriminative performance in predicting survival to hospital discharge.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 4","pages":"521-532"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724528","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":"Rural and Ethnic Disparities in Out-of-hospital Care and Transport Pathways After Road Traffic Trauma in New Zealand.","authors":"Rebbecca Lilley, Gabrielle Davie, Bridget Dicker, Papaarangi Reid, Shanthi Ameratunga, Charles Branas, Nicola Campbell, Ian Civil, Bridget Kool","doi":"10.5811/westjem.18366","DOIUrl":"10.5811/westjem.18366","url":null,"abstract":"<p><strong>Introduction: </strong>The out-of-hospital emergency medical service (EMS) care responses and the transport pathways to hospital play a vital role in patient survival following injury and are the first component of a well-functioning, optimised system of trauma care. Despite longstanding challenges in delivering equitable healthcare services in the health system of Aotearoa-New Zealand (NZ), little is known about inequities in EMS-delivered care and transport pathways to hospital-level care.</p><p><strong>Methods: </strong>This population-level cohort study on out-of-hospital care, based on national EMS data, included trauma patients <85 years in age who were injured in a road traffic crash (RTC). In this study we examined the combined relationship between ethnicity and geographical location of injury in EMS out-of-hospital care and transport pathways following RTCs in Aotearoa-NZ. Analyses were stratified by geographical location of injury (rural and urban) and combined ethnicity-geographical location (rural Māori, rural non-Māori, urban Māori, and urban non-Māori).</p><p><strong>Results: </strong>In a two-year period, there were 746 eligible patients; of these, 692 were transported to hospital. Indigenous Māori comprised 28% (196) of vehicle occupants attended by EMS, while 47% (324) of patients' injuries occurred in a rural location. The EMS transport pathways to hospital for rural patients were slower to reach first hospital (total in slowest tertile of time 44% vs 7%, <i>P</i> ≥ 0.001) and longer to reach definitive care (direct transport, 77% vs 87%, <i>P</i> = 0.001) compared to urban patients. Māori patients injured in a rural location were comparatively less likely than rural non-Māori to be triaged to priority transport pathways (fastest dispatch triage, 92% vs 97%, respectively, <i>P</i> = 0.05); slower to reach first hospital (total in slowest tertile of time, 55% vs 41%, <i>P</i> = 0.02); and had less access to specialist trauma care (reached tertiary trauma hospital, 51% vs 73%, <i>P</i> = 0.02).</p><p><strong>Conclusion: </strong>Among RTC patients attended and transported by EMS in NZ, there was variability in out-of-hospital EMS transport pathways through to specialist trauma care, strongly patterned by location of incident and ethnicity. These findings, mirroring other health disparities for Māori, provide an equity-focused evidence base to guide clinical and policy decision makers to optimize the delivery of EMS care and reduce disparities associated with out-of-hospital EMS care.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 4","pages":"602-613"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724545","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":"What the <i>Fika</i>? Implementation of Swedish Coffee Breaks During Emergency Medicine Conference.","authors":"Jesse Zane Kellar, Hanna Barrett, Jaclyn Floyd, Michelle Kim, Matthias Barden, Jason An, Ashley Garispe, Matthew Hysell","doi":"10.5811/westjem.18462","DOIUrl":"10.5811/westjem.18462","url":null,"abstract":"<p><strong>Introduction: </strong>In this study we aimed to investigate the effects of incorporating Swedish-style <i>fika</i> (coffee) breaks into the didactic schedule of emergency medicine residents on their sleepiness levels during didactic sessions. Fika is a Swedish tradition that involves a deliberate decision to take a break during the workday and usually involves pastries and coffee. We used the Karolinska Sleepiness Scale to assess changes in sleepiness levels before and after the implementation of <i>fika</i> breaks.</p><p><strong>Methods: </strong>The study design involved a randomized crossover trial approach, with data collected from emergency medicine residents over a specific period. This approach was done to minimize confounding and to be statistically efficient.</p><p><strong>Results: </strong>Results revealed the average sleepiness scale was 4.6 and 5.5 on <i>fika</i> and control days, respectively (<i>P</i> = 0.004).</p><p><strong>Conclusion: </strong>Integration of <i>fika</i> breaks positively influenced sleepiness levels, thus potentially enhancing the educational experience during residency didactics.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 4","pages":"574-578"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724547","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":"Bystanders Saving Lives with Naloxone: A Scoping Review on Methods to Estimate Overdose Reversals.","authors":"Andrew T Kinoshita, Soheil Saadat, Bharath Chakravarthy","doi":"10.5811/westjem.18037","DOIUrl":"10.5811/westjem.18037","url":null,"abstract":"<p><strong>Introduction: </strong>People who use drugs in community settings are at risk of a fatal overdose, which can be mitigated by naloxone administered via bystanders. In this study we sought to investigate methods of estimating and tracking opioid overdose reversals by community members with take-home naloxone (THN) to coalesce possible ways of characterizing THN reach with a metric that is useful for guiding both distribution of naloxone and advocacy of its benefits.</p><p><strong>Methods: </strong>We conducted a scoping review of published literature on PubMed on August 15, 2022, using PRISMA-ScR protocol, for articles discussing methods to estimate THN reversals in the community. The following search terms were used: <i>naloxone AND (\"take home\" OR kit OR \"community distribution\" OR \"naloxone distribution\")</i>. We used backwards citation searching to potentially find additional studies. Overdose education and naloxone distribution program-based studies that analyzed only single programs were excluded.</p><p><strong>Results: </strong>The database search captured 614 studies, of which 14 studies were relevant. Backwards citation searching of 765 references did not reveal additional relevant studies. Of the 14 relevant studies, 11 were mathematical models. Ten used Markov models, and one used a system dynamics model. Of the remaining three articles, one was a meta-analysis, and two used spatial analysis. Studies ranged in year of publication from 2013-2022 with mathematical modeling increasing in use over time. Only spatial analysis was used with a focus on characterizing local naloxone use at the level of a specific city.</p><p><strong>Conclusion: </strong>Of existing methods to estimate bystander administration of THN, mathematical models are most common, particularly Markov models. System dynamics modeling, meta-analysis, and spatial analysis have also been used. All methods are heavily dependent upon overdose education and naloxone distribution program data published in the literature or available as ongoing surveillance data. Overall, there is a paucity of literature describing methods of estimation and even fewer with methods applied to a local focus that would allow for more targeted distribution of naloxone.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 4","pages":"500-506"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724526","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":"Improving Healthcare Professionals' Access to Addiction Medicine Education Through VHA Addiction Scholars Program.","authors":"Zahir Basrai, Manuel Celedon, Nathalie Dieujuste, Julianne Himstreet, Jonathan Hoffman, Cassidy Pfaff, Jonie Hsiao, Robert Malstrom, Jason Smith, Michael Radeos, Terri Jorgenson, Melissa Christopher, Comilla Sasson","doi":"10.5811/westjem.17850","DOIUrl":"10.5811/westjem.17850","url":null,"abstract":"<p><strong>Introduction: </strong>The seemingly inexorable rise of opioid-related overdose deaths despite the reduced number of COVID-19 pandemic deaths demands novel responses and partnerships in our public health system's response. Addiction medicine is practiced in a broad range of siloed clinical environments that need to be included in addiction medicine training beyond the traditional fellowship programs. Our objective in this project was to implement a knowledge-based, live virtual training program that would provide clinicians and other healthcare professionals with an overview of addiction, substance use disorders (SUD), and clinical diagnosis and management of opioid use disorder (OUD).</p><p><strong>Methods: </strong>The Veterans Health Administration (VHA) Emergency Department Opioid Safety Initiative (ED OSI) offered a four-day course for healthcare professionals interested in gaining knowledge and practical skills to improve VHA-based SUD care. The course topics centered around the diagnosis and treatment of SUD, with a focus on OUD. Additionally, trainees received six months of support to develop addiction medicine treatment programs. Evaluations of the course were performed immediately after completion of the program and again at the six-month mark to assess its effectiveness.</p><p><strong>Results: </strong>A total of 56 clinicians and other healthcare professionals participated in the Addiction Scholars Program (ASP). The participants represented nine Veteran Integrated Service Networks and 21 different VHA medical facilities. Nearly 70% of participants completed the initial post-survey. Thirty-eight respondents (97.4%) felt the ASP series contained practical examples and useful information that could be applied in their work. Thirty-eight respondents (97.4%) felt the workshop series provided new information or insights into the diagnosis and treatment of SUD. Eleven capstone projects based on the information acquired during the ASP were funded (a total of $407,178). Twenty participants (35.7%) completed the six-month follow-up survey. Notably, 90% of respondents reported increased naloxone prescribing and 50% reported increased prescribing of buprenorphine to treat patients with OUD since completing the course.</p><p><strong>Conclusion: </strong>The ASP provided healthcare professionals with insight into managing SUD and equipped them with practical clinical skills. The students translated the information from the course to develop medication for opioid use disorder (M-OUD) programs at their home institutions.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 4","pages":"465-469"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724530","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":"Perceived Versus Actual Time of Prehospital Intubation by Paramedics.","authors":"Daniel Shou, Matthew Levy, Ruben Troncoso, Becca Scharf, Asa Margolis, Eric Garfinkel","doi":"10.5811/westjem.18400","DOIUrl":"10.5811/westjem.18400","url":null,"abstract":"<p><strong>Introduction: </strong>Situational awareness is essential during emergent procedures such as endotracheal intubation. Previous studies suggest that time distortion can occur during intubation. However, only in-hospital intubations performed by physicians have been studied. We aimed to determine whether time distortion affected paramedics performing intubation by examining the perceived vs actual total laryngoscopy time, defined as time elapsed from the laryngoscope blade entering the mouth until the endotracheal tube balloon passes the vocal cords.</p><p><strong>Methods: </strong>For this retrospective study we collected prehospital intubation data from a suburban, fire department-based emergency medical services (EMS) system from January 5, 2021-May 21, 2022. The perceived total laryngoscopy time was queried as a part of the electronic health record. Video laryngoscopy recordings were reviewed by a panel of experts to determine the actual time. Patients >18 years old who underwent intubation by paramedics with video laryngoscopy were included for analysis. The primary outcome was the difference between actual and perceived total laryngoscopy time. Secondary analysis examined the relationship between high time distortion, defined as the highest quartile of the primary outcome, and patient age, paramedic years of experience, perceived presence of difficult anatomy, excess secretions, use of rapid sequence intubation, and multiple intubation attempts. We conducted descriptive analysis followed by logistic regression analysis, chi-square tests, and Fisher exact tests when appropriate.</p><p><strong>Results: </strong>A total of 122 intubations were collected for analysis, and 10 were excluded due to lack of video recording. Final analysis included 112 intubations. Mean actual laryngoscopy time was 50.0 seconds (s) (95% confidence interval [CI] 43.7-56.3). Mean perceived laryngoscopy time was 27.8 s (95% CI 24.7-31.0). The median difference between actual and perceived time was 18 s (interquartile range 6-30). We calculated high time distortion as having a difference greater than 30 s between actual and perceived laryngoscopy time. None of the secondary variables had statistically significant associations with high time distortion. Overall, we show that the paramedic's perception of total laryngoscopy time is significantly underestimated even when accounting for paramedic experience and perceived airway difficulty.</p><p><strong>Conclusion: </strong>This study suggests that time distortion may lead to an unrecognized prolonged procedure time. Limitations include use of a convenience sample, small sample size, and potential uncollected confounding variables.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 4","pages":"645-650"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724533","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":"Initiation of Buprenorphine in the Emergency Department: A Survey of Emergency Clinicians.","authors":"Ariana Barkley, Laura Lander, Brian Dilcher, Meghan Tuscano","doi":"10.5811/westjem.18029","DOIUrl":"10.5811/westjem.18029","url":null,"abstract":"<p><strong>Introduction: </strong>Initiation of buprenorphine for opioid use disorder (OUD) in the emergency department (ED) is supported by the American College of Emergency Physicians and is shown to be beneficial. This practice, however, is largely underutilized.</p><p><strong>Methods: </strong>To assess emergency clinicians' attitudes and readiness to initiate buprenorphine in the ED we conducted a cross-sectional, electronic survey of clinicians (attendings, residents, and non-physician clinicians) in a single, academic ED of a tertiary-care hospital, which serves a rural population. Our survey aimed to assess emergency clinicians' attitudes toward and readiness to initiate buprenorphine in the ED and identify clinician-perceived facilitators and barriers. Our survey took place after the initiation of the IMPACT (Initiation of Medication, Peer Access, and Connection to Treatment) project.</p><p><strong>Results: </strong>Our results demonstrated the level of agreement that buprenorphine prescribing is within the emergency clinician's scope of practice was inversely correlated to average years in practice (R² = 0.93). X-waivered clinicians indicated feeling more prepared to administer buprenorphine in the ED R² = 0.93. However, they were not more likely to report ordering buprenorphine or naloxone in the ED within the prior three months. Those who reported having a family member or close friend with substance use disorder (SUD) were not more likely to agree buprenorphine initiation is within the clinician's scope of practice (<i>P</i> = 0.91), nor were they more likely to obtain an X-waiver (<i>P</i> = 0.58) or report ordering buprenorphine or naloxone for patients in the ED within the prior three months (<i>P</i> = 0.65, <i>P</i> = 0.77). Clinicians identified availability of pharmacists, inpatient/outpatient referral resources, and support staff (peer recovery support specialists and care managers) as primary facilitators to buprenorphine initiation. Inability to ensure follow-up, lack of knowledge of available resources, and insufficient education/preparedness were primary barriers to ED buprenorphine initiation. Eighty-three percent of clinicians indicated they would be interested in additional education regarding OUD treatment.</p><p><strong>Conclusion: </strong>Our data suggests that newer generations of emergency clinicians may have less hesitancy initiating buprenorphine in the ED. In time, this could mean increased access to treatment for patients with OUD. Understanding clinician-perceived facilitators and barriers to buprenorphine initiation allows for better resource allocation. Clinicians would likely further benefit from additional education regarding medications for opioid use disorder (MOUD), available resources, and follow-up statistics.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 4","pages":"470-476"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724531","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}