Academic Emergency Medicine最新文献

{"title":"Comparison of the incidence of recovery agitation with two different doses of ketamine in procedural sedation: A randomized clinical trial.","authors":"Çağrı Türkücü, İsmet Parlak, Kamil Kokulu, Ekrem T Sert, Hüseyin Mutlu","doi":"10.1111/acem.15116","DOIUrl":"10.1111/acem.15116","url":null,"abstract":"<p><strong>Objectives: </strong>The objective was to compare the incidence of recovery agitation and efficacy of two different intravenous (IV) doses of ketamine (0.5 mg/kg vs. 1 mg/kg) in adult patients who presented to the emergency department (ED) requiring procedural sedation with ketamine.</p><p><strong>Methods: </strong>This randomized, prospective clinical trial included patients aged 18-75 years who required procedural sedation with ketamine in the ED. Patients were randomized to receive IV ketamine at either 0.5 mg/kg (low dose) or 1 mg/kg (high dose). The primary outcome was the incidence of recovery agitation, assessed by the Richmond Agitation-Sedation Scale (RASS) at 5, 15, and 30 min following the procedure, in both dosage groups. Secondary outcomes included overall efficacy, sedation duration, and changes in vital signs.</p><p><strong>Results: </strong>A total of 108 patients were enrolled in the study, 54 in each group. The median (IQR) RASS scores at 5, 15, and 30 min were -4 (-5 to -4), -1 (-1.3 to 0), and 0 (-1 to 0.5), respectively, in the low-dose group and -4 (-5 to -4), -1 (-3 to 0), and 0 (0 to 0), respectively, in the high-dose group. The incidence of recovery agitation was similar between the low- and high-dose groups (difference 1.9%, 95% confidence interval [CI] -14.8% to 18.4%). No significant difference was observed in sedation duration between the two groups (difference 0%, 95% CI -3.0% to 4.0%). While no additional ketamine was required in the high-dose group, four patients (7.4%) in the low-dose group required an additional half-dose (difference 7.4%, 95% CI -2.3% to 18.7%). Changes in vital signs were similar between the two groups.</p><p><strong>Conclusions: </strong>There was no significant difference in recovery agitation, sedation duration, and changes in vital signs between 0.5 and 1 mg/kg IV ketamine for procedural sedation in the ED.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"857-862"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057626","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":"The use of TENS for the treatment of back pain in the emergency department: A randomized controlled trial.","authors":"Karalynn Otterness, Brian McMahon, Mason Ma, Henry C Thode, Adam J Singer","doi":"10.1111/acem.70013","DOIUrl":"10.1111/acem.70013","url":null,"abstract":"<p><strong>Objective: </strong>Back pain is one of the most common complaints in the emergency department (ED). Since current pharmacological treatments for back pain are often suboptimal, a multimodal approach that includes nonpharmacological modalities has promise to improve pain management. The objective of the current study was to test the hypothesis that transcutaneous electrical nerve stimulation (TENS) would be more effective at relieving back pain than sham TENS.</p><p><strong>Methods: </strong>We conducted a patient- and observer-blinded, randomized controlled trial that included adult (≥18 years) ED patients with lumbar or thoracic back pain of at least moderate pain severity. Participants were randomly assigned (1:1) to TENS or sham TENS. The primary outcome was absolute reduction in pain severity at 30 min after treatment measured with a verbal numeric scale from 0 to 10 (none to worst). A sample of 80 patients had 80% power to detect a 1.5-point between-group difference in pain severity. The trial was registered with ClinicalTrials.gov (NCT04227067).</p><p><strong>Results: </strong>We enrolled 80 subjects (40 to the TENS group, 40 to the sham group). Mean (±SD) age was 46 (±16) years, and 51% were female. Mean (±SD) pain scores before and after treatment were 8.4 (±1.6) and 6.8 (±2.4) in patients treated with TENS. Mean (±SD) pain scores before and after treatment were 8.0 (±1.7) and 7.5 (±2.1) in patients treated with sham TENS. The mean (±SD) reduction in pain score was significantly greater in TENS versus sham patients, 1.7 (±2.0) versus 0.5 (±1.0; p = 0.002). Rescue medication was administered to fewer patients treated with TENS than with sham (45% vs. 73%, p = 0.02) and patient satisfaction was higher in the TENS than in the sham group (78% vs. 50%, p = 0.02).</p><p><strong>Conclusions: </strong>TENS was more effective than sham TENS at reducing pain severity in adult ED patients with back pain.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"828-835"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810154","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":"Commentary on \"The Use of TENS for the Treatment of Back Pain in the Emergency Department: A Randomized Controlled Trial\".","authors":"Tatsuya Tanaka, Akira Matsuno","doi":"10.1111/acem.70112","DOIUrl":"https://doi.org/10.1111/acem.70112","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726442","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":"Exploring Patients' Perceptions of an Advance Care Planning Intervention in the Emergency Department: A Qualitative Study.","authors":"Youkie Shiozawa, Saaya Morton, Nanako Shirai, Hannah Oelschlager, Lucy Kiernat, Anita N Chary, Anna C Revette, Adrian Haimovich, Smit Desai, Kai-Wei Chang, Shan W Liu, Maura Kennedy, Mara A Schonberg, Kei Ouchi","doi":"10.1111/acem.70109","DOIUrl":"10.1111/acem.70109","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency department (ED) visits offer opportunities for seriously ill patients to formulate future medical care goals, yet ED clinicians lack practical strategies for these conversations. ED GOAL, a behavioral intervention, engages seriously ill yet clinically stable older adults in the ED to address advance care planning (ACP) with their outpatient clinicians. In a randomized trial, goals-of-care documentation was significantly higher in the intervention group compared to controls after three (24.3% vs. 9.9%, p = 0.03) and 6 months (31.4% vs. 12.7%, p < 0.01). This study is a sub-analysis to learn about intervention arm participants' perceived benefits and obstacles of the intervention.</p><p><strong>Methods: </strong>We conducted semi-structured interviews between October 2022 and August 2024 (N = 52) with intervention-arm patients aged 50+ years at three hospitals in Boston, Massachusetts. Using rapid qualitative analyses, we identified themes in intervention-arm participants' comments to open-ended questions about the intervention's benefits and obstacles to continue ACP outside the ED.</p><p><strong>Results: </strong>Of 70 intervention-arm participants, 52 completed interviews, of which two were surrogates. ED GOAL motivated most patients to initiate ACP with outpatient clinicians and loved ones and improved the quality of conversations by clarifying patients' wishes and improving patient-clinician relations. Barriers to continuing ACP were the lack of clinician availability and patient/surrogate readiness. Those with clear care goals found the intervention less useful yet harmless.</p><p><strong>Conclusions: </strong>The intervention provided participants with insights into actionable ACP steps. To address the lack of clinician availability, these conversations may be completed by non-physician clinicians or through non-personnel resources. Better tailored ACP interventions may improve patients' readiness.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT05209880.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740820","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":"Balanced Crystalloids for Pediatric Sepsis and Septic Shock.","authors":"Brit Long, Michael Gottlieb","doi":"10.1111/acem.70115","DOIUrl":"https://doi.org/10.1111/acem.70115","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726441","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":"Letter to the Editor on \"Prevalence of Violence Against Health Care Workers Among Agitated Patients in an Urban Emergency Department\".","authors":"Tatsuya Tanaka, Akira Matsuno","doi":"10.1111/acem.70103","DOIUrl":"https://doi.org/10.1111/acem.70103","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688587","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":"Inconsistencies in the Impact of Electronic Health Record-Based Clinical Decision Support on Reducing Potentially Inappropriate Medications in Older Adults.","authors":"Brijesh Sathian, Hanadi Al Hamad, Israel Júnior Borges do Nascimento","doi":"10.1111/acem.70107","DOIUrl":"https://doi.org/10.1111/acem.70107","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673694","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":"La Sagrada.","authors":"Rama A Salhi","doi":"10.1111/acem.70111","DOIUrl":"https://doi.org/10.1111/acem.70111","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681742","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":"Reply: Inconsistencies in the Impact of Electronic Health Record-Based Clinical Decision Support on Reducing Potentially Inappropriate Medications in Older Adults.","authors":"Gina A Elder, Kevin King, Marc Willner, Matthew J Campbell, Baruch S Fertel, Saket Saxena, Stephen Meldon","doi":"10.1111/acem.70106","DOIUrl":"https://doi.org/10.1111/acem.70106","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673695","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":"Benzodiazepine Co-Exposure Among Patients Presenting to the Emergency Department With a Confirmed Opioid Overdose.","authors":"Adrienne Hughes, Hannah Spungen, Rachel Culbreth, Kim Aldy, Alex Krotulski, Robert G Hendrickson, Alexandra Amaducci, Bryan Judge, Christopher Meaden, Diane P Calello, Jennie Buchanan, Joseph Carpenter, Joshua Shulman, Jeffrey Brent, Paul Wax, Sharan Campleman, Michael Levine, Evan Schwarz, Alex F Manini","doi":"10.1111/acem.70104","DOIUrl":"10.1111/acem.70104","url":null,"abstract":"<p><strong>Background: </strong>Simultaneous exposure to both benzodiazepines and opioids can lead to synergistic respiratory depression, complicating overdose management. Our objective was to report on the detection of prescription and novel benzodiazepine co-exposures among patients treated in emergency departments (EDs) with suspected opioid overdoses. We aimed to describe novel benzodiazepine exposures in this population and to compare the clinical severity of co-exposure to benzodiazepines and opioids versus opioids alone.</p><p><strong>Methods: </strong>This study utilized data from the Toxicology Investigators Consortium (ToxIC) Fentalog Study, an observational study at 10 ED sites (Sept 2020-Dec 2023). Waste serum samples were analyzed using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) for the presence of over 1200 novel psychoactive substances (NPS), drugs, therapeutics, and metabolites. Analyses included demographics, clinical severity, and outcomes among those with prescription benzodiazepines, novel benzodiazepines, or no benzodiazepines.</p><p><strong>Results: </strong>Among the patients with opioids present (n = 1427), 29.0% of patients had detectable benzodiazepines. 20.5% of patients had detectable prescription benzodiazepines, and 8.5% of patients had detectable novel benzodiazepines. The most commonly detected prescription benzodiazepine was alprazolam (39.3%); the most common novel benzodiazepine was bromazolam (46.3% of novel benzodiazepines). The median age of those with novel benzodiazepines was 34, which was younger than those without benzodiazepines (40) and those with prescription benzodiazepines (41; p = 0.001). Patients without benzodiazepines received naloxone more frequently (p = 0.02), while novel benzodiazepine co-exposure was associated with higher naloxone nonresponse rates (p = 0.03). Patients with novel benzodiazepines (compared to the opioid-only group) had increased odds of requiring mechanical ventilation (aOR: 2.14; 95% CI: 1.07, 4.05) after adjusting for age, gender, race and ethnicity, and the presence of prescription benzodiazepines and/or fentanyl.</p><p><strong>Conclusions: </strong>Nearly a third of patients with confirmed opioid overdose presenting to the ED also had concomitant benzodiazepine exposures. Those with novel benzodiazepines had significantly higher odds of intubation, suggesting greater severity of overdose.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635924","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}