Reciprocal Abstracts July 29(4)

Abstract

both Study objective: Large doses of intramuscular (IM) naloxone are commonly used in out-of-hospital settings to reverse opioid toxicity; however, they are used less commonly in hospitals because of concerns about opioid withdrawal, particularly agitation. We aimed to determine the frequency of severe agitation following a single 1.6 mg IM naloxone dose. Methods : We undertook a prospective study of adult ( > 15 years) patients treated by an Australian state ambu-lance service with 1.6 mg IM administration of naloxone for respiratory depression (respiratory rate 1) within 1 hour of naloxone administration. Secondary outcomes were the proportion of presentations with acute opioid withdrawal (tachycardia [pulse rate > 100 beats/min], hypertension [systolic > 140 mm Hg], vomiting, agitation, seizure, myo-cardial infarction, arrhythmia, or pulmonary edema), and reversal of respiratory depression (respiratory rate > 10 and saturation > 92% or Glasgow Coma Scale score 15). Results : From October 2019 to July 2021, there were 197 presentations in 171 patients, with a median age of 41 years (range, 18–80 years); of the total patients, 119 were men (70%). The most common opioids were heroin (131 [66%], oxycodone 14 [7%], and morphine 11 [6%]). Severe agitation occurred in 14 presentations (7% [95% confidence interval {CI} 4% to 12%]). Opioid withdrawal occurred in 76 presentations (39% [95% CI 32% to 46%]), most commonly in the form of tachycardia (18%), Q7 mild agita-tion/anxiety (18%), and hypertension (14%). Three presentations (1.5%) received chemical Background and objective: The maintenance of sinus rhythm by means of antiarrhythmic drugs and/or upstream therapy to counter cardiac remodeling is fundamental to the management of atrial fibrillation (AF). This study aimed to analyze this approach and its appropriateness in the setting of hospital emergency departments. Methods: Secondary analysis of data from the Conclusions: Treatment to prevent the recurrence of AF is underprescribed in emergency departments. Increasing such prescription and ensuring the appropriateness of antiarrhythmic therapy prescribed are points emergency depart-ments can improve in the interest of better sinus rhythm maintenance. care hospital ED between January 7 and February 17, 2021. The inclusion criteria were as follows: (1) absence of pneumonia but presence of serious comorbidity and/or elevated biomarkers of inflammation and (2) pneumonia with or without elevated inflammatory markers but without respiratory insufficiency. The main outcome was need for an ED revisit with hospital admission and time from ED evaluation to hospitalization. Secondary outcomes were the number of COVID-A2R visits and the potential economic impact. Results: We included 278 patients with a median age of 57 years (57.9% men) and a median Charlson Comorbidity Index of 1. The median time since onset of symptoms was 7 days (interquartile range, 4–11 days). Pneumonia was diagnosed in 71.8%, and 64.7% required only 1 in-person visit in the COVID-A2R pathway. No revisits to the ED were needed by 87.8% (83.4%–91.1%) of the patients. Of the 34 patients who were hospitalized, 88.2% were admitted within 5 days. The COVID-A2R model potentially saved 1708 days of hospitalization. Conclusion: The fast-track ambulatory care model was effective after ED discharge of patients with COVID-19 without respiratory insufficiency but with clinical or labo-ratory indicators of risk for poor outcome. Abstract Objectives: A high number of emergency medical service (EMS) patients are not transported to hospital by ambu-lance. Various non-transport protocols and guidelines have been implemented by different EMS providers. This study examines subsequent tertiary care emergency department (ED) and hospital admission and mortality of the patients assessed and not transported by EMS in Northern Finland and evaluates the factors predicting these outcomes. Methods: Data from