Emergency
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Colorado Program Significantly Reduces Opioid Prescribing in 10 EDs During Six-month Period
A pilot group of 10 EDs in Colorado has shown impressive reductions in opioid prescribing by encouraging the use of alternatives to opioids (ALTO) in the care of five key pain pathways. Between June and November 2017, the pilot sites reduced the use of opioids by 36% when compared to the same six-month period in 2016. The Colorado Hospital Association, which championed the initiative, is moving to expand the ALTO approach used in the pilot to other hospitals in the state.
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Surgeon General: Clinicians Must End Addiction Stigma, Use Evidence-based Care
During a recent town hall, the surgeon general stressed the importance of recognizing that substance use disorder is a chronic disease that must be treated with the same skill, compassion, and urgency that clinicians use to treat other chronic health conditions.
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Alarming Increases in ED Visits for Opioid Overdoses Highlight Need for Robust Solutions
While it is clear that more action must be taken to address the problem, some states already have taken steps to respond to the epidemic in a coordinated way.
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Skin Infestations: Fungal and Scabies
Although cutaneous fungal infections rarely are life-threatening, they are common, and they are irritating. This article provides an in-depth look at common rashes caused by fungi and scabies.
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Evidence-based Management of Atrial Fibrillation in the Emergency Department
This article provides an overview of atrial fibrillation (AF) and evidence-based guidance on controversial aspects of AF workup and management in the emergency department. The evidence is provided to help safely reduce unnecessary testing and expand the emergency provider’s management armamentarium to include electrical and pharmacologic conversion in recent-onset AF patients.
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Respiratory Distress in Pediatric Patients
Respiratory diseases are common in pediatrics, and providers need to have an in-depth knowledge of the presentation, diagnostic approach, and therapeutic options to optimize outcomes.
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ECMO vs. Prone Position in ARDS: The Curious Rejection of Evidence-based Practice
Despite credible evidence from a large, randomized, controlled trial and numerous meta-analyses demonstrating improved outcomes, prone position is seldom attempted prior to initiating extracorporeal membrane oxygenation to treat severe acute respiratory distress syndrome.
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Critical Illness-related Corticosteroid Insufficiency: What’s New?
For critically ill patients with sepsis, septic shock, acute respiratory distress syndrome, and major trauma, a multispecialty task force of 16 international experts developed evidence-based recommendations for the diagnosis of corticosteroid insufficiency and use of corticosteroids in the ICU.
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A Perspective on PEEP at 50 Years
Fifty years ago, positive end-expiratory pressure (PEEP) was introduced as an effective technique for improving oxygenation in patients with large intrapulmonary shunt, the hallmark of acute respiratory distress syndrome (ARDS). Although PEEP remains the primary means for stabilizing oxygenation in ARDS, consensus on how to approach setting it remains elusive. This is a narrative review on how our understanding and approach to PEEP has evolved over the past half century.
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ED Malpractice Claims Allege Failure to Obtain Translator
According to one expert: “An entire case can be brought around one inadvertent slip-up."