Age-related mortality risk in cycling trauma: analysis of the National Trauma Databank 2017-2023.

Background: Cycling promotes health but carries significant injury risks, especially for older adults. In the U.S.

Investigating the Impact of Caregiver Adverse Childhood Experiences Screening and Pediatrician-Led Discussions on Posttraumatic Stress Disorder Symptoms in a Majority-Hispanic Pediatric Primary Care Clinic Setting.

Background: Evidence suggests that screening and provider-led discussions of parental adverse childhood experiences (ACEs) may help identify at-risk families and be linked to positive health outcomes in caregivers and their children. However, the direct effect of ACEs screening and discussions on posttraumatic stress disorder (PTSD) has yet to be studied.

Objectives: To determine if screening or provider-led discussions of parental ACEs are associated with inadvertent worsening of PTSD symptoms 1 week after screening.

Clinical presentation, outcome and management of snakebite cases in Saudi Arabia.

Background: Snakebite envenomation remains a significant public health concern in Asir Province of Saudi Arabia.

Aim: To characterize snake species and the clinical presentation, outcome and management of snakebite cases admitted to 4 major hospitals in Asir Province, Saudi Arabia .

Methods: This retrospective study reviewed medical records of paediatric and adult snakebite cases admitted to 4 regional hospitals in Saudi Arabia between January 2000 and December 2021 using search terms "snakebite", "cobra", "polyvalent antivenin", "antivenom", "compartment syndrome", and "fasciotomy".

Predictors of prolonged supratherapeutic serum lithium concentrations: a retrospective chart review.

Introduction: The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup suggests hemodialysis in severe lithium poisoning if specific criteria are met. One criterion is if the expected time to obtain a lithium concentration <1.0 mEq/L with optimal management is >36 h.

Emergency department encounters and opioid prescribing following orthopaedic trauma among Black and White patients with substance use disorders.

Introduction: Patients living with substance use disorder (SUD) have complex pain management needs, which may be mismanaged during hospital admission. Ineffectively managed pain following orthopaedic trauma, influenced by clinician biases related to race or SUD diagnosis, may subject patients to worse pain outcomes and subsequent emergency department (ED) encounters. This study examined ED encounters and opioid prescribing for pain-related complaints following orthopaedic trauma, among patients with SUD who identify as Black or African American relative to White patients.

Bridging the Gap: Evaluation of an Electrocardiogram Curriculum for Advanced Practice Clinicians.

Background: Training programs for advanced practice providers (APP) often have significant variability in their curriculum, including electrocardiogram (ECG) education. Despite limitations in formal ECG training, APPs in the emergency department (ED) may be the first practitioner to interpret an ECG. Foundations of Emergency Medicine (FoEM) offers free, open-access curricula that are widely used for resident education.

The feasibility of emergency department observation units in the management of mild to moderate hyponatremia.

Objective: To describe the feasibility of managing hyponatremia patients under outpatient observation status in an academic medical center, and compare outcomes based on the use of an emergency department observation unit (EDOU).

Methods: This is a retrospective cohort study of emergency department hyponatremic patients managed in four hospitals within a large urban academic medical center over 27 months. All patients had an admit-to-observation order, ICD-10 codes for hyponatremia, and mild (130-135 mmol/L) to moderate (121-129 mmol/L) hyponatremia.

Access to, Experience with, and Attitudes towards Take Home Naloxone: An Online Survey.

The opioid public health crisis continues to burden individuals, communities, and economies. Public health opinion has emphasized the need for increased access to harm reduction services, but there is a dearth of information on the views and experiences of people who use opioids. Our study aimed to investigate the prevalence of naloxone use, attitudes, and experiences with naloxone among an online community of people who use drugs.

Low- versus high-dose nitroglycerin infusion in the management of acute pulmonary edema.

Background: Nitroglycerin (NTG) is commonly used for the management of pulmonary edema in acute heart failure presentations. Although commonly initiated at low infusion rates, higher infusion rates have favorable pharmacodynamic properties and may improve outcomes in the management of acute pulmonary edema.

Objectives: To characterize the clinical outcomes including the time to resolution of severe hypertension when using an initial low dose (<100 μg/min) versus high-dose (≥100 μg/min) strategy.

Use of person-centered goals to direct interdisciplinary care for military service members and Veterans with chronic mTBI and co-occurring psychological conditions.

Objective: To explore the use of person-centered goals (PCGs) to direct interdisciplinary care to support PCG attainment in military service members and Veterans (SM/Vs) with chronic mild traumatic brain injury (mTBI) and co-occurring psychological conditions.

Methods: A retrospective chart review was completed for 146 United States military SM/Vs reporting chronic symptoms following mTBI and co-occurring psychological conditions who received care in the SHARE Military Initiative intensive outpatient program, a donor-funded program administered by a not-for-profit hospital, between April 1, 2015 and March 31, 2019. PCGs were used to direct care consisting of individual and group-based interventions and therapies delivered by an interdisciplinary, co-located team including behavioral health, case management, neurology or physiatry, nursing, occupational therapy, physical therapy, recreation therapy, speech-language pathology, and transition support.

Electronic Advisories Increase Naloxone Prescribing Across Health Care Settings.

Background: Naloxone is a life-saving, yet underprescribed, medication that is recommended to be provided to patients at high risk of opioid overdose.

Objective: We set out to evaluate the changes in prescriber practices due to the use of an electronic health record (EHR) advisory that prompted opioid prescribers to co-prescribe naloxone when prescribing a high-dose opioid. It also provided prescribers with guidance on decreasing opioid doses for safety.

The Impact of Virtual Care in an Emergency Department Observation Unit.

Study Objective(s): We report the impact of telemedicine virtual rounding in emergency department observation units (EDOU) on the effectiveness, safety, and cost relative to traditional observation care.

Methods: In this retrospective diff-in-diff study, we compared observation visit outcomes from 2 EDOUs before (pre) and after (post) full adoption of telemedicine rounding tele-observation (tele-obs) with usual care in control EDOU and care in a hospital bed in an integrated health system without tele-obs. Tele-obs physicians did not work at the control hospital.

Limited English Proficiency as a Barrier to Inclusion in Emergency Medicine-Based Clinical Stroke Research.

Aims: Individuals with Limited English Proficiency (LEP) represent a growing percentage of the U.S. population yet face inequities in health outcomes and barriers to routine care.

Elevated methemoglobin levels in patients treated with hydroxocobalamin: a case series and analysis.

Background: Historically, the first step in treating cyanide (CN) toxicity utilized antidotes to induce methemoglobinemia. This is concerning in patients who are already hypoxemic or have elevated carboxyhemoglobin. Hydroxocobalamin (OHCbl) is now the first-line antidote for CN toxicity and is not known to induce methemoglobinemia.

The association of indoor heat exposure with diabetes and respiratory 9-1-1 calls through emergency medical dispatch and services documentation.

Background: People with pre-existing medical conditions, who spend a large proportion of their time indoors, are at risk of emergent morbidities from elevated indoor heat exposures. In this study, indoor heat of structures wherein exposed people received Grady Emergency Services based care in Atlanta, GA, U.S.

Management of Minor Traumatic Brain Injury in an ED Observation Unit.

Introduction: Traumatic intracranial hemorrhages (TIH) have traditionally been managed in the intensive care unit (ICU) setting with neurosurgery consultation and repeat head CT (HCT) for each patient. Recent publications indicate patients with small TIH and normal neurological examinations who are not on anticoagulation do not require ICU-level care, repeat HCT, or neurosurgical consultation. It has been suggested that these patients can be safely discharged home after a short period of observation in emergency department observation units (EDOU) provided their symptoms do not progress.

Application of the RE-AIM Framework for the Pediatric Mild Traumatic Brain Injury Evaluation and Management Intervention: A Study Protocol for Program Evaluation.

Background: Children who experience a mild Traumatic Brain Injury (mTBI) may encounter cognitive and behavioral changes that often negatively impact school performance. Communication linkages between the various healthcare systems and school systems are rarely well-coordinated, placing children with an mTBI at risk for prolonged recovery, adverse impact on learning, and mTBI re-exposure. The objective of this study is to rigorously appraise the pediatric Mild Traumatic Brain Injury Evaluation and Management Intervention that was designed to enhance diagnosis and management of pediatric mTBI through enhanced patient discharge instructions and communication linkages between school and primary care providers.

Hormonal contraceptive use moderates the association between worry and error-related brain activity.

Uncovering mechanisms that can help explain the experience and impact of anxiety in women is important for improving etiological models and treatments to meet the needs of unique individuals. An enlarged error-related negativity (ERN) - an electrophysiological marker of cognitive control-related error monitoring- represents one indicator of neural processes more strongly related to anxiety in women than men. In this study, we further examined this association in women by testing the moderating effect of hormonal contraceptive (HC) use on the relationship between worry - i.

The Effect of Nighttime Rental Restrictions on E-Scooter Injuries at a Large Urban Tertiary Care Center.

Safety policy for e-scooters in the United States tends to vary by municipality, and the effects of safety interventions have not been well studied. We reviewed medical records at a large, urban tertiary care and trauma center in Atlanta, Georgia with the goal of identifying trends in e-scooter injury and the effects of Atlanta's nighttime ban on e-scooter rentals on injuries treated in the emergency department (ED). Records from all ED visits occurring between June 2018 through August 2020 were reviewed.

The Secret of Serotinous Leadership:: The Pandemic Crisis Changed Care Models, But Only After Leaders Changed Their Minds About Them.

The COVID-19 pandemic punctured the status quo, triggering a reassessment of mindsets, biases and assumptions that had impeded widespread adoption of virtual care models and advanced nursing practice roles within them. Now, as we move to a post-pandemic environment, we enter a new phase, one in which continued progress on these fronts is not assured. Formalizing these breakthroughs as new standards of care - and securing nurses' expanded practice roles - rests on the ability of nurse leaders to address a phenomenon called "cultural lag" and imaginatively shape the transformation on which continued progress depends.

Adverse Childhood Experiences and Healthcare Utilization of Children in Pediatric Emergency Departments.

Objective: To determine the prevalence of adverse childhood experiences (ACEs) and healthcare utilization patterns of children seen in pediatric emergency departments (PEDs).

Study Design: In this cross-sectional study, caregivers of patients who presented to 2 urban PEDs completed a survey regarding their children's ACEs, health care utilization patterns, and acceptance of PED-based ACEs screening and resources. Inclusion criteria were English-speaking caregivers of patients 0-17 years of age not requiring acute stabilization.

Patient Characteristics and Perspectives of Firearm Safety Discussions in the Emergency Department.

Introduction: Firearm injury prevention discussions with emergency department (ED) patients provide a unique opportunity to prevent death and injury in high-risk patient groups. Building mutual understanding of safe firearm practices between patients and providers will aid the development of effective interventions. Examining ED patient baseline characteristics, perspectives on healthcare-based safety discussions, and experience with and access to firearms, will allow practitioners to craft more effective messaging and interventions.

The impact of emergency department observation units on a health system.

Importance: Protocol driven ED observation units (EDOU) have been shown to improve outcomes for patients and payers, however their impact on an entire health system is unknown. Two thirds of US hospitals do not have such units.

Objective: To determine the impact of a protocol-driven EDOU on health system length of stay, cost, and resource utilization.