Key articles and guidelines for the emergency medicine clinical pharmacist: 2011-2018 update.

Purpose: To summarize recently published research reports and practice guidelines on emergency medicine (EM)-related pharmacotherapy.

Summary: Our author group was composed of 14 EM pharmacists, who used a systematic process to determine main sections and topics for the update as well as pertinent literature for inclusion. Main sections and topics were determined using a modified Delphi method, author and peer reviewer groups were formed, and articles were selected based on a comprehensive literature review and several criteria for each author-reviewer pair.

Compliance and Related Outcomes of Prophylactic Antibiotics in Traumatic Open Fractures.

Prophylactic antibiotic therapy is a standard of care for patients who present with open fractures due to the risk of infectious complications. This study was conducted to characterize the use of initial prophylactic antibiotic use in open fractures, guideline compliance, and its impact on care. Retrospective chart review of adult patients presenting with an open fracture to a Level 1 Trauma Center Emergency Department over a 12-month period was conducted.

Lung cancer screening in Appalachian Kentucky: The impact of Lung-RADS on subsequent testing and cancer identification.

The National Lung Cancer Screening Trial (NLST) demonstrated the use of low dose helical computed tomography (LDCT) scans for lung cancer screening. However, the NLST was implemented in urban hospitals and prior to the Lung CT Screening Reporting and Data System (Lung-RADS). In this retrospective cohort study, 774 eligible patients received LDCT screening using Lung-RADS criteria.

Reducing 30-day readmission rates in a high-risk population using a lay-health worker model in Appalachia Kentucky.

This exploratory study aimed to address the effectiveness of a lay-health worker (LHW) model in addressing social needs and readmissions of high-risk patients admitted in a rural community hospital. A quasi-experimental study design assessed implementation of a LHW model for assisting high-risk patients with their post-discharge social needs. Outcome measures included 30-day hospital readmissions rates during a 4-month baseline period compared with a 6-month post-implementation period.

Improving Chronic Pain Management Processes in Primary Care Using Practice Facilitation and Quality Improvement: The Central Appalachia Inter-Professional Pain Education Collaborative.

Purpose: With the increasing burden of chronic pain and opioid use, provider shortages in Eastern Kentucky and West Virginia have experienced many challenges related to chronic pain management. This study tested a practice facilitator model in both academic and community clinics that selected and implemented best practice processes to better assist patients with chronic pain and increase the use of interdisciplinary health care services.

Methods: Using a quasi-experimental design, a practice facilitator was assigned to each state's clinics and trained clinic teams in quality improvement methods to implement chronic pain tool(s) and workflow processes.

Return-on-Investment (ROI) Analyses of an Inpatient Lay Health Worker Model on 30-Day Readmission Rates in a Rural Community Hospital.

Purpose: The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates.

Methods: The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period.

Antiemetic Use in the Emergency Department.

Nausea and vomiting are 2 of the most common complaints of patients presenting to the emergency department (ED). In addition, antiemetics are the most commonly prescribed medications in the ED behind analgesics. Treating these conditions can be complex, especially as one considers that nausea and/or vomiting could be the primary presenting illness or simply a symptom of a more complex etiology.

Review of Intranasally Administered Medications for Use in the Emergency Department.

Background: Intranasal (IN) medication delivery is a viable alternative to other routes of administration, including intravenous (IV) and intramuscular (IM) administration. The IN route bypasses the risk of needle-stick injuries and alleviates the emotional trauma that may arise from the insertion of an IV catheter.

Objective: This review aims to evaluate published literature on medications administered via the IN route that are applicable to practice in emergency medicine.

Delayed hematologic toxicity following rattlesnake envenomation unresponsive to crotalidae polyvalent antivenom.

North American rattlesnake envenomations are known to produce coagulopathies and thrombocytopenia. However, the occurrence of delayed hematologic toxicity (less than seven days after envenomation) is poorly characterized in the medical literature. While the recurrence of hematologic derangements has been documented following envenomation, it is usually in the absence of clinically significant bleeding.

Chemotherapy in the Emergency Department? There Is a Role for That: Methotrexate for Ectopic Pregnancy.

Approximately 1.6% of all emergency department (ED) visits in the United States are for vaginal bleeding in early pregnancy, translating to around 500,000 ED visits per year. A potentially life-threatening condition, ectopic pregnancy occurs in 1.

Identification of Rate-Limiting Steps in the Provision of Thrombolytics for Acute Ischemic Stroke.

Background: Tissue plasminogen activator (tPA) is the only pharmacotherapy shown to improve outcomes in acute ischemic stroke. The American Heart Association (AHA) recommends a door-to-needle (DTN) time of <60 minutes in at least 50% of patients presenting with acute ischemic stroke.

Objective: The purpose of this study was to analyze the possible barriers that may delay tPA administration within the emergency department (ED) of an academic medical center.

A Review on the Reversal of the Old and New Anticoagulants.

It is not uncommon for providers in the emergency department to take care of patients who are taking anticoagulant therapy in the outpatient setting. However, the bigger challenge is caring for these patients when they present with bleeding that could be secondary to 1 or more of these medications. In recent years, this class of medications has expanded from warfarin to include direct thrombin inhibitors and Factor Xa inhibitors.

Complements Are Not Always a Good Thing: Novel Therapies for Angioedema.

Hereditary angioedema attacks are rare, but emergency care providers must be aware of the clinical presentation and treatment of these patients because the emergency department remains the most common setting where these patients seek treatment. If providers are not aware of the past medical history of these patients, they are likely to receive standard therapies for respiratory distress and anaphylaxis including antihistamines, corticosteroids, and epinephrine. However, these medications may not work in these patients, given the pathophysiology of their underlying disease.

Effectiveness of glucagon in relieving esophageal foreign body impaction: a multicenter study.

Purpose: Glucagon is thought to decrease lower esophageal sphincter tone and is used as an alternative to invasive endoscopy for esophageal foreign body impaction (EFBI). The purpose of this study was to evaluate efficacy and safety of glucagon and identify characteristics associated with success.

Methods: A multicenter, retrospective study of patients receiving glucagon for EFBI at 2 academic emergency departments was conducted between 2006 and 2010.

Bedside Reporting: Protocols for Improving Patient Care.

Bedside reporting continues to gain much attention and is being investigated to support the premise that "hand-off" communications enhance efficacy in delivery of patient care. Patient inclusion in shift reports enhances good patient outcomes, increased satisfaction with care delivery, enhanced accountability for nursing professionals, and improved communications between patients and their direct care providers. This article discusses the multiple benefits of dynamic dialogue between patients and the health care team, challenges often associated with bedside reporting, and protocols for managing bedside reporting with the major aim of improving patient care.