Association Between Operator Experience and Procedural Outcomes of Tracheal Intubation in the Emergency Department and ICU.

Study Objectives: Complications are common during emergency tracheal intubation. Although graduate medical education in emergency medicine and critical care mandate competency in this procedure, thresholds for proficiency are poorly defined. We evaluated the relationship between the operator performing intubation and complications of emergency tracheal intubation.

Effect of pretreatment opioids on hemodynamics during emergency intubations: a systematic review.

Rapid sequence intubation in emergency settings may involve opioid pretreatment to blunt hemodynamic responses during laryngoscopy and intubation; however, opioids may lead to postintubation hypotension, increasing morbidity and mortality. Global clinical practice varies significantly, reflecting uncertainty about opioids' benefits and risks. Our goal was to evaluate the association between opioid pretreatment and hemodynamic instability, focusing on postintubation hypotension in adult patients undergoing emergency intubation.

Mortality risk factors for patients with cardiotoxic exposures treated with high-dose insulin: analysis of the National Poison Data System.

Introduction: High-dose insulin/glucose is an inotrope, vasodilator, and standard therapy for beta-adrenoceptor and calcium channel blocker poisoning, yet no large database studies have examined its use. This study sought to describe high-dose insulin use in the United States using the National Poison Data System. Determining mortality risk factors was the primary aim.

Time to adequate preoxygenation when using flush rate oxygen.

Objective: Preoxygenation utilizing a non-rebreather mask (NRB) to deliver oxygen at the maximal flow rate (>50 L/min) from a standard hospital gas flowmeter (i.e., the flush rate) is an accepted technique during emergency airway management.

Prevalence of violence against health care workers among agitated patients in an urban emergency department.

Objective: Violence is a common hazard for those working in emergency departments (EDs), yet it remains understudied. We describe a prospectively derived estimate of the prevalence of violence against health care workers among agitated patients in an ED.

Methods: This was a secondary analysis of two prospective, observational studies of patients receiving care in a dedicated portion of the ED meant primarily to observe patients with intoxication.

Eliciting Patient Preferences for Pragmatic Critical Care Trials: A Qualitative Study.

Conducting pragmatic comparative effectiveness trials in critically ill populations poses distinct challenges. Knowledge gaps exist in how to best conduct pragmatic research while demonstrating respect for critically ill patients and their families. To engage patients with lived critical care experience to elicit their perspectives on ) decisions related to the design and conduct of pragmatic comparative effectiveness trials in acute and critical care settings and ) subsequent notification of pragmatic trial participation.

Protocol and Statistical Analysis Plan for the Randomized Trial of Sedative Choice for Intubation (RSI).

Background: Emergency tracheal intubation is a common and high-risk procedure. Ketamine and etomidate are sedative medicines commonly used to induce anesthesia for emergency tracheal intubation, but whether the induction medication used affects patient outcomes is uncertain.

Research Question: Does the use of ketamine for induction of anesthesia decrease the incidence of death among adults undergoing emergency tracheal intubation, compared to the use of etomidate?

Study Design And Methods: The Randomized trial of Sedative choice for Intubation (RSI) is a pragmatic, multicenter, unblinded, parallel-group, randomized trial being conducted in 14 sites (6 emergency departments and 8 intensive care units) in the United States.

Video vs Direct Laryngoscopy for Tracheal Intubation After Cardiac Arrest: A Secondary Analysis of the Direct vs Video Laryngoscope Trial.

Background: Airway management is a critical component of the care of patients experiencing cardiac arrest, but data from randomized trials on the use of video vs direct laryngoscopy for intubation in the setting of cardiac arrest are limited. Current American Heart Association guidelines recommend placement of an endotracheal tube either during CPR or shortly after return of spontaneous circulation, but do not provide guidance around intubation methods, including the choice of laryngoscope.

Research Question: Does use of video laryngoscopy improve the incidence of successful intubation on the first attempt, compared with use of direct laryngoscopy, among adults undergoing tracheal intubation after experiencing cardiac arrest?

Study Design And Methods: This secondary analysis of the Direct vs Video Laryngoscope (DEVICE) trial compared video laryngoscopy vs direct laryngoscopy in the subgroup of patients who were intubated after cardiac arrest.

Factors and outcomes associated with under- and overdiagnosis of sepsis in the first hour of emergency department care.

Background: Sepsis remains the leading cause of in-hospital death and one of the costliest inpatient conditions in the United States, while treatment delays worsen outcomes. We sought to determine factors and outcomes associated with a missed emergency physician (EP) diagnosis of sepsis.

Methods: We conducted a secondary analysis of a prospective single-center observational cohort of undifferentiated, critically ill medical patients (September 2020-May 2022).

Continuous regional anesthesia with erector spinae plane catheters for patients with multiple rib fractures.

Introduction: Opioids are commonly used for acute pain management in patients with rib fractures, but their use poses known risks of addiction and respiratory depression. Regional anesthesia, namely the erector spinae plane(ESP) block, has shown promise as an alternative to opioids in case series. Our aim was to evaluate the efficacy and safety of continuous ropivacaine infusion ESP catheters performed by emergency physicians (EP) for patients with multiple unilateral rib fractures.

Physostigmine reversal of delirium from second generation antipsychotic exposure: a retrospective cohort study from a regional poison center.

Introduction: Physostigmine is an effective antidote for antimuscarinic delirium. There is little evidence for its use to reverse delirium following second generation antipsychotic exposure. The purpose of this study is to describe the safety and effectiveness of physostigmine in reversing delirium from second generation antipsychotic exposure.

Comparing Intubation Rates in Patients Receiving Parenteral Olanzapine With and Without a Parenteral Benzodiazepine in the Emergency Department.

Study Objective: United States prescribing information recommends against coadministration of injectable olanzapine with injectable benzodiazepines due to a risk of cardiorespiratory depression, whereas European prescribing information recommends the 2 drugs not be administered within 60 minutes of each other. In contrast, a recently published American College of Emergency Physicians clinical policy recommends injectable olanzapine and benzodiazepines be coadministered for treating severe agitation. We sought to compare injectable olanzapine with and without injectable benzodiazepines for evidence of cardiorespiratory depression.

Flexible endoscopic intubation in emergency medicine: A mixed-methods needs assessment.

Objectives: This needs assessment aimed to improve understanding of flexible endoscopic intubation training and practice in emergency medicine (EM), providing insights to educators and practice leaders seeking to improve education and practices.

Methods: We conducted a multicenter, mixed-methods needs assessment of emergency physicians (EPs) incorporating focus groups and a survey. Focus groups comprised community EPs, academic EPs, and resident EPs.

Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients.

Study Objective: Compare physician gestalt to existing screening tools for identifying sepsis in the initial minutes of presentation when time-sensitive treatments must be initiated.

Methods: This prospective observational study conducted with consecutive encounter sampling took place in the emergency department (ED) of an academic, urban, safety net hospital between September 2020 and May 2022. The study population included ED patients who were critically ill, excluding traumas, transfers, and self-evident diagnoses.

Awareness with paralysis and symptoms of post-traumatic stress disorder among mechanically ventilated emergency department survivors (ED-AWARENESS-2 Trial): study protocol for a pragmatic, multicenter, stepped wedge cluster randomized trial.

Background: Awareness with paralysis (AWP) is memory recall during neuromuscular blockade (NMB) and can cause significant psychological harm. Decades of effort and rigorous trials have been conducted to prevent AWP in the operating room, where prevalence is 0.1-0.