Time to hemostatic agent administration increases mortality in veterans with factor Xa inhibitor-related intracranial hemorrhage.

Background: The two hemostatic agents utilized for reversal of life-threatening hemorrhage associated with Factor Xa (fXa) inhibition are andexanet alfa (AA) and four-factor prothrombin complex concentrate (4F-PCC). In May 2018, AA was approved with possible superior short-term hemostatic efficacy but has been linked with higher rates of thrombotic events. Considering these concerns, the absence of high-quality comparative studies, and the higher cost compared to other agents, four-factor prothrombin complex concentrate remained the more utilized agent.

Assessing the impact of emergency medicine pharmacists on fibrinolytic door-to-needle times in acute ischemic stroke: A systematic review and meta-analysis (Pharmacist-assisted Stroke Treatments I (PhAST-1)).

Background: Acute ischemic stroke (AIS) requires time-sensitive fibrinolytic therapy measured by door-to-needle (DTN) time. Emergency medicine pharmacists (EMPs) are integral in emergency departments (EDs) for optimizing AIS care as they possess expertise in drug therapy and emergency response.

Objective: The purpose of this systematic review and meta-analysis (SR/MA) is to evaluate EMP impact on DTN time.

Reversing Anticoagulants: Influence of Anticoagulation Stewardship and Key Considerations for Optimizing Outcomes.

The reversal of anticoagulants can be a complex process with limited data describing the optimal overall approach beyond a specific reversal agent. Recent advances in anticoagulation stewardship have created opportunities to standardize and optimize the reversal of anticoagulants, especially in urgent life-threatening bleeding events. This article explores how pharmacists provided anticoagulation stewardship activities positively impact outcomes related to urgent anticoagulation reversal.

Hepatitis B vaccination and immune globulin administration in patients presenting to the emergency department following sexual assault.

Objective: Sexual assault is unfortunately common in patients seen in the emergency department (ED). Following sexual assault, patients are at risk for several transmissible infections, including hepatitis B virus (HBV). HBV screening, HBV vaccination, and treatment with hepatitis B immune globulin (HBIG) is recommended in select scenarios by the Centers for Disease Control and Prevention (CDC).

Andexanet alfa increases 30-day thrombotic events relative to four-factor prothrombin complex concentrate for factor Xa inhibitors-related intracerebral hemorrhage in veterans.

Background And Objectives: Two hemostatic agents are commonly used to reverse factor Xa (fXa) inhibitor-related intracranial hemorrhage (ICH): andexanet alfa (AA) or 4-factor prothrombin complex concentrate (4F-PCC). We sought evaluate real-world data in Veterans diagnosed with fXa inhibitor-related ICH by comparing short-term mortality and thrombotic events in patients who received AA vs. 4F-PCC.

Improving Initial Management of Septic Patients: Comparing Intravenous Push vs. Intravenous Piggyback Antibiotics.

Background: Although β-lactam antibiotics are traditionally administered through intravenous piggyback (IVPB), intravenous push (IVP) antibiotics have become more popular recently, given they have a shortened time to administration, which may impact patient outcomes.

Objectives: This study explores the advantages of using IVP vs. IVPB method by evaluating the difference in time from sepsis diagnosis to first dose administration of broad-spectrum antibiotics.

Risk factors for enterococcal urinary tract infection in emergency department patients: A sub-analysis of the UNTRIED study.

Introduction: Empiric antibiotic selection for urinary tract infections (UTIs) in the emergency department (ED) typically target gram-negative bacteria, potentially missing gram-positive organisms such as Enterococcus spp. This study aimed to evaluate whether a combination of positive leukocyte esterase (LE+) and negative nitrite (NI-) on urinalysis was associated with Enterococcus UTIs in ED patients. Secondary objectives included identifying additional risk factors for Enterococcus-positive urine cultures.

CuratED: The emergency medicine pharmacotherapy literature of 2024.

The purpose of this article is to summarize pharmacotherapy related emergency medicine (EM) literature indexed in 2024. Articles were selected utilizing a modified Delphi approach. The table of contents from predetermined journals were reviewed and independently evaluated via the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system by paired authors.

Impact of desmopressin on hematoma expansion in patients presenting to the emergency department on antiplatelet therapy.

Introduction: Current guidelines state the effectiveness of desmopressin to reduce hematoma expansion in antiplatelet-related intracerebral hemorrhage (ICH) is uncertain. This study sought to determine if desmopressin decreased hematoma expansion in ICH patients on antiplatelet agents.

Methods: We conducted a multi-center, retrospective propensity-matched cohort study at 11 US emergency departments (ED) that participate in EMPHARM-NET.

Strategies to prevent awareness with paralysis following administration of neuromuscular blocking agents.

Purpose: Awareness with paralysis (AWP) is an increasingly recognized complication of neuromuscular blocker use and is associated with adverse patient experiences. This manuscript describes the incidence of AWP and mitigation strategies that can be employed to prevent its occurrence and ensure optimal patient care.

Summary: Preventative strategies are essential to reduce the incidence of AWP.

PHarmacist Avoidance or Reductions in Medical Costs Considering Board of Pharmacy Specialties Certification (PHARM-BPS).

Clinical pharmacists bring unparalleled medication expertise, but quantifying their impact on a health system's bottom line remains unestablished. To classify interventions by pharmacists with and without board certification and quantify the cost avoidance (CA) from accepted interventions. This multicenter prospective observational study, conducted between August 2018 and January 2019, included board certified (BPS) and non-board certified (Non-BPS) emergency medicine (EM) and intensive care unit (ICU) clinical pharmacists from 89 U.

Intravenous push administration of anti-seizure medications.

Intravenous push (IVP) administration of anti-seizure medications is becoming increasingly popular among emergency departments. IVP administration eliminates the need for compounding and preparation by the pharmacy department, as well as the need to gather infusion materials or set up a patient's tubing and pump, all of which translate to faster drug administration. This is important given the time-sensitive nature of status epilepticus treatment.

Interpreter Modalities and Unplanned Emergency Department Revisits in Limited English Proficiency Patients.

Introduction: Emergency department encounters include an increasing number of patients with limited English proficiency, yet little is known about the impact of interpreter services on unplanned revisits to the emergency department. This study aims to assess interpreters' utilization and unplanned ED revisits, serving as an indicator of care quality.

Methods: This was a single-center, retrospective chart review of ED visits at an urban academic center between January and April 2019.

Anti-Amyloid Therapies for Alzheimer's Disease and Amyloid-Related Imaging Abnormalities: Implications for the Emergency Medicine Clinician.

Alzheimer's disease is the neurodegenerative disorder responsible for approximately 60% to 70% of all cases of dementia and is expected to affect 152 million by 2050. Recently, anti-amyloid therapies have been developed and approved by the Food and Drug Administration as disease-modifying treatments given as infusions every 2 to 5 weeks for Alzheimer's disease. Although this is an important milestone in mitigating Alzheimer's disease progression, it is critical for emergency medicine clinicians to understand what anti-amyloid therapies are and how they work to recognize, treat, and mitigate their adverse effects.

Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study.

Study Objective: The primary objective of our study was to compare the effectiveness of oral cephalosporins versus fluroquinolones and trimethoprim/sulfamethoxazole (TMP-SMX) for the treatment of pyelonephritis in patients discharged home from the emergency department (ED).

Methods: This was a multicenter, retrospective, observational cohort study of 11 geographically diverse US EDs. Patients aged ≥18 years diagnosed with pyelonephritis and discharged home from the ED between January 1, 2021 and October 31, 2023 were included.

Emergency department utilization in Veterans with spinal cord injuries & disorders.

Objective: To determine frequency that ED visits are needed, and the most common chief complaints and medications prescribed to Veterans with spinal cord injuries and disorders (SCI/D).

Methods: The Veterans Health Administration (VHA) SCI and Disorders (SCI/D) Registry (VHA SCIDR) was used to identify Veterans with SCI/D over a five-year period (fiscal years 2018-2022). The primary outcome was the proportion of Veterans with SCI/D who had visits to the ED during the study period.

Utility of D-dimer in predicting pulmonary embolism in patients with COVID-19 presenting to the emergency department.

Objectives: While our understanding of coronavirus disease 2019 (COVID-19) has evolved, uncertainty remains regarding utility of previously established pulmonary embolism (PE) screening guidelines in patients with COVID-19. Many studies have investigated the efficacy of D-dimer (DD) screenings for patients with COVID-19 admitted to inpatient services, but few have evaluated patients in the emergency department (ED). The purpose of this study was to investigate utility of DD threshold for PE screening in patients with COVID-19 presenting to the ED.