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A Review of the Relationship of Atrial Fibrillation and Acute Coronary Syndrome
Abstract Purpose of Review Patients with co-morbid acute coronary syndromes (ACS) and atrial fibrillation (AF) are less likely to receive appropriate therapies and more likely to experience adverse outcomes than those in sinus rhythm. This review of current research findings on the bidirectional relationship between AF and ACS encompasses risk factors for one disease progressing to the other, corresponding patient outcomes, and important implications for clinicians. Recent findings Clin...
Source: Current Emergency and Hospital Medicine Reports - July 5, 2016 Category: Emergency Medicine Source Type: research

Novel Cardiac Biomarkers for Emergency Department Evaluation of Acute Coronary Syndrome: The Recent Evidence on Non-troponin Biomarkers and Their Limitations
This article reviews the most recent literature regarding four of the biomarkers that have generated the most interest: matrix metalloproteinases, copeptin, ischemia-modified albumin, and heart-type fatty acid binding protein. Pregnancy-associated plasma protein A is also considered. Research has studied these both independently, and in conjunction with troponin assays. This review additionally addresses the potential role of risk stratification in applying these biomarkers. Summary There remain concerns about the limitations of a troponin-based ...
Source: Current Emergency and Hospital Medicine Reports - July 3, 2016 Category: Emergency Medicine Source Type: research

The Safe and Rational Use of Analgesics: Opioid Analgesics
Abstract Purpose of the Review The safe and effective treatment of acute pain is a complex and challenging area for clinicians. In this review we use three cases describing common clinical scenarios to discuss the safe and appropriate use of opioid analgesics. Review Findings Opioids are effective and can be used safely for the treatment of acute pain, but have predictable and dose dependent adverse effects. As the dose of opioid increases, respiratory depression, somnolence, and confusio...
Source: Current Emergency and Hospital Medicine Reports - July 1, 2016 Category: Emergency Medicine Source Type: research

The Chronic Pain Patient in the Emergency Department
This article presents the scope of chronic pain, evaluation issues of the chronic pain patient, barriers to effective management, targeted pharmacotherapy suggestions, patient assessment strategies, prescribing guidelines, and other outpatient modalities used for treatment of chronic pain. The goal of this article is to improve the reader’s understanding of the issues surrounding the chronic pain patient and improve the care of these patients. (Source: Current Emergency and Hospital Medicine Reports)
Source: Current Emergency and Hospital Medicine Reports - April 21, 2016 Category: Emergency Medicine Source Type: research

The Prescribing of Opioids to Emergency Patients for the Treatment of Pain: The Issues Continue
In this report, we will investigate many of the issues surrounding the use of opioids and steps we, as practitioners, can take to avoid some of these problems while providing appropriate care to our patients. (Source: Current Emergency and Hospital Medicine Reports)
Source: Current Emergency and Hospital Medicine Reports - April 15, 2016 Category: Emergency Medicine Source Type: research

Acute Traumatic Pain in the Prehospital and Emergency Department Setting
Abstract Pain is a common complaint in the emergency and acute care settings. Adequate control of a child’s pain is important for improved patient assessments and can have long-term benefits affecting future medical care. Pain in children may be difficult to distinguish from anxiety, but there are validated tools to assist in objectively quantifying the severity pain in children of all ages. Pharmacologic as well as non-pharmacologic pain therapies can be effective. Providers who practice in the prehospital, emergency department, and other acute care settings should consider standardized protocols or gu...
Source: Current Emergency and Hospital Medicine Reports - April 15, 2016 Category: Emergency Medicine Source Type: research

Pediatric Pain and Anxiety in the Emergency Department: An Evidence-Based Approach to Creating an Anti-Pain Environment
Abstract There have been real advances in the area of pain and anxiety management in pediatric patients in the urgent and emergent settings. The focus on the “patient experience” and not just the obtaining of a diagnosis and a treatment has forced many Emergency Departments to reassess how they address pain and anxiety. Many new products and methods, whether pharmacological based or not, are being utilized to make the patient encounter less stressful and less painful for both children and families. Additionally, it has been recognized that appreciating the importance of the patient’s developmental a...
Source: Current Emergency and Hospital Medicine Reports - April 14, 2016 Category: Emergency Medicine Source Type: research

Review of the Typical and Atypical Treatment Options for Acute Migraine Headache in the Emergency Department
Abstract Migraine headache is a common chief complaint for patients presenting to their local emergency department or primary care office. Patients present for treatment of their acute migraine flare, ultimately seeking pain control in order to return to their baseline functional ability. This review focuses on both the typical as well as atypical migraine headache treatment options in emergency departments. Several treatment options are included within the review, but it is ultimately up to the individual provider to decide upon the best treatment regimen on an individualized basis, taking into account t...
Source: Current Emergency and Hospital Medicine Reports - April 6, 2016 Category: Emergency Medicine Source Type: research

Managing Pharyngeal and Oral Mucosal Pain
Abstract Oropharyngeal pain is a common chief complaint in the emergency department and primary care offices. Etiologies include pharyngitis from viral or bacterial infections, tonsillitis, oral mucositis from chemotherapeutic agents, infections such as the herpes simplex virus, aphthous stomatitis and dental pain from abscesses, decay and post-extractions. Patients present for evaluation of their disease, but importantly, patients also seek pain control. This review focuses on pain management of the simple acute sore throat, dental pain, and oral mucosal pain. Common medications such as acetaminophen, no...
Source: Current Emergency and Hospital Medicine Reports - April 4, 2016 Category: Emergency Medicine Source Type: research

Prothrombin Complex Concentrate for Non-Bleeding Urgent Warfarin Reversal in Ventricular Assist Device Patients Undergoing Heart Transplantation
We describe 4-factor prothrombin complex concentrate (4F-PCC) use for this indication. This single center, retrospective chart review included BTTVAD patients who received a heart transplant at Brigham and Women’s Hospital (BWH) from December 2013 to November 2014. Patients who did not receive 4F-PCC were excluded. Twelve BTTVAD patients (mean age 54 years, 58 % male, INR of 2.7 ± 0.8) were admitted for urgent heart transplantation. To reverse the INR prior to surgery, patients received a combination of interruption of warfarin and administration of vitamin K, 4F-PCC, and fresh frozen plasma (FFP). All patients rece...
Source: Current Emergency and Hospital Medicine Reports - April 4, 2016 Category: Emergency Medicine Source Type: research

The Safe and Rational Use of Analgesics: Non-opioid Analgesics
Abstract Non-opioid medications have long been part of a comprehensive pain management strategy for acute conditions. Many pharmacologic agents that fall into this heterogeneous group are inexpensive and readily available, and are perceived to have a lower risk of adverse events when compared to opioids. This narrative review provides an overview of several classes of non-opioid analgesics and discusses some of the evidence that examines their effectiveness. Three cases are used to highlight specific situations in which non-opioid medications could be considered. NSAIDs and acetaminophen have been demonst...
Source: Current Emergency and Hospital Medicine Reports - April 3, 2016 Category: Emergency Medicine Source Type: research

Invited Commentary: Initial Experience with Direct Oral Anticoagulants in the Perioperative Setting
Abstract The perioperative period represents a challenging situation for antithrombotic management. There is a lack of data on the perioperative use of direct oral anticoagulants (DOACs). We sought to describe the initial perioperative experience with these agents at our institution. Patients who were taking dabigatran, rivaroxaban, or apixaban prior to cardiac valve or coronary artery bypass surgery were included if they were at least 18 years old and had a platelet count >100,000 and hemoglobin >8 g/dl. We evaluated bleeding and thromboembolic events. Dabigatran, rivaroxaban, and apixaban were s...
Source: Current Emergency and Hospital Medicine Reports - April 3, 2016 Category: Emergency Medicine Source Type: research

Pain Management as a Predictor of Patient Satisfaction in the Emergency Department
Abstract Patient satisfaction has become an increasingly important metric of quality of care and of the patient experience. It has also become an important driver of reimbursement for provider services. Components of patient satisfaction include provision of timely care, keeping the patient and their families apprised of the progress of their diagnostic work-up and treatment, cleanliness of the environment, responsiveness of the treatment team, as well as relief of pain and discomfort. In an era of increasing patient expectations of care, as well as the recent epidemic of opiate abuse, the emergency provi...
Source: Current Emergency and Hospital Medicine Reports - April 3, 2016 Category: Emergency Medicine Source Type: research

Nitrous Oxide, From the Operating Room to the Emergency Department
Abstract Nitrous oxide is a gas inhalation agent that has a long history of administration in procedures requiring analgesia and sedation. Although use may be limited by patient condition, patient comorbidities, and appropriate scavenging equipment, nitrous is a proven and safe tool for use in many health care settings—from the dental office to the operating room to the emergency department. (Source: Current Emergency and Hospital Medicine Reports)
Source: Current Emergency and Hospital Medicine Reports - March 21, 2016 Category: Emergency Medicine Source Type: research

A Guide to Pain Assessment and Management in the Neonate
Abstract Newborn infants experience acute pain with various medical procedures. Evidence demonstrates that controlling pain in the newborn period is beneficial, improving physiologic, behavioral, and hormonal outcomes. Multiple validated scoring systems exist to assess pain in a neonate; however, there is no standardized or universal approach for pain management. Healthcare facilities should establish a neonatal pain control program. The first step is to minimize the total number of painful iatrogenic events when possible. If a procedure cannot be avoided, a tiered approach to manage pain using environme...
Source: Current Emergency and Hospital Medicine Reports - March 12, 2016 Category: Emergency Medicine Source Type: research