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Mehmood N, Nesiama JAO, Yen K, Dhar A, Lowe GS. Assessing the New Norm: A Simulation Study to Assess Pediatric Emergency Physician Success in Critical Procedures With an Air Purifying Respirator. Pediatr Emerg Care 2023; 39:e86-e89. [PMID: 37205872 DOI: 10.1097/pec.0000000000002976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Physicians caring for patients with COVID-19 are at high risk for contracting the disease, thus, significant emphasis has been placed on personal protective equipment (PPE). The study aims to assess the impact of advanced PPE across 4 common procedures: endotracheal intubation, bag-valve mask ventilation, intraosseous (IO) insertion, and lumbar puncture (LP) performed by pediatric emergency physicians. METHOD Physicians performed the procedures in a simulated environment. Lumbar puncture and IO were performed with standard precautions versus an air purifying respirator (APR). A direct comparison was drawn for endotracheal intubation and bag-valve mask ventilation between 2 commonly used APRs. Success rate and number of attempts toward successful completion was recorded for all 4 procedures. Physicians filled out a postprocedure survey to assess their ease of use of the APR. RESULTS Twenty participants performed IO and LP using an APR and standard precautions. There was no statistical difference in the success rate, number of attempts, average time, or maintenance of sterility (LP only) for both procedures. Twenty total participants divided across 2 types of APR groups performed intubation and BMV. Success rate and number of attempts had no statistical difference for both procedures. Physician feedback surveys to assess the ease of use of APR compared with standard precautions had no statistically significant difference for all 4 procedures. CONCLUSIONS Wearing increased levels of PPE did not impact procedural success, length of time, sterility, number of attempts, or the physicians' ease in our study. Physicians should be encouraged to wear all appropriate PPE.
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Affiliation(s)
- Noormah Mehmood
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Jo-Ann O Nesiama
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Kenneth Yen
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Archana Dhar
- Division of Pediatric Critical Care, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Geoffrey S Lowe
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
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Harris MI, Adelgais KM, Linakis SW, Magill CF, Brazauskas R, Shah MI, Nishijima DK, Lowe GS, Chadha K, Chang TP, Lerner EB, Leonard JC, Schwartz HP, Gaither JB, Studnek JR, Browne LR. Impact of Prehospital Pain Management on Emergency Department Management of Injured Children. PREHOSP EMERG CARE 2023; 27:1-9. [PMID: 34734787 DOI: 10.1080/10903127.2021.2000683] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Provision of analgesia for injured children is challenging for Emergency Medical Services (EMS) clinicians. Little is known about the effect of prehospital analgesia on emergency department (ED) care. We aimed to determine the impact of prehospital pain interventions on initial ED pain scale scores, timing and dosing of ED analgesia for injured patients transported by EMS. METHODS This is a planned, secondary analysis of a prospective multicenter cohort of children with actual or suspected injuries transported to one of 11 PECARN-affiliated EDs from July 2019-April 2020. Using Wilcoxon rank sum for continuous variables and chi-square testing for categorical variables, we compared the change in EMS-to-ED pain scores and timing and dosing of ED-administered opioid analgesia in those who did and those who did not receive prehospital pain interventions. RESULTS We enrolled 474 children with complete prehospital and ED pain management data. Prehospital interventions were performed on 262/474 (55%) of injured children and a total of 88 patients (19%) received prehospital opioids. Children who received prehospital opioids with or without adjunctive non-pharmacologic pain management experienced a greater reduction in pain severity and were more likely to receive ED opioids in higher doses earlier and throughout their ED care. Non-pharmacologic pain interventions alone did not impact ED care. CONCLUSIONS We demonstrate that prehospital opioid analgesia is associated with both a significant reduction in pain severity at ED arrival and the administration of higher doses of opioid analgesia earlier and throughout ED care.
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Affiliation(s)
- M I Harris
- Department of Pediatrics, Northwell Hofstra School of Medicine, New Hyde Park, New York
| | - K M Adelgais
- Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - S W Linakis
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - C F Magill
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina
| | - R Brazauskas
- Department of Institute for Health Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - M I Shah
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | - D K Nishijima
- Department of Emergency Medicine, University of California - Davis, Sacramento, California
| | - G S Lowe
- Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
| | - K Chadha
- Department of Emergency Medicine, University at Buffalo, Buffalo, New York
| | - T P Chang
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - E B Lerner
- Department of Emergency Medicine, University at Buffalo, Buffalo, New York
| | - J C Leonard
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - H P Schwartz
- Division of Emergency Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - J B Gaither
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona
| | - J R Studnek
- Mecklenburg EMS Agency, Charlotte, North Carolina
| | - L R Browne
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Nishijima DK, Tancredi DJ, Adelgais KM, Chadha K, Chang TP, Harris MI, Leonard JC, Lerner EB, Linakis SW, Lowe GS, Magill CF, Schwartz HP, Shah MI, Browne LR. Impact of Race and Ethnicity on Emergency Medical Services Administration of Opioid Pain Medications for Injured Children. J Emerg Med 2023; 64:55-61. [PMID: 36641254 DOI: 10.1016/j.jemermed.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/04/2022] [Accepted: 10/11/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Treatment with analgesics for injured children is often not provided or delayed during prehospital transport. OBJECTIVE Our aim was to evaluate racial and ethnic disparities with the use of opioids during transport of injured children. METHODS We conducted a prospective study of injured children transported to 1 of 10 emergency departments from July 2019 to April 2020. Emergency medical services (EMS) providers were surveyed about prehospital pain interventions during transport. Our primary outcome was the use of opioids. We performed multivariate regression analyses to evaluate the association of patient demographic characteristics (race, ethnicity, age, and gender), presence of a fracture, EMS provider type (Advanced Life Support [ALS] or non-ALS) and experience (years), and study site with the use of opioids. RESULTS We enrolled 465 patients; 19% received opioids during transport. The adjusted odds ratios (AORs) for Black race and Hispanic ethnicity were 0.5 (95% CI 0.2-1.2) and 0.4 (95% CI 0.2-1.3), respectively. The presence of a fracture (AOR 17.0), ALS provider (AOR 5.6), older patient age (AOR 1.1 for each year), EMS provider experience (AOR 1.1 for each year), and site were associated with receiving opioids. CONCLUSIONS There were no statistically significant associations between race or ethnicity and use of opioids for injured children. The presence of a fracture, ALS provider, older patient age, EMS provider experience, and site were associated with receiving opioids.
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Affiliation(s)
- Daniel K Nishijima
- Department of Emergency Medicine, University of California, Davis, Sacramento, California.
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis, Sacramento, California
| | - Kathleen M Adelgais
- Departments of Pediatrics and Emergency Medicine, University of Colorado, Aurora, Colorado
| | - Kunal Chadha
- Department of Pediatrics, University of Buffalo, Buffalo, New York
| | - Todd P Chang
- Children's Hospital of Los Angeles and Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Matthew I Harris
- Department of Pediatrics, Cohen Children's Medical Center, Zucker School of Medicine - Hofstra University, New Hyde Park, New York
| | - Julie C Leonard
- Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - E Brooke Lerner
- Departments of Emegency Medicine and Pediatrics, University of Buffalo, Buffalo, New York
| | - Seth W Linakis
- Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Geoffrey S Lowe
- Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
| | - Christyn F Magill
- Children's Hospital of Los Angeles and Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina
| | - Hamilton P Schwartz
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Manish I Shah
- Department of Pediatrics, Division of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | - Lorin R Browne
- Departments of Pediatrics and Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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