RESUMEN
Patients with opioid use disorder (OUD) are commonly admitted to various inpatient services where treatment can be started. The typical initiation of buprenorphine involves delay of treatment until withdrawal symptoms occur, however, those symptoms may interfere with other medical therapy. The purpose of this study was to evaluate the safety and efficacy of initiation of buprenorphine for inpatients with OUD.We reviewed the charts of 99 patients for whom the inpatient addiction medicine consult service was contacted over a 15-month period from January 2020 to identify those patients started on buprenorphine. We abstracted data on toxicology results, prior use of buprenorphine, and Clinical Opioid Withdrawal Scale (COWS) and pain scores before and after the administration of buprenorphine.There was no significant difference in COWS classification post treatment based on ancillary or non use of full agonist therapy. There was no significant change in COWS scores based on prior buprenorphine or methadone use. 5% of patients developed moderate withdrawal (COWS score 12-24) after the initiation of buprenorphine. Twenty of the study patients (20%) developed a 2-point increase in pain scores after the initiation of buprenorphine. SUMMARY: The initiation of buprenorphine for inpatients rarely results in a significant increase in withdrawal symptoms. A larger percent of patients may have an increase in pain scores which would need to be managed. Further prospective work on this subject is warranted.
Asunto(s)
Buprenorfina , Trastornos Relacionados con Opioides , Síndrome de Abstinencia a Sustancias , Analgésicos Opioides/efectos adversos , Buprenorfina/uso terapéutico , Humanos , Pacientes Internos , Narcóticos/uso terapéutico , Tratamiento de Sustitución de Opiáceos/métodos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Dolor/inducido químicamente , Dolor/tratamiento farmacológico , Síndrome de Abstinencia a Sustancias/tratamiento farmacológicoRESUMEN
OBJECTIVES: Needle decompression is potentially life-saving in cases of tension pneumothorax. Although Advanced Trauma Life Support recommends an 8-cm needle for decompression for adults, no detailed pediatric guidelines exist, specifically regarding needle length or site of decompression. METHODS: Point-of-care ultrasound was used to measure chest wall thickness (CWT), the distance between skin and pleural line, bilaterally at the second intercostal midclavicular line and the fourth intercostal anterior axillary line in children of various ages and sizes. Patients were grouped based on Broselow tape weight categories. Measurements were compared between left versus right sides at the 2 anatomic sites. Interclass correlation coefficients were calculated to assess for interrater reliability. RESULTS: A convenience sample of 163 patients from our emergency department was enrolled. For patients who fit into Broselow tape categories, CWT at the second intercostal midclavicular line ranged from 1.11 to 1.91 cm and at the fourth intercostal anterior axillary line ranged from 1.13 to 1.92 cm. In patients larger than the largest Broselow category, 77% had a CWT less than the length of a standard 1.25-in (3.175 cm) catheter. There were no significant differences in the measurements of CWT based on laterality nor anatomic site. CONCLUSIONS: The standard 1.25-in (3.175 cm) catheters are sufficient to treat most tension pneumothoraces in pediatric patients.
Asunto(s)
Neumotórax , Pared Torácica , Adulto , Niño , Descompresión Quirúrgica , Humanos , Agujas , Neumotórax/diagnóstico por imagen , Neumotórax/cirugía , Reproducibilidad de los Resultados , Pared Torácica/diagnóstico por imagen , Pared Torácica/cirugía , ToracostomíaRESUMEN
BACKGROUND: The use of big data and machine learning within clinical decision support systems (CDSSs) has the potential to transform medicine through better prognosis, diagnosis and automation of tasks. Real-time application of machine learning algorithms, however, is dependent on data being present and entered prior to, or at the point of, CDSS deployment. Our aim was to determine the feasibility of automating CDSSs within electronic health records (EHRs) by investigating the timing, data categorization, and completeness of documentation of their individual components of two common Clinical Decision Rules (CDRs) in the Emergency Department. METHODS: The CURB-65 severity score and HEART score were randomly selected from a list of the top emergency medicine CDRs. Emergency department (ED) visits with ICD-9 codes applicable to our CDRs were eligible. The charts were reviewed to determine the categorization components of the CDRs as structured and/or unstructured, median times of documentation, portion of charts with all data components documented as structured data, portion of charts with all structured CDR components documented before ED departure. A kappa score was calculated for interrater reliability. RESULTS: The components of the CDRs were mainly documented as structured data for the CURB-65 severity score and HEART score. In the CURB-65 group, 26.8% of charts had all components documented as structured data, and 67.8% in the HEART score. Documentation of some CDR components often occurred late for both CDRs. Only 21 and 11% of patients had all CDR components documented as structured data prior to ED departure for the CURB-65 and HEART score groups, respectively. The interrater reliability for the CURB-65 score review was 0.75 and 0.65 for the HEART score. CONCLUSION: Our study found that EHRs may be unable to automatically calculate popular CDRs-such as the CURB-65 severity score and HEART score-due to missing components and late data entry.