Individual risk factors associated with the development of severe alcohol withdrawal syndrome (SAWS) included a history of delirium tremens and baseline BP ≥ 140mmHg but no individual symptoms or signs associated with exclusion of SAWS. Composite measures fared better, such as the Prediction of Alcohol Withdrawal Severity Scale; a score ≥ 4 had a LR of 174 (95% CI 43-696).

EMS providers had 39% greater odds of death by suicide than the general population in this Arizona-based sample. This problem is real. Reach out if you need help. See below.

Ketamine was effective for treatment of agitation, but 30% of patients given higher doses IM by EMS were intubated once in the ED.

Although opioids are not first-line treatment for ankle sprains, an opioid was prescribed for 25% of emergency department patients diagnosed with an isolated ankle sprain. Prescribing varied widely among states. Additionally, patients prescribe greater quantities of opioids were more likely to transition to continued use.

The incidence of suicide nearly doubled in patients who had traumatic brain injury (TBI) compared to baseline.  Risk increased with severity of injury, number of visits, and was highest in the first 6 months post-injury.

Patient preference for a specific analgesic should raise concern that the individual is at greater risk for overdose.

Midazolam 5mg IM beat haloperidol 5 mg, ziprasidone 20 mg, olanzapine 10 mg, and haloperidol 10 mg (all also given IM), with 71% sedated at 15 minutes.  Olazapine came in second.

Volume of children and teens needing psychiatric care in the PED has doubled, and length of stay has gone from 5 to 17 hours.

Risk of completed suicide in young adults or adolescents was much higher in the year following a self-harm event, especially if by a violent means.

One percent of patients presenting with acute alcohol intoxication eventually needed critical care admission.  Be wary of abnormal vital signs, hypoglycemia, or the need for additional chemical sedation, as these were associated with an increased odds of needing the ICU in such people.