Predicting Severe Alcohol Withdrawal

Predicting Severe Alcohol Withdrawal

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).

RICO? Rest, Ice, Compression, Opiate for Ankle Sprain?

RICO? Rest, Ice, Compression, Opiate for Ankle Sprain?

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.

New Risk After TBI - Suicide

New Risk After TBI - Suicide

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.

Midazolam Beat Haloperidol for Agitation

Midazolam Beat Haloperidol for Agitation

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.

Just Drunk or Critically Ill?

Just Drunk or Critically Ill?

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.

Supply of Opiates - Who's Prescribing Them?

Supply of Opiates - Who's Prescribing Them?

Episodic prescribers (most prescribers in the ED) contributed to less than 3% of the total morphine milligram equivalents prescribed, compared to the top 5% of prescribers who were responsible for 48.8%. Efforts to curb the opioid supply may be better served by targeting high-quantity prescribers.

Post-op Rx for Opiates and Subsequent Abuse

Post-op Rx for Opiates and Subsequent Abuse

Total duration of opioid use was the strongest predictor of misuse. Each refill and additional week of opioid use increased the hazard of misuse by 44% and 19.9% respectively. Shorter prescriptions (<2 weeks) of high vs low dosage prescriptions had a lower hazard.

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