Comprehensive drug screening in decision making of patients attending the emergency department for suspected drug overdose

Dologesic is a commonly prescribed analgesic in accident and emergency department. Yet report of overdose with this drug is not common. We report a case in which the patient developed cardiac arrest within an hour of ingestion. Dextropropoxyphene, a component of the drug Dologesic, used to be a common cause of fatalities after drug overdose in the seventies. It is highly toxic in overdose and therefore caution should be exercised when prescribing this drug.

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Exploring Factors Affecting the Emergency Specialists’ Decision-Making in Case of Emergencies in Patients

Critical Care Research and Practice ◽

10.1155/2018/9579807 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Abbasali Ebrahimian ◽

Seyed-Hossein Hashemi-Amrei ◽

Mohammadreza Monesan

Keyword(s):

Decision Making ◽

Emergency Department ◽

Qualitative Content Analysis ◽

Decision Makers ◽

Decision Making Process ◽

Factors Affecting ◽

Emergency Situations ◽

The Core ◽

Semistructured Interviews ◽

Emergency Decision

Introduction. Appropriate decision-making is essential in emergency situations; however, little information is available on how emergency decision-makers decide on the emergency status of the patients shifted to the emergency department of the hospital. This study aimed at explaining the factors that influence the emergency specialists’ decision-making in case of emergency conditions in patients. Methods. This study was carried out with a qualitative content analysis approach. The participants were selected based on purposive sampling by the emergency specialists. The data were collected through semistructured interviews and were analyzed using the method proposed by Graneheim and Lundman. Results. The core theme of the study was “efforts to perceive the acute health threats of the patient.” This theme was derived from the main classes, including “the identification of the acute threats based on the patient’s condition” and “the identification of the acute threats based on peripheral conditions.” Conclusions. The conditions governing the decision-making process about patients in the emergency department differ from the conditions in other health-care departments at hospitals. Emergency specialists may have several approaches to decide about the patients’ emergency conditions. Therefore, notably, the emergency specialists’ working conditions and the others’ expectations from these specialists should be considered.

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Decision-Making Processes of Patients Who Use the Emergency Department for Primary Care Needs

Journal of Health Care for the Poor and Underserved ◽

10.1353/hpu.2013.0140 ◽

2013 ◽

Vol 24 (3) ◽

pp. 1288-1305 ◽

Cited By ~ 29

Author(s):

Eric K. Shaw ◽

Jenna Howard ◽

Elizabeth C. Clark ◽

Rebecca S. Etz ◽

Rajiv Arya ◽

...

Keyword(s):

Primary Care ◽

Decision Making ◽

Emergency Department ◽

Care Needs ◽

Decision Making Processes

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Descriptive exploration of overdose codes in hospital and emergency department discharge data to inform development of drug overdose morbidity surveillance indicator definitions in ICD-10-CM

Injury Prevention ◽

10.1136/injuryprev-2019-043520 ◽

2021 ◽

Vol 27 (S1) ◽

pp. i27-i34

Author(s):

Leigh M Tyndall Snow ◽

Katelyn E Hall ◽

Cody Custis ◽

Allison L Rosenthal ◽

Emilia Pasalic ◽

...

Keyword(s):

Emergency Department ◽

Adverse Effects ◽

Drug Overdose ◽

International Classification Of Diseases ◽

Primary Diagnosis ◽

Epidemiological Surveillance ◽

Discharge Data ◽

Aggregated Data ◽

Data Coding ◽

Icd 10

BackgroundIn October 2015, discharge data coding in the USA shifted to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), necessitating new indicator definitions for drug overdose morbidity. Amid the drug overdose crisis, characterising discharge records that have ICD-10-CM drug overdose codes can inform the development of standardised drug overdose morbidity indicator definitions for epidemiological surveillance.MethodsEight states submitted aggregated data involving hospital and emergency department (ED) discharge records with ICD-10-CM codes starting with T36–T50, for visits occurring from October 2015 to December 2016. Frequencies were calculated for (1) the position within the diagnosis billing fields where the drug overdose code occurred; (2) primary diagnosis code grouped by ICD-10-CM chapter; (3) encounter types; and (4) intents, underdosing and adverse effects.ResultsAmong all records with a drug overdose code, the primary diagnosis field captured 70.6% of hospitalisations (median=69.5%, range=66.2%–76.8%) and 79.9% of ED visits (median=80.7%; range=69.8%–88.0%) on average across participating states. The most frequent primary diagnosis chapters included injury and mental disorder chapters. Among visits with codes for drug overdose initial encounters, subsequent encounters and sequelae, on average 94.6% of hospitalisation records (median=98.3%; range=68.8%–98.8%) and 95.5% of ED records (median=99.5%; range=79.2%–99.8%), represented initial encounters. Among records with drug overdose of any intent, adverse effect and underdosing codes, adverse effects comprised an average of 74.9% of hospitalisation records (median=76.3%; range=57.6%–81.1%) and 50.8% of ED records (median=48.9%; range=42.3%–66.8%), while unintentional intent comprised an average of 11.1% of hospitalisation records (median=11.0%; range=8.3%–14.5%) and 28.2% of ED records (median=25.6%; range=20.8%–40.7%).ConclusionResults highlight considerations for adapting and standardising drug overdose indicator definitions in ICD-10-CM.

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Defining criteria to choose appropriate destination hospital for trauma patients: Piacenza Local Health Authority’s Piacenza trauma algorithm protocol

Emergency Care Journal ◽

10.4081/ecj.2016.5359 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

Fabio Mozzarelli ◽

Stefano Nani ◽

Enrica Rossi ◽

Mario Pizzamiglio

Keyword(s):

Decision Making ◽

Emergency Department ◽

Observational Study ◽

Electronic Device ◽

Local Health ◽

Trauma Patients ◽

Medical Facility ◽

Provincial Hospital ◽

Trauma Algorithm ◽

Data Context

Ambulance crew’s choosing of appropriate destination hospital for trauma patients can affect survival and morbidity outcomes. Aim of the present study is to devise a decision-making algorithm in order to allow the best choice of destination hospital for trauma patients and to apply it on an electronic device able to facilitate the decision made by ambulance staff. The method used was analysis of literature data, context and workload with a retrospective observational study. A comparison between the destination hospitals actually chosen and those that could have been chosen with the <em>Piacenza trauma algorithm</em> has been applied. The data shows a 9.5% (P>0.10) more advantageous change in appropriateness in the choice of medical facility and a 1.4% increase in admissions to the Emergency Department of the provincial hospital. The creation and use of a medical protocol and its consequent installation on an electronic device (tablet) that can be shared over a computer platform could help medical staff make appropriate pre-hospital choices as regards the destination hospital for trauma patients.

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