No abstract

A moderate dose of IV dexamethasone should not be administered routinely for the emergency department-based treatment of acute migraine, although it might be useful for patients with migraine lasting longer than 72 hours.

Standard resuscitation and IFE increase MAP and survival in an animal model of severe verapamil toxicity compared with standard resuscitation alone.

Objectives: Recent animal studies have shown that intravenous fat emulsion (IFE) increases survival and hemodynamics in severe verapamil toxicity. However, the optimal dose of IFE is unknown. The primary objective was to determine the optimal dose of IFE based on survival in severe verapamil toxicity. Secondary objectives were to determine the effects on hemodynamic and metabolic parameters. The hypothesis was that there is a dose-dependent effect of IFE on survival until a maximum dose is reached.Methods: This was a controlled dose-escalation study. Thirty male rats were anesthetized, ventilated, and instrumented to record mean arterial pressure (MAP) and heart rate (HR). Verapamil toxicity was achieved by a constant infusion of 15 mg ⁄ kg ⁄ hr. After 5 minutes, a bolus of 20% IFE was given. Animals were divided into six groups based on differing doses of IFE. Arterial base excess (ABE) was measured every 30 minutes. Data were analyzed with analysis of variance. Results:The mean survival time for each dose of IFE was 0 mL ⁄ kg = 34 minutes, 6.2 mL ⁄ kg = 58 minutes, 12.4 mL ⁄ kg = 63 minutes, 18.6 mL ⁄ kg = 143.8 minutes, 24.8 mL ⁄ kg = 125.6 minutes, and 37.6 mL ⁄ kg = 130 minutes. Post hoc testing determined that the 18.6 mL ⁄ kg dose resulted in the greatest survival when compared to other doses. It increased survival 107.2 minutes (p = 0.004), 91.2 minutes (p = 0.001), and 80.8 minutes (p = 0.023) when compared to the lower doses of 0, 6.2, and 12.4 mL ⁄ kg, respectively. There was no added benefit to survival for doses greater than 18.6 mL ⁄ kg. The secondary outcomes of HR, MAP, and ABE showed the most benefit with 24.8 mL ⁄ kg of IFE at both 30 and 60 minutes. Conclusions:The greatest benefit to survival occurs with 18.6 mL ⁄ kg IFE, while the greatest benefit to HR, MAP, and BE occurs at 24.8 mL ⁄ kg IFE. The optimal dose for the treatment of severe verapamil toxicity in this murine model was 18.6 mL ⁄ kg.

ILE appears to be effective for reversal of cardiovascular or neurological features in some cases of LA toxicity, but there is currently no convincing evidence showing that ILE is more effective than vasopressors or to indicate which treatment should be instituted as first line therapy in severe LA toxicity.

Computer-based video provides a valuable tool for HIV prevention in hospital emergency departments. However, the type of video content and protocol that will be most effective remain underexplored and the subject of debate. This study employs a new and highly replicable methodology that enables comparisons of multiple video segments, each based on conflicting theories of multimedia learning. Patients in the main treatment areas of a large urban hospital’s emergency department used handheld computers running custom-designed software to view video segments and respond to pre-intervention and postintervention data collection items. The videos examine whether participants learn more depending on the race of the person who appears onscreen and whether positive or negative emotional content better facilitates learning. The results indicate important differences by participant race. African American participants responded better to video segments depicting White people. White participants responded better to positive emotional content.

The Centers for Disease Control and Prevention (CDC) recommend routine HIV screening in clinical settings, including emergency departments (EDs), because earlier diagnosis enables treatment before symptoms develop and delivery of interventions to reduce continued transmission. However, patients frequently decline testing. This study delivered a 16-minute video-based intervention to 160 patients who declined HIV tests in a high volume, urban ED. One third of participants (N=53) accepted an HIV test post-intervention. Interviews with a subset of participants (n=40) show that before the video, many were unaware HIV testing could be conducted without drawing blood, or that results could be delivered in 20 minutes.

Although video is increasingly used in public health education, studies generally do not implement randomized trials of multiple video segments in clinical environments. Therefore, the specific configurations of educational videos that will have the greatest impact on outcome measures ranging from increased knowledge of important public health issues, to acceptance of a voluntary HIV test, remain largely unknown. Interventions can be developed to run on affordable handheld computers, including inexpensive tablets or netbooks that each patient can use individually, and to integrate video delivery with automated data collection. These video interventions can then be used not only to educate patients who otherwise might not be reached, but to examine how content can be optimized for greater effectiveness as measured by cognitive and behavioral outcomes. This approach may prove especially valuable in high volume urban facilities, such as hospital emergency departments, that provide points of contact for lower income, lower literacy, and high-risk populations who may not otherwise interact with healthcare providers or researchers. This article describes the development and evaluation of an intervention that educates emergency department patients about HIV prevention and testing while comparatively examining a set of videos, each based upon competing educational theories. The computer-based video intervention and methodology are both highly replicable and can be applied to subject areas and settings far beyond HIV or the emergency department.