Introduction

Pediatric obesity threatens the efficacy of life-saving medications given intramuscularly to anaphylactic patients. Epinephrine auto-injector needle lengths are potentially too short to reach the muscle compartment in patients with elevated body habitus. The objective of the study was to determine needle length requirements for intramuscular injections in pediatric patients.

Methods

Ultrasound was used to measure the distance from skin to muscle compartment of the thigh in 200 pediatric patients of various weight and body mass index who presented to the Emergency Department.

Results

Patients with higher body mass index had an increased distance to muscle and bone. If current auto-injector recommendations were followed, 12% of patients weighing less than 30 kilograms and 9% of patients weighing more than 30 kilograms would have potentially used an auto-injector inadequate in needle length.

Conclusion

With the increase in childhood obesity, auto-injector needle lengths may be too short to effectively deliver medications. Needle length should be evaluated to accommodate pediatric patients with increased skin to muscle distance.

Introduction: Use of electronic health record (EHR) systems can place a considerable data entry burden upon the emergency department (ED) physician. Voice recognition data entry has been proposed as one mechanism to mitigate some of this burden; however, no reports are available specifically comparing emergency physician (EP) time use or number of interruptions between typed and voice recognition data entry-based EHRs. We designed this study to compare physician time use and interruptions between an EHR system using typed data entry versus an EHR with voice recognition.

Methods: We collected prospective observational data at 2 academic teaching hospital EDs, one using an EHR with typed data entry and the other with voice recognition capabilities. Independent raters observed EP activities during regular shifts. Tasks each physician performed were noted and logged in 30 second intervals. We compared time allocated to charting, direct patient care, and change in tasks leading to interruptions between sites.

Results: We logged 4,140 minutes of observation for this study. We detected no statistically significant differences in the time spent by EPs charting (29.4% typed; 27.5% voice) or the time allocated to direct patient care (30.7%; 30.8%). Significantly more interruptions per hour were seen with typed data entry versus voice recognition data entry (5.33 vs. 3.47; p=0.0165).

Conclusion: The use of a voice recognition data entry system versus typed data entry did not appear to alter the amount of time physicians spend charting or performing direct patient care in an ED setting. However, we did observe a lower number of workflow interruptions with the voice recognition data entry EHR. Additional research is needed to further evaluate the data entry burden in the ED and examine alternative mechanisms for chart entry as EHR systems continue to evolve. [West J Emerg Med. 2014;15(4):541-547.]

Introduction: Various types of sedation can be used for the reduction of a dislocated total hip arthroplasty. Traditionally, an Opiate/Benzodiazepine combination has been employed. The use of other pharmacologic agents, such as Etomidate and Propofol, has more recently gained popularity. Currently no studies directly comparing these sedation agents have been carried out.  The purpose of this study is to compare differences in reduction and sedation outcomes including recovery times of these three different sedation agents.

Methods: A retrospective chart review was performed examining 198 patient’s charts who presented with dislocated total hip arthroplasty at two academic affiliated medical centers. The patients were organized into groups according to the type of sedation agent used during their reduction. The percentages of reduction and sedation complications were calculated along with overall recovery times. Reduction complications included fracture, skin or neurovascular injury, and failure of reduction requiring general anesthesia. Sedation complications included use of bag-valve mask and artificial airway, intubation, prolonged recovery, use of a reversal agent, and inability to achieve sedation. The data were then compared for each sedation agent.

Results: The reduction complications rates found were 8.7% in the Propofol group, 24.68% in the Etomidate, and 28.85% in the Opiate/Benzodiazepine groups. The reduction complication rate in the Propofol group was significantly different than those of the other two agents (p≤0.01). Sedation complications were found to happen 7.25% of the time in the Propofol group, 11.69% in the Etomidate group, and 21.25% in the Opiate/ Benzodiazepine group with Propofol having complication rates significantly different than that of the Opiate/Benzodiazepine group (p=0.02). Average lengths of recovery were 25.17 minutes for Propofol, 30.83 minutes for Etomidate, and 44.35 minutes for Opiate/ Benzodiazepine with Propofol averaging a significantly less recovery time than the Opiate/Benzodiazepine group (p=0.05).