Ketamine Infusion for Acute Sickle Cell Crisis in the Emergency Department
PainSickle Cell DisorderPain associated with sickle cell disease is a common emergency department visit. It is also frequently associated with a high emergency department recidivism rate for pain control and admissions to the hospital. Opiates are considered the first line therapy for acute flares and to manage chronic pain. This often times leads to a stigma of being "opiate seekers" or "frequent fliers". With this study, we wish to explore whether adding ketamine to standard acute opiate therapy (morphine or dilaudid) will decrease subsequent repeat doses of opiates while improving the patient's perception of pain. In addition, we will be exploring whether ketamine as an adjuvant therapy can help reduce hospital admissions for the management of acute sickle cell crisis pain.
IM Olanzapine Versus Haloperidol or Midazolam
Acute AgitationBehavioural EmergencyThe purpose of this study is to determine whether intramuscular olanzapine is safer (fewer adverse events) and more effective (shorter time to sedation) than conventional haloperidol or midazolam when used in the management of acute agitation in the emergency department.
Ketamine and Morphine Versus Morphine Alone for the Treatment of Acute Pain in the Emergency Department...
Acute PainOur goal is to study whether giving people low dose ketamine along with morphine when they come to the Emergency Department will help their pain more than giving morphine by itself. There have been many studies showing that low dose ketamine is safe and effective for pain control. Ketamine is frequently used for pain control in ambulances and helicopters transporting injured patients to the hospital and has also been used for pain control in people who have just had surgery. The investigators would like to see if low dose ketamine would be safe and effective for patients with pain in the Emergency Department. Patients are eligible for the study if they come to the Emergency Department and their treating physician decides to treat them with morphine (with certain exceptions such as pregnant patients and patients with eye injuries). They will be given information about participating in the study and if they agree, they will be given the study drug. The study drug will be either ketamine or salt water (saline). If patients continue to be in pain they will continue to receive doses of morphine just as they would if they were not in the study. If the treating physician feels that morphine alone is not enough, they will be free to choose another pain medication as they would normally.
Intranasal Ketamine for Anxiolysis in Pediatric Emergency Department Patients
AnxietyPediatric ALL1 moreInvestigators plan to conduct a randomized, double-blinded, controlled study among pediatric patients requiring minor procedures in the Emergency Department setting. Patients will be randomized to one of two arms of intranasal treatments: ketamine 1.0 mg/kg (K) or midazolam 0.3 mg/kg (M). The primary outcome will be change in anxiety using the Modified Yale Preoperative Anxiety Scale (mYPAS).
Intracutaneous Sterile Water Injections for Acute Low Back Pain in the Emergency Department
Low Back PainThe purpose of this study is to evaluate the efficacy of intracutaneous sterile water injections (ISWI) for treatment of acute low back pain in patients presenting to the emergency department. The primary aim is to determine if ISWI provides pain relief for acute low back pain in the ED. The secondary aim is to evaluate whether ISWI provides improved patient satisfaction in the ED setting. The hypothesis is that ISWI will improve pain amongst patients presenting with acute low back pain to the ED.
Older Emergency Department Users and Short-term Adverse Events at the Index Visit
Health ImpairmentAdverse Event1 moreThis study evaluates the difference between PRISMA-7 and ER2 tool. There are some differences between PRISMA-7 and ER2 tool. The differences consist in evaluation criteria that are used to perform the both surveys. We suppose that evaluation criteria of PRISMA-7 is not accurately enough to calculate the length of hospital stay and to predict the short-term outcomes.
Risk for Short-term Adverse Events in Older Users in the Emergency Department
Old AgeMedical Care1 moreThe study evaluates the performance criteria of abnormal PRISMA-7 score, length of stay in Emergency department and in hospital, and hospital admission in older Emergency department users.
Establishing a Cohort for Occupational Disease of Emergency Medical Workers
Occupational DiseasesEmergency DepartmentsThis study aims to understand the epidemiological characteristics, related factors , and current status of occupational diseases and damage that occur in emergency medical workers (doctors and nurses). A number of surveys were conducted on about 100 emergency medical workers for about a year with occupational factors, physical health, and mental health.
Video-instructed First Aid in Emergency Medical Call Centers
InjuriesEmergenciesVideo streaming as an additional tool to telephone was introduced in some Norwegian emergency medical call centers during the spring of 2020. This allows the dispatchers to communicate with the caller through video streaming during emergency calls. Some studies are conducted on this use of video streaming, but further research is needed. In this study, the investigators have chosen to focus on potential effect from video streaming on bystander first aid for injured patients. The investigators have knowledge from preliminary results that dispatchers often find video streaming useful in emergency calls regarding injuries. This study will investigate whether the use of video streaming might have an effect on the recognition rate by dispatchers on the need for bystander first aid for injured patients. In addition, the investigators will investigate whether video-instructions from dispatcher can improve bystander first aid quality. The investigators will be using data collected by ambulance personnel including patients with injuries, as well as data from EMCC journals and audio logs.
Initiating Ketamine in Acutely Suicidal Patients in the Emergency Department
SuicideSuicide Threat1 moreCurrent treatment for acutely suicidal patients are limited to hospitalization, psychotherapy, electro-convulsant therapy, or a combination of the aforementioned. However, this has added to the national boarding problem. Long term pharmacologic treatment for suicidal behaviors and mood stabilization has been studied in specific populations. In these populations, the decreases in suicidal ideation results from stabilization of the underlying psychiatric illness. Ketamine is most commonly used as an anesthetic with analgesic properties. It has been used off-label for pain management, procedural sedation, status epilepticus, and treatment resistant depression. It has been safely administered intravenously and well tolerated for chronic Post Traumatic Stress Disorder. It increases norepinephrine, dopamine, and serotonin through adrenergic neuron stimulation and prevention of catecholamine uptake. There is a strong corollary between stress and the development of depression and suicidal behaviors. It is proposed that the use of low dose intravenous ketamine may have benefit on the suicidal ideation of patients presenting to the Emergency Department.