Ketamine is a safe, effective alternative to opioids in treating acute pain in the ED

Press Release:

Intravenous, low-dose ketamine (LDK) is as effective as intravenous morphine in the control of acute pain in adults in the emergency department (ED). That is the finding of a study to be published in the October 2018 issue of Academic Emergency Medicine (AEM), a journal of the Society for Academic Emergency Medicine (SAEM). The results indicate that ketamine can be considered as an alternative to opioids for ED short-term pain control.

The lead author of the study is Nicholas Karlow, MPHS, a medical student at the Washington University School of Medicine in St. Louis, Missouri. The findings of the study are discussed in the featured episode of SGEM Hop (Skeptics Guide to EM Hot Off the Press).

The systematic review and meta-analysis by Karlow, et al. maintains that there is a role for opioids in the treatment of pain in the ED, but suggest that as physicians continue to face pressure to reduce opioid use, it is important to establish that alternatives such as ketamine are comparable in providing patients with appropriate analgesia in a similar time frame.

The study further suggests that for patients with opioid use disorders or substance use disorders that require a potent analgesic in the emergency department, ketamine may be a favorable option compared to an opioid.

Moving forward, the authors suggest that observational studies assessing adverse events should use similar outcome measures and time frames, and that researchers should explore patient and physician satisfaction with ketamine analgesia and side effects compared to other opioid alternatives for acute pain.

“Karlow and colleagues provide persuasive evidence that emergency physicians can reasonably expect sub-dissociative ketamine to be as effective as morphine for patients with acute abdominal or musculoskeletal pain. Minor ketamine adverse effects will likely prevent this therapy from becoming routinely first line, but low dose ketamine represents a good alternative choice for selected patients,” commented Steven M. Green, MD, professor of emergency medicine and residency director at Loma Linda University, California.

Dr. Green’s principal research interest has been on procedural sedation and analgesia, with numerous studies of ketamine dating back to 1990 and more recent works relating to sedation’s optimal practice, politics, and future. He is a deputy editor at Annals of Emergency Medicine journal.

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About Academic Emergency Medicine

Academic Emergency Medicine, the monthly journal of Society for Academic Emergency Medicine, features the best in peer-reviewed, cutting-edge original research relevant to the practice and investigation of emergency care. The above study is published open access and can be downloaded by following the DOI link: https://doi.org/10.1111/acem.13502. Journalists wishing to interview the authors may contact Stacey Roseen at sroseen@saem.org.

About the Society for Academic Emergency Medicine

SAEM is a 501(c)(3) not-for-profit organization dedicated to the improvement of care of the acutely ill and injured patient by leading the advancement of academic emergency medicine through education and research, advocacy, and professional development. To learn more, visit saem.org.

UI Hospitals debuts more help for mental health patients

From the Gazette:

With the new unit in play, patients who arrive in the ER with a mental health concern will be evaluated, checked for medical issues and transferred to the stabilization space, where professionals will craft a treatment plan that could include medication, therapy and referral to community resources.

In a calmly-lit room with an open layout that includes several private spaces, reclining chairs, a place to get clean and storage for belongings, patients will have — ideally — 20 to 24 hours to either stabilize and head home or find a bed in the hospital or with a community partner.

Strengthening Health and Health Care in Rural America

From the Commonwealth Fund:

Sustaining and developing new access points for prioritized population health and health care services should be a top priority, given the high levels of need in rural communities. Compared with other regions, rural communities have higher proportions of elderly residents, higher rates of uninsured residents, greater burden of chronic diseases, and higher rates of poverty.

Rural America also needs next-generation care models that incorporate disease prevention and chronic disease management and attend to the social determinants of health, particularly food insecurity and transportation challenges, which are common in rural areas.

How Independence, Kansas, survived losing its hospital and what it means for endangered health care in rural Kansas

From The Journal:

When Independence saw its hospital close in the fall of 2015, it exemplified the challenges facing rural health care in a state that has not expanded its Medicaid program. But when it came to meeting the medical needs of residents, the community found a way to not just survive but thrive. The process has been contentious and chaotic at times. Rather than closing the book on the state’s ongoing Medicaid expansion debate, the Independence story opens it wider.

A Quality Framework for Emergency Department Treatment of Opioid Use Disorder

From the Annals of EM

Emergency clinicians are on the front lines of responding to the opioid epidemic and are leading innovations to reduce opioid overdose deaths through safer prescribing, harm reduction, and improved linkage to outpatient treatment. Currently, there are no nationally recognized quality measures or best practices to guide emergency department quality improvement efforts, implementation science researchers, or policymakers seeking to reduce opioid-associated morbidity and mortality. To address this gap, in May 2017, the National Institute on Drug Abuse’s Center for the Clinical Trials Network convened experts in quality measurement from the American College of Emergency Physicians’ (ACEP’s) Clinical Emergency Data Registry, researchers in emergency and addiction medicine, and representatives from federal agencies, including the National Institute on Drug Abuse and the Centers for Medicare & Medicaid Services. Drawing from discussions at this meeting and with experts in opioid use disorder treatment and quality measure development, we developed a multistakeholder quality improvement framework with specific structural, process, and outcome measures to guide an emergency medicine agenda for opioid use disorder policy, research, and clinical quality improvement.

Tight Iowa congressional races key on pre-existing condition protections

From Modern Healthcare:

The battle over keeping the Affordable Care Act’s strong insurance protections for people with pre-existing medical conditions has surged to the center of tight House and Senate contests across the country.

But the issue has become particularly heated in two toss-up House races in Iowa. Unregulated Farm Bureau health plans will go on sale Nov. 1, and they can consider pre-existing conditions under a new state law. It’s expected that some Iowans applying for the cheaper Farm Bureau plans will get turned down or will be quoted higher rates based on their health status. That could raise the stakes for voters.

Katie Heldt Named IHA Outstanding Nurse Executive for 2018

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The Iowa Hospital Association’s 2018 Outstanding Nurse Executive is Katie Heldt, chief nurse executive at Green County Medical Center in Jefferson. Heldt is a registered nurse and has worked in health care for more than 30 years. Her experience includes clinical and leadership roles at both rural and urban facilities. She was honored as one of Iowa’s 100 Great Nurses in 2013.