No abstract

The treatment of severe agitation, aggression, and violent behavior in behavioral health patients who present to the emergency department (ED) often requires the intramuscular administration of a sedative. However, administering an intramuscular sedative to an uncooperative patient is associated with the risk of needlestick injuries to both patients and health care providers, and times to onset of sedation range from 15 to 45 minutes. Intranasal absorption is more rapid than intramuscular, with sedatives such as lorazepam reaching peak serum concentrations up to 6 times faster when administered intranasally. We present the first report of using intranasal lorazepam as a needle-free method of providing rapid and effective sedation to treat severe agitation in a pediatric behavioral health patient presenting to the ED.

No abstract

Objective: Our objectives were to assess the comfort level of pediatric emergency physicians (PEPs) providing urgent care to adult patients on telemedicine (APOTM) when redeployed during the coronavirus disease 2019 (COVID-19) pandemic, how it changed over time, and what resources were helpful.Materials and methods: We conducted a retrospective pre-post cross-sectional survey of PEPs providing urgent care to APOTM with COVID-19 symptoms during the COVID-19 surge from March 12, 2020, to June 12, 2020 (the "care period") at two academic pediatric emergency departments in New York City. A retrospective chart review was also conducted. We include data on demographics of PEPs and adult patients; comfort level of PEPs providing urgent care to APOTM with COVID-19 symptoms pre-and post-threemonth care period and effective resources.Results: Sixty-five PEPs provided urgent care to 1515 APOTM with COVID-19 symptoms during the care period. Pre-pandemic, 22/43 (51%) of responders feared caring for APOTM; 6/43 (14%) were comfortable. At the end of the care period, 25/42 (58%) of the responders stated they were comfortable caring for these patients. Factors associated with increased comfort level were: increased volume of patients over time, treatment algorithms, group support via electronic communication, and real-time back-up by a general emergency medicine (GEM) physician. Reduced medicolegal liability was also cited. Conclusion:With minimal additional training and resources, PEPs can increase their comfort to provide urgent care to APOTM with COVID-19 symptoms. As future pandemics may disproportionately affect certain patient populations (adults versus pediatrics), interventions such as treatment algorithms, group support via emails and texts, and sub-specialty backup should be incorporated into redeployment plans for urgent care telemedicine programs. Future research is needed to determine the adaptability of other medical specialties to cross-cover a different specialty from their own if needed.

Objective During the height of the coronavirus disease‐2019 (COVID‐19) pandemic, there was a decline and shift in pediatric medical care use. We aimed to assess changes to pediatric medical use and perceptions/barriers that influenced caregivers’ decision‐making during the New York State mandated lockdown from March 22 to June 8, 2020, in a population that opted to use the pediatric emergency department (PED) during this period. This study was conducted in New York City (NYC), one of the epicenters at the height of the COVID‐19 pandemic. Methods From June 14 to December 28, 2020, a convenience sample of caregivers who brought children 0–17 years to a NYC PED completed a survey. Results Participants in the survey included 290 caregivers: 76% were Hispanic; 91% reported having accessed medical care when their children were ill during the lockdown. In‐person primary care visits decreased from 64% before to 9% during lockdown; 28% missed well‐child checkups or vaccinations, and 26% missed specialist appointments. Telemedicine usage increased from 10% to 54%; none reported lack of internet or electronic devices as barriers to using telemedicine. Regarding access to care: 36% perceived increased difficulty during the lockdown, whereas 56% felt no difference. Barriers included fear of contracting COVID‐19 and government advice to avoid health care visits for minor problems. Conclusion During the initial wave of the COVID‐19 pandemic, medical care shifted from an in‐person to a virtual platform. Identification of factors and barriers surrounding caregivers’ decision‐making may positively inform strategies toward future public health emergencies.