Falls affect more than 29 million American adults ages ≥65 years annually. Many older adults experience recurrent falls requiring medical attention. These recurrent falls may be prevented through screening and intervention. In 2014 to 2015, records for 199 older adult patients admitted from a major urban teaching hospital’s emergency department were queried. Open-ended variables from clinicians’ notes were coded to supplement existing closed-ended variables. Of the 199 patients, 52 (26.1%) experienced one or more recurrent falls within 365 days after their initial fall. Half (50.0%) of all recurrent falls occurred within the first 90 days following discharge. A large proportion of recurrent falls among older adults appear to occur within a few months and are statistically related to identifiable risk factors. Prevention and intervention strategies, delivered either during treatment for an initial fall or upon discharge from an inpatient admission, may reduce the incidence of recurrent falls among this population.

We aimed to assess physicians' perceptions of barriers to starting medication-assisted treatment (MAT) in the Emergency Department (ED), views of the utility of MAT, and abilities to link patients with opioid use disorder (OUD) to MAT programs in their respective communities. MethodsThis was a cross-sectional survey study of American emergency medicine (EM) physicians with a selfadministered online survey via SurveyMonkey (Survey Monkey, San Mateo, California). The survey was emailed to the Council of Residency Directors in Emergency Medicine (CORD) listserv and HCA Healthcare affiliated EM residency programs' listservs. Attendings and residents of all post-graduate years participated. Questions assessed perceptions of barriers to starting OUD patients on MAT, knowledge of the X-waiver, and knowledge of MAT details. Statistics were performed with JMP software (SAS Institute Inc., Cary, NC) using the two-tailed Z-test for proportions. ResultsThere were 98 responses, with 33% female, 55% resident physicians, and an overall 17% response rate. Residents were more eager to start OUD patients on MAT (71% vs 52%, p=0.04) than attendings but were less familiar with the X-waiver (38% vs 73%, p=0.001) or where community outpatient MAT facilities were (21% vs 43%, p=0.02). ConclusionBarriers in the ED were identified as a shortage of qualified prescribers, the lengthy X-waiver process, and the poor availability of outpatient MAT resources. EM residents showed more willingness to prescribe MAT but lacked a core understanding of the process. This shows an area of improvement for residency training as well as advocacy among attendings.

respiration in the normal animal, and normal neonate.We agree with Dr. Shaw that nasal obstruction can lead to death in in¬ fants, but it is less certain that nasal obstruction is a major factor in SID. As we pointed out, the first month of life is the period in which obligatory nose breathing is most prevalent, but this does not match the incidence of SID, which peaks at 3 or 4 months of age. We have additional information, which is to be published in the Jour¬ nal of Pediatrics, in which we sur¬ veyed a large number of infants who were victims of SID. With post¬ mortem radiographs, we were unable to demonstrate nasal obstruction in this group. Although these negative findings do not rule out nasal obstruc¬ tion as an explanation of SID, it must be said that there has been no posi¬ tive evidence for Dr. Shaw's theory in any substantial number of infant vic¬ tims of SID.It is our hope that the modest spec¬ ulation in our paper might stimulate further work in the control of respira¬ tion in the fetus and the neonate, and perhaps demonstrate a link to crib death. We will feel fortunate if we can stimulate as much thought and discussion as did Dr. Shaw with his excellent contributions relating to ob¬ ligatory nose breathing.

Introduction: Drug overdose represents a growing reason for emergency department visits and hospitalizations in the United States. Co-ingestion of multiple substances is also on the rise, and toxidromes can be seen from any of multiple drugs in a single patient. Case Report: We present a case of diffuse alveolar hemorrhage secondary to cocaine abuse in a patient who was apneic and unresponsive after heroin overdose. The patient responded to supportive care and was discharged with complete return to physical and mental baseline. Conclusion: Clinicians must be vigilant for any number of concomitant toxidromes when a patient is brought in with complications following drug overdose.