Annals of Emergency Medicine

Use of Pharmacologic Sleep Aids and Stimulants Among Emergency Medicine Staff Physicians in a Canadian Tertiary Care Setting: A Web-Based Survey

Presented at the Canadian Association of Emergency Physicians national conference, June 2016, Quebec City, Quebec, Canada.

Marc N. Francis, MD, FRCPC

Study objective

Emergency medicine by its nature requires shift work that follows an erratic and unpredictable pattern. Faced with this challenge, we hypothesize that many emergency physicians have taken steps to minimize their personal sleep deprivation through the use of pharmacologic sleep aids. The extent and nature of pharmacologic sleep aid use in this population is not well studied. We seek to describe the use of pharmacologic sleep aids among practicing emergency physicians in a Canadian tertiary care setting.

Methods

A cross-sectional descriptive Web-based survey was sent by e-mail to all practicing staff emergency physicians within the Calgary zone of Alberta Health Services. Descriptive statistics were used to assess frequencies and explore associations between selected variables.

Results

Of the 198 eligible emergency physicians, 144 (73%) completed the survey. Ninety-six emergency physicians (67%; 95% confidence interval [CI] 59% to 74%) had used a pharmacologic sleep aid at some time in their career, and 81 (56%; 95% CI 48% to 64%) were currently using one with any frequency. The most frequent sleep aids being used by physician respondents were nonbenzodiazepine hypnotics (38%), alcohol (17%), and melatonin (15%). Sixty-five respondents (45%; 95% CI 37% to 53%) required a prescription for their pharmacologic sleep aid and 38 (58%; 95% CI 46% to 70%) of those had obtained a prescription from an emergency physician colleague. None of the physicians believed that their use of pharmacologic sleep aids adversely affected their ability to provide quality patient care.

Conclusion

Pharmacologic sleep aid use among Canadian emergency physicians may be more common than previously assumed. This could have implications for physician well-being and performance.

 

Normal Saline Solution and Lactated Ringer’s Solution Have a Similar Effect on Quality of Recovery: A Randomized Controlled Trial

Presented at the Society for Academic Emergency Medicine (SAEM) Great Plains regional meeting, September 2017, Columbia, MO; and the SAEM annual meeting, May 2018, Indianapolis, IN.

Andrew Friederich, BA, Natalie Martin, BA, Morgan B. Swanson, BS, Brett A. Faine, PharmD, MS, Nicholas M. Mohr, MD, MSnicholas.mohr@uiowa.edu

Study objective

The purpose of this study is to test the hypothesis that balanced crystalloids improve quality of recovery more than normal saline solution (0.9% sodium chloride) in stable emergency department (ED) patients. Secondary outcomes measured differences in health care use.

Methods

A single-site, participant- and evaluator-blinded, 2-arm parallel allocation (1:1), comparative effectiveness, randomized controlled trial allocated adults receiving intravenous fluids in the ED before discharge to receive 2 L of lactated Ringer’s solution or normal saline solution. The primary outcome was symptom scores measured by the validated Quality of Recovery–40 instrument (scores 40 to 200) 24 hours after enrollment. Secondary outcomes included subsequent health care use and medication compliance.

Results

Participants (N=157) were enrolled and follow-up was analyzed for 94 (follow-up rate of 60%) with intention-to-treat methodology. There was no difference in postenrollment Quality of Recovery–40 scores between normal saline solution and lactated Ringer’s solution groups (mean difference 2.4; 95% confidence interval [CI] –6.8 to 11.6). Although preenrollment scores were higher in the lactated Ringer’s solution group (mean difference 10.5; 95% CI 1.9 to 19.0), adjusting for presurvey imbalances did not change the primary outcome (adjusted difference –3.9; 95% CI –12.9 to 5.2). There were no differences in return to ED (mean difference 7.5%; 95% CI –8.7% to 23.8%), prescriptions filled (mean difference 22.2%; 95% CI –3.3% to 47.6%), or seeking care from another provider (mean difference –2.0%; 95% CI –19.9% to 15.9%) at 7 days.

Conclusion

Normal saline solution and lactated Ringer’s solution were associated with similar 24-hour recovery scores and 7-day health care use in stable ED patients. These results supplement those of recent trials by informing fluid choice for stable ED patients.

 

Subarachnoid Mirage: A Case of Pseudosubarachnoid Hemorrhage

Mario A. Camacho, MD, Jeff Druck, MD

A 22-year-old man with a history of intravenous methamphetamine use presented with severe headache for 5 days, was afebrile, and had nuchal rigidity. Computed tomography and magnetic resonance imaging results were interpreted as revealing acute subarachnoid hemorrhage. Twenty-four hours later, he developed acute neurologic deterioration. A lumbar puncture was performed, revealing the presence of Staphylococcus aureus. The false-positive image mimicking blood was potentially a result of an extremely high protein concentration present in the cerebrospinal fluid, provoked by an intense inflammatory reaction leading to disruption of the blood-brain barrier. Pyogenic meningitis is one of the causes of pseudosubarachnoid hemorrhage, or a false diagnosis of subarachnoid hemorrhage, when one does

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