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TRAUMA PATIENTS CAN SAFELY BE EXTUBATED IN THE EMERGENCY DEPARTMENT

Our specialty has a high level of expertise with most aspects of airway management. Emergency Physicians have become experts at inserting an endotracheal tube (ET) for definitive control of the airway. However, very little training is given for the removal of the ET tube. Although extubation is commonly performed during peri-operative management, a search of the Emergency Medicine literature revealed no studies on extubation in the emergency department (ED). At some centers, ED extubation is routine, though the safety of this procedure has not been definitively established. Importance Intubation in the ED requires admission to a high-acuity bed and intensive monitoring by nurses and physicians during the entirety of the patient’s ED stay (1). If a subset of patients can have their endotracheal tube removed safely, it will allow admission to a lower-acuity bed or, in some cases, even discharge. This has the potential to save resources and decrease length of stay. CLIQUEZ

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Systemic Lidocaine Decreased the Perioperative Opioid Analgesic Requirements but Failed to Reduce Discharge Time After Ambulatory Surgery

Perioperative systemic lidocaine significantly reduces opioid requirements in the ambulatory setting without affecting time to discharge. Postoperative pain is the most common reason for delay in discharge and unplanned hospital admission after ambulatory surgery. 1–3 Because postoperative pain is to a large extent an inflammatory phenomenon, administration of systemic local anesthetics, which have inflammatory modulatory properties, 4 could significantly reduce pain and therefore allow more rapid discharge. 5 Lidocaine has an excellent safety record when administered by low-dose infusion. 5–7 However, whereas decreased hospital stay after inpatient surgery has been demonstrated, the effect of intraoperative and early postoperative lidocaine infusion on duration of stay after ambulatory surgery is not known. Although it see...