419 Extended Length Peripheral Catheters Placed Under Ultrasound Guidance Are Associated With Increased Risk of Computed Tomography Contrast Extravasation

Study Objectives: Ultrasound guided intravenous catheter (USGIV) placement is a safe and effective alternative for traditional vascular access in patients with known difficult intravenous (IV) access. However, multiple studies have shown increased risk of computed tomography (CT) contrast extravasation. These studies are retrospective and did not control for the USGIV catheter length. This study assesses the risk of CT contrast extravasation through 2.5-inch 18-gauge USGIV versus standard 1.16-inch catheters placed by traditional landmark technique.

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418 Emergency Medicine Clinicians' Views and Practices for Identifying Opioid Misuse in the Era of Prescription Drug Monitoring Programs

To describe emergency medicine (EM) clinicians' experience and application with prescription drug monitoring programs (PDMP) and to characterize their opinions on information believed to suggest opioid misuse behavior (OMB).

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430 Characterizing Community Naloxone Programs and Opioid Overdose Trends in the United States

To characterize the current state of opioid overdose (OOD) in the United States, as well as the community naloxone programs that exist to combat overdose; to identify variables that could be used to predict when increases in overdose would occur, and when high potency synthetic opioids (HPSO) are likely present.

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305 Language Assistance for Limited English Proficiency Patients in the Emergency Department: Determining the Unmet Need

Many patients who present to public emergency departments (EDs) have limited english proficiency (LEP). LEP patients have worse understanding of their conditions and high rates of ED recidivism often due to poor understanding of their care. LEP patients are entitled to language assistance under title IV of the 1964 Civil Rights Act. The objective of this study is to characterize the unmet need for language assistance in a public ED.

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1 Chest Pain Care Patterns Across the Carolinas: Determining the Readiness for Widespread HEART Pathway Dissemination

Greater than 50% of patients who present to the ED with chest pain are admitted but <10% are ultimately diagnosed with ACS. This pervasive over-triage costs $10-13 billion annually. The HEART Pathway uses a validated clinical decision aid and serial troponin measures to provide real-time decision support to providers. In prior studies, the HEART Pathway decreased hospitalizations, stress testing, and hospital length of stay, without increasing adverse events, demonstrating efficacy at a single site.

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337 Accuracy of Landmark-Guided Glenohumeral Intra-Articular Injections in Patients With Anterior Shoulder Dislocations

The shoulder joint is the most commonly dislocated joint and accounts for more than 70,000 emergency department (ED) visits per year in the United States alone. Current evidence suggests that intra-articular injection of the shoulder with local anesthetic agents can provide adequate analgesia to facilitate reduction and obviate the need for more resource intensive methods such as procedural sedation. However, studies have not determined the rate at which landmark-guided shoulder joint injections (LGI) truly deposit local anesthetic into the joint space.

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2 Effectiveness of Provider-Focused Interventions to Eliminate Care Disparities: Results from the Equity in Diagnostic Imaging Trial (EDIT)

African Americans have almost twice the incidence of subarachnoid hemorrhage (SAH) compared to Whites, yet studies indicate they are less likely to receive neuroimaging when presenting to the emergency department (ED) with headache, even when adjusting for age, sex, co-morbidity and acuity. Regulatory efforts and quality initiatives to reduce CT imaging for ED patients with headache may exacerbate this disparity and increase the likelihood that Black patients, who are at higher risk for SAH, do not receive an appropriate ED workup for severe headache.

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