L Brichko, R Gaddam, C Roman, G O'Reilly, C Luckhoff, P Jennings, D Smit, P Cameron, B Mitra
OBJECTIVE: To evaluate the effectiveness of methoxyflurane versus standard care for the initial management of severe pain among adult emergency department (ED) patients. METHODS: This randomised parallel group open-label phase IV trial of methoxyflurane was conducted in a tertiary hospital ED setting in Australia. Inclusion criteria required adult patients to have an initial pain score ≥8 on the 11-point Numerical Rating Scale (NRS). Patients were randomised 1:1 to receive either inhaled methoxyflurane (3mls) or standard analgesic treatment at ED triage...
September 28, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Brit Long, Michael Gottlieb
In the United States, up to 2% of ambulatory visits are related to sore throats.1 'Sore throat' is a broad term with a wide range of etiologies. Infections are the most common cause, with group A beta-hemolytic streptococcus (GABHS) accounting for 10% of cases in adults and up to 30% in pediatric patients.2,3 A variety of interventions can be used to reduce pain, and while antibiotics are frequently used to treat infection, their overall analgesic effect is likely small and their overuse may lead to bacterial resistance and other adverse events...
September 28, 2020: Academic Emergency Medicine
Anna Stacy
It was my second day of clinical rotations. I was checking a sedated patient's breathing, watching her chest move up and down with the whir of the ventilator, when a resident stuck his head in the door. He pointed at me, then pointed down the hall at a group of rapidly retreating backs, and said, "Run."
September 26, 2020: Academic Emergency Medicine
Jared Strote
Being a 75-year-old emergency physician at the start of a viral pandemic skewed toward older victims is something. But despite pleas from the chair and many others for him to take a leave, the most senior of our faculty by at least a decade continued to work; he even volunteered to do extra shifts if some preferred to stay home.
September 24, 2020: Academic Emergency Medicine
Eric Jaton, Jamie Stang, Michelle Biros, Abbey Staugaitis, Julie Scherber, Florian Merkle, Nicholas M Mohr, Christopher Streib, Lauren Klein, Michael A Puskarich
The novel SARS-CoV-2 coronavirus poses many unique challenges to the implementation of clinical research, particularly as it relates to the processes of informed consent. Traditional methods of in-person informed consent were no longer plausible, as face-to-face discussions may expose researchers and patients to increased risk of contracting and spreading the virus. In many circumstances the research personnel obtaining consent were considered non-essential workers, and thus did not have priority for personal protective equipment in light of national shortages...
September 24, 2020: Academic Emergency Medicine
Robert R Ehrman, Jonathan Collins, Nicholas Harrison
A strong association between PE and patients hospitalized with COVID-19 (15.3% overall range 0-35%) has been reported, but the prevalence in ED patients remains unknown. The contribution of traditional risk factors is likewise unclear. While Freund et al. attempted to answer to this question, we have methodologic concerns we feel require attention before emergency physicians proceed as if COVID-19 does not increase risk of PE.
September 23, 2020: Academic Emergency Medicine
Yonathan Freund, Marie Drogrey, Marine Cachanado, Ben Bloom
We thank « John Doe » et al. for their interest and comments on our paper "Association between Pulmonary Embolism and COVID-19 in ED patients: the PEPCOV international retrospective study". The authors raised the important issue of a possible bias, because we only analyzed patients that were tested for pulmonary embolism (PE) with computed tomography pulmonary angiogram (CTPA). We acknowledge that this is a limitation, and accordingly highlighted in our manuscript that whether these results apply to the general population is unknown...
September 23, 2020: Academic Emergency Medicine
Bonny J Baron, Thomas M Scalea
In the evidence-based summary by Serigano et al. (Ref 1.) published in this issue of Academic Emergency Medicine under the Brass Tacks series, the authors critically appraise the evidence for the long-standing practice of prehospital and emergency department cervical spinal motion restriction (SMR) in blunt trauma patients. They highlight the absence of class I data demonstrating a benefit and describe some of the potentially harmful side effects of cervical collars.
September 23, 2020: Academic Emergency Medicine
Corey Heitz, Justin Morgenstern, Christopher Bond, William K Milne
In late 2019 and early 2020, the COVID-19 virus swept the world, creating a pandemic the likes of which the world hadn't experienced since the influenza pandemic of 1918. Diagnostic signs and symptoms, testing, and treatments were investigated in rapid fashion. In this manuscript, we summarize a scoping review of diagnostic symptoms, signs, and testing along with a discussion with the primary author.
September 23, 2020: Academic Emergency Medicine
Olivia Serigano, Matthew Riscinti
Spinal immobilization or spinal motion restriction after blunt trauma is a routine practice and standard care in most settings due to fear of movement causing or worsening spinal cord injury. This is ingrained in guidelines for trauma management. Immobilization is typically performed with backboards, cervical collars, sandbags, straps, and vacuum mattresses. The aim of these interventions is to restrict mobility in order to prevent secondary spinal cord injury during extrication and transport. However, the benefits of this approach are unclear while harms are common...
September 21, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Paul Ishimine
Parents of febrile young infants who present to the emergency department are frequently overwhelmed, surprised by the potential seriousness of their child's condition and the need for extensive testing and possible hospitalization.1 In this stressful context, communication can be challenging. Emergency physicians are faced with the responsibilities of explaining the need for testing, answering questions, addressing concerns, and providing support.
September 19, 2020: Academic Emergency Medicine
Gunjan Tiyyagura, Beth Emerson, Julie R Gaither, Kirsten Bechtel, John M Leventhal, Heather Becker, Karen Della Guistina, Thomas Balga, Bonnie Mackenzie, May Shum, Eugene D Shapiro, Marc Auerbach, Caitlin McVaney, Patricia Morrell, Andrea G Asnes
OBJECTIVE: Emergency care for children is provided predominantly in community emergency departments (CEDs), where abusive injuries frequently go unrecognized. Increasing access to regional child abuse experts may improve detection of abuse in CEDs. In 3 CEDs, we intervened to increase involvement of a regional hospital child protection team (CPT) for injuries associated with abuse in children <12-months-old. We aimed to increase CPT consultations about these infants from the 3% baseline to an average of 50% over 12 months...
September 15, 2020: Academic Emergency Medicine
Richard D Zane, Sean S Michael
The growth and promulgation of Advanced Practice Providers (APPs) across the entire spectrum of healthcare delivery has been profound, and APPs are increasingly common members of emergency department (ED) care teams. Emergency APP workforce growth is outpacing that of emergency physicians with little to suggest that this trend will subside. The evolution of the deployment of APPs in emergency care has been dramatic; initially, emergency APPs were deployed to lower acuity patients or environments-minor injury and illness and in conjunction with an emergency physician-hence the now antiquated description of APPs as "physician extenders...
September 14, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
R Andrew Taylor, Dowin Boatright, Ambrose H Wong
We read with interest the manuscript by Shnitzer et al.1 on the role of race in physical restraint use and the accompanying invited commentary by Corbin et al.2 We commend the effort put forth in this study as management of agitated patients is a challenging but often overlooked problem. In addition, we agree that racial bias likely exists with regards to physical restraint use, as described in the mental health literature3 and by Dr. Corbin's personal experiences as an African American emergency physician...
September 11, 2020: Academic Emergency Medicine
Preston N Dean, Erin F Hoehn, Gary L Geis, Mary E Frey, Mary K Cabrera-Thurman, Benjamin T Kerrey, Yin Zhang, Erika L Stalets, Matthew W Zackoff, Andrea R Maxwell, Tena M Pham, Andrew J Lautz
BACKGROUND: The risk factors for peri-intubation cardiac arrest in critically ill children are incompletely understood. The study objective was to derive physiologic risk factors for deterioration during tracheal intubation in a pediatric emergency department (PED). METHODS: This was a retrospective cohort study of patients undergoing emergency tracheal intubation in a PED. Using the published literature and expert opinion, a multidisciplinary team developed high-risk criteria for peri-intubation arrest: (1) hypotension, (2) concern for cardiac dysfunction, (3) persistent hypoxemia, (4) severe metabolic acidosis (pH<7...
September 7, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Hai Hu, Ni Yao, Yanru Qiu
In our previous research, we found that both Modified Early Warning Score(MEWS) and Rapid Emergency Medicine Score(REMS) demonstrated acceptable predictive values for the in-hospital mortality of critical ill patients with novel coronavirus disease (COVID-19) 1 . If each parameter could be collected in a busy emergency department, REMS might be more accurate than MEWS for critical ill patients with COVID-19, especially for the patients aged<65 years.
September 7, 2020: Academic Emergency Medicine
Mustafa Emin Canakci, Murat Cetin
We have read with interest the recent article, "Comparing Rapid Scoring Systems in Mortality Prediction of Critically Ill Patients With Novel Coronavirus Disease" by Hai Hu et al. 1 Although there are many studies about the critical patients hospitalized in the hospital with the diagnosis of COVID-19, we think that this scoring evaluation is very important especially at the bedside since there are no studies evaluating the scores in the emergency department. REMS has come to the fore among the scoring performed to evaluate critical patients in order to recognize the patients at high risk in the emergency department quickly and to prevent mortality...
September 7, 2020: Academic Emergency Medicine
Diane P Calello
The manuscript should be blinded for institution and location as well as authors, as those will often reveal authorship.
September 6, 2020: Academic Emergency Medicine
Lauren Diercks, D Mark Courtney, Carl Piel, Sterling Overstreet, Mike Mayo, Deborah Diercks
Patient satisfaction scores and rankings are reflected in administrative decisions and have been used for 40 years. Survey results can determine physician compensation at the group level and create rankings of individual providers. Externally, satisfaction data is used to rank hospitals against peers and competitors. Rankings can affect longevity of billing contracts and selection of hospital systems by patients and employers1 . Despite importance of patient satisfaction data there is variance as a function of site-dependent factors and small sample sizes...
September 5, 2020: Academic Emergency Medicine
Ian C Mitchell, Bradley J Norat, Marc Auerbach, Colleen J Bressler, John Como, Mauricio A Escobar, Katherine T Flynn-O'Brien, Daniel M Lindberg, Todd Nickoles, Norell Rosado, Kerri Weeks, Sabine Maguire
BACKGROUND: Child abuse is a significant cause of morbidity and mortality in re-verbal children who cannot explain their injuries. Fractures are among the most common injuries associated with abuse but of themselves fractures may not be recognized as abusive until a comprehensive child abuse evaluation is completed, often prompted by other signs or subjective features. We aim to determine which children presenting with rib or long bone fractures should undergo a routine abuse evaluation based on age...
September 5, 2020: Academic Emergency Medicine
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