Academic Emergency Medicine

OBJECTIVES: We determined how often emergency physician pediatric musculoskeletal (MSK) radiograph interpretations were discordant to that of a radiologist and led to an adverse event (AE). We also established the variables independently associated with this outcome. METHODS: This prospective cohort study was conducted in an urban, tertiary care children's emergency department (ED). We enrolled children who presented to an ED with an extremity injury and received radiographs...

OBJECTIVES: Survivors of acute cardiovascular disease events, such as acute coronary syndrome and stroke may experience significant psychological distress during and following the acute event. Long term adverse effects may follow, including the development of posttraumatic stress disorder (PTSD) and increased overall all-cause mortality and recurrent cardiac events. The goal of this concepts paper is to describe and summarize the rates of adverse psychological outcomes, such as PTSD, following cardiovascular emergencies, to review how these psychological factors are associated with increased risk of future events and long-term health, and to provide a theoretical framework for future work...

Over 3 million cases of skin and soft tissue infections (SSTI) including cellulitis and abscesses are managed in U.S. emergency departments (EDs) each year.1-4 Overlap in presentations of cellulitis and abscess, which require different therapeutic approaches, has prompted increasing research into point-of-care ultrasound (POCUS) to help differentiate the two.2,5,6 .

STUDY HYPOTHESIS: A single-syringe of adenosine diluted in normal saline will be non-inferior to the standard two-syringe method for conversion of supraventricular tachycardia to normal sinus rhythm. OBJECTIVE: To compare the relative efficacy and safety of a novel route of administration of adenosine to usual care. METHODS: A single center, prospective, observational study was conducted from November 1, 2016 through February 28, 2018 on patients presenting to the emergency department in supraventricular tachycardia treated with adenosine...

OBJECTIVES: Transitional Care Nurse (TCN) care has been associated with decreased hospitalizations for older adults in the emergency department (ED). The objective of this study is to evaluate the association between TCN care and readmission for geriatric patients who visit the ED within 30 days of a prior hospital discharge. METHODS: We studied a prospective cohort of ED patients aged 65 and older with an ED visit within 30 days of inpatient discharge. Patients with an Emergency Severity Index of 1 or prior TCN contact were excluded...

The experience of being treated for an acute medical event is a frightening and stressful experience for many patients. Understanding the impact of psychological stress during medical events is important, not only for our understanding of the potential development of short and long-term adverse psychological outcomes, but for its implications with broader health and recovery.

BACKGROUND: Our objectives were to test if during a potentially life-threatening medical emergency, perceived threat (a patient's sense of life endangerment) in the emergency department (ED) is common and associated with the subsequent development of posttraumatic stress disorder (PTSD) symptoms. METHODS: ED-based prospective cohort study in an academic hospital. We included adult patients requiring acute intervention in the ED for resuscitation of a potentially life-threatening medical emergency, defined as respiratory or cardiovascular instability...

Near-simultaneous administration of a sedative and neuromuscular blocking agent (NMBA) define the process of rapid sequence intubation (RSI). Sedation for this procedure is brief (eg, etomidate lasts 5-10 minutes), and should not be confused with ongoing sedation during mechanical ventilation in the intensive care unit (the setting for the authors' references provided as evidence that insufficient sedation is associated with patient morbidity and mortality). It is physiologically implausible that a several-second delay sedation during RSI could be associated with subsequent organ dysfunction or death; furthermore, administering the NMBA first in RSI does not result in an unsedated paralyzed patient...

We read with great interest the article by Driver and colleagues that investigated the optimal order of drug administration (i.e., sedative first vs. neuromuscular blocking agent first) in the process of rapid sequence intubation (RSI), focusing on the time elapsed from the first RSI drug administration to the end of first-attempt success at intubation.

BACKGROUND: Freestanding emergency departments (FrEDs) could reduce wait times in overcrowded emergency departments (EDs), but they might also increase usage and overall spending for emergency care. We investigate the relationship between the number of FrEDs entering a local market and overall spending on emergency care. METHODS: We accessed data from Arizona, Florida, North Carolina, and Texas in Blue Cross Blue Shield Axis; a limited data set of deidentified insurance data claims that we linked to Public Use Microdata Area (PUMA) data from the American Community Survey; and lists of licensed FrEDs from state agencies...

No abstract text is available yet for this article.

Atrial Fibrillation (AF) is a significant dysrhythmia that often requires treatment in the emergency department (ED). This can be performed with rhythm control using electrical or chemical cardioversion, or with rate control. There is widespread variation in management of AF within Canada and worldwide. This study focuses on rhythm control techniques, comparing emergency department length of stay when using an electrical-first strategy versus a chemical-first strategy of cardioversion.

OBJECTIVE: To determine the proportion of patients with pulmonary embolism (PE) treated with unfractionated heparin (UFH) who achieved therapeutic activated partial thromboplastin time (aPTT) values within 48 hours of treatment. METHODS: Retrospective analysis of a PE Response Team Database was performed at a large, urban, academic teaching hospital. Inclusion criteria were adult patients with acute pulmonary embolism for whom the PE Response Team was consulted and who received anticoagulation with unfractionated heparin according to guideline standard dosing...

BACKGROUND: Antibiotic stewardship efforts have expanded focus from inpatient to include outpatient settings. However, stewardship is urgently needed in acute care ambulatory settings: emergency departments (EDs) and urgent care centers (UCCs). Implementation of antibiotic stewardship in acute ambulatory care settings has been limited. Two major barriers to effective implementation exist: 1) lack of adaptation of successful outpatient stewardship interventions to the acute care ambulatory setting; and 2) absence of rigorous measurement of implementation processes in EDs and UCCs in a manner that informs future scale and spread...

Acute pulmonary embolism (PE) is a "can't miss" diagnosis in the emergency department (ED) that mandates investigation should clinical suspicion be aroused. As the growing availability of multidetector row computed tomography pulmonary angiography (CTPA) has decreased the threshold for testing, the prevalence of PE has rapidly increased to as many as 112.3 cases per 100,000 US adults.1 For PE management, there remains considerable debate regarding inpatient versus outpatient treatment, which patients benefit from advanced therapies, and who requires long-term anticoagulation...

OBJECTIVES: Propofol has not been extensively studied as an acute migraine therapy; however, based on the limited evidence from outpatient and inpatient settings, propofol has been proposed as an option for patients who present to the emergency department (ED). The purpose of this review is to evaluate the existing literature regarding the safety and efficacy of propofol for acute migraine treatment in the ED. METHODS: A systematic review of clinical studies of propofol treatment for acute migraine in the ED was performed using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines...

OBJECTIVE: With respect to first-attempt intubation success, the pediatric literature demonstrates either clinical equipoise or superiority of direct laryngoscopy (DL) when compared to video laryngoscopy (VL). Furthermore, it is unknown how VL compares to DL, when DL is "augmented" by maneuvers, such as optimal external laryngeal manipulation (OELM), upright or ramped positioning, or the use of the bougie. The objective of our study was to compare first-attempt success between VL and all DL, including "augmented DL" for pediatric intubations...

BACKGROUND: Hyperkalemia is common and potentially life threatening. Patiromer is a Food and Drrug Administration (FDA) cleared oral potassium binder effective in the chronic treatment of hyperkalemia. OBJECTIVE: To investigate the potential efficacy and safety of oral patiromer in treating acute hyperkalemia in the ED. METHODS: This is a single-center, randomized, open label convenience sample pilot study in an inner-city emergency department...

BACKGROUND: In the United States (US), rates of teenage pregnancy and sexually transmitted infections (STI) remain exceptionally high and racial and ethnic disparities persist. Emergency departments (ED) care for over 19 million adolescents each year, the majority being minority and low socioeconomic status. Single-center studies demonstrate infrequent use of contraceptives among adolescent ED patients and an association between risky sex and behaviors such as alcohol and drug use; however, no multi-center ED data exist...

Migraine headache results in over 1 million emergency department visits per year in the United States.1-3 Several treatments have been offered to treat the headache.4-6 Prochlorperazine has been tested in randomized trials and, despite adverse effects such as dystonic reactions several societies recommend its use.4,6 .