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Academic Emergency Medicine

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https://read.qxmd.com/read/31074175/intensive-glucose-control-for-critically-ill-patients
#1
John Conway, Benjamin Friedman
In the past decade, ED to ICU admissions increased by 79% to 2.2 million admissions annually, reflecting the increasing role of Emergency Medicine physicians in providing care for critically ill patients.1 Optimal glucose control in critical care patients has been a topic of contention for decades. This article is protected by copyright. All rights reserved.
May 10, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://read.qxmd.com/read/31070830/hot-off-the-press-assessing-risk-of-future-suicidality-in-emergency-department-patients
#2
Justin Morgenstern, Corey Heitz, Chris Bond, William K Milne
Suicidal ideation is common, accounting for about 1% of emergency department visits, or about 1.4 million visits a year in the United States.1 Although there are numerous validated screening tools, such as the PHQ9, the ED-Safe Patient Safety Screener, and the Suicide Behaviors Questionnaire-Revised (SBQ-R), none have been tested against physician gestalt, and none are widely used in clinical practice. This article is protected by copyright. All rights reserved.
May 9, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://read.qxmd.com/read/31046166/diagnostic-accuracy-of-ultrasound-for-confirmation-of-endotracheal-tube-placement
#3
Brit Long, Alex Koyfman, Michael Gottlieb
Endotracheal intubation is a common intervention in the emergency department (ED) and prehospital setting. Direct visualization of endotracheal tube (ETT) placement through the vocal cords is limited at times, and esophageal intubation can be dangerous if not recognized.1 Therefore, additional methods (e.g. lung auscultation, esophageal detector devices, capnography) are necessary for confirmation of tube placement. This article is protected by copyright. All rights reserved.
May 2, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://read.qxmd.com/read/31012508/emergency-department-risk-stratification-after-opiate-overdose-is-just-the-beginning
#4
LETTER
Brian M Clemency, Joshua J Lynch, Terrance Creighton, Heather A Lindstrom
The January 2019 edition of Academic Emergency Medicine reported on the Hospital Observation Upon Reversal (HOUR) with Naloxone Study. This study examined the ability of emergency medicine providers to use clinical judgment, a decision rule or both to evaluate patients for safe discharge from the emergency department (ED) one hour after naloxone administration for suspected opiate overdose.1  The topic of safe and timely discharge is important for the practice of emergency medicine, but not nearly as important as what comes next for our patients...
April 23, 2019: Academic Emergency Medicine
https://read.qxmd.com/read/31006937/the-yield-of-computed-tomography-of-the-head-among-patients-presenting-with-syncope-a-systematic-review
#5
REVIEW
J Alexander Viau, Hina Chaudry, Ailish Hannigan, Mish Boutet, Muhammad Mukarram, Venkatesh Thiruganasambandamoorthy
BACKGROUND: Overuse of head computed tomography (CT) for syncope has been reported. However, there is no literature synthesis on this overuse. We undertook a systematic review to determine the use and yield of head CT and risk factors for serious intracranial conditions among syncope patients. METHODS: We searched Embase, Medline, and Cochrane databases from inception until June 2017. Studies including adult syncope patients with part or all of patients undergoing CT head were included...
April 22, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://read.qxmd.com/read/31006152/an-old-man-s-love
#6
Siu Fai Li
He was just another old man in a busy Emergency Department during my clinical attending shift. An ambulance brought him in after he fell in the grocery store. My senior resident Carlo and I were called to see him because he was struggling with a C-collar that he didn't need. He clearly broke his wrist even though he said it didn't hurt. This article is protected by copyright. All rights reserved.
April 21, 2019: Academic Emergency Medicine
https://read.qxmd.com/read/31004525/response-to-invited-commentary-for-civil-monetary-penalties-resulting-from-violations-of-the-emergency-medical-treatment-and-labor-act-emtala-involving-psychiatric-emergencies-2002-2018
#7
Sophie Terp, Elizabeth Burner, Michael Menchine
We would like to thank Dr. Bitterman for his thoughtful and detailed commentary on our manuscript "Civil monetary penalties resulting from violations of EMTALA involving psychiatric emergencies, 2002-2018." We appreciate his recognition of the importance of our work in raising the issue of psychiatric care under EMTALA and highlighting the difficulties hospitals and physicians have in managing psychiatric patients in compliance with the law. We would like to take this opportunity to respond to a number of points raised by Dr...
April 20, 2019: Academic Emergency Medicine
https://read.qxmd.com/read/31002450/pharmacokinetics-and-pharmacodynamics-of-naloxone
#8
Brian M Clemency, William Eggleston, Heather A Lindstrom
We appreciate the insights of Dr. Koons and colleagues in response to our study Hospital Observation Upon Reversal (HOUR) with Naloxone: A Prospective Clinical Prediction Rule Validation Study. As they noted, a majority (85.4%) of our patients received intranasal (IN) naloxone rather than parenteral (IV) naloxone. This finding mirrors the national trend of increasing IN naloxone utilization. IN naloxone has many potential advantages over IV naloxone, especially when administered by individuals without formal medical training...
April 19, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://read.qxmd.com/read/31002448/procainamide-vs-amiodarone-for-stable-ventricular-tachycardia
#9
Kyle Kelson, Ian deSouza
Electrical cardioversion is an effective treatment for termination of ventricular tachycardia (VT)1,2 but is typically performed with procedural sedation, and thus involves associated risk. In hemodynamically stable VT, pharmacologic cardioversion is an option. Historically, lidocaine, amiodarone, procainamide, and sotalol have been used for pharmacologic cardioversion, based mostly upon expert opinion. This article is protected by copyright. All rights reserved.
April 19, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://read.qxmd.com/read/31002439/hour-prediction-rule-letter-to-the-editor
#10
Andrew L Koons, Robert D Cannon, Gillian A Beauchamp, Kenneth D Katz, Matthew D Cook, Ryan M Surmaitis
In a recent issue of Academic Emergency Medicine, we read with interest the article titled: Hospital Observation Upon Reversal (HOUR) with Naloxone: A Prospective Clinical Prediction Rule Validation Study by Clemency et al. In order to avoid over-reliance on this decision rule and possible untoward effects of early discharge, we feel that there are some key points worth considering in this regard. It is important to note that the average dose of prehospital naloxone was 3.1mg, which was administered intranasally (IN) in 85% of the patients...
April 19, 2019: Academic Emergency Medicine
https://read.qxmd.com/read/30994255/civil-monetary-penalties-resulting-from-violations-of-the-emergency-medical-treatment-and-labor-act-emtala-involving-psychiatric-emergencies-2002-to-2018
#11
Sophie Terp, Brandon Wang, Elizabeth Burner, Denton Connor, Seth A Seabury, Michael Menchine
OBJECTIVE: The objective was to describe characteristics of civil monetary penalties levied by the Office of the Inspector General (OIG) related to violations of the Emergency Medical Treatment and Labor Act (EMTALA) involving psychiatric emergencies. METHODS: Descriptions of EMTALA-related civil monetary penalty settlements from 2002 to 2018 were obtained from the OIG. Cases related to psychiatric emergencies were identified by inclusion of key words in settlement descriptions...
April 17, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://read.qxmd.com/read/30985949/hot-off-the-press-she-works-hard-for-the-money-time-s-up-in-health-care
#12
Christopher Bond, Justin Morgenstern, Corey Heitz, William K Milne
Salary disparity between men and women continues to exist in medicine despite our documentation of this earnings gap since the mid-1970s. The number of women in medicine continues to rise, and despite our knowledge of the problem the gender pay gap in medicine is one of the highest for any professional industry. After controlling for multiple variables, male physicians across multiple fields continue to earn significantly more than their female counterparts. This study is a 5-year review of compensation for both clinical and academic emergency physicians by gender, to determine if there have been any changes in the gender disparity trends...
April 15, 2019: Academic Emergency Medicine
https://read.qxmd.com/read/30974004/acceptability-usability-and-effectiveness-a-qualitative-study-evaluating-a-pediatric-telemedicine-program
#13
Hadley S Sauers-Ford, Michelle Y Hamline, Melissa M Gosdin, Laura R Kair, Gary M Weinberg, James P Marcin, Jennifer L Rosenthal
BACKGROUND: Pediatric emergency telemedicine consultations have been shown to provide support to community emergency departments treating critically ill pediatric patients. However, despite the recognized value of telemedicine, adoption has been slow. To determine why clinicians frequently do not use telemedicine when it is available for pediatric patients, as well as to learn how to improve telemedicine programs, we conducted a qualitative study using stakeholder interviews. METHODS: We conducted a qualitative study using grounded theory methodology, with in-depth interviews of referring and accepting physicians and referring, transport, and transfer center nurses...
April 11, 2019: Academic Emergency Medicine
https://read.qxmd.com/read/30946513/whose-job-is-it-anyway
#14
Phillip D Levy
As health care providers we all seek to do good for our patients, or at the very least, do no harm. This core principle is and always should be independent of where one is educated or trains, specialty, practice setting, payer mix, etc. However, interlaced with this is a self-protective mechanism that draws a line in the sand when it comes to action or inaction for certain aspects of patient care. This article is protected by copyright. All rights reserved.
April 4, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://read.qxmd.com/read/30945391/hey-doctor
#15
Benjamin D Boodaie, Amir A Hakimi
I'm midway through my third year of medical school, and today is the first day of my emergency medicine rotation. The emergency department (ED) is crowded. I snake through staff and stretchers as I try to find my resident. This article is protected by copyright. All rights reserved.
April 3, 2019: Academic Emergency Medicine
https://read.qxmd.com/read/30933407/the-folly-of-the-r-a-case-study
#16
Robert M Rodriguez
The "You should apply for this" message from a colleague popped up on my work email seven months ago. Reading through the funding announcement, I thought "Yeah, this is pretty much exactly in line with what I'm doing. But ugh!! Do I want to put myself through this again?" For the sake of clarity, I have entered the autumn of my career, secure as a Professor of Emergency Medicine (Step 4), with no major push to get funded. I have always been proud of my .400 grant funding batting average...
April 1, 2019: Academic Emergency Medicine
https://read.qxmd.com/read/30933392/tranexamic-acid-for-the-treatment-of-epistaxis
#17
Michael Gottlieb, Alex Koyfman, Brit Long
Epistaxis is a common reason for patients to present to the Emergency Department (ED), reflecting 1 out of every 200 ED visits in the United States.1 While many cases of epistaxis are self-limiting, those requiring medical treatment can be associated with significant time and healthcare costs.2 This article is protected by copyright. All rights reserved.
April 1, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://read.qxmd.com/read/30901130/subdissociative-dose-ketamine-is-effective-for-treating-acute-exacerbations-of-chronic-pain
#18
Debryna D Lumanauw, Sylvia Youn, Timothy Horeczko, Kabir Yadav, David A Tanen
BACKGROUND: Sub-dissociative dose ketamine (SDDK) is used to treat acute pain. We sought to determine if SDDK is effective in relieving acute exacerbations of chronic pain. METHODS: Randomized double-blind placebo-controlled trial conducted May 2017-June 2018 at a public teaching hospital (ClinicalTrials. gov#NCT02920528). Primary endpoint was a 20 mm decrease on a 100 mm Visual Analog Scale (VAS) at 60 minutes. Power analysis using three groups (ketamine 0.5 mg/kg, 0...
March 22, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://read.qxmd.com/read/30884046/comments-on-manuscript-aemj-18-765-r1-civil-monetary-penalties-resulting-from-violations-of-emtala-involving-psychiatric-emergencies-2002-2018
#19
Robert A Bitterman
The authors' stated objective is to describe characteristics of EMTALA civil monetary penalties (CMPs) levied by the Office of Inspector General (OIG) between 2002 and 2018. [ 1 ] However, the description provided is just the government's version of the 'description', it leaves out the affected hospitals' side of the story; and the authors' statistical analysis of the penalties assessed overlooks known critical factors which could substantively undermine their conclusions. This article is protected by copyright...
March 18, 2019: Academic Emergency Medicine
https://read.qxmd.com/read/30884035/depression-in-emergency-department-patients-and-association-with-health-care-utilization
#20
David G Beiser, Charlotte E Ward, Milkie Vu, Neda Laiteerapong, Robert D Gibbons
BACKGROUND: Depression is one of the most common illnesses in the United States, with increased prevalence among people with lower socioeconomic status and chronic mental illness who often seek care in the emergency department (ED). We sought to estimate the rate and severity of major depressive disorder (MDD) in a nonpsychiatric ED population and its association with subsequent ED visits and hospitalizations. METHODS: This prospective cohort study enrolled a convenience sample of English-speaking adults presenting to an urban academic medical center ED without psychiatric complaints between January 1, 2015, and September 21, 2015...
March 18, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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