Academic Emergency Medicine

In the era of COVID-19, it has been challenging to feel connected to one another in meaningful ways. During these unprecedented times, we've had the chance to reflect upon ways we've created significant bonds with people in our lives, including residents, faculty and, patients.

The COVID19 pandemic has lined our psyches with anxiety, uncertainty, and foreboding. Emergency physicians have co-existed with it for nearly a year and its tentacles have wrapped ever more tightly around us. Many in emergency medicine have experienced the negative and sometimes tragic consequences of COVID19 either in their work or in their own families. To balance the negativity surrounding COVID19, we postulate there may be some silver linings: positive consequences resulting from the pandemic that have stimulated changes in clinical medicine delivery and impacted physician wellbeing...

STUDY OBJECTIVE: Provider-performed endocervical sampling (PPES) in the diagnosis of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) may be difficult to perform in a busy emergency department (ED) due to patient preference, availability of the pelvic examination room, or provider availability. Our objective was to assess if self-obtained vaginal swabs (SOVS) were noninferior to PPES in the ED diagnosis of NG/CT using a rapid nucleic acid amplification test (NAAT). METHODS: We conducted a prospective observational cohort study in a single ED...

We commend Westafer and colleagues for their study of home discharge of adults with acute pulmonary embolism (PE) from emergency departments (EDs) across 740 diverse U.S. acute care hospitals.1 They found that outpatient management of ED patients with acute PE in the United States in 2016-2018 was uncommon (4.1%). Among 568 hospitals in the study with 20 PE cases or more, the median proportion of home discharge from the ED was only 3.1% and ranged broadly from 0% to 13.0% at 10th and 90th percentiles.

Migraines are common and most often described as painful pulsatile headaches with nausea and sensory sensitivities. Sumatriptan is one of many medications available for treatment of acute migraine attacks.

BACKGROUND: Despite concern that the global pandemic will worsen depression and suicide rates, their remains little data on its actual effect. The purpose of this study was to determine the effect of the COVID-19 pandemic on suicidal ingestions reported to the California Poison Control System (CPCS). METHODS: Cross sectional comparison of suicidal ingestions reported to the CPCS during the 2020 COVID-19 pandemic compared to suicidal ingestions reported during the same period in 2018 and 2019...

OBJECTIVES: Comparing undocumented Latinx immigrants (UDLI), Latinx citizens/residents (LCR) and non-Latinx citizens/residents (NLCR), we sought to assess rates of crime victimization, fear of reporting crimes, causes of this fear, and whether political rhetoric from the US president had changed the reporting of crimes. METHODS: From October 2018 to February 2020, we conducted this in-person survey study, enrolling similar numbers of UDLI, LCR and NLCR patients at two urban county hospital emergency departments (EDs) in San Francisco and Oakland, California...

As I entered the emergency room bay, her scared eyes shouted silently. An elderly female in obvious distress, she was non-verbal except for head nods. No family accompanied her. As a medical student, I felt clinically powerless, but I knew I wanted to assist however possible. As an extrovert, it was natural for me to think in terms of a human connection. I navigated through the crowded room, hearing conversations of suspected infection, and positioned myself at the bedside.

BACKGROUND: Given the many causes of seizures, emergency physicians often utilize brain computed tomography (CT) to evaluate for intracranial pathology. However, a CT exposes patients to 100 times more radiation than a chest radiograph. Previously, we developed a four-item clinical decision instrument (CDI) to determine which patients with status epilepticus (SE) do not require emergent neuroimaging. In this study, we seek to prospectively validate our CDI in patients with a history of seizures with both SE and generalized tonic-clonic seizures...

BACKGROUND: The prehospital phase is critical in ensuring that stroke treatment is delivered quickly and is a major source of time delay. This study sought to identify and examine Pre-Hospital Stroke Workflow Optimizations (PSWO) and their impact on improving health systems, reperfusion rates, treatment delays, and clinical outcomes. METHODS: The authors conducted a systematic literature review and meta-analysis by extracting data from several research databases (PubMed, Cochrane, Medline, and Embase) published since 2005...

OBJECTIVES: Emergency department patients with unexplained syncope are at risk of experiencing an adverse event within 30 days. Our objective was to systematically review the accuracy of multivariate risk stratification scores for identifying adult syncope patients at high and low risk of an adverse event over the next 30 days. METHODS: We conducted a systematic review of electronic databases (MEDLINE, Cochrane, Embase and CINAHL) from database creation until May 2020...

BACKGROUND: Ketorolac tromethamine is a nonsteroidal anti-inflammatory drug (NSAID) which is extensively used for the management of renal colic in the emergency department (ED). It has been proposed that ketorolac is used at doses above its analgesic ceiling with no more advantages and increased risk of adverse effects. In this study, we compared the analgesic effects of 3 doses of intravenous ketorolac in patients with renal colic. METHODS: This non-inferiority, randomized, double-blind clinical trial evaluated the analgesic efficacy of 3 doses of intravenous ketorolac (10, 20, and 30mg) in adult patients presenting to the ED with renal colic...

BACKGROUND: The validated Pediatric Emergency Care Applied Research Network (PECARN) prediction rules are meant to aid clinicians in safely reducing unwarranted imaging in children with minor head injuries (MHI). Even so, computed tomography (CT) scan utilization remains high, especially in intermediate-risk (per PECARN) MHI patients. The primary objective of this quality improvement initiative was to reduce CT utilization rates in the intermediate-risk MHI patients. METHODS: This project was conducted in a Level I trauma pediatric emergency department (ED)...

BACKGROUND: Social determinants of health (SDoH) have significant implications for health outcomes in the United States (US). Emergency Departments (EDs) function as the safety nets of the American healthcare system, caring for many vulnerable populations. ED-based interventions to assess social risk and mitigate social needs have been reported in the literature. However, the breadth and scope of these interventions have not been evaluated. As the field of Social Emergency Medicine expands, a mapping and categorization of previous interventions may help shape future research...

OBJECTIVE: This study aimed to determine if 0.15 mg/kg of intravenous (IV) sub-dissociative ketamine is non-inferior to 0.3 mg/kg in emergency department (ED) patients with acute pain. METHODS: This randomized, prospective, double-blinded, non-inferiority trial included patients age 18-59 years presenting to the ED with acute moderate to severe pain. Subjects were randomized to IV sub-dissociative ketamine 0.15mg/kg ("low" dose) or 0.30 mg/kg ("high" dose) over 15 minutes...

The hope that death from suicide and injuries from suicidal behavior can be reduced from routine screening in emergency departments is a promising hypothesis. The most recent study by Goans et al casts renewed doubt on the promise and practicality of that approach.1 Ostensibly, the Columbia Suicide Severity Rating Scale (C-SSRS) has promise for use in emergency departments (EDs): it is simple to read, results in stratified categories of risk, and is a relatively brief tool.

OBJECTIVE: Emergency medicine clinicians are uniquely positioned to deliver interventions to enhance linkage to evidence-based treatment for opioid use disorder (OUD) in the acute overdose period, yet little is known about patient perspectives to effectively engage patients immediately following opioid overdose. Our objective was to explore patients' perspectives on substance use treatment, perceived needs, and contextual factors that shape the choice of patients seen in the Emergency Department (ED) to engage with treatment and other patient support services in the acute post-opioid overdose period...

OBJECTIVES: We describe the Columbia-Suicide Severity Rating Scale (C-SSRS)-Clinical Practice Screener's ability to predict suicide and emergency department (ED) visits for self-harm in the year following an ED encounter. METHODS: Screening data from adult patients' first ED encounter during a 27-month study period were analyzed. Patients were excluded if they died during the encounter or left without being identified. The outcomes were suicide as reported by the state health department and a recurrent ED visit for suicide attempt or self-harm reported by the state hospital association...

Giant cell arteritis (GCA), an inflammation of temporal arteries, can lead to multiple complications including vision loss if not diagnosed promptly.1 Unfortunately, diagnoses can often be delayed, particularly in those without classic features.2 Once the diagnosis is suspected, patients are typically started on high-dose glucocorticoids and referred for urgent temporal artery biopsy (TAB) or advanced imaging (e.g., computed tomography, magnetic resonance imaging). Unfortunately, high-dose glucocorticoids have significant side effects...

BACKGROUND: Patients with ST-elevation myocardial infarction (STEMI) require timely reperfusion, and percutaneous coronary intervention (PCI) decreases morbidity and mortality. Regionalization of ST-elevation myocardial infarction (STEMI) care has increased timeliness and use of percutaneous coronary intervention (PCI), but it is unknown whether benefits to regionalization depend on a community's distance from its nearest PCI center. We sought to determine if STEMI regionalization benefits, measured by access to PCI centers, timeliness of treatment (same-day or in-hospital PCI), and mortality, differ by baseline distance to nearest PCI center...