Academic Emergency Medicine

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...

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...

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."

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.

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...

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.

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...

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.

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.

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...

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.

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...

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...

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...

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...

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.

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...

The manuscript should be blinded for institution and location as well as authors, as those will often reveal authorship.

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...

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...