Academic Emergency Medicine

Adult coloring books have been shown to reduce anxiety in healthy students as well as oncology patients in hospital settings. Anxiety and stress can be a cause of concern in emergency department patients. No previous randomized controlled trials exist evaluating the use of therapeutic coloring in the emergency department. We provide critical analysis of the article, and summarize the social media discussion and a podcast in which the authors discuss their work.

Acute pain is one of the most common complaints in the emergency department. With recent efforts to find effective non-opioid analgesics, ketamine has surfaced as a potential option for ED analgesia.1-3 While ketamine is typically used as a sedative agent, several studies have shown that when it is administered in sub-dissociative doses, both as a stand-alone agent and as an adjunct to opioids, it may also provide analgesia.4 Two recently published meta-analyses compared ketamine with opioid analgesics in adult ED patients with acute pain...

Infant colic affects approximately 1 in 5 infants under 3 months of age and is defined by crying and/or fussing > 3 hours per day for ≥ 3 days per week. While the exact etiology is unknown, recent evidence suggests that it may be associated with adverse effects on allergies, behavior, and sleep. Other studies have suggested that differences in gut microbiota may be a potential cause among patients with colic. This has prompted authors to evaluate whether Lactobacillus reuteri DSM17938 reduces colic in breastfed infants...

If you're like me, in recent days you've experienced moments of fear. Feelings like when you woke up in bed at night as a kid, and saw a dark shadow in the corner, and wondered if it was going to get you. If you're like me, in recent days you've also experienced awe at so many triumphs over such fear, individual and collective - our 65 year old ED clerk showing up to their shift, through great anxiety, or healthcare providers boarding buses heading into the teeth of the Wuhan epidemic. The pages of AEM this month provide further examples of such triumphs, of individuals in a time and place of great stress overcoming the impulse to curl up and focus on themselves, and instead expanding beyond themselves to help others...

BACKGROUND: While emergency medical services (EMS) often use endotracheal intubation (ETI) or supraglottic airways (SGA), some patients receive only bag-valve-mask (BVM) ventilation during out-of-hospital cardiac arrests (OHCA). Our objective was to compare patient characteristics and outcomes for BVM ventilation to advanced airway management (AAM) in adults with OHCA. METHODS: Using data from the Pragmatic Airway Resuscitation Trial, we identified patients receiving AAM (ETI or a SGA), BVM ventilation only (BVM-only), and BVM ventilation as a rescue after at least one failed attempt at advanced airway placement (BVM-rescue)...

OBJECTIVES: Providers often pursue imaging in patients at low risk of pulmonary embolism (PE), resulting in imaging yields <10% and false-positive imaging rates of 10% to 25%. Attempts to curb overtesting have had only modest success and no interventions have used implementation science frameworks. The objective of this study was to identify barriers and facilitators to the adoption of evidence-based diagnostic testing for PE. METHODS: We conducted semistructured interviews with a purposeful sample of providers...

BACKGROUND: The accuracy and speed by which acute myocardial infarction (AMI) is excluded are an important determinant of emergency department (ED) length of stay and resource utilization. While high-sensitivity troponin I (hsTnI) >99th percentile (upper reference level [URL]) represents a "rule-in" cutpoint, our purpose was to evaluate the ability of the Beckman Coulter hsTnI assay, using various level-of-quantification (LoQ) cutpoints, to rule out AMI within 3 hours of ED presentation in suspected acute coronary syndrome (ACS) patients...

No abstract text is available yet for this article.

BACKGROUND: Parenteral opioids are commonly used to treat acute severe pain. We measured pleasurable sensations in patients administered intravenous analgesics to determine if these sensations were associated with receipt of an opioid, after controlling for relief of pain. Pleasurable sensations not accounted for by relief of pain were considered opioid-induced euphoria. METHODS: These data were from a randomized study of 1 mg of hydromorphone versus 120 mg of lidocaine for abdominal pain...

On March 13th, the United States (US) declared the novel coronavirus (COVID-19) pandemic a national emergency. By March 18th , according to the Centers for Disease Control and Prevention, COVID-19 had spread to all 50 US states, with 7,038 cases and 97 deaths.1 The trajectory of cases mirrors that of Italy, where doctors are forced to consider who is more deserving of a ventilator.2 In response, social distancing measures are being promoted across the US in the hopes of slowing the growth in new cases, i.e...

BACKGROUND: The White House "Stop the Bleed" campaign has renewed interest in public-access bleeding kits and the use of tourniquets by the lay public. The objective of this study was to determine which type of tourniquet could be applied most effectively by the lay public using only manufacturer instructions included with each tourniquet. METHODS: This prospective study randomized participants to one of four different tourniquets (SOFTT-W, CAT, RMT, SWAT-T)...

I felt my heart skip a beat as I took off my lead gown, preparing to put in my post-operative orders. A transient wave of apprehension, and I daresay fear swept past me that very moment. It has been a good 8 years since I've graduated medical school, with nary an exposure to emergency medicine since my intern days. I wasn't sure I could remember how to read an EKG accurately, much less manage a patient in respiratory failure.

OBJECTIVES: The CRASH-2 trial demonstrated that tranexamic acid (TXA) in adults with significant traumatic hemorrhage safely reduces mortality. Given that the CRASH-2 trial did not include U.S. sites, our objective was to evaluate patient characteristics, TXA dosing strategies, and the incidence of mortality and adverse events in adult trauma patients receiving TXA at a U.S. Level I trauma center in the post-CRASH-2 era. METHODS: We conducted a retrospective study that included patients aged 18 years or older who received TXA after an acute injury from July 2014 to June 2017...

The Centers for Disease Control and Prevention (CDC) recently recommended that people who inject drugs, men who have sex with men (MSM), and heterosexuals at increased risk, should be screened for HIV at least once annually and sexually active MSM from testing every 3-6 months. 1 However, national surveys show that up to 70 percent of these high-risk individuals have not re-tested for HIV in the past year.2-4 Developing methods to increase engagement for routine testing for them remains a top priority in the national HIV preventive strategy...

Champagne, a sparkling wine produced from grapes grown in the Champagne region of France, is the requisite drink of celebration, symbolizing all things congratulatory from new years to new unions. A "champagne tap" colloquially refers to a lumbar puncture (LP) with no cerebrospinal (CSF) red blood cells (RBCs), which appears colorless (reminiscent of its clear bubbly namesake) and signifies a technically perfect procedure.

The word 'stoic' brings images of a cold, emotionless logician. This misleading caricature steers individuals away from an effective tool for personal wellness. The tranquil (not apathetic) stoic prioritizes three core principles: Virtue, Control of Emotions, and Community. Early Stoics built on Hippocrates's philosophy, but rarely does the medical literature highlight this timeless wisdom. Let us revive this surgically precise antidote for burnout. Overcome harmful, negative emotions by recognizing them as judgements...

OBJECTIVES: In patients at low clinical probability of acute aortic syndromes (AASs), decision on advanced aortic imaging is cumbersome. Integration of the aortic dissection detection risk score (ADD-RS) with D-dimer (DD) provides a potential pipeline for standardized diagnostic rule-out. We systematically reviewed and summarized supporting data. METHODS: Cross-sectional studies assessing integration of ADD-RS with DD for diagnosis of AASs were identified on MEDLINE, EMBASE and Web Of Science databases...

Mechanical circulatory support is increasingly used as a long-term treatment option for patients with end-stage heart failure. Patients with implanted ventricular assist devices are at high risk for a range of diverse medical urgencies and emergencies. Given the increasing prevalence of mechanical circulatory support devices, this expert clinical consensus document seeks to help inform emergency medicine and prehospital providers regarding the approach to acute medical and surgical conditions encountered in these complex patients...

INTRODUCTION: Dizziness is a common complaint presented in the emergency department. A subset of these patients will present with acute vestibular syndrome (AVS). AVS is a clinical syndrome defined by the presence of vertigo, nystagmus, head motion intolerance, ataxia, and nausea/vomiting. These symptoms are most often due to benign vestibular neuritis; however, can be a sign of a dangerous central cause i.e. vertebrobasilar stroke. The Head Impulse test, Nystagmus, Test of Skew (HINTS ) exam has been proposed as a bedside test for frontline clinicians to rule out stroke in those presenting with AVS...

No abstract text is available yet for this article.