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American Journal of Emergency Medicine

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https://read.qxmd.com/read/30777374/acute-coronary-syndrome-after-cannabis-use-correlation-with-quantitative-toxicology-testing
#1
John R Richards, Gagan D Singh, Aman K Parikh, Sandhya Venugopal
Excluding ethanol, cannabis is the most commonly used drug in the United States and worldwide. Several published case series and reports have demonstrated an association between cannabis use and acute coronary syndrome (ACS). We report the first ever published case of ACS precipitated by cannabis use that was confirmed with concomitant rising quantitative plasma levels of 11-nor-9-carboxy-Δ9-tetrahydrocannabinol, a secondary metabolite of cannabis. A 63-year-old non-tobacco smoking male with no prior medical history presented to the emergency department with chest pain immediately after smoking cannabis, and anterior ST-segment elevation pattern was observed on his electrocardiogram...
February 13, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30777373/implications-of-culture-collection-after-the-first-antimicrobial-dose-in-septic-emergency-department-patients
#2
Vincent J Cascone, Rose S Cohen, Nicholas P Dodson, Chad M Cannon
BACKGROUND: Previous research has illustrated the importance of collection of microbiologic cultures prior to first antimicrobial dose (FAD) in septic patients to avoid sterilization of pathogens and thus allowing confirmation of infection, identification of pathogen(s), and de-escalation of antimicrobial therapy. There is currently a lack of literature characterizing the implications and clinical courses of patients who have cultures collected after FAD. METHODS: In this single-center, retrospective chart review of 163 sepsis cases in the emergency department, the primary outcome was positive-cultures from appropriate sources...
February 13, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30777375/aspartate-aminotransferase-to-platelet-ratio-index-score-for-predicting-hellp-syndrome
#3
Muhammed İkbal Şaşmaz, Muhammed Ali Ayvaz, Ahmet Cumhur Dülger, Eylem Kuday Kuday Kaykısız, Ramazan Güven
INTRODUCTION: HELLP (hemolysis, elevated liver enzyme levels, low platelet counts)-syndrome is a rare but dramatic pregnancy-related illness. The difficult part of this syndrome is the lack of standardised diagnostic criterias and tests to be used to predict it. The aim of this study is determining the role of APRI score in the diagnosis of HELLP syndrome. MATERIAL AND METHODS: In this cross sectional, retrospective study, patients with HELLP syndrome as case group and age-matched healthy pregnants at the similar pregnancy trimester as control group were included between January 12,017 and May 31, 2018...
February 12, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30773306/nursing-driven-approaches-to-improving-emergency-department-discharge
#4
LETTER
Anish K Agarwal, Sean Foster, Carolina Garzon Mrad, Brooks Martino, Christopher K Snider, Leighann Mazzone, Allen Fasnacht, Kelly Patton, Christopher Edwards, John Flamma
No abstract text is available yet for this article.
February 12, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30777376/a-case-of-purulent-pneumococcal-pericarditis
#5
Itay Zmora, Yonit Wiener-Well, Evan Avraham Alpert
BACKGROUND: Purulent bacterial pericarditis is a rare and potentially fatal disease. The course may be fulminant, and the presentation may pose a diagnostic challenge. CASE REPORT: An otherwise healthy 75-year-old male was brought to the emergency department in a state of general deterioration, confusion, and shock. Bedside ultrasound showed a significant pericardial effusion. His condition quickly deteriorated and the resuscitation included emergent bedside pericardiocentesis...
February 11, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30772130/flexible-nasotracheal-intubation-compared-to-blind-nasotracheal-intubation-in-the-setting-of-simulated-angioedema
#6
Seth Parkey, Thomas Erickson, Emily M Hayden, Calvin A Brown Iii, Jestin N Carlson
BACKGROUND: Nasotracheal intubation is rarely performed in the emergency department (ED) but may be required in specific situations such as angioedema. Both blind and flexible nasal intubation (FNI) may be utilized; however, the preferred technique is unknown. METHODS: We performed a randomized, crossover manikin study using a convenience sample of emergency physicians and medical students from a local community teaching hospital. Using a simulated angioedema model, we sought to compare the time required to successfully perform nasotracheal intubation between traditional blind nasotracheal intubation and FNI...
February 11, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30770243/ultrasound-guided-supra-inguinal-fascia-iliaca-compartment-blocks-in-hip-fracture-patients-an-alternative-technique
#7
M L Ridderikhof, E De Kruif, M F Stevens, H M Baumann, P B Lirk, J C Goslings, M W Hollmann
INTRODUCTION: In the Emergency Department, regional anesthesia is increasingly used in elderly patients with hip fractures. An example is a Fascia Iliaca Compartment Block (FICB). Traditionally, this block is administered below the inguinal ligament. There is no Emergency Department data regarding effectivity of an alternative, more cranial approach above the inguinal ligament. The objective was to determine analgesic effects of an ultrasound-guided supra-inguinal FICB in hip fracture patients in the Emergency Department...
February 11, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30770241/asking-the-correct-questions-of-push-dose-vasopressors
#8
LETTER
Nicholas Farina
No abstract text is available yet for this article.
February 8, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30770240/lactate-and-news-l-are-fair-predictors-of-mortality-in-critically-ill-geriatric-emergency-department-patients
#9
Zerrin Defne Dundar, Sedat Kocak, Abdullah Sadik Girisgin
INTRODUCTION: In this study, we aimed to investigate the prognostic power of the first lactate level measured in the emergency department (ED), National Early Warning Score (NEWS), and NEWS-lactate (NEWS-L) on ED admission in critically ill geriatric patients. METHODS: This retrospective observational study was conducted in the ED of a university hospital. Consecutive patients ≥65 years of age admitted to our ED between July 1, 2017, and December 31, 2017, and transferred to the intensive care unit after the ED follow-up period were included in the study...
February 7, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30765279/the-ottawa-subarachnoid-hemorrhage-clinical-decision-rule-for-classifying-emergency-department-headache-patients
#10
Wei-Ting Wu, Hsiu-Yung Pan, Kuan-Han Wu, Yi-Syun Huang, Chien-Hung Wu, Fu-Jen Cheng
BACKGROUND: Subarachnoid hemorrhage (SAH) is a serious cause of headaches. The Ottawa subarachnoid hemorrhage (OSAH) rule helps identify SAH in patients with acute nontraumatic headache with high sensitivity, but provides limited information for identifying other intracranial pathology (ICP). OBJECTIVES: To assess the performance of the OSAH rule in emergency department (ED) headache patients and evaluate its impact on the diagnosis of intracranial hemorrhage (ICH) and other ICP...
February 7, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30765276/emergency-department-sepsis-huddles-achieving-excellence-for-sepsis-benchmarks-in-new-york-state
#11
Danielle Walsh, Robert Gekle, Robert Bramante, Eric Decena, Christopher Raio, David Levy
The sepsis order set at our institution was created with the intent to facilitate the prompt initiation of appropriate sepsis care. Once clinical features meeting criteria for systemic inflammatory response syndrome (SIRS) are identified and an infectious source is considered, a "sepsis huddle" is concomitantly initiated. The sepsis huddle was implemented in March of 2016 in order to increase compliance with the sepsis bundles. The sepsis huddle is called via overhead paging system in the emergency department (ED) to notify all staff that there is a patient present who meets SIRS criteria with concern for sepsis requiring immediate attention...
February 7, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30765277/heart-rate-variability-in-patients-presenting-with-neurally-mediated-syncope-in-an-emergency-department
#12
Hikaru Akizuki, Naoyuki Hashiguchi
BACKGROUND: Neurally mediated syncope (NMS) is a disorder of autonomic nervous system (ANS) regulation. Orthostatic stress is one of the most common causative factors seen in clinical practice. Analysis of heart rate variability (HRV) is a non-invasive method that is used to assess ANS regulation. In this study, we investigated the pathophysiology of NMS using HRV in our emergency department. METHODS: The subjects were 19 patients (age 25.8 ± 6.2 years old) who presented with NMS and 20 healthy individuals (age 26...
February 6, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30745074/the-impact-of-an-emergency-care-access-point-on-pediatric-attendances-at-the-emergency-department-an-observational-study
#13
Mireille E M Platter, Roel A J Kurvers, Loes Janssen, Marjoke M J Verweij, Dennis G Barten
OBJECTIVE: Crowding is a growing concern in general and pediatric Emergency Departments (EDs). The Emergency Care Access Point (ECAP) - a collaboration between general practitioners and the ED - has been established to reduce the number of self-referrals and non-urgent ED visits. The aim of this study was to determine the impact of an ECAP on pediatric attendances in the ED. METHODS: Retrospective analysis of 3997 pediatric patients who visited the ED of a regional teaching hospital in the Netherlands, one year before and one year after the implementation of an ECAP...
February 6, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30744914/intravenous-dexketoprofen-versus-paracetamol-in-non-traumatic-musculoskeletal-pain-in-the-emergency-department-a-randomized-clinical-trial
#14
Ezgi Demirozogul, Atakan Yilmaz, Mert Ozen, Ibrahim Turkcuer, Murat Seyit, Cuneyt Arikan
INTRODUCTION: Although acute musculoskeletal pain has a wide range of causes from tendinitis, muscle spasm, to bone and joint injuries, it is a frequent occurrence in emergency services. Paracetamol and non-steroidal anti-inflammatory analgesics (NSAID) are common used in the treatment of musculoskeletal pain. This study sets out to compare the effectiveness of intravenous dexketoprofen and paracetamol in musculoskeletal pain relief. METHODS: This prospective, randomized, double blind, controlled study was carried out in a university emergency room...
February 4, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30744912/ultrasound-and-optic-neuritis
#15
LETTER
Palmiro Cornetta, Giuseppe Marotta, Maddalena De Bernardo, Livio Vitiello, Nicola Rosa
No abstract text is available yet for this article.
February 4, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30765278/diagnostic-considerations-in-detecting-apical-hypertrophic-cardiomyopathy-while-utilizing-point-of-care-ultrasound
#16
LETTER
Melanie F Molina, Andrew S Liteplo, Calvin Huang, Hamid Shokoohi
No abstract text is available yet for this article.
February 1, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30738590/pre-hospital-modified-shock-index-for-prediction-of-massive-transfusion-and-mortality-in-trauma-patients
#17
Il-Jae Wang, Byung-Kwan Bae, Sung-Wook Park, Young-Mo Cho, Dae-Sup Lee, Mun-Ki Min, Ji-Ho Ryu, Gil-Hwan Kim, Jae-Hoon Jang
BACKGROUND: Modified shock index (MSI) is a useful predictor in trauma patients. However, the value of prehospital MSI (preMSI) in trauma patients is unknown. The aim of this study was to investigate the accuracy of preMSI in predicting massive transfusion (MT) and hospital mortality among trauma patients. METHODS: This was a retrospective, observational, single-center study. Patients presenting consecutively to the trauma center between January 2016 and December 2017, were included...
February 1, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30737001/traumatic-cerebrovascular-injury-prevalence-and-risk-factors
#18
Thara Tunthanathip, Nakornchai Phuenpathom, Sakchai Saehaeng, Thakul Oearsakul, Ittichai Sakarunchai, Anukoon Kaewborisutsakul
BACKGROUND: Traumatic cerebrovascular injury (TCVI) is uncommon in traumatic brain injury (TBI). Although TCVI is a rare condition, this complication is serious. A missed or delayed diagnosis may lead to an unexpected life-threatening hemorrhagic event or persistent neurological deficit. The object of this study was to determine the prevalence and risk factors associated with TCVI. METHODS: The authors retrospectively reviewed medical records and neuroimaging studies of 5178 patients with TBI...
January 31, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30733103/nurse-practitioners-and-physician-assistants-in-emergency-medical-services-who-billed-independently-2012-2016
#19
Ge Bai, Gabor D Kelen, Kevin D Frick, Gerard F Anderson
OBJECTIVE: As nurse practitioners (NPs) and physician assistants (PAs) become an integral part of delivering emergency medical services, we examined the involvement of NPs and PAs who billed independently in emergency departments (EDs). METHODS: We used Medicare provider utilization and payment data from 2012 to 2016 to conduct a retrospective analysis. We examined the changes in the number of each clinician type who billed independently for four common emergency services (CPT codes: 99282-5), the change in their service volume, and the change in their average number of services billed...
January 31, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30723001/lev-s-syndrome-a-rare-case-of-progressive-cardiac-conduction-disorder-presenting-to-the-emergency-department
#20
Brandon M Carius, Brit Long, Steve Schauer
Lev's Syndrome is a rare, progressive cardiac conduction defect (PCCD) due to myocardial fibrosis first described by Maurice Lev in 1964. This condition, proposed to start in the fourth decade of life, involves a sclerotic fibro-fatty degeneration of the Bundle of His and Purkinje fibers, which Lev proposed caused increasing AV delay with age. With the prevalence of electrocardiogram (ECG) use in the emergency department (ED) for cardiac- and non-cardiac complaints, dysrhythmias can be incidentally found and confuse diagnosis and disposition...
January 31, 2019: American Journal of Emergency Medicine
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