American Journal of Emergency Medicine

INTRODUCTION: Angiotensin converting enzyme inhibitor (ACEi) associated angioedema is frequently encountered in the emergency department. Airway management is the primary treatment, but published evidence supporting the decision to intubate patients with this condition is extremely limited. METHOD: We performed a retrospective study of all cases of ACEi associated angioedema encountered in a large, urban, tertiary referral emergency department. We classified demographics, duration of symptoms before presentation, physical exam findings and nasopharyngoscopy findings in patients that did and did not require intubation...

PURPOSE: We aimed to investigate the prevalence, risk factors and outcome of hypo- and hypernatremia in emergency patients with acute kidney injury (AKI). METHODS: In this cross-sectional analysis all emergency patients between January 1st 2017 and December 31st 2018 with measurements of creatinine and sodium were included. Baseline characteristics, medication and laboratory data were gathered. Chart reviews were performed to identify patients with a diagnosis of chronic kidney disease (CKD) and to extract baseline creatinine...

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BACKGROUND: The SEP-1 measures have tied financial reimbursement to the treatment of patients with severe sepsis and septic shock. The purpose of this study was to assess the impact of a SEP-1 initiative on the utilization of broad-spectrum combination therapy (BSCT) in the emergency department (ED). METHODS: This was an IRB-approved, retrospective evaluation of adult patients who received vancomycin plus an antipseudomonal beta-lactam for a urinary tract infection (UTI) or skin or soft tissue infection (SSTI) in the ED...

Sialolithiasis represents the most common issue of the salivary gland, ranging from asymptomatic to airway compromising. In rapidly progressing, completely obstructive salivary stones, the presentation can mimic emergent oropharyngeal diseases, primarily Ludwig's angina. We present a case of a large and obstructive sialolith with abscess whose initial presentation was concerning for Ludwig's angina with impending airway compromise. While a common complaint, emergency providers should be aware of the nefarious presentation of an everyday complaint...

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Spontaneous ureter rupture (SUR) is a rare condition that can present mimicking many acute abdominal diseases. There is no probable explanation of the theoretical mechanism of spontaneous ureter rupture in the literature. Mostly calculus can cause spontaneous ureter rupture with ureteral obstruction. If left untreated, it can lead to life-threatening complications. Herein we report a case of SUR that was occurred due to urinary stone disease in a male patient who presented with abdominal pain. A non-contrast enhanced and a late phase contrast-enhanced abdominal computed tomography (CT) demonstrated the urinary stone disease and contrast extralumination from the proximal part of the left ureter...

OBJECTIVES: Cardiovascular disease is the leading cause of mortality and morbidity. Serial troponin tests have been endorsed as essential diagnostic steps to rule out/-in acute myocardial infarction (AMI), and hs-cTn assays have shown promise in enhancing the accuracy and efficiency of AMI diagnosis in the emergency department (ED). METHODS: A systematic review and meta-analysis of diagnostic test accuracy studies were conducted to compare the diagnostic performance of various accelerated diagnostic algorithms of hs-cTn assays for patients with symptoms of AMI...

Carbon monoxide (CO) poisoning occurs due to CO gas which is produced by the incomplete combustion of hydrocarbons. Several causes of CO poisoning have been defined in the literature. The most frequent causes are defective heaters, fires and exposure to exhaust gas in closed areas. The lung diffusion test is a method used to detect alveolar membrane diffusion capacity. The standart gas used in the diffusion test is CO. The case is here presented of a patient who was poisoned by CO during a DLCO test. To the best of our knowledge, this is the first case report defining CO poisoning during a DLCO test and treated at the Emergency Department...

BACKGROUND: Emergency Department (ED) follow-up programs ensure that cultures, laboratory studies, and empiric antimicrobials are appropriately managed post-discharge. We sought to provide a comprehensive assessment of a pharmacist-driven laboratory follow-up process in a large, integrated health system. METHODS: A retrospective, observational review of 13 EDs was conducted. Patients were included if they had a laboratory study sent from the ED between December 1, 2017 and May 31, 2018 that did not result while the patient was in the ED...

BACKGROUND: Helicopter Emergency Medical Service (HEMS) conducts the evaluation of a patient's condition using NACA score before transporting the patient to hospital. The conditions inside the rescue helicopter limit or even make it impossible to conduct some medical procedures. An appropriate classification of the patient may lead to a lower possibility of occurrence of adverse events during the flight. The aim of the research was to evaluate the correlation of NACA score with the cardiac arrhythmia that may be life threatening...

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OBJECTIVE: In the assessment and management of septic patients in the emergency department (ED), serum lactate is often measured to stratify severity to guide decision making. Increased adrenergic drive has been postulated as a contributory factor for hyperlactatemia in sepsis. We aim to prospectively evaluate the effect of chronic beta-blocker use on serum lactate levels in sepsis at initial presentation to the ED. METHODS: We conducted a prospective observational study at the ED of a tertiary care academic medical center in Singapore...

BACKGROUND: Double sequential defibrillation (DSD) has been proposed as a viable treatment option for patients in refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) out-of-hospital cardiac arrests (OHCA). However, currently there is insufficient evidence to support a widespread implementation of this therapy. STUDY OBJECTIVES: The aim of this scoping review was to summarize the current available evidence of DSD for patients with refractory VF/pVT OHCA as well as to identify gaps in the literature that may require further research...

As many as 5% of patients using oral anticoagulants suffer from a major bleeding event annually. Spontaneous retroperitoneal hemorrhage is a rare but serious complication, with a mortality rate as high as 20%. Oral anticoagulants were responsible for 2.83 million office visits per quarter in 2014 and use is increasing, therefore, rapid recognition of life threatening complications is critical. We present a case of an 86-year-old female taking apixaban for atrial fibrillation who presented with right hip pain upon standing...

AIM: To analyse the effect of oxygen fraction reduction (O2 14%, equivalent to 3250 m) on Q-CPR and rescuers' physiological demands. METHODOLOGY: A quasi-experimental study was carried out in a sample of 9 Q-CPR proficient health care professionals. Participants, in teams of 2 people, performed 10 min CPR on a Laerdal ResusciAnne mannequin (30:2 compression/ventilation ratio and alternating roles between rescuers every 2 min) in two simulated settings: T21-CPR at sea level (FiO2 of 21%) and T14 - CPR at 3250 m altitude (FiO2 of 14%)...

INTRODUCTION: Tuberculosis (TB) is a common disease worldwide, affecting nearly one-third of the world's population. While TB has decreased in frequency in the United States, it remains an important infection to diagnose and treat. OBJECTIVE: This narrative review discusses the evaluation and management of tuberculosis, with an emphasis on those factors most relevant for the emergency clinician. DISCUSSION: TB is caused by Mycobacterium tuberculosis and is highly communicable through aerosolized particles...

PURPOSE: Evaluate opioid prescribing before and after emergency department (ED) renal colic guideline implementation focused on multi-modal pain management. METHODS: Retrospective study of ED patients who received analgesia for urolithiasis before and after guideline implementation. The guideline recommends oral acetaminophen, intravenous (IV) ketorolac, and a fluid bolus as first line, IV lidocaine as second line, and opioids as refractory therapy to control pain...

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