Journals American Journal of Emergency ...

American Journal of Emergency Medicine
Nathan J Alcasid, Cynthia J Susai, Kian C Banks, Lara Senekjian, Timothy D Browder, Gregory P Victorino
BACKGROUND: Routine evaluation with CTA for patients with isolated lower extremity penetrating trauma and normal ankle-brachial-indices (ABI) remains controversial. While prior literature has found normal ABI's (≥0.9) and a normal clinical examination to be adequate for safe discharge, there remains concern for missed injuries which could lead to delayed surgical intervention and unnecessary morbidity. Our hypothesis was that routine CTA after isolated lower extremity penetrating trauma with normal ABIs and clinical examination is not cost-effective...
May 11, 2024: American Journal of Emergency Medicine
Min-Po Ho
No abstract text is available yet for this article.
May 9, 2024: American Journal of Emergency Medicine
Hitoshi Kobata, Akira Sugie, Makiko Kawakami, Suguru Tanaka, Gemmalynn Sarapuddin, Adam Tucker
INTRODUCTION: Collapse after out-of-hospital cardiac arrest (OHCA) can cause severe traumatic brain injury (TBI). We aimed to investigate the clinical characteristics and treatment strategies for patients with OHCA and TBI. METHODS: We analyzed a consecutive cohort of patients with intrinsic OHCA retrospectively treated between January 2011 and December 2021 at a single critical care center, and presented a case series of seven patients. Patients with collapse-related TBI were examined for the causes and situations of cardiac arrest, laboratory data, radiological images, targeted temperature management (TTM), coronary angiography (CAG), percutaneous coronary intervention (PCI), and extracorporeal cardiopulmonary resuscitation (ECPR)...
May 9, 2024: American Journal of Emergency Medicine
Zlatan Zvizdic, Asmir Jonuzi, Una Glamoclija, Denisa Zvizdic, Semir Vranic
BACKGROUND: Cryptorchidism and testicular torsion (TT) are relatively common conditions in clinical practice; however, sparse information about cryptorchid TT is available in the current literature. METHODS: We retrospectively reviewed the clinical characteristics, treatment modalities, and long-term outcomes of pediatric patients treated for acute cryptorchid TT. RESULTS: We found eight patients with unilateral acute cryptorchid TT with a prevalence of 8...
May 9, 2024: American Journal of Emergency Medicine
Benjamin W Friedman, Yen Ting Chen, Caron Campbell, Rebecca Nerenberg, Freda Afrifa, Kristen Schimmrich, Victoria Adewunmi, Jesse Baer, Eddie Irizarry
BACKGROUND: Most methodologically rigorous, ED-based, comparative effectiveness analgesic studies completed in the last two decades failed to find a clinically important difference between the comparators. We believe that many of these comparative effectiveness studies were biased towards the null hypothesis because some ED patients with intense pain will respond to relatively mild interventions. We hypothesized that including a run-in period would alter the results of an acute pain RCT...
May 9, 2024: American Journal of Emergency Medicine
Aditya C Shekhar, Molly K Childers, Ethan E Abbott, Joshua Kimbrell, Ryan A Coute, Timothy J Mader, N Clay Mann, Manu Madhok
BACKGROUND: A growing body of evidence suggests outcomes for cardiac arrest in adults are worse during nights and weekends when compared with daytime and weekdays. Similar research has not yet been carried out in the infant setting. METHODS: We examined the National Emergency Medical Services Information System (NEMSIS), a database containing millions of emergency medical services (EMS) runs in the United States. Inclusion criteria were infant out-of-hospital cardiac arrests (patients <1 years old) taking place prior to EMS arrival between January 2021 and December 2022 where EMS documented whether return of spontaneous circulation (ROSC) was achieved...
May 9, 2024: American Journal of Emergency Medicine
Jamie L Holland, Sriram Ramgopal, Nathan Money, Christopher Graves, Yu Hsiang Lo, Andrew Hashikawa, Alexander Rogers
No abstract text is available yet for this article.
May 9, 2024: American Journal of Emergency Medicine
Francesco S Pappalardo, Maxwell Krieger, Carolyn Park, Francesca L Beaudoin, Rachel S Wightman
BACKGROUND: In the context of polysubstance use and fentanyl detection in non-opioid drugs supplies (e.g., cocaine, methamphetamine), it is important to re-evaluate and expand our understanding of which populations are at high risk for fatal drug overdoses. The primary objective of this pilot study was to gather data from the ED to characterize the population presenting with drug overdose, including demographics, drug use patterns and comorbidities, to inform upstream overdose prevention efforts...
May 8, 2024: American Journal of Emergency Medicine
Amanda Apato, Stephany Nuñez Cruz, Dharati Desai, Giles W Slocum
BACKGROUND: The updated 2021 CDC treatment guidelines recommend a single dose of 500 mg intramuscular ceftriaxone for Neisseria gonorrhea and doxycycline 100 mg by mouth twice daily for 7 days for Chlamydia trachomatis coinfection. However, there is a significant public health concern regarding patient non-adherence to the 7-day course of doxycycline. To date, there are no studies assessing this concern. Therefore, the objective of this study was to evaluate a patient's adherence to doxycycline for chlamydial infections after discharge from the Emergency Department (ED)...
May 5, 2024: American Journal of Emergency Medicine
David Cannata, Kyle A Chin, Abeid Anslip, Trent She, Seth Lotterman, Timothy Herbst, Meghan Kelly Herbst
BACKGROUND: Gallbladder distention has been described in radiology literature but its value on point-of-care ultrasound (PoCUS) performed by emergency physicians is unclear. We sought to determine the test characteristics of gallbladder distention on PoCUS for cholecystitis (acute or chronic), and secondarily whether distention was associated with an obstructing stone-in-neck (SIN), acute cholecystitis on subsequent pathology report, and longer cholecystectomy operative times. METHODS: This was a dual-site retrospective cohort study of all Emergency Department (ED) patients that underwent diagnostic biliary PoCUS and were subsequently admitted from 11/1/2020 to 10/31/2022...
May 5, 2024: American Journal of Emergency Medicine
Andrew Shieh, Alexander J Rogers, Chiu-Mei Chen, Sriram Ramgopal
BACKGROUND: Weight estimation is essential in the care of ill children when a weight cannot be obtained. This is particularly important for children with medical complexity, who are at higher risk for adverse drug events. Our objective was to compare the accuracy of different methods of weight estimation in children and stratify by the presence of medical complexity. METHODS: We performed a retrospective cross-sectional study of children (<18 years) seen in the emergency department (ED) or ambulatory clinic from January 1, 2013 to December 31, 2022 at a tertiary academic pediatric center...
May 3, 2024: American Journal of Emergency Medicine
Gürbüz Meral, Serdal Ateş, Serkan Günay, Ahmet Öztürk, Mikail Kuşdoğan
INTRODUCTION: The term Artificial Intelligence (AI) was first coined in the 1960s and has made significant progress up to the present day. During this period, numerous AI applications have been developed. GPT-4 and Gemini are two of the best-known of these AI models. As a triage system The Emergency Severity Index (ESI) is currently one of the most commonly used for effective patient triage in the emergency department. The aim of this study is to evaluate the performance of GPT-4, Gemini, and emergency medicine specialists in ESI triage against each other; furthermore, it aims to contribute to the literature on the usability of these AI programs in emergency department triage...
May 3, 2024: American Journal of Emergency Medicine
Halil Ahmet Bilginer, Ozgur Sogut, Adem Az, Huseyin Ergenc
PURPOSE: We explored the relationships between electrocardiographic (ECG) abnormalities and the clinical outcomes and mortality of patients with non-traumatic aneurysmal subarachnoid hemorrhages (SAHs). METHODS: This retrospective cohort study enrolled consecutive adult patients who presented to emergency departments with non-traumatic aneurysmal SAHs. We recorded their demographics, clinical characteristics, and ECG findings, and explored the relationships between ECG abnormalities, on the one hand, and 28-day mortality and prognosis, on the other...
May 3, 2024: American Journal of Emergency Medicine
Michael Gottlieb, Katherine Kravchuk, James R O'Brien
Lumbar puncture is performed to evaluate for multiple neurologic conditions, including meningitis and subarachnoid hemorrhage. However, success rates with the landmark-based technique are limited. Ultrasound is most commonly used for pre-marking without dynamic guidance, which presents several limitations, including absence of real-time guidance and lack of reliability if any patient movement occurs after skin marking. We describe a novel, ultrasound-guided paramedian approach which was successfully performed in the Emergency Department setting for lumbar puncture...
May 3, 2024: American Journal of Emergency Medicine
Brit Long, Michael Gottlieb
INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a condition commonly seen in the emergency department (ED). Therefore, it is important for emergency clinicians to be aware of the current evidence regarding the diagnosis and management of this disease. OBJECTIVE: This paper evaluates key evidence-based updates concerning UGIB for the emergency clinician. DISCUSSION: UGIB most frequently presents with hematemesis. There are numerous causes, with the most common peptic ulcer disease, though variceal bleeding in particular can be severe...
May 3, 2024: American Journal of Emergency Medicine
Sai-Ching Jim Yeung, Aiham Qdaisat, Jason J Bischof, Jeffrey M Caterino, Demetrios N Kyriacou, Christopher Coyne Md
The number of approved immune checkpoint inhibitors (ICIs) and their indications have significantly increased over the past decade. Immune-related adverse effects (irAEs) of ICIs vary widely in presentation and symptoms and can present diagnostic challenges to emergency department (ED) physicians. Moreover, when ICIs are combined with radiotherapy, cytotoxic chemotherapy, or targeted therapy, the attribution of signs and symptoms to an immune-related cause is even more difficult. Here, we report a series of 5 ED cases of adrenal insufficiency in ICI-treated cancer patients...
April 30, 2024: American Journal of Emergency Medicine
Akira Kawauchi, Makoto Aoki, Nobuya Kitamura, Takashi Tagami, Kei Hayashida, Shotaro Aso, Hideo Yasunaga, Mitsunobu Nakamura
BACKGROUND: Neuromuscular blocking agents (NMBAs) can control shivering during targeted temperature management (TTM) of patients with cardiac arrest. However, the effectiveness of NMBA use during TTM on neurologic outcomes remains unclear. We aimed to evaluate the association between NMBA use during TTM and favorable neurologic outcomes after out-of-hospital cardiac arrest (OHCA). MATERIALS AND METHODS: A multicenter, prospective, observational cohort study from 2019 to 2021...
April 30, 2024: American Journal of Emergency Medicine
August Supervía, Antonio F Caballero-Bermejo, Jordi Puiguriguer, Francisca Córdoba, Andrea Martínez-Baladrón, Francisco Callado, Victoria Lobo-Antuña, Elena Fuentes, Valle Molina-Samper, Susana Vert, Francisco Ruíz-Ruíz, F Javier Guijarro-Eguinoa, Beatriz Martín-Pérez, Samuel Olmos, Belén Ruiz-Antorán, María Teresa Maza-Vera, Oriol Pallàs, Benjamín Climent, Maider Igartua-Astibia, Edith Gutiérrez, Santiago Nogué, Ana Ferrer-Dufol, Guillermo Burillo-Putze
BACKGROUND: Digoxin poisonings are relatively common and potentially fatal, requiring immediate therapeutic intervention, with special attention to the patient's hemodynamic status and the presence of electrocardiographic and electrolytic disturbances. OBJECTIVE: To identify factors associated with seven-day and thirty-day mortality in digoxin poisoning. DESIGN, SETTINGS AND PARTICIPANTS: A retrospective, observational, multicenter study was conducted across 15 Hospital Emergency Departments (HED) in Spain...
April 28, 2024: American Journal of Emergency Medicine
Andrew Burton, Darlene J DeBona, Michele Handzel, Sarah Kelly-Pisciotti, Min Qiao, Dana Rojek, Nicole M Acquisto
Extended-release formulations of buprenorphine offer less frequent dosing, provide consistent medication delivery, and improve adherence for treatment of opioid use disorder (OUD). Although buprenorphine is a partial agonist with seemingly less precipitated withdrawal and easier initiation than full opioid agonists used for OUD, its use is not benign and understanding of the different extended-release formulations is necessary. We report a case of a patient that received a long-acting buprenorphine formulation (Sublocade®) administered subcutaneously that presented to the emergency department with tachycardia, hyperglycemia, elevated anion gap, and sustained nausea and vomiting refractory to pharmacotherapy requiring surgical removal of the buprenorphine depot for resolution of nausea and vomiting symptoms...
April 27, 2024: American Journal of Emergency Medicine
Sara Safari, Christine G Saad, Gavin C Barr
Hemolacria, or bloody tears, is a symptom caused by several ocular disorders ranging from trauma to hormonal changes. We describe a case in which a 21-year-old, 28-week pregnant patient presented to the emergency department (ED) following her second occurrence of nocturnal left eye bleeding in a week. During her examination in the ED, a small abrasion to the lateral edge of the upper left lid was noted. No other injuries, traumatic mechanisms, or relevant past medical history were noted. Due to her pregnancy, the nascent pyogenic granuloma responsible for her hemolacria was managed conservatively...
April 27, 2024: American Journal of Emergency Medicine
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