American Journal of Emergency Medicine

INTRODUCTION: Ultrasound has been increasingly utilized for the identification of endotracheal tube (ETT) location after an intubation attempt, particularly among patients in cardiac arrest. However, prior studies have varied with respect to the choice of transducer and no studies have directly compared the accuracy between transducer types. Our study is the first to directly compare the accuracy of ETT confirmation between the linear and curvilinear transducer. METHODS: This study was performed in a cadaver lab using three different cadavers chosen to represent varying neck circumferences...

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An emergency physician (EP) is often the first health care provider to evaluate, resuscitate, and manage a critically ill patient. Between 2001 and 2009, the annual hours of critical care delivered in emergency departments (EDs) across the United States increased >200% [1]! This trend has persisted since then. In addition to seeing more critically ill patients, EPs are often tasked with providing critical care long beyond the initial resuscitation period. In fact, >33% of critically ill patients who are brought to an ED remain there for >6 h [1]...

OBJECTIVE: Patients suffering from aneurysmatic Subarachnoid Hemorrhage (SAH) may present with a variety of symptoms. The aim of this study is to evaluate the spectrum of misdiagnoses and to analyze the significance of delay of correct diagnosis on the clinical outcome. METHODS: The data was collected prospectively from 2003 to 2013. Patients diagnosed with disease different from aneurysmal SAH by the initially treating physician, and admitted to our department with a delay of at least 24 h after the beginning of the symptoms, were included in this study...

INTRODUCTION: Foreign body airway obstruction (FBAO) is a common medical emergency; however, few studies of life-threatening FBAO have been reported and no standard classification system is available. METHODS: We retrospectively evaluated patients who presented to the emergency departments of two hospitals and were diagnosed with FBAO. The primary outcome was cerebral performance category (CPC) score at discharge. To establish a new classification system for FBAO, FBAO was classified into three types based on the anatomical and physiological characteristics of the obstructed airway...

BACKGROUND: Phenibut is a synthetically produced central nervous system (CNS) depressant that is structurally similar to the inhibitory neurotransmitter γ-aminobutyric acid (GABA). Phenibut has been identified as a drug of abuse with numerous clinical effects in overdose and a withdrawal syndrome with chronic use. The purpose of this study is to report the incidence of exposure calls regarding phenibut to a poison center, describe the reasons for its use and clinical effects. METHODS: Study subjects were identified using Toxicall®, the electronic medical record utilized by the Minnesota Poison Control System...

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OBJECTIVE: Croup treatment usually involves a single dose of systemic dexamethasone combined with nebulized epinephrine. However, the optimal dose of l-epinephrine remains unclear. We examined whether a low dose (0.1 mg/kg) was inferior to the conventional dose (0.5 mg/kg) of 1:1000 nebulized l-epinephrine in patients with moderate to severe croup. METHODS: This randomized double-blind clinical non-inferiority trial was conducted in three pediatric emergency departments from May 2015 to October 2017...

OBJECTIVE: The quick sequential organ failure assessment (qSOFA) score is calculated from three variables measured at the scene of trauma-systolic blood pressure, respiratory rate and consciousness. This study aimed to evaluate the discriminative ability of the prehospital qSOFA score for in-hospital mortality in patients with trauma. METHODS: This retrospective multicenter study used data from 42,722 patients with trauma included in a Japanese nationwide trauma registry...

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BACKGROUND: In developed nations, the age of patients in emergency departments (ED) continues to increase. Many emergency triage systems, such as the Canadian Triage and Acuity Scale (CTAS), triage patients as a homogenous group, regardless of age. However, older adults have multiple comorbidities and a higher risk of undertriage. The Japan Acuity and Triage Scale (JTAS) was developed based on the CTAS and has been validated for overall adults. We assessed the validity of the JTAS for use in elderly ED patients...

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INTRODUCTION: The present study evaluates the predictive value of such markers as ischemia-modified albumin (IMA), malondialdehyde (MDA) and glutathione peroxide (GSH-Px), in addition to parameters associated with inflammation, oxidative stress and ischemia, playing roles in the pathology of acute appendicitis (AA), including c-reactive protein (CRP), procalcitonin (PCT) and complete blood count (CBC) parameters and their ratios, for the diagnosis of AA in adults. MATERIAL AND METHODS: The study included 51 patients with histologically confirmed appendicitis and 45 healthy controls who referred to the emergency care unit between January and June 2018...

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BACKGROUND: Community paramedicine (CP) leverages trained emergency medical services personnel outside of emergency response as an innovative model of health care delivery. Often used to bridge local gaps in healthcare delivery, the CP model has existed for decades. Recently, the number of programs has increased. However, the level of robust data to support this model is less well known. OBJECTIVE: To describe the evidence supporting community paramedicine practice...

OBJECTIVES: To compare clinical impact after early initiation of high-flow nasal cannula oxygen therapy (HFNC) versus standard oxygen in patients admitted to an emergency department (ED) for acute hypoxemic respiratory failure. METHODS: We performed a prospective before-after study at EDs in two centers including patients with acute hypoxemic respiratory failure defined by a respiratory rate above 25 breaths/min or signs of increased breathing effort under additional oxygen for a pulse oximetry above 92%...

BACKGROUND AND OBJECTIVE: Managing respiratory failure (RF) secondary to acute decompensated heart failure (ADHF) with non-invasive positive-pressure ventilation (NIPPV) has been shown to significantly improve morbidity and mortality in patients presenting to the emergency department (ED). This subgroup analysis compares high-velocity nasal insufflation (HVNI), a form of high-flow nasal cannula, with NIPPV in the treatment of RF secondary to ADHF with respect to therapy failure, as indicated by the requirement for intubation or all-cause arm failure including subjective crossover to the alternate therapy...

INTRODUCTION: Fluid resuscitation is a fundamental component of the management of critically ill patients, but whether choice of crystalloid affects patient outcomes remains controversial. Therefore, we performed this meta-analysis to compare the efficacy and safety of balanced crystalloids with normal saline. METHODS: We searched the MEDLINE, Cochrane Central and EMBASE up to October 2018 to identify randomized controlled trials (RCTs) that compared balanced crystalloids versus normal saline in critically ill patients...

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