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Journal of Emergency Medicine

Jennifer Devries, Sally Rafie, Toluwalase A Ajayi, Allyson Kreshak, Kyle P Edmonds
BACKGROUND: The Emergency Department (ED) is a medical setting increasingly utilized by opioid users. In January 2016, our health system initiated a take-home naloxone education and distribution program. From July to August 2016, screening was performed in the ED to identify patients for take-home naloxone. OBJECTIVE: To evaluate the outcomes of routine screening for take-home naloxone in the ED setting and to determine key screening questions. Secondary analysis of Electronic Health Records for discrete elements that could help identify individuals for naloxone...
February 12, 2019: Journal of Emergency Medicine
Peter V Bui, Nathan L Haas, Nicholas W C Herrman, Matthew Macias, Victoria Hoch, William Schaeffer, Christopher Wallace
BACKGROUND: Brugada pattern on electrocardiography (ECG) can manifest as type 1 (coved pattern) and type 2 (saddleback pattern). Brugada syndrome represents an ECG with Brugada pattern in a patient with symptoms or clinical factors, including syncope, cardiac arrest, ventricular dysrhythmias, and family history. Brugada syndrome is caused by a genetic channelopathy, but the Brugada pattern may be drug-induced. Epinephrine-induced Brugada pattern has not been reported previously. CASE REPORT: A 63-year-old man developed anaphylaxis secondary to a bee sting, had a transient loss of consciousness, and self-administered intramuscular epinephrine...
February 9, 2019: Journal of Emergency Medicine
Albert Wang, Ryan Roten, Jacqueline Le
No abstract text is available yet for this article.
February 9, 2019: Journal of Emergency Medicine
Lindsay A Weiner, Adam C Richardson, Semhar Z Tewelde
BACKGROUND: Spontaneous spinal and intracranial subdural hematomas are rarely reported, especially occurring simultaneously. Anticoagulation use has been associated with spontaneous hemorrhages. Prompt diagnosis is required to prevent permanent neurological sequelae. In this case report, we describe a spontaneous spinal and intracranial subdural hematoma in a woman taking warfarin and initially presenting with severe vaginal pain. CASE REPORT: A 42-year-old woman who had a history of mechanical valve replacement and was therefore taking warfarin, came to an emergency department for relief of severe vaginal pain...
February 8, 2019: Journal of Emergency Medicine
Shinichi Fukuhara, Tomohiro Sameshima, Hidetoshi Matsuo, Tamaki Ohashi
BACKGROUND: Although fractures of the sternum are rare in young children, owing to the compliance of the chest wall, these fractures are still possible and require thorough examination. We present a case that emphasizes the usefulness of point-of-care ultrasound in the diagnosis of a pediatric sternal fracture complicated by a subcutaneous abscess. CASE REPORT: A 5-year-old boy presented with tenderness of the sternum, with diffuse swelling extending bilaterally to the anterior chest wall...
February 8, 2019: Journal of Emergency Medicine
Junaidah Badron, Gene Yong-Kwang Ong
BACKGROUND: Headache and monocular visual disturbance are worrisome pediatric presenting complaints in the emergency department. Appropriate and timely initial evaluation is critical. Most would opt for urgent computer tomography in such cases. Pediatric optic neuritis is a rare condition and is better evaluated by magnetic resonance imaging. With the increase in the use and scope of bedside ultrasound, there might be a potential role for transorbital ultrasound to be part of the emergency department evaluation of pediatric optic neuritis...
February 8, 2019: Journal of Emergency Medicine
Elhaam Mesghali, Scott Fitter, Khaled Bahjri, Kayvan Moussavi
BACKGROUND: Hypertonic saline (HTS) and mannitol are frequently utilized in the emergency department (ED) to manage elevations in intracranial pressure (ICP). OBJECTIVE: The objective of this study was to compare the incidence of extravasation injury when HTS or mannitol was administered via peripheral i.v. line (PIV). METHODS: This retrospective cohort study evaluated adult and pediatric patients given either 3% HTS or mannitol via PIV while in the ED...
February 8, 2019: Journal of Emergency Medicine
Lauren R Klein, Brian E Driver, Gabriella Horton, Sarah Scharber, Marc L Martel, Jon B Cole
BACKGROUND: Rapid treatment of agitation in the emergency department (ED) is critical to avoid injury to patients and providers. Treatment with intramuscular antipsychotics is often utilized, but there is a paucity of comparative effectiveness evidence available. OBJECTIVE: The purpose of this investigation was to compare the effectiveness of droperidol, olanzapine, and haloperidol for treating agitation in the ED. METHODS: This was a retrospective observational study of adult patients who received intramuscular medication to treat agitation...
February 8, 2019: Journal of Emergency Medicine
Olivia L Kamensky, Destiny Horton, Donald P Kingsley, Christy C Bridges
BACKGROUND: Mercury poisoning is an uncommon diagnosis in the United States, but it is a differential diagnosis that physicians should consider because it can lead to potentially fatal complications if untreated. Due to the nonspecific presentation of mercury poisoning, which includes symptoms such as fever, nausea, vomiting, and abdominal pain, misdiagnosis may occur unless a proper history is taken. CASE REPORT: In the present case, a white female patient was misdiagnosed repeatedly with a viral illness and sent home from the local hospital...
February 1, 2019: Journal of Emergency Medicine
Brett Rosen, Ryan Shanahan, Mohamad Ali Cheaito, Amin Kazzi, Shahram Lotfipour, Micheal Epter
Emergency medicine (EM) is a swiftly developing yet still relatively young discipline. We are going to present in the Medical Student Forum section of the Journal of Emergency Medicine several article series covering the key topics that medical students interested in emergency medicine will find helpful. This article introduces the topics that will be tackled in the first compilation of articles dealing with the residency application process.
January 30, 2019: Journal of Emergency Medicine
Kolia Milojevic, Alexandra Beltramini, Mohsen Nagash, Alexandre Muret, Olivier Richard, Yves Lambert
BACKGROUND: Recent-onset atrial fibrillation (RAF) is the most frequent supraventricular dysrhythmia in emergency medicine. Severely compromised patients require acute treatment with injectable drugs OBJECTIVE: The main purpose of this external validity study was to compare the short-term efficacy of esmolol with that of amiodarone to treat severe RAF in an emergency setting. METHODS: This retrospective survey was conducted in mobile intensive care units by analyzing patient records between 2002 and 2013...
January 30, 2019: Journal of Emergency Medicine
Heewon Yang, Hyukhoon Kim, Jae Ryoung Kwak, Sangchun Choi
No abstract text is available yet for this article.
January 30, 2019: Journal of Emergency Medicine
Shweta Iyer, Karen Goodman
BACKGROUND: Babesiosis is a disease caused by parasites that infect red blood cells; in infants it can be acquired from tick bites, blood transfusions, or congenitally via vertical transmission. It can present with thrombocytopenia, fevers, and parasitemia. CASE REPORT: A case of vertically transmitted babesiosis in an infant is described. Thrombocytopenia and parasitemia > 4% developed in this well-appearing infant. The diagnosis was made by history and blood smear in both infant and mother, and the patient recovered fully with oral antibiotics...
January 29, 2019: Journal of Emergency Medicine
Steven J Holcomb
BACKGROUND: In order to simulate a heartbeat in a cardiac arrest patient, cardiopulmonary resuscitation (CPR) requires that chest compressions be delivered with a force of at least 560 N at a rate >100 compressions/min. Many new learners initially use CPR forms that may not meet these parameters sufficiently. We examined three forms of CPR: the form recommended by the American Heart Association (AHA) and two forms that are common among new learners but that are considered incorrect, using a CPR manikin placed on a force plate...
January 29, 2019: Journal of Emergency Medicine
Erkman Sanri, Sinan Karacabey
BACKGROUND: Guidelines recommend placing a cervical collar (c-collar) until spinal injury is excluded. Previous studies have shown that c-collar placement increases intracranial pressure (ICP), which can worsen outcomes for trauma patients who are at risk of increased ICP. Head of bed elevation (HBE) has been found to decrease ICP. However, there is no consensus in the literature for the optimal degree of HBE to decrease ICP. OBJECTIVE: We aimed to find an optimal HBE degree to decrease ICP to its baseline values in healthy volunteers with increased ICP caused by c-collar...
January 29, 2019: Journal of Emergency Medicine
Jessica L Mckee, Ian A Mckee, Melanie D Bouclin, Dennis F Filips, Ian J Atkinson, Chad G Ball, Paul B McBeth, Major Andrew W Kirkpatrick
BACKGROUND: Penetrating neck wounds are common in the civilian and military realms. Whether high or low velocity, they carry a substantial morbidity and mortality rate. OBJECTIVES: We endeavored to ascertain whether the iTClamp is equivalent to direct manual pressure (DMP) and Foley catheter balloon tamponade (BCT). METHODS: Using a perfused cadaver, a 4.5-cm wound was made in Zone 2 of the neck with a 1-cm carotid arteriotomy. Each of the hemorrhage control modalities was randomized and then applied to the wound separately...
January 29, 2019: Journal of Emergency Medicine
Edmond A Hooker, Peter J Mallow, Michelle M Oglesby
BACKGROUND: It is important that policy makers, health administrators, and emergency physicians have up-to-date statistics on the most common diagnoses of patients seen in the emergency department (ED). OBJECTIVES: We sought to describe the changes that occurred in ED visits from 2010 through 2014 and to describe the frequency of different ED diagnoses. METHODS: This is a retrospective analysis of ED visit data from the National Emergency Department Sample from 2010 through 2014...
January 28, 2019: Journal of Emergency Medicine
John Teijido, Amy L Drendel
BACKGROUND: Blastomycosis is caused by a fungus endemic to states and providences bordering the Lawrence Rivers and the Great Lakes. It can lead to significant pathology in both immunocompetent and immunocompromised hosts. This case report describes disseminated blastomycosis in an otherwise healthy 16-year-old patient. CASE REPORT: A 16-year-old male presented with a chief complaint of flank pain. In the Emergency Department he described additional symptoms of emesis, cough, and weight loss...
January 25, 2019: Journal of Emergency Medicine
Jonathan Kei, Donald P Mebust, Laura V Duggan
BACKGROUND: Surgical cricothyrotomy is a rare procedure but it must be mastered by any physician who is involved in advanced airway management. Lack of experience and practice, the high-stress nature of a "can't intubate, can't oxygenate" emergency, and the unavailability of realistic simulators all contribute to physician hesitance and inaptitude while employing cricothyrotomy during difficult and failed airways. The REAL CRIC Trainer was created to alleviate some of the barriers surrounding a surgical airway...
January 23, 2019: Journal of Emergency Medicine
Brit Long, Alex Koyfman, Michael Gottlieb
BACKGROUND: Acute compartment syndrome (ACS) is a time-sensitive surgical emergency caused by increased pressure within a closed compartment. ACS can lead to significant morbidity and mortality if it is not rapidly identified and treated. OBJECTIVE: This article provides an evidence-based review of the diagnosis and management of ACS, with focused updates for the emergency clinician. DISCUSSION: ACS is the result of decreased perfusion within a compartment and is associated with a number of risk factors, but it occurs most commonly after fractures or trauma to the involved area...
January 23, 2019: Journal of Emergency Medicine
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