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Open Access Emergency Medicine: OAEM

Bardia Barimani, Rayan Fairag, Fahad Abduljabbar, Ahmed Aoude, Carlo Santaguida, Jean Ouellet, Michael Weber
Background: Traumatic atlanto-axial rotatory subluxation (AARS) in an adult is a rare condition, which if left untreated can be fatal. In addition to this, many symptoms experienced such as neck pain and stiffness are non-specific which often leads to misdiagnosis, thus delaying definitive treatment. AARS can be divided into traumatic and non-traumatic causes with the latter generally encompassing congenital cervical spine abnormalities. Case presentation: We present a case of a 66-year-old female with traumatic rotatory AARS, which was initially misdiagnosed in the emergency department...
2019: Open Access Emergency Medicine: OAEM
Lesley A Osborn, Megan L Brenner, Samuel J Prater, Laura J Moore
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has recently gained popularity as a minimally invasive alternative to open aortic cross-clamping in the management of patients with non-compressible hemorrhage arising below the diaphragm. The purpose of this review is to provide a description of the technical aspects of REBOA use along with an overview of the current animal and clinical data regarding its use.
2019: Open Access Emergency Medicine: OAEM
Christian R Timbol, James N Baraniuk
Purpose: Chronic fatigue syndrome (CFS) is a debilitating disease characterized by fatigue, postexertional malaise, cognitive dysfunction, sleep disturbances, and widespread pain. A pilot, online survey was used to determine the common presentations of CFS patients in the emergency department (ED) and attitudes about their encounters. Methods: The anonymous survey was created to score the severity of core CFS symptoms, reasons for going to the ED, and Likert scales to grade attitudes and impressions of care...
2019: Open Access Emergency Medicine: OAEM
Reza Mosaddegh, Neda Ashayeri, Mahdi Rezai, Gholamreza Masoumi, Samira Vaziri, Fatemeh Mohammadi, Hamed Givzadeh, Nasrin Noohi
Objective: Routine serial hematocrit measurements are a component of the trauma evaluation for patients without serious injury identified on initial evaluation. We sought to determine whether serial hematocrit testing was useful in predicting the probable injuries in blunt abdominal trauma. Materials and method: We performed a prospective study of trauma patients admitted in our observation unit over a 12-month period. Patients routinely underwent serial hematocrit testing in 6-hour intervals (two hematocrit levels)...
2019: Open Access Emergency Medicine: OAEM
Camilla Hansen, Kasper G Lauridsen, Anders S Schmidt, Bo Løfgren
Introduction: Many cardiopulmonary resuscitation (CPR) attempts are unsuccessful and must be terminated. On the contrary, premature termination results in a self-fulfilling prophecy. This study aimed to investigate 1) physicians' self-assessed competence in terminating CPR, 2) physicians' and nurses' knowledge of the European Resuscitation Council guidelines on termination, and 3) single factors leading to termination. Methods: Questionnaires were distributed at advanced cardiac life support (ACLS) courses at a university hospital in Denmark...
2019: Open Access Emergency Medicine: OAEM
Aleksandr M Tichter, Grigory Ostrovskiy
Background: COPD is the third leading cause of death, with acute exacerbations accounting for 1.5 million emergency department (ED) visits annually. Guidelines include recommendations for antibiotic therapy, though evidence for benefit is limited, and little is known about ED prescribing patterns. Our objectives were to determine the rate with which ED patients with acute exacerbations of COPD (AECOPD) are treated with antibiotics, compare the proportions of antibiotic classes prescribed, describe trends of antibiotic treatment, and identify predictors of antibiotic therapy...
2018: Open Access Emergency Medicine: OAEM
German Devia Jaramillo, Jenny Castro Canoa, Emiro Valverde Galván
Sepsis and septic shock constitute a complex disease condition that requires the engagement of several medical specialties. A great number of patients with this disease are constantly admitted to the emergency department, which warrants the need for emergency physicians to lead in the recognition and early management of septic patients. Timely and appropriate interventions may help reduce mortality in a disease with an unacceptably high mortality rate. Poor control of cellular hypoperfusion is one of the most influential mechanisms contributing to the high mortality rate in these patients...
2018: Open Access Emergency Medicine: OAEM
Tian-Tee Ng
Background: Managing patients with aural foreign body (AFB) may pose a dilemma regarding which removal technique to use for different AFB types. The current study comprises a review of all the possible methods one could employ in removing AFB. My aim was to describe the best methods for different types of AFBs, complete with a description of the method and tool(s) required, and descriptions of the AFBs for which they are best used. Materials and methods: The medical literature published between 2000 and 2016 was reviewed using Medline, Cinahl, Embase, Cochrane, PubMed, and Scopus to compile a list of all published AFB removal methods...
2018: Open Access Emergency Medicine: OAEM
Giorgos Papoutsis, Sylvana Papoutsi, Jolanta Klukowska-Rötzler, Benoît Schaller, Aristomenis K Exadaktylos
Purpose: Temporomandibular joint (TMJ) dislocation is an uncommon and debilitating condition of the facial skeleton. The condition may be traumatic or nontraumatic, in an acute or chronic form, and with bilateral or monolateral expression. Patients and methods: In this study, conducted from May 2012 to July 2016, we retrospectively analyzed TMJ dislocations treated in the Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, by focusing on the following parameters: age, gender, reason, localization, frequency, and therapy...
2018: Open Access Emergency Medicine: OAEM
Elizabeth A Brooks, Mark Piehl
Background: While early fluid resuscitation has been shown to significantly improve health and economic metrics in septic shock, providers are often unable to achieve fluid delivery guidelines using current techniques. Purpose: To examine expected clinical and economic consequences of more consistent achievement of fluid resuscitation guidelines through use of a novel fluid delivery technology. Patients and methods: A decision analytic model was developed to compare expected costs and outcomes associated with the standard technique vs a novel, faster technique for rapid fluid resuscitation in adult patients with severe sepsis or septic shock...
2018: Open Access Emergency Medicine: OAEM
Keith M Porter, Anthony D Dayan, Sara Dickerson, Paul M Middleton
Methoxyflurane is an inhaled analgesic administered via a disposable inhaler which has been used in Australia for over 40 years for the management of pain associated with trauma and for medical procedures in children and adults. Now available in 16 countries worldwide, it is licensed in Europe for moderate to severe pain associated with trauma in conscious adults, although additional applications are being made to widen the range of approved indications. Considering these ongoing developments, we reviewed the available evidence on clinical usage and safety of inhaled analgesic methoxyflurane in trauma pain and in medical procedures in both adults and children...
2018: Open Access Emergency Medicine: OAEM
Samina Ali, Aaron Moodley, Amrita Bhattacharjee, Eddie Chang, Allison Kabaroff, Kevin Lobay, Dominic Allain
Objectives: Croup is one of the most common childhood respiratory illnesses. Early dexamethasone administration in croup can improve patient outcomes. The objective of this study was to assess the clinical impact of prehospital administration of dexamethasone to children with croup. Methods: A medical record review that included children between 6 months and 6 years, who were brought via emergency medical services (EMS) to the emergency department (ED) with a final diagnosis of croup, between January 2010 and December 2012, was conducted...
2018: Open Access Emergency Medicine: OAEM
Tjokorda Gde Bagus Mahadewa, Nyoman Golden, Anne Saputra, Christopher Ryalino
Background: Traumatic brain injury (TBI) is a common healthcare problem related to disability. An easy-to-use trauma scoring system informs physicians about the severity of trauma and helps to decide the course of management. The purpose of this study is to use the combination of both physiological and anatomical assessment tools that predict the outcome and develop a new modified prognostic scoring system in TBIs. Patients and methods: A total of 181 subjects admitted to the emergency department (ED) of Sanglah General Hospital were documented for both Marshall CT scan classification score (MCTC) and Revised Trauma Score (RTS) upon admission...
2018: Open Access Emergency Medicine: OAEM
Siriwimon Tantarattanapong, Nuraianee Arwae
Objective: The aim of this study was to identify factors associated with perforated acute appendicitis in geriatric patients at the emergency department (ED). Patients and methods: The medical records of 223 consecutive patients aged >60 years with acute appendicitis between 2006 and 2017 were retrospectively reviewed. Patients were grouped into those with perforated and non-perforated appendicitis. A comparison was made between the two groups in regard to baseline characteristics, clinical presentation, physical examination, time from onset of symptoms to ED arrival, time from ED arrival to operation, postoperative complications, hospital length of stay, and mortality...
2018: Open Access Emergency Medicine: OAEM
Mathilde Stærk, Kasper G Lauridsen, Troels Mygind-Klausen, Bo Løfgren
Introduction: Guideline implementation is essential to improve survival following cardiac arrest. This study aimed to investigate awareness, expected time frame, and strategy for implementation of the European Resuscitation Council (ERC) Guidelines 2015 in Danish hospitals. Methods: All public, somatic hospitals with a cardiac arrest team in Denmark were included. A questionnaire was sent to hospital resuscitation committees one week after guideline publication...
2018: Open Access Emergency Medicine: OAEM
Adam J Kruse, Andrew S Nugent, Andrew R Peterson
Purpose: Traumatic brain injury (TBI) is a significant cause of death and disability in the United States. Many patients with TBI are initially treated in the emergency department (ED), but there is no evidence-based method of detecting or grading TBI in patients who have normal structural neuroimaging. This study aims to evaluate the validity of two common sideline concussion tests. The Concussion Symptom Severity Score (CSSS) and modified Balance Error Scoring System (mBESS) tests are well-validated sideline tests for concussion, but have not been validated in the setting of non-sport-related concussion, in settings other than the sideline or athletic training room or in moderate or severe TBI...
2018: Open Access Emergency Medicine: OAEM
Ar-Aishah Dadeh, Banjaparat Nuanjaroan
Objective: To examine the initial level of lactate to predict sustained return of spontaneous circulation (ROSC) in nontraumatic out-of-hospital cardiac arrest (OHCA) patients. Materials and methods: This was a 30-month retrospective cohort study in an emergency department (ED) of a tertiary care hospital. The inclusion criteria were adult nontraumatic OHCA patients who came to the ED with ongoing chest compression. The primary outcome was initial serum lactate level at the ED to predict sustained ROSC in nontraumatic OHCA...
2018: Open Access Emergency Medicine: OAEM
Ki Hoon Kim, Sang Hyun Park
Perforation is the rarest complication of the duodenal diverticulum (DD), but it is the most serious complication. Mortality rate was reported up to 30%, which may be related to diagnostic delay because the symptoms of the perforated DD are vague and nonspecific. Therefore, accurate diagnosis is important to improve the clinical outcome. Surgical treatment was considered as the standard therapeutic option. However, surgical intervention may increase morbidity and mortality due to surgical complications. Therefore, nonoperative management can be considered in some patients with perforated diverticulum who have stable vital signs without generalized peritonitis, or in elderly patients with comorbidities...
2018: Open Access Emergency Medicine: OAEM
Mostafa A Abolfotouh, Mohamed A Hussein, Sameh M Abolfotouh, Alanoud Al-Marzoug, Suliman Al-Teriqi, Abeer Al-Suwailem, Ra'ed A Hijazi
Background: The aim of this study was to describe the pattern of traumatic injuries and determine the predictors of inhospital mortality in patients admitted to the emergency department. Patients and methods: This is a retrospective cohort study of 3,786 patients with traumat injuries admitted to the emergency department of King Abdulaziz Medical City, Riyadh, Saudi Arabia, between January 2012 and December 2014. Data on patient characteristics, trauma characteristics and outcomes were extracted from medical records...
2018: Open Access Emergency Medicine: OAEM
Gabriella F Pogorzelski, Taline Aal Silva, Thamara Piazza, Tomás M Lacerda, Fernando Ac Spencer Netto, Amaury Cesar Jorge, Péricles Ad Duarte
Background: Trauma is a major cause of hospital admissions and is associated with manifold complications and high mortality rates. However, data on intensive care unit (ICU) admissions are scarce in developing and low-income countries, where its incidence has been increasing. Objectives: To analyze epidemiological and clinical factors and outcomes in adult trauma patients admitted to the ICU of a public teaching hospital in a developing country as well as to identify risk factors for complications in the ICU...
2018: Open Access Emergency Medicine: OAEM
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