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Publisher: Elsevier   (Total: 3123 journals)

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Showing 1 - 200 of 3120 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 26, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 378, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 26, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 237, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
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Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 5)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 140, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 4)
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Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
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Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 6)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 47, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 52, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 17, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 27)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 10)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 371, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 45, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 338, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 433, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 42, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 49, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 42, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 207, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 61, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 24, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 26, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 36, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 60, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 36, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 173, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 176, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)

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Journal Cover American Journal of Emergency Medicine
  [SJR: 0.574]   [H-I: 65]   [42 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0735-6757
   Published by Elsevier Homepage  [3123 journals]
  • Preventive effects of motorcycle helmets on intracranial injury and
           mortality from severe road traffic injuries
    • Authors: Sola Kim; Young Sun Ro; Sang Do Shin; Kyoung Jun Song; Ki Jeong Hong; Joo Jeong
      Pages: 173 - 178
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Sola Kim, Young Sun Ro, Sang Do Shin, Kyoung Jun Song, Ki Jeong Hong, Joo Jeong
      Introduction Road traffic injuries caused by motorcycle crashes are one of the major public health burdens leading to high mortality, functional disability, and high medical costs. The helmet is crucial protective equipment for motorcyclists. This study aimed to measure the protective effect of motorcycle helmets on clinical outcomes and to compare the effects of high- and low-speed motorcycle crashes. Methods A cross-sectional observational study was conducted using a nationwide registry of severe trauma patients treated by emergency medical services (EMS) providers in Korea. The study population consisted of severe trauma patients injured in motorcycle crashes between January and December 2013. The primary and secondary outcomes were intracranial injury and in-hospital mortality. We calculated adjusted odds ratios (AORs) of helmet use and motorcycle speeds for study outcomes after adjusting for potential confounders. Results Among 495 eligible patients, 105 (21.2%) patients were wearing helmets at the time of the crash, and 256 (51.7%) patients had intracranial injuries. The helmeted group was less likely to have an intracranial injury compared with the un-helmeted group (41.0% vs. 54.6%, AOR: 0.53 (0.33–0.84)). However, there was no significant difference in in-hospital mortality between the two groups (16.2% vs. 16.9%, AOR: 0.91 (0.49–1.69)). In the interaction analysis, there was a significant preventive effect of motorcycle helmet use on intracranial injury when the speed of the motorcycle was <30km/h (AOR: 0.50 (0.27–0.91)). Conclusion Wearing helmets for severe trauma patients in motorcycle crashes reduced intracranial injuries. The preventive effect on intracranial injury was significant in low-speed motorcycle crashes.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.044
       
  • Efficacy of corticosteroid treatment for severe community-acquired
           pneumonia: A meta-analysis
    • Authors: Wei-Fang Wu; Qiang Fang; Guo-Jun He
      Pages: 179 - 184
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Wei-Fang Wu, Qiang Fang, Guo-Jun He
      Background The benefits and adverse effects of corticosteroids in the treatment of severe community-acquired pneumonia (CAP) have not been well assessed. The aim of this systematic review of the literature and meta-analysis was to evaluate the clinical efficacy of adjuvant corticosteroid therapy in patients with severe CAP. Methods The following databases were searched: PubMed, the Cochrane database, Embase, Wanfang, the China National Knowledge Infrastructure (CNKI), and the WeiPu (VIP) database in Chinese. Published randomized controlled clinical trial results were identified that compared corticosteroid therapy with conventional therapy for patients with severe CAP, up to November 2016. The relative risk (RR), weighted mean difference (WMD), and 95% confidence interval (CI) were evaluated. Statistical analysis was performed using STATA 10.0. The quality of the published studies was evaluated using the Oxford quality scoring system (Jadad scale). Results Ten randomized controlled trials (RCTs) were identified that included 729 patients with severe CAP. Data analysis showed that corticosteroid therapy did not have a statistically significant clinical effect in patients with severe CAP (RR: 1.19; 95% CI: 0.99–1.42), mechanical ventilation time (WMD: −2.30; 95% CI: −6.09–1.49). However, corticosteroids treatment was significantly associated with reduced in-hospital mortality (RR: 0.49; 95% CI: 0.29–0.85), reduced length of hospital stay (WMD: −4.21; 95% CI: −6.61 to −1.81). Conclusion Corticosteroids adjuvant therapy in patients with severe CAP may reduce the rate of in-hospital mortality, reduce the length of hospital stay, and reduce CRP levels.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.050
       
  • Integrating heart rate variability, vital signs, electrocardiogram, and
           troponin to triage chest pain patients in the ED
    • Authors: Jeffrey Tadashi Sakamoto; Nan Liu; Zhi Xiong Koh; Dagang Guo; Micah Liam Arthur Heldeweg; Janson Cheng Ji Ng; Marcus Eng Hock Ong
      Pages: 185 - 192
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Jeffrey Tadashi Sakamoto, Nan Liu, Zhi Xiong Koh, Dagang Guo, Micah Liam Arthur Heldeweg, Janson Cheng Ji Ng, Marcus Eng Hock Ong
      Background Current triage methods for chest pain patients typically utilize symptoms, electrocardiogram (ECG), and vital sign data, requiring interpretation by dedicated triage clinicians. In contrast, we aimed to create a quickly obtainable model integrating the objective parameters of heart rate variability (HRV), troponin, ECG, and vital signs to improve accuracy and efficiency of triage for chest pain patients in the emergency department (ED). Methods Adult patients presenting to the ED with chest pain from September 2010 to July 2015 were conveniently recruited. The primary outcome was a composite of revascularization, death, cardiac arrest, cardiogenic shock, or lethal arrhythmia within 72-h of presentation to the ED. To create the chest pain triage (CPT) model, logistic regression was done where potential covariates comprised of vital signs, ECG parameters, troponin, and HRV measures. Current triage methods at our institution and modified early warning score (MEWS) were used as comparators. Results A total of 797 patients were included for final analysis of which 146 patients (18.3%) met the primary outcome. Patients were an average age of 60years old, 68% male, and 56% triaged to the most acute category. The model consisted of five parameters: pain score, ST-elevation, ST-depression, detrended fluctuation analysis (DFA) α1, and troponin. CPT model>0.09, CPT model>0.15, current triage methods, and MEWS≥2 had sensitivities of 86%, 74%, 75%, and 23%, respectively, and specificities of 45%, 71%, 48%, and 78%, respectively. Conclusion The CPT model may improve current clinical triage protocols for chest pain patients in the ED.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.054
       
  • The occurrence of aspiration pneumonia after emergency endotracheal
           intubation
    • Authors: Brian E. Driver; Lauren R. Klein; Alexandra L. Schick; Matthew E. Prekker; Robert F. Reardon; James R. Miner
      Pages: 193 - 196
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Brian E. Driver, Lauren R. Klein, Alexandra L. Schick, Matthew E. Prekker, Robert F. Reardon, James R. Miner
      Study objective Adverse events, including aspiration, occur during Emergency Department (ED) intubation, but their contemporary incidence is not well described. We sought to estimate the rate of aspiration pneumonia potentially related to emergency intubation. Methods We conducted a prospective observational study of adult patients who were endotracheally intubated in the ED. Using a standard definition, we determined the proportion of patients who developed aspiration pneumonia after intubation. Aspiration pneumonia was defined as any of the following in patients without a diagnosis of community acquired pneumonia, healthcare-associated pneumonia, or aspiration prior to intubation: pathogenic growth in sputum culture, unexplained hypoxemia, or radiographic evidence of pneumonia in the first 48h after intubation. Baseline characteristics and intubation details were compared for those with and without aspiration pneumonia. Results 879 patients were enrolled over a 30-month period. Intubation was facilitated by video laryngoscopy (49%), direct laryngoscopy (45%), nasal intubation (4%), a intubating laryngeal mask airway (1%), and a surgical airway (0.1%). 85% were intubated on the first attempt, 12% on the second, 3% on the third or more attempts. 25% of patients experienced an oxygen saturation <90% during the intubation. After excluding patients not eligible for the outcome assessment (those who died within 48h without findings of pneumonia), 66/823 (8%) developed aspiration pneumonia potentially related to ED intubation. In comparing those with and without aspiration pneumonia, there were no differences between first intubation attempt parameters and the occurrence of aspiration pneumonia. Conclusion Aspiration pneumonia occurred commonly in this cohort. Although we did not identify any intubation factors that differed between those with and without with aspiration pneumonia, these findings should remind emergency physicians that emergency endotracheal intubation remains a high-risk procedure, and all care should be taken to minimize the risk of peri-intubation complications.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.066
       
  • Effects of intravenous administration of fentanyl and lidocaine on
           hemodynamic responses following endotracheal intubation
    • Authors: Amir Masoud Hashemian; Hamid Zamani Moghadam Doloo; Maziar Saadatfar; Roya Moallem; Maryam Moradifar; Raheleh Faramarzi; Mohammad Davood Sharifi
      Pages: 197 - 201
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Amir Masoud Hashemian, Hamid Zamani Moghadam Doloo, Maziar Saadatfar, Roya Moallem, Maryam Moradifar, Raheleh Faramarzi, Mohammad Davood Sharifi
      Objectives To compare the effects of intravenous fentanyl and lidocaine on hemodynamic changes following endotracheal intubation in patients requiring Rapid Sequence Intubation (RSI) in the emergency department (ED). Methods A single-centered, prospective, simple non-randomized, double-blind clinical trial was conducted on 96 patients who needed RSI in Edalatian ED. They were randomly divided into three groups (fentanyl group (F), lidocaine group (L), and fentanyl plus lidocaine (M) as our control group). M was administered with 3 μgr/kg intravenous fentanyl and 1.5 μgr/kg intravenous lidocaine, F was injected with 3g/kg intravenous fentanyl and L received 1.5mg/kg intravenous lidocaine prior to endotracheal intubation. Heart rate (HR) and mean arterial pressure (MAP) were assessed four times with the chi-square test: before, immediately after, 5 and 10 min after intubation. Intervention was discontinued for five people due to unsuccessful CPR. Results HR was notably different in F, L and M groups during four time courses (p<0.05). Comparison of MAP at measured points in all groups exhibited no significant difference (p>0.05). In fentanyl group both HR and MAP increased immediately after intubation, and significantly decreased 10 min after intubation (p<0.05). Conclusions Overall, the result of this study shows that lidocaine effectively prevents MAP and HR fluctuations following the endotracheal intubation. According to our findings, lidocaine or the combination of fentanyl and lidocaine are able to diminish hemodynamic changes and maintain the baseline conditions of the patient, thus could act more effectively than fentanyl alone.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.069
       
  • Anti-inflammatory and organ protective effect of insulin in scalded MODS
           rats without controlling hyperglycemia
    • Authors: Zhongzhen Zhu; Tian Hu; Zhanke Wang; Jin Wang; Rui Liu; Qianyong Yang; Xiaoyun Zhang; Yuanyuan Xiong
      Pages: 202 - 207
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Zhongzhen Zhu, Tian Hu, Zhanke Wang, Jin Wang, Rui Liu, Qianyong Yang, Xiaoyun Zhang, Yuanyuan Xiong
      Background Insulin, as an anti-inflammatory drug, could not be freely used in patients who experienced trauma according to the degree of inflammation, because of the side effect of hypoglycemia. In vivo experimental evidence is lacking concerning whether the effect is dosage dependent and whether it relies on controlling hyperglycemia. Methods By adjusting the dosage ratio of glucose and insulin, different dosages of insulin were used to treat severely scalded MODS rats to achieve uncontrolled or controlled hyperglycemia. One hundred forty rats with severe scalded were randomly divided into a hyperglycemia-controlled group, hyperglycemia-uncontrolled group, and control group. The levels of inflammation response indexes and major organ dysfunction indexes were measured and compared between groups. Results The blood indexes of inflammatory response and major organ dysfunction did not show statistical difference between hyperglycemia-controlled groups (A) and uncontrolled groups (B) in the same dosage of insulin (all P>0.05). The blood indexes of inflammatory response and major organ dysfunction demonstrated statistical difference in different dosages of insulin with hyperglycemia-controlled groups (A1–A3 groups) and hyperglycemia-uncontrolled groups (B1–B3 groups) (all P<0.01). The higher dosage of insulin, the better effect of anti-inflammation and organ protection it would demonstrate with or without controlling hyperglycemia. Conclusions The effect of anti-inflammation and organ protection of insulin is dosage dependent in vivo; it does not rely on controlling hyperglycemia. Temporary traumatic hyperglycemia itself might not be detrimental to the body. Adjusting the ratio of insulin and glucose could provide a novel train of thought for freely treating patients with severe traumatic injury with different dosages of insulin according to the degree of inflammation.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.070
       
  • Variation in the evaluation of testicular conditions across United States
           pediatric emergency departments
    • Authors: Lois K. Lee; Michael C. Monuteaux; Joel D. Hudgins; John J. Porter; Susan C. Lipsett; Florence Bourgeois; Bartley G. Cilento; Mark I. Neuman
      Pages: 208 - 212
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Lois K. Lee, Michael C. Monuteaux, Joel D. Hudgins, John J. Porter, Susan C. Lipsett, Florence Bourgeois, Bartley G. Cilento, Mark I. Neuman
      Objectives To explore the variation in diagnostic testing and management for males diagnosed with three testicular conditions (testicular torsion, appendix testis torsion, epididymitis/orchitis) using a large pediatric health care database. Diagnostic testing is frequently used in evaluation of the acute scrotum; however, there is likely variability in the use of these tests in the emergency department setting. Methods We conducted a cross-sectional study of males with the diagnoses of testicular torsion, appendix testis torsion, and epididymitis/orchitis. We identified emergency department patients in the Pediatric Health Information Systems (PHIS) database from 2010 to 2015 using diagnostic and procedure codes from the International Classification of Diseases Codes 9 and 10. Frequencies of diagnoses by demographic characteristics and of procedures and diagnostic testing (ultrasound, urinalysis, urine culture and sexually transmitted infection testing) by age group were calculated. We analyzed testing trends over time. Results We identified 17,000 males with the diagnoses of testicular torsion (21.7%), appendix testis torsion (17.9%), and epididymitis/orchitis (60.3%) from 2010 to 2015. There was substantial variation among hospitals in all categories of testing for each of the diagnoses. Overall, ultrasound utilization ranged from 33.1–100% and urinalysis testing ranged from 17.0–84.9% for all conditions. Only urine culture testing decreased over time for all three diagnoses (40.6% in 2010 to 31.5 in 2015). Conclusions There was wide variation in the use of diagnostic testing across pediatric hospitals for males with common testicular conditions. Development of evaluation guidelines for the acute scrotum could decrease variation in testing.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.078
       
  • The impact of CT head scans on ED management and length of stay in bizarre
           behavior patients
    • Authors: P. Ng; M. McGowan; M. Goldstein; C.D. Kassardjian; B.D. Steinhart
      Pages: 213 - 217
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): P. Ng, M. McGowan, M. Goldstein, C.D. Kassardjian, B.D. Steinhart
      Methods A 5-year retrospective chart review was conducted at 3 EDs. Inclusion criteria were patients ≥18years old triaged as “mental health - bizarre behavior” (deviation from normal cognitive behaviour with no obvious cause) with a CT head scan ordered in the ED. Exclusion criteria were focal neurologic deficits on exam, alternative medical etiology (i.e. delirium, trauma) and/or pre-existing CNS disease. Clinical, demographic and administrative data were extracted with 10% of charts independently reviewed by an Emergency Physician for inter-rater reliability. Results 266 cases met study criteria. Population demographics: 49% percent female, average age 51years old, 28% homeless, 58% arrived by police or ambulance. CT head results: 1 (0.4%) case with possible acute findings, 105 (39%) with incidental findings (i.e. cerebral atrophy) that did not impact clinical management. Average time to physician assessment was 1:48 (hour:min) (sd 1:11), time to CT completion was 5:05 (sd 7:28) and an average delay of 3:17 awaiting results. Subgroup analysis revealed a net increase in ED length of stay (ED LOS) of 5:02 from obtaining neuroimaging. 85% of patients were referred to a consultant, 92% were to psychiatry. Conclusions CT head results prolonged ED LOS, delayed patient disposition and did not change the patient's clinical management. A prospective trial for ordering CT head scans in these patients is warranted.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.080
       
  • Predictors for under-prescribing antibiotics in children with respiratory
           infections requiring antibiotics
    • Authors: Aaron E. Kornblith; Jahan Fahimi; Hemal K. Kanzaria; Ralph C. Wang
      Pages: 218 - 225
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Aaron E. Kornblith, Jahan Fahimi, Hemal K. Kanzaria, Ralph C. Wang
      Background/objective Previous studies showed variability in the use of diagnostic and therapeutic resources for children with febrile acute respiratory tract infections (ARTI), including antibiotics. Unnecessary antibiotic use has important public and individual health outcomes, but missed antibiotic prescribing also has important consequences. We sought to determine factors associated with antibiotic prescribing in pediatric ARTI, specifically those with pneumonia. Methods We assessed national trends in the evaluation and treatment of ARTI for pediatric emergency department (ED) patients by analyzing the National Hospital Ambulatory Medical Care Survey from 2002 to 2013. We identified ED patients aged ≤18 with a reason for visit of ARTI, and created 4 diagnostic categories: pneumonia, ARTI where antibiotics are typically indicated, ARTI where antibiotics are typically not indicated, and “other” diagnoses. Our primary outcome was factors associated with the administration or prescription of antibiotics. A multivariate logistic regression model was fit to identify risk factors for underuse of antibiotics when they were indicated. Results We analyzed 6461 visits, of which 10.2% of the population had a final diagnosis of pneumonia and 86% received antibiotics. 41.5% of patients were diagnosed with an ARTI requiring antibiotics, of which 53.8% received antibiotics. 26.6% were diagnosed with ARTI not requiring antibiotics, of which 36.0% received antibiotics. Black race was a predictor for the underuse of antibiotics in ARTIs that require antibiotics (OR: 0.72; 95% CI: 0.58–0.90). Conclusions For pediatric patients presenting to the ED with pneumonia and ARTI requiring antibiotics, we found that black race was an independent predictor of antibiotic underuse.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.081
       
  • The effect of high-flow nasal cannula in reducing the mortality and the
           rate of endotracheal intubation when used before mechanical ventilation
           compared with conventional oxygen therapy and noninvasive positive
           pressure ventilation. A systematic review and meta-analysis
    • Authors: Yue-Nan Ni; Jian Luo; He Yu; Dan Liu; Bin-Miao Liang; Zong-An Liang
      Pages: 226 - 233
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Yue-Nan Ni, Jian Luo, He Yu, Dan Liu, Bin-Miao Liang, Zong-An Liang
      Background The effects of high flow nasal cannula (HFNC) on adult patients when used before mechanical ventilation (MV) are unclear. We aimed to determine the effectiveness of HFNC when used before MV by comparison to conventional oxygen therapy (COT) and noninvasive positive pressure ventilation (NIPPV). Methods The Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL) as well as the Information Sciences Institute (ISI) Web of Science were searched for all the controlled studies that compared HFNC with NIPPV and COT when used before MV in adult patients. The primary outcome was the rate of endotracheal intubation and the secondary outcomes were intensive care unit (ICU) mortality and length of ICU stay (ICU LOS). Results Eight trials with a total of 1084 patients were pooled in our final studies. No significant heterogeneity was found in outcome measures. Compared both with COT and NIPPV, HFNC could reduce both of the rate of endotracheal intubation (OR 0.62, 95% CI 0.38–0.99, P =0.05; OR 0.48, 95% CI 0.31–0.73, P =0.0006) and ICU mortality (OR 0.47, 95% CI 0.24–0.93, P =0.03; OR 0.36, 95% CI 0.20–0.63, P =0.0004). As for the ICU LOS, we did not find any advantage of HFNC over COT or NIPPV. Conclusions When used before MV, HFNC can improve the prognosis of patients compared both with the COT and NIPPV.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.083
       
  • Utilization of ultrasound for the evaluation of small bowel obstruction: A
           systematic review and meta-analysis
    • Authors: Michael Gottlieb; Gary D. Peksa; Ananda Vishnu Pandurangadu; Damali Nakitende; Sukhjit Takhar; Raghu R. Seethala
      Pages: 234 - 242
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Michael Gottlieb, Gary D. Peksa, Ananda Vishnu Pandurangadu, Damali Nakitende, Sukhjit Takhar, Raghu R. Seethala
      Introduction Small bowel obstruction (SBO) is a common presentation to the Emergency Department (ED). While computed tomography (CT) is frequently utilized to confirm the diagnosis, this modality is expensive, exposes patients to radiation, may lead to time delays, and is not universally available. This study aimed to determine the test characteristics of ultrasound for the diagnosis of SBO. Methods PubMed, CINAHL, Scopus, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were assessed for prospective trials evaluating the accuracy of ultrasound for the detection of SBO. Data were double extracted into a predefined worksheet and quality analysis was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Results This systematic review identified 11 studies comprising 1178 total patients. Overall, ultrasound was found to be 92.4% sensitive (95% CI 89.0% to 94.7%) and 96.6% specific (95% CI 88.4% to 99.1%) with a positive likelihood ratio of 27.5 (95% CI 7.7 to 98.4) and a negative likelihood ratio of 0.08 (95% CI 0.06 to 0.11). Discussion The existing literature suggests that ultrasound is a valuable tool in the diagnosis of SBO with a sensitivity and specificity comparable to that of CT. Ultrasound may save time and radiation exposure, while also allowing for serial examinations of patients to assess for resolution of the SBO. It may be particularly valuable in settings with limited or no access to CT. Future studies should include more studies in the Emergency Department setting, comparison of probe choices, and inclusion of more pediatric patients.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.085
       
  • Age is related to neurological outcome in patients with out-of-hospital
           cardiac arrest (OHCA) receiving therapeutic hypothermia (TH)
    • Authors: Se Jong Oh; Jin Joo Kim; Jae Ho Jang; In Cheol Hwang; Jae Hyuk Woo; Yong Su Lim; Hyuk Jun Yang
      Pages: 243 - 247
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Se Jong Oh, Jin Joo Kim, Jae Ho Jang, In Cheol Hwang, Jae Hyuk Woo, Yong Su Lim, Hyuk Jun Yang
      Introduction In this study, we retrospectively reviewed the patients' outcomes after cardiac arrest based on age in one center, to determine whether geriatric patients had worse outcomes. Methods This was a single-center, retrospective cohort study. The patients admitted to the intensive care unit on successful resuscitation after OHCA were retrospectively identified and evaluated. Results This was a retrospective cohort study of patients over 18years of-age with return of spontaneous circulation (ROSC) (>24h) after cardiac arrest who were admitted to the emergency intensive care unit (EICU) and received post-cardiac arrest care between March 2007 and December 2013. Finally, a total of 295 patients were enrolled during the study period; of these, 79 patients (36.6%) had a good cerebral performance category (CPC). In stepwise multivariate analysis, young age (per 10years) (odds ratio [OR] 1.42, 95% CI 1.00–1.99, p=0.044), high hemoglobin level (per 1g/dL) (OR 1.31, 95% CI 1.07–1.60, p=0.008), non-diabetic patients (OR 15.21, 95% CI 1.85–125.3, p=0.01), cardiogenic cardiac arrest (OR 8.68, 95% CI 3.72–20.30, p<0.001), pre-hospital cardiopulmonary resuscitation (CPR) by bystander (OR 3.61, 95% CI 1.23–10.57, p=0.019), short time from collapsed to ACLS (per 1min) (OR 1.12, 95% CI 1.06–1.18, p<0.001) had good CPC at 6-month post-admission. Conclusion Elderly patients with OHCA had a poor neurological outcome; but several other factors were also related with the outcome. In decision-making for resuscitation, physicians should consider the patients' physiologic factors as well as age.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.087
       
  • The effect of team-based CPR on outcomes in out of hospital cardiac arrest
           patients: A meta-analysis
    • Authors: Sola Kim; Ki Ok Ahn; Seungmin Jeong
      Pages: 248 - 252
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Sola Kim, Ki Ok Ahn, Seungmin Jeong
      Objectives The objective of this systematic review and meta-analysis was to determine the effects of team cardiopulmonary resuscitation (CPR) on outcomes of patients with out-of-hospital cardiac arrest (OHCA). Methods A systematic literature review was performed using PubMed, EMBASE, and the Cochrane database to identify relevant articles for this meta-analysis. All studies that described the implementation of team CPR performed by emergency medical services for OHCA patients with presumed cardiac etiology were included in this study. Outcomes included return of spontaneous circulation (ROSC), survival to hospital discharge, and good neurological recovery. Results A total of 2504 studies were reviewed. After excluding studies according to exclusion criteria, 4 studies with 15,455 OHCA patients were included in this study. The odds of survival and neurologic recovery for patients who received team CPR were higher than those for patients who did not (survival odds ratio [OR]: 1.68; 95% confidence interval [CI]: 1.48–1.91; neurologic recovery OR: 1.52; 95% CI: 1.31–1.77). There was no significant difference in the odds of ROSC between the two patient groups (OR: 1.59; 95% CI: 0.76–3.33). Conclusions In this meta-analysis, team CPR improved the outcomes of OHCA patients, consistently increasing their odds of survival to discharge and neurologic recovery.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.089
       
  • Prevalence of pulmonary embolism in patients presenting to the emergency
           department with syncope
    • Authors: Alison Frizell; Nicole Fogel; Jacob Steenblik; Margaret Carlson; Joseph Bledsoe; Troy Madsen
      Pages: 253 - 256
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Alison Frizell, Nicole Fogel, Jacob Steenblik, Margaret Carlson, Joseph Bledsoe, Troy Madsen
      Objectives A recent study reported a high prevalence of pulmonary embolism (PE) among patients admitted with syncope. We sought to determine whether these findings were validated in our patient population. Methods We performed a retrospective, secondary analysis of prospectively gathered data from patients presenting with syncope to an academic emergency department (ED) from July 2010 to December 2015. We analyzed baseline information from the time of the ED visit, recorded outcomes during the hospital stay, and contacted patients by phone at least 30days after the ED visit. The primary study outcome was the diagnosis of acute PE in the ED, during inpatient admission or ED observation unit stay, or by patient report over a 30-day follow-up period. Results Over the 5.5-year study period, 348 patients with syncope agreed to participate in the study. 52% of patients were female [95% confidence interval (CI): 46.6–57.4] and the average age was 48.4years. Of the enrolled patients, 50.1% (CI: 44.8–55.2) underwent further evaluation for syncope beyond the ED stay: 27% (CI: 22.6–31.9) of patients were admitted to an inpatient unit for further work-up and 23.9% (CI: 19.7–28.6) of patients were placed in the ED observation unit. The overall rate of PE among patients presenting to the ED with syncope was 1.4% (CI: 0.6–3.3%). 2 patients (0.6%, CI: 0.2–2.1) were diagnosed with a PE while in the ED. None of the patients were diagnosed with a PE during hospital admission or the observation stay associated with the index ED visit. 3 patients (0.9%, CI: 0.3–2.5) reported they had been diagnosed with a PE during the 30days following their ED visit, two of whom had been admitted to the hospital at the index ED visit but were not diagnosed with a PE at that time. All patients diagnosed with a PE at the time of the ED visit or during the follow-up period were Pulmonary Embolism Rule Out Criteria (PERC) positive and reported shortness of breath in the ED. Conclusion In contrast to a previous study, our findings do not support a high rate of PE among ED patients presenting with syncope.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.090
       
  • Validation of the criteria for early critical care resource use in
           assessing the effectiveness of field triage
    • Authors: Ki Ok Ahn; Sang Chul Kim; Ju Ok Park; Sang Do Shin; Kyoung Jun Song; Ki Jeong Hong
      Pages: 257 - 261
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Ki Ok Ahn, Sang Chul Kim, Ju Ok Park, Sang Do Shin, Kyoung Jun Song, Ki Jeong Hong
      Background This study aimed to validate the criteria for early critical care resource (CCR) use as an outcome predictor for seriously injured patients triaged in the field by comparing the effectiveness of the criteria for early CCR use with that of criteria defined by an Injury Severity Score (ISS) >15. Methods We analysed data from seriously injured trauma patients who were triaged using a field triage protocol by emergency medical service providers (EMS-ST patients). Early CCR use was defined as the use of any of the following treatment modalities or outcomes: advanced airway management, blood transfusion, or interventional radiology (<4h), emergency operation or cardiopulmonary resuscitation, or thoracotomy (<24h), or admission for spinal cord injury. The primary endpoint was inhospital mortality. We generated area under the receiver operating characteristic (AUROC) curves to compare the value of the early CCR use criteria with that of the ISS >15 criteria in the discrimination between survivors and non-survivors. Results Of the 14,352 adult EMS-ST patients, 9299 were enrolled in this study. Approximately 19.6% required early CCR use, and 18.0% had an ISS >15. The rate of in-hospital mortality was 9.4%. The AUROC values for the performances of the early CCR use and ISS>15 criteria in the prediction of in-hospital mortality were 0.89 (95% confidence interval [CI] 0.85–0.91) and 0.84 (95% CI 0.79–0.86), respectively (p<0.01). Conclusion The early CCR use criteria demonstrated better performance than the ISS >15 criteria in the prediction of mortality in EMS-ST patients.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.091
       
  • The impact of IV alteplase on long-term patient survival: The Georgia
           Coverdell acute stroke registry's experience
    • Authors: Moges S. Ido; Michael R. Frankel; Ike S. Okosun; Richard B. Rothenberg
      Pages: 262 - 265
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Moges S. Ido, Michael R. Frankel, Ike S. Okosun, Richard B. Rothenberg
      Introduction Intravenous alteplase reduces disability and improves functionality among acute ischemic stroke patients. Two decades after its approval, only a small fraction of patients get the treatment, and demonstrating its impact on mortality may make a strong case for its wider use. This study assessed the impact of thrombolytic treatment by alteplase on 1-year mortality and readmission among acute ischemic stroke patients. Method The 2008–2013 Georgia Coverdell Acute Stroke Registry data were linked with the 2008–2013 hospital discharge and the 2008–2014 death data in Georgia. Multiple imputation was applied; a propensity score measuring the probability of receiving intravenous alteplase was calculated and used for matching. A conditional logistic regression was applied to compare 1-year mortality and readmission among propensity score matched pairs. Results Overall, 20.3% of 9620 acute ischemic stroke patients died and 22.4% were readmitted in one year. The multivariable regression result showed that patients who did not receive IV alteplase had a 1.49 (95%CI: 1.09–2.04; p-value=0.01) times higher odds of dying at one year than those who were treated with the thrombolytic agent. Among patients discharged home, no statistically significant difference was documented in the odds of being readmitted at least once within 365days post-stroke discharge. Discussion and conclusion After accounting for patient differences and missing value, intravenous alteplase is associated with reduction in long-term mortality. The results of this study suggest that patients who are identified as eligible for intravenous alteplase need to be offered the treatment.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.07.092
       
  • A role of the endothelial nitric oxide system in acute renal colic caused
           by ureteral stone
    • Authors: Emre Bulbul; Elif Funda Sener; Nahide Ekici Gunay; Bahadir Taslidere; Elif Taslidere; Serhat Koyuncu; Nurullah Gunay
      Pages: 266 - 270
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Emre Bulbul, Elif Funda Sener, Nahide Ekici Gunay, Bahadir Taslidere, Elif Taslidere, Serhat Koyuncu, Nurullah Gunay
      Background and aims Endothelial nitric oxide synthase gene polymorphisms play a role in some pathophysiological processes. In this study, the possible effects of endothelial nitric oxide synthase gene polymorphisms on ureteral stone disease in patients who were admitted to the emergency department with severe pain due to renal colic are examined. Materials and methods The study groups were designed as controls and patients. The control group was formed from the healthy volunteers who applied to the blood center next to the emergency service. The patient group comprised patients who were diagnosed with ureteral stone disease with severe pain. All of the genetic studies were based on extracted peripheral blood samples using the necessary procedures from the Genome and Stem Cell Center at Erciyes University (GENKOK). The data were analyzed with SPSS (IBM, ver 20, United Sate). Results The study group comprised 62 females and 138 males, and the control group comprised 64 females and 136 males. All of the stones that caused renal colic were found to be localized in the ureters and the ureterovesical junction. The genotypes of the intron 4 polymorphism were found to be as follows: 4a/4a in 10 people, 4b/4a in 115, and 4b/4b in 275 people. The GG genotype of the eNOS-G894T polymorphism was found in 108 patients in the study group and in117 of the healthy individuals. There was no statistically significant difference between the two groups regarding these data. Conclusion Although this study is the first in the literature to examine the relationship between renal colic and endothelial nitric oxide synthase gene polymorphisms, our study demonstrated that no relation was found.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.08.008
       
  • Incidence and risk factors of delayed intracranial hemorrhage in the
           emergency department
    • Authors: Byunghyun Kim; Hyeonjeong Jeong; Joonghee Kim; Tackeun Kim; Kyuseok Kim; Heeyoung Lee; Soyeon Ahn; Yoo Hwan Jo; Jae Hyuk Lee; Ji Eun Hwang
      Pages: 271 - 276
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Byunghyun Kim, Hyeonjeong Jeong, Joonghee Kim, Tackeun Kim, Kyuseok Kim, Heeyoung Lee, Soyeon Ahn, Yoo Hwan Jo, Jae Hyuk Lee, Ji Eun Hwang
      Objectives This study was performed to identify the risk factors for delayed intracranial hemorrhage and develop a risk stratification system for disposition of head trauma patients with negative initial brain imaging. Methods The data source was National Health Insurance Service-National Sample Cohort of Korea. We analyzed adult patients presenting to the ER from January 2004 to September 2012, who underwent brain imaging and discharged with or without short-term observation no longer than two days. The primary outcome was defined as any intracranial bleeding within a month defined by a new appearance of any of the diagnostic codes for intracranial hemorrhage accompanied by a new claim for brain imaging(s) within a month of the index visit. We performed a multivariable logistic regression analysis and built a parsimonious model for variable selection to develop a simple scoring system for risk stratification. Results During the study period, a total of 19,723 head injury cases were identified from the cohort and a total of 149 cases were identified as having delayed intracranial hemorrhage within 30days. In multivariable logistic regression model, old age, craniofacial fracture, neck injury, diabetes mellitus and hypertension were independent risk factors for delayed intracranial hemorrhage. We constructed the parsimonious model included age, craniofacial fracture and diabetes mellitus. The score showed area under the curve of 0.704 and positive predictive value of the score system was 0.014 when the score≥2. Conclusions We found old age, associated craniofacial fracture, any neck injury, diabetes mellitus and hypertension are the independent risk factors of delayed intracranial hemorrhage.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.08.009
       
  • Prevalence and predictors associated with severe pulmonary hypertension in
           COPD
    • Authors: Mitra Samareh Fekri; Mehdi Torabi; Sara Azizi Shoul; Moghaddameh Mirzaee
      Pages: 277 - 280
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Mitra Samareh Fekri, Mehdi Torabi, Sara Azizi Shoul, Moghaddameh Mirzaee
      Background Pulmonary hypertension (PH) is one of the most common complications of COPD (chronic obstructive pulmonary disease), but its severe form is uncommon. Various factors play an important role in the occurrence and severity of pulmonary hypertension in patients. Methods This cross-sectional study was performed on patients with COPD referred to an emergency department over a one-year period. The tests—including complete blood count (CBC) and arterial blood gas (ABG), pulmonary functional test (PFT) and echocardiography—were performed for all patients to measure mPAP (mean pulmonary artery pressure), ejection fraction (EF) and body mass index (BMI). The prevalence of severe pulmonary hypertension and its associated factors were investigated in these patients. Results A total of 1078 patients was included in the study, of whom 628 (58.3%) were male and 450 (41.7%) were female. The mean age of the patients undergoing the study was 70.1±12.2. A total of 136 (13.7%) of them had mPAP (mm Hg)≥40mm Hg as severe pulmonary hypertension. Following multivariable analysis by using the backward conditional method, it was shown that seven variables had a significant correlation with severe PH. Conclusions The results showed that there is an independent correlation between hypoxia, hypopnea and compensatory metabolic alkalosis, polycythemia, left ventricular dysfunction, emaciation, and cachectic with severe pulmonary hypertension. The prevalence of severe PH in these patients was 13.7%.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.08.014
       
  • High rate of isolated right ventricular dysfunction in patients with
           non-significant CT pulmonary angiography
    • Authors: Frances M. Russell; Jeffrey A. Kline; Timothy Lahm
      Pages: 281 - 284
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Frances M. Russell, Jeffrey A. Kline, Timothy Lahm
      Background Right ventricular (RV) dysfunction and pulmonary hypertension (PH) are commonly unrecognized in the emergency department (ED), but are associated with poor outcomes. Prior research has found a 30% prevalence of isolated RV dysfunction in ED patients after non-significant computed tomographic pulmonary angiography (CTPA). We aimed to prospectively define the prevalence of RV dysfunction and/or PH in short of breath ED patients, and assess outcomes. Methods Prospective observational study of patients with a non-significant CTPA. Isolated RV dysfunction and/or PH was defined as normal left ventricular function plus RV dilation, moderate to severe tricuspid regurgitation or RV systolic pressure>40mmHg on comprehensive echocardiography. Results Of 83 patients, 20 (24%, 95% [confidence interval] CI: 16–34%) had isolated RV dysfunction and/or PH. These patients had 40% ED recidivism and 30% hospital readmission at 30-days. When compared to patients with normal echocardiographic function, they had significantly longer intensive care unit and hospital length of stays. Conclusions In a prospective cohort of ED patients, we found a high prevalence of isolated RV dysfunction and/or PH after a non-significant CTPA. These patients had high rates of recidivism and hospital readmission. This data supports a continued need for ED based screening and specialty referral.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.10.023
       
  • An exploratory study of IV metoclopramide+diphenhydramine for acute
           post-traumatic headache
    • Authors: Benjamin W. Friedman; Kayla Babbush; Eddie Irizarry; Deborah White; E. John Gallagher
      Pages: 285 - 289
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Benjamin W. Friedman, Kayla Babbush, Eddie Irizarry, Deborah White, E. John Gallagher
      Background Headache is a frequent complaint among the 1.4 million patients who present to US emergency departments (ED) annually following trauma to the head. There are no evidence-based treatments of acute post-traumatic headache. Methods This was an ED-based, prospective study of intravenous (IV) metoclopramide 20mg+diphenhydramine 25mg for acute post-traumatic headache. Patients who presented to our EDs with a moderate or severe headache meeting international criteria were enrolled and followed by telephone 2 and 7days later. The primary outcome was “sustained headache relief” (headache level less than “moderate” in the ED, no additional headache medication, and no relapse to headache worse than “mild”).We also gathered data on associated symptomotology using the validated Post Concussion Symptom Scale (PCSS). Results 21 patients were enrolled. Twelve of 20 (60%) patients with available follow-up data reported sustained headache relief. All but one of the 21 enrolled patients (95%) reported improvement of headache to no worse than mild. Seven of 19 (37%) patients with available data reported moderate or severe headache during the 48h after ED discharge. One week later, 5/19 patients reported experiencing headaches “frequently” or “always”. The mean Post Concussion Symptom Score improved from 47.5 (SD 29.4) before treatment to 10.9 (SD 14.8) at the time of ED discharge and 11.4 (SD 21.4) at one week after treatment. Conclusion IV metoclopramide 20mg+diphenhydramine 25mg is an effective and well-tolerated medication regimen for patients presenting to the ED with acute post-traumatic headache, though 1/3 of patients report headache relapse after ED discharge and 1/4 of patients report persistent headaches one week later.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.10.034
       
  • Impact of an emergency medicine pharmacist on initial antibiotic
           prophylaxis for open fractures in trauma patients
    • Authors: Somer Harvey; A. Brad Hall; Kayla Wilson
      Pages: 290 - 293
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Somer Harvey, A. Brad Hall, Kayla Wilson
      Background Targeted antibiotic treatment reduces the infection risk of open fractures when soft tissue and bone are exposed to the environment. The risk of infection increases with higher degrees of injury. The Gustilo-Anderson system was developed to identify the degree of injury of open fractures and can be utilized to guide initial antibiotic therapy. Few studies have been published evaluating the potential impact of emergency medicine pharmacists in trauma, and currently no study has evaluated a pharmacist's influence on antibiotic selection and timing for open fractures. Objective The objective of this study was to determine the impact of an emergency medicine pharmacist on initial antibiotic selection and timing in trauma patients with open fractures. Methods This was a retrospective cohort study. Trauma alerts with open fractures from May 1, 2014 to June 30, 2016 were eligible for inclusion. The primary outcome was to determine if pharmacist participation during trauma resuscitation was associated with an increased proportion of initial antibiotic selection meeting guideline recommendations. The secondary outcome was the door-to-antibiotic administration time during resuscitation. Results Initial prophylactic antibiotic recommendations were met in 81% of trauma resuscitations when a pharmacist was present versus 47% without a pharmacist present (p<0.01). The median door-to-antibiotic time was 14min in the PHARM group versus 20min in the NO-PHARM group (p=0.02). Conclusions The participation of an EM pharmacist during initial trauma resuscitation resulted in improved initial antibiotic selection and faster door-to-antibiotic administration times in trauma patients with open fractures.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.10.039
       
  • Implications of iodinated contrast media extravasation in the emergency
           department
    • Authors: Jonathan D. Sonis; Ravi V. Gottumukkala; McKinley Glover; Brian J. Yun; Benjamin A. White; Mannudeep K. Kalra; Alexi Otrakji; Ali S. Raja; Anand M. Prabhakar
      Pages: 294 - 296
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Jonathan D. Sonis, Ravi V. Gottumukkala, McKinley Glover, Brian J. Yun, Benjamin A. White, Mannudeep K. Kalra, Alexi Otrakji, Ali S. Raja, Anand M. Prabhakar
      Purpose To characterize the management, outcomes, and emergency department (ED) length of stay (LOS) following iodinated contrast media extravasation events in the ED. Methods All ED patients who developed iodinated contrast media extravasation following contrast-enhanced CT (CECT) from October 2007–December 2016 were retrospectively identified. Medical records were reviewed and management, complications, frequency of surgical consultation, and ED LOS were quantified using descriptive statistics. The Wilcoxon rank sum test was used to compare ED LOS in patients who did and did not receive surgical consultation. Results A total of 199 contrast extravasation episodes occurred in ED patients during the 9-year study period. Of these, 42 patients underwent surgical consultation to evaluate the contrast extravasation event. No patient developed progressive symptoms, compartment syndrome, or tissue necrosis, and none received treatment beyond supportive care (warm/cold packs, elevation, compression). Median ED LOS for patients who did and did not receive surgical consultation was 11.3h versus 9.0h, respectively (p<0.01). Conclusion Close observation and supportive care are sufficient for contrast extravasation events in the ED without concerning symptoms (progressive pain/swelling, altered tissue perfusion, sensory changes, or blistering/ulceration). Routine surgical consultation is likely unnecessary in the absence of these symptoms – concordant with the current American College of Radiology guidelines – and may be associated with longer ED LOS without impacting management.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.11.012
       
  • Syncope on presentation is a surrogate for submassive and massive acute
           pulmonary embolism
    • Authors: Hesham R. Omar; Mehdi Mirsaeidi; Michael B. Weinstock; Garett Enten; Devanand Mangar; Enrico M. Camporesi
      Pages: 297 - 300
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Hesham R. Omar, Mehdi Mirsaeidi, Michael B. Weinstock, Garett Enten, Devanand Mangar, Enrico M. Camporesi
      Introduction There are conflicting data regarding the prognostic value of syncope in patients with acute pulmonary embolism (APE). Methods We retrospectively reviewed data of 552 consecutive adults with computed tomography pulmonary angiogram-confirmed APE to determine the correlates and outcome of the occurrence of syncope at the time of presentation. Results Among 552 subjects with APE (mean age 54years, 47% men), syncope occurred in 12.3% (68/552). Compared with subjects without syncope, those with syncope were more likely to have admission systolic blood pressure<90mmHg (odds ratio (OR) 5.788, P <0.001), and an oxygen saturation<88% on room air (OR 5.560, P <0.001), right ventricular dilation (OR 2.480, P =0.006), right ventricular hypokinesis (OR 2.288, P =0.018), require mechanical ventilation for respiratory failure (OR 3.152, P =0.014), and more likely to receive systemic thrombolysis (OR 4.722, P =0.008). On multivariate analysis, syncope on presentation was an independent predictor of a massive APE (OR 2.454, 95% CI 1.109–5.525, P =0.03) after adjusting for patients' age, sex, requirement of antibiotics throughout hospitalization, peak serum creatinine, admission oxygen saturation<88% and admission heart rate>100bpm. There was no difference in mortality in cases with APE with or without syncope (P =0.412). Conclusion Syncope at the onset of pulmonary embolization is a surrogate for submassive and massive APE but is not associated with higher in-hospital mortality.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.11.014
       
  • Factors associated with imaging overuse in the emergency department: A
           systematic review
    • Authors: Monica Tung; Ritu Sharma; Jeremiah S. Hinson; Stephanie Nothelle; Jean Pannikottu; Jodi B. Segal
      Pages: 301 - 309
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Monica Tung, Ritu Sharma, Jeremiah S. Hinson, Stephanie Nothelle, Jean Pannikottu, Jodi B. Segal
      Background Emergency departments (ED) are sites of prevalent imaging overuse; however, determinants that drive imaging in this setting are not well-characterized. We systematically reviewed the literature to summarize the determinants of imaging overuse in the ED. Methods We searched MEDLINE® and Embase® from January 1998 to March 2017. Studies were included if they were written in English, contained original data, pertained to a U.S. population, and identified a determinant associated with overuse of imaging in the ED. Results Twenty relevant studies were included. Fourteen evaluated computerized tomography (CT) scanning in patents presenting to a regional ED who were then transferred to a level 1 trauma center; incomplete transfer of data and poor image quality were the most frequently described reasons for repeat scanning. Unnecessary pre-transfer scanning or repeated scanning after transfer, in multiple studies, was highest among older patients, those with higher Injury Severity Scores (ISS) and those being transferred further. Six studies explored determinants of overused imaging in the ED in varied conditions, with overuse greater in older patients and those having more comorbid diseases. Defensive imaging reportedly influenced physician behavior. Less integration of services across the health system also predisposed to overuse of imaging. Conclusions The literature is heterogeneous with surprisingly few studies of determinants of imaging in minor head injury or of spine imaging. Older patient age and higher ISS were the most consistently associated with ED imaging overuse. This review highlights the need for precise definitions of overuse of imaging in the ED.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.10.049
       
  • The use of intranasal analgesia for acute pain control in the emergency
           department: A literature review
    • Authors: Billy Sin; Jennifer Wiafe; Christine Ciaramella; Luis Valdez; Sergey M. Motov
      Pages: 310 - 318
      Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2
      Author(s): Billy Sin, Jennifer Wiafe, Christine Ciaramella, Luis Valdez, Sergey M. Motov
      Background Traditional routes for administration of pain medications include oral (PO), intravenous (IV), or intramuscular routes (IM). When these routes are not feasible, the intranasal (IN) route may be considered. The objectives of this evidence-based review were: to review the literature which compared the safety and efficacy of IN analgesia to traditional routes and to determine if IN analgesia should be considered over traditional routes for acute pain control in the ED. Methods The MEDLINE and EMBASE databases from July 1970 to July 2017 were searched. Randomized controlled trials (RCT) that evaluated the use of IN analgesia for acute pain in the ED were included. Methodological quality of the trials was assessed using the Grading of Recommendations Assessment, Development, and Evaluation criteria. Results Eleven randomized controlled trials (RCT) met the inclusion criteria. Four trials found significant reductions in pain scores, favoring IN analgesia. However, in all of the trials, pain relief was not sustained. Three trials reported superior pain reduction with comparators and three trials reported no statistical significance. One trial described effective pain relief with IN analgesia but did not provide data on statistical analysis. Conclusion Eleven randomized controlled trials with various methodological flaws revealed conflicting conclusions. There is limited evidence to support the use of the IN analgesia over traditional routes for acute pain in the ED. The IN route may be a good alternative in scenarios where IV access is not feasible, patients are refusing injectable medications, or a fast onset of pain relief is needed.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2017.11.043
       
  • Surveillance of carbon monoxide-related incidents — Implications for
           prevention of related illnesses and injuries, 2005–2014
    • Authors: Sutapa Mukhopadhyay; Annie Hirsch; Suze Etienne; Natalia Melnikova; Jennifer Wu; Kanta Sircar; Maureen Orr
      Abstract: Publication date: Available online 13 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Sutapa Mukhopadhyay, Annie Hirsch, Suze Etienne, Natalia Melnikova, Jennifer Wu, Kanta Sircar, Maureen Orr
      Background Carbon monoxide (CO) is an insidious gas responsible for approximately 21,000 emergency department visits, 2300 hospitalizations, and 500 deaths in the United States annually. We analyzed 10 combined years of data from two Agency for Toxic Substances and Disease Registry acute hazardous substance release surveillance programs to evaluate CO incident-related injuries. Methods Seventeen states participated in these programs during 2005–2014. Results In those 10 years, the states identified 1795 CO incidents. Our analysis focused on 897 CO incidents having injured persons. Of the 3414 CO injured people, 61.0% were classified as general public, 27.7% were employees, 7.6% were students, and 2.2% were first responders. More than 78% of CO injured people required hospital or pre-hospital treatment and 4.3% died. The location for most injured people (39.9%) were homes or apartments, followed by educational facilities (10.0%). Educational services had a high number of people injured per incident (16.3%). The three most common sources of CO were heating, ventilation, and air conditioning systems; generators; and motor vehicles. Equipment failure was the primary contributing factor for most CO incidents. Conclusions States have used the data to evaluate trends in CO poisoning and develop targeted public health outreach. Surveillance data are useful for setting new policies or supporting existing policy such as making CO poisoning a reportable condition at the state level and requiring CO alarms in all schools and housing. Public health needs to remain vigilant to the sources and causes of CO to help reduce this injury and death.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2018.02.011
       
  • REBOA by a non-surgeon as an adjunct during MASCAL: A case report
    • Authors: Regan F. Lyon; D. Marc Northern
      Abstract: Publication date: Available online 13 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Regan F. Lyon, D. Marc Northern
      Use of Resuscitative endovascular balloon occlusion of the aorta (REBOA) for control of non-compressible hemorrhage is a re-emerging technology that historically is employed by surgeons. We present a case in which REBOA was successfully placed by an emergency physician in a critical mass casualty patient awaiting transfer to the operating table. This case is an example in which emergency physicians, in collaboration with the surgeon, can utilize REBOA to temporize non-compressible hemorrhage when a surgeon is not immediately available.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2018.02.013
       
  • Simulated internal jugular vein cannulation using a needle-guiding device
    • Authors: Ji Hoon Kim; Jin Ha Park; Junho Cho; Tae Young Kong; Ji Hwan Lee; Jin Ho Beom; Young Seon Joo; Dong Ryul Ko; Hyun Soo Chung
      Abstract: Publication date: Available online 12 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Ji Hoon Kim, Jin Ha Park, Junho Cho, Tae Young Kong, Ji Hwan Lee, Jin Ho Beom, Young Seon Joo, Dong Ryul Ko, Hyun Soo Chung
      Background Using a two-dimensional ultrasound-guided approach does not guarantee success during the first attempt at internal jugular vein cannulation. Our randomized, parallel simulation study examined whether a new disposable device could improve the success rate of the first attempt at ultrasound-guided internal jugular vein cannulation of a simulated internal jugular vein. Methods Eighty-eight participants were randomized to perform needle insertion for internal jugular vein cannulation of a phantom using the ultrasound-guided approach with (case group) or without (control group) this new device. The primary outcome was the success rate of the first attempt. The secondary outcome was the frequency of mechanical complications such as arterial puncture and posterior wall puncture, procedure time, and level of difficulty. Results Among 44 participants using the device, 33 (75.0%) achieved successful cannulation on the first attempt. However, only 12 (27.3%) of the 44 participants not using the device recorded success during the first attempt (risk difference, 0.477; 95% confidence interval [CI] 0.294–0.661; P < 0.001). The number of attempts was significantly lower (risk difference, −3.955; 95% CI, −5.014 to −3.712; P < 0.001) when participants performed cannulation with the device (1.63 ± 1.71) than without the device (5.59 ± 5.78). Our study also showed that participants were comfortable when performing the ultrasound-guided approach with the new device (risk difference, −1.955; 95% CI, −2.016 to −1.493; P < 0.0001). Conclusions The new disposable device was effective for successful first attempts at needle insertion during ultrasound-guided internal jugular vein cannulation. Future clinical trials are needed to assess the effectiveness of this device.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2018.02.012
       
  • Prehospital quick sequential organ failure assessment as a tool to predict
           in-hospital mortality
    • Authors: Kyohei Miyamoto; Naoaki Shibata; Tsuyoshi Nakashima; Seiya Kato
      Abstract: Publication date: Available online 10 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Kyohei Miyamoto, Naoaki Shibata, Tsuyoshi Nakashima, Seiya Kato
      Objective This study aimed to evaluate the predictive ability of quick sequential organ failure assessment (qSOFA) score for in-hospital mortality among patients transported by physician-staffed helicopters. Methods We conducted a single-center, retrospective observational study using the physician-staffed helicopter registry data between 2003 and 2016. We calculated the qSOFA scores based on the patients' vital signs, which were measured on the scene. The tool's discriminatory ability was determined using the area under the curve of the receiver operating characteristic. Results A total of 1849 patients with a mean age of 63.0 (standard deviation [SD], 18.4) years were included in this study. The diagnostic categories included were trauma and nontrauma cases (1038 [56%] and 811 [44%], respectively). In-hospital mortality was documented in 169 (9%) patients. Meanwhile, the in-hospital mortality rates among patients with qSOFA scores of 0, 1, 2, and 3 were 5/411 (1%), 69/797 (9%), 71/541 (13%), and 24/100 (24%), respectively (P < 0.0001 for trend). If the cutoff point is ≥1, the sensitivity and specificity of the qSOFA scores were 0.97 and 0.24, respectively. The area under the curve of the qSOFA scores was 0.67 for all patients, whereas that for trauma patients was 0.75. Conclusion An increase in the qSOFA score is associated with a gradual increase in the in-hospital mortality rate among all patients. In particular, a very low mortality rate was observed among patients with a qSOFA score of 0. The qSOFA score predicted the in-hospital mortality of patients with trauma well.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2018.02.009
       
  • Acute corrosive poisonings - Frequent cause for fatal outcome
    • Authors: Andon Chibishev; Natasha Davceva; Emilija Shikole; Cvetanka Bozinovska
      Abstract: Publication date: Available online 9 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Andon Chibishev, Natasha Davceva, Emilija Shikole, Cvetanka Bozinovska


      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2018.02.010
       
  • An incidental image of a patient with chest pain after fall from a tree:
           Swyer-James-MacLeod syndrome'
    • Authors: Sadiye Yolcu; Levent Albayrak; Ibrahim Caltekin
      Abstract: Publication date: Available online 9 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Sadiye Yolcu, Levent Albayrak, Ibrahim Caltekin


      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2018.02.008
       
  • High dose insulin for beta-blocker and calcium channel-blocker poisoning:
           17years of experience from a single poison center
    • Authors: Jon B. Cole; Ann M. Arens; JoAn R. Laes; Lauren R. Klein; Stacey A. Bangh; Travis D. Olives
      Abstract: Publication date: Available online 6 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Jon B. Cole, Ann M. Arens, JoAn R. Laes, Lauren R. Klein, Stacey A. Bangh, Travis D. Olives
      Background/objectives High dose insulin (HDI) is a standard therapy for beta-blocker (BB) and calcium channel-blocker (CCB) poisoning, however human case experience is rare. Our poison center routinely recommends HDI for shock from BBs or CCBs started at 1U/kg/h and titrated to 10U/kg/h. The study objective was to describe clinical characteristics and adverse events associated with HDI. Methods This was a structured chart review of patients receiving HDI for BB or CCB poisoning with HDI defined as insulin infusion of ≥0.5U/kg/h. Results In total 199 patients met final inclusion criteria. Median age was 48years (range 14–89); 50% were male. Eighty-eight patients (44%) were poisoned by BBs, 66 (33%) by CCBs, and 45 (23%) by both. Median nadir pulse was 54 beats/min (range 12–121); median nadir systolic blood pressure was 70mmHg (range, 30–167). Forty-one patients (21%) experienced cardiac arrest; 31 (16%) died. Median insulin bolus was 1U/kg (range, 0.5–10). Median starting insulin infusion was 1U/kg/h (range 0.22–10); median peak infusion was 8U/kg/h (range 0.5–18). Hypokalemia occurred in 29% of patients. Hypoglycemia occurred in 31% of patients; 50% (29/50) experienced hypoglycemia when dextrose infusion concentration ≤10%, and 30% (31/105) experienced hypoglycemia when dextrose infusion concentration ≥20%. Conclusions HDI, initiated by emergency physicians in consultation with a poison center, was feasible and safe in this large series. Metabolic abnormalities were common, highlighting the need for close monitoring. Hypoglycemia was more common when less concentrated dextrose maintenance infusions were utilized.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2018.02.004
       
  • Comparison of primary compliance in electronic versus paper prescriptions
           prescribed from the emergency department
    • Authors: Shannon L. Toohey; Jessica Andrusaitis; Megan Boysen-Osborn; John Billimek; Maxwell Jen; Scott Rudkin
      Abstract: Publication date: Available online 5 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Shannon L. Toohey, Jessica Andrusaitis, Megan Boysen-Osborn, John Billimek, Maxwell Jen, Scott Rudkin


      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2018.02.003
       
  • Management of dyspepsia—The role of the emergency department observation
           unit to optimize patient outcomes
    • Authors: Wei Ping Daniel Chor; Pei Xian Lorraine Yong; Li Lin Lim; Chew Yian Chai; Tiong Beng Sim; Win Sen Kuan
      Abstract: Publication date: Available online 3 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Wei Ping Daniel Chor, Pei Xian Lorraine Yong, Li Lin Lim, Chew Yian Chai, Tiong Beng Sim, Win Sen Kuan
      Background Dyspepsia is a common complaint that can confer significant burden on one's quality of life and may also be associated with serious underlying conditions. The objective of this study was to determine if patients admitted to the emergency department observation unit (EDOU) for severe or persistent dyspepsia would have cost effective management in terms of investigations performed, length and cost of hospital stay. The secondary objective was to determine if any patient characteristics could predict a need for admission to the inpatient unit. Methods Retrospective chart reviews of patients admitted to the EDOU under the Dyspepsia protocol between January 2008 and August 2014 were conducted. Baseline demographics, investigations performed, outcomes related to EDOU stay, admission and 30-day re-presentation outcomes were recorded. Results A total of 1304 patients were included. Median length of stay was 1day. Cumulative bed-saved days were 38 per month. Two hundred eighteen (16.7%) patients required admission to the inpatient service for further management, while 533 (40.9%) and 313 (24.0%) patients underwent esophagogastroduodenoscopy and hepatobiliary ultrasonography, respectively. No major adverse events were attributed to the EDOU admissions or delays in treatment. No significant clinically relevant factors were associated with a need for admission from the EDOU to the inpatient unit. Median cost of the EDOU admission was approximately one-third that of a similar admission to the inpatient unit. Conclusion The EDOU is an appropriate setting to facilitate investigations and treatment of patients with dyspepsia with considerable bed-saved days.

      PubDate: 2018-02-14T21:42:06Z
      DOI: 10.1016/j.ajem.2018.01.057
       
  • Information for Authors
    • Abstract: Publication date: February 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 2


      PubDate: 2018-02-14T21:42:06Z
       
  • Patient centered medical homes did not improve access to timely follow-up
           after ED visit
    • Authors: Shih-Chuan Chou; Craig Rothenberg; Alicia Agnoli; Ilse Wiechers; Jason Lott; Jennifer Voorhees; Steven L. Bernstein; Arjun K. Venkatesh
      Abstract: Publication date: Available online 4 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Shih-Chuan Chou, Craig Rothenberg, Alicia Agnoli, Ilse Wiechers, Jason Lott, Jennifer Voorhees, Steven L. Bernstein, Arjun K. Venkatesh
      Background Patients newly insured through coverage expansion under the Affordable Care Act (ACA) may have difficulty obtaining timely primary care follow-up appointments after emergency department (ED) discharge. We evaluated the association between availability of timely follow-up appointment with practice access improvements, including patient-centered medical home (PCMH) designations or extended-hours appointments. Methods We performed a secret-shopper audit of primary care practices in greater New Haven, Connecticut. Two callers, posing as patients discharged from the ED, called these practices requesting follow-up appointments. They followed standardized scripts varying in ED diagnosis (uncontrolled hypertension, acute back pain) and insurance status (commercial, exchange, Medicaid). We linked our findings with data from a previously completed survey that assessed practice characteristics and examined the associations between appointments availability and practice access improvements. Results Of the 58 included primary care practices, 49 (84.5%) completed both the audit and the survey. Overall, 167/536 calls (31.2%) obtained an appointment in 7 days. Practices with PCMH designation were less likely to offer appointments within 7 days (23.4% vs. 33.1%, p = 0.03). However, callers were more likely to obtain an appointment in 7 days from practices offering after-hour appointments (36.3% vs. 27.8%, p = 0.04). After adjusting for insurance type, there were no significant associations between practice improvements and 7-day appointment availability or appointment wait time. Conclusion PCMH designation and extended-hours appointments were not associated with improved availability of timely primary care follow-up appointment for discharged ED patients. EDs should engage local clinicians and other stakeholders to strengthen linkage and care transition with outpatient practices.

      PubDate: 2018-02-04T20:57:40Z
      DOI: 10.1016/j.ajem.2018.01.070
       
  • Comparison of the combination of propofol–fentanyl with combination of
           propofol–ketamine for procedural sedation and analgesia in patients with
           trauma
    • Authors: Hamed Aminiahidashti; Sajad Shafiee; Seyed Mohammad Hosseininejad; Abulfazl Firouzian; Ayyub Barzegarnejad; Alieh Zamani Kiasari; Behzad Feizzadeh Kerigh; Farzad Bozorgi; Misagh Shafizad; Ahmad Geraeeli
      Abstract: Publication date: Available online 4 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Hamed Aminiahidashti, Sajad Shafiee, Seyed Mohammad Hosseininejad, Abulfazl Firouzian, Ayyub Barzegarnejad, Alieh Zamani Kiasari, Behzad Feizzadeh Kerigh, Farzad Bozorgi, Misagh Shafizad, Ahmad Geraeeli
      Objective Many procedures performed in emergency department are stressful and painful, and creating proper and timely analgesia and early and effective assessment are the challenges in this department. This study has been conducted in order to compare the efficacy of propofol and fentanyl combination with propofol and ketamine combination for procedural sedation and analgesia (PSA) in trauma patients in the emergency department. Method This is a randomized prospective double-blind clinical trial conducted in the emergency department of Imam Khomeini Hospital, a tertiary academic trauma center in northern Iran. Patients with trauma presenting to the emergency department who needed PSA were included in study. Patients were divided into two groups of propofol fentanyl (PF) and propofol ketamine (PK). Pain score and sedation depth were set as primary outcome measures and were recorded. Results Out of about 379 patients with trauma, who needed PSA, 253 met the criteria to be included in the study, 117 of which were excluded. The remaining 136 patients were randomly allocated to either PF group (n = 70) or PK group (n = 66). Pain management after drug administration was significantly different between the groups and the analgesia caused by fentanyl was significantly higher than ketamine. The sedation score after 15 min of PSA in the group PF was significantly higher than the group PK. Conclusion It seems that regarding PSA in the emergency department, PF caused better analgesia and deeper sedation and it is recommended to use PF for PSA in the emergency departments.

      PubDate: 2018-02-04T20:57:40Z
      DOI: 10.1016/j.ajem.2018.01.080
       
  • Cardiac arrest while exercising on mountains
    • Authors: Martin Burtscher
      Abstract: Publication date: Available online 3 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Martin Burtscher


      PubDate: 2018-02-04T20:57:40Z
      DOI: 10.1016/j.ajem.2018.01.049
       
  • Group C strep mediastinitis: A case report
    • Authors: Joseph G. Kotora; Eric J. Schmieler; Christian S. McEvoy; Stephen L. Noble
      Abstract: Publication date: Available online 3 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Joseph G. Kotora, Eric J. Schmieler, Christian S. McEvoy, Stephen L. Noble
      This case is significant to the practice of emergency medicine because it represents the development of an uncommon and potentially fatal mediastinal infection from a commonly encountered and appropriately treated community respiratory pathogen. Most published reports on mediastinitis are those that are status-post cardiothoracic surgery. In our report, we discuss a case of a healthy, young individual who developed this morbid entity from extension of a simple respiratory infection where Group C Streptococcus has been isolated as the causative organism, which to our knowledge has not been previously reported. Further, this report outlines how a community acquired pneumonia progressed to a life threatening illness despite proper initial treatment per local and national guidelines.

      PubDate: 2018-02-04T20:57:40Z
      DOI: 10.1016/j.ajem.2018.01.076
       
  • The utility of the triage electrocardiogram for the detection of
           ST-segment elevation myocardial infarction
    • Authors: Samantha Noll; Heidi Alvey; Namita Jayaprakash; Aniruddha Paranjpe; Joseph Miller; Michele L. Moyer; Richard Nowak
      Abstract: Publication date: Available online 3 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Samantha Noll, Heidi Alvey, Namita Jayaprakash, Aniruddha Paranjpe, Joseph Miller, Michele L. Moyer, Richard Nowak
      Introduction Current AHA/ACC guidelines on the management of ST-elevation myocardial infarction (STEMI) suggest that an ECG is indicated within 10 min of arrival for patients arriving to the Emergency Department (ED) with symptoms concerning for STEMI. In response, there has been a creep towards performing ECGs more frequently in triage. The objectives of this study were to quantify the number of triage ECGs performed at our institution, assess the proportion of ECGs performed within current hospital guidelines, and evaluate the rate of STEMI detection in triage ECGs. Methods A retrospective chart review of all emergency department patients presenting over a period of 8 days who had a triage ECG performed. Cases of bradycardia or tachycardia were excluded. Data collection included patient demographics, presenting complaint, cardiac risk factors, troponin values, and final diagnosis. Summary statistics are reported in a descriptive manner. Results During the study period, 538 patients had a triage ECG for possible STEMI with no STEMI identified and 16 NSTEMI diagnoses (confirmed as positive troponins following ED assessment). Sixty-three (11.7%) patients did not meet internal criteria for a triage ECG. A NSTEMI ED diagnosis was identified in 3% of patients who met internal triage ECG criteria and 1.6% who did not meet criteria (p = 0.29). A cost analysis was performed using an average of 50 STEMI cases diagnosed in our ED per given year. Current institutional ECG billing rates for ECGs performed and interpreted is $125 per ECG, providing an estimated triage ECG charge to detect one STEMI at $54,295. Discussion This retrospective study of 538 triage ECG's performed over an 8 day period identified no STEMIs and 16 NSTEMIs. A very large number of ECGs were done at triage overall and included patients who do not meet our own hospital criteria. Given the extremely low yield and high associated charges, current guidelines for triage ECG for identifying a possible STEMI should be reviewed.

      PubDate: 2018-02-04T20:57:40Z
      DOI: 10.1016/j.ajem.2018.01.083
       
  • Ventricular fibrillation in conscious patients witnessed by the emergency
           medical service
    • Authors: Miguel Freire-Tellado; Rubén Navarro-Patón; Javier Mateos Lorenzo; Álvaro Sende-Cenzano
      Abstract: Publication date: Available online 3 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Miguel Freire-Tellado, Rubén Navarro-Patón, Javier Mateos Lorenzo, Álvaro Sende-Cenzano


      PubDate: 2018-02-04T20:57:40Z
      DOI: 10.1016/j.ajem.2018.02.002
       
  • Low-level troponin elevations following a reduced troponin I cutoff:
           Increased resource utilization without improved outcomes
    • Authors: Brent A. Becker; Barbara A. Stahlman; Nathaniel McLean; Erik I. Kochert
      Abstract: Publication date: Available online 3 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Brent A. Becker, Barbara A. Stahlman, Nathaniel McLean, Erik I. Kochert
      Objective The study sought to evaluate changes in mortality and resource utilization in patients with low level troponin elevations following a reduction in the cutoff for normal troponin I (TnI) from 0.5 ng/mL to the 99th percentile (0.06 ng/mL). Methods This was an interrupted time series comparing emergency department (ED) patients with possible acute coronary syndrome (ACS) and TnI values 0.06–0.5 ng/mL before and after an institutional decrease in the TnI cutoff. The primary outcome was overall mortality at 90 days. Secondary outcomes included rates of rehospitalization, subsequent ACS, and coronary intervention within 90 days, as well as rates of anticoagulation, cardiology consultation, cardiac testing, and coronary intervention during the index visit. Outcomes for the pre-cutoff change group (control) and post-cutoff change group (post) were compared using tests of proportions and odds ratios. Results The study included a total of 1058 subjects with 529 in each cohort. No significant differences in 90 day outcomes were observed between groups, including mortality (13.2% post vs 14.1% control, OR 0.93 [95% CI: 0.65–1.34], p = 0.705). During the index visit, the post-group demonstrated higher rates of cardiology consultation (55.4% vs 41.2%, OR 1.77 [1.39–2.26], p < 0.0001) and cardiac stress testing (16.4% vs 10.6%, OR 1.66 [1.16–2.38], p = 0.006), but no significant differences in coronary intervention or short-term mortality were observed. Conclusion A reduction in the TnI cutoff to the 99th percentile did not change mortality or rates of coronary intervention in ED patients with low level troponin elevations, but significantly increased the use of cardiology resources.

      PubDate: 2018-02-04T20:57:40Z
      DOI: 10.1016/j.ajem.2018.02.001
       
  • Severe deep venous thromboembolism presenting with syncope associated with
           airplane travel: Case report and public health quandary
    • Authors: Nicholas A. Daniels
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Nicholas A. Daniels


      PubDate: 2018-02-02T20:47:20Z
      DOI: 10.1016/j.ajem.2018.01.061
       
  • Airway ultrasound for the confirmation of endotracheal tube placement in
           cadavers by military flight medic trainees – A pilot study
    • Authors: Erin R. Hanlin; Jeffrey Zelenak; Michael Barakat; Kenton L. Anderson
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Erin R. Hanlin, Jeffrey Zelenak, Michael Barakat, Kenton L. Anderson
      Objective Confirming correct endotracheal tube (ETT) placement is a key component of successful airway management. Ultrasound (US) as a tool for the confirmation of ETT placement has been investigated in the hospital setting but not in the pre-hospital setting. We hypothesized that after a short educational session, military flight medic trainees would be able to accurately identify ETT placement in a cadaver model. Methods We conducted a prospective, randomized trial in a human cadaver model. Participants received a brief didactic and hands-on presentation on airway US techniques. Each participant then performed transtracheal US on cadaver models which were randomly assigned to tracheal or esophageal intubation; time to verbalize ETT location was also recorded. Participants were then asked whether they felt airway US would be a useful adjunctive skill in their practice. Results Thirty-two military flight medic trainees were enrolled. US had a sensitivity of 66.7% and a specificity of 76.4% for identification of esophageal intubations. The positive predictive value was 71.4% and the negative predictive value was 72.2%. Mean time to report ETT placement was 47.3 s. Time did not vary between medics with accurate identification versus inaccurate identification (p = 0.176). 83% of participants felt airway US would be a useful adjunctive skill for the confirmation of ETT placement. Conclusions Military flight medic trainees can rapidly use airway US to identify ETT placement after a short educational session with moderate sensitivity and specificity. These advanced military medics are interested in learning and implementing this skill into their practice.

      PubDate: 2018-02-02T20:47:20Z
      DOI: 10.1016/j.ajem.2018.01.074
       
  • Is computed tomography tractography reliable in patients with anterior
           abdominal stab wounds'
    • Authors: İnanc Samil Sarici; Mustafa Uygar Kalayci
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): İnanc Samil Sarici, Mustafa Uygar Kalayci
      Introduction The current literature and guidelines recommend that determination of peritoneal violation is done first in cases of anterior abdominal stab wounds. The primary endpoint of this study was to determine the reliability of computed tomographic (CT) tractography to assess peritoneal violation in anterior abdominal stab wounds. The secondary endpoint is to compare local wound exploration between conventional CT and CT tractography in the evaluation of peritoneal violation. Material and methods A total of 252 patients who were referred with anterior abdominal stab wounds were included in this prospective observational study. Three techniques (local wound exploration, conventional abdominal tomography, and CT tractography) were used to evaluate peritoneal violation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for each technique to determine peritoneal violation. Results The results for the local wound exploration were 100% sensitivity, 100% specificity, 100% PPV, 100% NPV, and 100% accuracy. The results for CT tractography were 95% sensitivity, 100% specificity, 100% PPV, 80% NPV, and 96% accuracy. Conventional abdominal tomography results were 87% sensitivity, 50% specificity, 91% PPV, 40% NPV, and 82% accuracy. Conclusion Local wound exploration is 100% effective in determining peritoneal violation with anterior abdominal stab wounds. CT tractography is better than conventional CT in detecting peritoneal violation. However, we do not recommend CT tractography in anterior abdominal stab wounds due to the false-negative results.

      PubDate: 2018-02-02T20:47:20Z
      DOI: 10.1016/j.ajem.2017.12.065
       
  • Real-time elastography evaluation of differential penetrating liver trauma
           in a rabbit model
    • Authors: Dong Wang; Lichun An; Jiangke Tian; Tengfei Yu; Xia Xie; Yuejuan Gao; Yanfen Zang; Yanyan Tao; Yanqing Liu; Ying Jin
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Dong Wang, Lichun An, Jiangke Tian, Tengfei Yu, Xia Xie, Yuejuan Gao, Yanfen Zang, Yanyan Tao, Yanqing Liu, Ying Jin
      Background Real-time ultrasound elastography (RTE) is used to examine liver fibrosis and benign and malignant lesions, but its use for the diagnosis of liver trauma has not been examined. The purpose of this study was to examine the use of RTE for the evaluation of differential penetrating liver trauma in a rabbit model. Material and methods Eighty New Zealand rabbits were divided into 2 groups. In one group, a single incision (type “-” lesion) was made, and in the other group a hash mark incision (type “#” lesion) was made (about 0.5 cm in depth; 1.0–2.0 cm in length). RTE was performed at 10, 30, and 60 min after injury. Results There were no differences in mean RTE scores between the 2 types of lesions at 10 and 30 min. However, the mean values for the 2 types of lesions increased from 10 min to 60 min (type ‘-’ lesion: 0.88 ± 0.32 to 2.06 ± 0.88; type ‘#’ lesion: 0.89 ± 0.34 to 2.63 ± 1.16). At 60 min, the mean elasticity score in the type ‘#’ lesion group was significantly higher than in the type ‘-’ lesion group (P < .001). Strain ratios were not different between the groups at each time point, but in each group the values decreased from the 10 min time point to the 60 min time point (P-value for the trends, <.001). Conclusions RTE may be able to distinguish mild or severe penetrating liver trauma at 60 min or more after injury.

      PubDate: 2018-02-02T20:47:20Z
      DOI: 10.1016/j.ajem.2018.01.052
       
  • Paramedics attitudes toward endotracheal intibation
    • Authors: Togay Evrin; Halla Kaminska; Wojciech Wieczorek
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Togay Evrin, Halla Kaminska, Wojciech Wieczorek


      PubDate: 2018-02-02T20:47:20Z
      DOI: 10.1016/j.ajem.2018.01.053
       
 
 
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