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Publisher: Elsevier   (Total: 3163 journals)

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Showing 1 - 200 of 3163 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 30, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 88, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 35, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 394, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 244, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 16, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3, SJR: 0.732, CiteScore: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 134, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 29, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 7, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 8)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 43, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 53, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 14, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 16, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 6, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
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: 19, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 385, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 10, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 335, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 10, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 436, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 10, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 50, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 51, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 44, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 34, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 43)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 203, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 27, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 37, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 15, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 39, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 174, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)

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Journal Cover
American Journal of Emergency Medicine
Journal Prestige (SJR): 0.604
Citation Impact (citeScore): 1
Number of Followers: 44  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0735-6757
Published by Elsevier Homepage  [3163 journals]
  • Comparison of intubation devices in level C personal protective equipment:
           A cadaveric study
    • Authors: R. Scott Taylor; Matthew Pitzer; Grayson Goldman; Augusta Czysz; Thomas Simunich; John Ashurst
      Pages: 922 - 925
      Abstract: Publication date: June 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 6
      Author(s): R. Scott Taylor, Matthew Pitzer, Grayson Goldman, Augusta Czysz, Thomas Simunich, John Ashurst
      Background With the advancement of chemical, biological and nuclear warfare and the reemergence of infectious diseases, the possibility of intubating in personal protective equipment has become increasingly more real to the emergency physician. Human cadaveric models have been found to simulate real world conditions better than mannequins. The aim of the study was to determine the first pass success rate and average time to successful intubation while wearing Personal Protective Equipment (PPE). Secondarily, subjects were asked to rank their choice of a primary and back up device, as well as the most common encountered barriers using PPE. Methods Emergency medicine residents and pre-hospital providers were enrolled in a double randomized sequence to either intubation with direct laryngoscopy (DL), video laryngoscopy (VL), or the Supraglottic Airway Laryngopharyngeal Tube (SALT) in a cadaveric model while wearing level C PPE or without PPE. Results First pass success rate was 96% without PPE and 58% while wearing PPE when all devices were considered (p≤0.001). Time to intubation while wearing PPE was 35.0s while no PPE was 22.2s (p=0.012). While wearing PPE both DL and VL were found to allow for a faster intubation as compared to the SALT (23.0s and 18.8s; p=0.002 and p=0.006 respectively). No statistical difference was noted in intubations without PPE. Participants indicated the most common barrier to successful intubation included visibility while wearing hoods (73.7%). Furthermore, 52.6% of participants indicated they would choose DL as the primary method to intubate with if wearing PPE while 47.4% would choose VL. Conclusion There is a statistically significant difference in first pass success and time to successful intubation while wearing and not wearing PPE in human cadaveric models.

      PubDate: 2018-06-06T23:49:08Z
      DOI: 10.1016/j.ajem.2017.10.047
       
  • Positive guaiac and bloody stool are poor predictors of intussusception
    • Authors: Amir A. Kimia; Scotty Williams; Peter N. Hadar; Assaf Landschaft; John Porter; Richard G. Bachur
      Pages: 931 - 934
      Abstract: Publication date: June 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 6
      Author(s): Amir A. Kimia, Scotty Williams, Peter N. Hadar, Assaf Landschaft, John Porter, Richard G. Bachur
      Background Currant jelly stool is a late manifestation of intussusception and is rarely seen in clinical practice. Other forms of GI bleeding have not been thoroughly studied and little is known about their respective diagnostic values. Objective To assess the predictive value of GI bleeding (positive guaiac test, bloody stool and rectal bleeding in evaluation of intussusception. Methods We performed a retrospective cross-sectional study cohort of all children, ages 1month-6years of age, who had an abdominal ultrasound obtained evaluating for intussusception over 5year period. We identified intussusception if diagnosed by ultrasound, air-contrast enema or surgery. Univariate and a multivariate logistic regression analysis were performed. Results During the study period 1258 cases met the study criteria; median age was 1.7years (IQR 0.8, 2.9) and 37% were females. Overall 176 children had intussusception; 153 (87%) were ileo-colic and 23 were ileo-ileal. Univariate risk ratio and adjusted Odds ratio were 1.3 (95% CI, 0.8, 2.0) and 1.3 (0.7, 2.4) for positive guaiac test, 1.1 (0.6, 2.1) and 0.9 (0.3, 3.0) for bloody stool, and 1.7 (1.02, 2.8) and 1.3 (0.5, 3.1) for rectal bleeding . Conclusion Blood in stool, whether visible or tested by guaiac test has poor diagnostic performance in the evaluation of intussusception and is not independently predictive of intussusception. If the sole purpose of a rectal exam in these patients is for guaiac testing it should be reconsidered.

      PubDate: 2018-06-06T23:49:08Z
      DOI: 10.1016/j.ajem.2017.10.051
       
  • Face mask leak with nasal cannula during noninvasive positive pressure
           ventilation: A randomized crossover trial
    • Authors: Derek J. Brown; Stephen M. Carroll; Michael D. April
      Pages: 942 - 948
      Abstract: Publication date: June 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 6
      Author(s): Derek J. Brown, Stephen M. Carroll, Michael D. April
      Background Nasal cannula can achieve apneic oxygenation during emergency intubation. However, pre-procedure nasal cannula placement may be difficult in patients undergoing non-invasive positive pressure ventilation (NPPV) prior to intubation. Our objective was to compare mask leak during NPPV with versus without simultaneous application of nasal cannula. We hypothesized mask leak would be no worse with concomitant use of nasal cannula (non-inferiority design). Methods We performed a randomized crossover non-inferiority study of healthy volunteers. We randomized subjects undergoing 60s trials of NPPV (10cmH2O continuous positive airway pressure) to either NPPV alone (NPPV-a) or NPPV with nasal cannula at 15L/min (NPPV-nc). After a brief rest period, all subjects underwent the alternative intervention. The primary outcome was time averaged mask leak over 60s (L/min). We defined a non-inferiority margin of 5L/min. Results We enrolled 64 subjects. Mean time-averaged mask leak was 2.2L/min for NPPV-a versus 4.0L/min for NPPV-nc for a difference of 1.7L/min (one-sided 95% CI −∞ to 3.2L/min). NPPV-a resulted in higher mean minute volume received (13.5 versus 12.2L) and higher mean respiratory rates (14.8 versus 13.5 breaths per minute). Conclusion The addition of nasal cannula during NPPV does not significantly increase mask leak. The simultaneous application of nasal cannula with NPPV may be a useful strategy to streamline airway management among patients undergoing NPPV prior to intubation.

      PubDate: 2018-06-06T23:49:08Z
      DOI: 10.1016/j.ajem.2017.10.055
       
  • Sufentanil sublingual tablet 30mcg for moderate-to-severe acute pain in
           the ED
    • Authors: James R. Miner; Zubaid Rafique; Harold S. Minkowitz; Karen P. DiDonato; Pamela P. Palmer
      Pages: 954 - 961
      Abstract: Publication date: June 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 6
      Author(s): James R. Miner, Zubaid Rafique, Harold S. Minkowitz, Karen P. DiDonato, Pamela P. Palmer
      Background Pharmacological properties of the sufentanil sublingual tablet 30mcg (SST 30mcg) could offer potential analgesic advantages in settings requiring noninvasive, acute pain management. The feasibility of using SST 30mcg for moderate-to-severe pain management in the emergency department (ED) was evaluated. Methods This open-label, multicenter feasibility study included patients aged ≥18years who presented to the ED with moderate-to-severe pain (≥4 on the numeric rating scale of pain intensity (NRS); opioid-tolerant patients were excluded. Patients received a single SST 30-mcg dose (single-dose cohort) or, upon request, ≤3 additional doses ≥60min apart (multiple-dose cohort) and were evaluated over 1 or 2h. Effectiveness was assessed by patient-reported pain scores (11-point NRS; 5-point pain relief scale). Safety and tolerability were also assessed. Results Overall, 76 patients enrolled into the single-dose (n =40) and multiple-dose (n =36) cohorts. In the first hour (combined cohorts), mean pain intensity was significantly lower 15-min post-dosing (P <0.001; clinically meaningful within 30-minutes post-dosing) and continued to decrease during the first hour (P <0.001 for each 15-minute interval). Mean pain intensity (multiple-dose cohort) decreased from 7.6 at baseline to 4.5 at 1h and to 4.6 at 2h (P <0.001 for both); mean pain relief increased from baseline to 1.9 at 1h (P <0.001) and to 2.0 at 2h (P <0.001). Most (79%) patients had no adverse events (AEs), and there were no severe AEs. Conclusions SST 30mcg was feasible for managing moderate-to-severe acute pain in an ED setting.

      PubDate: 2018-06-06T23:49:08Z
      DOI: 10.1016/j.ajem.2017.10.058
       
  • Utility of common bile duct measurement in ED point of care ultrasound: A
           prospective study
    • Authors: Shadi Lahham; Brent A. Becker; Abdulatif Gari; Steven Bunch; Maili Alvarado; Craig L. Anderson; Eric Viquez; Sophia C. Spann; John C. Fox
      Pages: 962 - 966
      Abstract: Publication date: June 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 6
      Author(s): Shadi Lahham, Brent A. Becker, Abdulatif Gari, Steven Bunch, Maili Alvarado, Craig L. Anderson, Eric Viquez, Sophia C. Spann, John C. Fox
      Background Measurement of the common bile duct (CBD) is considered a fundamental component of biliary point-of-care ultrasound (POCUS), but can be technically challenging. Objective The primary objective of this study was to determine whether CBD diameter contributes to the diagnosis of complicated biliary pathology in emergency department (ED) patients with normal laboratory values and no abnormal biliary POCUS findings aside from cholelithiasis. Methods We performed a prospective, observational study of adult ED patients undergoing POCUS of the right upper quadrant (RUQ) and serum laboratory studies for suspected biliary pathology. The primary outcome was complicated biliary pathology occurring in the setting of normal laboratory values and a POCUS demonstrating the absence of gallbladder wall thickening (GWT), pericholecystic fluid (PCF) and sonographic Murphy's sign (SMS). The association between CBD dilation and complicated biliary pathology was assessed using logistic regression to control for other factors, including laboratory findings, cholelithiasis and other sonographic abnormalities. Results A total of 158 patients were included in the study. 76 (48.1%) received non-biliary diagnoses and 82 (51.9%) were diagnosed with biliary pathology. Complicated biliary pathology was diagnosed in 39 patients. Sensitivity of CBD dilation for complicated biliary pathology was 23.7% and specificity was 77.9%. Conclusion Of patients diagnosed with biliary pathology, none had isolated CBD dilatation. In the absence of abnormal laboratory values and GWT, PCF or SMS on POCUS, obtaining a CBD measurement is unlikely to contribute to the evaluation of this patient population.

      PubDate: 2018-06-06T23:49:08Z
      DOI: 10.1016/j.ajem.2017.10.064
       
  • The value of lactate clearance in admission decisions of patients with
           acute exacerbation of COPD
    • Authors: Uğur Durmuş; Nurettin Özgür Doğan; Murat Pekdemir; Serkan Yılmaz; Elif Yaka; Adnan Karadaş; Seda Güney Pınar
      Pages: 972 - 976
      Abstract: Publication date: June 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 6
      Author(s): Uğur Durmuş, Nurettin Özgür Doğan, Murat Pekdemir, Serkan Yılmaz, Elif Yaka, Adnan Karadaş, Seda Güney Pınar
      Background Lactate and lactate clearance are being used as biomarkers in several critical conditions. The aim of this study was to examine the value of sixth hour lactate clearance in patients who were hospitalized with chronic obstructive pulmonary disease (COPD) exacerbations. Methods This single-center, cross-sectional study was conducted in a tertiary emergency department (ED) on patients who presented with acute exacerbation of COPD. Discharge or admission decisions were specified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria and the clinician's decision. In the study, lactate clearance was defined as the percent decrease in lactate from the time of presentation to the ED to the sixth hour. Results A total of 495 patients were evaluated and 397 patients were excluded. Among included patients, 53 (54.1%) were admitted to the hospital and 45 (45.9%) were discharged. The median lactate clearance was found to be −11.8% (95% CI: −50.0 to 34.5) in the admitted group and 14.7% (95% CI: −11.3 to 42.3) in the discharged group. Between the two groups, the median difference of lactate clearance was found to be 26.5% (95% CI: 0.6 to 52.4). Multivariate logistic regression analysis revealed that the delta lactate value can determine the hospitalization need of patients (OR: 0.91, 95% CI: 0.85 to 0.97). Conclusion Lactate clearance can be evaluated as a useful marker in patients with COPD exacerbations. This study suggests that lactate monitoring in the ED has clinical benefits in addition to GOLD guidelines when deciding whether to discharge or hospitalize a patient.

      PubDate: 2018-06-06T23:49:08Z
      DOI: 10.1016/j.ajem.2017.11.002
       
  • Gestalt for shock and mortality in the emergency department: A prospective
           study
    • Authors: Yan-ling Li; Jun-rong Mo; Nga-man Cheng; Stewart S.W. Chan; Pei-yi Lin; Xiao-hui Chen; Colin A. Graham; Timothy H. Rainer
      Pages: 988 - 992
      Abstract: Publication date: June 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 6
      Author(s): Yan-ling Li, Jun-rong Mo, Nga-man Cheng, Stewart S.W. Chan, Pei-yi Lin, Xiao-hui Chen, Colin A. Graham, Timothy H. Rainer
      Objective The diagnosis of shock in patients presenting to the emergency department (ED) is often challenging. We aimed to compare the accuracy of experienced emergency physician gestalt against Li's pragmatic shock (LiPS) tool for predicting the likelihood of shock in the emergency department, using 30-day mortality as an objective standard. Method In a prospective observational study conducted in an urban, academic ED in Hong Kong, adult patients aged 18years or older admitted to the resuscitation room or high dependency unit were recruited. Eligible patients had a standard ED workup for shock. The emergency physician treating the patient was asked whether he or she considered shock to be probable, and this was compared with LiPS. The proxy ‘gold’ or reference standard was 30-day mortality. The area under the receiver operating curve (AUROC) was used to predict prognosis. The primary outcome measure was 30-day mortality. Results A total of 220 patients fulfilled the inclusion criteria and were included in the analysis. The AUROC for LiPS (0.722; sensitivity=0.733, specificity=0.711, P <0.0001) was greater than emergency physician gestalt (0.620, sensitivity=0.467, specificity=0.774, P =0.0137) for diagnosing shock using 30-day mortality as a proxy (difference P =0.0229). LiPS shock patients were 6.750 times (95%CI =2.834–16.076, P <0.0001) more likely to die within 30-days compared with non-shock patients. Patients diagnosed by emergency physicians were 2.991 times (95%CI =1.353–6.615, P =0.007) more likely to die compared with the same reference. Conclusions LiPS has a higher diagnostic accuracy than emergency physician gestalt for shock when compared against an outcome of 30-day mortality.

      PubDate: 2018-06-06T23:49:08Z
      DOI: 10.1016/j.ajem.2017.11.007
       
  • Can different physicians providing urgent and non-urgent treatment improve
           patient flow in emergency department'
    • Authors: Flora Fei-Fei Yau; Tsung-Cheng Tsai; Yan-Ren Lin; Kuan-Han Wu; Yuan-Jhen Syue; Chao-Jui Li
      Pages: 993 - 997
      Abstract: Publication date: June 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 6
      Author(s): Flora Fei-Fei Yau, Tsung-Cheng Tsai, Yan-Ren Lin, Kuan-Han Wu, Yuan-Jhen Syue, Chao-Jui Li
      Background Emergency Department (ED) overcrowding is a worldwide problem, and it might be caused by prolonged patient stay in the ED. This study tried to analyze if different practice models influence patient flow in the ED. Materials and methods A retrospective, 1-year cohort study was conducted across two EDs in the largest healthcare system in Taiwan. A total of 37,580 adult non-trauma patients were involved in the study. The clinical practice between two ED practice models was compared. In one model, urgent and non-urgent patients were treated by different emergency physicians (EPs) separately (separated model). In the other, EPs treated all patients assigned randomly (merged model). The ED length of stay (LOS), diagnostic tool use (including laboratory examinations and computed tomography scans), and patient dispositions (including discharge, general ward admission, intensive care unit (ICU) admissions, and ED mortality) were selected as outcome indicators. Result Patients discharged from ED had 0.4h shorter ED LOS in the separated model than in merged model. After adjusting for the potential confounding factors through regression model, there was no difference of patient disposition of the two practice models. However, the separated model showed a slight decrease in laboratory examination use (adjusted odds ratio, 0.9; 95% confidence interval, 0.83–0.96) compared with the merged model. Conclusion The separated model had better patient flow than the merged model did. It decreased the ED LOS in ED discharge patients and laboratory examination use.

      PubDate: 2018-06-06T23:49:08Z
      DOI: 10.1016/j.ajem.2017.11.010
       
  • Effects of opioid medications on cognitive skills among Emergency
           Department patients
    • Authors: Catherine A. Marco; Dennis Mann; Jordan Rasp; Michael Ballester; Oswald Perkins; Michael B. Holbrook; Kyle Rako
      Pages: 1009 - 1013
      Abstract: Publication date: June 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 6
      Author(s): Catherine A. Marco, Dennis Mann, Jordan Rasp, Michael Ballester, Oswald Perkins, Michael B. Holbrook, Kyle Rako
      Introduction Treatment for pain and related conditions has been identified as the most common reason for Emergency Department (ED) visits. Concerns exist regarding the effects of opioid pain medications on cognition and patient ability to consent for procedures, hospital admission, or to refuse recommended medical interventions. This study was undertaken to identify cognitive skills before and after opioid pain medication in the ED setting. Methods This was a prospective study comparing performance on the Mini-Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA) before and after administration of opioid pain medications. Eligible participants included ED patients with pain, who received opioid treatment. Participants were randomized to receive either the MMSE before pain medication and the MoCA after medication, or the reverse. MoCA scores were converted to MMSE equivalent scores for comparison. Results Among 65 participants, the median age was 36 and median triage pain score was 8. 35% of patients were considered cognitively impaired based on their MMSE score prior to any opioid medication (MMSE<27). There was a median decrease in pain scores of 1 point following pain medication, p-value<0.001. There was a median decrease in MMSE scores of 1 point following pain medication, p-value=0.003. The range of change in scores (post minus pre) on the MMSE-equivalent was −7 to 3. 35 patients (56%) had a decrease in scores, 6 (10%) had no change, and 21 (34%) had an increase. After medication, 31 (48%) were abnormal (MMSE score<27). No differences in MMSE scores were identified by gender, ethnicity, mode of arrival, insurance, age, triage pain scores, opioid agent given, or ED diagnosis. Conclusions There is an association between opioid pain medication and decrease in cognitive performance on the MMSE. Because of the wide range of cognitive performance following opioid pain medication, assessment of individual patients' cognitive function is indicated.

      PubDate: 2018-06-06T23:49:08Z
      DOI: 10.1016/j.ajem.2017.11.017
       
  • Molecular diagnosis and outcome in patients with sepsis: Are emergency
           clinicians ready for it'
    • Authors: Daryelle S. Varon; Joseph Varon
      Pages: 687 - 688
      Abstract: Publication date: Available online 5 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Daryelle S. Varon, Joseph Varon


      PubDate: 2018-06-06T23:49:08Z
      DOI: 10.1016/j.ajem.2017.12.011
       
  • Supraglottic airway device placement by respiratory therapists
    • Abstract: Publication date: Available online 13 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): David J. Heegeman, William D. Rosandick, Rachel H. Boehning-Anderson, Andrew R. Woltmann
      Objective Respiratory Therapists (RTs) are some of the first staff to arrive at in-hospital incidents where cardiopulmonary resuscitation (CPR) is needed, yet at some facilities, their ability to intubate is limited by hospital scope of practice. During the intubation process, CPR is often interrupted which could potentially increase the likelihood of adverse patient outcomes. Training RTs to secure the airway using non-intubation methods may reduce or eliminate time for CPR interruptions and allow for earlier continuous/uninterrupted chest compressions. Design A pilot study was developed to assess the effectiveness of a new policy for RT scope of practice. Methods RTs were trained for supraglottic airway device placement prior to procedure initiation. After each device insertion event, RTs completed a written survey. Time between cardiac arrest and device insertion, number of insertion attempts, ease of placement, technical specifications of the device, complications, and survival were compiled and compared between supraglottic airway device and endotracheal tube (ETT) placement. Results Procedural information from 23 patients who received a supraglottic airway device during the trial was compared to retrospective data of CPR events requiring intubation from the previous year. Time between initiation of cardiac arrest and advanced airway placement decreased significantly (p < 0.0001) when RTs placed the supraglottic airway device (4.7 min) versus ETT at CPR events the previous year (8.6 min). Device-associated complications were minimal and patient mortality was the same regardless of device. Conclusion We propose that more RTs should be trained to insert supraglottic airway devices during inpatient CPR events.

      PubDate: 2018-06-19T00:01:06Z
       
  • “I'm pregnant'” Emergency department utilization by newly pregnant
           adolescents: A community-based study
    • Abstract: Publication date: Available online 13 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Lindsey Ouellette, Stephanie Wigstadt, Adam Nicholson, Angela Zamarripa, Jeffrey Jones


      PubDate: 2018-06-19T00:01:06Z
       
  • A rare case of synchronous urinothorax and uroperitoneum
    • Abstract: Publication date: Available online 12 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Natalia Vallianou, Victoria Gennimata, Fotis Constantinou, Dimitrios Karamanolakis, Alkiviades Grigorakis
      Urinothorax was first described in 1968 by Corriere et al. as the presence of urine in the pleural cavity due to retroperitoneal leakage of accumulated urine. Herein, we present a female patient, who complained of dyspnea due to urinothorax. This is the first case of urinothorax that developed so tardive after radiotherapy and was diagnosed due to high clinical evidence despite the negative scintigraphy.

      PubDate: 2018-06-12T23:55:13Z
       
  • Paramedic determination of appropriate emergency department destination
    • Abstract: Publication date: Available online 12 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Charles W. Hwang, Desmond E. Fitzpatrick, Torben K. Becker, Jason M. Jones
      Background Freestanding emergency departments (FSED) are equipped to care for most emergencies, but do not have all the resources that hospital-based emergency departments (ED) offer. As the number of FSEDs grows rapidly, emergency medical services (EMS) must routinely determine whether a FSED is an appropriate destination. Inappropriate triage may delay definitive care, potentially increasing morbidity, mortality, and resource utilization. We sought to evaluate paramedics' ability in determining whether a FSED is the most appropriate destination. Methods We conducted a retrospective study of two county EMS agencies and two FSEDs over a 25-month period in [blinded] and [blinded] County, [blinded], USA. Both EMS agencies allow paramedic discretion in determining transport destination. To determine whether paramedics can correctly identify patients that can be cared for fully at a FSED, our primary outcome was the percentage of patients transported to FSEDs by EMS that were discharged without additional hospital-based resources. Results We identified 1247 EMS patients that had a selected destination of FSED. We excluded patients that did not arrive at their selected FSED destination, left before FSED disposition, or were transferred from the FSED to unaffiliated hospitals. A total of 1184 patients were included for analysis, and 885 (74.7%) did not require additional hospital resources. Comparing the two EMS agencies yielded similar results. Conclusion In this study, involving two EMS agencies over a 25-month period, we found that 3 out of 4 patients deemed appropriate for transport to a FSED by a paramedic did not require additional hospital-based services.

      PubDate: 2018-06-12T23:55:13Z
       
  • Comparison of clinical risk scores for triaging high-risk chest pain
           patients at the emergency department
    • Authors: Salah S. Al-Zaiti; Ziad Faramand; Mohammad Alrawashdeh; Susan M. Sereika; Christian Martin-Gill; Clifton Callaway
      Abstract: Publication date: Available online 8 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Salah S. Al-Zaiti, Ziad Faramand, Mohammad Alrawashdeh, Susan M. Sereika, Christian Martin-Gill, Clifton Callaway
      Background Many of the clinical risk scores routinely used for chest pain assessment have not been validated in patients at high risk for acute coronary syndrome (ACS). We performed an independent comparison of HEART, TIMI, GRACE, FRISC, and PURSUIT scores for identifying chest pain due to ACS and for predicting 30-day death or re-infarction in patients arriving through Emergency Medical Services (EMS). Methods and results We enrolled consecutive EMS patients evaluated for chest pain at three emergency departments. A reviewer blinded to outcome data retrospectively reviewed patient charts to compute each risk score. The primary outcome was ACS diagnosed during the primary admission, and the secondary outcome was death or re-infarction within 30-days of initial presentation. Our sample included 750 patients (aged 59 ± 17 years, 42% female), of whom 115 (15.3%) had ACS and 33 (4.4%) had 30-day death or re-infarction. The c-statistics of HEART, TIMI, GRACE, FRISC, and PURSUIT for identifying ACS were 0.87, 0.86, 0.73, 0.84, and 0.79, respectively, and for predicting 30-day death or re-infarction were 0.70, 0.73, 0.72, 0.72, and 0.62, respectively. Sensitivity/negative predictive value of HEART ≥ 4 and TIMI ≥ 3 for ACS detection were 0.94/0.98 and 0.87/0.97, respectively. Conclusions In chest pain patients admitted through EMS, HEART and TIMI outperform other scores for identifying chest pain due to ACS. Although both have similar negative predictive value, HEART has better sensitivity and lower rate of false negative results, thus it can be used preferentially over TIMI in the initial triage of this population.

      PubDate: 2018-06-09T23:52:06Z
      DOI: 10.1016/j.ajem.2018.06.020
       
  • Effectiveness of the “timed up and go” (TUG) and the chair test as
           screening tools for geriatric fall risk assessment in the ED
    • Authors: Richard B. Chow; Andre Lee; Bryan G. Kane; Jeanne L. Jacoby; Robert D. Barraco; Stephen W. Dusza; Matthew C. Meyers; Marna Rayl Greenberg
      Abstract: Publication date: Available online 7 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Richard B. Chow, Andre Lee, Bryan G. Kane, Jeanne L. Jacoby, Robert D. Barraco, Stephen W. Dusza, Matthew C. Meyers, Marna Rayl Greenberg
      Objective We sought to evaluate the effectiveness of the “Timed Up and Go” (TUG) and the Chair test as screening tools in the Emergency Department (ED), stratified by sex. Methods This prospective cohort study was conducted at a Level 1 Trauma center. After consent, subjects performed the TUG and the Chair test. Subjects were contacted for phone follow-up and asked to self-report interim falling. Results Data from 192 subjects were analyzed. At baseline, 71.4% (n = 137) screened positive for increased falls risk based on the TUG evaluation, and 77.1% (n = 148) scored below average on the Chair test. There were no differences by patient sex. By the six-month evaluation 51 (26.6%) study participants reported at least one fall. Females reported a non-significant higher prevalence of falls compared to males (29.7% versus 22.2%, p = 0.24). TUG test had a sensitivity of 70.6% (95% CI: 56.2%–82.5%), a specificity of 28.4% (95% CI: 21.1%–36.6%), a positive predictive (PP) value 26.3% (95% CI: 19.1%–34.5%) and a negative predictive (NP) value of 72.7% (95% CI: 59.0%–83.9%). Similar results were observed with the Chair test. It had a sensitivity of 78.4% (95% CI: 64.7%–88.7%), a specificity of 23.4% (95% CI: 16.7%–31.3%), a PP value 27.0% (95% CI: 20.1%–34.9%) and a NP value of 75.0% (95% CI: 59.7%–86.8%). No significant differences were observed between sexes. Conclusions There were no sex specific significant differences in TUG or Chair test screening performance. Neither test performed well as a screening tool for future falls in the elderly in the ED setting.

      PubDate: 2018-06-09T23:52:06Z
      DOI: 10.1016/j.ajem.2018.06.015
       
  • QSOFA score in identifying the septic patients according to Sepsis 1.0 or
           Sepsis 2.0, putting new wine into old bottles'
    • Authors: Xianshi Zhou; Fanwei Wu
      Abstract: Publication date: Available online 7 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Xianshi Zhou, Fanwei Wu


      PubDate: 2018-06-09T23:52:06Z
      DOI: 10.1016/j.ajem.2018.06.017
       
  • Rhabdomyolysis in a patient complicated with hypopituitarism and multiple
           organ dysfunction syndrome and the literature review
    • Authors: Chuan Zhou; Shichao Lai; Yong Xie; Su Zhang; Yiping Lu
      Abstract: Publication date: Available online 7 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Chuan Zhou, Shichao Lai, Yong Xie, Su Zhang, Yiping Lu
      Introduction Muscular symptoms, including stiffness, myalgia, cramps, and fatigue, are present in the majority of the patients with hypopituitarism, adrenal insufficiency and hypothyroidism, but rhabdomyolysis, the rapid breakdown of skeletal muscle, is a rare manifestation. In most patients who develop rhabdomyolysis, precipitating factors, such as strenuous exercise or use of lipid-lowering drugs, can be identified. Case report We report the case of a 23-year-old male with primary hypopituitarism who developed acute renal impairment (AKI) with rhabdomyolysis after strenuous physical activity (push-ups). His blood test confirmed marked hypopituitarism. Severe elevation of serum CK consistent with rhabdomyolysis was noted and an elevated creatinine indicated AKI and multiple organ dysfunction syndrome (MODS). Patient's condition improved significantly after continuous renal replacement therapy (CRRT), glucocorticoid hormone replacement therapy and aggressive hydration. MODS with rhabdomyolysis in patients with hypothyroidism is quite rare and we expect that this case report adds to the existing literature on this subject. We also emphasize that thyroid and adrenal gland status should be evaluated in patients with unexplained AKI, MODS and presenting with the symptoms of muscle involvement. Literature review We respectively reviewed 23 patients with hypopituitarism, adrenal Insufficiency and hypothyroidism induced rhabdomyolysis who were involved in the past 40 years relevant literatures. Conclusion We report a successfully treated case of rhabdomyolysis, which is a rare but potentially serious complication of hypopituitarism. Screening for endocrine abnormality in patients with elevated muscle enzymes should be considered, since an early diagnosis and prompt treatment is essential to prevent rhabdomyolysis and its consequences.

      PubDate: 2018-06-09T23:52:06Z
      DOI: 10.1016/j.ajem.2018.06.019
       
  • Acute infectious aortitis presenting as pyelonephritis
    • Authors: Goran Rimac; Alexandre Lafleur
      Abstract: Publication date: Available online 7 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Goran Rimac, Alexandre Lafleur


      PubDate: 2018-06-09T23:52:06Z
      DOI: 10.1016/j.ajem.2018.06.018
       
  • Step right up! Healthcare provider weight estimation vs. a professional
           weight guesser
    • Authors: Orlando V.A.; LaBond
      Abstract: Publication date: Available online 6 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): J. Orlando, V.A. LaBond


      PubDate: 2018-06-06T23:49:08Z
       
  • The wider implications of AD-related AR and pulmonary oedema
    • Authors: Oscar M.P.; Jolobe
      Abstract: Publication date: Available online 6 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Oscar M.P. Jolobe


      PubDate: 2018-06-06T23:49:08Z
       
  • Gastric ultrasonography in evaluating NPO status of pediatric patients in
           the emergency department
    • Authors: Aftab Azad; Hamad Madi Shaik Farid Abdull Wahab Hamid Shokoohi
      Abstract: Publication date: Available online 6 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Aftab M. Azad, Hamad A. Al Madi, Shaik Farid Abdull Wahab, Hamid Shokoohi, Ye Jin Kang, Andrew S. Liteplo


      PubDate: 2018-06-06T23:49:08Z
       
  • Circulating lncRNA NEAT1 correlates with increased risk, elevated severity
           and unfavorable prognosis in sepsis patients
    • Authors: Qinghe Huang; Cuiyu Huang; Yan Luo; Fuyun He; Rongfang Zhang
      Abstract: Publication date: Available online 5 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Qinghe Huang, Cuiyu Huang, Yan Luo, Fuyun He, Rongfang Zhang
      Objective To investigate the correlation of circulating long non-coding RNA nuclear-enriched abundant transcript 1 (lncRNA NEAT1) expression with disease risk, severity, prognosis and inflammatory cytokine levels in sepsis patients. Methods 152 sepsis patients and 150 health controls (HCs) were enrolled in this study. Plasma and serum samples were obtained from sepsis patients and HCs, and lncRNA NEAT1 expression in plasma was determined by quantitative polymerase chain reaction, while levels of inflammatory cytokines in serum were detected by enzyme linked immune sorbent assay. Results LncRNA NEAT1 expression was remarkably higher in sepsis patients than in HCs (P < 0.001). Receiver operating characteristic (ROC) curve disclosed a good predictive value of lncRNA NEAT1 expression for sepsis risk with area under curve (AUC) of 0.730 (95% CI: 0.740–0.861). Subsequent multivariate logistic regression analysis demonstrated that lncRNA NEAT1 expression was independently associated with higher sepsis risk (P < 0.001). In sepsis patients, lncRNA NEAT1 expression was also observed to be positively correlated with Acute Physiology and Chronic Health Evaluation (APACHE) II score (P < 0.001), serum tumor necrosis factor-α (P < 0.001), interleukin (IL)-1β (P = 0.043), IL-6 (P = 0.001) and IL-8 (P = 0.038), while negatively correlated with IL-10 (P < 0.001). In addition, lncRNA NEAT1 expression was increased in non-survivors compared to survivors (P = 0.006), and ROC curve revealed a good prognostic value of lncRNA NEAT1 for non-survivor risk with AUC 0.641 (95% CI: 0.536–0.746). Conclusion Circulating lncRNA NEAT1 correlates with increased disease risk, elevated severity and unfavorable prognosis as well as higher expression of pro-inflammatory cytokines in sepsis patients.

      PubDate: 2018-06-06T23:49:08Z
      DOI: 10.1016/j.ajem.2018.06.008
       
  • Information for Authors
    • Abstract: Publication date: June 2018
      Source:The American Journal of Emergency Medicine, Volume 36, Issue 6


      PubDate: 2018-06-06T23:49:08Z
       
  • Successful treatment of massive thrombosis in different locations with
           prolonged thrombolytic therapy: A life-saving intervention
    • Authors: Ibrahim Rencuzogullari; Metin Cağdaş; Suleyman Karakoyun; Yavuz Karabağ; Tufan Çınar
      Abstract: Publication date: Available online 3 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Ibrahim Rencuzogullari, Metin Cağdaş, Suleyman Karakoyun, Yavuz Karabağ, Tufan Çınar
      Venous thrombosis is recognized as one of the most important complications of nephrotic syndrome (NS). In patients with NS, venous thrombosis may develop in the renal veins, the deep veins of the lower limb, and the inferior vena cava. Here, we describe a case report of an NS patient with multiple venous thrombosis in the right renal vein, the left iliac vein, the vena cava inferior, the right atrium, and the pulmonary arteries. Moreover, we describe the successful treatment of multiple venous thrombosis with prolonged thrombolytic treatment in spite of an increased risk of bleeding due to renal biopsy.

      PubDate: 2018-06-03T23:46:15Z
      DOI: 10.1016/j.ajem.2018.06.003
       
  • The intracranial number of foreign bodies as a predictor of mortality
           after penetrating brain injury
    • Authors: Mustafa Bolatkale; Ahmet Cagdas Acara
      Abstract: Publication date: Available online 2 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Mustafa Bolatkale, Ahmet Cagdas Acara
      Penetrating brain injury (PBI) is the most lethal form of traumatic brain injury, which is a leading cause of mortality. PBI has a mortality rate of 23%–93% and 87%–100% with poor neurological status. Despite the use of various prognostic factors there is still a need for a specific prognostic factor for early prediction of mortality in PBI to reduce mortality and provide good outcomes with cost-effective surgical treatments. The aim of this study was to investigate the predictive value of the number of intracranial foreign bodies (FBs) on mortality in PBI in the Emergency Department. The study included 95 patients admitted with PBI caused by barrel bomb explosion. The intracranial number of FB was examined by brain computed tomography. Logistic regression was used to assess the association of the intracranial number of FB on mortality. Correlation analyses were performed to investigate the association of Glasgow Coma Scale (GCS) with intracranial number of FB. The optimal cut-off value of the intracranial number of FB calculated for mortality was 2, which was effective for predicting mortality (p < .001). In patients with >2 intracranial FB, the mortality rate was statistically significantly 51-fold higher than those with ≤2 (p < .001). A statistically significant negative correlation was determined between GCS and number of. FB (r = −0.697;p < .001). When the intracranial number of FB was >2, mortality significantly increased in patients with PBI. The intracranial number of FBs may be considered as a novel prognostic factor for the prediction of mortality in PBI. Penetrating brain injury, mortality, foreign body, barrel bomb.

      PubDate: 2018-06-03T23:46:15Z
      DOI: 10.1016/j.ajem.2018.06.005
       
  • When it is not just DKA; diabetic ketoacidosis as a first presentation of
           pancreatic adenocarcinoma
    • Authors: Danny Markabawi; Divya Kondapi; Vikrant Tambe; Rahul Seth
      Abstract: Publication date: Available online 2 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Danny Markabawi, Divya Kondapi, Vikrant Tambe, Rahul Seth


      PubDate: 2018-06-03T23:46:15Z
      DOI: 10.1016/j.ajem.2018.05.070
       
  • Sick and unsheltered: Homelessness as a major risk factor for emergency
           care utilization
    • Authors: Stas Amato; Flavia Nobay; David Petty Amato; Beau Abar; David Adler
      Abstract: Publication date: Available online 2 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Stas Amato, Flavia Nobay, David Petty Amato, Beau Abar, David Adler
      Objective Homelessness is a critical public health issue and socioeconomic epidemic associated with a disproportionate burden of disease and significant decrease in life expectancy. We compared emergency care utilization between individuals with documented homelessness to those enrolled in Medicaid without documented homelessness. Methods We conducted a retrospective cohort study consisting of electronic medical record review of demographics, chief complaints, and health care utilization metrics of adults with homelessness compared to a group enrolled in Medicaid without identified homelessness. The chart review spanned two years of emergency visits at a single urban, academic, tertiary care medical center. Descriptive statistics, bivariate and multivariate analyses were utilized. Results Over the study period, 986 patients experiencing homelessness accounted for 7532 ED visits, with a mean of 7.6 (SD 19.9) and max of 316 visits. The control group of 3482 Medicaid patients had 5477 ED visits, with a mean of 1.6 visits (SD 2.1) and max of 49 visits. When controlling for age, sex, race, ethnicity, and ESI, those living with homelessness were 7.65 times more likely to return to the ED within 30 days of their previous visit, 9.97 times more likely to return within 6 months, 10.63 times more likely to return within one year, and 11 times more likely to return within 2 years. Conclusions Compared to non-homeless Medicaid patients, patients with documented homelessness were over seven times more likely to return to the ED within 30 days and over eleven times more likely to return to the ED in two years.

      PubDate: 2018-06-03T23:46:15Z
      DOI: 10.1016/j.ajem.2018.06.001
       
  • Eye injury from electrical weapon probes: Mechanisms and treatment
    • Authors: Mark W. Kroll; Mollie B. Ritter; Eric A. Kennedy; Nora K. Siegal; Roman Shinder; Michael A. Brave; Howard E. Williams
      Abstract: Publication date: Available online 2 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Mark W. Kroll, Mollie B. Ritter, Eric A. Kennedy, Nora K. Siegal, Roman Shinder, Michael A. Brave, Howard E. Williams
      Purpose While generally reducing morbidity and mortality, TASER® electrical weapons have risks associated with their usage, including burn injuries and head and cervical trauma associated with uncontrolled falls. The primary non-fatal complications appear to significant eye injury but no analysis of the mechanisms or suggested treatments has been published. Methods We used a biomechanical model to predict the risk of eye injury as a function of distance from the weapon muzzle to the eye. We compared our model results to recently published epidemiological findings. We also describe the typical presentation and suggest treatment options. Results The globe rupture model predicted that a globe rupture can be expected (50% risk) when the eye is within 6 m of the muzzle and decreases rapidly beyond that. This critical distance is 9 m for lens and retinal damage which is approximately the range of the most common probe cartridges. Beyond 9 m, hyphema is expected along with a perforation by the dart portion of the probe. Our prediction of globe rupture out to 6 m (out of a typical range of 9 m) is consistent with the published risk of enucleation or unilateral blindness being 69 ± 18%, with an eye penetration. Conclusions Significant eye injury is expected from a penetration by an electrical weapon probes at close range. The risk decreases rapidly at extended distances from the muzzle. Not all penetrating globe injuries from electrical weapon probes will result in blindness.

      PubDate: 2018-06-03T23:46:15Z
      DOI: 10.1016/j.ajem.2018.06.004
       
  • National unintentional carbon monoxide poisoning estimates using
           hospitalization and emergency department data
    • Authors: Dorothy Stearns; Kanta Sircar
      Abstract: Publication date: Available online 2 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Dorothy Stearns, Kanta Sircar
      Unintentional non-fire-related (UNFR) carbon monoxide (CO) poisoning is a leading cause of poisoning in the US and a preventable cause of death. We generated national estimates of accidental CO poisoning and characterized the populations most at risk. UNFR CO poisoning cases were assessed using hospitalization and emergency department (ED) data from the Healthcare Costs and Utilization Project National Inpatient Sample and Nationwide Emergency Department databases. We used hospitalization data from 2003 to 2013 and ED data from 2007 to 2013. We calculated trends using a linear regression of UNFR CO poisonings over the study period and age-adjusted rates using direct standardization and U.S. Census Bureau estimates. During 2003–2013, approximately 14,365 persons (4.1 cases/million annually) with confirmed or probable UNFR CO poisoning were admitted to hospitals and the annual rate of poisonings showed a weak downward trend (p = 0.12). During 2007–2013, approximately 101,847 persons (48.3 visits/million annually) visited the ED and the annual rate of poisonings showed a significant downward trend (p ≤ 0.01). Most UNFR CO hospital cases involved patients who were older (aged 45–64 years), white, male, or living in the South or Midwest. Overall, the rate of hospitalizations did not change over the study period. Unintentional CO poisoning is preventable and these cases represent the most recent national estimates. ED visits declined over the study period, but the hospitalization rates did not change. This emphasizes the need for prevention efforts, such as education in the ED setting, increased use of CO alarms, and proper use and maintenance of fuel-powered household appliances.

      PubDate: 2018-06-03T23:46:15Z
      DOI: 10.1016/j.ajem.2018.06.002
       
  • Novel information and communication technology system to improve surge
           capacity and information management in the initial hospital response to
           major incidents
    • Authors: Mami Yamada; Taka-aki Nakada; Shota Nakao; Eiji Hira; Koichiro Shinozaki; Rui Kawaguchi; Yasuaki Mizushima; Tetsuya Matsuoka
      Abstract: Publication date: Available online 2 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Mami Yamada, Taka-aki Nakada, Shota Nakao, Eiji Hira, Koichiro Shinozaki, Rui Kawaguchi, Yasuaki Mizushima, Tetsuya Matsuoka


      PubDate: 2018-06-03T23:46:15Z
      DOI: 10.1016/j.ajem.2018.06.007
       
  • Blood lactate measurement within the emergency department: A two-year
           retrospective analysis
    • Authors: Julie Contenti; Celine Occelli; Fabien Lemoel; Patricia Ferrari; Jacques Levraut
      Abstract: Publication date: Available online 2 June 2018
      Source:The American Journal of Emergency Medicine
      Author(s): Julie Contenti, Celine Occelli, Fabien Lemoel, Patricia Ferrari, Jacques Levraut
      We evaluate in this retrospective cohort, the clinical situations leading emergency physicians to take a blood lactate sample, the prevalence of hyperlactatemia and its impact on short-term adverse outcome. ED patients requiring a blood lactate measurement (BLM) during a two-year period were included. Early patients' outcomes were extracted and discharge diagnoses were classified into 12 diagnostic categories. A total of 118,737 patients were analyzed. A BLM was carried out in 13,089 of them. Surprisingly, the proportion of patients having a BLM was higher in those admitted for seizure (31.4%) than in those admitted for infection (27.9%). Ten percent of patients who had a blood lactate test had a lactate level >4 mmol/l (1,315). Among them, 23.2% were admitted for infections, 20% for seizures, and 11% for cardiovascular diseases. After excluding the patients older than 75 years from the analysis in order to prevent a selection bias, the patient's severity was independently associated to an age over 65 years (OR: 1.26), an arterial blood sampling (OR: 2.77) and the blood lactate level (OR: 1.31). The blood lactate level was very informative to detect the sicker patients in the infection group whereas its interest was poor in the group of patients admitted for seizures. In conclusion, blood lactate testing has become routine in emergency departments and a large proportion of patients have abnormal blood lactate levels. The most frequent causes of high blood lactate in the ED are infection and seizures but the prognostic value of blood lactate seems to be different from one diagnostic category to the other.

      PubDate: 2018-06-03T23:46:15Z
      DOI: 10.1016/j.ajem.2018.05.065
       
 
 
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