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Publisher: Elsevier   (Total: 3042 journals)

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Showing 1 - 200 of 3042 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 19, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 81, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, 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: 326, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
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   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 203, 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: 9, 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: 22, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
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: 3)
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: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 124, 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: 16, 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: 24, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
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: 25, 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)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
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: 24, 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: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, 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 Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 44, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 12)
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: 20, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 24)
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: 34, 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: 4)
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: 9)
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: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, 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: 3)
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: 21, 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: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, 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: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
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: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 58)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 339, 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: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
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: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, 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: 311, 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: 4, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 398, 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: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 50, 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: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 5)
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  
Algal Research     Partially Free   (Followers: 8, 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: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 46, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 46, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 30, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 44, 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: 182, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
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: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 33, 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: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 52, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 4)
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: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 161, 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: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, 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: 153, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Emergency Medicine
  [SJR: 0.574]   [H-I: 65]   [34 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0735-6757
   Published by Elsevier Homepage  [3042 journals]
  • Clevidipine versus sodium nitroprusside in acute aortic dissection: A
           retrospective chart review
    • Authors: Alexandru Ulici; Jon Jancik; Timothy S. Lam; Shannon Reidt; Domenico Calcaterra; Jon B. Cole
      Abstract: Publication date: Available online 16 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Alexandru Ulici, Jon Jancik, Timothy S. Lam, Shannon Reidt, Domenico Calcaterra, Jon B. Cole
      Aim Intravenous vasodilators are often added to beta-blocking agents to reach BP goals in aortic dissection. Control of BP using clevidipine has been described in hypertensive emergencies and cardiac surgery but not in aortic dissection. The aim of this study was to compare clevidipine versus sodium nitroprusside (SNP) as adjunct agents to esmolol for blood pressure (BP) management in aortic dissection. Methods A single-center retrospective chart review evaluated patients diagnosed with aortic dissection. The primary outcome measure was time to reach patient specific systolic blood pressure (SBPPT) goals after initiation of esmolol infusion. Efficacy of clevidipine and SNP was assessed using area under the curve analysis of positive and negative excursions outside of SBPPT goals (AUCSBPe). Cost data was calculated using average wholesale price in U.S. dollars. Results Fourteen patients were included in final analyses. Median systolic BP immediately prior to initiation of esmolol was 162mm Hg vs 160.5mm Hg for clevidipine and SNP groups, respectively (p=0.99). Median time to reach SBPPT goal was similar between clevidipine and SNP (1.68 versus 1.03h [p=0.99]). Median AUCSBPe was similar for clevidipine and SNP (206.9 versus 538.9 mm Hg∗min∗hr−1 [p=0.11]). Cost was significantly reduced using clevidipine versus SNP ($1223.28/day versus $7674.24/day [p<0.001]). Conclusions Clevidipine administration during initial medical management of aortic dissection showed similar efficacy compared to SNP when used as adjunct therapy to esmolol. These data suggest clevidipine is a less costly, reasonable alternative to SNP in acute aortic dissection as adjunct therapy to esmolol. Further studies are needed to validate these results.

      PubDate: 2017-06-19T08:07:54Z
      DOI: 10.1016/j.ajem.2017.06.030
       
  • Multicenter prevalence of opioid medication use as abortive therapy in the
           emergency department treatment of migraine headaches
    • Authors: Neil Young; Daniel Silverman; Heather Bradford; Jeffrey Finkelstein
      Abstract: Publication date: Available online 16 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Neil Young, Daniel Silverman, Heather Bradford, Jeffrey Finkelstein
      Despite a range of therapeutic options for treating acute migraine headaches, the use of opioids is still reported to be common practice. This study describes treatment practices in regards to migraines in the ED. It characterizes the prevalence of opioid orders during visits in three different settings, an academic medical center, a non-academic urban ED, and a community ED. Fourteen months of consecutive migraine visits were identified. All medications ordered were separated into first-line and rescue medications. Number of visits, length of stay, door to provider time, and total provider time were compared. A total of 1222 visits were identified. Opioids were ordered in 35.8% of these visits. By facility, opioids were ordered in 12.3% of academic medical center visits, 40.9% of urban ED visits, and 68.6% of community ED visits. This ranged from 6.9% of first-line therapies in the academic center to 69.9% of rescue therapies in the community ED. Of those who received opioids, 36.0% versus 25.1% required rescue medications. Patients who received opioids had more repeat visits, 1.79 versus 1.30. The academic center and urban ED both found greater than 30% decrease in length of stay in visits where opioids were not given. In the face of evidence against opioids for migraines, over one third of patients received them. There was a higher prevalence in the community setting. There were no significant benefits in overall throughput time, however, opioid visits required more rescue medications, increased length of stay, and resulted in more repeat visits.

      PubDate: 2017-06-19T08:07:54Z
      DOI: 10.1016/j.ajem.2017.06.015
       
  • Bi-objective approach for placing ground and air ambulance base and
           helipad locations in order to optimize EMS response
    • Authors: Milad Shahriari; Ali Bozorgi-Amiri; Shayan Tavakoli; Abolghasem Yousefi-Babadi
      Abstract: Publication date: Available online 15 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Milad Shahriari, Ali Bozorgi-Amiri, Shayan Tavakoli, Abolghasem Yousefi-Babadi
      Shortening the travel time of patient transfer has clinical implications for many conditions such as cardiac arrest, trauma, stroke and STEMI. As resources are often limited precise calculations are needed. In this paper we consider the location problem for both ground and aerial emergency medical services. Given the uncertainty of when patients are in need of prompt medical attention we consider these demand points to be uncertain. We consider various ways in which ground and helicopter ambulances can work together to make the whole process go faster. We develop a mathematical model that minimizes travel time and maximizes service level. We use a compromising programming method to solve this bi-objective mathematical model. For numerical experiments we apply our model to a case study in Lorestan, Iran, using geographical and population data, and the location of the actual hospital based in the capital of the province. Results show that low-accessibility locations are the main focus of the proposed problem and with mathematical modeling access to a hospital is vastly improved. We also found out that once the budget reaches a certain point which suffices for building certain ambulance bases more investments does not necessarily result in less travel time.

      PubDate: 2017-06-19T08:07:54Z
      DOI: 10.1016/j.ajem.2017.06.026
       
  • How can lifeguards recover better' A cross-over study comparing
           resting, running, and foam rolling
    • Authors: Antón Kalén; Alexandra Pérez-Ferreirós; Roberto Barcala-Furelos; María Fernández-Méndez; Alexis Padrón-Cabo; Jose-Antonio Prieto; Andrés Ríos-Ave; Cristian Abelairas-Gómez
      Abstract: Publication date: Available online 15 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Antón Kalén, Alexandra Pérez-Ferreirós, Roberto Barcala-Furelos, María Fernández-Méndez, Alexis Padrón-Cabo, Jose-Antonio Prieto, Andrés Ríos-Ave, Cristian Abelairas-Gómez
      Purpose The aim of this study is to compare the effectiveness of active recovery in form of running or foam rolling on clearing blood lactate compared to remain sitting after a water rescue. Method A quasi experimental cross-over design was used to test the effectiveness of two active recovery methods: foam rolling (FR) and running (RR), compared with passive recovery (PR) on the blood lactate clearance after performing a water rescue. Twelve lifeguards from Marín (Pontevedra) completed the study. The participants performed a 100-meter water rescue and a 25-minute recovery protocol. Results The post recovery lactate levels were significantly lower for foam rolling (4.4±1.5mmol/l, P =0.005, d =0.94) and running (4.9±2.3mmol/l, P =0.027, d =1.21) compared with resting (7.2±2.5mmol/l); there was no significant difference between foam rolling and running (P =1.000). Conclusions We found that surf lifesavers clear out blood lactate more efficient when performing an active recovery protocol. Foam rolling is an effective method of increasing the rate of blood lactate clearance. These two recovery methods are also adequate for surf lifeguards as they do not interfere with the surveillance aspect of their job.

      PubDate: 2017-06-19T08:07:54Z
      DOI: 10.1016/j.ajem.2017.06.028
       
  • Apneic oxygenation reduces the incidence of hypoxemia during emergency
           intubation: A systematic review and meta-analysis
    • Authors: Ivan Pavlov; Sofia Medrano; Scott Weingart
      Abstract: Publication date: Available online 15 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Ivan Pavlov, Sofia Medrano, Scott Weingart
      Study objective Apneic oxygenation has been advocated for the prevention of hypoxemia during emergency endotracheal intubation. Because of conflicting results from recent trials, the efficacy of apneic oxygenation remains unclear. We performed a systematic review and metaanalysis to investigate the effect of apneic oxygenation on the incidence of clinically significant hypoxemia during emergency endotracheal intubation. Methods MEDLINE, EMBASE, and PubMed databases were searched without language and time restrictions for studies of apneic oxygenation performed in a critical care setting. Meta-analysis was conducted with a random-effect model, and according to intention-to-treat allocation wherever applicable. Subgroup analyses were performed to ensure the robustness of findings across various clinical outcomes. Results Eight studies (n =1953) were included in the meta-analysis. The pooled absolute risk of clinically significant hypoxemia was 27.6% in the usual care group and 19.1% in the apneic oxygenation group, without any heterogeneity across studies (I2 =0%; p =0.42). Apneic oxygenation reduced the relative risk of hypoxemia by 30% (95% confidence interval 0.59 to 0.82). There was a trend toward lower mortality in the apneic oxygenation group (relative risk of death 0.77; 95% confidence interval 0.59 to 1.02). Conclusion Apneic oxygenation significantly reduces the incidence of hypoxemia during emergency endotracheal intubation. These findings support the inclusion of apneic oxygenation in everyday clinical practice.

      PubDate: 2017-06-19T08:07:54Z
      DOI: 10.1016/j.ajem.2017.06.029
       
  • Variable methodological quality and use found in systematic reviews
           referenced in STEMI clinical practice guidelines
    • Authors: Jared Scott; Benjamin Howard; Philip Sinnett; Michael Schiesel; Jana Baker; Patrick Henderson; Matt Vassar
      Abstract: Publication date: Available online 6 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Jared Scott, Benjamin Howard, Philip Sinnett, Michael Schiesel, Jana Baker, Patrick Henderson, Matt Vassar
      Background The objective of this study was to assess the methodological quality and clarity of reporting of the systematic reviews (SRs) supporting clinical practice guideline (CPG) recommendations in the management of ST-elevation myocardial infarction (STEMI) across international CPGs. Methods We searched 13 guideline clearinghouses including the National Guideline Clearinghouse and Guidelines International Network (GIN). To meet inclusion criteria CPGs must be pertinent to the management of STEMI, endorsed by a governing body or national organization, and written in English. We retrieved SRs from the reference sections using a combination of keywords and hand searching. Two investigators scored eligible SRs using AMSTAR and PRISMA. Results We included four CPGs. We extracted 71 unique SRs. These SRs received AMSTAR scores ranging from 1 (low) to 9 (high) on an 11-point scale. All CPGs consistently underperformed in areas including disclosure of funding sources, risk of bias, and publication bias according to AMSTAR. PRISMA checklist completeness ranged from 44% to 96%. The PRISMA scores indicated that SRs did not provide a full search strategy, study protocol and registration, assessment of publication bias or report funding sources. Only one SR was referenced in all four CPGs. All CPGs omitted a large subset of available SRs cited by other guidelines. Conclusions Our study demonstrates the variable quality of SRs used to establish recommendations within guidelines included in our sample. Although guideline developers have acknowledged this variability, it remains a significant finding that needs to be addressed further. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

      PubDate: 2017-06-19T08:07:54Z
      DOI: 10.1016/j.ajem.2017.06.010
       
  • Internal validation of a scoring system to evaluate the probability of
           ureteral stones: The CHOKAI score
    • Authors: Hiroki Fukuhara; Osamu Ichiyanagi; Shinichi Midorikawa; Hiroshi Kakizaki; Hisashi Kaneko; Norihiko Tsuchiya
      Abstract: Publication date: Available online 13 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Hiroki Fukuhara, Osamu Ichiyanagi, Shinichi Midorikawa, Hiroshi Kakizaki, Hisashi Kaneko, Norihiko Tsuchiya
      Objective The CHOKAI and STONE scores are prediction models for ureteral stones. The aims of the present study were to evaluate the diagnostic performance, to examine the optimal cut-off value, and to compare the diagnostic performance of each model. Methods Patients who presented to our emergency department with renal colic were considered for this prospective study. We analyzed the predictive performance of both STONE and CHOKAI scores at their optimal cut-off values, using receiver operating characteristic (ROC) curve and area under the curve (AUC), as well as sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR−) at the optimal cut-off value. Results Of the 96 patients who met the inclusion criteria, 79 were definitively diagnosed with ureteral stones. All patients were of Japanese descent. The AUC of the CHOKAI score was 0.971 at an optimal cut-off value of 6, showing a sensitivity of 0.911, specificity of 0.941, LR+ of 15.49, and LR− of 0.094. The AUC of the STONE score was 0.873 at an optimal cut-off value of 8, showing a sensitivity of 0.823, specificity of 0.824, LR+ of 4.662, and LR− of 0.215. The AUC of the CHOKAI score was significantly higher than that of the STONE score (p =0.010). Of the 73 patients with a CHOKAI score of ≥6, 98.6% had ureteral stones, and of the 68 patients with a STONE score of ≥8, 95.6% had ureteral stones. Conclusions The simplified CHOKAI score is a useful tool to screen for ureteral stones in patients with renal colic.

      PubDate: 2017-06-14T08:02:10Z
      DOI: 10.1016/j.ajem.2017.06.023
       
  • Temporal artery and axillary thermometry comparison with rectal
           thermometry in children presenting to the emergency department
    • Authors: Adam J. Forrest; Michael L. Juliano; Sean P. Conley; Patrick D. Cronyn; Andrea McGlynn; Jonathan D. Auten
      Abstract: Publication date: Available online 11 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Adam J. Forrest, Michael L. Juliano, Sean P. Conley, Patrick D. Cronyn, Andrea McGlynn, Jonathan D. Auten
      Background Accurate temperature readings, often obtained rectally, are an important part of the initial evaluation of pediatric patients in the Emergency Department. Temporal artery thermometry (TAT) is one way to noninvasively measure temperature. We sought to compare the accuracy of axillary and temporal artery temperatures compared to rectal. Methods This prospective study included children age 0–36months presenting to the Emergency Department of a large military treatment facility. Rectal, axillary, and temporal artery temperatures were obtained. Test characteristics (sensitivity, specificity, NPV, PPV) were reported. The effect of cutoff values 99.9°F, 100.4°F, and 102.2°F on test characteristics were also evaluated. Results The sensitivities of axillary and temporal artery thermometry to detect rectal fever is 11.5% and 61.5% respectively. Cutoff values did not significantly alter test characteristics. In this study, temporal artery thermometry was 0.2°C lower than rectal temperature, axillary measurement was 0.9°C below the reference standard. Mean temperature difference in the febrile group between TAT and rectal thermometry was >0.5°C compared with a mean temperature difference 0.05°C in afebrile patients. Conclusion The findings of our study do not support using axillary thermometry to screen pediatric patients for fever in the emergency department. TAT cannot be recommended as a rectal thermometry replacement where height and duration of fever are used in pediatric disease prediction models. TAT may have a role in screening for fever in the appropriate pediatric patient population like primary orthopedic or trauma presentations where the balance between device precision, data capture and patient comfort may favor use of TAT.

      PubDate: 2017-06-14T08:02:10Z
      DOI: 10.1016/j.ajem.2017.06.017
       
  • US emergency department visits for adults with abdominal and pelvic pain
           (2007–13): Trends in demographics, resource utilization and medication
           usage
    • Authors: Andrew C. Meltzer; Jesse M. Pines; Lorna M. Richards; Peter Mullins; Maryann Mazer-Amirshahi
      Abstract: Publication date: Available online 9 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Andrew C. Meltzer, Jesse M. Pines, Lorna M. Richards, Peter Mullins, Maryann Mazer-Amirshahi


      PubDate: 2017-06-14T08:02:10Z
      DOI: 10.1016/j.ajem.2017.06.019
       
  • Patient preference to participate in shared decision making for performing
           a CT scan in the emergency department
    • Authors: Hamza Ijaz; Chloe Michel; Paige E. Kulie; Lorna M. Richards; Andrew C. Meltzer
      Abstract: Publication date: Available online 9 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Hamza Ijaz, Chloe Michel, Paige E. Kulie, Lorna M. Richards, Andrew C. Meltzer


      PubDate: 2017-06-14T08:02:10Z
      DOI: 10.1016/j.ajem.2017.06.020
       
  • Where do they need us' Determining the future of emergency medicine
    • Authors: Daniel B. Gingold; Robert M. Brown
      Abstract: Publication date: Available online 9 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Daniel B. Gingold, Robert M. Brown


      PubDate: 2017-06-14T08:02:10Z
      DOI: 10.1016/j.ajem.2017.06.018
       
  • Novel applications of agent-based modeling in emergency medicine research
           – A systematic literature review
    • Authors: Jason M. Adleberg; Christina L. Catlett; Richard E. Rothman; Katie Lobner; Yu-Hsiang Hsieh
      Abstract: Publication date: Available online 9 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Jason M. Adleberg, Christina L. Catlett, Richard E. Rothman, Katie Lobner, Yu-Hsiang Hsieh


      PubDate: 2017-06-14T08:02:10Z
      DOI: 10.1016/j.ajem.2017.06.021
       
  • Usefulness of serial measurement of the red blood cell distribution width
           to predict 28-day mortality in patients with trauma
    • Authors: Taeyoung Kong; Jong Eun Park; Yoo Seok Park; Hye Sun Lee; Je Sung You; Hyun Soo Chung; Incheol Park; Sung Phil Chung
      Abstract: Publication date: Available online 8 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Taeyoung Kong, Jong Eun Park, Yoo Seok Park, Hye Sun Lee, Je Sung You, Hyun Soo Chung, Incheol Park, Sung Phil Chung
      Background This is the first study to evaluate the association between the serially measured RDW values and clinical severity in patients surviving >24 h after sustaining trauma. We evaluated the serial measurement and cut-off values of RDW to determine its significance as a prognostic marker of early mortality in patients with suspected severe trauma. Methods This study retrospectively analyzed prospective data of eligible adult patients who were admitted to the ED with suspected severe trauma. The RDW was determined on each day of hospitalization. The primary outcome was all-cause mortality within 28-days of ED admission. Results We included 305 patients who met our inclusion criteria. The multivariate Cox regression model demonstrated that higher RDW values on day 1 (hazard ratio [HR], 1.558; 95% confidence interval [CI], 1.09–2.227; p =0.015) and day 2 (HR, 1.549; 95% CI, 1.046–2.294; p =0.029) were strong independent predictors of short-term mortality among patients with suspected severe trauma. Considering the clinical course of severe trauma patients, the RDW is an important ancillary test for determining severity. Specifically, we found that RDW values >14.4% on day 1 (HR, 4.227; 95% CI: 1.672–10.942; p <0.001) and >14.7% on day 2 (HR, 6.041; 95% CI: 2.361–15.458; p <0.001) increased the hazard 28-day all-cause mortality. Conclusion An increased RDW value is an independent predictor of 28-day mortality in patients with suspected severe trauma. The RDW, routinely obtained as part of the complete blood count without added cost or time, can be serially measured as indicator of severity after trauma.

      PubDate: 2017-06-09T07:29:33Z
      DOI: 10.1016/j.ajem.2017.06.008
       
  • Pre-oxygenation: Implications in emergency airway management
    • Authors: Ali Pourmand; Chelsea Robinson; Kelsey Dorwart; Francis O'Connell
      Abstract: Publication date: Available online 8 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Ali Pourmand, Chelsea Robinson, Kelsey Dorwart, Francis O'Connell
      Transient oxygen desaturation during emergency department intubation is an event with potentially devastating consequences. Pre-oxygenation is an important means of increasing a patient's oxygen reserve and duration of safe apnea prior to intubation. In the emergent setting, important modifications to pre-oxygenation techniques need to be considered to best manage critically ill patients. In this review, we discuss recent updates in pre-oxygenation techniques and evaluate the evidence supporting both commonly used and newly emerging techniques for pre-oxygenation, assessing nature and level of illness, the best delivery method of oxygen, using delayed sequence intubation in patients who cannot tolerate non-invasive pre-oxygenation and using apneic oxygenation via nasal cannula and non-rebreather mask during intubation.

      PubDate: 2017-06-09T07:29:33Z
      DOI: 10.1016/j.ajem.2017.06.006
       
  • Characteristics and outcome among 14,933 adult cases of in-hospital
           cardiac arrest: A nationwide study with the emphasis on gender and age
    • Authors: Nooraldeen Al-Dury; Araz Rawshani; Johan Israelsson; Anneli Strömsöe; Solveig Aune; Jens Agerström; Thomas Karlsson; Annica Ravn-Fischer; Johan Herlitz
      Abstract: Publication date: Available online 7 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Nooraldeen Al-Dury, Araz Rawshani, Johan Israelsson, Anneli Strömsöe, Solveig Aune, Jens Agerström, Thomas Karlsson, Annica Ravn-Fischer, Johan Herlitz
      Aim To investigate characteristics and outcome among patients suffering in-hospital cardiac arrest (IHCA) with the emphasis on gender and age. Methods Using the Swedish Register of Cardiopulmonary Resuscitation, we analyzed associations between gender, age and co-morbidities, etiology, management, 30-day survival and cerebral function among survivors in 14,933 cases of IHCA. Age was divided into three ordered categories: young (18–49years), middle-aged (50–64years) and older (65years and above). Comparisons between men and women were age adjusted. Results The mean age was 72.7years and women were significantly older than men. Renal dysfunction was the most prevalent co-morbidity. Myocardial infarction/ischemia was the most common condition preceding IHCA, with men having 27% higher odds of having MI as the underlying etiology. A shockable rhythm was found in 31.8% of patients, with men having 52% higher odds of being found in VT/VF. After adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days. Older individuals were managed less aggressively than younger patients. Increasing age was associated with lower 30-day survival but not with poorer cerebral function among survivors. Conclusion When adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days after in-hospital cardiac arrest. Older individuals were managed less aggressively than younger patients, despite a lower chance of survival. Higher age was, however, not associated with poorer cerebral function among survivors.

      PubDate: 2017-06-09T07:29:33Z
      DOI: 10.1016/j.ajem.2017.06.012
       
  • Medication errors with push dose pressors in the emergency department and
           intensive care units
    • Authors: Nicole M. Acquisto; Ryan P. Bodkin; Christine Johnstone
      Abstract: Publication date: Available online 7 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Nicole M. Acquisto, Ryan P. Bodkin, Christine Johnstone


      PubDate: 2017-06-09T07:29:33Z
      DOI: 10.1016/j.ajem.2017.06.013
       
  • Case of multiple myeloma presenting as acute pancreatitis
    • Authors: Shakti Bedanta Mishra; Afzal Azim; Arindam Mukherjee
      Abstract: Publication date: Available online 6 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Shakti Bedanta Mishra, Afzal Azim, Arindam Mukherjee


      PubDate: 2017-06-09T07:29:33Z
      DOI: 10.1016/j.ajem.2017.06.009
       
  • The impact of the BLUE protocol ultrasonography on the time taken to treat
           acute respiratory distress in the emergency department
    • Authors: Javad Seyedhosseini; Golnaz Bashizadeh-fakhar; Shirani Farzaneh; Mehdi Momeni; Ehsan Karimialavijeh
      Abstract: Publication date: Available online 6 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Javad Seyedhosseini, Golnaz Bashizadeh-fakhar, Shirani Farzaneh, Mehdi Momeni, Ehsan Karimialavijeh


      PubDate: 2017-06-09T07:29:33Z
      DOI: 10.1016/j.ajem.2017.06.007
       
  • Early initiation of low-dose hydrocortisone treatment for septic shock in
           adults: A randomized clinical trial
    • Authors: Qing-quan Lv; Xiao-hua Gu; Qi-hong Chen; Jiang-quan Yu; Rui-qiang Zheng
      Abstract: Publication date: Available online 5 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Qing-quan Lv, Xiao-hua Gu, Qi-hong Chen, Jiang-quan Yu, Rui-qiang Zheng
      Background Physiologic dose hydrocortisone is part of the suggested adjuvant therapies for patients with septic shock. However, the association between the corticosteroid therapy and mortality in patients with septic shock is still not clear. Some authors considered that the mortality is related to the time frame between development of septic shock and start of low dose hydrocortisone. Thus we designed a placebo-controlled, randomized clinical trial to assess the importance of early initiation of low dose hydrocortisone for the final outcome. Methods A total of 118 patients with septic shock were recruited in the study. All eligible patients were randomized to receive hydrocortisone (n=58) or normal saline (n=60). The study medication (hydrocortisone and normal saline) was initiated simultaneously with vasopressors. The primary end-point was 28-day mortality. The secondary end-points were the reversal of shock, in-hospital mortality and the duration of ICU and hospital stay. Results The proportion of patients with reversal of shock was similar in the two groups (P=0.602); There were no significant differences in 28-day or hospital all-cause mortality; length of stay in the ICU or hospital between patients treated with hydrocortisone or normal saline. Conclusion The early initiation of low-dose of hydrocortisone did not decrease the risk of mortality, and the length of stay in the ICU or hospital in adults with septic shock. Trial registration: www.clinicaltrials.gov NCT02580240.

      PubDate: 2017-06-09T07:29:33Z
      DOI: 10.1016/j.ajem.2017.06.004
       
  • The need for hands-on defibrillation during the late downstroke phase of
           ongoing abdominal compressions only CPR
    • Authors: Eric M. Rottenberg
      Abstract: Publication date: Available online 5 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Eric M. Rottenberg


      PubDate: 2017-06-09T07:29:33Z
      DOI: 10.1016/j.ajem.2017.05.019
       
  • Are height and weight estimates in ED patients reliable for setting the
           ventilator?
    • Authors: Sabrine N.T. Hemmes; Lorenzo Ball; Ary Serpa Neto; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J. Schultz
      Abstract: Publication date: Available online 5 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Sabrine N.T. Hemmes, Lorenzo Ball, Ary Serpa Neto, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J. Schultz


      PubDate: 2017-06-09T07:29:33Z
      DOI: 10.1016/j.ajem.2017.06.003
       
  • Non-compliance in the Emergency Department: Is there a difference between
           medical and psychiatric patient's reasons and use of the Emergency
           Department
    • Authors: La Vonne A. Downey; Leslie S. Zun
      Abstract: Publication date: Available online 5 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): La Vonne A. Downey, Leslie S. Zun


      PubDate: 2017-06-09T07:29:33Z
      DOI: 10.1016/j.ajem.2017.06.001
       
  • Body mass index is associated with inappropriate tidal volumes in adults
           intubated in the emergency department
    • Authors: Munish Goyal; Rahul Bhat; Shannon K. Graf; Jeffrey S. Dubin; Anu Bhooshan; Eshetu Tefera; William J. Frohna
      Abstract: Publication date: Available online 5 June 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Munish Goyal, Rahul Bhat, Shannon K. Graf, Jeffrey S. Dubin, Anu Bhooshan, Eshetu Tefera, William J. Frohna


      PubDate: 2017-06-09T07:29:33Z
      DOI: 10.1016/j.ajem.2017.06.005
       
  • Serum sodium correction rate and the outcome in severe hyponatremia
    • Authors: Mauro Giordano; Tiziana Ciarambino; Emanuela Lo Priore; Pietro Castellino; Lorenzo Malatino; Alessandro Cataliotti; Giuseppe Paolisso; Luigi Elio Adinolfi
      Abstract: Publication date: Available online 31 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Mauro Giordano, Tiziana Ciarambino, Emanuela Lo Priore, Pietro Castellino, Lorenzo Malatino, Alessandro Cataliotti, Giuseppe Paolisso, Luigi Elio Adinolfi
      Study objective We investigated the serum sodium correction rate on length of hospitalization and survival rate, in severe chronic hyponatremic patients at the Emergency Department (ED). Design An observational study using clinical chart review. Setting The ED of the University Hospital of Marcianise, Caserta, Italy with approximately 30,000 patients visits a year. Type of participants We reviewed sixty-seven patients with severe hyponatremia subdivided in 2 subgroups: group A consisting of 35 patients with serum sodium correction rate<0.3mmol/h and group B consisting of 32 patients with serum sodium correction rate between <0.5 and ≥0.3mmol/h. Intervention Emergency patients were evaluated for serum sodium correction rate for hyponatremia by clinical chart review. Measurements and main results Severe hyponatremia was defined as a serum sodium level<120mmol/l. Mean serum sodium correction rate of hyponatremia was of 0.17±0.09% in group A and 0.41±0.05% in group B (p <0.001 vs group A). The length of hospital stay was 10.7±3.7days for group A, and it was significantly decreased to 3.8±0.4days for group B (p <0.005 vs group A). In addition we observed that correction rate of hyponatremia in group A was associated with a significantly lower survival rate (25%) in comparison to group B (60%) (p <0.001 vs group A). Conclusion: We observed that serum sodium correction rate ≥0.3 and <0.5mmol/h was associated with a shorter length of hospital stay and a major survival rate.

      PubDate: 2017-06-04T07:26:04Z
      DOI: 10.1016/j.ajem.2017.05.050
       
  • Could B-type natriuretic peptides be a biomarker for trauma brain injury?
           A systematic review and meta-analysis
    • Authors: Yuan Zhang; Zhanpeng Feng; Yun Bao; Lizhi Zhou; Binghui Qiu
      Abstract: Publication date: Available online 31 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Yuan Zhang, Zhanpeng Feng, Yun Bao, Lizhi Zhou, Binghui Qiu


      PubDate: 2017-06-04T07:26:04Z
      DOI: 10.1016/j.ajem.2017.05.051
       
  • Two, three, and four-drug regimens for HIV post-exposure prophylaxis in a
           North American sexual assault victim population
    • Authors: Thara Kumar; Kari Sampsel; Ian G. Stiell
      Abstract: Publication date: Available online 31 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Thara Kumar, Kari Sampsel, Ian G. Stiell
      Background/objectives Due to perceived increased tolerability and compliance, and decreased cost, recent trends in practice are moving towards using fewer drugs for HIV post-exposure prophylaxis. However, there is limited literature to assess this is in the North American sexual assault victim population. Methods This retrospective before-and-after cohort study compared patients seen at a sexual assault care facility before and after the introduction of two and three-drug post-exposure prophylaxis regimens. Our primary outcome was completion of the 28-day regimen. Secondary objectives included HIV seroconversion rates and patient reported side effects. Results Six-hundred-thirty charts from a 2-year period were reviewed, and 429 met inclusion criteria. There was no difference in completion rates of post-exposure prophylaxis between the two cohorts (50.5% vs. 51.6%). However, there were fewer reported side effects (72.2% vs. 17.6%) in the later cohort. We subsequently compared all patients in either cohort who received four-drug therapy (N =128) versus those who received two or three-drug regimens (N =47). The two or three-drug regimen group had a higher completion rate (66.0% vs. 42.2%; p =0.03), and a lower rate of reported side effects (19.1% vs. 53.9%), specifically for nausea (12.8% vs. 36.7%), constipation (0% vs. 7.9%), diarrhea (2.1% vs. 21.1%), mood changes (0% vs. 10.9%), headache (2.1% vs. 16.4%), and fatigue (6.4% vs. 26.6%). There were no HIV seroconversions in either group. Conclusion Two and three-drug HIV post-exposure prophylaxis regimens are better tolerated by patients and associated with greater compliance than four-drug therapy, and could be considered in the sexual assault victim population.

      PubDate: 2017-06-04T07:26:04Z
      DOI: 10.1016/j.ajem.2017.05.054
       
  • Anemia considerations when assessing natriuretic peptide levels in ED
           patients
    • Authors: Inanc Karakoyun; Ayfer Colak; Fatma Demet Arslan; Aybike Gunaslan Hasturk; Can Duman
      Abstract: Publication date: Available online 31 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Inanc Karakoyun, Ayfer Colak, Fatma Demet Arslan, Aybike Gunaslan Hasturk, Can Duman
      Introduction The incidence of heart failure (HF) has reached epidemic levels in western populations, and the majority of these patients are admitted to hospitals through the emergency department (ED). We aimed to aid clinicians assessing natriuretic peptide (NP) levels in cases with suspected HF. In this study, we investigated the effect of anemia on amino-terminal pro-BNP (NT-proBNP) and on B-type natriuretic peptide (BNP) levels. Methods This retrospective study examined patients who were admitted to the ED with suspected HF. After admission, the treating physician requested complete blood count and creatinine tests with NT-proBNP (n=2.637) or BNP (n=11.159). The exclusion criteria were used to minimize the factors that could affect the NT-proBNP and BNP results. We examined the data using the Mann-Whitney U test, Chi-square test, Spearman correlation test, and multivariate linear regression analyses. Results The NT-proBNP and BNP levels were statistically higher in the groups with anemia (p=0.016 and p=0.009, respectively). There was a statistically significant negative correlation between hemoglobin and NP levels (r=−0.272, p<0.001 for NT-proBNP and r=−0.179, p<0.001 for BNP). The results indicated that advanced age and low hemoglobin levels were significantly associated with the increase in NT-proBNP (p=0.024 and p=0.004, respectively). Advanced age, low hemoglobin and low GFR-MDRD levels were significantly associated with the increase in BNP (p<0.001, p=0.002 and p=0.013, respectively). Discussion The data suggest that clinicians examining patients admitted to the ED with suspected HF should consider that anemia could lead to increases in NT-proBNP and BNP levels.

      PubDate: 2017-06-04T07:26:04Z
      DOI: 10.1016/j.ajem.2017.05.048
       
  • Diagnosing acute aortic dissection with aneurysmal degeneration with point
           of care ultrasound
    • Authors: John Bernett; Robert Strony
      Abstract: Publication date: Available online 30 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): John Bernett, Robert Strony


      PubDate: 2017-06-04T07:26:04Z
      DOI: 10.1016/j.ajem.2017.05.052
       
  • Characteristics and outcomes of acute pediatric blunt torso trauma based
           on injury intent
    • Authors: Rohit P. Shenoi; Elizabeth A. Camp; Daniel M. Rubalcava; Andrea T. Cruz
      Abstract: Publication date: Available online 29 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Rohit P. Shenoi, Elizabeth A. Camp, Daniel M. Rubalcava, Andrea T. Cruz
      Introduction Blunt trauma is a leading cause of pediatric morbidity. We compared injuries, interventions and outcomes of acute pediatric blunt torso trauma based on intent. Methods We analyzed de-identified data from a prospective, multi-center emergency department (ED)-based observational cohort of children under age eighteen. Injuries were classified based on intent (unintentional/inflicted). We compared demographic, physical and laboratory findings, ED disposition, hospitalization, need for surgery, 30-day mortality, and cause of death between groups using Chi-squared or Fisher's test for categorical variables, and Mann-Whitney test for non-normal continuous factors comparing median values and interquartile ranges (IQR). Results There were 12,044 children who sustained blunt torso trauma: Inflicted=720 (6%); Unintentional=9563 (79.4%); Indeterminate=148 (1.2%); Missing=1613 (13.4%). Patients with unintentional torso injuries significantly differed from those with inflicted injuries in median age in years (IQR) [10 (5, 15) vs. 14 (8, 16); p-value<0.001], race, presence of pelvic fractures, hospitalization and need for non-abdominal surgery. Mortality rates did not differ based on intent. Further adjustment using binary, logistic regression revealed that the risk of pelvic fractures in the inflicted group was 96% less than the unintentional group (OR: 0.04; 95%CI: 0.01–0.26; p-value=0.001). Conclusions Children who sustain acute blunt torso trauma due to unintentional causes have a significantly higher risk of pelvic fractures and are more likely to be hospitalized compared to those with inflicted injuries.

      PubDate: 2017-06-04T07:26:04Z
      DOI: 10.1016/j.ajem.2017.05.053
       
  • Can we imagine a survival chain also for ischemic stroke?
    • Authors: Aurora Vecchiato
      Abstract: Publication date: Available online 29 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Aurora Vecchiato


      PubDate: 2017-06-04T07:26:04Z
      DOI: 10.1016/j.ajem.2017.05.056
       
  • Digoxin use in atrial fibrillation
    • Authors: Murat Biteker; Bülent Özlek; Eda Özlek; Funda Sungur Biteker; Nesrin Başaran; Edip Guvenç Çekiç
      Abstract: Publication date: Available online 27 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Murat Biteker, Bülent Özlek, Eda Özlek, Funda Sungur Biteker, Nesrin Başaran, Edip Guvenç Çekiç


      PubDate: 2017-05-29T15:52:50Z
      DOI: 10.1016/j.ajem.2017.05.040
       
  • Spontaneous rupture of inferior vena cava
    • Authors: Hyoung In Choi; Yeo Koon Kim; Sang Il Choi; Kyuseok Kim
      Abstract: Publication date: Available online 26 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Hyoung In Choi, Yeo Koon Kim, Sang Il Choi, Kyuseok Kim
      Spontaneous ruptures of the inferior vena cava (IVC) are rare. The mortality rate is high associated with all IVC injuries despite prompt resuscitation or operation. We present a case of 68-year-old women with spontaneous IVC dissection, presented as acute chest pain. Chest CT demonstrated a large amount of hemopericardium, and dilated inferior vena cava (IVC), suggesting cardiac tampon. Subsequently, hypovolemic shock and cardiac arrest occurred. After resuscitation, abdomen CT angiography was taken to find bleeding focus. Second CT demonstrated massive contrast extravasation to pericardial space due to rupture of IVC. Patient expired due to multi-organ failure.

      PubDate: 2017-05-29T15:52:50Z
      DOI: 10.1016/j.ajem.2017.05.042
       
  • Need for in-hospital simulation-based educational facilitation for
           practical patient safety improvement
    • Authors: Nobuyasu Komasawa; Benjamin W. Berg; Toshiaki Minami
      Abstract: Publication date: Available online 26 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Nobuyasu Komasawa, Benjamin W. Berg, Toshiaki Minami


      PubDate: 2017-05-29T15:52:50Z
      DOI: 10.1016/j.ajem.2017.05.045
       
  • Prognosis of septic shock
    • Authors: Michael D. April; Chase Donaldson; James H. Lantry
      Abstract: Publication date: Available online 26 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Michael D. April, Chase Donaldson, James H. Lantry


      PubDate: 2017-05-29T15:52:50Z
      DOI: 10.1016/j.ajem.2017.05.047
       
  • Linezolid versus vancomycin in Methicillin Resistant Staphylococcus aureus
           nosocomial pneumonia in the elderly
    • Authors: Julie Dupont; Dominique Prat; Benjamin Sztrymf
      Abstract: Publication date: Available online 26 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Julie Dupont, Dominique Prat, Benjamin Sztrymf


      PubDate: 2017-05-29T15:52:50Z
      DOI: 10.1016/j.ajem.2017.05.043
       
  • The authors respond
    • Authors: Hiroaki Takada; Toru Hifumi; Naoki Nishimoto
      Abstract: Publication date: Available online 26 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Hiroaki Takada, Toru Hifumi, Naoki Nishimoto


      PubDate: 2017-05-29T15:52:50Z
      DOI: 10.1016/j.ajem.2017.05.041
       
  • Prognosis of septic shock
    • Authors: Funda Sungur Biteker; Oğuzhan Çelik; Bülent Özlek; Eda Özlek; Murat Biteker
      Abstract: Publication date: Available online 26 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Funda Sungur Biteker, Oğuzhan Çelik, Bülent Özlek, Eda Özlek, Murat Biteker


      PubDate: 2017-05-29T15:52:50Z
      DOI: 10.1016/j.ajem.2017.05.046
       
  • Low yield of blood and wound cultures in patients with skin and
           soft-tissue infections
    • Authors: Jesus Torres; Lauro Avalos; Lamarr Echols; Jillian Mongelluzzo; Robert M. Rodriguez
      Abstract: Publication date: Available online 26 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Jesus Torres, Lauro Avalos, Lamarr Echols, Jillian Mongelluzzo, Robert M. Rodriguez
      Background Current guidelines recommend blood cultures in skin and soft-tissue infection (SSTI) patients only with signs of systemic toxicity and wound cultures for severe purulent infections. Our objectives were to determine: 1) blood and wound culture yields in patients admitted with SSTIs; 2) whether injection drug users (IDUs) and febrile patients had higher blood culture yields; and 3) whether blood and wound cultures grew organisms sensitive to typical SSTI empiric antibiotics. Methods We prospectively enrolled adult patients admitted from the ED with SSTIs at an urban hospital. We recorded patient characteristics, including IDU, comorbidities and temperatures, and followed admitted patients throughout their hospital course. Results Of 734 SSTI patients enrolled, 246 (33.5%) were admitted. Of 86 (35.0%) patients who had blood cultures, six had positive cultures (yield=7.0%; 95% confidence intervals [CIs] 3.2–14.4); 4 were methicillin sensitive Staphylococcus aureus (MSSA) and 2 were methicillin resistant (MRSA). Of 29 febrile patients, 1 had a positive culture (yield=3.5%; 95% CI 0.6–17.2). Of 101 admitted IDU patients, 46 (46%) received blood cultures, and 4 had positive cultures (yield=8.7%; 95% CI 3.4–20.3). Of 89 patients with purulent wounds, 44 (49.4%) patients had ED wound cultures. Thirteen had positive cultures (yield=29.6%; 95% CI 18.2–44.2%). Most were MRSA, MSSA, and group A Streptococcus species — all sensitive to Vancomycin. Conclusions Febrile and IDU patients had low yields of blood cultures similar to yields in non-IDU and afebrile patients. All blood and wound culture species were adequately covered by currently recommended empiric antibiotic regimens.

      PubDate: 2017-05-29T15:52:50Z
      DOI: 10.1016/j.ajem.2017.05.039
       
  • Treatment-naïve spontaneous tumor lysis syndrome in metastatic prostate
           adenocarcinoma: An unusual suspect
    • Authors: Maya Ignaszewski; Patrick Kohlitz
      Abstract: Publication date: Available online 26 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Maya Ignaszewski, Patrick Kohlitz
      Tumor lysis syndrome (TLS) is a potentially fatal condition defined both by laboratory and clinical criteria. It is caused by the catabolism of tumor cells which leads to considerable release and elevated levels of phosphate, potassium and uric acid in the bloodstream. These electrolyte derangements predispose patients to renal tubule uric acid precipitation, acute kidney injury, arrhythmias, neuromuscular irritability and even seizures. Although this phenomenon is well described with hematological malignancies, it is also known to occur among solid tumors. We present a rare case of treatment-naïve spontaneous TLS that occurred in a 69-year-old male with metastatic prostate adenocarcinoma with hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia, elevated liver enzymes, AKI and hemodynamic instability. Despite our best resuscitative efforts with intravenous hydration, electrolyte monitoring, Rasburicase and renal replacement therapy, the patient continued to decline, was made comfort care and expired shortly thereafter. Physicians encountering patients with the above presentation must entertain a diagnosis of TLS despite its rarity in solid tumors, as early diagnosis leads to timely treatment, thereby maximizing patients' chances at survival.

      PubDate: 2017-05-29T15:52:50Z
      DOI: 10.1016/j.ajem.2017.05.044
       
  • An educational intervention allows for greater prehospital recognition of
           acute stroke
    • Authors: Tara Henry-Morrow; Bryan Nelson Erin Conahan Claranne Mathiesen Bernadette Glenn-Porter
      Abstract: Publication date: Available online 24 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Tara K. Henry-Morrow, Bryan D. Nelson, Erin Conahan, Claranne Mathiesen, Bernadette Glenn-Porter, Matthew T. Niehaus, Lauren M. Porter, Mitchell R. Gesell, Gregory T. Monaghan, Jeanne L. Jacoby


      PubDate: 2017-05-24T15:49:41Z
       
  • Prognosis at 6 and 12months after self-attempted hanging
    • Authors: Guillaume Gantois; Erika Parmentier-Decrucq; Thibault Duburcq; Raphaël Favory; Daniel Mathieu; Julien Poissy
      Abstract: Publication date: Available online 23 May 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Guillaume Gantois, Erika Parmentier-Decrucq, Thibault Duburcq, Raphaël Favory, Daniel Mathieu, Julien Poissy
      Introduction Patients surviving a self-attempted hanging have a total neurological recovery in 57–77% of cases at hospital discharge, but no long-term data are available. Methods In this observational study, all patients hospitalized post-self-attempted hanging in the intensive care unit (ICU) in a 5-year period were included. Neurological evaluations at 6 and 12months were performed according to Cerebral Performance Category (CPC) scores. Factors associated with neurological recovery were determined by comparing CPC2+3+4 (bad recovery) vs. CPC1 (good recovery). Results Of 231 patients included, 104 (47%) were found to have cardiac arrest (CA). Ninety-five (41%) patients died in the ICU: 93 (89%) in the CA group and 2 (1.6%) in the group without CA. Neurological evaluations at 6 and 12months were obtained in 97 of the 136 surviving patients. At 6months, in the CA group (n=9), the CPC score was 1 for 6 patients, 2 for 2, and 4 for 1 patient. In the group without CA (n=88), 79 patients had normal neurological status at 6months and 78 at 12months. Among these patients, 96% returned home, 77% returned to work, 16 (18%) patients re-attempted suicide within the year. Risk factors of neurological sequelae at 6months were a CA at the hanging site (P=0.045), an elevated diastolic blood pressure (87 vs. 70 mm Hg; P=0.04), a lower initial Glasgow score (4 vs. 5; P=0.04), and an elevated blood glucose level (139 vs. 113 mg/dL; P<0.001). Conclusion Patients surviving a self-attempted hanging who did not have a CA had a good neurological outcome. The rate of suicidal recidivism is particularly important, which justifies joint work with psychiatrists.

      PubDate: 2017-05-24T15:49:41Z
      DOI: 10.1016/j.ajem.2017.05.037
       
 
 
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