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Publisher: Elsevier   (Total: 3043 journals)

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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 18, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 83, 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: 332, 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   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 211, 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: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
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: 8, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 129, 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: 25, 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: 22, 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: 10, 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: 41, 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: 47, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
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: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, 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: 25)
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: 35, 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: 5)
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: 6, 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: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 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: 60)
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: 345, 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: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, 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: 309, 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: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 405, 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: 53, 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: 6)
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: 4, 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: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, 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: 48, 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: 38, 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: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, 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: 33, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, 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: 191, 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: 3)
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: 26, 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: 34, 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: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 10)
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: 162, 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: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 158, 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   (Followers: 1, 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]   [38 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0735-6757
   Published by Elsevier Homepage  [3043 journals]
  • Defibrillation before EMS arrival in western Sweden
    • Authors: A. Claesson; J. Herlitz; L. Svensson; L. Ottosson; L. Bergfeldt; J. Engdahl; C. Ericson; P. Sandén; C. Axelsson; A. Bremer
      Pages: 1043 - 1048
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): A. Claesson, J. Herlitz, L. Svensson, L. Ottosson, L. Bergfeldt, J. Engdahl, C. Ericson, P. Sandén, C. Axelsson, A. Bremer
      Background Bystanders play a vital role in public access defibrillation (PAD) in out-of-hospital cardiac arrest (OHCA). Dual dispatch of first responders (FR) alongside emergency medical services (EMS) can reduce time to first defibrillation. The aim of this study was to describe the use of automated external defibrillators (AEDs) in OHCAs before EMS arrival. Methods All OHCA cases with a shockable rhythm in which an AED was used prior to the arrival of EMS between 2008 and 2015 in western Sweden were eligible for inclusion. Data from the Swedish Register for Cardiopulmonary Resuscitation (SRCR) were used for analysis, on-site bystander and FR defibrillation were compared with EMS defibrillation in the final analysis. Results Of the reported 6675 cases, 24% suffered ventricular fibrillation (VF), 162 patients (15%) of all VF cases were defibrillated before EMS arrival, 46% with a public AED on site. The proportion of cases defibrillated before EMS arrival increased from 5% in 2008 to 20% in 2015 (p<0.001). During this period, 30-day survival increased in patients with VF from 22% to 28% (p=0.04) and was highest when an AED was used on site (68%), with a median delay of 6.5min from collapse to defibrillation. Adjusted odds ratio for on-site defibrillation versus dispatched defibrillation for 30-day survival was 2.45 (95% CI: 1.02–5.95). Conclusions The use of AEDs before the arrival of EMS increased over time. This was associated with an increased 30-day survival among patients with VF. Thirty-day survival was highest when an AED was used on site before EMS arrival.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.02.030
       
  • Timely bystander CPR improves outcomes despite longer EMS times
    • Authors: Gwan Jin Park; Kyoung Jun Song; Sang Do Shin; Kyung Won Lee; Ki Ok Ahn; Eui Jung Lee; Ki Jeong Hong; Young Sun Ro
      Pages: 1049 - 1055
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Gwan Jin Park, Kyoung Jun Song, Sang Do Shin, Kyung Won Lee, Ki Ok Ahn, Eui Jung Lee, Ki Jeong Hong, Young Sun Ro
      Objectives This study aimed to determine the impact of bystander CPR on clinical outcomes in patients with increasing response time from collapse to EMS response. Methods A population-based observational study was conducted in patients with witnessed out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology from 2012 to 2014. The time interval from collapse to CPR by EMS providers was categorized into quartile groups: fastest group (<4min), fast group (4 to <8min), late group (8 to <15min), and latest group (15 to <30min). The primary outcome was hospital discharge and the secondary outcome was survival with good neurological outcome. Multivariable logistic regression analysis was performed to evaluate the interaction between bystander CPR and the time interval from collapse to CPR by EMS providers. Results A total of 15,354 OHCAs were analyzed. Bystander CPR was performed in 8591 (56.0%). Survival to hospital discharge occurred in 1632 (10.6%) and favorable neurological outcome in 996 (6.5%). In an interaction model of bystander CPR, compared to the fastest group, adjusted odds ratios (AORs) (95% CIs) for survival to discharge were 0.89 (0.66–1.20) in the fast group, 0.76 (0.57–1.02) in the late group, and 0.52 (0.37–0.73) in the latest group. For favorable neurological outcome, AORs were 1.12 (0.77–1.62) in the fast group, 0.90 (0.62–1.30) in the late group, 0.59 (0.38–0.91) in the latest group. Conclusion The survival from OHCA decreases as the ambulance response time increases. The increase in mortality and worsening neurologic outcomes appear to be mitigated in those patients who receive bystander CPR.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.02.033
       
  • Comparison of modified Kampala trauma score with trauma mortality
           prediction model and trauma-injury severity score: A National Trauma Data
           Bank Study
    • Authors: Serhat Akay; Ahmet Mucteba Ozturk; Huriye Akay
      Pages: 1056 - 1059
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Serhat Akay, Ahmet Mucteba Ozturk, Huriye Akay
      Background Mortality prediction of trauma patients relies on anatomical, physiological or combined scores. The purpose of this study is to compare the diagnostic accuracy of the modified Kampala Trauma Score (M-KTS) with the Trauma Mortality Prediction Model (TMPM), and Trauma-Injury Severity Score (TRISS) using data from a large dataset from a developed registry, the National Trauma Data Bank (NTDB). Methods Using 2011 and 2012 data from NTDB, patient based trauma scores (M-KTS, TMPM, and TRISS) were calculated and predictive ability of M-KTS for mortality was compared with other trauma scores using receiver operating characteristics (ROC) curves. Results A total of 841089 patients were included in the study. TRISS outperformed other scores (AUC=0.922, %95 CI 0.920–0.924) with M-KTS as the second best score (AUC=0.901, %95 CI 0.899–0.903) followed by TMPM (AUC=0.887, 95% CI 0.844–0.889). For blunt trauma, TRISS (AUC=0.917, 95% CI 0.915–0.919) performed better than M-KTS (AUC=0.891, %95 CI 0.889–0.893) and TMPM (AUC=0.874, 95% CI 0.871–0.877). For penetrating trauma, M-KTS (AUC=0.956, 95% CI 0.954–0.959) and TMPM (AUC=0.955, 95% CI 0.951–0.958) had similar performance after TRISS (AUC=0.969, 95% CI 0.967–0.971). Conclusion M-KTS performed worse than TRISS although its' main advantage is simple use in resource-limited settings.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.02.035
       
  • Desaturation in procedural sedation for children with long bone fractures:
           Does weight status matter'
    • Authors: Danielle G. Hirsch; John Tyo; Brian H. Wrotniak
      Pages: 1060 - 1063
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Danielle G. Hirsch, John Tyo, Brian H. Wrotniak
      Introduction Childhood obesity remains a serious problem in the United States. Significant associated adverse incidents have been reported with sedation of children with obesity, namely hypoxemia. The objective of our study was to determine if overweight and obesity were associated with increased desaturations during procedural sedation compared with patients of healthy weight. Methods This was a single-center retrospective chart review of data from a three-year period of patient's age 2–17years. Of the 1700 charts reviewed 823 of these patients received procedural sedation and met the study inclusion criteria. Weight status was classified based on age and gender specific body mass index (BMI) percentiles: underweight, healthy weight, overweight, obese. Results Among all weight categories there was no statistical significance, however children with obesity had greater desaturation rates (9.9%) compared with children of underweight, healthy weight, or overweight combined (5.4%), χ2 =4.46, p=0.035. Discussion The results indicate that children with obesity are almost twice as likely to have a desaturation related to procedural sedation compared with children of other weight status. Providers should be aware that children with obesity may be more likely to desaturate than other children, and therefore be skilled at recognizing this.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.02.036
       
  • Comparing the effectiveness of vapocoolant spray and lidocaine/procaine
           cream in reducing pain of intravenous cannulation: A randomized clinical
           trial
    • Authors: Asghar Dalvandi; Hadi Ranjbar; Maryam Hatamizadeh; Abolfazl Rahgoi; Colleen Bernstein
      Pages: 1064 - 1068
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Asghar Dalvandi, Hadi Ranjbar, Maryam Hatamizadeh, Abolfazl Rahgoi, Colleen Bernstein
      Introduction Venous cannulation is the most common procedure in emergency departments. The aim of this study was to compare the effectiveness of vapocoolant spray and EMLA cream in reduction of pain during venous cannulation in 6–12years old children. Methods The study was a randomized clinical trial with a crossover design. It took place between June and December 2015 at Ali-Asghar hospital in Tehran, Iran. 40 Thalassemic children who need regular blood transfusions were randomly assigned in two groups. The pain of intravenous cannulation was measured using a visual analogue scale for pain (VAS-P). With the crossover design each patient received vapocoolant spray and EMLA cream in the next two visits. The patients were allocated into two groups (A and B). The patients in Group (A) received Vapocoolant spray in the first visit and EMLA cream in the second visit before intravenous cannulation. The patients in Group (B) group were exposed to the opposite order. Results The pain after Vapocoolant spray was 3.22±1.18 which was significantly lower than control (7.12±1.36) and higher than EMLA cream (0.77±1.09), p>0.001. The anxiety before cannulation had a significant effects on the reported pain by children. The ANCOVA showed that despite the effects of anxiety the results did not change significantly. Conclusion The results indicated that vapocoolant spray was not as effective as EMLA cream, in the event of an emergency and in patients with allergic reactions to lidocaine and procaine ingredients Vapocoolant is an efficacious alternative.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.02.039
       
  • Medical expulsive therapy use in emergency department patients diagnosed
           with ureteral stones
    • Authors: Ralph C. Wang; Newton Addo; Thomas Chi; Christopher Moore; Michael Mallin; Stephen Shiboski; Marshall Stoller; Rebecca Smith-Bindman
      Pages: 1069 - 1074
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Ralph C. Wang, Newton Addo, Thomas Chi, Christopher Moore, Michael Mallin, Stephen Shiboski, Marshall Stoller, Rebecca Smith-Bindman
      Objective Recent studies have clarified the role of alpha-blockers, such as tamsulosin, for patients diagnosed with ureteral stones <10mm not requiring an urgent intervention. Prior studies have reported low rates of use of MET by emergency physicians. We sought to describe patterns of alpha-blocker use and to determine factors associated with utilization in patients diagnosed with ureterolithiasis in the ED. Methods We used data from a randomized trial of CT scan vs. ultrasound in participants with suspected urolithiasis enrolled at 15 EDs between October 2011 and February 2013. The use of medical expulsive therapy was identified by the prescription of an alpha-blocker, calcium channel blocker, or steroid at the ED visit. The prevalence of alpha-blocker use in participants with ureteral stones on imaging was calculated, and multivariable models were used to examine risk factors for utilization. Results Of the 524 participants who were identified with a ureteral stone on CT scan and discharged from the ED, 375 (71.4%) received an alpha-blocker, and 2 (<1%) received a steroid. There was no significant difference in alpha-blocker use for participants based on stone size or location. However, there was a 3.6-fold difference in alpha-blocker use between the lowest and highest use ED sites. In the multivariable analysis, ED site was independently associated with utilization of alpha-blockers. Conclusions Alpha-blockers were prescribed in more than two-thirds of patients with a distal ureteral stone on imaging, a much higher prevalence than previously reported. There was substantial variability in alpha-blocker use based on ED site.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.02.040
       
  • The effect of hydraulic bed movement on the quality of chest compressions
    • Authors: Maeng Real Park; Dae Sup Lee; Yong In Kim; Ji Ho Ryu; Young Mo Cho; Hyung Bin Kim; Seok Ran Yeom; Mun Ki Min
      Pages: 1075 - 1077
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Maeng Real Park, Dae Sup Lee, Yong In Kim, Ji Ho Ryu, Young Mo Cho, Hyung Bin Kim, Seok Ran Yeom, Mun Ki Min
      Objectives The hydraulic height control systems of hospital beds provide convenience and shock absorption. However, movements in a hydraulic bed may reduce the effectiveness of chest compressions. This study investigated the effects of hydraulic bed movement on chest compressions. Materials and methods Twenty-eight participants were recruited for this study. All participants performed chest compressions for 2min on a manikin and three surfaces: the floor (Day 1), a firm plywood bed (Day 2), and a hydraulic bed (Day 3). We considered 28 participants of Day 1 as control and each 28 participants of Day 2 and Day 3 as study subjects. The compression rates, depths, and good compression ratios (>5-cm compressions/all compressions) were compared between the three surfaces. Results When we compared the three surfaces, we did not detect a significant difference in the speed of chest compressions (p=0.582). However, significantly lower values were observed on the hydraulic bed in terms of compression depth (p=0.001) and the good compression ratio (p=0.003) compared to floor compressions. When we compared the plywood and hydraulic beds, we did not detect significant differences in compression depth (p=0.351) and the good compression ratio (p=0.391). Conclusions These results indicate that the movements in our hydraulic bed were associated with a non-statistically significant trend towards lower-quality chest compressions.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.02.042
       
  • The impact of prolonged waiting time for coronary care unit admission on
           patients with non ST-elevation acute coronary syndrome
    • Authors: Chien-Chih Chen; I-Min Chiu; Fu-Jen Cheng; Kuan-Han Wu; Chao-Jui Li
      Pages: 1078 - 1081
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Chien-Chih Chen, I-Min Chiu, Fu-Jen Cheng, Kuan-Han Wu, Chao-Jui Li
      Background The boarding of patients in the emergency department consumes nursing and physician resources, and may delay the evaluation of new patients. It may also contribute to poor cardiovascular outcomes in patients with acute coronary syndrome (ACS). This study analyzed the relationship between the delay in coronary care unit (CCU) admission and the clinical outcomes of patients with ACS with non-ST-segment elevation (NSTE-ACS). Methods Patients were divided into 2 groups according to the CCU waiting time (<12h and >12h). Outcome variables including in-hospital mortality, gastrointestinal bleeding and stroke during hospitalization, and duration of hospital stay were compared between the 2 study groups. We used the GRACE risk scores to classify disease severity of the study patients for stratifying analysis. Result A difference was found in the outcome of gastrointestinal bleeding. Among those with GRACE risk scores of <3 (low mortality risk) and 3 (high mortality risk), 5% and 3.1% of patients developed gastrointestinal bleeding, respectively, with CCU waiting time of >12h compared to CCU waiting time of <12h. However, there was no significant statistical difference (P=0.065 and 0.547). In addition, there were no significant differences in the in-hospital mortality rate, incidence of stoke, and duration of hospital stay between the 2 groups. Conclusion There was no significant difference in the clinical outcomes of NSTE-ACS patients without profound shock between those with CCU waiting times of <12 and >12h. If necessary, CCU admission should be prioritized for patients whose hemodynamic instability or respiratory failure.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.02.049
       
  • Cardioprotective effect of nicorandil against myocardial injury following
           cardiac arrest in swine
    • Authors: Li-Ning Liang; Xia Zhong; Yi Zhou; Zhi-Qiang Hou; Hao-Ran Hu; Fang-Fang Zhu; Ji-Bin Chen; Xian-Fei Ji; De-Ya Shang
      Pages: 1082 - 1089
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Li-Ning Liang, Xia Zhong, Yi Zhou, Zhi-Qiang Hou, Hao-Ran Hu, Fang-Fang Zhu, Ji-Bin Chen, Xian-Fei Ji, De-Ya Shang
      Introduction Nicorandil, a vasodilatory drug used to treat angina, was reported to protect against myocardial ischemia-reperfusion injury in various animal models. However, its cardioprotective action following cardiac arrest is unknown. We examined the cardioprotective effects of nicorandil in a porcine model of cardiac arrest and resuscitation. Methods Ventricular fibrillation was induced electrically for 4min in anesthetized domestic swine, followed by cardiopulmonary resuscitation. Sixteen successfully resuscitated animals were randomized to saline control (n=8) or nicorandil (n=8) groups. Nicorandil (150μg/kg) was administered by central intravenous injection at onset of restoration of spontaneous circulation (ROSC), followed by 3μg/kg/min infusion until reperfusion end. Sham-operated animals received surgery only (n=4). Hemodynamic parameters were monitored continuously. Blood samples were taken at baseline, 5, 30, 180, and 360min after ROSC. Left ventricular ejection fraction was assessed by echocardiography at baseline and 6h after ROSC. The animals were euthanized 6h after ROSC, and the cardiac tissue was removed for analysis. Results 6 h after ROSC, nicorandil had significantly improved all hemodynamic variables (all P <0.05) except the maximum rate of left ventricular pressure decline and heart rate (P >0.05) compared with the control group. Control animals showed elevated cardiac troponin I and lactate levels compared with sham animals, which were significantly decreased following nicorandil treatment (P <0.05). In the saline control group, the adenosine triphosphate (ATP) content was largely reduced but subsequently rescued by nicorandil (P <0.05). Histopathologic injury was reduced with nicorandil treatment. Nicorandil reduced cardiomyocyte apoptosis as evidenced by reduced terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL)-positive cells, decreased Bax and caspase-3 expression, and increased Bcl-2 expression in the myocardium (all P <0.05). Conclusion Nicorandil exhibited cardioprotective effects on myocardial injury following cardiac arrest via improvement in post-resuscitation myocardial dysfunction and energy metabolism, reduction in myocardial histopathologic injury, and antiapoptotic effects.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.02.051
       
  • Predictive parameters of retained foreign body presence after foreign body
           swallowing
    • Authors: Sung Il Kim; Kyung Min Lee; Yoon Hee Choi; Dong Hoon Lee
      Pages: 1090 - 1094
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Sung Il Kim, Kyung Min Lee, Yoon Hee Choi, Dong Hoon Lee


      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.03.002
       
  • A prospective randomized, double-dummy trial comparing IV push low dose
           ketamine to short infusion of low dose ketamine for treatment of  pain in
           the ED
    • Authors: Sergey Motov; Mo Mai; Illya Pushkar; Antonios Likourezos; Jefferson Drapkin; Matthew Yasavolian; Jason Brady; Peter Homel; Christian Fromm
      Pages: 1095 - 1100
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Sergey Motov, Mo Mai, Illya Pushkar, Antonios Likourezos, Jefferson Drapkin, Matthew Yasavolian, Jason Brady, Peter Homel, Christian Fromm
      Study objective Compare adverse effects and analgesic efficacy of low-dose ketamine for acute pain in the ED administered either by single intravenous push (IVP) or short infusion (SI). Methods Patients 18–65, presenting to ED with acute abdominal, flank, or musculoskeletal pain with initial pain score≥5, were randomized to ketamine 0.3mg/kg by either IVP or SI with placebo double-dummy. Adverse effects were evaluated by Side Effects Rating Scale for Dissociative Anesthetics (SERSDA) and Richmond Agitation-Sedation Scale (RASS) at 5, 15, 30, 60, 90, and 120min post-administration; analgesic efficacy was evaluated by Numerical Rating Scale (NRS). Results 48 patients enrolled in the study. IVP group had higher overall rates of feeling of unreality on SERSDA scale: 92% versus 54% (difference 37.5%; p =0.008; 95% CI 9.3–59.5%). At 5min median severity of feeling of unreality was 3.0 for IVP versus 0.0 for SI (p =0.001). IVP also showed greater rates of sedation on RASS scale at 5min: median RASS −2.0 versus 0.0 (p =0.01). Decrease in mean pain scores from baseline to 15min was similar across groups: 5.2±3.53 (95% CI 3.7–6.7) for IVP; 5.75±3.48 (95% CI 4.3–7.2) for SI. There were no statistically significant differences with respect to changes in vital signs and need for rescue medication. Conclusion Low-dose ketamine given as a short infusion is associated with significantly lower rates of feeling of unreality and sedation with no difference in analgesic efficacy in comparison to intravenous push.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.03.004
       
  • Evaluation of methohexital as an alternative to propofol in a high volume
           outpatient pediatric sedation service
    • Authors: Nicholas E. Jones; Michael S. Kelleman; Harold K. Simon; Jana A. Stockwell; Courtney McCracken; Michael D. Mallory; Pradip P. Kamat
      Pages: 1101 - 1105
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Nicholas E. Jones, Michael S. Kelleman, Harold K. Simon, Jana A. Stockwell, Courtney McCracken, Michael D. Mallory, Pradip P. Kamat
      Background Propofol is a preferred agent for many pediatric sedation providers because of its rapid onset and short duration of action. It allows for quick turn around times and enhanced throughput. Occasionally, intravenous (IV) methohexital (MHX), an ultra-short acting barbiturate is utilized instead of propofol. Objective Describe the experience with MHX in a primarily propofol driven outpatient sedation program and to see if it serves as an acceptable alternative when propofol is not the preferred pharmacologic option. Methods Retrospective chart review from 2012 to 2015 of patients receiving IV MHX as their primary sedation agent. Data collected included demographics, reason for methohexital use, dosing, type of procedure, success rate, adverse events (AE), duration of the procedure, and time to discharge. Results Methohexital was used in 240 patient encounters. Median age was 4years (IQR 2–7), 71.8% were male, and 80.4% were ASA-PS I or II. Indications for MHX use: egg+soy/peanut allergy in 93 (38.8%) and mitochondrial disorder 9 (3.8%). Median induction bolus was 2.1mg/kg (IQR, 1.9–2.8), median maintenance infusion was 4.5mg/kg/h (IQR, 3.0–6.0). Hiccups 15 (6.3%), secretions requiring intervention 14 (5.8%), and cough 12 (5.0%) were the most commonly occurring minor AEs. Airway obstruction was seen in 28 (11.6%). Overall success rate was 94%. Median time to discharge after procedure completion was 40.5min (IQR 28–57). Conclusion Methohexital can be used with a high success rate and AEs that are not inconsistent with propofol administration. Methohexital should be considered when propofol is not a preferred option.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.03.008
       
  • FDP/fibrinogen ratio reflects the requirement of packed red blood cell
           transfusion in patients with blunt trauma
    • Authors: Shuichi Hagiwara; Makoto Aoki; Masato Murata; Minoru Kaneko; Yumi Ichikawa; Jun Nakajima; Yuta Isshiki; Yusuke Sawada; Jun'ichi Tamura; Kiyohiro Oshima
      Pages: 1106 - 1110
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Shuichi Hagiwara, Makoto Aoki, Masato Murata, Minoru Kaneko, Yumi Ichikawa, Jun Nakajima, Yuta Isshiki, Yusuke Sawada, Jun'ichi Tamura, Kiyohiro Oshima
      Purpose To find factors that predict the requirement of packed red blood cells (pRBC) transfusion in patients with blunt trauma on arrival at the hospital. Methods We conducted blood tests in trauma patients whose trauma severity was suspected as being 3 and over in the Abbreviated Injury Scale. Patients were divided into the blood transfusion (BT) and control groups according to the requirement of pRBC transfusion within 24h after arrival. Results We analyzed 347 patients (BT group, n=14; control group, n=333). On univariate analysis, there were significant differences in Glasgow Coma Scale (GCS), rate of positive FAST (focused assessment with sonography for trauma) finding, hematocrit, international normalized ratio of prothrombin time, activated partial thromboplastin time, fibrinogen (Fib), and level of fibrin degradation products (FDP). On multivariable analysis, positive FAST finding, GCS, Fib, and FDP influenced the requirement of pRBC transfusion. In the area under the receiver operating characteristic curve analysis, Fib and FDP were markers that predicted the requirement of pRBC transfusion. The FDP/Fib ratio had a better correlation with the requirement of pRBC transfusion than FDP or Fib. Conclusions The FDP/Fib ratio can be easily measured and may be a predictor of the need for pRBC transfusion.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.03.009
       
  • Soft tissue oxygen saturation to predict admission from the emergency
           department: A prospective observational study
    • Authors: William T. Davis; Josh Lospinso; Robert M. Barnwell; John Hughes; Steven G. Schauer; Thomas B. Smith; Michael D. April
      Pages: 1111 - 1117
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): William T. Davis, Josh Lospinso, Robert M. Barnwell, John Hughes, Steven G. Schauer, Thomas B. Smith, Michael D. April
      Objective We evaluated a soft tissue oxygen saturation (Sto2) measurement at triage for predicting admission to the hospital in adults presenting to the emergency department (ED) in addition to data routinely gathered at triage. Methods This was a prospective, observational, single center study of adults presenting to the ED for evaluation. Research assistants obtained thenar eminence Sto2 measurements on subjects in ED triage. ED providers not involved in the study then made all management and disposition decisions. We prospectively collected data on each subject's final ED disposition (admission versus discharge). We identified the optimal Sto2 cutoff value for predicting admission. We then used logistic regression modeling to describe the added predictive value of Sto2 beyond routinely collected triage data including Emergency Severity Index level, age, and vital signs. Results We analyzed 2588 adult (>17years) subjects with 743 subjects (28.7%) admitted to the hospital. Sto2<76% was the optimal diagnostic cutoff for predicting admission. Of subjects with Sto2<76%, 158 of 384 (41.1%) underwent admission versus 585 of 2204 (26.5%) subjects with Sto2≥76. After controlling for age, vital signs, and ESI level in the logistic regression analysis, Sto2<76% had an odds ratio of 1.54 (95% confidence interval (CI), 1.19 to 1.98) for predicting admission. Conclusions Sto2 may provide additional prognostic data to routine triage assessment regarding the disposition for undifferentiated adult patients presenting to the ED.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.03.013
       
  • Haloperidol undermining gastroparesis symptoms (HUGS) in the emergency
           department
    • Authors: Rene Ramirez; Philip Stalcup; Brandon Croft; Michael A. Darracq
      Pages: 1118 - 1120
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Rene Ramirez, Philip Stalcup, Brandon Croft, Michael A. Darracq
      Background Gastroparesis associated nausea, vomiting & abdominal pain (GP N/V/AP) are common presentations to the emergency department (ED). Treatment is often limited to antiemetic, prokinetic, opioid, & nonopioid agents. Haloperidol (HP) has been shown to have analgesic & antiemetic properties. We sought to evaluate HP in the ED as an alternative treatment of GP N/V/AP. Methods Using an electronic medical record, 52 patients who presented to the ED w/GP N/V/AP secondary to diabetes mellitus and were treated w/HP were identified. Patients who received HP were compared to themselves w/the most recent previous encounter in which HP was not administered. ED length of stay (LOS), additional antiemetics/prokinetics administered, hospital LOS, and morphine equivalent doses of analgesia (ME) from each visit were recorded. Descriptive statistics, categorical (Chi Square Test or Z-Test for proportion) and continuous (Wilcoxon Signed Rank Test) comparisons were calculated. Statistical significance was considered for two tail p-values less than 0.05. Results A statistically significant reduction in ME (Median 6.75 [IQR 7.93] v 10.75 [IQR12]: p=0.001) and reduced admissions for GP (5/52 v 14/52: p=0.02) when HP was administered was observed. There were no statistically significant differences in ED or hospital LOS, and additional antiemetics administered between encounters in which HP was administered and not administered. No complications were identified in patients who received HP. Conclusions The rate of admission and ME was found to be significantly reduced in patients with GP secondary to diabetes mellitus who received HP. HP may represent an appropriate, effective, and safe alternative to traditional analgesia and antiemetic therapy in the ED management of GP associated N/V/AP.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.03.015
       
  • A novel biochemical marker for community-acquired pneumonia:
           Ischemia-modified albumin
    • Authors: Mustafa Bolatkale; Mustafa Duger; Gözde Ülfer; Çağdaş Can; Ahmet Cagdas Acara; Türkan Yiğitbaşı; Ekrem Cengiz Seyhan; Mehtap Bulut
      Pages: 1121 - 1125
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Mustafa Bolatkale, Mustafa Duger, Gözde Ülfer, Çağdaş Can, Ahmet Cagdas Acara, Türkan Yiğitbaşı, Ekrem Cengiz Seyhan, Mehtap Bulut
      Introduction Community-acquired pneumonia (CAP) is a frequent cause of hospitalization and a leading cause of mortality worldwide. Early diagnosis and the initiation of appropriate antibiotic therapy are essential to reduce pneumonia-related morbidity and mortality. CRP is a well-established biomarker in many clinical settings, but has been traditionally considered not specific enough to be a useful guide in the diagnostic process of pneumonia. There is still a need for more specific and practical markers in CAP for diagnosis. The aim of this study was to investigate the diagnostic value of ischemia-modified albumin (IMA) levels in the diagnosis of CAP in the Emergency Department. Methods The study included 81 patients admitted with CAP and 81 control patients. Initial hour levels of IMA and CRP were measured. The IMA mean levels were compared between the study and control group. Correlation analyses were performed to investigate the association of serum IMA levels with CRP. Results Mean levels of IMA were 0.532±0.117IU/ml in the study group and 0.345±0.082IU/ml in the control group. IMA levels were significantly higher in the study group compared to the control group. The IMA level of 0.442IU/ml had sensitivity of 75.3% and specificity of 91.3% and was positively correlated with CRP levels (r =0.506; p <0.05). Conclusion Blood IMA levels significantly increase in adult patients presenting with CAP. IMA may be considered as a novel biomarker in the diagnosis of CAP.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.03.018
       
  • Sedation effects of intranasal dexmedetomidine delivered as sprays versus
           drops on pediatric response to venous cannulation
    • Authors: Zhubin Xie; Weihua Shen; Jingyi Lin; Liwen Xiao; Minyan Liao; Xiaoliang Gan
      Pages: 1126 - 1130
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Zhubin Xie, Weihua Shen, Jingyi Lin, Liwen Xiao, Minyan Liao, Xiaoliang Gan
      Objectives Mucosal atomization device (MAD) was designed to increase the bioavailability of intranasal medications by facilitating absorption, the present study aimed to evaluate and compare the sedation effects of intranasal dexmedetomidine delivered as drops versus sprays on pediatric responses to intravenous cannulation. Methods One hundred and six pediatric patients (aged from 2 to 5years) scheduled for elective ophthalmic surgery were intranasally received a dose of 2μg/kg in 20μl/kg of dexmedetomidine for sedation to reduce response to venous cannulation. The patients were randomized into syringe group and MAD group in which dexmedetomidine was delivered as drops or sprays via syringe or MAD respectively. The primary outcome was the response to peripheral vein cannulation assessed by the FLACC scores (faces, legs, activity, cry and consolability) 30min after intranasal administration of dexmedetomidine. The secondary outcomes included acceptance for intranasal medication, sedation onset time, and needle insertion times and any adverse event at the preoperative holding area. Results The FLACC scores in MAD group were significantly decreased than that treated by drops (P =0.021). The acceptance for intranasal administration between both groups was comparable (P >0.05), the onset time and the incidences in two and more times of needle insertion did not differ significantly between syringe and MAD groups (all P >0.05). None of patients were required to clinically intervene in heart rates reduction and none suffered respiratory depression after administrations of dexmedetomidine in either group. Conclusion Intranasal dexmedetomidine by sprays offers better sedation effects to reduce responses to venous cannulation than drops.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.03.021
       
  • Utility of the simplified Wells and revised Geneva scores to exclude
           pulmonary embolism in femur fracture patients
    • Authors: Youn-Jung Kim; Dae-Hee Choi; Eu Sun Lee; Seung Mok Ryoo; Shin Ahn; Chang Hwan Sohn; Dong-Woo Seo; Kyoung Soo Lim; Won Young Kim
      Pages: 1131 - 1135
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Youn-Jung Kim, Dae-Hee Choi, Eu Sun Lee, Seung Mok Ryoo, Shin Ahn, Chang Hwan Sohn, Dong-Woo Seo, Kyoung Soo Lim, Won Young Kim
      Objectives The diagnosis of acute pulmonary embolism (PE) in trauma patients is challenging. This study evaluated the diagnostic value of simplified Wells and simplified revised Geneva scores to predict PE in femur fracture patients in emergency department (ED). Methods All consecutive adult patients with femur fractures and elevated D-dimer levels (>0.5μg/mL) who underwent CTPA within 72h of injury from January 2010 to December 2014 were included. The simplified Wells and simplified revised Geneva scores were applied to evaluate the clinical probability of PE. Results Among 519 femur fracture patients, 446 patients were finally included, and 23 patients (5.2%) were diagnosed with acute PE. The median values of simplified Wells and simplified revised Geneva scores [0 (IQR: 0–1) vs. 0 (IQR: 0–0), P=0.23; 3 (IQR: 2–4) vs. 3 (IQR: 2–3), P=0.48] showed no differences between the PE (n=23) and non-PE (n=423) groups. Using the simplified Wells score, 98% of the patients were categorized into the “PE unlikely” group. The sensitivity, specificity, positive predictive value, and negative predictive value of the simplified revised Geneva score (≥3 points) for the diagnosis of PE were 74%, 35%, 6%, and 96%, respectively. Conclusion In femur fracture patients with elevated D-dimer levels, the simplified Wells and simplified revised Geneva scores have limited predictive value. However, the simplified revised Geneva score of <3 points may be possibly used as a diagnostic tool.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.03.023
       
  • Persistent hyperlactatemia-high central venous-arterial carbon dioxide to
           arterial-venous oxygen content ratio is associated with poor outcomes in
           early resuscitation of septic shock
    • Authors: Juandi Zhou; Jia Song; Shijin Gong; Li Li; Haixiang Zhang; Minjia Wang
      Pages: 1136 - 1141
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Juandi Zhou, Jia Song, Shijin Gong, Li Li, Haixiang Zhang, Minjia Wang
      Objective Several studies reported Pv-aCO2/Ca-vO2 ratio as a surrogate of VCO2/VO2 to detect global tissue hypoxia. The present study aimed to evaluate the prognostic value of Pv-aCO2/Ca-vO2 ratio combined with lactate levels during the early phases of resuscitation in septic shock. Methods A retrospective study was conducted in 144 septic shock patients in a 30-bed mixed ICU. A Pv-aCO2/Ca-vO2 ratio>1.4 was considered abnormal. Patients were classified into four predefined groups according to lactate levels and Pv-aCO2/Ca-vO2 ratio after the first 6h of resuscitation. Sequential Organ Failure Assessment (SOFA) score at day 3 was assessed. A Kaplan-Meier curve showed the survival probabilities at day 28 using a log-rank test to evaluate the differences between groups. A receiver operating characteristics (ROC) curve evaluated the ability of lactate, Pv-aCO2/Ca-vO2 ratio and Pv-aCO2/Ca-vO2 ratio combined with lactate to predict mortality at day 28. Results Combination of hyperlactatemia and high Pv-aCO2/Ca-vO2 ratio was associated with poor SOFA scores and low survival rates at day 28 (P <0.001). The Cox multivariate survival analysis demonstrated that Pv-aCO2/Ca-vO2 ratio and lactate at T6 were independent predictors of mortality at day 28. The area under the ROC curve of the Pv-aCO2/Ca-vO2 ratio combined with lactate for predicting mortality at day 28 was highest and superior to that of lactate and Pv-aCO2/Ca-vO2 ratios. Conclusion Combination of Pv-aCO2/Ca-vO2 ratio and lactate at early stages of resuscitation of septic shock can better predict the prognosis of patients. The Pv-aCO2/Ca-vO2 ratio may become a useful parameter supplementary to lactate in the resuscitation of septic shock.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.03.027
       
  • C-MAC compared with direct laryngoscopy for intubation in patients with
           cervical spine immobilization: A manikin trial
    • Authors: Jacek Smereka; Jerzy R. Ladny; Amanda Naylor; Kurt Ruetzler; Lukasz Szarpak
      Pages: 1142 - 1146
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Jacek Smereka, Jerzy R. Ladny, Amanda Naylor, Kurt Ruetzler, Lukasz Szarpak
      Introduction The aim of this study was to compare C-MAC videolaryngoscopy with direct laryngoscopy for intubation in simulated cervical spine immobilization conditions. Methods The study was designed as a prospective randomized crossover manikin trial. 70 paramedics with <5years of medical experience participated in the study. The paramedics attempted to intubate manikins in 3 airway scenarios: normal airway without cervical immobilization (Scenario A); manual inline cervical immobilization (Scenario B); cervical immobilization using cervical extraction collar (Scenario C). Results Scenario A: Nearly all participants performed successful intubations with both MAC and C-MAC on the first attempt (95.7% MAC vs. 100% C-MAC), with similar intubation times (16.5s MAC vs. 18s C-MAC). Scenario B: The results with C-MAC were significantly better than those with MAC (p <0.05) for the time of intubation (23 s MAC vs. 19 s C-MAC), success of the first intubation attempt (88.6% MAC vs. 100% C-MAC), Cormack-Lehane grade, POGO score, severity of dental compression, device difficulty score, and preferred airway device. Scenario C: The results with C-MAC were significantly better than those with MAC (p <0.05) for all the analysed variables: success of the first attempt (51.4% MAC vs. 100% C-MAC), overall success rate, intubation time (27 s MAC vs. 20.5 s C-MAC), Cormack-Lehane grade, POGO score, dental compression, device difficulty score and the preferred airway device. Conclusion The C-MAC videolaryngoscope is an excellent alternative to the MAC laryngoscope for intubating manikins with cervical spine immobilization.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.03.030
       
  • Remote management of low to intermediate risk chest pain: A case series
    • Authors: Alexander Chiu; Kathleen Shumaker; Christopher del Corral; Blessy George; Michael Kasper; Marie-Carmelle Elie; Preeti Jois; Daniel Dipsia; Meaghan Donnelly; MHS Lauren Sidow; BS Caroline Chau; Adam Ash
      Pages: 1147 - 1149
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Alexander Chiu, Kathleen Shumaker, Christopher del Corral, Blessy George, Michael Kasper, Marie-Carmelle Elie, Preeti Jois, Daniel Dipsia, Meaghan Donnelly, MHS Lauren Sidow, BS Caroline Chau, Adam Ash
      We report a case series of three low to intermediate risk chest pain patients who presented to the emergency department and were managed as outpatients via the Cellular Outpatient Twelve-Lead Telemetry with Emergency Response (COTTER™). This technology allows for certain chest pain patients to be managed remotely via telemedicine while receiving care comparable to that which would be available in a hospital or chest pain observation unit.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.02.029
       
  • Management of spontaneous pneumomediastinum: Are hospitalization and
           prophylactic antibiotics needed'
    • Authors: Masatomo Ebina; Akira Inoue; Akihiro Takaba; Koichi Ariyoshi
      Pages: 1150 - 1153
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Masatomo Ebina, Akira Inoue, Akihiro Takaba, Koichi Ariyoshi
      Background Spontaneous pneumomediastinum is defined as the presence of free air in the mediastinum without any apparent concomitant factors or disease. It is uncommon but usually benign and self-limiting. Generally, patients with spontaneous pneumomediastinum are admitted to hospital, and occasionally, prophylactic antibiotics are administered to prevent mediastinitis. The purpose of this study was to describe practices concerning the feasibility of outpatient treatment and follow-up of spontaneous pneumomediastinum and the necessity of prophylactic antibiotics. Methods We conducted this study in a single emergency medical center located in Kobe, Japan. We retrospectively evaluated patients with spontaneous pneumomediastinum from January 2007 to December 2014. Spontaneous pneumomediastinum was defined as cases in which pneumomediastinum did not occur in the setting of positive pressure ventilation or severe trauma. All case records were carefully reviewed considering the demographic data, symptoms, precipitating events, diagnostic workup performed, use of prophylactic antibiotics, length of hospital stay, and complications. Results Thirty-four patients who satisfied the inclusion criteria were identified. Twenty-three patients (67.6%) were followed up on an outpatient basis, and 11 patients (32.4%) were admitted to the hospital, with a mean length of stay of 3.4days. Prophylactic antibiotics were orally administered to 2 patients. None of the patients developed complications, such as tension pneumomediastinum, delayed pneumothorax, airway compromise, and mediastinitis. Conclusion Spontaneous pneumomediastinum is a benign condition presenting primarily in young adults, with an uneventful recovery. Therefore, patients may recover from this condition without admission or the need for prophylactic antibiotics.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.03.017
       
  • Risk factors for unplanned transfer to the intensive care unit after
           emergency department admission
    • Authors: Lena M. Boerma; Eef P.J. Reijners; Roger A.P.A. Hessels; Martijn A.A. v Hooft
      Pages: 1154 - 1158
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Lena M. Boerma, Eef P.J. Reijners, Roger A.P.A. Hessels, Martijn A.A. v Hooft
      Introduction Unplanned Intensive Care Unit (ICU) admission has been used as a surrogate marker of adverse events, and is used by the Australian Council of Healthcare Accreditation as a reportable quality indicator. If we can identify independent variables predicting deterioration which require ICU transfer within 24h after emergency department (ED) admission, direct ICU admission should be considered. This may improve patient safety and reduce adverse events by appropriate disposition of patients presenting to the ED. Objective(s) The aim of this study was to identify independent variables predicting deterioration which require ICU transfer within 24h after ED admission. Methods A case control study was performed to examine characteristics of patients who underwent an unplanned transfer to the ICU within 24h after ED admission. Results There were significantly more hypercapnia patients in the ICU admission group (n=17) compared to the non-ICU group (n=5) (p=0.028). There were significantly greater rates of tachypnea in septic patients (p=0.022) and low oxygen saturation for patients with pneumonia (p=0.045). The level of documentation of respiratory rate was poor. Conclusions In patients presenting to the ED, hypercapnia was a predictor for deterioration which requires ICU transfer within 24h after ED admission. Additional predicting factors in patients with sepsis or pneumonia were respectively tachypnea and low oxygen saturation. For these patient groups direct ICU admission should be considered to prevent unplanned ICU admission. This data emphasizes the importance of measuring the vital signs, particularly the respiratory rate.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.03.019
       
  • Low yield of blood and wound cultures in patients with skin and
           soft-tissue infections
    • Authors: Jesus Torres; Nathaniel Avalos; Lamarr Echols; Jillian Mongelluzzo; Robert M. Rodriguez
      Pages: 1159 - 1161
      Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8
      Author(s): Jesus Torres, Nathaniel 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: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.05.039
       
  • Hemodynamic characteristics of suspected stroke in the emergency
           department
    • Authors: Joseph B. Miller; Richard M. Nowak; Brian P. Reed; Salvatore DiSomma; Prabath Nanayakkara; Michele Moyer; Scott Millis; Harish Kinni; Phillip Levy
      Abstract: Publication date: Available online 8 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Joseph B. Miller, Richard M. Nowak, Brian P. Reed, Salvatore DiSomma, Prabath Nanayakkara, Michele Moyer, Scott Millis, Harish Kinni, Phillip Levy
      Background Systemic hemodynamic characteristics of patients with suspected acute ischemic stroke are poorly described. The objective of this study was to identify baseline hemodynamic characteristics of emergency department (ED) patients with suspected acute stroke. Methods This was a planned analysis of the stroke cohort from a multicenter registry of hemodynamic profiling of ED patients. The registry prospectively collected non-invasive hemodynamic measurements of patients with suspicion for acute stroke within 12h of symptom onset. K-means cluster analysis identified hemodynamic phenotypes of all suspected stroke patients, and we performed univariate hemodynamic comparisons based on final diagnoses. Results There were 72 patients with suspected acute stroke, of whom 38 (53%) had a final diagnosis of ischemic stroke, 10 (14%) had hemorrhagic stroke, and 24 (33%) had transient ischemic attack (TIA). Analysis defined three phenotypic clusters based on low or normal cardiac index (CI) and normal or high systemic vascular resistance index (SVRI). Patients with TIA had lower mean CI (2.3L/min/m2) compared to hemorrhagic or ischemic stroke patients (p<0.01). Conclusions The study demonstrates the feasibility of defining hemodynamic phenotypes of ED patients with suspected stroke.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.017
       
  • 72h returns: A trigger tool for diagnostic error
    • Authors: Emily Aaronson; Pierre Borczuk; Theodore Benzer; Elizabeth Mort; Elizabeth Temin
      Abstract: Publication date: Available online 8 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Emily Aaronson, Pierre Borczuk, Theodore Benzer, Elizabeth Mort, Elizabeth Temin
      Background Patients who return to the Emergency Department (ED) within 72h of discharge are often used for ED Quality Assurance efforts, however little is known about the yield of this kind of review and the types of errors it identifies. Our objective was to identify the prevalence, types and severity of errors in these cases. Methods Retrospective review of patients who presented to an urban, university affiliated ED between 10/1/2012–9/30/2015 who returned within 72 h requiring hospital admission. Results There were 413,167 ED visits during the study period with 2001 (0.48%) patients who returned within 72h and were admitted to the hospital. An event requiring further investigation was identified in 59 (2.95%) of these patients and 50 (2.49%) of them were deemed to represent a deviation from optimal care. Of these, 48 (96%) represented diagnostic error. When a standard diagnostic process of care framework was applied to these, the majority of cases represented failures in the initial diagnostic pathway (29 cases, 60.4%). When Error Severity Codes were applied, 16 (32%) resulted in minor harm and 34 (68%) resulted in major harm or death. Conclusion Screening of 72h ED returns has low yield in identifying suboptimal care, with less than 3% of cases representing deviations from standard care. Of these, the majority represent cognitive errors in the diagnostic pathway. These reviews may be useful as a tool for Ongoing Professional Practice Evaluation of individual clinicians, however likely serve less value in identifying systems issues contributing to unsafe care.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.019
       
  • Can the addition of low dose lidocaine improve the effectiveness of
           narcotics in reducing renal colic pain'
    • Authors: Seyed Mohammad Hosseininejad
      Abstract: Publication date: Available online 8 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Seyed Mohammad Hosseininejad


      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.022
       
  • A role of the endothelial nitric oxide system in acute renal colic caused
           by ureteral stone
    • Authors: Emre Bulbul; Elif Funda Sener; Nahide Ekici Gunay; Bahadir Taslidere; Elif Taslidere; Serhat Koyuncu; Nurullah Gunay
      Abstract: Publication date: Available online 7 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Emre Bulbul, Elif Funda Sener, Nahide Ekici Gunay, Bahadir Taslidere, Elif Taslidere, Serhat Koyuncu, Nurullah Gunay
      Background and aims Endothelial nitric oxide synthetase gene polymorphisms play a role in some pathophysiological processes. In this study, the possible effects of endothelial nitric oxide synthetase gene polymorphisms on ureteral stone disease in patients who were admitted to the emergency department with severe pain due to renal colic are examined. Materials and methods The study groups were designed as controls and patients. The control group was formed from the healthy volunteers who applied to the blood center next to the emergency service. The patient group comprised patients who were diagnosed with ureteral stone disease with severe pain. All of the genetic studies were based on extracted peripheral blood samples using the necessary procedures from the Genome and Stem Cell Center at Erciyes University (GENKOK). The data were analyzed with SPSS (IBM, ver 20, United Sate). Results The study group comprised 62 females and 138 males, and the control group comprised 64 females and 136 males. All of the stones that caused renal colic were found to be localized in the ureters and the ureterovesical junction. The genotypes of the intron 4 polymorphism were found to be as follows: 4a/4a in 10 people, 4b/4a in 115, and 4b/4b in 275 people. The GG genotype of the eNOS-G894T polymorphism was found in 108 patients in the study group and in117 of the healthy individuals. There was no statistically significant difference between the two groups regarding these data. Conclusion Although this study is the first in the literature to examine the relationship between renal colic and endothelial nitric oxide synthetase gene polymorphisms, our study demonstrated that no relation was found.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.008
       
  • The accuracy of emergency physician performed ultrasonography as a
           diagnostic tool for lateral malleolar fracture
    • Authors: Pinar Ozturk; Ersin Aksay; Nese Colak Oray; Basak Bayram; Onur Basci; Duygu Tokgoz
      Abstract: Publication date: Available online 7 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Pinar Ozturk, Ersin Aksay, Nese Colak Oray, Basak Bayram, Onur Basci, Duygu Tokgoz
      Objective Many studies in the literature related to the investigation of the sensitivity and specificity of ultrasound examinations in lateral malleolar fractures is limited. The aim of this study is to investigate the sensitivity and specificity of ultrasound examinations performed by emergency physicians in fractures who are presented to the emergency department with blunt lateral malleolar trauma. Method Patients over 18years of age who were admitted to the ED with lateral malleolar tenderness were enrolled to this study with convenience sampling. Ultrasonographic examination was performed by emergency physicians. Following the ultrasound examination, a two-sided X-ray was performed. In the case of inconsistency between the US exam and the X-ray evaluated by the emergency physician, a CT was performed on the patients. The X-ray or CT imaging evaluation of an orthopedic surgeon was accepted as the gold standard. Results A hundred-twenty patients were included in the study. Fractures in the lateral malleolus were detected in 47 patients. The sensitivity of X-ray in the diagnosis of lateral malleolar fractures was 92.8%, (95% CI, 79.4–98.1) and the specificity was 100% (95% CI, 89.5–100), while the sensitivity of US exam was 100% (95% CI, 94.1–100), and the specificity was 93% (95% CI, 85–97.6). X-ray gave false negative results in 3 patients, whereas US gave false positive results in 5 patients. Conclusion In patients admitted to ED with lateral malleolus tenderness, the sensitivity of the ultrasound examination performed by emergency physicians regarding diagnosis of lateral malleolar fracture is higher than X-ray.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.020
       
  • Fewer immigrants have preventable emergency department visits in the
           United States
    • Authors: Yang Wang; Fernando A. Wilson; Jim P. Stimpson; Hongmei Wang; David W. Palm; Baojiang Chen; Li-Wu Chen
      Abstract: Publication date: Available online 7 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Yang Wang, Fernando A. Wilson, Jim P. Stimpson, Hongmei Wang, David W. Palm, Baojiang Chen, Li-Wu Chen
      Objective The aim of this study is to examine differences in having preventable emergency department (ED) visits between noncitizens, naturalized and US-born citizens in the United States. Methods We linked to 2008–2012 Medical Expenditure Panel Survey with National Health Interview Survey data to draw a nationally representative sample of US adults. Univariate analysis described distribution of preventable ED visits identified by the Prevention Quality Indicators across immigration status. We also assessed the association between preventable ED visits and immigration status, controlling for demographics, socioeconomic status, health service utilization, and health status. We finally applied the Oaxaca-Blinder decomposition method to measure the contribution of each covariate to differences in preventable ED services utilization between US natives, naturalized citizens, and noncitizens. Results Of US natives, 2.1% had any preventable ED visits within the past years as compared to 1.0% of noncitizens and 1.5% of naturalized citizens. Multivariate results also revealed that immigrants groups had significantly lower odds (adjusted OR: naturalized citizen 0.77 [0.61–0.96], noncitizen 0.62 [0.48–0.80]) of having preventable ED visits than natives. Further stratified analysis by insurance status showed these differences were only significant among the uninsured. Race/ethnicity and health insurance explained about 68% of the difference in preventable ED service utilization between natives and noncitizens. Conclusion Our study documents the existing differences in preventable ED visits across immigration status, and highlights the necessity to explore unmet health needs among immigrants and eliminate disparities.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.018
       
  • Eyelid inflammation: An uncommon cause in occidental countries
    • Authors: Hélène Devambez; Morgane Richeux; Maximilien Guericolas; Christophe Choquet; Enrique Casalino; Aiham Daniel Ghazali
      Abstract: Publication date: Available online 7 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Hélène Devambez, Morgane Richeux, Maximilien Guericolas, Christophe Choquet, Enrique Casalino, Aiham Daniel Ghazali
      Background Myiasis designates the infestation of live human and vertebrate animals with dipterous (two-winged) larvae (maggots) and is the fourth most common travel-associated skin disease. Furuncle is the most common aspect of cutaneous myiasis. Case presentation A 24-year-old Caucasian female had been back from Cap-Vert. She described pruritus, slight pain, and the sensation of a foreign body moving in the eyelid. Physical examination showed a single furuncle-like nodule with surrounding erythema and a central pore of the upper eyelid through which a serosanguinous fluid was exuding. A larval end was visible to the naked eye through the aforementioned pore. Treatment consisted of the application of petroleum jelly (Vaseline®) to produce localized hypoxia. A transparent occlusive dressing was set for a duration of 2 h. The larva, Cordylobia antropophaga, spontaneously externalized to breathe and was extracted. Discussion There is an increase in travelers returning from tropical countries. Consequently, travel-associated dermatoses are increasing in non-endemic countries. Context of travel and typical clinical presentation strongly suggested to evoke a cutaneous myiasis. The typical furuncular lesion is a papule or nodule with a central punctum that exudes serosanguinous or purulent fluid. Ultrasound can be used to confirm the diagnosis. Treatment consists of three techniques: methods producing localized hypoxia to force emergence of the larvae, application of toxic substances to the eggs and larvae, and mechanical or surgical debridement. Surgery and antibiotics are usually unnecessary. Prevention of furunculous myiasis is based on vector control and individual actions to improve hygiene.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.021
       
  • Outcomes and predictors of failure of non-invasive ventilation in patients
           with community acquired pneumonia in the emergency department
    • Authors: Amjad Al-Rajhi; Anwar Murad; P.Z. Li; Jason Shahin
      Abstract: Publication date: Available online 7 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Amjad Al-Rajhi, Anwar Murad, P.Z. Li, Jason Shahin
      Objective We set out to describe the use and analyze the predictors of non-invasive ventilation failure in patients with community-acquired pneumonia who receive non-invasive ventilation as first line ventilatory therapy in the emergency department. Methods A retrospective cohort study was conducted among consecutive patients with community acquired pneumonia requiring ventilator support presenting to two tertiary care university-affiliated emergency departments. Multivariable logistic regression analysis was used to determine predictors of non-invasive ventilation failure at initiation of non-invasive ventilation and at two hours of non-invasive ventilation use; Result After excluding patients with a do not resuscitate order status, 163 (74.8%) patients with community acquired pneumonia were initially treated with non-invasive ventilation on initial presentation to the emergency department. Non-invasive ventilation failure occurred in 50% of patients and was found to be associated with the presence of chronic obstructive airway disease, APACHE II score, the need for hemodynamic support and the number of CXR quadrants involved. Two-hour physiological parameters associated with non-invasive ventilation failure included higher respiratory rate, lower serum pH and the ongoing need of hemodynamic support. Conclusion In conclusion, the use of non-invasive ventilation to support patients presenting to the emergency department with respiratory failure and community acquired pneumonia is common and is associated with a significant failure rate. Hemodynamic support is a strong predictor of failure. The selection of the appropriate patient and monitoring of physiological parameters while on NIV is crucial to ensure successful treatment.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.016
       
  • Safe and effective administration of lactulose retention enema in the ED
           using specialized rectal medication administration catheter
    • Authors: Kim Marie C. Macygin; Jillian Lee; Anson Lam; Ruth Carlstedt; Brad Macy
      Abstract: Publication date: Available online 6 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Kim Marie C. Macygin, Jillian Lee, Anson Lam, Ruth Carlstedt, Brad Macy


      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.011
       
  • Extracorporeal cardiopulmonary resuscitation for blunt cardiac rupture: A
           case report
    • Authors: Shunsuke Kudo; Keiji Tanaka; Kunihiko Okada; Takahiro Takemura
      Abstract: Publication date: Available online 5 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Shunsuke Kudo, Keiji Tanaka, Kunihiko Okada, Takahiro Takemura
      Extracorporeal cardiopulmonary resuscitation (ECPR) followed by operating room sternotomy, rather than resuscitative thoracotomy, might be life-saving for patients with blunt cardiac rupture and cardiac arrest who do not have multiple severe traumatic injuries. A 49-year-old man was injured in a vehicle crash and transferred to the emergency department. On admission, he was hemodynamically stable, but a plain chest radiograph revealed a widened mediastinum, and echocardiography revealed hemopericardium. A computed tomography scan revealed hemopericardium and mediastinal hematoma, without other severe traumatic injuries. However, the patient's pulse was lost soon after he was transferred to the intensive care unit, and cardiopulmonary resuscitation was initiated. We initiated ECPR using femorofemoral veno-arterial extracorporeal membrane oxygenation (ECMO) with heparin administration, which achieved hemodynamic stability. He was transferred to the operating room for sternotomy and cardiac repair. Right ventricular rupture and pericardial sac laceration were identified intraoperatively, and cardiac repair was performed. After repairing the cardiac rupture, the cardiac output recovered spontaneously, and ECMO was discontinued intraoperatively. The patient recovered fully and was discharged from the hospital on postoperative day 7. In this patient, ECPR rapidly restored brain perfusion and provided enough time to perform operating room sternotomy, allowing for good surgical exposure of the heart. Moreover, open cardiac massage was unnecessary. ECPR with sternotomy and cardiac repair is advisable for patients with blunt cardiac rupture and cardiac arrest who do not have severe multiple traumatic injuries.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.015
       
  • Prevalence and predictors associated with severe pulmonary hypertension in
           COPD
    • Authors: Mitra Samareh Fekri; Mehdi Torabi; Sara Azizi Shoul; Moghaddameh Mirzaee
      Abstract: Publication date: Available online 5 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Mitra Samareh Fekri, Mehdi Torabi, Sara Azizi Shoul, Moghaddameh Mirzaee
      Background Pulmonary hypertension (PH) is one of the most common complications of COPD (chronic obstructive pulmonary disease), but its severe form is uncommon. Various factors play an important role in the occurrence and severity of pulmonary hypertension in patients. Methods This cross-sectional study was performed on patients with COPD referred to an emergency department over a one-year period. The tests—including complete blood count (CBC) and arterial blood gas (ABG), pulmonary functional test (PFT) and echocardiography—were performed for all patients to measure mPAP (mean pulmonary artery pressure), ejection fraction (EF) and body mass index (BMI). The prevalence of severe pulmonary hypertension and its associated factors were investigated in these patients. Results A total of 1078 patients was included in the study, of whom 628 (58.3%) were male and 450 (41.7%) were female. The mean age of the patients undergoing the study was 70.1±12.2. A total of 136 (13.7%) of them had mPAP (mm Hg)≥40mm Hg as severe pulmonary hypertension. Following multivariable analysis by using the backward conditional method, it was shown that seven variables had a significant correlation with severe PH. Conclusions The results showed that there is an independent correlation between hypoxia, hypopnea and compensatory metabolic alkalosis, polycythemia, left ventricular dysfunction, emaciation, and cachectic with severe pulmonary hypertension. The prevalence of severe PH in these patients was 13.7%.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.014
       
  • Incidence and risk factors of delayed intracranial hemorrhage in emergency
           department
    • Authors: Byunghyun Kim; Hyeonjeong Jeong; Joonghee Kim; Tackeun Kim; Kyuseok Kim; Heeyoung Lee; Soyeon Ahn; Yoo Hwan Jo; Jae Hyuk Lee; Ji Eun Hwang
      Abstract: Publication date: Available online 4 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Byunghyun Kim, Hyeonjeong Jeong, Joonghee Kim, Tackeun Kim, Kyuseok Kim, Heeyoung Lee, Soyeon Ahn, Yoo Hwan Jo, Jae Hyuk Lee, Ji Eun Hwang
      Objectives This study was performed to identify the risk factors for delayed intracranial hemorrhage and develop a risk stratification system for disposition of head trauma patients with negative initial brain imaging. Methods The data source was National Health Insurance Service-National Sample Cohort of Korea. We analyzed adult patients presenting to the ER from January 2004 to September 2012, who underwent brain imaging and discharged with or without short-term observation no longer than two days. The primary outcome was defined as any intracranial bleeding within a month defined by a new appearance of any of the diagnostic codes for intracranial hemorrhage accompanied by a new claim for brain imaging(s) within a month of the index visit. We performed a multivariable logistic regression analysis and built a parsimonious model for variable selection to develop a simple scoring system for risk stratification. Results During the study period, a total of 19,723 head injury cases were identified from the cohort and a total of 149 cases were identified as having delayed intracranial hemorrhage within 30days. In multivariable logistic regression model, old age, craniofacial fracture, neck injury, diabetes mellitus and hypertension were independent risk factors for delayed intracranial hemorrhage. We constructed the parsimonious model included age, craniofacial fracture and diabetes mellitus. The score showed area under the curve of 0.704 and positive predictive value of the score system was 0.014 when the score≥2. Conclusions We found old age, associated craniofacial fracture, any neck injury, diabetes mellitus and hypertension are the independent risk factors of delayed intracranial hemorrhage.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.009
       
  • The impracticality of surgically removing intramuscular long-acting
           injectable antipsychotic medication
    • Authors: Edward Kim; Srihari Gopal; Amy O'Donnell; Darmendra Ramcharran; Maju Mathews; Arun Singh
      Abstract: Publication date: Available online 4 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Edward Kim, Srihari Gopal, Amy O'Donnell, Darmendra Ramcharran, Maju Mathews, Arun Singh


      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.012
       
  • Emergency Medicine burnout and abuse — One doctor's perspective
    • Authors: Darren P. Mareiniss
      Abstract: Publication date: Available online 4 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Darren P. Mareiniss


      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.013
       
  • Diagnosis of delayed diffuse axonal İnjury
    • Authors: Çağri Kokkoz; Mehmet Irik; Halil I. Dayangaç; Mustafa Hayran; Adnan Bilge; Musa Çavuş
      Abstract: Publication date: Available online 4 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Çağri Kokkoz, Mehmet Irik, Halil I. Dayangaç, Mustafa Hayran, Adnan Bilge, Musa Çavuş
      Diffuse axonal injury is usually caused by head trauma, and patients have significant clinical symptoms during admission to the emergency department. In our case, we present a five-year-old patient who was involved in a car accident. During admission to the emergency department, the patient had no symptoms of trauma. However, 6 h after admission to emergency service, neurological symptoms occurred, and mental status changed. Diffuse axonal injury (DAI) is characterized by diffuse nerve axon injury in the brain and brainstem. This is one of the worst results of a head trauma and occurs in one-third of the patients admitted to the hospital with head trauma. In some studies, it has been reported that diffuse axonal injury is permanent in accelerated and decelerated head traumas without accompanying loss of consciousness. Neurological sequels have occurred in the recovery phase of some patients with diffuse axonal damage. In this study, we present a delayed diffuse axonal injury case accompanying a head trauma.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.010
       
  • Findings from a rivaroxaban program for acute venous thromboembolism upon
           emergency department discharge, with focus on utility of commercially
           available dose pack
    • Authors: Aileen Chu; Jill Limberg
      Abstract: Publication date: Available online 2 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Aileen Chu, Jill Limberg
      Objective To evaluate the impact of a rivaroxaban discharge initiative on the efficacy and safety of acute venous thromboembolism treatment in emergency department patients. Practice innovation Patients discharged on rivaroxaban from the emergency department were provided extensive counseling along with a commercially-available medication dose pack by the ED pharmacist. Patients were contacted by phone until they had obtained outpatient follow-up and remained adherent to anticoagulation beyond the initial first month of treatment. Methods In this retrospective chart review over a thirteen month period, efficacy and safety outcomes were compared between patients with intervention versus those who received usual care. Efficacy was defined by reduced 90-day readmission rates due to noncompliance or treatment failure, and improved medication compliance beyond the first month from discharge. Safety was determined by comparing 90-day readmission rates due to bleeding or adverse event. Results 41 patients received intervention with rivaroxaban, and 34 patients received usual care, with 76% prescribed rivaroxaban and remaining patients started on enoxaparin alone (6%) or enoxaparin plus warfarin (18%). Improved treatment efficacy in the intervention group was not found to be statistically significant. Safety outcomes were similar between the two groups. Conclusion Home treatment of acute VTE, facilitated by medication dose pack, is a promising tactic to ensure both immediate and long-term treatment efficacy and safety. Further studies are warranted to demonstrate clinical superiority of this intervention.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.001
       
  • A honey bee can threat ear: Sudden sensorineural hearing loss
    • Authors: Ufuk Düzenli; Nazım Bozan; Abdurrahman Ayral; Ahmet Faruk Kıroğlu
      Abstract: Publication date: Available online 2 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Ufuk Düzenli, Nazım Bozan, Abdurrahman Ayral, Ahmet Faruk Kıroğlu
      Sudden sensorineural hearing loss is an otologic emergency. Many etiological factors can lead to this pathology. Honey bee (Apis mellifera) sting may lead to local and systemic reactions due to sensitization of the patient. In this paper we described a sudden sensorineural hearing loss occurred after honey bee sting.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.005
       
  • Response to: AJEM 16046 “Response to: Medication errors with push dose
           pressors in the ED and ICU”
    • Authors: Nicole M. Acquisto; Ryan P. Bodkin; Christine Johnstone
      Abstract: Publication date: Available online 2 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Nicole M. Acquisto, Ryan P. Bodkin, Christine Johnstone


      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.007
       
  • Advance directives in emergency medicine: Patient perspectives and
           application to clinical scenarios
    • Authors: Catherine A. Marco; Eric Mozeleski; Dennis Mann; Michael B. Holbrook; Mark R. Serpico; Alban Holyoke; Karolin Ginting; Ahnas Ahmed
      Abstract: Publication date: Available online 2 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Catherine A. Marco, Eric Mozeleski, Dennis Mann, Michael B. Holbrook, Mark R. Serpico, Alban Holyoke, Karolin Ginting, Ahnas Ahmed


      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.002
       
  • Weight is time. What we carry matters
    • Authors: Tomasz Kłosiewicz; Andrzej Rut; Radosław Zalewski; Adrian Maciejewski; Karolina Andrysiak; Monika Rut; Marek Dąbrowski; Łukasz Szarpak; Mateusz Puślecki; Maciej Sip
      Abstract: Publication date: Available online 2 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Tomasz Kłosiewicz, Andrzej Rut, Radosław Zalewski, Adrian Maciejewski, Karolina Andrysiak, Monika Rut, Marek Dąbrowski, Łukasz Szarpak, Mateusz Puślecki, Maciej Sip


      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.003
       
  • Response to: “Medication errors with push dose pressors in the emergency
           department and intensive care units
    • Authors: Nadia I. Awad; Howard K. Mell; Anand K. Swaminathan; Bryan D. Hayes
      Abstract: Publication date: Available online 2 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Nadia I. Awad, Howard K. Mell, Anand K. Swaminathan, Bryan D. Hayes


      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.006
       
  • The impact of computed tomography head scans on emergency department
           management and length of stay in bizarre behavior patients
    • Authors: P. Ng; M. McGowan; M. Goldstein; C.D. Kassardjian; B.D. Steinhart
      Abstract: Publication date: Available online 2 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): P. Ng, M. McGowan, M. Goldstein, C.D. Kassardjian, B.D. Steinhart


      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.07.080
       
  • Kohler's disease presenting as acute foot injury
    • Authors: Mazin Alhamdani; Christopher Kelly
      Abstract: Publication date: Available online 2 August 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Mazin Alhamdani, Christopher Kelly
      Kohler's disease is rare cause of foot pain and limping in the pediatric population. The exact etiology of Kohler's disease is unknown. It usually presents as sudden and unexplained foot pain and limping. We report a case of a 5-year-old male who presented to the Pediatric Emergency Department with foot pain and inability to bear weight for two days after overactivity and acute foot injury. The patient was eventually diagnosed with Kohler's disease (avascular necrosis of the navicular bone). Although Kohler's disease is not very common, it should be considered in the differential diagnosis of foot pain in the pediatric population, as it may prevent unnecessary tests and treatments.

      PubDate: 2017-08-08T21:05:45Z
      DOI: 10.1016/j.ajem.2017.08.004
       
  • Information for Authors
    • Abstract: Publication date: August 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 8


      PubDate: 2017-08-08T21:05:45Z
       
 
 
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