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Publisher: Elsevier   (Total: 3031 journals)

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Showing 1 - 200 of 3031 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: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 79, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 22, 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: 303, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 196, 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: 21, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, 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: 4)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 119, 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: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 24, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 38, 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: 41, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 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: 18, 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: 22)
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: 33, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 7, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 6, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
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: 20, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 14)
Advances in Pharmacology     Full-text available via subscription   (Followers: 13, 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: 17, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 56)
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: 1, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 332, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 7)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 28, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 14)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 12)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 42, 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: 303, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 4, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 388, 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: 29, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 36, 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: 48, 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: 3, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 5)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 7, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 45, 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: 45, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 25, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 48, 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: 173, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 51, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 22, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 32, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 13, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 52, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 3)
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: 151, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 7, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 141, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Emergency Medicine
  [SJR: 0.574]   [H-I: 65]   [34 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0735-6757
   Published by Elsevier Homepage  [3031 journals]
  • MR angiography can guide ED management of suspected acute aortic
           dissection
    • Authors: Gary X. Wang; Sandeep S. Hedgire; Thang Q. Le; Jonathan D. Sonis; Brian J. Yun; Michael H. Lev; Ali S. Raja; Anand M. Prabhakar
      Pages: 527 - 530
      Abstract: Publication date: April 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 4
      Author(s): Gary X. Wang, Sandeep S. Hedgire, Thang Q. Le, Jonathan D. Sonis, Brian J. Yun, Michael H. Lev, Ali S. Raja, Anand M. Prabhakar
      Background Aortic dissection is typically evaluated with computed tomography angiography (CTA). However, the feasibility of using magnetic resonance angiography (MRA) in the ED is unclear. This study examined the indications and outcomes of MRA in suspected aortic dissection evaluation in the ED. Methods An IRB approved review identified patients who underwent MRA in the ED for acute thoracic aortic dissection from January 2010 to June 2016. Demographics, clinical assessment, CTA contraindications, outcomes, and ED disposition were analyzed. Results 50 MRAs were ordered for suspected thoracic aortic dissection. 21 (42%) for iodinated contrast allergy, 21 (42%) for renal insufficiency, 2 (4%) due to both, 2 (4%) to spare ionizing radiation, 2 (4%) for further work-up after CTA, and 2 (4%) due to prior contrast enhanced CT within 24h. Median ED arrival to MRA completion time was 311min. 42 studies were fully diagnostic; 7 were limited. One patient could not tolerate the examination. 49 MRAs were completed: 2 (4%) patients had acute dissection on MRA and 47 (96%) had negative exams. 17 (35%) received gadolinium. 18 (37%) patients were discharged home from the ED with a median length of stay of 643min. 2 (4%) were admitted for acute dissection seen on MRA and 29 (59%) for further evaluation. Conclusion MRA has a clear role in the evaluation for acute thoracic aortic dissection in the ED in patients with contraindications to CTA, and can guide management and facilitate safe discharge to home.

      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2016.11.039
       
  • Predicting morphine related side effects in the ED: An international
           cohort study
    • Authors: Vincent Bounes; Béatrice Charriton-Dadone; Jacques Levraut; Cyril Delangue; Françoise Carpentier; Stéphanie Mary-Chalon; Vanessa Houze-Cerfon; Agnès Sommet; Charles-Henri Houze-Cerfon; Michael Ganetsky
      Pages: 531 - 535
      Abstract: Publication date: April 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 4
      Author(s): Vincent Bounes, Béatrice Charriton-Dadone, Jacques Levraut, Cyril Delangue, Françoise Carpentier, Stéphanie Mary-Chalon, Vanessa Houze-Cerfon, Agnès Sommet, Charles-Henri Houze-Cerfon, Michael Ganetsky
      Study objectives Morphine is the reference treatment for severe acute pain in an emergency department. The purpose of this study was to describe and analyse opioid-related ADRs (adverse drug reactions) in a large cohort of emergency department patients, and to identify predictive factors for those ADRs. Methods In this prospective, observational, pharmaco-epidemiological international cohort study, all patients aged 18years or older who were treated with morphine were enrolled. The study was done in 23 emergency departments in the US and France. Baseline numerical rating scale score and initial and total doses of morphine titration were recorded. Logistic regression analysis was used to study the effects of demographic, clinical and medical history covariates on the occurrence of opioid-induced ADRs within 6h after treatment. Results A total of 1128 patients were included over 10months. Median baseline initial pain scores were 8/10 (7–10) versus 3/10 (1–4) after morphine administration. Median titration duration was 10min (IQR, 1–30). The occurrence of opioid-induced ADRs was 25% and 2% were serious. Patients experienced mainly nausea and drowsiness. Medical history of travel sickness (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.01–2.86) and history of nausea or vomiting post morphine (OR, 3.86; 95% CI, 2.29–6.51) were independent predictors of morphine related ADRs. Conclusion Serious morphine related ADRs are rare and unpredictable. Prophylactic antiemetic therapy could be proposed to patients with history of travel sickness and history of nausea or vomiting in a postoperative setting or after morphine administration.

      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2016.11.053
       
  • Presenting phenotypes of acute heart failure patients in the ED:
           Identification and implications
    • Authors: Richard M. Nowak; Brian P. Reed; Salvatore DiSomma; Prabath Nanayakkara; Michele Moyer; Scott Millis; Phillip Levy
      Pages: 536 - 542
      Abstract: Publication date: April 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 4
      Author(s): Richard M. Nowak, Brian P. Reed, Salvatore DiSomma, Prabath Nanayakkara, Michele Moyer, Scott Millis, Phillip Levy
      Background There is little known about the baseline hemodynamic (HD) profiles (beyond pulse/blood pressure) of patients presenting to the Emergency department (ED) with acute heart failure (AHF). Assessing these baseline parameters could help differentiate underlying HD phenotypes which could be used to develop specific phenotypic specific approaches to patient care. Methods Patients with suspected AHF were enrolled in the PREMIUM (Prognostic Hemodynamic Profiling in the Acutely Ill Emergency Department Patient) multinational registry and continuous HD monitoring was initiated on ED presentation using noninvasive finger cuff technology (Nexfin, BMEYE, Edwards Lifesciences, Irvine, California). Individuals with clinically suspected and later confirmed AHF were included in this analysis and initial 15minute averages for available HD parameters were calculated. K-means clustering was performed to identify out of 23 HD variables a set that provided the greatest level of inter-cluster discrimination and intra-cluster cohesions. Results A total of 127 patients had confirmed AHF. The final model, using mean normalized patient baseline HD values was able to differentiate these individuals into 3 distinct phenotypes. Cluster 1: normal cardiac index (CCI) and systemic vascular resistance index (SVRI); cluster 2: very low CI and markedly increased SVRI: and cluster 3: low CI and an elevated SVRI. These clusters were not differentiated using clinically available ED information. Conclusions Three distinct clusters were defined using novel noninvasive presenting HD monitoring technology in this cohort of ED AHF patients. Further studies are needed to determine whether phenotypic specific therapies based on these clusters can improve outcomes.

      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2016.12.003
       
  • A comparison between evacuation from the scene and interhospital
           transportation using a helicopter for subarachnoid hemorrhage
    • Authors: Kouhei Ishikawa; Kazuhiko Omori; Ikuto Takeuchi; Kei Jitsuiki; Toshihiko Yoshizawa; Hiromichi Ohsaka; Yasuaki Nakao; Takuji Yamamoto; Youichi Yanagawa
      Pages: 543 - 547
      Abstract: Publication date: April 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 4
      Author(s): Kouhei Ishikawa, Kazuhiko Omori, Ikuto Takeuchi, Kei Jitsuiki, Toshihiko Yoshizawa, Hiromichi Ohsaka, Yasuaki Nakao, Takuji Yamamoto, Youichi Yanagawa
      Purpose We investigated the changes in the vital signs and the final outcomes subarachnoid hemorrhage (SAH) patients who were evacuated from the scene using the doctor-helicopter (Dr. Heli) service and those who only underwent interhospital transportation using the doctor-helicopter Dr. Heli service to investigate safety of this system. Methods We retrospectively investigated all of the patients with non-traumatic SAH who were transported by a Dr. Heli between January 2010 and March 2016. The subjects were divided into two groups: the Scene group included subjects who were evacuated from the scene by a Dr. Heli, while the Interhospital group included subjects who were transported by a ground ambulance to a nearby medical facility and then transported by a Dr. Heli to a single tertiary center. Results The systolic blood pressure, ratio of cardiac arrest, and Fisher classification values of the patients in the Scene group were significantly greater than those in the Interhospital group. The Glasgow Coma Scale in the Scene group was significantly lower than that in the Interhospital group. After excluding the patients with cardiac arrest, the Glasgow Coma Scale scores of the patients in the two groups did not differ to a statistically significant extent during, before or after transportation. There were no significant differences in Glasgow Outcome Scores or the survival ratio of the two groups, even when cardiac arrest patients were included. Conclusion The present study indirectly suggests the safety of using a Dr. Heli to evacuate SAH patients from the scene.

      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2016.12.007
       
  • Nasal flaring as a clinical sign of respiratory acidosis in patients with
           dyspnea
    • Authors: José Gregorio Zorrilla-Riveiro; Anna Arnau-Bartés; Ramón Rafat-Sellarés; Dolors García-Pérez; Arantxa Mas-Serra; Rafael Fernández-Fernández
      Pages: 548 - 553
      Abstract: Publication date: April 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 4
      Author(s): José Gregorio Zorrilla-Riveiro, Anna Arnau-Bartés, Ramón Rafat-Sellarés, Dolors García-Pérez, Arantxa Mas-Serra, Rafael Fernández-Fernández
      Objective To determine whether the presence of nasal flaring is a clinical sign of respiratory acidosis in patients attending emergency departments for acute dyspnea. Methods Single-center, prospective, observational study of patients aged over 15 requiring urgent attention for dyspnea, classified as level II or III according to the Andorran Triage Program and who underwent arterial blood gas test on arrival at the emergency department. The presence of nasal flaring was evaluated by two observers. Demographic and clinical variables, signs of respiratory difficulty, vital signs, arterial blood gases and clinical outcome (hospitalization and mortality) were recorded. Bivariate and multivariate analyses were performed using logistic regression models. Results The sample comprised 212 patients, mean age 78years (SD=12.8), of whom 49.5% were women. Acidosis was recorded in 21.2%. Factors significantly associated with the presence of acidosis in the bivariate analysis were the need for pre-hospital medical care, triage level II, signs of respiratory distress, presence of nasal flaring, poor oxygenation, hypercapnia, low bicarbonates and greater need for noninvasive ventilation. Nasal flaring had a positive likelihood ratio for acidosis of 4.6 (95% CI 2.9–7.4). In the multivariate analysis, triage level II (aOR 5.16; 95% CI: 1.91 to 13.98), the need for oxygen therapy (aOR 2.60; 95% CI: 1.13–5.96) and presence of nasal flaring (aOR 6.32; 95% CI: 2.78–14.41) were maintained as factors independently associated with acidosis. Conclusions Nasal flaring is a clinical sign of severity in patients requiring urgent care for acute dyspnea, which has a strong association with acidosis and hypercapnia.

      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2016.12.008
       
  • Derivation of decision rules to predict clinically important outcomes in
           acute flank pain patients
    • Authors: Ralph C. Wang; Robert M. Rodriguez; Jahan Fahimi; M. Kennedy Hall; Stephen Shiboski; Tom Chi; Rebecca Smith-Bindman
      Pages: 554 - 563
      Abstract: Publication date: April 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 4
      Author(s): Ralph C. Wang, Robert M. Rodriguez, Jahan Fahimi, M. Kennedy Hall, Stephen Shiboski, Tom Chi, Rebecca Smith-Bindman
      Objective Routine CT for patients with acute flank pain has not been shown to improve patient outcomes, and it may unnecessarily expose patients to radiation and increased costs. As preliminary steps toward the development of a guideline for selective CT, we sought to determine the prevalence of clinically important outcomes in patients with acute flank pain and derive preliminary decision rules. Methods We analyzed data from a randomized trial of CT vs. ultrasonography for patients with acute flank pain from 15 EDs between October 2011 and February 2013. Clinically important outcomes were defined as inpatient admission for ureteral stones and alternative diagnoses. Clinically important stones were defined as stones requiring urologic intervention. We sought to derive highly sensitive decision rules for both outcomes. Results Of 2759 participants, 236 (8.6%) had a clinically important outcome and 143 (5.2%) had a clinically important stone. A CDR including anemia (hemoglobin <13.2g/dl), WBC count >11000/μl, age>42years, and the absence of CVAT had a sensitivity of 97.9% (95% CI 94.8–99.2%) and specificity of 18.7% (95% 17.2–20.2%) for clinically important outcome. A CDR including hydronephrosis, prior history of stone, and WBC count <8300/μl had a sensitivity of 98.6% (95% CI 94.5–99.7%) and specificity of 26.0% (95% 24.2–27.7%) for clinically important stone. Conclusions We determined the prevalence of clinically important outcomes in patients with acute flank pain, and derived preliminary high sensitivity CDRs that predict them. Validation of CDRs with similar test characteristics would require prospective enrollment of 2100 patients.

      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2016.12.009
       
  • A case of minimal pneumothorax with dynamic changes in ST segment similar
           to myocardial infarction
    • Authors: Seok-Ran Yeom; Sung-Wook Park; Young-Dae Kim; Byung-Jae Ahn; Jin-Hee Ahn; Il-Jae Wang
      Abstract: Publication date: Available online 19 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Seok-Ran Yeom, Sung-Wook Park, Young-Dae Kim, Byung-Jae Ahn, Jin-Hee Ahn, Il-Jae Wang
      Pneumothorax can cause a variety of electrocardiographic changes. ST segment elevation, which is mainly observed in myocardial infarction, can also be induced by pneumothorax. The mechanism is presumed to be a decrease in cardiac output, due to increased intra-thoracic pressure. We encountered a patient with ST segment elevation with minimal pneumothorax. Coronary angiography with ergonovine provocation test and echocardiogram had normal findings. The ST segment elevation was normalized by decreasing the amount of pneumothorax. We reviewed the literature and present possible mechanisms for this condition.

      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.037
       
  • Prognostic role of copeptin after traumatic brain injury: A systematic
           review and meta-analysis of observational studies
    • Authors: Kyu-Sun Choi; Youngsuk Cho; Bo-Hyoung Jang; Wonhee Kim; Chiwon Ahn; Tae Ho Lim; Hyoung-Joong Yi
      Abstract: Publication date: Available online 19 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Kyu-Sun Choi, Youngsuk Cho, Bo-Hyoung Jang, Wonhee Kim, Chiwon Ahn, Tae Ho Lim, Hyoung-Joong Yi
      Purpose Copeptin, the C-terminal portion of provasopressin, has emerged as a novel prognostic marker in neurocritical care, such as in traumatic brain injury (TBI). The aim of this study was to quantitatively assess the prognostic significance of initial plasma copeptin levels in the neurological outcome and mortality after traumatic brain injury. Materials and methods Six relevant studies with data from 552 patients were included in this meta-analysis. Results The plasma copeptin levels were found to be significantly higher in patients who died than in the survivors (standardized mean difference [SMD], 1.80). In the four studies reporting Glasgow outcome scale (GOS) data, patients with unfavorable outcomes had significantly higher copeptin levels than those with favorable outcomes (SMD, 1.62). The plasma copeptin level predicted mortality and unfavorable outcomes (AUC, 0.873; AUC, 0.876). Conclusions The present meta-analysis suggests that early measurement of plasma copeptin levels can provide better prognostic information about the functional outcome and mortality in patients with TBI.

      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.038
       
  • Using a new plateau hyperbaric chamber to alleviate high altitude hypoxia:
           Rabbit and human studies
    • Authors: Liang Sun; Meng-jiang Ding; Tian-cai Cai; Hao-jun Fan; Hong-mei Gao; Jian-peng Zhang
      Abstract: Publication date: Available online 19 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Liang Sun, Meng-jiang Ding, Tian-cai Cai, Hao-jun Fan, Hong-mei Gao, Jian-peng Zhang
      Objectives To validate the effects of the new plateau hyperbaric chamber on alleviating high altitude hypoxia on Mount Kun Lun. Methods A prospective, controlled study of rabbits and adult volunteers was conducted at altitudes of 355, 2880 and 4532m. We obtained arterial blood samples from rabbits and volunteers before and after hyperbaric treatment. The respiratory rate, heart rate, and blood pressure (BP) of adult volunteers were monitored during hyperbaric treatment. Results The mean PaO2 levels of experimental group rabbits and volunteers increased significantly after 60min of hyperbaric treatment at 350, 2880 and 4532m. The mean PaCO2 and pH levels of rabbits were not significant different before and after hyperbaric treatment at each altitude. The mean PaCO2 and pH levels were not significant different at 355m in the human study. However, at 2880 and 4532m, pH fell with increasing PaCO2 levels in humans before and after hyperbaric treatment. Conclusions The new multiplace plateau hyperbaric chamber may be used to alleviate plateau hypoxia by increasing patient PaO2. However, its value in treating AMS must be confirmed in field conditions.

      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.034
       
  • Acute pulmonary edema associated with ketamine use in a patient with
           coronary artery disease
    • Authors: Georges Mion
      Abstract: Publication date: Available online 18 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Georges Mion


      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.036
       
  • Parkour injuries presenting to United States emergency departments,
           2009–2015
    • Authors: Matthew E. Rossheim; Caroline J. Stephenson
      Abstract: Publication date: Available online 18 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Matthew E. Rossheim, Caroline J. Stephenson
      Background Few studies have examined injuries resulting from practicing parkour. The current study provides details on more parkour-related emergency department visits than existed in the combined research literature. Methods Cross-sectional data from the U.S. Consumer Product Safety Commission‘s National Electronic Injury Surveillance System were used to examine parkour-related injuries presenting to U.S. emergency departments over a seven year period. Results Most parkour injuries were reportedly caused by landing or from striking objects. Common diagnoses included fractures, sprains/strains, abrasions/contusions, and lacerations. More than half of reported injuries (57.7%) affected the patients' extremities. In this data, there appears to be a trend of increasing parkour injuries over time. Patients as young as 8years old have presented to emergency departments with parkour-related injuries in recent years. Conclusions Given the relatively severe injuries obtained by youth participants, more research is needed to guide injury prevention efforts. Understanding the nature of parkour-related injuries may help inform prevention efforts. However, more systematic monitoring of participation in parkour and related injuries is needed.

      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.040
       
  • Ultrasound-guided interscalene nerve block vs procedural sedation by
           propofol and fentanyl for anterior shoulder dislocations
    • Authors: Esmaeel Rayatdoost; Mohammad Mehdi Heyran; Mitra Movahedi; Amirhossin Mirafzal
      Abstract: Publication date: Available online 14 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Esmaeel Rayatdoost, Mohammad Mehdi Heyran, Mitra Movahedi, Amirhossin Mirafzal
      Background Few studies were performed to compare ultrasound guided brachial plexus block with procedural sedation for reduction of shoulder dislocations in the Emergency Department (ED). This study was done to provide further evidence regarding this comparison. Methods This was a randomized clinical trial performed on patients presenting with anterior shoulder dislocations to the emergency department of an academic level 2 trauma center. Exclusion criteria were any contraindications to the drugs used, any patient which may not be potentially assigned into both groups because of an underlying medical condition, presence of neurovascular compromise related to the dislocation, presence of concomitant fractures, and patient refusal to participate in the study. Patients were randomly assigned into the Procedural Sedation and Analgesia (PSA) group with propofol and fentanyl or ultrasound guided Inter-Scalene Brachial Plexus Block (ISBPB) with lidocaine and epinephrine. Results A total of 60 patients (30 in each group) were included in the study. The emergency room length of stay was significantly lower in the ISBPB group, with mean (SD) values of 108.6 (42.1) vs. 80.2 (25.2) minutes (p =0.005). However, pain scores in the PSA group during reduction showed advantage over ISBPB [0.38 vs. 3.43 (p <0.001)]. Moreover, patient satisfaction was higher with PSA (p <0.001). Conclusion Using ISBPB for reduction of anterior shoulder dislocations takes less time to discharge and may make it more feasible in conditions mandating faster discharge of the patient. However, since pain scores may be lower using PSA, this method may be preferred by many physicians in some other situations.

      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.032
       
  • Risk factors for unplanned transfer to the intensive care unit after
           emergency department admission: Methodological issues
    • Authors: Saeid Safiri; Erfan Ayubi
      Abstract: Publication date: Available online 14 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Saeid Safiri, Erfan Ayubi


      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.031
       
  • Determination of the appropriate oropharyngeal airway size in adults:
           Assessment using ventilation and an endoscopic view
    • Authors: Hyun Joo Kim; Shin Hyung Kim; Ji Young Min; Wyun Kon Park
      Abstract: Publication date: Available online 14 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Hyun Joo Kim, Shin Hyung Kim, Ji Young Min, Wyun Kon Park
      Introduction Size 9 and 8 airways for men and women, respectively, have been proposed as most appropriate based on endoscopy. However, a limitation of this guideline is that ventilation was not assessed. Methods In this retrospective review of prospectively collected data, 149 patients requiring tracheal intubation for general anaesthesia were included. The adequacy for manual and pressure-controlled mechanical ventilation and views at the distal end of each airway was assessed using a fibre-optic bronchoscope with various airway sizes (7, 8, 9, 10, and 11). Results For men, size 9, 10, and 11 airways permitted clear manual and adequate mechanical ventilation; size 7 and 8 airways caused partially obstructed manual and inadequate mechanical ventilation. On endoscopy, size 7 and 8 airways caused complete obstruction by the tongue; size 10 and 11 airways either touched or passed beyond the tip of the epiglottis. For women, the size 7 airway caused partially obstructed manual and inadequate mechanical ventilation; size 9 and 10 airways provided clear manual and adequate mechanical ventilation. The size 8 airway permitted clear manual ventilation, though mechanical ventilation was inadequate in one patient. On endoscopy, the size 7 airway caused complete obstruction in >50% of women; size 9, 10, and 11 airways either touched or passed beyond the tip of the epiglottis. Conclusions With respect to adequate ventilation in conjunction with an acceptable endoscopic view, size 9 and size 8 oropharyngeal airways appear to be the most appropriate sizes for clinical use in men and women, respectively.

      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.029
       
  • A trade-off relationship between chest compression depth and chest wall
           recoil during cardiopulmonary resuscitation
    • Authors: Hyeok
      Abstract: Publication date: Available online 14 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Je Hyeok Oh


      PubDate: 2017-04-20T14:34:07Z
       
  • Emergency department visits involving benzodiazepines and
           non-benzodiazepine receptor agonists
    • Authors: Christopher N. Kaufmann; Adam P. Spira; Caleb Alexander; Lainie Rutkow; Ramin Mojtabai
      Abstract: Publication date: Available online 14 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Christopher N. Kaufmann, Adam P. Spira, Caleb Alexander, Lainie Rutkow, Ramin Mojtabai
      Objective Sedative-hypnotic medications (e.g., Benzodiazepines [BZDs] and non-benzodiazepine receptor agonists [nBZRAs]) are associated with adverse events, especially in the elderly, that may require emergency department (ED) treatment. This study assessed outcomes from ED visits attributed to BZDs and/or nBZRAs, and variations in these associations by age group. Methods Data came from the 2004–2011 waves of the Drug Abuse Warning Network (DAWN). Visits were categorized as involving: (1) BZDs-only, (2) nBZRAs-only, (3) combination of BZDs and nBZRAs, or (4) any other sedative-hypnotic medication. DAWN also recorded the disposition (i.e., outcome) of the visit. Analyses focused on outcomes indicating a serious disposition defined as hospitalization, patient transfer or death. Using logistic regression, the association of BZD and nBZRA use with visit disposition was assessed after applying sample weights so as to be nationally representative of ED visits in the United States involving medications or illicit substances. Results Nineteen percent of visits involving other sedative-hypnotics, 28% involving BZDs-only, 20% involving nBZRAs-only and 48% involving a combination of BZDs and nBZRAs resulted in a serious disposition. Compared to visits involving other sedative-hypnotics, visits involving BZDs-only had 66% greater odds (Odds Ratio [OR]=1.66, 95% Confidence Interval [CI]=1.37–2.01), and visits involving a combination of BZDs and nBZRAs had almost four times increased odds of a serious disposition (OR=3.91, 95% CI=2.38–6.41). Results were similar across age groups. Conclusions Findings highlight the need for clinical and regulatory initiatives to reduce BZD use, especially in combination with nBZRAs, and to promote treatment with safer alternatives to these medications.

      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.023
       
  • Delayed admission to ICU in acute respiratory failure: Critical time for
           critical conditions
    • Authors: Sibel Ocak Serin; Gulsah Karaoren; Antonio M. Esquinas
      Abstract: Publication date: Available online 14 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Sibel Ocak Serin, Gulsah Karaoren, Antonio M. Esquinas


      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.026
       
  • Plasma copeptin levels in the patients with gastrointestinal bleeding
    • Authors: Ömer Salt; Polat Durukan; S. Ozkan; R. Saraymen; A. Sen; M.A. Yurci
      Abstract: Publication date: Available online 14 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Ömer Salt, Polat Durukan, S. Ozkan, R. Saraymen, A. Sen, M.A. Yurci
      Introduction Gastrointestinal bleeding is a significant cause of morbidity and mortality worldwide. In addition, it constitutes an important part of health expenditures. In this study, we aimed to determine whether there is a relationship between plasma copeptin levels and the etiology, location and severity of gastrointestinal bleeding. Materials and methods This study was performed prospectively in 104 consecutive patients who were admitted to an emergency department with complaints of bloody vomiting or bloody or black stool. To evaluate the level of biochemical parameters such as Full Blood Count (FBC), serum biochemistry, bleeding parameters and copeptin, blood samples were obtained at admission. For the copeptin levels, 2 more blood samples were obtained at the 12th and 24th hours after admission. The values obtained were compared using statistical methods. Results In terms of the etiology of bleeding, the copeptin levels in the patients with peptic ulcer were higher than the levels in patients with other gastrointestinal bleeding. However, the difference was not statistically significant. There were no significant differences among all groups' 0th, 12th and 24th hour levels of copeptin. Discussion We conclude that copeptin cannot be effectively used as a biochemical parameter in an emergency department to determine the etiology and location of gastrointestinal bleeding. It can, however, be used to make decisions on endoscopy and the hospitalization of patients with suspected gastrointestinal bleeding.

      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.033
       
  • Differences in test ordering between nurse practitioners and attending
           emergency physicians when acting as Provider in Triage
    • Authors: Tomer Begaz; David Elashoff; Tristan R. Grogan; David Talan; Breena Taira
      Abstract: Publication date: Available online 14 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Tomer Begaz, David Elashoff, Tristan R. Grogan, David Talan, Breena Taira
      Study objectives To compare diagnostic test ordering practices of NPs with those of physicians in the role of Provider in Triage (PIT). Methods This was a secondary analysis of data from a prospective RCT of waiting room diagnostic testing, where 770 patients had diagnostic studies ordered from the waiting room. The primary outcome was the number of test categories ordered by provider type. Other outcomes included total tests ordered by the end of ED stay, and time in an ED bed. We compared variables between groups using t-test and chi-square, constructed logistic regression models for individual test categories, and univariate and multivariate negative binomial models. Results Physicians ordered significantly more diagnostic test categories than NPs (1.75 vs. 1.54, p<0.001). By the end of their ED stay, there was no significant difference in total test categories ordered between provider type: physician 2.67 vs. NP 2.53 (p=0.08), using a nonbinomial model, incidence rate ratio (IRR) 1.07 (0.98–1.17). Patient time in an ED bed was not significantly different between physicians and NPs (NP 244min, SD=133, Physicians 248min, SD=152) difference 4min (−24.3–16.1) p=0.688. Conclusion NPs in the PIT role ordered slightly less diagnostic tests than attending physicians. This slight difference did not affect time spent in an ED bed. By the end of the ED stay, there was no significant difference in total test categories ordered between provider types. PIT staffing with NPs does not appear to be associated with excess test ordering or prolonged ED patient stays.

      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.027
       
  • The diagnostic and prognostic value of the optic nerve sheath diameter on
           CT for diagnosis spontaneous subarachnoid hemorrhage
    • Authors: Murat Yesilaras; Turgay Yilmaz Kilic; Suveyda Yesilaras; Ozge Duman Atilla; Dilek Öncel; Mahmut Çamlar
      Abstract: Publication date: Available online 14 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Murat Yesilaras, Turgay Yilmaz Kilic, Suveyda Yesilaras, Ozge Duman Atilla, Dilek Öncel, Mahmut Çamlar
      Introduction The aim of this study was to investigate the relationship between the optic nerve sheath diameter (ONSD) measured on non-contrast head computed tomography (CT) and the diagnosis and prognosis of spontaneous subarachnoid hemorrhage (SAH) on emergency department (ED) patients. Method We used a matched control group of patients with the same age and gender who were diagnosed in the ED with spontaneous SAH and who admitted to the ED with headache. Four emergency medicine attending physicians made the ONSD measurements. For measurements, the 3-mm posterior location where the optic nerve enters the eyeball was used. Results This study was done with 61 spontaneous SAHs with an equal number of control patients. The median ONSD for control and spontaneous SAH groups was 5.76 [interquartile range (IQR): 0.96] mm and 6.72 (IQR: 1.42) mm, respectively (p<0.001). The area under the receiver operating characteristic curve was determined as 0.791 (confidence interval 95% 0.710–0.872). At an ONSD threshold value of 6.1 mm, the sensitivity and specificity of SAH was 72%. There was no significant relationship between ONSD and in-hospital mortality in spontaneous SAH patients (p>0.05). The intra-class correlation coefficients for inter and intra-rater reliability were 0.84 and 0.95, respectively. Conclusion In patients with spontaneous SAH, the ONSD measured in the orbital sections of a head CT is strongly correlated with a SAH diagnosis. Assessment of ONSD in head CTs taken with spontaneous SAH suspicion may contribute to the diagnoses of spontaneous SAH.

      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.022
       
  • The effect of hypertonic saline and mannitol on coagulation in moderate
           traumatic brain injury patients
    • Authors: Haifeng Wang; Hongshi Cao; Xiaohong Zhang; Liang Ge; Li Bie
      Abstract: Publication date: Available online 14 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Haifeng Wang, Hongshi Cao, Xiaohong Zhang, Liang Ge, Li Bie
      Background Hyperosmolar therapy, using either hypertonic saline (HTS) or mannitol (MT), is considered the treatment of choice for intracranial hypertension, a disorder characterized by high intracranial pressure (ICP). However, hyperosmolar agents have been postulated to impair coagulation and platelet function. The aim of this study was to identify whether HTS and MT could affect coagulation in moderate traumatic brain injury (TBI) patients. Methods In this prospective and randomized double-blind study, we included adult patients with moderate TBI. Patients were divided into two groups according to the type of hypertonic solution administered. Group A patients received 20% MT and group B patients received 3% HTS. Rotational thromboelastometry (ROTEM) parameters were used to assess coagulation and platelet function. Results ROTEM parameters included CT (clotting time), CFT (clot formation time), maximum clot firmness (MCF) measured by MCF (EXTEM and INTEM), MCF (FIBTEM) and standard coagulation tests (p >0.05). No significant differences were found between the two groups. Moreover, ROTEM parameters did not show significant changes at different time points after administration of the hyperosmolar solutions (p >0.05). Conclusions Overall, use of 3% HTS and 20% MT for the control of ICP did not significantly affect patients' coagulation function. Therefore, hyperosmotic solution is safe and does not increase the risk of intracranial rebleeding.

      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.020
       
  • A randomized comparison of three chest compression techniques and
           associated hemodynamic effect during infant CPR: A randomized manikin
           study
    • Authors: Jacek Smereka; Lukasz Szarpak; Antonio Rodríguez-Núñez; Jerzy R. Ladny; Steve Leung; Kurt Ruetzler
      Abstract: Publication date: Available online 14 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Jacek Smereka, Lukasz Szarpak, Antonio Rodríguez-Núñez, Jerzy R. Ladny, Steve Leung, Kurt Ruetzler
      Introduction Pediatric cardiac arrest is an uncommon but critical life-threatening event requiring effective cardiopulmonary resuscitation. High-quality cardio-pulmonary resuscitation (CPR) is essential, but is poorly performed, even by highly skilled healthcare providers. The recently described two-thumb chest compression technique (nTTT) consists of the two thumbs directed at the angle of 90° to the chest while having the fingers fist-clenched. This technique might facilitate adequate chest-compression depth, chest-compression rate and rate of full chest-pressure relief. Methods 42 paramedics from the national Emergency Medical Service of Poland performed three single-rescuer CPR sessions for 10 minutes each. Each session was randomly assigned to the conventional two-thumb (TTHT), the conventional two-finger (TFT) or the nTTT. The manikin used for this study was connected with an arterial blood pressure measurement device and blood measurements were documented on a 10-seconds cycle. Results The nTTT provided significant higher systolic (82 vs. 30 vs. 41 mmHg). A statistically significant difference was noticed between nTTT and TFT (p<.001), nTTT and TTHT (p<0.001), TFT and TTHT (p=0.003). The median diastolic preassure using nTTT was 16 mmHg compared with 9 mmHg for TFT (p<0.001), and 9.5 mmHg for TTHT (p<0.001). Mean arterial pressure using distinct methods varied and amounted to 40 vs. 22. vs. 26 mmHg (nTTT vs. TFT vs. TTHT, respectively). A statistically significant difference was noticed between nTTT and TFT (p<0.001), nTTT and TTEHT (p<0.001), and TFT and TTHT (p<0.001). The highest median pulse pressure was obtained by the nTTT 67.5 mmHg. Pulse pressure was 31.5 mmHg in the TTHT and 24 mmHg in the TFT. The difference between TFT and TTHT (p=0.025), TFT and nTTT (p<0.001), as well as between TTHT and nTTT (p<0.001) were statistically significant. Conclusions The new nTTT technique generated higher arterial blood pressures compared to established chest compression techniques using an infant manikin model, suggesting a more effective chest compression. Our results have important clinical implications as nTTT was simple to perform and could be widely taught to both healthcare professionals and bystanders. Whether this technique translates to improved outcomes over existing techniques needs further animal studies and subsequent human trials.

      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.024
       
  • Peritoneal fluid localization on FAST examination in the pediatric trauma
           patient
    • Authors: Timothy E. Brenkert; Cynthia Adams; Rebecca L. Vieira; Rachel G. Rempell
      Abstract: Publication date: Available online 14 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Timothy E. Brenkert, Cynthia Adams, Rebecca L. Vieira, Rachel G. Rempell
      Objective To determine the location of intraperitoneal free fluid on FAST exam in pediatric patients undergoing evaluation for trauma. Methods Retrospective review of all FAST exams positive for intraperitoneal free fluid performed in patients sustaining trauma between August 2009 and February 2016 in an urban pediatric emergency department. Positive results were categorized into one of nine potential intraperitoneal locations; 4 each in the right and left upper quadrants, and the pelvis. Results One hundred and three complete positive studies were reviewed. The median age of patients was 10years (IQR 7–14) with 66% being male. Ninety-five percent had fluid present in the pelvis, 35% had fluid present in the RUQ, and 16.5% had fluid present in the LUQ. Overall, the most frequent location of fluid outside of the pelvis was found at the inferior tip of the liver, present in 83.3% of patients with fluid in the RUQ and 29% of all patients with a positive FAST. Conclusions The majority of pediatric trauma patients with a positive FAST exam will exhibit free fluid in the pelvis. Particular attention should be directed to the inferior tip of the liver in children as this represents the most common location for fluid collection outside the pelvis.

      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.025
       
  • Attending documentation contribution to billing at an academic emergency
           department with an electronic health record
    • Authors: Brian J. Yun; Stephen C. Dorner; Brian M. Baccari; John Brennan; Karen Smith; Ali S. Raja; Benjamin A. White
      Abstract: Publication date: Available online 14 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Brian J. Yun, Stephen C. Dorner, Brian M. Baccari, John Brennan, Karen Smith, Ali S. Raja, Benjamin A. White
      Introduction In emergency medicine (EM), patient care documentation serves many functions, including supporting reimbursement. In addition, many electronic health record systems facilitate automatically populating certain data fields. As a result, in the academic model, the attending's note may now more often recapitulate many of the same elements found in the resident's or physician assistant's (PA) note. We sought to determine the value of additional attending documentation, and how often the attending documentation prevented a downcoding event. Methods This retrospective, cross-sectional study was exempted by the Institutional Review Board. We randomly reviewed 10 charts for each attending physician during the study period. Outcome measures included the frequency of prevented downcoding events, and the difference in this incidence between residents and PAs. Results 530 charts were identified, but 6 were excluded as these patients left without being seen. 524 charts remained, of which 286 (45%) notes were written by residents and 238 (55%) notes were written by PAs. Attending documentation prevented 16 (3%) downcoding events, of which 11 were in patient encounters documented by residents and 5 were in encounters documented by PAs (p=0.057). Conclusions In this study of an academic medical center documentation model with an EHR, EM attending documentation of the history of present illness, review of systems, physical exam, and medical decision making portions prevented downcoding in a small number of cases. In addition, there was no significant difference in the incidence of prevented downcoding events between residents and PAs.

      PubDate: 2017-04-20T14:34:07Z
      DOI: 10.1016/j.ajem.2017.04.021
       
  • The imperative for emergency medicine to create its own alternative
           payment model
    • Authors: Laura Medford-Davis; David Marcozzi; Shantanu Agrawal; Brendan G. Carr; Emily Carrier
      Abstract: Publication date: Available online 14 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Laura N. Medford-Davis
      Seven years after the Affordable Care Act legislated Alternative Payment Models, it is time for Emergency Medicine to find its place within this value-based trend by developing its own Alternative Payment Model.

      PubDate: 2017-04-14T11:24:40Z
      DOI: 10.1016/j.annemergmed.2016.10.031
       
  • A novel clinical index for the assessment of RVD in acute pulmonary
           embolism: Blood pressure index
    • Authors: Hale Ates; Ihsan Ates Harun Kundi Mehmet Fettah Arikan Fatma
      Abstract: Publication date: Available online 12 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Hale Ates, Ihsan Ates, Harun Kundi, Mehmet Fettah Arikan, Fatma Meric Yilmaz
      Background This study aims to investigate the role of the blood pressure index (BPI), which is a new index that we developed, in detection of right ventricular dysfunction (RVD) in acute pulmonary embolism (APE). Methods A total of 539 patients, (253 males and 286 females), diagnosed with APE using computer tomography pulmonary angiography were included in the study. The BPI was obtained by dividing systolic blood pressure (SBP) by diastolic blood pressure (DBP). Results Mean DBP (75±11mmHg vs 63±15mmHg; p <0.001, respectively) was found to be higher in RVD patients compared to those without RVD, whereas BPI (1.5±0.1 vs 1.9±0.2; p <0.001, respectively) was lower. Examining the performance of BPI in prediction of RVD using receiver operating characteristic curve analysis (area under curve±SE=0.975±0.006; p <0.001), it was found that BPI could predict RVD with very high sensitivity (92.8%) and specificity (100%) and had a positive predictive value of 100% and a negative predictive value of 42.1%. According to the analysis, the highest youden index for the optimal prediction value was found to be 0.478 and the BPI≤1.4 was found to predict mortality 68.6% sensitivity and 80.8% specificity (Area under curve±SE=0.777±0.051; p <0.001). Conclusions We found that BPI was an index with high positive predictive value and low negative predictive value in detection of RVD.

      PubDate: 2017-04-14T11:24:40Z
       
  • Effectiveness of finger-marker for maintaining the correct compression
           point during paediatric resuscitation: A simulation study
    • Authors: Jae Yun Jung; Young Ho Kwak; Hyuksool Kwon; Yoo Jin Choi; Do Kyun Kim; Hee Chan Kim; Jung Chan Lee; Ji Heum Park; Hyungsoo Lim
      Abstract: Publication date: Available online 11 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Jae Yun Jung, Young Ho Kwak, Hyuksool Kwon, Yoo Jin Choi, Do Kyun Kim, Hee Chan Kim, Jung Chan Lee, Ji Heum Park, Hyungsoo Lim
      Objective High-quality cardiopulmonary resuscitation is a significant factor for increasing the survival rate of paediatric patients. This study is to investigate the effectiveness of finger-marker stickers for maintaining the correct compression point during simulated infant cardiopulmonary resuscitation (CPR). Methods This crossover simulation study was conducted with 40 emergency physicians and paramedics at emergency departments of 2 tertiary hospitals. We used a remodeled infant CPR manikin developed to measure CPR quality indicators. After random coupling of participants (20 pairs), the pre-group (10 pairs) performed conventional 2-rescuer infant manikin CPR, then performed sticker-applied CPR after 1month. The post-group (10 pairs) performed the process in the opposite order. The participants placed finger-marker stickers to indicate the appropriate compression point before starting CPR. We compared accurate finger placement rates and other CPR quality indicators (compression depth, rate, complete chest recoil, and hands-off time) with and without the finger-marker sticker. Results All finger-marker stickers were correctly attached within 5s (4.88±1.28s) of approaching the model. There were significant differences in the rate of correct finger compression position between conventional and sticker-applied CPR (25.4% [IQRs 7.6–69.8] vs. 88.2% [IQRs 69.6–95.5], P<0.001). Results did not differ according to sex, career, and job of the participants. There were no significant differences in mean compression rate, depth, hands-off times, and rate of fully recoiled compression between the 2 groups. Conclusion Finger-marker stickers can be used to maintain correct finger positioning during 2-rescuer infant manikin CPR.

      PubDate: 2017-04-14T11:24:40Z
      DOI: 10.1016/j.ajem.2017.04.003
       
  • Comparison of outcomes for pediatric paraphimosis reduction using topical
           anesthetic versus intravenous procedural sedation
    • Authors: Brett Burstein; Raphael Paquin
      Abstract: Publication date: Available online 11 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Brett Burstein, Raphael Paquin
      Background Paraphimosis is an acute urologic emergency requiring urgent manual reduction, frequently necessitating procedural sedation (PS) in the pediatric population. The present study sought to compare outcomes among pediatric patients undergoing paraphimosis reduction using a novel topical anesthetic (TA) technique versus PS. Methods We performed a retrospective analysis of all patients <18-years-old, presenting to a tertiary pediatric ED requiring analgesia for paraphimosis reduction between October 2013 and September 2016. The primary outcome was reduction first attempt success; secondary outcomes included Emergency Department length of stay (ED LOS), adverse events and return visits. Dichotomous outcomes were analyzed by Chi-square testing and multivariate linear regression was used to compare continuous variables. Results Forty-six patients were included; 35 underwent reduction using TA, 11 by PS. Patient age and duration of paraphimosis at ED presentation did not differ between groups. There was no difference in first attempt success between TA (32/35, 91.4%) and PS groups (9/11, 81.8%; p =0.37). Mean ED LOS was 209min shorter for TA patients (148min vs. 357min, p =0.001) and remained significantly shorter after controlling for age and duration of paraphimosis (adjusted mean difference −198min, p =0.003). There were no return visits or major adverse events in either group, however, among successful reduction attempts, PS patients more frequently experienced minor adverse events (7/9 vs. 0/32, p <0.001). Conclusions Paraphimosis reduction using TA was safe and effective. Compared to PS, TA was associated with a reduced ED LOS and fewer adverse events. TA could potentially allow more timely reduction with improved patient experience and resource utilization.

      PubDate: 2017-04-14T11:24:40Z
      DOI: 10.1016/j.ajem.2017.04.015
       
  • The association of hemodialysis and survival in intubated
           salicylate-poisoned patients
    • Authors: Daniel J. McCabe; Jenny J. Lu
      Abstract: Publication date: Available online 10 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Daniel J. McCabe, Jenny J. Lu
      Introduction Salicylate poisonings are common due to their multiple uses and wide availability. The variation of presenting symptoms contributes to inconsistent treatments in the emergency department. Patients with severe salicylate overdose require a high minute ventilation. Early in the course of an overdose, a patient will require hyperventilation. If they become too fatigued to compensate, mechanical ventilation may be needed. It can be impossible to recreate such a high minute ventilation with mechanical ventilation. This places patients at a high risk for decompensation and death. Hemodialysis is an effective elimination technique for salicylate overdose and should be considered early. Methods All salicylate cases reported to the Illinois Poison Center were reviewed from 2003–2014. All intubated patients with a salicylate level >50mg/dl were included for analysis. Survival was compared to measured serum salicylate level and the administration of hemodialysis. Results 56 Cases were identified with an overall survival rate of 73.2% in patients with a serum salicylate level >50mg/dL. When patients did not receive hemodialysis, a peak salicylate level >50mg/dL had a 56% survival rate and 0% survival when the level was >80mg/dL. In the patients who received hemodialysis, a peak salicylate level >50mg/dL had a 83.9% survival rate and 83.3% survival when the level was >80mg/dL. Conclusion Survival was decreased in these patients if hemodialysis was not performed. Mortality increases with the measured serum salicylate level. Timely hemodialysis for intubated salicylate overdose patients decreases mortality.

      PubDate: 2017-04-14T11:24:40Z
      DOI: 10.1016/j.ajem.2017.04.017
       
  • Prehospital removal improves neurological outcomes in elderly patient with
           foreign body airway obstruction
    • Authors: Yutaka Igarashi; Shoji Yokobori; Yudai Yoshino; Tomohiko Masuno; Masato Miyauchi; Hiroyuki Yokota
      Abstract: Publication date: Available online 10 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Yutaka Igarashi, Shoji Yokobori, Yudai Yoshino, Tomohiko Masuno, Masato Miyauchi, Hiroyuki Yokota
      Objective In Japan, the number of patients with foreign body airway obstruction by food is rapidly increasing with the increase in the population of the elderly and a leading cause of unexpected death. This study aimed to determine the factors that influence prognosis of these patients. Methods This is a retrospective single institutional study. A total of 155 patients were included. We collected the variables from the medical records and analyzed them to determine the factors associated with patient outcome. Patient outcomes were evaluated using cerebral performance categories (CPCs) when patients were discharged or transferred to other hospitals. A favorable outcome was defined as CPC 1 or 2, and an unfavorable outcome was defined as CPC 3, 4, or 5. Results A higher proportion of patients with favorable outcomes than unfavorable outcomes had a witness present at the accident scene (68.8% vs. 44.7%, P=0.0154). Patients whose foreign body were removed by a bystander at the accident scene had a significantly high rate of favorable outcome than those whose foreign body were removed by emergency medical technicians or emergency physician at the scene (73.7% vs. 31.8%, P<0.0075) and at the hospital after transfer (73.7% vs. 9.6%, P<0.0001). Conclusions The presence of a witness to the aspiration and removal of the airway obstruction of patients by bystanders at the accident scene improves outcomes in patients with foreign body airway obstruction. When airway obstruction occurs, bystanders should remove foreign bodies immediately.

      PubDate: 2017-04-14T11:24:40Z
      DOI: 10.1016/j.ajem.2017.04.016
       
  • Yankauer suction catheters with “safety” vent holes may impair safety
           in emergent airway management
    • Authors: Robert Cox; Mark Andreae; Bradley Shy; James DuCanto; Reuben Strayer
      Abstract: Publication date: Available online 10 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Robert Cox, Mark Andreae, Bradley Shy, James DuCanto, Reuben Strayer


      PubDate: 2017-04-14T11:24:40Z
      DOI: 10.1016/j.ajem.2017.04.009
       
  • The timing of chest compressions and artificial ventilation: A
           re-appraisal
    • Authors: Ignacy Baumberg; David Baker; Przemysław Wołoszyn; Janusz Andres; Wojciech Kopacki; Paweł Krawczyk; Wojciech Gaszyński
      Abstract: Publication date: Available online 9 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Ignacy Baumberg, David Baker, Przemysław Wołoszyn, Janusz Andres, Wojciech Kopacki, Paweł Krawczyk, Wojciech Gaszyński


      PubDate: 2017-04-14T11:24:40Z
      DOI: 10.1016/j.ajem.2017.04.018
       
  • The relative contribution of provider and ED-level factors to variation
           among the top 15 reasons for ED admission
    • Authors: Imad Khojah; Suhui Li; Qian Luo; Griffin Davis; Jessica E. Galarraga; Michael Granovsky; Ori Litvak; Samuel Davis; Robert Shesser; Jesse M. Pines
      Abstract: Publication date: Available online 6 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Imad Khojah, Suhui Li, Qian Luo, Griffin Davis, Jessica E. Galarraga, Michael Granovsky, Ori Litvak, Samuel Davis, Robert Shesser, Jesse M. Pines
      Study objective We examine adult emergency department (ED) admission rates for the top 15 most frequently admitted conditions, and assess the relative contribution in admission rate variation attributable to the provider and hospital. Methods This was a retrospective, cross-sectional study of ED encounters (≥18years) from 19 EDs and 603 providers (January 2012–December 2013), linked to the Area Health Resources File for county-level information on healthcare resources. “Hospital admission” was the outcome, a composite of inpatient, observation, or intra-hospital transfer. We studied the 15 most commonly admitted conditions, and calculated condition-specific risk-standardized hospital admission rates (RSARs) using multi-level hierarchical generalized linear models. We then decomposed the relative contribution of provider-level and hospital-level variation for each condition. Results The top 15 conditions made up 34% of encounters and 49% of admissions. After adjustment, the eight conditions with the highest hospital-level variation were: 1) injuries, 2) extremity fracture (except hip fracture), 3) skin infection, 4) lower respiratory disease, 5) asthma/chronic obstructive pulmonary disease (A&C), 6) abdominal pain, 7) fluid/electrolyte disorders, and 8) chest pain. Hospital-level intra-class correlation coefficients (ICC) ranged from 0.042 for A&C to 0.167 for extremity fractures. Provider-level ICCs ranged from 0.026 for abdominal pain to 0.104 for chest pain. Several patient, hospital, and community factors were associated with admission rates, but these varied across conditions. Conclusion For different conditions, there were different contributions to variation at the hospital- and provider-level. These findings deserve consideration when designing interventions to optimize admission decisions and in value-based payment programs.

      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.03.074
       
  • Transvaginal ultrasounds in nonpregnant emergency department patients with
           abnormal uterine bleeding
    • Authors: Brian J. Yun; Ali S. Raja; Stephen C. Dorner; McKinley Glover; Melody J. Eckardt; Benjamin A. White; Jonathan D. Sonis; Anand M. Prabhakar
      Abstract: Publication date: Available online 6 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Brian J. Yun, Ali S. Raja, Stephen C. Dorner, McKinley Glover, Melody J. Eckardt, Benjamin A. White, Jonathan D. Sonis, Anand M. Prabhakar


      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.04.011
       
  • Potential drug interaction with opioid agonist in the setting of chronic
           low-dose opioid antagonist use
    • Authors: James B. Leonard; Vidya Nair; Christopher J. Diaz; Jonathan B. Penoyar; Penelope A. Goode
      Abstract: Publication date: Available online 6 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): James B. Leonard, Vidya Nair, Christopher J. Diaz, Jonathan B. Penoyar, Penelope A. Goode
      Low dose naltrexone (LDN) has been evaluated in several small studies for the treatment of inflammatory conditions. It is thought to work through modulation of inflammatory mediators and upregulation of endogenous opioid receptors. This may hypersensitize patients to exogenous opioids. Drug-drug interaction screening tools built into electronic health records and other services identify the interaction as risk of opioid withdrawal rather than hypersensitivity. We present a case of a drug-drug interaction in a patient who was receiving LDN treatment of multiple sclerosis. The patient received a single dose of oxycodone 5mg that resulted in obtundation unresponsive to painful stimuli necessitating the administration of naloxone boluses and infusion along with admission to the intensive care unit for 1 night. The patient responded well to naloxone therapy. He was discharged in satisfactory condition.

      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.04.012
       
  • Comparing performance of Macintosh and Intubrite laryngoscopes for
           intubation
    • Authors: Jin-Hua Jin; Fu-Shan Xue; Hui-Xian Li; Ya-Yang Liu
      Abstract: Publication date: Available online 6 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Jin-Hua Jin, Fu-Shan Xue, Hui-Xian Li, Ya-Yang Liu


      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.04.010
       
  • Prospective study of a non-restrictive decision rule for acute aortic
           syndrome
    • Authors: Judah Goldschmiedt; Jeffrey M. Levsky; Eran Y. Bellin; Esther Mizrachi; David Esses; Linda B. Haramati
      Abstract: Publication date: Available online 6 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Judah Goldschmiedt, Jeffrey M. Levsky, Eran Y. Bellin, Esther Mizrachi, David Esses, Linda B. Haramati
      Objectives To determine the impact of a non-restrictive clinical decision rule on CT utilization for Emergency Department patients suspected of having an acute aortic syndrome (AAS). Methods We prospectively assessed the performance of a previously described, collaboratively designed, non-restrictive clinical decision rule for AAS. Emergency Department patients with suspected AAS were stratified into low and high-risk groups based on decision rule results, from July 2013–August 2014. Patients with acute trauma, prior AAS or aortic surgery were excluded. CT dose reduction protocols were concurrently implemented as a quality improvement measure. Bivariate analysis was performed to compare the prospective cohort with the historical derivation cohort for CT utilization rates, results of CT, AAS incidence and radiation exposure. The performance of the clinical decision rule was evaluated. Results Compared with the historic cohort, the study cohort demonstrated a lower CT utilization rate [0.344% (427/124,093) versus 0.477% (1465/306,961), (p <0.001)], a trend toward higher CT diagnostic yield [4.4% (19/427) versus 2.7% (40/1465), (p =0.08)]. AAS incidence was similar [0.015% (19/124,093) versus 0.013% (40/306,961), (p =0.57)]. The mean effective radiation dose was markedly lower [12±5.5mSv versus 43±20mSv, (p <0.0001)]. The clinical decision rule correctly stratified only 56% (10/18) of patients with AAS as high-risk. Conclusions A non-restrictive, collaboratively designed, clinical decision rule for Emergency Department patients with suspected AAS performed poorly in risk-stratifying patients for AAS. However, its implementation was associated with a significant and safe decrease in CT utilization.

      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.04.014
       
  • ETView® VivaSight SL as a novel method of endotracheal intubation
    • Authors: Adrian Maciejewski; Michal Maciej Nowicki; Marek Dabrowski; Agata Dabrowska; Tomasz Klosiewicz
      Abstract: Publication date: Available online 5 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Adrian Maciejewski, Michal Maciej Nowicki, Marek Dabrowski, Agata Dabrowska, Tomasz Klosiewicz


      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.04.013
       
  • Caution using the new “no pain no gain” approach
    • Authors: Jared Strote
      Abstract: Publication date: Available online 5 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Jared Strote


      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.04.008
       
  • Reply to: Caution using the new “no pain no gain” approach
    • Authors: Reuben J. Strayer; Sergey M. Motov; Lewis Nelson
      Abstract: Publication date: Available online 5 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Reuben J. Strayer, Sergey M. Motov, Lewis Nelson


      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.04.007
       
  • Diltiazem versus esmolol for acute rate control in the emergency
           department
    • Authors: Somer Harvey; Kayla Wilson; A. Brad Hall
      Abstract: Publication date: Available online 4 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Somer Harvey, Kayla Wilson, A. Brad Hall


      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.04.005
       
  • Removing default dispense quantity from opioid prescriptions in the
           electronic medical record
    • Authors: Michael D. Zwank; Shaun M. Kennedy; Logan H. Stuck; Bradley D. Gordon
      Abstract: Publication date: Available online 3 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Michael D. Zwank, Shaun M. Kennedy, Logan H. Stuck, Bradley D. Gordon


      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.04.002
       
  • Lung ultrasonography to diagnose pneumothorax of the newborn
    • Authors: Jing Liu; Jing-Han Chi; Xiao-Ling Ren; Jie Li; Ya-Juan Chen; Zu-Lin Lu; Ying Liu; Wei Fu; Rong-Ming Xia
      Abstract: Publication date: Available online 3 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Jing Liu, Jing-Han Chi, Xiao-Ling Ren, Jie Li, Ya-Juan Chen, Zu-Lin Lu, Ying Liu, Wei Fu, Rong-Ming Xia
      Objective To explore the reliability and accuracy of lung ultrasound for diagnosing neonatal pneumothorax. Methods This study was divided into two phases. (1) In the first phase, from January 2013 to June 2015, 40 patients with confirmed pneumothorax had lung ultrasound examinations performed to identify the sonographic characteristics of neonatal pneumothorax. (2) In the second phase, from July 2015 to August 2016, lung ultrasound was undertaken on 50 newborn infants with severe lung disease who were suspected of having pneumothorax, to evaluate the sonographic accuracy and reliability to diagnose pneumothorax. Results (1) The main ultrasonic manifestations of pneumothorax are as follows: ① lung sliding disappearance, which was observed in all patients (100%); ② the existence of the pleural line and the A-line, which was also observed in all patients (100%); ③ the lung point, which was found in 75% of the infants with mild-moderate pneumothorax but not found to exist in 25% of the severe pneumothorax patients; ④ the absence of B-lines in the area of the pneumothorax (100% of the pneumothorax patients); and ⑤ no lung consolidation existed in the area of the pneumothorax (100% of the pneumothorax patients). (2) The accuracy and reliability of the lung sonographic signs of lung sliding disappearance as well as the existence of the pleural line and the A-line in diagnosing pneumothorax were as follows: 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predictive value. When the lung point exists, the diagnosis is mild-moderate pneumothorax, whereas if no lung point exists, the diagnosis is severe pneumothorax. Conclusion Lung ultrasound is accurate and reliable in diagnosing and ruling out neonatal pneumothorax and, in our study, was found to be as accurate as chest X-ray.

      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.04.001
       
  • Erratum to “Real-time tidal volume feedback guides optimal ventilation
           during simulated CPR” [Am J Emerg Med 35(2) (2017) 292–29]
    • Authors: Kyoung Min You; Chiwon Lee; Woon Yong Kwon; Jung Chan Lee; Gil Joon Suh; Kyung Su Kim; Min Ji Park; Sungwan Kim
      Abstract: Publication date: Available online 3 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Kyoung Min You, Chiwon Lee, Woon Yong Kwon, Jung Chan Lee, Gil Joon Suh, Kyung Su Kim, Min Ji Park, Sungwan Kim


      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.03.020
       
  • Performance of an outpatient stress testing protocol for low risk chest
           pain patients presenting to the emergency department
    • Authors: Jessica R. Balderston; Taruna Aurora; Michael C. Kontos; Richard Zhang; Zachary M. Gertz
      Abstract: Publication date: Available online 3 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Jessica R. Balderston, Taruna Aurora, Michael C. Kontos, Richard Zhang, Zachary M. Gertz


      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.04.004
       
  • Successful treatment of propafenone-induced cardiac arrest by calcium
           gluconate: A case report
    • Authors: Xiaoyu Chen; Zaixing Yang
      Abstract: Publication date: Available online 3 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Xiaoyu Chen, Zaixing Yang
      Propafenone is prescribed for the control of cardiac ventricular arrhythmias. Poisoning from propafenone intoxication is rare, but the survival rate of patients is low. We present a case of a 37-year-old man who developed cardiac arrest due to propafenone intoxication. Cardiopulmonary resuscitation, plasmapheresis, and other medical treatments had no effect on cardiac arrest. After repeated administrations of calcium gluconate, the patient achieved a full recovery. To the best of our knowledge, this is the first case report in which a full recovery from cardiac arrest was achieved by administration of calcium gluconate. We recommend that for patients poisoned by propafenone, close monitoring for decreased blood calcium is important.

      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.04.006
       
  • The effect of the apneic period on the respiratory physiology of patients
           undergoing intubation in the emergency department
    • Authors: Jason R. West; Anthony Scoccimarro; Cody Kramer; Nicholas D. Caputo
      Abstract: Publication date: Available online 2 April 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Jason R. West, Anthony Scoccimarro, Cody Kramer, Nicholas D. Caputo
      Objectives We sought to examine the physiological impact the apneic period has on the respiratory physiology of patients undergoing intubation in the emergency department and whether DAO, the delivery of 15L oxygen by nasal cannula during apnea, can affect the development of respiratory acidosis. Methods This was a prospective observational cohort study conducted at an urban academic level 1 trauma center. A convenience sample of 100 patients was taken. Timed data collection forms were completed during the periintubation period. We report the mean ABG and end-tidal CO2 (EtCO2) values between those with normal and prolonged apnea times (>60s) and between those who received DAO and those who did not. Results 100 patients met our inclusion criteria. There were no significant differences in the pre-RSI ABG values between those who received DAO and those who did not and between those with apnea times less than or >60s. Only in the group of patients with apnea times >60s did significant changes in respiratory physiology occur. DAO did not alter the trend in respiratory acidosis during the periintubation period. EtCO2 increased as apnea times were prolonged, and DAO altered this trend. Conclusions Post-RSI EtCO2 increased as apnea times were prolonged. DAO may alter this trend. Statistically significant changes in pH and PaCO2 (mean differences of 0.15 and 12.5, respectively) occurred in the group of patients who had mean apnea times of >60s but not in those with apnea times <60s.

      PubDate: 2017-04-07T11:16:35Z
      DOI: 10.1016/j.ajem.2017.03.076
       
  • Information for Authors
    • Abstract: Publication date: April 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 4


      PubDate: 2017-04-07T11:16:35Z
       
 
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
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