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Publisher: Elsevier   (Total: 3049 journals)

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Showing 1 - 200 of 3089 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 7)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 25, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 86, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 363, 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)
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Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
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Acta Pharmaceutica Sinica B     Open Access   (Followers: 1)
Acta Poética     Open Access   (Followers: 4)
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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: 6)
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Additives for Polymers     Full-text available via subscription   (Followers: 21)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 133, SJR: 5.2, h-index: 222)
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Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
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Advances in Digestive Medicine     Open Access   (Followers: 7)
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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: 51, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
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Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
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Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 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: 8, 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 Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
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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)
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Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
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Advances in Psychology     Full-text available via subscription   (Followers: 62)
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Advances in Radiation Oncology     Open Access  
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Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
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Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
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Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 44, 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: 331, 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: 417, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 16, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 40, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 55, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 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)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 46, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 49, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 40, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, 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: 199, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 59, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 25, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 35, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 58, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 12)
Anales de Cirugia Vascular     Full-text available via subscription  
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Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 167, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
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Angiologia e Cirurgia Vascular     Open Access  

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Journal Cover American Journal of Emergency Medicine
  [SJR: 0.574]   [H-I: 65]   [40 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0735-6757
   Published by Elsevier Homepage  [3049 journals]
  • Characteristics and outcomes of acute pediatric blunt torso trauma based
           on injury intent
    • Authors: Rohit P. Shenoi; Elizabeth A. Camp; Daniel M. Rubalcava; Andrea T. Cruz
      Pages: 1791 - 1797
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Rohit P. Shenoi, Elizabeth A. Camp, Daniel M. Rubalcava, Andrea T. Cruz
      Introduction Blunt trauma is a leading cause of pediatric morbidity. We compared injuries, interventions and outcomes of acute pediatric blunt torso trauma based on intent. Methods We analyzed de-identified data from a prospective, multi-center emergency department (ED)-based observational cohort of children under age eighteen. Injuries were classified based on intent (unintentional/inflicted). We compared demographic, physical and laboratory findings, ED disposition, hospitalization, need for surgery, 30-day mortality, and cause of death between groups using Chi-squared or Fisher's test for categorical variables, and Mann-Whitney test for non-normal continuous factors comparing median values and interquartile ranges (IQR). Results There were 12,044 children who sustained blunt torso trauma: Inflicted=720 (6%); Unintentional=9563 (79.4%); Indeterminate=148 (1.2%); Missing=1613 (13.4%). Patients with unintentional torso injuries significantly differed from those with inflicted injuries in median age in years (IQR) [10 (5, 15) vs. 14 (8, 16); p-value<0.001], race, presence of pelvic fractures, hospitalization and need for non-abdominal surgery. Mortality rates did not differ based on intent. Further adjustment using binary, logistic regression revealed that the risk of pelvic fractures in the inflicted group was 96% less than the unintentional group (OR: 0.04; 95%CI: 0.01–0.26; p-value=0.001). Conclusions Children who sustain acute blunt torso trauma due to unintentional causes have a significantly higher risk of pelvic fractures and are more likely to be hospitalized compared to those with inflicted injuries.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.05.053
       
  • Two, three, and four-drug regimens for HIV post-exposure prophylaxis in a
           North American sexual assault victim population
    • Authors: Thara Kumar; Kari Sampsel; Ian G. Stiell
      Pages: 1798 - 1803
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Thara Kumar, Kari Sampsel, Ian G. Stiell
      Background/objectives Due to perceived increased tolerability and compliance, and decreased cost, recent trends in practice are moving towards using fewer drugs for HIV post-exposure prophylaxis. However, there is limited literature to assess this is in the North American sexual assault victim population. Methods This retrospective before-and-after cohort study compared patients seen at a sexual assault care facility before and after the introduction of two and three-drug post-exposure prophylaxis regimens. Our primary outcome was completion of the 28-day regimen. Secondary objectives included HIV seroconversion rates and patient reported side effects. Results Six-hundred-thirty charts from a 2-year period were reviewed, and 429 met inclusion criteria. There was no difference in completion rates of post-exposure prophylaxis between the two cohorts (50.5% vs. 51.6%). However, there were fewer reported side effects (72.2% vs. 17.6%) in the later cohort. We subsequently compared all patients in either cohort who received four-drug therapy (N =128) versus those who received two or three-drug regimens (N =47). The two or three-drug regimen group had a higher completion rate (66.0% vs. 42.2%; p =0.03), and a lower rate of reported side effects (19.1% vs. 53.9%), specifically for nausea (12.8% vs. 36.7%), constipation (0% vs. 7.9%), diarrhea (2.1% vs. 21.1%), mood changes (0% vs. 10.9%), headache (2.1% vs. 16.4%), and fatigue (6.4% vs. 26.6%). There were no HIV seroconversions in either group. Conclusion Two and three-drug HIV post-exposure prophylaxis regimens are better tolerated by patients and associated with greater compliance than four-drug therapy, and could be considered in the sexual assault victim population.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.05.054
       
  • Usefulness of direct W-plasty application to wound debridement for
           minimizing scar formation in the ED
    • Authors: Jin Hong Min; Kyung Hye Park; Hong Lak Choi; Jung Soo Park; Ji Han Lee; Hoon Kim; Byung Kook Lee; Dong Hun Lee; Taek Gu Lee
      Pages: 1804 - 1809
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Jin Hong Min, Kyung Hye Park, Hong Lak Choi, Jung Soo Park, Ji Han Lee, Hoon Kim, Byung Kook Lee, Dong Hun Lee, Taek Gu Lee
      Purpose A suture line placed with the same direction as the relaxed skin tension line leads to good healing, but a suture line with over 30 degrees of angle from the relaxed skin tension line leads to longer healing time and more prominent scarring. W-plasty is widely used to change the direction of the scar or to divide it into several split scars. In this study, we applied W-plasty to patients with facial lacerations in the emergency department. Methods From June 2012 to December 2014, 35 patients underwent simple repair or W-plasty for facial lacerations. Patients in the simple repair group underwent resection following a thermal margin, and the W-plasty group was resected within a pre-designed margin of W-shaped laceration. We assessed prognosis using the Stony Brook Scar Evaluation Scale (SBSES) after 10 days (short-term) and six months (long-term), respectively, following suture removal. Results Among 35 patients, 15 (42.9%) underwent simple debridement and 20 (57.1%) underwent W-plasty. In the W-plasty group, there was no difference between short-term and long-term follow-up showing high SBSES, but in the simple debridement group, long-term follow-up SBSES significantly decreased. W-plasty SBSES was higher than simple debridement at short-term as well as long-term follow-up. Conclusion We experienced good results of direct W-plasty application at six-month long-term follow-up. Therefore, W-plasty application is more effective in reducing scar appearance than a simple debridement method for facial laceration patients with an angle of 30 degrees or more to the relaxed skin tension line.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.05.055
       
  • Early initiation of low-dose hydrocortisone treatment for septic shock in
           adults: A randomized clinical trial
    • Authors: Qing-quan Lv; Xiao-hua Gu; Qi-hong Chen; Jiang-quan Yu; Rui-qiang Zheng
      Pages: 1810 - 1814
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Qing-quan Lv, Xiao-hua Gu, Qi-hong Chen, Jiang-quan Yu, Rui-qiang Zheng
      Background Physiologic dose hydrocortisone is part of the suggested adjuvant therapies for patients with septic shock. However, the association between the corticosteroid therapy and mortality in patients with septic shock is still not clear. Some authors considered that the mortality is related to the time frame between development of septic shock and start of low dose hydrocortisone. Thus we designed a placebo-controlled, randomized clinical trial to assess the importance of early initiation of low dose hydrocortisone for the final outcome. Methods A total of 118 patients with septic shock were recruited in the study. All eligible patients were randomized to receive hydrocortisone (n=58) or normal saline (n=60). The study medication (hydrocortisone and normal saline) was initiated simultaneously with vasopressors. The primary end-point was 28-day mortality. The secondary end-points were the reversal of shock, in-hospital mortality and the duration of ICU and hospital stay. Results The proportion of patients with reversal of shock was similar in the two groups (P=0.602); There were no significant differences in 28-day or hospital all-cause mortality; length of stay in the ICU or hospital between patients treated with hydrocortisone or normal saline. Conclusion The early initiation of low-dose of hydrocortisone did not decrease the risk of mortality, and the length of stay in the ICU or hospital in adults with septic shock. Trial registration: www.clinicaltrials.gov NCT02580240.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.004
       
  • The impact of the BLUE protocol ultrasonography on the time taken to treat
           acute respiratory distress in the ED
    • Authors: Javad Seyedhosseini; Golnaz Bashizadeh-fakhar; Shirani Farzaneh; Mehdi Momeni; Ehsan Karimialavijeh
      Pages: 1815 - 1818
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Javad Seyedhosseini, Golnaz Bashizadeh-fakhar, Shirani Farzaneh, Mehdi Momeni, Ehsan Karimialavijeh


      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.007
       
  • Usefulness of serial measurement of the red blood cell distribution width
           to predict 28-day mortality in patients with trauma
    • Authors: Taeyoung Kong; Jong Eun Park; Yoo Seok Park; Hye Sun Lee; Je Sung You; Hyun Soo Chung; Incheol Park; Sung Phil Chung
      Pages: 1819 - 1827
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Taeyoung Kong, Jong Eun Park, Yoo Seok Park, Hye Sun Lee, Je Sung You, Hyun Soo Chung, Incheol Park, Sung Phil Chung
      Background This is the first study to evaluate the association between the serially measured RDW values and clinical severity in patients surviving >24 h after sustaining trauma. We evaluated the serial measurement and cut-off values of RDW to determine its significance as a prognostic marker of early mortality in patients with suspected severe trauma. Methods This study retrospectively analyzed prospective data of eligible adult patients who were admitted to the ED with suspected severe trauma. The RDW was determined on each day of hospitalization. The primary outcome was all-cause mortality within 28-days of ED admission. Results We included 305 patients who met our inclusion criteria. The multivariate Cox regression model demonstrated that higher RDW values on day 1 (hazard ratio [HR], 1.558; 95% confidence interval [CI], 1.09–2.227; p =0.015) and day 2 (HR, 1.549; 95% CI, 1.046–2.294; p =0.029) were strong independent predictors of short-term mortality among patients with suspected severe trauma. Considering the clinical course of severe trauma patients, the RDW is an important ancillary test for determining severity. Specifically, we found that RDW values >14.4% on day 1 (HR, 4.227; 95% CI: 1.672–10.942; p <0.001) and >14.7% on day 2 (HR, 6.041; 95% CI: 2.361–15.458; p <0.001) increased the hazard 28-day all-cause mortality. Conclusion An increased RDW value is an independent predictor of 28-day mortality in patients with suspected severe trauma. The RDW, routinely obtained as part of the complete blood count without added cost or time, can be serially measured as indicator of severity after trauma.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.008
       
  • Variable methodological quality and use found in systematic reviews
           referenced in STEMI clinical practice guidelines
    • Authors: Jared Scott; Benjamin Howard; Philip Sinnett; Michael Schiesel; Jana Baker; Patrick Henderson; Matt Vassar
      Pages: 1828 - 1835
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Jared Scott, Benjamin Howard, Philip Sinnett, Michael Schiesel, Jana Baker, Patrick Henderson, Matt Vassar
      Background The objective of this study was to assess the methodological quality and clarity of reporting of the systematic reviews (SRs) supporting clinical practice guideline (CPG) recommendations in the management of ST-elevation myocardial infarction (STEMI) across international CPGs. Methods We searched 13 guideline clearinghouses including the National Guideline Clearinghouse and Guidelines International Network (GIN). To meet inclusion criteria CPGs must be pertinent to the management of STEMI, endorsed by a governing body or national organization, and written in English. We retrieved SRs from the reference sections using a combination of keywords and hand searching. Two investigators scored eligible SRs using AMSTAR and PRISMA. Results We included four CPGs. We extracted 71 unique SRs. These SRs received AMSTAR scores ranging from 1 (low) to 9 (high) on an 11-point scale. All CPGs consistently underperformed in areas including disclosure of funding sources, risk of bias, and publication bias according to AMSTAR. PRISMA checklist completeness ranged from 44% to 96%. The PRISMA scores indicated that SRs did not provide a full search strategy, study protocol and registration, assessment of publication bias or report funding sources. Only one SR was referenced in all four CPGs. All CPGs omitted a large subset of available SRs cited by other guidelines. Conclusions Our study demonstrates the variable quality of SRs used to establish recommendations within guidelines included in our sample. Although guideline developers have acknowledged this variability, it remains a significant finding that needs to be addressed further. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.010
       
  • Clinical characteristics of type A acute aortic dissection with CNS
           symptom
    • Authors: Yuji Shono; Tomohiko Akahoshi; Satomi Mezuki; Kenta Momii; Noriyuki Kaku; Jun Maki; Kentaro Tokuda; Tetsuro Ago; Takanari Kitazono; Yoshihiko Maehara
      Pages: 1836 - 1838
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Yuji Shono, Tomohiko Akahoshi, Satomi Mezuki, Kenta Momii, Noriyuki Kaku, Jun Maki, Kentaro Tokuda, Tetsuro Ago, Takanari Kitazono, Yoshihiko Maehara
      Background and purpose Accurate diagnosis of acute aortic dissection (AAD) is sometimes difficult because of accompanying central nervous system (CNS) symptoms. The purpose of this study was to investigate the clinical characteristics of Type A AAD (TAAAD) with CNS symptoms. Methods We retrospectively reviewed the medical records of 8403 patients ambulanced to our emergency and critical care center between April 2009 and May 2014. Results We identified 59 TAAAD patients for the analysis (mean age, 67.3±10.5years; 37 (62.0%) male). Eleven patients (18.6%) presented CNS symptoms at the onset of TAAAD, and these patients complained less frequently of typical chest and back pain than those without CNS symptoms (p <0.0001). Initial systolic and diastolic blood pressure were lower (p =0.003, and p =0.049, respectively) and involvement of the supra-aortic artery was more frequent in patients with CNS symptoms (p <0.0001). Conclusion Because CNS symptom can mask chest and back pain caused by TAAAD, physicians should always consider the possibility of TAAAD in patients with CNS symptoms in emergency medicine settings.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.011
       
  • Characteristics and outcome among 14,933 adult cases of in-hospital
           cardiac arrest: A nationwide study with the emphasis on gender and age
    • Authors: Nooraldeen Al-Dury; Araz Rawshani; Johan Israelsson; Anneli Strömsöe; Solveig Aune; Jens Agerström; Thomas Karlsson; Annica Ravn-Fischer; Johan Herlitz
      Pages: 1839 - 1844
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Nooraldeen Al-Dury, Araz Rawshani, Johan Israelsson, Anneli Strömsöe, Solveig Aune, Jens Agerström, Thomas Karlsson, Annica Ravn-Fischer, Johan Herlitz
      Aim To investigate characteristics and outcome among patients suffering in-hospital cardiac arrest (IHCA) with the emphasis on gender and age. Methods Using the Swedish Register of Cardiopulmonary Resuscitation, we analyzed associations between gender, age and co-morbidities, etiology, management, 30-day survival and cerebral function among survivors in 14,933 cases of IHCA. Age was divided into three ordered categories: young (18–49years), middle-aged (50–64years) and older (65years and above). Comparisons between men and women were age adjusted. Results The mean age was 72.7years and women were significantly older than men. Renal dysfunction was the most prevalent co-morbidity. Myocardial infarction/ischemia was the most common condition preceding IHCA, with men having 27% higher odds of having MI as the underlying etiology. A shockable rhythm was found in 31.8% of patients, with men having 52% higher odds of being found in VT/VF. After adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days. Older individuals were managed less aggressively than younger patients. Increasing age was associated with lower 30-day survival but not with poorer cerebral function among survivors. Conclusion When adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days after in-hospital cardiac arrest. Older individuals were managed less aggressively than younger patients, despite a lower chance of survival. Higher age was, however, not associated with poorer cerebral function among survivors.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.012
       
  • Multicenter prevalence of opioid medication use as abortive therapy in the
           ED treatment of migraine headaches
    • Authors: Neil Young; Daniel Silverman; Heather Bradford; Jeffrey Finkelstein
      Pages: 1845 - 1849
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Neil Young, Daniel Silverman, Heather Bradford, Jeffrey Finkelstein
      Despite a range of therapeutic options for treating acute migraine headaches, the use of opioids is still reported to be common practice. This study describes treatment practices in regards to migraines in the ED. It characterizes the prevalence of opioid orders during visits in three different settings, an academic medical center, a non-academic urban ED, and a community ED. Fourteen months of consecutive migraine visits were identified. All medications ordered were separated into first-line and rescue medications. Number of visits, length of stay, door to provider time, and total provider time were compared. A total of 1222 visits were identified. Opioids were ordered in 35.8% of these visits. By facility, opioids were ordered in 12.3% of academic medical center visits, 40.9% of urban ED visits, and 68.6% of community ED visits. This ranged from 6.9% of first-line therapies in the academic center to 69.9% of rescue therapies in the community ED. Of those who received opioids, 36.0% versus 25.1% required rescue medications. Patients who received opioids had more repeat visits, 1.79 versus 1.30. The academic center and urban ED both found greater than 30% decrease in length of stay in visits where opioids were not given. In the face of evidence against opioids for migraines, over one third of patients received them. There was a higher prevalence in the community setting. There were no significant benefits in overall throughput time, however, opioid visits required more rescue medications, increased length of stay, and resulted in more repeat visits.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.015
       
  • Emergency department DNR order in patients with spontaneous intracerebral
           hemorrhage
    • Authors: Ju-Sing Fan; Hsien-Hao Huang; Yen-Chia Chen; Chorng-Kuang How; David Hung-Tsang Yen
      Pages: 1850 - 1854
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Ju-Sing Fan, Hsien-Hao Huang, Yen-Chia Chen, Chorng-Kuang How, David Hung-Tsang Yen
      Objectives To explore the determinant factors and prognostic significance of emergency department do-not-resuscitate (ED-DNR) orders for patients with spontaneous intracerebral hemorrhage (SICH). Methods Consecutive adult SICH patients treated in our ED from January 1, 2012 to December 31, 2016 were selected as the eligible cases from our hospital's stroke database. Patients' information was comprehensively reviewed from the database and medical and nursing charts. ED-DNR orders were defined as DNR orders written during ED stay. Multiple logistic regression analysis was used to identify significant determinants of ED-DNR orders. Thirty- and 90-day neurological outcomes were analyzed to test the prognosis impact of ED-DNR orders. Results Among 835 enrolled patients, 112 (12.1%) had ED-DNR orders. Significant determinant factors of ED-DNR orders were age, ambulatory status before the event, brain computed tomography findings of midline shift, intraventricular extension, larger hematoma size, and ED arrival GCS ≤8. Patients with and without ED-DNR orders had a similar 30-day death rate if they had the same initial ICH score point. During 30 to 90days, patients with ED-DNR orders had a significantly increased mortality rate. However, the rate of improvement in neurological status between the two groups was not significantly different. Conclusions Older and sicker SICH patients had higher rate of ED-DNR orders. The mortality rates between patients with and without ED-DNR orders for each ICH score point were not significantly different. During the 30-to-90-day follow-up, the rates of neurological improvement in both groups were similar.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.016
       
  • Temporal artery and axillary thermometry comparison with rectal
           thermometry in children presenting to the ED
    • Authors: Adam J. Forrest; Michael L. Juliano; Sean P. Conley; Patrick D. Cronyn; Andrea McGlynn; Jonathan D. Auten
      Pages: 1855 - 1858
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Adam J. Forrest, Michael L. Juliano, Sean P. Conley, Patrick D. Cronyn, Andrea McGlynn, Jonathan D. Auten
      Background Accurate temperature readings, often obtained rectally, are an important part of the initial evaluation of pediatric patients in the Emergency Department. Temporal artery thermometry (TAT) is one way to noninvasively measure temperature. We sought to compare the accuracy of axillary and temporal artery temperatures compared to rectal. Methods This prospective study included children age 0–36months presenting to the Emergency Department of a large military treatment facility. Rectal, axillary, and temporal artery temperatures were obtained. Test characteristics (sensitivity, specificity, NPV, PPV) were reported. The effect of cutoff values 99.9°F, 100.4°F, and 102.2°F on test characteristics were also evaluated. Results The sensitivities of axillary and temporal artery thermometry to detect rectal fever is 11.5% and 61.5% respectively. Cutoff values did not significantly alter test characteristics. In this study, temporal artery thermometry was 0.2°C lower than rectal temperature, axillary measurement was 0.9°C below the reference standard. Mean temperature difference in the febrile group between TAT and rectal thermometry was >0.5°C compared with a mean temperature difference 0.05°C in afebrile patients. Conclusion The findings of our study do not support using axillary thermometry to screen pediatric patients for fever in the emergency department. TAT cannot be recommended as a rectal thermometry replacement where height and duration of fever are used in pediatric disease prediction models. TAT may have a role in screening for fever in the appropriate pediatric patient population like primary orthopedic or trauma presentations where the balance between device precision, data capture and patient comfort may favor use of TAT.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.017
       
  • Internal validation of a scoring system to evaluate the probability of
           ureteral stones: The CHOKAI score
    • Authors: Hiroki Fukuhara; Osamu Ichiyanagi; Shinichi Midorikawa; Hiroshi Kakizaki; Hisashi Kaneko; Norihiko Tsuchiya
      Pages: 1859 - 1866
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Hiroki Fukuhara, Osamu Ichiyanagi, Shinichi Midorikawa, Hiroshi Kakizaki, Hisashi Kaneko, Norihiko Tsuchiya
      Objective The CHOKAI and STONE scores are prediction models for ureteral stones. The aims of the present study were to evaluate the diagnostic performance, to examine the optimal cut-off value, and to compare the diagnostic performance of each model. Methods Patients who presented to our emergency department with renal colic were considered for this prospective study. We analyzed the predictive performance of both STONE and CHOKAI scores at their optimal cut-off values, using receiver operating characteristic (ROC) curve and area under the curve (AUC), as well as sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR−) at the optimal cut-off value. Results Of the 96 patients who met the inclusion criteria, 79 were definitively diagnosed with ureteral stones. All patients were of Japanese descent. The AUC of the CHOKAI score was 0.971 at an optimal cut-off value of 6, showing a sensitivity of 0.911, specificity of 0.941, LR+ of 15.49, and LR− of 0.094. The AUC of the STONE score was 0.873 at an optimal cut-off value of 8, showing a sensitivity of 0.823, specificity of 0.824, LR+ of 4.662, and LR− of 0.215. The AUC of the CHOKAI score was significantly higher than that of the STONE score (p =0.010). Of the 73 patients with a CHOKAI score of ≥6, 98.6% had ureteral stones, and of the 68 patients with a STONE score of ≥8, 95.6% had ureteral stones. Conclusions The simplified CHOKAI score is a useful tool to screen for ureteral stones in patients with renal colic.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.023
       
  • Short and long-term mortality of patients presenting with bleeding events
           to the Emergency Department
    • Authors: Alberto Conti; Noemi Renzi; Daniele Molesti; Simone Bianchi; Irene Bogazzi; Giada Bongini; Giuseppe Pepe; Fabiana Frosini; Alessio Bertini; Massimo Santini
      Pages: 1867 - 1872
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Alberto Conti, Noemi Renzi, Daniele Molesti, Simone Bianchi, Irene Bogazzi, Giada Bongini, Giuseppe Pepe, Fabiana Frosini, Alessio Bertini, Massimo Santini
      Background Death of patients presenting with bleeding events to the Emergency Department still represent a major problem. We sought to analyze clinical characteristics associated with worse outcomes including short- and long-term death, beyond antithombotic treatment strategy. Methods Patients presenting with any bleeding events during 2016–2017years were enrolled. Clinical parameters, site of bleeding, major bleeding, ongoing anti-thrombotic treatment strategy and death were collected. Hard 5:1 propensity score matching was performed to adjust dead patients in baseline characteristics. Endpoints were one-month and one-year death. Results Out of 166,000 visits to the Emergency Department, 3.050 patients (1.8%) were enrolled and eventually 429 were analyzed after propensity. Overall, anticoagulants or antiplatelets were given to 234(54%). Major bleeding account for 111(26%) patients, without differences between those taking anticoagulants or antiplatelets versus others. Death at one-month and one-year was 26(6%) and 72(17%), respectively. Independent predictors of one-month death were major bleeding (Odds Ratio, OR 26, p<0.001), female gender (OR 7, p<0.001) and white blood cells (OR 1.2, p=0.01); of one-year were major bleeding (OR 7, p<0.001), age (OR 1.1, p<0.001) and female gender (OR 2.3, p=0.043). Of note, death rate of gastrointestinal and intracranial bleeding where higher than others (p<0.001). Overall mortality was approximately 40% on one-month; 60% in older patients and 80% in female gender with CHA2D2VASC-score≥2. Receiver operator characteristics analysis showed larger areas for major bleeding and age (0.75 and 0.72, respectively) over others; p<0.05 on C-statistic. Conclusions In patients with bleeding events, death rate was driven by major bleeding on short-term and older age on long-term. Among dead patients mortality was approximately 40% on one-month; 60% in older patients, and 80% in female gender.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.025
       
  • Bi-objective approach for placing ground and air ambulance base and
           helipad locations in order to optimize EMS response
    • Authors: Milad Shahriari; Ali Bozorgi-Amiri; Shayan Tavakoli; Abolghasem Yousefi-Babadi
      Pages: 1873 - 1881
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Milad Shahriari, Ali Bozorgi-Amiri, Shayan Tavakoli, Abolghasem Yousefi-Babadi
      Shortening the travel time of patient transfer has clinical implications for many conditions such as cardiac arrest, trauma, stroke and STEMI. As resources are often limited precise calculations are needed. In this paper we consider the location problem for both ground and aerial emergency medical services. Given the uncertainty of when patients are in need of prompt medical attention we consider these demand points to be uncertain. We consider various ways in which ground and helicopter ambulances can work together to make the whole process go faster. We develop a mathematical model that minimizes travel time and maximizes service level. We use a compromising programming method to solve this bi-objective mathematical model. For numerical experiments we apply our model to a case study in Lorestan, Iran, using geographical and population data, and the location of the actual hospital based in the capital of the province. Results show that low-accessibility locations are the main focus of the proposed problem and with mathematical modeling access to a hospital is vastly improved. We also found out that once the budget reaches a certain point which suffices for building certain ambulance bases more investments does not necessarily result in less travel time.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.026
       
  • The Revised Trauma Score plus serum albumin level improves the prediction
           of mortality in trauma patients
    • Authors: Seong Chun Kim; Dong Hoon Kim; Tae Yun Kim; Changwoo Kang; Soo Hoon Lee; Jin Hee Jeong; Yong Joo Park; Sang Bong Lee; Daesung Lim
      Pages: 1882 - 1886
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Seong Chun Kim, Dong Hoon Kim, Tae Yun Kim, Changwoo Kang, Soo Hoon Lee, Jin Hee Jeong, Yong Joo Park, Sang Bong Lee, Daesung Lim
      Introduction The Revised Trauma Score (RTS) is used worldwide in prehospital practice and in the emergency department (ED) settings to triage trauma patients. The main purpose of this study was to evaluate the value of the RTS plus serum albumin (RTS-A) and to compare it with other existing trauma scores as well as to compare the predictive performance of the Trauma and Injury Severity Score with the RTS-A (TRISS-A) with the original TRISS. Methods This was a single center, trauma registry based observational cohort study. Data were collected from consecutive patients with blunt or penetrating injuries who presented to the emergency department of a tertiary referral hospital, between January 2012 and June 2016. 3145 and 2447 patients were assigned to the derivation group and validation group, respectively. Main outcome was in-hospital mortality. Results Among patients in the derivation group, the median [interquartile range] age was 59 [43–73] years, and 66.7% were male. The area under the receiver operating characteristic curves (AUC) of the RTS-A (0.948; 95% CI: 0.939–0.955) was higher than that of the RTS (0.919; 95% CI: 0.909–0.929). In patients with blunt trauma, the AUC of the TRISS-A (0.960; 95% CI: 0.952–0.967) was significantly higher than that of the original TRISS (0.949; 95% CI: 0.941–0.957). Conclusion The value of the RTS-A predicts the in-hospital mortality of trauma patients better than the RTS, and the TRISS-A is a better mortality predictor compared to the original TRISS in patients with blunt trauma.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.027
       
  • How can lifeguards recover better' A cross-over study comparing
           resting, running, and foam rolling
    • Authors: Anton Kalén; Alexandra Pérez-Ferreirós; Roberto Barcala-Furelos; María Fernández-Méndez; Alexis Padrón-Cabo; Jose A. Prieto; Andrés Ríos-Ave; Cristian Abelairas-Gómez
      Pages: 1887 - 1891
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Anton Kalén, Alexandra Pérez-Ferreirós, Roberto Barcala-Furelos, María Fernández-Méndez, Alexis Padrón-Cabo, Jose A. Prieto, Andrés Ríos-Ave, Cristian Abelairas-Gómez
      Purpose The aim of this study is to compare the effectiveness of active recovery in form of running or foam rolling on clearing blood lactate compared to remain sitting after a water rescue. Method A quasi experimental cross-over design was used to test the effectiveness of two active recovery methods: foam rolling (FR) and running (RR), compared with passive recovery (PR) on the blood lactate clearance after performing a water rescue. Twelve lifeguards from Marín (Pontevedra) completed the study. The participants performed a 100-meter water rescue and a 25-minute recovery protocol. Results The post recovery lactate levels were significantly lower for foam rolling (4.4±1.5mmol/l, P =0.005, d =0.94) and running (4.9±2.3mmol/l, P =0.027, d =1.21) compared with resting (7.2±2.5mmol/l); there was no significant difference between foam rolling and running (P =1.000). Conclusions We found that surf lifesavers clear out blood lactate more efficient when performing an active recovery protocol. Foam rolling is an effective method of increasing the rate of blood lactate clearance. These two recovery methods are also adequate for surf lifeguards as they do not interfere with the surveillance aspect of their job.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.028
       
  • Clinical evaluation of active abdominal lifting and compression CPR in
           patients with cardiac arrest
    • Authors: Min Li; Wei Song; Yan-hong Ouyang; Duo-hu Wu; Jun Zhang; Li-xiang Wang; Jing Li
      Pages: 1892 - 1894
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Min Li, Wei Song, Yan-hong Ouyang, Duo-hu Wu, Jun Zhang, Li-xiang Wang, Jing Li
      Background Chest compression is a standard recommendation during cardiopulmonary resuscitation (CPR). However, chest compression cannot be effectively applied under certain situations, such as chest wall deformity, rib fracture, or hemopneumothorax. An alternative method, abdominal compression, was reported to achieve better resuscitation outcomes in these patients. Materials and methods A prospective study was performed in adult patients with cardiac arrest and anticipated ineffective chest compression (thoracic trauma, chest deformity, rib fracture, and hemopneumothorax). Active abdominal lifting and compression cardiopulmonary resuscitation was used. Primary outcome was success rate of restoration of spontaneous circulation (ROSC). Secondary outcomes included heart rate (HR), mean arterial pressure (MAP), pulse oximetry saturation (SpO2), arterial blood pH value, arterial oxygen pressure (PaO2), and arterial carbon dioxide tension (PaCO2), which were measured during the periods of pre-CPR, CPR, and 30min post-ROSC. Results A total of 35 patients were enrolled into the study. Five of them had ROSC (14.3%), which was statistically significantly higher than that (0%) reported in the 2015 Advanced Cardiovascular Life Support manual. HR, MAP, and SpO2 during CPR were also statistically significantly higher during CPR when compared to the period of pre-CPR period (HR 58 versus 0 beats/min, P<0.01; MAP 25 versus 0mm Hg, P<0.01; SpO2 0.68 versus 0.48%, P<0.01). In post-ROSC period, HR was statistically significantly higher than that during pre-CPR period (121 versus 0 best/min, P<0.01). Conclusions Active abdominal lifting and compression cardiopulmonary resuscitation could reach better resuscitation outcomes in certain cardiac arrest patients.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.031
       
  • Investigation of UCH-L1 levels in ischemic stroke, intracranial hemorrhage
           and metabolic disorder induced impaired consciousness
    • Authors: Ihsan Yigit; Metin Atescelik; Mustafa Yilmaz; Mehmet Cagri Goktekin; Mehtap Gurger; Nevin Ilhan
      Pages: 1895 - 1898
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Ihsan Yigit, Metin Atescelik, Mustafa Yilmaz, Mehmet Cagri Goktekin, Mehtap Gurger, Nevin Ilhan
      Objective We aimed to determine the levels of ubiquitin C-terminal hydrolase-L1 (UCH-L1) in patients admitted to the emergency department with impaired consciousness due to metabolic or neurological reasons. Materials – methods The study included 80 patients with ischemic stroke (IS), 40 patients with intracranial hemorrhage (ICH), 80 patients with metabolic disorder induced impaired consciousness (MDIC) and 40 healthy controls. Results The levels of UCH-L1 [median (IQR)] were as follows: 5.59ng/mL (3.90–9.37) in IS, 5.44ng/ml (4.01–13.98) in ICH, 3.34ng/ml (2.29–5.88) in MDIC and 3.94ng/ml (3.31–7.95) in healthy volunteers. Significantly higher levels were detected in IS and ICH than in MDIC and healthy volunteers. In ROC curve analysis, we detected 63.75% sensitivity and 62.5% specificity (AUC=0.626, p<0.0199, 95% CI: 0.533–0.713) with a cutoff value of 4.336ng/ml for IS and 75% sensitivity and 55% specificity (AUC=0.664, p<0.0071, 95% CI: 0.549–0.766) with a cut-off value of 4.036ng/ml for ICH. However, the sensitivity and specificity for MDIC was 36.25% and 77.5%, respectively, with a cut-off value of 3.256ng/ml (AUC=0.525, p=0.6521, 95% CI: 0.432–0.617). UCH-L1 levels were found to increase significantly with increasing time between the onset of symptoms and blood sampling (r=0.345, p<0.001). However, no correlation was found between UCH-L1 levels and age (r=0.014, p=0.833), GCS (r=−0.115, p=0.074), mRS (r=0.063, p=0.475) and NIHSS (r=0.056, p=0.520). Conclusion In this study, we detected significantly higher levels of UCH-L1 in patients with IS and ICH compared to patients with MDIC and healthy volunteers.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.06.032
       
  • The optimum chest compression site with regard to heart failure
           demonstrated by computed tomography
    • Authors: Keunha Hwang; Sung-Bin Chon; Jung Gi Im
      Pages: 1899 - 1906
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Keunha Hwang, Sung-Bin Chon, Jung Gi Im
      Background To determine the optimum chest compression site during cardiopulmonary resuscitation (CPR) with regard to heart failure (HF) by applying three-dimensional (3D) coordinates on computed tomography (CT). Methods This retrospective, cross-sectional study involved adults who underwent echocardiography and CT on the same day from 2007 to 2017. Incomplete CT images or information on HF, cardiac medication between echocardiography and CT, or thoracic abnormalities were excluded. Cases were checked whether they had HF through symptom/sign assessment, N-terminal pro-B type natriuretic peptide, and echocardiography. We set the xiphisternal joint's midpoint as the reference (0, 0, 0) to draw a 3D coordinate system, designating leftward, upward, and into-the-thorax directions as positive. The coordinate of the maximum LV diameter's midpoint (P_max.LV) was identified. Results Enrolled were 148 patients (63.0±15.1 years) with 87 females and 76 HF cases. P_max.LV of HF cases was located more leftwards, lower, and deeper than non-HF cases (5.69±0.98, −1.51±1.67, 5.76±1.09 cm vs. 5.00±0.83, −0.99±1.36, 5.25±0.71 cm, all p <0.05). Fewer HF cases had their LV compressed than non-HF cases (59.2% vs. 77.8%, p =0.025) when being compressed according to the current guidelines. The aorta (vs. LV) was compressed in 85.5% and 81.9% of HF and non-HF cases, respectively, at 3 cm above the xiphisternal joint. At 6cm above the joint, the highest allowable position according to the current guidelines, all victims would have their aorta compressed directly during CPR rather than the LV. Conclusions The lowest possible sternum just above the xiphisternal joint should be compressed especially for HF patients during CPR.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.07.041
       
  • The influence of insurance type on interfacility pediatric emergency
           department transfers
    • Authors: Chris A. Rees; Stephanie Pryor; Ben Choi; Mamata V. Senthil; Nicholas Tsarouhas; Sage R. Myers; Michael C. Monuteaux; Richard G. Bachur; Joyce Li
      Pages: 1907 - 1909
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      Author(s): Chris A. Rees, Stephanie Pryor, Ben Choi, Mamata V. Senthil, Nicholas Tsarouhas, Sage R. Myers, Michael C. Monuteaux, Richard G. Bachur, Joyce Li
      Background Disparities exist in the care children receive in the emergency department (ED) based on their insurance type. It is unknown if these differences exist among children transferred from outside EDs to pediatric tertiary care EDs. Objective To compare reasons for transfer and services received at pediatric tertiary care EDs between children with private and public insurance. Methods We performed a secondary analysis of a multicenter survey of ED providers transferring patients to pediatric tertiary care EDs in three major U.S. cities. Risk differences (RD) and 95% confidence intervals (CI) were calculated to compare reasons for transfer and care received at pediatric tertiary care EDs based on insurance type. Results There were 561 surveys completed by transferring providers describing reasons for transfer to pediatric tertiary care EDs with 52.2% of patients with private insurance and 47.8% with public insurance. We found no significant differences between privately and publicly insured children in reason for transfer for subspecialty consultation or need for admission. We found no significant differences in frequency of admission, radiologic studies, or ED procedures at the receiving facilities. However, a greater proportion of privately insured children had a subspecialty consultation at receiving facilities compared to publicly insured children (RD 9.7, 95% CI 2.0 to 17.4). Conclusions Transferred pediatric patients with private insurance were more likely to have subspecialty consultations than children with public insurance. Further studies are needed to better characterize the interplay between patients' insurance type and both the request for, and the provision of, ED subspecialty consultations.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.07.048
       
  • Rivaroxaban program for acute venous thromboembolism upon ED discharge,
           with focus on utility of commercially available dose pack
    • Authors: Aileen Chu; Jill Limberg
      Pages: 1910 - 1914
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      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 nonadherence or treatment failure, and improved medication adherence 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: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.08.001
       
  • 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
      Pages: 1915 - 1918
      Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12
      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: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.08.017
       
  • Emergency department length of stay for ethanol intoxication encounters
    • Authors: Lauren R. Klein; Brian E. Driver; James R. Miner; Marc L. Martel; Jon B. Cole
      Abstract: Publication date: Available online 8 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Lauren R. Klein, Brian E. Driver, James R. Miner, Marc L. Martel, Jon B. Cole
      Background Emergency Department (ED) encounters for ethanol intoxication are becoming increasingly common. The purpose of this study was to explore factors associated with ED length of stay (LOS) for ethanol intoxication encounters. Methods This was a multi-center, retrospective, observational study of patients presenting to the ED for ethanol intoxication. Data were abstracted from the electronic medical record. To explore factors associated with ED LOS, we created a mixed-effects generalized linear model. Results We identified 18,664 eligible patients from 6 different EDs during the study period (2012–2016). The median age was 37years, 69% were male, and the median ethanol concentration was 213mg/dL. Median LOS was 348min (range 43–1658). Using a mixed-effects generalized linear model, independent variables associated with a significant increase in ED LOS included use of parenteral sedation (beta=0.30, increase in LOS=34%), laboratory testing (beta=0.21, increase in LOS=23%), as well as the hour of arrival to the ED, such that patients arriving to the ED during evening hours (between 18:00 and midnight) had up to an 86% increase in LOS. Variables not significantly associated with an increase in LOS included age, gender, ethanol concentration, psychiatric disposition, using the ED frequently for ethanol intoxication, CT use, and daily ED volume. Conclusion Variables such as diagnostic testing, treatments, and hour of arrival may influence ED LOS in patients with acute ethanol intoxication. Identification and further exploration of these factors may assist in developing hospital and community based improvements to modify LOS in this population.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.017
       
  • A clinical pathway for heart failure reduces admissions from the ED
           without increasing congestion in the ED
    • Authors: Thomas F. Spiegel; Travis B. Wassermann; Natalie Neumann; Mitchell J. Coplan; Kirk T. Spencer; Daniel Adelman; Rupa Mehta Sanghani; Corey E. Tabit
      Abstract: Publication date: Available online 7 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Thomas F. Spiegel, Travis B. Wassermann, Natalie Neumann, Mitchell J. Coplan, Kirk T. Spencer, Daniel Adelman, Rupa Mehta Sanghani, Corey E. Tabit
      Background A multidisciplinary team at a major academic medical center established an Acutely Decompensated Heart Failure Clinical Pathways (ADHFCP) program to reduce inpatient readmission rates among patients with heart failure which, among several interventions, included an immediate consultation from a cardiologist familiar with an ADHFCP patient when the patient presented at the Emergency Department (ED). This study analyzed how that program impacted utilization of services in the ED and its subsequent effect on rates of admission from the ED and on disposition times. Methods ADHFCP inpatient visits were retrospectively risk stratified and matched with non-program inpatient visits to create a control group. A Cox survival model analyzed the ADHFCP's impact on patients' likelihood to visit the ED. Multivariable ANOVA evaluated the impact of the program on the patients' likelihood of being admitted when presenting at the ED. The ADHFCP's impact on bed-to-disposition time in the ED was evaluated by Wilcoxon's rank-sum test, as were doses of diuretics administered in the ED. Results The survival analysis showed no impact of the ADHFCP on patients' likelihood of visiting the ED, but ADHFCP patients presenting to the ED were 13.1 (95% CI: 3.6–22.6) percentage points less likely to be admitted. There was no difference in bed-to-disposition times, but ADHFCP patients received diuretics more frequently and at higher doses. Conclusions Improved communication between cardiologists and ED physicians through the establishment of an explicit pathway to coordinate the care of heart failure patients may decrease that population's likelihood of admission without increasing ED disposition times.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.012
       
  • Ketamine is a good first-line option for severely agitated patients in the
           prehospital environment
    • Authors: James R. Miner
      Abstract: Publication date: Available online 7 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): James R. Miner


      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.015
       
  • Predicting long-term outcomes after cardiac arrest by using serum
           neutrophil gelatinase-associated lipocalin
    • Authors: Yu-Ri Park; Joo Suk Oh; Hyunho Jeong; Jungtaek Park; Young Min Oh; Semin Choi; Kyoung Ho Choi
      Abstract: Publication date: Available online 7 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Yu-Ri Park, Joo Suk Oh, Hyunho Jeong, Jungtaek Park, Young Min Oh, Semin Choi, Kyoung Ho Choi
      Objectives Neutrophil gelatinase-associated lipocalin (NGAL) is secreted by various tissues in pathologic states. Previous studies reported that post-cardiac arrest serum NGAL levels correlate with short-term neurologic outcomes and survival. The aim of this study was to examine the associations between NGAL levels post-cardiac arrest and long-term outcomes and survival. Methods This prospective observational study and retrospective review included adult out-of-hospital cardiac arrest survivors who were treated by hypothermia-targeted temperature management. Serum NGAL was assessed at 0, 24, 48, and 72h after return of spontaneous circulation. The primary outcome was poor outcome at six months after cardiac arrest, defined as cerebral performance category score of 3–5. The secondary outcome was six-month mortality. Results In total, 76 patients were analyzed. The patients with poor outcomes showed significantly higher NGAL levels at 24, 48 and 72h after cardiac arrest than the patients with good outcomes. Long-term survival rates were significantly lower in the high-NGAL group than in the low-NGAL group at each time point. Subgroup analysis of patients who survived 72h showed that only serum NGAL 72h after cardiac arrest had prognostic value for long-term outcomes (area under the receiver operating characteristic curve=0.72; p =0.02). Conclusions Post-cardiac arrest serum NGAL is associated with long-term outcomes and survival; particularly, three days post-cardiac arrest is the optimal time point for predicting long-term outcomes. However, the predictive power of NGAL is unsatisfactory, and it should be regarded as an additional prognostic modality.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.013
       
  • Trauma patients presenting with a King laryngeal tube™ in place can be
           safely intubated in the emergency department
    • Authors: Kenneth W. Dodd; Brian E. Driver; Robert F. Reardon
      Abstract: Publication date: Available online 7 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Kenneth W. Dodd, Brian E. Driver, Robert F. Reardon


      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.016
       
  • In reply: Ketamine is an important therapy for prehospital agitation - Its
           exact role and side effect profile are still undefined
    • Authors: Jon B. Cole; Brian E. Driver; Lauren R. Klein; Johanna C. Moore; Paul C. Nystrom; Jeffrey D. Ho
      Abstract: Publication date: Available online 7 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Jon B. Cole, Brian E. Driver, Lauren R. Klein, Johanna C. Moore, Paul C. Nystrom, Jeffrey D. Ho


      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.014
       
  • Post-bariatric surgery starvation ketoacidosis and lipase elevation in the
           absence of DKA or pancreatitis
    • Authors: Runbo Song; Shanjin Cao
      Abstract: Publication date: Available online 7 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Runbo Song, Shanjin Cao
      We report a case of post bariatric surgery by laparoscopic sleeve gastrectomy who presented with post-surgical poor oral tolerance and high anion gap metabolic ketoacidosis, who was initially misdiagnosed with diabetic ketoacidosis and treated with volume supplementation without improvement. The metabolic derangements were found to be caused by starvation ketoacidosis, and then treated with glucose supplementation, the anion gap quickly closed. Moreover, this patient also presented with non-pancreatitis lipase elevation. This case highlights the recognition and management of post-bariatric surgery starvation ketoacidosis; additionally, clinicians should be vigilant about the interpretation and management of elevated lipase without clinical pancreatitis.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.10.068
       
  • In reply: Trauma patient presenting with a King laryngeal tube in place
           can be safely intubated in the emergency department
    • Authors: Matthew C. Hernandez; Martin D. Zielinski; David S. Morris
      Abstract: Publication date: Available online 7 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Matthew C. Hernandez, Martin D. Zielinski, David S. Morris


      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.018
       
  • Emergency department naloxone rescue kit dispensing and patient follow-up
    • Authors: Kevin A. Kaucher; Nicole M. Acquisto; Kerry Broderick
      Abstract: Publication date: Available online 7 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Kevin A. Kaucher, Nicole M. Acquisto, Kerry Broderick


      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.020
       
  • Is there an association between trichomoniasis and other sexually
           transmitted infections in adolescent ED patients'
    • Authors: Lindsey Ouellette; Kristen Eischens; Lindsey Retterath; Colleen Bush; Erica Tavares; Jeffrey Jones
      Abstract: Publication date: Available online 7 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Lindsey Ouellette, Kristen Eischens, Lindsey Retterath, Colleen Bush, Erica Tavares, Jeffrey Jones


      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.019
       
  • Face mask leak with nasal cannula during noninvasive positive pressure
           ventilation: A randomized crossover trial
    • Authors: Derek J. Brown; Stephen M. Carroll; Michael D. April
      Abstract: Publication date: Available online 6 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Derek J. Brown, Stephen M. Carroll, Michael D. April
      Background Nasal cannula can achieve apneic oxygenation during emergency intubation. However, pre-procedure nasal cannula placement may be difficult in patients undergoing non-invasive positive pressure ventilation (NPPV) prior to intubation. Our objective was to compare mask leak during NPPV with versus without simultaneous application of nasal cannula. We hypothesized mask leak would be no worse with concomitant use of nasal cannula (non-inferiority design). Methods We performed a randomized crossover non-inferiority study of healthy volunteers. We randomized subjects undergoing 60s trials of NPPV (10cmH2O continuous positive airway pressure) to either NPPV alone (NPPV-a) or NPPV with nasal cannula at 15L/min (NPPV-nc). After a brief rest period, all subjects underwent the alternative intervention. The primary outcome was time averaged mask leak over 60s (L/min). We defined a non-inferiority margin of 5L/min. Results We enrolled 64 subjects. Mean time-averaged mask leak was 2.2L/min for NPPV-a versus 4.0L/min for NPPV-nc for a difference of 1.7L/min (one-sided 95% CI −∞ to 3.2L/min). NPPV-a resulted in higher mean minute volume received (13.5 versus 12.2L) and higher mean respiratory rates (14.8 versus 13.5 breaths per minute). Conclusion The addition of nasal cannula during NPPV does not significantly increase mask leak. The simultaneous application of nasal cannula with NPPV may be a useful strategy to streamline airway management among patients undergoing NPPV prior to intubation.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.10.055
       
  • Syphilis and vision loss: A role for point-of-care ultrasound
    • Authors: Mariko Nomura; Daniel Mantuani; Arun Nagdev
      Abstract: Publication date: Available online 6 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Mariko Nomura, Daniel Mantuani, Arun Nagdev
      Vision loss in young adults is relatively rare. In patients with suspected HIV or syphilis, the risk of developing vision loss is increased, and should alert the emergency physician of specific retinal pathologies. We present a case of a 33-year-old man with recently identified syphilis and HIV, who was diagnosed with bilateral retinal detachments (RDs) with the help of point-of-care ultrasound (POCUS) in the setting of panuveitis (preventing visualization with direct fundoscopy).

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.009
       
  • Cardiac tamponade due to internal mammary artery injury after
           cardiopulmonary resuscitation: A case report
    • Authors: Keon Kim; Eun Kim; DukHee Lee
      Abstract: Publication date: Available online 6 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Keon Kim, Eun Kim, DukHee Lee


      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.004
       
  • Another failure in predicting sepsis outcomes in the emergency department
    • Authors: Daryelle S. Varon; Joseph Varon
      Abstract: Publication date: Available online 6 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Daryelle S. Varon, Joseph Varon


      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.011
       
  • Thigh emphysema as the initial presentation of colon ischemia
    • Authors: Chin-Chuan Hsu; Ping-Yuan Chen; Chih-Cheng Lai
      Abstract: Publication date: Available online 6 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Chin-Chuan Hsu, Ping-Yuan Chen, Chih-Cheng Lai
      The incidence of colon ischemia has increased in recent years, and is associated with high morbidity and mortality. The typical presentations of colon ischemia include abdominal pain, bloody diarrhea, and in severe case, ileus, fever and peritonitis. Here, we document a rare case of colon ischemia presenting with subcutaneous and intramuscular emphysema of the thigh. A 76-year-old woman presented to the emergency department for left thigh pain for three days. Physical examination revealed tenderness without obvious crepitus, erythema or swelling over the left groin area and a soft abdomen without tenderness. Plain abdominal film showed abnormal gas formation at the left thigh and chest film demonstrated subphrenic free air. Abdominal computer tomography found sigmoid perforation causing left retroperitoneal abscess, and subcutaneous and intramuscular emphysema over the left pelvic and thigh region. During operation, irreversible ischemia from the terminal ileum through the cecum to the sigmoid colon with gangrene and retroperitoneal abscess were found. Total colectomy with end ileostomy and peritoneal toilet were performed. However, massive bloody ascites from abdominal drainage developed on the 13th day of admission. She later passed away due to hemorrhagic shock. In conclusion, emphysema of the thigh may rarely be caused by an intestinal lesion, such as colon ischemia. Clinicians should be alert of these unusual presentations to find the hidden underlying etiologies.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.008
       
  • Effect of platelet–lymphocyte ratio and lactate levels obtained on
           mortality with sepsis and septic shock
    • Authors: Ebru Biyikli; Afsin Emre Kayipmaz; Cemil Kavalci
      Abstract: Publication date: Available online 6 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Ebru Biyikli, Afsin Emre Kayipmaz, Cemil Kavalci
      Background Sepsis is a potentially fatal condition with high treatment costs, and is especially common among the elderly population. The emergency management of septic patients has gained importance. Objective Herein, we investigated the effect of admission lactate levels and the platelet-lymphocyte ratio (PLR) on the 30-day mortality among patients older than 65years who were diagnosed with sepsis and septic shock according to the qSOFA criteria at our hospital's emergency department. Methods This observational study was conducted retrospectively. We obtained information regarding patients' demographic characteristics, comorbid conditions, hemodynamic parameters at admission, initial treatment needs at the emergency department. Results 131 patients received a diagnosis of sepsis and septic shock at our emergency department in two years. Among these, 45% (n =59) of the patients died within 30days of admission. Forty (30.5%) patients required mechanical ventilation. There was a significant difference between the survival and non-survival groups with regard to systolic and diastolic blood pressures (p =0.013 and 0.045, respectively). There were significant differences between the two groups with respect to the Glasgow Coma Scale score (p <0.001) and BUN levels (p <0.001). The mortality status according to qSOFA scores was revealed a significant difference between the two groups (p <0.001). Conclusion Our results showed that the patients who died within 30days of admission and those who did not had comparable PLR and lactate levels (p =0.821 and 0.120, respectively). We opine that serial lactate measurements would be more useful than a single admission lactate measurement for the prediction of mortality.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.010
       
  • Do wave heights and water levels increase ocean lifeguard rescues'
    • Authors: William Koon; Ali Rowhani-Rahbar; Linda Quan
      Abstract: Publication date: Available online 5 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): William Koon, Ali Rowhani-Rahbar, Linda Quan
      Objective To investigate the association of wave height and tidal water level changes with the frequency of ocean lifeguard rescues. Methods All ocean lifeguard rescues recorded by Newport Beach Lifeguards in 2015 and 2016 were linked by time and location to weather and ocean variables contained in other historical databases. We performed separate multivariable analyses using mixed effects negative binomial regression to evaluate the total effects of wave height, mean water level (primarily set by tidal elevation), and rising vs. falling water level, on the frequency of ocean rescue in the study location, controlling for confounding variables. Results Newport Beach Lifeguards made 8046 rescues during the study period. In all areas of the beach, rescue frequency increased as waves got larger (IRR: 3.25; 95%CI: 2.91–3.79) but then decreased in large surf (IRR: 0.52; 95%CI: 0.37–0.73). In two sections of beach, lifeguards made more rescues during lower water levels, but in the third section of beach, made more rescues during higher water levels. Rescue frequency increased in two sections of beach with rising water levels, but did not in the other section. Conclusions Wave height, water level, and water level direction were associated with rescue frequency, but the environmental factors included in the analysis did not fully account for most variation in rescue frequency. Other factors need to be evaluated to identify major determinants of rescue frequency.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.006
       
  • A population-based survey for emergency medical service transport of acute
           aortic syndrome patients
    • Authors: Akira Yamashita; Tetsuo Maeda; Yoshihito Kita; Satoru Sakagami; Yasuhiro Myojo; Yukihiro Wato; Yutaka Yoshita; Hideo Inaba
      Abstract: Publication date: Available online 5 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Akira Yamashita, Tetsuo Maeda, Yoshihito Kita, Satoru Sakagami, Yasuhiro Myojo, Yukihiro Wato, Yutaka Yoshita, Hideo Inaba
      Background The quality of acute aortic syndrome (AAS) assessment by emergency medical service (EMS) and the incidence and pre-hospital factors associated with 1-month survival remain unclear. Methods We retrospectively analyzed the data collected for 94,468 patients with non-traumatic medical emergency excluding out-of-hospital cardiac arrest during the period of 2011–2014. Results Of these transported by EMS, 22,075 had any of the AAS-related symptoms, and 330 had an EMS-assessed risk for AAS; of these, 195 received an in-hospital AAS diagnosis. Of the remaining 21,745 patients without EMS-assessed risk, 166 were diagnosed with AAS. Therefore, the sensitivity and specificity of our EMS-risk assessment for AAS was 54.0% (195/361) and 99.4% (21,579/21,714), respectively. EMS assessed the risk less frequently when patients were elderly and presented with dyspnea and syncope/faintness. Sign of upper extremity ischemia was rarely detected (6.9%) and absence of this sign was associated with lack of EMS-assessed risk. The calculation of modified aortic dissection detection risk score revealed that rigorous assessment based on this score may increase the EMS sensitivity for AAS. The 1-month survival rate was significantly higher in patients admitted to core hospitals with surgical teams for AAS than in those admitted to all other hospitals [87.5% (210/240) vs 69.4% (84/121); P <0.01]. Multiple logistic regression analysis demonstrated that Stanford type A, Glasgow coma scale ≤14, and admission to core hospitals providing emergency cardiovascular surgery were associated with 1-month survival. Conclusions Improvement of AAS survival is likely to be affected by rapid admission to appropriate hospitals providing cardiovascular surgery.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.005
       
  • Factors associated with advanced cardiac care in prehospital chest pain
           patients
    • Authors: Adam Frisch; Kenneth J. Heidle; Stephanie O. Frisch; Ashar Ata; Brandon Kramer; Caroline Colleran; Jestin N. Carlson
      Abstract: Publication date: Available online 5 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Adam Frisch, Kenneth J. Heidle, Stephanie O. Frisch, Ashar Ata, Brandon Kramer, Caroline Colleran, Jestin N. Carlson
      Introduction Many patients transported by emergency medical services (EMS) may require advanced cardiac care but do not have ST-segment elevation (STEMI) on the initial prehospital EKG. We sought to identify factors associated with the need for advanced cardiac care in undifferentiated EMS patients reporting chest pain in the absence of STEMI on EKG. Methods We performed a retrospective analysis of all adult patients, reporting atraumatic chest pain from a single EMS agency, presenting to a single, urban hospital over a 10-year period. Patients with STEMI on prehospital electrocardiogram were excluded. Patient demographics, chest pain characteristics and prehospital factors were abstracted for all patients. We identified those patients that required advanced cardiac care and performed regression analysis to determine associated factors. Results A total of 956 charts were analyzed. Of this total, 193 patients (20.2%) met the primary composite outcome. Of the outcome group, 185 patients (95.9%) had coronary artery disease documented on cardiac catheterization, 22 patients (11.4%) underwent CABG, and seven patients (3.6%) died in the hospital. Most significant variables (multivariable IRR) included age (1.02), male gender (1.65), history of MI (1.47), PCI (1.66), hyperlipidemia (1.40), diaphoresis (1.51), home aspirin (1.53), and improvement with EMS treatment (1.60). Conclusion We have identified several factors that could be considered when risk stratifying prehospital patients reporting chest pain. While potentially predictive, the factors are broad and support the need for other objective factors that could augment prediction of patients who may benefit from early advanced cardiac care.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.003
       
  • Severe headaches and 3rd or 6th nerve palsy associated with nicorandil: A
           hypothesis
    • Authors: Philippe Trechot; Jean Baptiste Conart; Nadine Petitpain; Fanny Trechot
      Abstract: Publication date: Available online 5 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Philippe Trechot, Jean Baptiste Conart, Nadine Petitpain, Fanny Trechot


      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.001
       
  • Chloride validity in Emergency Department settings
    • Authors: Matea Kolačević; Dina Vukičević Budoin; Alen Babacanli; Marina Repušić Babacanli; Ivan Brdar; Ivan Zeljković; Nikola Bulj
      Abstract: Publication date: Available online 5 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Matea Kolačević, Dina Vukičević Budoin, Alen Babacanli, Marina Repušić Babacanli, Ivan Brdar, Ivan Zeljković, Nikola Bulj


      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.12.002
       
  • Author's response to the reader's letter about our recent publication
           (Outcomes and predictors of failure of non-invasive ventilation in
           patients with community acquired pneumonia in the emergency department)
    • Authors: Amjad Al-Rajhi; Jason Shahin; Anwar Murad; P.Z. Li
      Abstract: Publication date: Available online 5 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Amjad Al-Rajhi, Jason Shahin, Anwar Murad, P.Z. Li


      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.11.068
       
  • Autonomic imbalance in sepsis
    • Authors: Funda Sungur Biteker; Bülent Özlek; Oğuzhan Çelik; Eda Özlek; Cem Çil; Volkan Doğan; Murat Biteker
      Abstract: Publication date: Available online 2 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Funda Sungur Biteker, Bülent Özlek, Oğuzhan Çelik, Eda Özlek, Cem Çil, Volkan Doğan, Murat Biteker


      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.11.054
       
  • Common weight loss procedures and their complications
    • Authors: Maria S. Altieri; Brian Wright; Andrew Peredo; Aurora D. Pryor
      Abstract: Publication date: Available online 2 December 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Maria S. Altieri, Brian Wright, Andrew Peredo, Aurora D. Pryor
      Background As the number of obese patients in the United States continues to grow, there is a parallel increase in the number of bariatric surgery patients. A quarter of these patients will return to the Emergency Department (ED) within the first two years of the index procedure. Objective An understanding of the most common bariatric procedures and their related complications will greatly aide the Emergency Medicine physician in the care of these patients. Discussion Abdominal pain is the most common reason for bariatric patients to present to the ED and can represent a diagnostic challenge to EM physicians. It is important that EM physicians have a good understanding of bariatric procedures. We describe the three most common bariatric procedures: 1) the Laparoscopic Adjustable Gastric Banding (LAGB); 2) the Laparoscopic Sleeve Gastrectomy (LSG); 3) and the Roux-en-Y Gastric Bypass (RYGB). Due to the unique altered anatomy following the procedures there are specific complications related to each individual procedure. We will describe the most common presentations of abdominal pain in the post bariatric surgery patient. Finally, we will review new endoscopic procedures and the associated complications that may cause patients to present to the ED. Conclusion Certain complications in bariatric surgery patients can have a high rate of morbidity and mortality. An improved understanding of bariatric procedures and their complications will allow for improved vigilance and management.

      PubDate: 2017-12-08T15:36:57Z
      DOI: 10.1016/j.ajem.2017.11.050
       
  • Information of Authors
    • Abstract: Publication date: December 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 12


      PubDate: 2017-12-08T15:36:57Z
       
 
 
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