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Publisher: Elsevier   (Total: 3043 journals)

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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 22, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 21, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 84, 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: 351, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 238, 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: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Acute Pain     Full-text available via subscription   (Followers: 13)
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: 21)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 135, 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: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, 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: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, 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 Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 6)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 41, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 41, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 50, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
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: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, 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: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 61)
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: 3, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 353, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 325, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 405, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 39, 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: 54, 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: 10, 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  
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: 8, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 49, 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: 39, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 8, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, 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: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, 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: 235, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 57, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5)
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: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 22, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 57, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 11)
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: 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: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 161, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Emergency Medicine
  [SJR: 0.574]   [H-I: 65]   [39 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0735-6757
   Published by Elsevier Homepage  [3043 journals]
  • 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
      Pages: 1396 - 1399
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      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: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.016
       
  • 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 Meric Yilmaz
      Pages: 1400 - 1403
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      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: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.019
       
  • 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
      Pages: 1404 - 1407
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      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: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.020
       
  • 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
      Pages: 1408 - 1413
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      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: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.022
       
  • Emergency department visits involving benzodiazepines and
           non-benzodiazepine receptor agonists
    • Authors: Christopher N. Kaufmann; Adam P. Spira; G. Caleb Alexander; Lainie Rutkow; Ramin Mojtabai
      Pages: 1414 - 1419
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      Author(s): Christopher N. Kaufmann, Adam P. Spira, G. 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: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.023
       
  • 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
      Pages: 1420 - 1425
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      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: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.024
       
  • 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 R. Taira
      Pages: 1426 - 1429
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      Author(s): Tomer Begaz, David Elashoff, Tristan R. Grogan, David Talan, Breena R. 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: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.027
       
  • 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
      Pages: 1430 - 1434
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      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 anesthesia were included. The adequacy for manual and pressure-controlled mechanical ventilation and views at the distal end of each airway was assessed using a fiber-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: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.029
       
  • Ultrasound-guided interscalene nerve block vs procedural sedation by
           propofol and fentanyl for anterior shoulder dislocations
    • Authors: Esmaeil Raeyat Doost; Mohammad Mehdi Heiran; Mitra Movahedi; Amirhossein Mirafzal
      Pages: 1435 - 1439
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      Author(s): Esmaeil Raeyat Doost, Mohammad Mehdi Heiran, Mitra Movahedi, Amirhossein 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: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.032
       
  • Plasma copeptin levels in the patients with gastrointestinal bleeding
    • Authors: Ömer Salt; Polat Durukan; S. Ozkan; R. Saraymen; A. Sen; M.A. Yurci
      Pages: 1440 - 1443
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      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: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.033
       
  • 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
      Pages: 1444 - 1450
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      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: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.038
       
  • Randomized clinical trial of propofol versus alfentanil for moderate
           procedural sedation in the emergency department
    • Authors: James R. Miner; Brian E. Driver; Johanna C. Moore; Erik Faegerstrom; Lauren Klein; Matthew Prekker; Jon B. Cole
      Pages: 1451 - 1456
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      Author(s): James R. Miner, Brian E. Driver, Johanna C. Moore, Erik Faegerstrom, Lauren Klein, Matthew Prekker, Jon B. Cole
      Study objective To compare the frequency of airway and respiratory adverse events leading to an intervention between moderate sedation using alfentanil or propofol. Methods We performed a randomized clinical trial in which adults undergoing moderate sedation in the ED received either alfentanil or propofol. Our primary outcome was the frequency of airway and respiratory adverse events leading to an intervention. Other outcomes included sedation depth, efficacy, sedation time, patient satisfaction, pain, and satisfaction. Results 108 subjects completed the trial: 52 receiving alfentanil and 56 receiving propofol. Airway or respiratory adverse events leading to an intervention were similar between the two groups: 23% for alfentanil and 20% for propofol (p =0.657). There were no serious adverse events in any group. Secondary outcomes were notably different in the rate of reported pain (48% for alfentanil, 13% for propofol) and recall (75% for alfentanil, 23% for propofol) and similar in the rate of satisfaction with the procedure (87% for alfentanil, 84% for propofol). Conclusion We found a similar frequency of airway and respiratory adverse events leading to intervention between alfentanil and propofol used for moderate procedural sedation. Both agents appear safe for moderate procedural sedation.

      PubDate: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.041
       
  • Long-term survival of out-of-hospital cardiac arrest patients with
           malignancy
    • Authors: Saee Byel Kang; Kyung Su Kim; Gil Joon Suh; Woon Yong Kwon; Kyoung Min You; Min Ji Park; Jung-In Ko; Taegyun Kim
      Pages: 1457 - 1461
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      Author(s): Saee Byel Kang, Kyung Su Kim, Gil Joon Suh, Woon Yong Kwon, Kyoung Min You, Min Ji Park, Jung-In Ko, Taegyun Kim
      Background The aim of this study was to investigate whether the 1-year survival rate of out-of-hospital cardiac arrest (OHCA) patients with malignancy was different from that of those without malignancy. Methods All adult OHCA patients were retrospectively analyzed in a single institution for 6years. The primary outcome was 1-year survival, and secondary outcomes were sustained return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and discharge with a good neurological outcome (CPC 1 or 2). Kaplan-Meier survival analysis and Cox proportional hazard regression analysis were performed to test the effect of malignancy. Results Among 341 OHCA patients, 59 patients had malignancy (17.3%). Sustained ROSC, survival to admission, survival to discharge and discharge with a good CPC were not different between the two groups. The 1-year survival rate was lower in patients with malignancy (1.7% vs 11.4%; P =0.026). Kaplan-Meier survival analysis revealed that patients with malignancy had a significantly lower 1-year survival rate when including all patients (n=341; P =0.028), patients with survival to admission (n=172, P =0.002), patients with discharge CPC 1 or 2 (n=18, P =0.010) and patients with discharge CPC 3 or 4 (n=57, P =0.008). Malignancy was an independent risk factor for 1-year mortality in the Cox proportional hazard regression analysis performed in patients with survival to admission and survival to discharge. Conclusions Although survival to admission, survival to discharge and discharge with a good CPC rate were not different, the 1-year survival rate was significantly lower in OHCA patients with malignancy than in those without malignancy.

      PubDate: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.051
       
  • Effects of repeated epinephrine administration and administer timing on
           witnessed out-of-hospital cardiac arrest patients
    • Authors: R. Sagisaka; H. Tanaka; H. Takyu; H. Ueta; S. Tanaka
      Pages: 1462 - 1468
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      Author(s): R. Sagisaka, H. Tanaka, H. Takyu, H. Ueta, S. Tanaka
      Background Repeated administration of epinephrine is associated with unfavorable cerebral outcome after out-of-hospital cardiac arrests (OHCA), but the timing of epinephrine administration has not been considered. Aim The aim of the study was to analyze the effects of repeated epinephrine administration after OHCA on favorable cerebral function coded by cerebral performance categories (CPC 1–2). Methods A nationwide, retrospective, population-based observational study was conducted by using Utstein-style data between 2010 and 2012 in Japan. The total of 11,876 cardiogenic and witnessed OHCA were stratified into 3 categories by the number of times epinephrine was administered (single, double, and three or more). In addition, the time elapsed between the emergency call and the initial epinephrine administration was divided into 3 time intervals (5 to 20min for the early administration group [EAG], 21 to 26min for the intermediate administration group [IAG], and 27 to 60min for the late administration group [LAG]). The primary endpoint was CPC 1–2 at 1month after cardiac arrest. A multivariable logistic regression was used for analysis. Results Achievement of CPC 1–2 at 1month was 4.8% for single, 2.4% for double, and 1.7% for three or more administered doses. For single and three or more administrations, CPC 1–2 was significantly higher in the IAG than in the LAG (adjusted odds ratio [AOR], 3.54, 3.02; 95% confidence interval [CI], 2.04–6.39, 1.16–9.43, for single and three or more administrations, respectively). The EAG showed significantly higher achievement of CPC 1–2 in all the epinephrine administration groups (AOR, 9.26, 7.57, 4.07; 95% CI, 5.44–16.59, 3.39–19.60, 1.59–12.69, for single, double, and three or more administrations, respectively). Conclusion Repeated epinephrine administration improved CPC 1–2 outcome when epinephrine was administrated within 20min after an emergency call for witnessed cardiogenic OHCA.

      PubDate: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.052
       
  • Esmolol reduces apoptosis and inflammation in early sepsis rats with
           abdominal infection
    • Authors: Yang Lu; Yang Yang; Xin He; Shangwen Dong; Wanhua Wang; Donghao Wang; Peng Zhang
      Pages: 1480 - 1484
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      Author(s): Yang Lu, Yang Yang, Xin He, Shangwen Dong, Wanhua Wang, Donghao Wang, Peng Zhang
      Background Esmolol is a highly selective beta 1 receptor blocker with various effects such as slowing heart rate, lowering blood pressure and reducing myocardial oxygen consumption. However, few studies have reported the use of beta blockers in sepsis with multiple organ dysfunctions. This study aimed to investigate the effects of esmolol on reducing apoptosis and inflammation in early sepsis rats with abdominal infection. Methods Rats were randomly divided into sham operation group, sepsis group, antibiotic group, Esmolol + antibiotic group with low, median and high dose Esmolol (L group, M group and H group). Values between two or more groups were compared by independent t-tests. Results In the liver and kidney, we found inflammatory infiltration in sepsis group while pathological aspects reduced in L, M and H groups. Bcl-2 mRNA and protein levels increased while Bax mRNA and protein levels decreased in the liver and kidney of L, M and H groups. Serum IL-6, HMGB-1 and TNF-α levels decreased but IL-10 level increased in L, M and H groups, compared to sepsis group. Compared to sepsis and antibiotic groups, the levels of myocardial enzymes were lower in L, M and H groups. Conclusion The administration of esmolol in early sepsis may reduce inflammation, inhibit apoptosis and protect key organs.

      PubDate: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.056
       
  • Diagnostic approach to constipation impacts pediatric emergency department
           disposition
    • Authors: Corrie E. Chumpitazi; Chris A. Rees; Elizabeth A. Camp; Erin B. Henkel; Karina L. Valdez; Bruno P. Chumpitazi
      Pages: 1490 - 1493
      Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10
      Author(s): Corrie E. Chumpitazi, Chris A. Rees, Elizabeth A. Camp, Erin B. Henkel, Karina L. Valdez, Bruno P. Chumpitazi
      Objectives Constipation is a common cause of abdominal pain in children presenting to the emergency department (ED). The objectives of this study were to determine the diagnostic evaluation undertaken for constipation and to assess the association of the evaluation with final ED disposition. Methods A retrospective chart review of children presenting to the pediatric ED of a quaternary care children's hospital with abdominal pain that received a soap suds enema therapy. Results A total of 512 children were included, 270 (52.7%) were female, and the median age was 8.0 (IQR: 4.0–11.0). One hundred and thirty eight patients (27%) had a digital rectal exam (DRE), 120 (22.8%) had bloodwork performed, 218 (43%) had urinalysis obtained, 397 (77.5%) had abdominal radiographs, 120 (23.4%) had abdominal ultrasounds, and 18 (3.5%) had computed tomography scans. Children who had a DRE had a younger median age (6.0, IQR: 3.0–9.25 vs. 8.0, IQR: 4.0–12.0; p <0.001) and were significantly less likely to have radiologic imaging (OR=0.50, 95% CI 0.32–0.78; p =0.002), but did not have an increased odds of being discharged home. After adjusting for gender, ethnicity, and significant past medical history those with an abdominal radiograph were less likely to be discharged to home (aOR=0.56, 95% CI 0.31–1.01; p =0.05). Conclusions The diagnostic evaluation of children diagnosed with fecal impaction in the ED varied. Abdominal imaging may be avoided if children receive a DRE. When children presenting to the ED with abdominal pain had an abdominal radiograph, they were more likely to be admitted.

      PubDate: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.04.060
       
  • Sizing capacity levels in emergency medical services dispatch centers:
           Using the newsvendor approach
    • Authors: Gorkem Sariyer
      Abstract: Publication date: Available online 12 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Gorkem Sariyer
      Background The increased volume in demand worldwide in the present day has led to the need for the establishment of effective ambulance services. As call centers have become the primary contact point between patients and emergency service providers, the planning of the call center has become a key task for administrators. Objectives The aim of this study is to apply a widely used operations management method, the newsvendor model, for optimizing the capacity level in EMS call centers with a minimum cost in order to efficiently meet the calls arriving. Methods Real-life data from a call center for ambulance services in a major city in Turkey was used. We propose using the newsvendor model for optimizing this call center's capacity level based on the forecasts of periodic call volumes via basic methods. Results Ambulance service call volumes vary during the day and weekday call profiles are different from weekends. By separating the analysis into weekdays and weekends and illustrating shorter time intervals within the days, call volume can be forecast. Taking not only the point forecast but also the variation of the forecast into account, the capacity level of each period can be planned in a cost-effective way. Conclusions This paper provides a basis for operation planning strategies of ambulance services by reconsidering the uncertainties of demand. The newsvendor model, which works well under parameter uncertainty, can be used in planning the capacities of health care services, especially when high service levels are required.

      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.027
       
  • Prehospital triage of septic patients at the SAMU regulation: Comparison
           of qSOFA, MRST, MEWS and PRESEP scores
    • Authors: R. Jouffroy; A. Saade; S. Ellouze; A. Carpentier; M. Michaloux; P. Carli; B. Vivien
      Abstract: Publication date: Available online 12 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): R. Jouffroy, A. Saade, S. Ellouze, A. Carpentier, M. Michaloux, P. Carli, B. Vivien
      Purpose A couple of scoring systems have been developed for risk stratification of septic patients. Their performance in the management of out-of-hospital initial care delivery is not documented. This study try to evaluate the predictive ability of Quick Sequential Organ Failure Assessment (qSOFA), Robson Screening Tool (RST), Modified Early Warning Score (MEWS) and Prehospital Early Sepsis Detection (PRESEP) scores on out of-hospital triage of septic patients, to predict intensive care unit (ICU) admission. Methods A retrospective study using call records received by the SAMU 15 regulation call centre including all patients with presumed septic shock was performed. The primary outcome was the admission to the ICU. Results Among the 47 000 reports received, 37 patients with presumed septic shock were included. Twenty-two patients (59%) were admitted to ICU. AUCs of qSOFA, RST, MEWS and PRESEP scores were respectively 0.40 [0.22-0.59], 0.60 [0.43-0.78], 0.66 [0.47-0.85] and 0.67 [0.51-0.84]. RST outperformed PRESEP, MEWS and qSOFA for sensitivity (1, 0.92, 0.85 and 0.62 respectively). MEWS showed better specificity than PRESEP, MRST and qSOFA (0.33, 0.29, 0.16 and 0.16). MEWS showed comparable positive predictive value than PRESEP and outperformed MRST and qSOFA (0.41, 0.41, 0.39 and 0.29 respectively). Negative predictive value of MRST outperformed PRESEP, MEWS and qSOFA (1, 0.88, 0.80 and 0.44 respectively). Conclusion Our findings suggest that screening patients at SAMU 15 regulation call centre using qSOFA, MRST, MEWS and PRESEP scores to predict ICU admission is irrelevant. Development of a specific scoring system for out-of-hospital triage of septic patients is needed.

      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.030
       
  • Comments on predictive performance of serum S100B for neuronal damage and
           poor clinical outcomes
    • Authors: Saeid Safiri; Erfan Ayubi
      Abstract: Publication date: Available online 12 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Saeid Safiri, Erfan Ayubi


      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.031
       
  • Ability of emergency medicine residents in the diagnosis of heart failure
           with a preserved ejection fraction by echocardiogram
    • Authors: Samuel Blake Kluger; Lawrence Haines; Eitan Dickman; Peter Homel
      Abstract: Publication date: Available online 12 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Samuel Blake Kluger, Lawrence Haines, Eitan Dickman, Peter Homel


      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.033
       
  • Which transfers can we avoid: Multi-state analysis of factors associated
           with discharge home without procedure after ED to ED transfer for
           traumatic injury
    • Authors: Laura N. Medford-Davis; Daniel N. Holena; David Karp; Michael J. Kallan; M. Kit Delgado
      Abstract: Publication date: Available online 11 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Laura N. Medford-Davis, Daniel N. Holena, David Karp, Michael J. Kallan, M. Kit Delgado
      Objective Among injured patients transferred from one emergency department (ED) to another, we determined factors associated with being discharged from the second ED without procedures, or admission or observation. Methods We analyzed all patients with injury diagnosis codes transferred between two EDs in the 2011 Healthcare Utilization Project State Emergency Department and State Inpatient Databases for 6 states. Multivariable hierarchical logistic regression evaluated the association between patient (demographics and clinical characteristics) and hospital factors, and discharge from the second ED without coded procedures. Results In 2011, there were a total of 48,160 ED-to-ED injury transfers, half of which (49%) were transferred to non-trauma centers, including 23% with major trauma. A total of 22,011 transfers went to a higher level of care, of which 36% were discharged from the ED without procedures. Relative to torso injuries, discharge without procedures was more likely for patients with soft tissue (OR 6.8, 95%CI 5.6–8.2), head (OR 3.7, 95%CI 3.1–4.6), facial (OR 3.8, 95%CI 3.1–4.7), or hand (OR 3.1, 95%CI 2.6–3.8) injuries. Other factors included Medicaid (OR 1.3, 95%CI 1.2–1.5) or uninsured (OR 1.3, 95%CI 1.2–1.5) status. Treatment at the receiving ED added an additional $2859 on average (95% CI $2750–$2968) per discharged patient to the total charges for injury care, not including the costs of ambulance transport between facilities. Conclusion Over a third of patients transferred to another ED for traumatic injury are discharged from the second ED without admission, observation, or procedures. Telemedicine consultation with sub-specialists might reduce some of these transfers.

      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.024
       
  • The relationship between fibrinogen and in-hospital mortality in patients
           with type A acute aortic dissection
    • Authors: Jun Liu; Lian-Lian Sun; Jue Wang; Guang Ji
      Abstract: Publication date: Available online 11 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Jun Liu, Lian-Lian Sun, Jue Wang, Guang Ji
      Background and purpose Fibrinogen plays an important role in hemostasis and thrombosis and is proven to have prognostic significance in patients with cardiovascular disease. We examined the utility of fibrinogen as a prognostic indicator for patients with type A acute aortic dissection (AAD). Methods This study was performed in consecutive patients with type A AAD admitted to our hospital within 24 hours after onset of symptoms. Fibrinogen levels were measured on admission. Baseline clinical characteristics and laboratory test results were collected. The endpoint was in-hospital mortality. Results A total of 143 patients with type A AAD were enrolled. Compared with the survivors, the nonsurvivors had significant lower fibrinogen levels (1.95(1.37, 2.38) vs. 2.37(1.85, 3.15) g/L, p =0.001). The cutoff level of fibrinogen determined by ROC curve analysis was 2.17 g/L, with a sensitivity, specificity of 71.9%, 60.4% respectively, and the area under the ROC curve was 0.686 (95% CI, 0.585–0.768; p =0.001). After controlling for potentially relevant confounding variables, we found an admission fibrinogen level less than 2.17g/L was associated with an increased risk of in-hospital mortality (odds ratio, 5.527; 95% CI, 1.660–18.401; p =0.005) compared with those with fibrinogen greater than 2.17g/L. Conclusion Low fibrinogen level on admission is an independent predictor of in-hospital mortality in patients with type A AAD.

      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.001
       
  • High rate of isolated right ventricular dysfunction in patients with
           non-significant computed tomographic pulmonary angiography
    • Authors: Frances M. Russell; Jeffrey A. Kline; Timothy Lahm
      Abstract: Publication date: Available online 10 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Frances M. Russell, Jeffrey A. Kline, Timothy Lahm
      Background Right ventricular (RV) dysfunction and pulmonary hypertension (PH) are commonly unrecognized in the emergency department (ED), but are associated with poor outcomes. Prior research has found a 30% prevalence of isolated RV dysfunction in ED patients after non-significant computed tomographic pulmonary angiography (CTPA). We aimed to prospectively define the prevalence of RV dysfunction and/or PH in short of breath ED patients, and assess outcomes. Methods Prospective observational study of patients with a non-significant CTPA. Isolated RV dysfunction and/or PH was defined as normal left ventricular function plus RV dilation, moderate to severe tricuspid regurgitation or RV systolic pressure>40mmHg on comprehensive echocardiography. Results Of 83 patients, 20 (24%, 95% [confidence interval] CI: 16–34%) had isolated RV dysfunction and/or PH. These patients had 40% ED recidivism and 30% hospital readmission at 30-days. When compared to patients with normal echocardiographic function, they had significantly longer intensive care unit and hospital length of stays. Conclusions In a prospective cohort of ED patients, we found a high prevalence of isolated RV dysfunction and/or PH after a non-significant CTPA. These patients had high rates of recidivism and hospital readmission. This data supports a continued need for ED based screening and specialty referral.

      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.023
       
  • Intentional cyanoacrylate ingestion: A rare cause of delayed gastric
           perforation requiring gastric wedge resection
    • Authors: Sun Hwa Lee; Seong Jong Yun; Seokyong Ryu; Seung Won Choi; Hye Jin Kim; Tae Kyung Kang; Sung Chan Oh; Suk Jin Cho
      Abstract: Publication date: Available online 7 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Sun Hwa Lee, Seong Jong Yun, Seokyong Ryu, Seung Won Choi, Hye Jin Kim, Tae Kyung Kang, Sung Chan Oh, Suk Jin Cho
      Cyanoacrylate (LOCTITE® 401™) is a fast-acting adhesive available nationwide, with medical and household uses. Most cases of cyanoacrylate exposure are accidental and occur in children less than 5years old. Various routes of exposure have been reported including the dermal, oral, ocular, otic, nasal, and urethral routes; however, very few result in serious complication and mortality. Although a few cases of airway obstruction related to cyanoacrylate ingestion have been reported, intentional cyanoacrylate ingestion-induced gastrointestinal tract injury has scarcely been reported. In addition, there have been no reports of serious complications following intentional cyanoacrylate ingestion requiring surgical intervention. Herein, we report a case of intentional ingestion of cyanoacrylate in a 70-year-old man who required gastric wedge resection due to delayed gastric perforation.

      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.017
       
  • A prospective study of ketamine as primary therapy for prehospital
           profound agitation
    • Authors: Jon B. Cole; Lauren R. Klein; Paul C. Nystrom; Johanna C. Moore; Brian E. Driver; Brandon J. Fryza; Justin Harrington; Jeffrey D. Ho
      Abstract: Publication date: Available online 7 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Jon B. Cole, Lauren R. Klein, Paul C. Nystrom, Johanna C. Moore, Brian E. Driver, Brandon J. Fryza, Justin Harrington, Jeffrey D. Ho
      Objective We investigated the effectiveness of ketamine as a primary therapy for prehospital profound agitation. Methods This was a prospective observational study of patients receiving 5mg/kg of intramuscular ketamine for profound agitation, defined as a score of +4 on the Altered Mental Status Scale (AMSS), a validated ordinal scale of agitation from −4 (unresponsive) to +4 (most agitated). The primary outcome was time to adequate sedation (AMSS<+1). Secondary outcomes included need for additional sedatives, intubation frequency, complications associated with ketamine, and mortality. Results Forty-nine patients were enrolled. Median age was 29years (range 18–66); 76% (37/49) were male. Median time to adequate sedation was 4.2min (95% CI: 2.5–5.9, range 1–25min) and 90% (44/49) had adequate sedation prehospital. Seven patients (14%) received a second sedative prehospital. Intubation occurred in 57% (28/49) of patients. Mechanical ventilation lasted <24h in 82% (23/28) of patients, and <48h in 96% (27/28) of patients. A single physician intubated 36% (10/28) of the patients. Complications related to ketamine included hypersalivation (n=9, 18%), vomiting (n=3, 6%), and emergence reaction (n=2, 4%). One patient died from complications of septic shock on hospital day 29, likely unrelated to ketamine. Conclusions In patients with prehospital profound agitation, ketamine provides rapid effective sedation when used as a primary therapy. Intubation was common but accompanied by a short duration of mechanical ventilation and appears to have been subject to individual physician practice variation.

      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.022
       
  • Choice of resuscitative fluids and mortality in emergency department
           patients with sepsis
    • Authors: Monica Sethi; Clark G. Owyang; Chad Meyers; Ram Parekh; Kaushal H. Shah; Alex F. Manini
      Abstract: Publication date: Available online 7 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Monica Sethi, Clark G. Owyang, Chad Meyers, Ram Parekh, Kaushal H. Shah, Alex F. Manini
      Objective Balanced resuscitative fluids (BF) have been associated with decreased incidence of hyperchloremic metabolic acidosis in sepsis. We hypothesized that higher proportions of BF during resuscitation would thus be associated with improved mortality in Emergency Department (ED) patients with sepsis. Methods This was a retrospective chart review of adult ED patients who presented with sepsis to a large, urban teaching hospital over one year. The choice of resuscitation fluid in the first 2days of hospitalization was defined as either normal saline (NS) or balanced fluids (BF; Lactated Ringer's or Isolyte). The primary study outcome was in-hospital mortality, which was analyzed with multivariable logistic regression based on the proportion of BF received during the initial ED resuscitation. Results Of 149 patients screened, 33 were excluded, leaving 115 for analysis, of whom 18 died (16% overall mortality). Sixty-one (53%) patients received BF and NS, 6 (5%) patients received BF exclusively, while 48 (42%) patients received NS only. The mean number of liters administered was 5.4, and the mean percentage of BF administered was 29%. In univariate analysis, a higher proportion of BF was associated with lower odds of mortality (OR 0.973 [95% CI 0.961–0.986], p=0.00003). This association held true in multivariable models controlling for comorbidities and admission lactate level. Conclusions We found that the proportion of BF during the initial ED resuscitation in septic patients was associated with a significant reduction in mortality. This association provides the necessary rationale for future randomized clinical trials of BF resuscitation in sepsis.

      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.09.042
       
  • Nonepileptic seizure provoked by cardiac dysrhythmia: A case of ST
           elevation myocardial infarction
    • Authors: A. Pourmand; S. Davis; K. Yensen
      Abstract: Publication date: Available online 7 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): A. Pourmand, S. Davis, K. Yensen
      Acute seizures represent 1% of all visits to emergency departments in the United States. While many acute seizures are correctly attributable to underlying epilepsy, approximately one-third of acute seizures are provoked by underlying and potentially life-threatening acute conditions. Many clinical syndromes associated with seizure-like activity are well-established and readily identified in the acute setting. Cardiac dysrhythmias are known causes of acute seizure-like activity and, if transient and not captured by electrocardiogram tracings during acute episodes, may be incorrectly diagnosed as epileptic seizures. We report a case of acute ST-segment elevation myocardial infarction presenting with acute symptomatic seizure due to occult transient cardiac dysrhythmia.

      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.013
       
  • Clinical value of triage lactate in risk stratifying trauma patients using
           interval likelihood ratios
    • Authors: Bonny J. Baron; Andrew Nguyen; Dimitre Stefanov; Amit Shetty; Shahriar Zehtabchi
      Abstract: Publication date: Available online 7 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Bonny J. Baron, Andrew Nguyen, Dimitre Stefanov, Amit Shetty, Shahriar Zehtabchi
      Emergency physicians face the challenge of rapidly identifying high-risk trauma patients. Lactate (LAC) is widely used as a surrogate of tissue hypoperfusion. However, clinically important values for LAC as a predictor of mortality are not well defined. Objectives: 1. To assess the value of triage LAC in predicting mortality after trauma. 2. To compute interval likelihood ratios (LR) for LAC. Methods Retrospective chart review of trauma patients with a significant injury mechanism that warranted labs at an urban trauma center. Outcome: In-hospital mortality. Data are presented as median and quartiles or percentages with 95% confidence intervals. Groups (lived vs. died) were compared with Man-Whitney-U or Fisher's-exact test. Multivariate analysis was used to measure the association of the independent variables and mortality. The interval likelihood ratios were calculated for all LAC observed values. Results 10,575 patients; median age: 38 [25–57]; 69% male; 76% blunt; 1.1% [n =119] mortality. LAC was statistically different between groups in univariate (2.3 [1.6,3.0] vs 2.8 [1.6,4.8], p =0.008) and multivariate analyses (odds ratio: 1.14 [1.08–1.21], p =0.0001). Interval ratios for LR- ranged from 0.6–1.0. Increasing LAC increased LR+. However, LR+ for LAC reached 5 with LAC>9mmol/L and passed 10 (moderate and conclusive increase in disease probability, respectively) with LAC>18mmol/L. Conclusions In a cohort of trauma patients with a wide spectrum of characteristics triage LAC was statistically able to identify patients at high risk of mortality. However, clinically meaningful contribution to decision-making occurred only at LAC>9. LAC was not useful at excluding those with a low risk of mortality.

      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.015
       
  • Monitoring the corrected QT in the acute care setting: A comparison of the
           12‑lead electrocardiogram and bedside monitor
    • Authors: James A. Chenoweth; Aaron M. Hougham; Daniel K. Colby; Jonathan B. Ford; Jordan Sandhu; Timothy E. Albertson; Mark E. Sutter
      Abstract: Publication date: Available online 7 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): James A. Chenoweth, Aaron M. Hougham, Daniel K. Colby, Jonathan B. Ford, Jordan Sandhu, Timothy E. Albertson, Mark E. Sutter
      Introduction Prolongation of the QT interval is a well-recognized complication associated with many commonly used medications. Emergency Department monitoring of the corrected QT (QTc) both before and after medication administration is typically performed using the 12‑lead electrocardiogram (ECG). The purpose of this study is to compare the QTc reported on the 12‑lead ECG to that reported by single brand of bedside monitor. Methods A convenience sample of emergency department patients over the age of 18 undergoing bedside monitoring and who had an ECG ordered by their treating physician were enrolled. These patients underwent simultaneous ECG and monitor QTc calculation. The primary outcome of interest was the correlation between the monitor and ECG QTc. Secondary outcomes included ability of each method to identify patients with a QTc >500ms and the ability of each method to identify patients with a QTc <450ms. Results A total of 125 patients had simultaneous ECG and monitor QTc measurements recorded. There was moderate correlation between the monitor and ECG QTc (Pearson's correlation coefficient=0.55). The median difference between the ECG QTc and the monitor QTc (ECG QTc minus monitor QTc) was −7ms (IQR −23 to 11ms). Conclusion We found that there was moderate correlation between the QTc reported on the 12 lead ECG and that reported by the bedside monitor. This correlation is not strong enough to support the use of the bedside monitor as a substitute for the 12‑lead ECG when evaluating a patient's QTc.

      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.012
       
  • More than a drink: A rare anaphylactic reaction to sparkling water
    • Authors: Ryan K. Dean; Rogin Subedi; Peter Christiano; Anil Ghimire
      Abstract: Publication date: Available online 7 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Ryan K. Dean, Rogin Subedi, Peter Christiano, Anil Ghimire
      Anaphylaxis is a potentially life threatening, type I hypersensitivity reaction which can occur within seconds to minutes after exposure to an allergen. Sulfites have been implicated in causing such reactions with symptoms ranging from mild to potentially life threatening. Here we present a patient who had an anaphylactic reaction secondary to exposure to sulfites found in sparkling water.

      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.019
       
  • Symptomatic relief as an outcome in studies of nasogastric decompression
           in small bowel obstruction
    • Authors: Stamatis Karakonstantis; Dimitra Kalemaki
      Abstract: Publication date: Available online 7 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Stamatis Karakonstantis, Dimitra Kalemaki


      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.018
       
  • Patterns of facial trauma before and after legalization of marijuana in
           Denver, Colorado: A joint study between two Denver hospitals
    • Authors: Mofiyinfolu Sokoya; Justin Eagles; Tyler Okland; Dylan Coughlin; Hannah Dauber; Christopher Greenlee; Andrew A. Winkler
      Abstract: Publication date: Available online 7 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Mofiyinfolu Sokoya, Justin Eagles, Tyler Okland, Dylan Coughlin, Hannah Dauber, Christopher Greenlee, Andrew A. Winkler
      Introduction The effect of marijuana on human health has been studied extensively. Marijuana intoxication has been shown to affect performance, attention span, and reaction time. The public health relationship between trauma and cannabis use has also been studied, with mixed conclusions. In this report, the effect of marijuana legalization on many aspects of facial trauma at two hospitals in Denver, Colorado is examined. Methods A retrospective review of the electronic medical records was undertaken. Mann-Whitney U tests were used to compare age of patients before and after legalization, and chi squared analyses were used to compare mechanism of injury, and fracture types before and after recreational marijuana legalization in Denver, Colorado. Geographical location of patients was also considered. Results No significant increase was found in race before and after marijuana legalization (p=0.19). A significant increase in age was found before (M=39.54,SD=16.37), and after (M=41.38,SD=16.66) legalization (p<0.01). Maxillary and skull base fracture proportions significantly increased following legalization (p<0.001 and p<0.001respectively). No significant differences were seen in the proportion of patients who lived in urban and rural counties before and after legalization (p>0.05). Conclusion Public health efforts should be directed towards educating residents and visitors of Colorado on the effects and toxicology of marijuana. More epidemiologic studies are needed for further assessment of the long-term effects of the legalization of marijuana on the population.

      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.014
       
  • Systemic lupus erythematosus following meningococcal vaccination
    • Authors: Alexandria D. Holmes; Osman Z. Abbasi; Jeanne L. Jacoby
      Abstract: Publication date: Available online 7 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Alexandria D. Holmes, Osman Z. Abbasi, Jeanne L. Jacoby


      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.020
       
  • Along the Colorado Trail: Assessing the average hikers' knowledge of
           altitude sickness
    • Authors: Layne Dylla; Michael L. Saulle; Edward Daingerfield; Courtney M.C. Jones; Ryan P. Bodkin
      Abstract: Publication date: Available online 6 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Layne Dylla, Michael L. Saulle, Edward Daingerfield, Courtney M.C. Jones, Ryan P. Bodkin


      PubDate: 2017-10-12T19:43:32Z
      DOI: 10.1016/j.ajem.2017.10.011
       
  • Effect of intravenous ondansetron on QTc interval in children with
           gastroenteritis
    • Authors: Robert J. Hoffman; Khalid Alansari
      Abstract: Publication date: Available online 4 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Robert J. Hoffman, Khalid Alansari
      Background The potential for ondansetron to cause QT prolongation and fatal dysrhythmia is well-reported, including a 2011 FDA report on the topic. Few clinical trials evaluating this phenomenon in the ED setting exist, and only one is pediatric. Objective We have sought to determine the effect of a standardized dose of intravenous ondansetron on the QTc duration of children under 14years of age treated for gastroenteritis-associated vomiting in a pediatric ED. This study is modeled closely after an FDA “thorough QT study”. Methods EGCs were obtained before and 15, 30,45, and 60min after a 0.15mg/kg IV dose of ondansetron given for gastroenteritis-associated vomiting. QT intervals were measured manually with digital calipers, and the QTc interval calculated both by Bazett's (QTcB) and Fridericia's (QTcF) correction. A paired t-test comparing QTc was conducted, and frequency of categorical outcomes of absolute prolongation>30msec, >60 msec, and prolongation >450 msec, >480 msec, and >500msec were evaluated. Results In a 4-month period, 134 patients were included in the study, 46% were male. The average QTc prior to ondansetron administration was: QTcB 415 msec (95% CI 343–565) and QTcF 373 (95% CI 304–499). The mean difference in QTc after ondansetron was 0.4msec for QTcB (95% CI −35–45msec) and 0.1msec for QTcF (95% CI −40–18msec). Conclusion In these children, 0.15mg/kg of intravenous ondansetron did not cause prolongation of QTcB or QTcF measured 15min after administration, nor at later times.

      PubDate: 2017-10-06T00:31:41Z
      DOI: 10.1016/j.ajem.2017.10.004
       
  • Are three ports better than one' An evaluation of flow rates using all
           ports of a triple lumen central venous catheter in volume resuscitation
    • Authors: Stephanie Traylor; Aveh Bastani Nora Butris-Daut Matthew Christensen Pamela Marsack
      Abstract: Publication date: Available online 4 October 2017
      Source:The American Journal of Emergency Medicine
      Author(s): Stephanie Traylor, Aveh Bastani, Nora Butris-Daut, Matthew Christensen, Pamela Marsack, Lauren Rodgers, Brett Todd
      Background Poiseuille's law states flow rates are directly proportional to the radius to the 4th power and indirectly proportional to the length of a tube. Because of this property, large bore catheters are commonly used in the resuscitation of the critically ill patient. However, there are no studies comparing simultaneous use of all three lumens of a triple lumen (TL) central venous catheter (CVC) with other catheter types. Our objective was to compare the flow rates of normal saline (NS) through various resuscitation catheters against a TL CVC using all 3 ports. Methods We performed a blinded prospective observational study of flow rates utilizing multiple resuscitation catheters. Each catheter type was attached to a 1l bag of NS using standard saline tubing and mean time to infuse 1 L of normal saline was determined. Three trials each were completed with and without pressure bags. Results Simultaneous infusion of NS through all ports of a TL CVC demonstrated no statistically significant difference compared to the following catheters: 16ga peripheral venous catheter (PVC) and 6 Fr CVC with pressure bag. The 14 g PVC and 8.5Fr CVC had statistically significant faster flow rates than the TL CVC both with and without a pressure bag. The 6Fr CVC showed significantly faster flow rates than the TL CVC without a pressure bag. Conclusions Simultaneous use of all 3 ports of a TL CVC generates flow rates comparable to many other commonly used resuscitation catheters.

      PubDate: 2017-10-06T00:31:41Z
       
  • Information for Authors
    • Abstract: Publication date: October 2017
      Source:The American Journal of Emergency Medicine, Volume 35, Issue 10


      PubDate: 2017-10-06T00:31:41Z
       
 
 
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