JournalTOCs

Current Emergency and Hospital Medicine Reports
Number of Followers: 5

Hybrid journal (It can contain Open Access articles)
ISSN (Online) 2167-4884
Published by Springer-Verlag

[2469 journals]

A Review of Rare Etiologies of Altered Mental Status in the Emergency
Department
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  Abstract: Purpose of Review Emergency providers are well prepared for the rapid diagnosis and management of common etiologies of altered mental status. However, patients with persistently altered mental status of unclear etiology can present diagnostic and management challenges. Recent Findings Enhanced laboratory and imaging testing for patients in the emergency department has enabled the expanded workup and rapid diagnosis of life-threatening etiologies of altered mental status. Emergency physicians can improve patient care by reviewing updates in the current understanding of complex conditions causing altered mental status such as posterior reversible encephalopathy syndrome, vasculitis, and autoimmune disorders. Summary Herein, we provide a discussion of clinical cues and brief management pearls for some of the less common causes of altered mental status encountered in adults in the emergency department.
  PubDate: 2022-09-14
Evaluation and Management of New Onset and Breakthrough Seizures in Adults
in the Emergency Department
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  Abstract: Purpose of Review This review seeks to inform ED providers about best practices in the evaluation and treatment of new onset seizures in adults as well as those with established seizure diagnosis and breakthrough seizures. Recent Findings Current evidence suggests that early EEG has a higher rate of detecting epileptiform activity which is important as it can determine which patients need initiation of AED therapy. Early initiation of AEDs is important because although it does not have a mortality benefit or improve long-term remission it does improve quality of life and number of seizures. Summary Appropriate assessment and treatment of new onset and breakthrough seizures are crucial for this common presentation. Successfully ruling out other etiologies and ensuring timely follow-up and EEG/neuroimaging are key decisions ED providers must make in the care of these patients. Given the variability of neurology consultation and follow-up based on location, ED providers must understand and well utilize their available resources to advocate for best care for patients with seizures in their EDs.
  PubDate: 2022-09-07
Cardiac Changes Related to COVID-19 in Athletes: A Brief Review
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  Abstract: Purpose of Review To describe the cardiac changes related to COVID-19 in athletes, in addition to presenting the current recommendations for cardiac assessment and return to sport after COVID-19 infection. Recent Findings The current state of the art suggests that myocarditis and pericarditis are the main cardiac pathologies related to the COVID-19 infection in athletes even after recovery. The criteria for determining and evaluating cardiac conditions are still discussed, as well as what stage of infection do cardiomyopathies occur. Return to sport should be aligned with cardiovascular risk stratification. Summary Cardiac changes related to COVID-19 infection have drawn the attention in the sports medicine field, while some questions about the course of the disease and its relationship with physical performance in athletes are still under investigation. In addition, feasible assessment techniques for cardiac assessments should be explored in the future.
  PubDate: 2022-08-24
Indications for Emergent Hyperbaric Oxygen Therapy
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  Abstract: Purpose of Review This review describes select emergent indications for hyperbaric oxygen therapy (HBOT), current treatment protocols, and recent literature regarding its use. Recent Findings Recent reports have continued to support the emergent use of hyperbaric oxygen (HBO) and new applications for therapy. Summary Emergent hyperbaric oxygen therapy is indicated in several conditions due to its ability to reduce morbidity and mortality. Recent reports support its use in multiple emergent indications; however, additional research is required to refine treatment protocols, including time from symptom onset to initiation of treatment. In addition, the shortage of available facilities offering emergent HBOT poses a significant threat to patient care and research advances.
  PubDate: 2022-08-18
Evaluation and Treatment of Adult Status Epilepticus in the Emergency
Department
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  Abstract: Purpose of Review This review summarizes the current knowledge and evidence behind the diagnosis and management of adult status epilepticus (SE) in the Emergency Department (ED). It incorporates the most recent evidence-based diagnostic and management strategies, while reflecting them back onto the foundational aspects of SE care. Recent Findings Recent studies have re-emphasized the importance of early and appropriately dosed benzodiazepines as first-line therapy for SE. Second-line therapy has evolved from phenytoin to alternative anti-epileptics (AEDs) like levetiracetam. Additionally, cerebral perfusion-computed tomography (PCT) and electroencephalogram (EEG) are critical in the diagnosis of non-convulsive SE (NCSE) in the ED. Summary Early and aggressive medical management is crucial to curb the morbidity and mortality of adult SE in the ED starting with benzodiazepines and progressing to AEDs. Patients who remain altered after treatment may still have NCSE. Due to the clinical subtleties associated with NCSE, it is essential to utilize tools such as alternative EEG monitoring and PCT.
  PubDate: 2022-08-15
Pneumonia Update for Emergency Clinicians
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  Abstract: Purpose of Review Many new concepts in diagnosis, management, and risk stratification of patients with pneumonia have been described recently. The COVID pandemic made importance of viruses as dangerous pathogens of pneumonia quite clear while several non-invasive measures for patients with respiratory failure gained a more wide-spread usage. Recent Findings Studies continue to examine feasibility of bedside ultrasound as a tool in accurate diagnosis of pneumonia in the emergency department, and several new antibiotics have been approved for treatment while others are in late-stage clinical trials. Additionally, the Infectious Diseases Society, American Thoracic Society, and their European counterparts published updated guidelines in recent years. For differences important to emergency medicine clinicians and new emphasis as compared to the prior guidelines, please see Table 1. Several new antibiotics have been approved recently but remain relatively unknown to emergency clinicians as their use is frequently restricted to infectious disease specialists. Table 1 Differences important to emergency medicine clinicians and new emphasis [8, 16, 18, 19••, 30, 34] New recommendations Difference with prior guidelines if any Comment Blood and sputum cultures recommended in severe disease and in inpatients treated for MRSA or P. aeruginosa Similar from the ED perspective Clinical gestalt performs as well as various decision instruments in deciding who needs blood cultures [13] Obtaining procalcitonin level not recommended to guide antibacterial therapy Was not covered in prior guidelines Recommend using validated risk factors to determine the need for P. aeruginosa or MRSA coverage instead of using hospital-acquired and ventilator-associated guidelines Emphasized healthcare-associated pneumonia category MDRO prevalence varies widely between communities challenging study interpretation [8] Macrolide monotherapy conditional for outpatients based on local resistance patterns Was strongly recommended S. pneumonia is increasingly resistant to macrolides Amoxicillin or doxycycline monotherapy for outpatients with no comorbidities or risk factors for MDRO. Amoxicillin/clavulanate or cephalosporin (cefuroxime or cefpodoxime) combined with a macrolide or doxycyclin...
  PubDate: 2022-07-20
Regional Anesthesia in the Emergency Department: an Overview of Common
Nerve Block Techniques and Recent Literature
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  Abstract: Purpose of Review This review seeks to discuss the use of RA in the ED including benefits of administration, types of RA by anatomic location, complications and management, teaching methods currently in practice, and future applications of RA in the ED. Recent Findings The early use of RA in pain management may reduce the transition of acute to chronic pain. Multiple plane blocks have emerged as feasible and efficacious for ED pain complaints and are now being safely utilized. Summary Adverse effects of opioids and their potential for abuse have necessitated the exploration of substitute therapies. Regional anesthesia (RA) is a safe and effective alternative to opioid treatment for pain in the emergency department (ED). RA can manage pain for a wide variety of injuries while avoiding the risks of opioid use and decreasing length of stay when compared to other forms of analgesia and anesthesia, without compromising patient satisfaction.
  PubDate: 2022-07-15
  DOI: 10.1007/s40138-022-00249-w
The Use of Wearable ECG Devices in the Clinical Setting: a Review
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  Abstract: Purpose of Review This review investigates the use of wearable electrocardiograms (ECGs) in the clinic and acute care setting, and their impact on patient care, particularly pertaining to the management of cardiac arrhythmias. Recent Findings Wearable ECGs have consistently demonstrated their non-inferiority in detecting arrhythmias when compared to the current standard of care. Different studies have highlighted their ability to improve patient care and reduce healthcare costs, while more devices are being created to work as a screening tool at a larger scale or to fit the physical abilities of a variety of patients. Summary The use of wearable cardiac monitoring devices demonstrated considerable symptom–rhythm correlation in various clinical settings, which often resulted in a reduction in time to diagnosis and lower rates of ED visits. However, this relatively new technology raised concerns for patient accessibility and privacy among others. Further research is needed to assess their sensitivity and specificity in the clinical setting, as well as their limitations.
  PubDate: 2022-06-25
  DOI: 10.1007/s40138-022-00248-x
Review of the Evaluation of Acute Upper Extremity Neuropathy
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  Abstract: Purpose of Review This review seeks to provide clinicians with an approach to evaluation of individuals with presenting symptoms of upper extremity weakness, paresthesia, or pain. We will discuss advances made in the evaluation and treatment of upper extremity palsies, focusing on expected physical examination findings, initial evaluation, and management. Recent Findings While more common syndromes such as carpal tunnel syndrome and cubital tunnel syndrome have well-established diagnostic and treatment algorithms, the less common syndromes also have made advances in examination, electrodiagnostic testing, and both conservative and surgical treatment algorithms. Summary In the evaluation of individuals with signs of an upper extremity palsy, it is critical to be comfortable with the anatomy and physical examination of the upper extremity. Advances in electrodiagnostic testing show promising opportunities for prognostication, treatment, and further development of surgical techniques to hopefully improve patient outcomes with upper extremity palsies.
  PubDate: 2022-06-18
  DOI: 10.1007/s40138-022-00244-1
Identification of Cervical Artery Dissections: Imaging Strategies and
Literature Review
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  Abstract: Purpose of Review Vertebral or carotid artery dissections, collectively called cervical artery dissections (CeADs), are uncommon, regularly missed vascular injuries. They are associated with major trauma, but also occur spontaneously or with relatively minor trauma. Diagnosis hinges on imaging identification. Previously, catheter angiogram was the gold standard, but currently, there is no consensus on the initial imaging study. Recent Findings Computer tomography angiography (CTA) is the most common initial study for CeAD, but can fail to identify some dissections. MRI/MRA provides better images and is preferred in the pediatric population, but misses some pathology. Newer MRI/MRA techniques are improving diagnostic accuracy for CeADs. Ultrasound is increasingly used for screening and monitoring. Treatment focuses on preventing thromboembolic events with antiplatelet or anticoagulation medications, though neither appears superior based on the CADISS trial. Summary No imaging study is the best initial CeAD study. MRI/MRA is preferred for pediatric patients. Ultrasound has good specificity for CeAD identification with caveats.
  PubDate: 2022-06-13
  DOI: 10.1007/s40138-022-00247-y
Managing Severe Hypoxic Respiratory Failure in COVID-19
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  Abstract: Purpose of Review Adult respiratory distress syndrome is a life-threatening complication from severe COVID-19 infection resulting in severe hypoxic respiratory failure. Strategies at improving oxygenation have evolved over the course of the pandemic. Recent Findings Although non-invasive respiratory support reduces the need for intubation, a significant number of patients with COVID-19 progress to invasive mechanical ventilation. Once intubated, a lung protective ventilation strategy should be employed that limits tidal volumes to 6 ml/kg of predicted body weight and employs sufficient positive end-expiratory pressure to maximize oxygen delivery while minimizing the fraction of inspired oxygen. Intermittent prone positioning is effective at improving survival, and there is a growing body of evidence that it can be safely performed in spontaneously breathing patients to reduce the need for invasive mechanical ventilation. Inhaled pulmonary vasodilators have not been shown to improve survival or cost-effectiveness in COVID-19 and should be used selectively. Summary Finally, the best outcomes are likely achieved at centers with experience at severe ARDS management and protocols for escalation of care.
  PubDate: 2022-05-11
  DOI: 10.1007/s40138-022-00245-0
Vaccine Hesitancy
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  Abstract: Purpose of Review The recent COVID-19 pandemic has caused over 800,000 deaths in the USA as of this writing. Remarkable, several effective vaccines have been developed within 1 year of the occurrence of the pandemic’s outbreak in the USA. Recent Findings Although the vaccine has proven to be remarkably effective in preventing hospitalization and death, the number of unvaccinated persons in the USA who are eligible for the vaccine remains over 35%. Summary Unvaccinated persons pose a risk for vaccine mutation and prolongation of the pandemic, with its attendant quarantines and societal shutdowns. The ability of clinicians to address this problem remains unclear in a population suspicious of science and of the health care community.
  PubDate: 2022-04-01
  DOI: 10.1007/s40138-022-00243-2
Current Guidelines and Controversies in the Management of Diverticulitis
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  Abstract: Purpose of Review This review discusses the most recent studies and guidelines regarding the treatment of acute diverticulitis. It specifically focuses on current controversies in initial evaluation, management, and follow-up after discharge. Recent Findings Many recent large-scale randomized control studies (such as the AVOD and DIABOLO trials) and systematic reviews have changed our current understanding of diverticulitis. Specifically, this review focuses on new evidence in stratifying patients, use of antibiotics, the indications for new therapies, and recommended follow-up after an acute episode. Summary The most important aspects of initial evaluation are a thorough history, physical exam, appropriate imaging, and lab work. Clinically well-appearing patients with uncomplicated diverticulitis without significant comorbidities may be able to avoid antibiotic therapy entirely. Recent studies have found little utility to medications such as mesalamine and probiotics and adjunct therapies for the prevention or resolution of diverticulitis. There has been no evidence to suggest that nuts and seeds should be avoided in preventing diverticulitis. Evidence surrounding high-fiber diet and diverticulitis has been inconsistent. All patients with complicated diverticulitis should receive a colonoscopy on follow-up.
  PubDate: 2022-03-31
  DOI: 10.1007/s40138-021-00240-x
Correction to: Large Vessel Occlusion Stroke Detection in the Prehospital
Environment
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  PubDate: 2022-03-29
  DOI: 10.1007/s40138-022-00242-3
Guidelines for Acute Urinary Tract Infections
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  Abstract: Purpose of Review This manuscript serves as a review article for updated guidelines for the treatment of urinary tract infections in 2021. This manuscript is a generalized review of best practices and provides treatment options; however, it notes that patient-specific factors and local antibiograms and resistance patterns must also be considered when selecting treatment regimens. Recent Findings Important findings based on recent literature emphasize antibiotic stewardship in growing prevalence of multidrug-resistant organisms and a shift in empiric treatment away from fluoroquinolones and cephalosporins, especially for uncomplicated cystitis. Summary Antibiotic stewardship is of paramount importance in a world with increasing antibiotic resistance. This paper provides guidance in best-practice treatments for patients with urinary tract infections.
  PubDate: 2022-02-18
  DOI: 10.1007/s40138-021-00241-w
Impact of the CDC 2021 Sexually Transmitted Infection Guideline Update on
Emergency Medicine
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  Abstract: Purpose of Review This review highlights recent changes to the CDC recommendations for sexually transmitted infections. Recent Findings Neisseria gonorrhoea has developed resistance to multiple antibiotics. A total of 500 mg intramuscular ceftriaxone (1000 mg in patients weighing greater than 150 kg) is required to achieve the mean inhibitory concentration to eradicate infection reliably. Mycoplasma genitalium has also been found to develop antibiotic resistance and is implicated in cases of recurrent urethritis and cervicitis. Summary The CDC has published a 2021 update to their sexually transmitted infection management guidelines. These guidelines include new first-line regimens for managing gonorrhea and chlamydia as well as for pelvic inflammatory disease. This review provides a succinct summary of the new treatment guidelines with an emphasis on updates pertinent to management of sexually transmitted infections in the emergency department.
  PubDate: 2021-12-01
  DOI: 10.1007/s40138-021-00238-5
Modern Technology for the Diagnosis and Treatment of Pulmonary Embolism
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  Abstract: Purpose of Review This review describes the current strategies used in the diagnosis and treatment of pulmonary embolism. The non-specific and potentially life-threatening presentations associated with the disease require clinicians to take an individualized approach in deciding the best route to follow for a given patient. Thus, knowledge of different diagnostic modalities and therapeutic interventions available can assist clinicians in deciding how to care for individual patients. Recent Findings Comparing data on the safety and effectiveness of different treatment interventions suggests the use of catheter-based therapeutic strategies will continue to increase in the future. With advancing applications in artificial intelligence, deep-learning models have been proposed for diagnostic imaging techniques and risk stratification. Though most of these systems are still in developmental stages, the potential benefit it offers is demonstrated in several studies. Summary Available data and literature surrounding the techniques implemented in pulmonary embolism diagnosis and treatment are important resources for the direction clinicians take in disease approach and management. More advanced techniques utilized in the clinical setting offer potential for improved short- and long-term patient outcomes. Future developments in disease management will likely be aimed towards creating more efficient and effective diagnostic systems as well as minimizing the risks associated with current interventions.
  PubDate: 2021-12-01
  DOI: 10.1007/s40138-021-00239-4
When Minutes Matter: Rapid Infusion in Emergency Care
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  Abstract: Purpose of Review This review provides historical context and an update on recent advancements in volume resuscitation for circulatory shock. Emergency department providers who manage critically ill patients with undifferentiated shock will benefit from the insights of early pioneers and an overview of newer techniques which can be used to optimize resuscitation in the first minutes of care. Recent Findings Rapid infusion of fluids and blood products can be a life-saving intervention in the management of circulatory and hemorrhagic shock. Recent controversy over the role of fluid resuscitation in sepsis and trauma management has obscured the importance of early and rapid infusion of sufficient volume to restore circulation and improve organ perfusion. Evidence from high-quality studies demonstrates that rapid and early resuscitation improves patient outcomes. Summary Current practice standards, guidelines, and available literature support the rapid reversal of shock as a key priority in the treatment of hypotension from traumatic and non-traumatic conditions. An improved understanding of the physiologic rationale of rapid infusion and the timing, volume, and methods of fluid delivery will help clinicians improve care for critically ill patients presenting with shock. Clinical Case A 23-year-old male presents to the emergency department (ED) after striking a tree while riding an all-terrain vehicle. On arrival at the scene, first responders found an unconscious patient with an open skull fracture and a Glasgow coma scale score of 3. Bag-valve-mask (BVM) ventilation was initiated, and a semi-rigid cervical collar was placed prior to transport to your ED for stabilization while awaiting air transport to the nearest trauma center. You are the attending emergency medicine physician at a community ED staffed by two attending physicians, two physicians assistants, and six nurses covering 22 beds. On ED arrival, the patient has no spontaneous respiratory effort, and vital signs are as follows: pulse of 140 bpm, blood pressure of 65/30 mmHg, and oxygen saturation 85% while receiving BVM ventilation with 100% oxygen. He is bleeding profusely through a gauze dressing applied to the exposed dura. The prehospital team was unable to establish intravenous access. What are the management priorities for this patient in shock, and how should his hypotension best be addressed'
  PubDate: 2021-12-01
  DOI: 10.1007/s40138-021-00237-6
Acute Concussion Assessment and Management in the Emergency Department
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  Abstract: Purpose of review This review summarizes how a concussion is defined and diagnosed. We seek to give physicians and other providers a better understanding of the tools available to help diagnose and manage concussion in the Emergency Department. Recent findings There is a paucity of research on how to diagnose and manage concussion in the Emergency Department. What has been done has demonstrated that there are patients with concussion who are not being diagnosed correctly or given proper discharge instructions on their condition. Most of the existing research focuses on sports-specific concussion. Summary Emergency Department physicians have an opportunity to correctly diagnose concussions and ensure patients have a plan for follow-up care and for gradual return to activity.
  PubDate: 2021-10-15
  DOI: 10.1007/s40138-021-00236-7
Correction to: The Use of Handheld Ultrasound Devices in Emergency
Medicine
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  Abstract: A Correction to this paper has been published: https://doi.org/https://doi.org/10.1007/s40138-021-00233-w
  PubDate: 2021-09-01
  DOI: 10.1007/s40138-021-00233-w