The Toxicity of Newer and Lesser-Known Anticonvulsant Drugs
AbstractPurpose of ReviewThis review describes newer and lesser-known anticonvulsant drugs. Due to increased diagnostic accuracy of seizure disorder subtypes, as well as escalating off-label and experimental usage, these agents are becoming more commonplace. Important mechanisms of action, pharmacokinetics/pharmacodynamics, critical medication interactions, adverse reactions, toxicities, and treatment strategies are discussed.Recent FindingsCenobamate, clobazam, eslicarbazepine, ethosuximide, everolimus, felbamate, lacosamide, perampanel, methsuximide, levetiracetam (and the related compound brivaracetam), rufinamide, stir...
Source: Current Emergency and Hospital Medicine Reports - August 22, 2020 Category: Emergency Medicine Source Type: research

Does Manganese Contribute to Methamphetamine-Induced Psychosis?
AbstractPurpose of ReviewThis review describes the increasing global problem of methamphetamine (MA) use and development of psychosis, the molecular and structural basis for this form of psychosis, and its treatment. The putative contribution of manganese (Mn), a common element found widely in nature and industry, to the development of MA-induced psychosis is discussed in relation to its shared toxicity with MA.Recent FindingsBoth MA and Mn cause damage to brain monoaminergic, glutaminergic, and GABAergic systems and to the blood brain barrier, leading to higher exposure to Mn. Iron (Fe) deficiency can also lead to Mn over...
Source: Current Emergency and Hospital Medicine Reports - August 18, 2020 Category: Emergency Medicine Source Type: research

Recent Developments in Infectious Disease Chemotherapy: Review for Emergency Department Practitioners 2020
This article provides Emergency Department clinicians with a useful summary with new information on antibiotic use and recent research into agents which may become available. (Source: Current Emergency and Hospital Medicine Reports)
Source: Current Emergency and Hospital Medicine Reports - June 16, 2020 Category: Emergency Medicine Source Type: research

Vaping Cardiovascular Health Risks: an Updated Umbrella Review
AbstractPurpose of ReviewModified risk products (MRP) such as electronic vaping cigarettes (EVC) and heat-not-burn cigarettes (HNBC) are alternatives to traditional combustion cigarettes (TCC) with an expanding consumer base. Yet, their cardiovascular health risks are still unclear. We aimed to summarize the evidence base on this topic by conducting an updated umbrella review.Recent FindingsWe identified 7 systematic reviews, totaling 183 studies and reports, ranging from in vitro and in animal studies to clinical studies in apparently healthy volunteers and patients at risk of cardiovascular disease. Overall, acute EVC us...
Source: Current Emergency and Hospital Medicine Reports - June 16, 2020 Category: Emergency Medicine Source Type: research

Importance of Selected Acute Flaccid Paralysis Diagnoses in an Emergency Department Setting for the Pediatric Population
AbstractPurpose of ReviewA review for the bedside practitioner of practical clinical exam, subtle differences, and diagnostic criteria for some of the difficult to distinguish acute flaccid paralysis diagnoses in the pediatric patient and to summarize the current findings of the evolving and elusive diagnosis termed acute flaccid myelitis.Recent FindingsSince the first public epidemiological reports in 2014 using the newly coined diagnosis of acute flaccid myelitis (AFM), emergency department clinicians and other frontline medical professionals have become primarily responsible for identifying patients who may become subse...
Source: Current Emergency and Hospital Medicine Reports - June 4, 2020 Category: Emergency Medicine Source Type: research

Pre-participation Cardiovascular Screening in Young Competitive Athletes
AbstractPurpose of ReviewThe purpose of this review was to highlight the current recommendations, data, and limitations for methods of cardiovascular screening in athletes.Recent FindingsWhile the history and physical (H&P) alone remains the cornerstone for pre-participation cardiovascular screening (PPCS) in athletes, the advent of modern electrocardiographic (ECG) screening criteria has drastically increased sensitivity and decreased false-positive rates for screening. Advanced imaging techniques remain an important component of secondary testing after an athlete has an abnormal initial screening exam; however, the u...
Source: Current Emergency and Hospital Medicine Reports - May 21, 2020 Category: Emergency Medicine Source Type: research

Acute Aortic Dissection: an Update
AbstractPurpose of ReviewThis review summarizes the pathophysiology of acute aortic dissection with recent findings and current strategies for diagnosis and treatment.Recent FindingsThe addition of clinical and laboratorial findings to radiologic classifications emerges as an approach to better stratify and treat patients with aortic dissection. Endovascular strategies grow in variety of treatment options, including for type A aortic dissection.SummaryAortic dissection is a wide spectrum syndrome, generally posing a life-threating risk. Early identification can be the difference between life and death. Better imaging diagn...
Source: Current Emergency and Hospital Medicine Reports - May 20, 2020 Category: Emergency Medicine Source Type: research

Triple Therapeutic Effects of Ketamine in Prehospital Settings: Systematic Review
AbstractPurpose of ReviewKetamine is a unique drug that, remarkably, provides three clinical benefits of analgesia, assisting intubation and sedation. It has minimal adverse events and may have major advantages for trauma patients and those with violent behaviours in prehospital environments. Twenty-one full-text articles were retrieved from 1119 journal abstracts in the databases PubMed, ScienceDirect and Taylor& Francis Group, and the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project was used to assess their quality.Recent FindingsFindings clearly demonstrated signific...
Source: Current Emergency and Hospital Medicine Reports - May 19, 2020 Category: Emergency Medicine Source Type: research

Management of Travel-Related Infectious Diseases in the Emergency Department
AbstractPurpose of ReviewEmergency physicians generally have limited exposure to internationally acquired illnesses. However, travelers can present quite ill, and delays in recognition and treatment can lead to increased morbidity and mortality. This paper aims to summarize typical presentations of common international diseases and provide the emergency physician with a practical approach based on current guidelines.Recent FindingsIn the treatment of traveler ’s diarrhea, azithromycin has become the treatment of choice due to the growing antibiotic resistance. Intravenous artesunate was approved in 2019 under investi...
Source: Current Emergency and Hospital Medicine Reports - May 6, 2020 Category: Emergency Medicine Source Type: research

Post Herpetic Neuralgia: Recent Advancements
AbstractPurpose of ReviewTo discuss updates and recommendations for the treatment of postherpetic neuralgia (PHN), a painful neuropathic condition caused by reactivation of the latent varicella-zoster virus (VZV). The focus of this review will include prevention, evaluation, diagnosis, and management.Recent FindingsUsing a multidisciplinary approach to management yields the best results, including oral and topical medication, physical therapy, psychotherapy, injections, complementary, and other procedural interventions, as well as neural stimulation.SummaryRecent advancements in the management of neuropathic pain condition...
Source: Current Emergency and Hospital Medicine Reports - March 26, 2020 Category: Emergency Medicine Source Type: research

Heart Failure and Comorbidities —Part 1
AbstractPurpose of ReviewThe main objective of the 1st part of this review is to demonstrate that a better understanding of comorbidities such as COPD, obstructive sleep apnea, thyroid dysfunction, cardiorenal syndrome, its pathophysiological and therapeutic implications, impact on the management of FH by interfering with its survival, and quality of life of patients.Recent FindingsThe prevalence of heart failure will increase 46% from 2012 to 2030, resulting in>  8 million people ≥ 18 years of age. This disease has a large burden of noncardiovascular comorbidities, which may increase the risk of m...
Source: Current Emergency and Hospital Medicine Reports - February 29, 2020 Category: Emergency Medicine Source Type: research

Heart Failure and Comorbidities —Part 2
AbstractPurpose of ReviewThe main objective in this 2nd part is to highlight comorbidities of great clinical importance such as diabetes, anemia, and chronic renal failure, either because of their high prevalence, or because of their relevance to impact on morbidity and mortality, and directly in the treatment of heart failure.Recent FindingsThe prevalence of heart failure will increase 46% from 2012 to 2030, resulting in>  8 million people ≥ 18 years of age. This disease have a large burden of noncardiovascular comorbidities, which may increase the risk of mortality and decrease quality of life. T...
Source: Current Emergency and Hospital Medicine Reports - February 24, 2020 Category: Emergency Medicine Source Type: research

Urinary Tract Infection Updates and Recent Developments
AbstractPurpose of ReviewThis review describes recent, relevant articles published regarding urinary tract infections (UTI). It reviews papers regarding the pathology, diagnosis, management, and prevention of urinary tract infections in addition to developments in the area of pediatric UTIs.Recent FindingsSeveral new papers demonstrated findings on antibiotic resistance of UTI pathogens. Diagnostic equipment and detection techniques were a significant area of focus in recent publications including one paper that reported a drastic reduction in time to identify bacteria compared with traditional culturing. A set of new guid...
Source: Current Emergency and Hospital Medicine Reports - February 22, 2020 Category: Emergency Medicine Source Type: research

Updates on Technology for Diabetes Mellitus
AbstractPurpose of ReviewTo update the medical community on the new and old technologies use for the control and management of diabetes mellitus.Recent FindingsDiabetes technology is defined as the different technology including hardware, devices, and software that are used by diabetic patients in order to help to manage blood glucose levels. This technology can be used in patients with any type of diabetes mellitus and, when applied appropriately, it can have a significant impact on these patients ’ health. They can be divided into different insulin delivery methods, blood glucose monitoring, and hybrid and implanta...
Source: Current Emergency and Hospital Medicine Reports - February 10, 2020 Category: Emergency Medicine Source Type: research

Watching the Brain: an Overview of Neuromonitoring Systems and Their Utility in the Emergency Department
This article focuses on the most common devices along with their adoption and implementation into the practice of emergency medicine.Recent FindingsThe field of non-invasive neuromonitoring techniques is rapidly flourishing with an emphasis on portability and reproducibility, enhancing adoption into the practice of emergency medicine. Devices such as the extra-ventricular drain have proven to be of both diagnostic and therapeutic benefit, allowing for both global ICP monitoring and CSF sampling. However, as emergency physicians become more facile in the use of ultrasound, procedures such as optic nerve sheath diameter eval...
Source: Current Emergency and Hospital Medicine Reports - January 17, 2020 Category: Emergency Medicine Source Type: research

Post-traumatic Stress Disorder Following Acute Stroke
AbstractPurpose of ReviewStroke is a devastating event that annually affects over 800,000 million individuals in the USA and is associated with significant individual and social costs. In this narrative review, we summarize current evidence regarding post-traumatic stress disorder (PTSD) following acute stroke.Recent FindingsIn addition to the long-term physical consequences, it is increasingly recognized that psychological distress is common after stroke and transient ischemic attack (TIA). Nearly 1 in 4 survivors of TIA and stroke report elevated symptoms of PTSD in the first year following their cerebrovascular event. T...
Source: Current Emergency and Hospital Medicine Reports - January 14, 2020 Category: Emergency Medicine Source Type: research

Mobile Stroke Units —the Changing Face of Emergency Medicine Stroke Management
AbstractPurpose of ReviewTo provide a summary of mobile stroke unit (MSU) utilization within Emergency Medicine stroke systems.Recent FindingsMSUs have been deployed around the world into prehospital stroke systems demonstrating the ability to differentiate stroke subtypes and to initiate thrombolysis in eligible patients with shorter symptom onset to treatment times than conventional systems. MSU technology may enable the administration of other standard interventions or future experimental agents in the hyperacute time window. It is conceivable that MSU technology may be extended to other disease states in resource-limit...
Source: Current Emergency and Hospital Medicine Reports - January 13, 2020 Category: Emergency Medicine Source Type: research

Wake-up Stroke: New Opportunities for Acute Stroke Treatment
AbstractPurposeThis review summarizes the current science underpinning the treatment of patients with ischemic stroke who awaken with stroke symptoms. This large subset of stroke patients has historically been precluded from treatment with disability-limiting reperfusion therapies such as intravenous thrombolysis. Recent advances in neuroimaging have shifted the paradigm of treatment based upon rigid time-based criteria to treatment guided by evidence of salvageable ischemic penumbra on advanced imaging.Recent FindingsSeveral recent randomized controlled trials provide evidence that imaging-guided treatment of wake-up and ...
Source: Current Emergency and Hospital Medicine Reports - January 10, 2020 Category: Emergency Medicine Source Type: research

Mechanical Circulatory Support: a Look Back and a Look Ahead
AbstractPurpose of reviewHeart failure is a growing problem across the world. Although many advances have been made in heart failure therapy, patients with cardiogenic shock still have a grim prognosis. The aim of this article is to discuss the current state of mechanical circulatory support and future directions.Recent findingsMechanical support can be classified as temporary or durable. Temporary support ranges from the intra-aortic balloon pump to extracorporeal membrane oxygenation. Durable support consists of left ventricular assist devices that are long-term and can be used as a bridge to transplant or destination th...
Source: Current Emergency and Hospital Medicine Reports - November 4, 2019 Category: Emergency Medicine Source Type: research

EMS Disease Exposure, Transmission, and Prevention: a Review Article
This article aims to review recent literature regarding the risks of disease exposure to pre-hospital providers and the patients they serve, as well as the challenges they face in minimizing transmission and exposure.Recent FindingsMany studies continue to show poor compliance with consistent universal precautions, as well as proper hand hygiene. Vaccination rates are suboptimal despite attempts to encourage compliance. With the spread of multi-drug resistant organisms, new techniques of decontamination need to be investigated.SummaryThere remains a general lack of information and studies regarding the risks of disease exp...
Source: Current Emergency and Hospital Medicine Reports - October 11, 2019 Category: Emergency Medicine Source Type: research

Why Does the Food and Drug Administration Need to Ban Kratom?
AbstractPurpose of ReviewKratom (Mitragyna speciosa) is an herb with no current indication for medical use with potentially addictive properties, yet it is being used in the management of pain, depression, and anxiety. The agent ’s pharmacology lends itself for concern regarding recreational misuse (Drugs of Abuse,2017).Recent FindingsKratom ’s increasing popularity for use in the USA is reflected by National Poison Data System data that in 2011 there were 13 cases reported to poison control centers while in 2017 there were 682 calls in response to kratom exposure (Kratom exposure in the US linked to serious me...
Source: Current Emergency and Hospital Medicine Reports - October 11, 2019 Category: Emergency Medicine Source Type: research

Complications After Transcatheter Aortic Valve Implantation: an Updated Umbrella Review
AbstractPurpose of ReviewWe conducted a comprehensive and updated overview on complications occurring after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis.Recent FindingsDespite remarkable improvements in patient selection, devices, procedures, and ancillary management, complications may still occur in patients undergoing TAVI. On top of most commonly described adverse events such as death, myocardial infarction, stroke, bleeding, vascular complication, renal failure, pacemaker implantation and residual valve regurgitation, other less common but similarly severe complications may still occur. The...
Source: Current Emergency and Hospital Medicine Reports - September 14, 2019 Category: Emergency Medicine Source Type: research

Using Data Science to Predict Readmissions in Heart Failure
AbstractPurpose of ReviewThis review describes the current literature on the use of data science to predict readmissions of patients with heart failure. We examine the chronology of heart failure management from the emergency department, inpatient unit, transition of care, and home care. We examine the software and hardware which may improve readmission rates of this common and complex disease process.Recent FindingsThere are multiple novel applications of data science which have been used to predict readmissions of heart failure patients. In the emergency department, efforts are focused on identifying patients who can be ...
Source: Current Emergency and Hospital Medicine Reports - September 13, 2019 Category: Emergency Medicine Source Type: research

Kratom from Head to Toe —Case Reviews of Adverse Events and Toxicities
AbstractPurpose of ReviewThis review describes case reports for patients with kratom-associated adverse events in order to assist clinicians with patient management. A stepwise approach is proposed for assessing active kratom users as well as considerations for the management of toxicities or withdrawal.Recent FindingsMultiple in vitro and in vivo studies illustrate the pharmacologic and toxicologic effects of kratom extract. No randomized controlled trials in humans exist that assess the safety and efficacy of the substance. Cross-sectional surveys from active users and reports from poison control centers have shown acute...
Source: Current Emergency and Hospital Medicine Reports - September 11, 2019 Category: Emergency Medicine Source Type: research

Pathophysiology of Complex Regional Pain Syndrome and Treatment: Recent Advancements
AbstractPurpose of ReviewComplex regional pain syndrome (CRPS) is a painful and debilitating disorder involving dysfunction in multiple body systems. This review seeks to evaluate recent data and present treatment options for the practical management of this condition.Recent FindingsThe mechanism by which CRPS develops is multifactorial, affecting both the peripheral and central nervous systems, and nerve changes can be seen at a histologic level. Treatment should be initiated as early as possible, as the chronic disease is less responsive to intervention.SummaryCRPS is a clinical diagnosis; treatment is symptomatic and ai...
Source: Current Emergency and Hospital Medicine Reports - September 7, 2019 Category: Emergency Medicine Source Type: research

Cannabinoids and Pain Management: an Insight into Recent Advancements
AbstractPurpose of ReviewThis review discusses the recent advancements in research on Cannabinoids ’ role in pain, including its use in cancer pain, neuropathic pain, fibromyalgia, headache, visceral pain, postoperative and failed back pain management, and concurrent use with opioids.Recent FindingsCurrent research suggests that a potential role exists for medical cannabis in pain management, although research shows varied effectiveness by the type of pain. Moreover, its coadministration with opioids may result in reduced opioid requirements.SummaryPatients with neuropathic pain, cancer pain, and migraine headache ma...
Source: Current Emergency and Hospital Medicine Reports - September 6, 2019 Category: Emergency Medicine Source Type: research

Heart Failure with Preserved Ejection Fraction
AbstractPurpose of ReviewThe incidence of heart failure with preserved ejection fraction (HFpEF] is rapidly increasing, yet many physicians may feel less knowledgeable about HFpEF when compared with heart failure with reduced ejection fraction (HFrEF]. The purpose of this review is to discuss the incidence, pathophysiology, clinical diagnosis, treatment, and prognosis of patients with HFpEF.Recent FindingsDespite an increasing understanding of the pathophysiology and nature of HFpEF, there has been little advancement in therapies.SummaryDespite similar clinical presentations and treatments for HFpEF when compared to HFrEF,...
Source: Current Emergency and Hospital Medicine Reports - August 29, 2019 Category: Emergency Medicine Source Type: research

Acupuncture in the Emergency Management of Painful Conditions
AbstractPurpose of ReviewA high percentage of patients present to the emergency department for management of painful conditions. It is in society ’s interest to provide pain relief without contributing to the ongoing opioid crisis.Recent FindingsAcupuncture is an ancient therapy dating from more than 4000  years. It has not historically been shown in rigorous duplicated studies to be effective in the management of acutely painful conditions. More recent literature has shown its promise in the treatment of a variety of defined and common complaints.SummaryNonopioid treatment options for management of moderate to ...
Source: Current Emergency and Hospital Medicine Reports - August 24, 2019 Category: Emergency Medicine Source Type: research

Haemodynamic Assessment in Cardiogenic Shock
AbstractPurpose of ReviewThis review will discuss the practical applications based on the physiology that underpins some of these commonly used haemodynamic parameters.Recent FindingsHaemodynamic parameters are integral to the management of cardiogenic shock. Some of these are easily measured and ubiquitous, such as arterial blood pressure and central venous pressure. Others, such as the use of pulmonary artery catheters, continue to be discussed and debated.SummaryThe management of cardiogenic shock is challenging. Clinicians employ a range of haemodynamic parameters to diagnose and guide therapeutic interventions in card...
Source: Current Emergency and Hospital Medicine Reports - August 24, 2019 Category: Emergency Medicine Source Type: research

Update on Hepatitis C Screening and Management: Actions for Emergency Departments
AbstractPurpose of ReviewReview epidemiology, screening recommendations, management, and treatment of hepatitis C virus and strategies to expand diagnosis and effective linkage to care.Recent FindingsHepatitis C virus (HCV) infections have increased threefold from 2010 to 2016 and close to half of people infected remain unaware of their HCV status. Emergency departments and hospitals are points of care where health care is provided to people who often do not otherwise receive regular primary health care and recommended screening tests. Recent studies in emergency departments have shown that expanded testing can identify ma...
Source: Current Emergency and Hospital Medicine Reports - August 19, 2019 Category: Emergency Medicine Source Type: research

Zoonosis: Update on Existing and Emerging Vector-Borne Illnesses in the USA
AbstractPurpose of reviewThis review describes mosquito- and tick-borne diseases found in the Western Hemisphere. It focuses on emerging diseases and recent geographic shifts in the presence of disease vectors.Recent FindingsMosquito and tick vectors have become more widespread as environmental conditions have become more favorable. Zika recently has emerged as a concern for fetal anomalies. West Nile Virus has become widespread. Lyme disease and other tick-borne diseases are more prevalent in areas previously inhospitable to these ticks.SummaryHealthcare providers must consider the possibility of mosquito- and tick-borne ...
Source: Current Emergency and Hospital Medicine Reports - August 13, 2019 Category: Emergency Medicine Source Type: research

Peripartum Cardiomyopathy: a Review
This article conducts a review of recent literature and gives insight into this disease.Recent FindingsThere is promising research in the fields of vascular, hormonal, and genetics. A number of genetic markers are being analyzed, including TTNC1, TTN, and STAT3. Mutations to these genes have been found to be prevalent in PPCM. These combined with the secretion of placental angiogenic factors potentially create imbalance in angiogenesis as the primary etiology.SummaryCurrent biomarkers do not differentiate between PPCM and other variants of heart failure. Women with PPCM are more likely to have a cesarean section, to have h...
Source: Current Emergency and Hospital Medicine Reports - July 22, 2019 Category: Emergency Medicine Source Type: research

Thromboprophylaxis Strategies in Acute Medically Ill Patients
AbstractPurpose of ReviewWe review pivotal clinical trials of extended-duration venous thromboembolism (VTE) prophylaxis strategies in acute medically ill patients.Recent FindingsFor VTE prophylaxis in medically ill patients, current guidelines recommend the use of parenteral anticoagulants during hospitalization but not for extended duration prophylaxis. In 2017, betrixaban was approved for VTE prophylaxis in acute medically ill patients based on the results of the APEX trial. The MARINER trial missed its primary endpoint of reducing the composite of symptomatic VTE and VTE-related mortality with rivaroxaban compared with...
Source: Current Emergency and Hospital Medicine Reports - July 18, 2019 Category: Emergency Medicine Source Type: research

Systematic Review of Current Treatment and Prevention Strategies for Clostridium difficile
AbstractPurpose of ReviewThe goal of this review was to determine the current treatment and prevention recommendations forClostridium difficile infections (CDI) and their efficacy. We elucidate new treatment and prevention strategies that are in development, and define populations that are at greatest risk of CDI.Recent FindingsNew practice guidelines recommend vancomycin or fidaxomicin as first-line treatment for CDI with oral metronidazole only being used in cases of non-severe CDI when vancomycin and fidaxomicin are not available. Metronidazole is recommended in an IV formulation in conjunction with oral vancomycin in f...
Source: Current Emergency and Hospital Medicine Reports - June 27, 2019 Category: Emergency Medicine Source Type: research

Infective Endocarditis in Intravenous Drug Users —a Modern Outlook
AbstractPurpose of ReviewInfective endocarditis (IE) is a significant risk and complication in patients with a history of intravenous (IV) drug use (DU), and treatments are becoming more invasive as infections become more serious. IV drug use is an extremely addictive behavior and challenging behavior to address, and patients are at high risk of relapse to IV drug use even after successful IE treatment. Addressing the underlying cause with behavioral modification is essential to prevent behavior and subsequent infection recurrence. Treatments depend on a multidisciplinary approach to address the physiologic and underlying ...
Source: Current Emergency and Hospital Medicine Reports - June 22, 2019 Category: Emergency Medicine Source Type: research

Neonatal Sepsis
AbstractPurpose of ReviewNeonatal sepsis is a diagnosis made in infants less than 28 days of life and consists of a clinical syndrome that may include systemic signs of infection, circulatory shock, and multisystem organ failure.Recent FindingsCommonly involved bacteria includeStaphylococcus aureus andEscherichia coli. Risk factors include central venous catheter use and prolonged hospitalization. Neonates are at significant risk of delayed recognition of sepsis until more ominous clinical findings and vital sign abnormalities develop. Blood culture remains the gold standard for diagnosis.SummaryNeonatal sepsis remains an ...
Source: Current Emergency and Hospital Medicine Reports - June 19, 2019 Category: Emergency Medicine Source Type: research

Regulatory and Clinical Perspective on Biosimilars: a Comparison of the US and European Experiences
AbstractPurpose of ReviewThe purpose of the review is to explore the reasons for low penetration of biosimilars in the United States (US) and to compare and contrast the US and European experiences.Recent FindingsA biosimilar is a biologic that is highly similar to and with no clinically meaningful differences from an existing Food and Drug Administration (FDA)-approved reference product, where the reference product is the biologic that was originally approved by the FDA. The Biologics Price Competition and Innovation Act of 2009 (BPCIA) created an abbreviated approval pathway (351(k)) for biosimilars to encourage their de...
Source: Current Emergency and Hospital Medicine Reports - June 15, 2019 Category: Emergency Medicine Source Type: research

Tick-Borne Illness for Emergency Medicine Providers
AbstractPurpose of ReviewTicks are the most important vectors of human diseases after mosquitoes. Emergency physicians throughout the USA can be expected to encounter Lyme disease, Rocky Mountain spotted fever, ehrlichiosis, and other disorders based upon geographic location.Recent FindingsThe number of identifiable disorders transmitted by these arthropods has increased in recent years. Severe fever with thrombocytopenia syndrome has only been described within the past decade, and the new millennium has seen over 10 new species of rickettsial disease discovered.SummaryTicks transmit more pathogenic species than any other ...
Source: Current Emergency and Hospital Medicine Reports - June 13, 2019 Category: Emergency Medicine Source Type: research

Resistant Organisms and Their Approach to Management in Clinical and Emergency Care
AbstractPurpose of ReviewThis review describes the multi-drug-resistant pathogens that lead to the most life-threatening infections, and the current state of prevention and management strategies used in clinical and emergency care.Recent FindingsNew methods of early detection and screening, novel combination antibiotics, and adjuvant therapy with a better understanding of the mechanisms employed by multi-drug-resistant bacteria are in the forefront of this impending public health crisis.SummaryThe incidence of infections caused by multi-drug-resistant pathogens is rising. A robust and concerted international response from ...
Source: Current Emergency and Hospital Medicine Reports - May 31, 2019 Category: Emergency Medicine Source Type: research

Effects of Telemonitoring and Hemodynamic Monitoring on Mortality in Heart Failure: a Systematic Review and Meta-analysis
AbstractPurpose of ReviewTo examine the effectiveness of telemonitoring and hemodynamic monitoring devices in reducing mortality rates in heart failure. PubMed and Cochrane Library were searched to 1 May 2017 for randomized controlled trials and real-world studies investigating the effects of telemonitoring or hemodynamic monitoring on mortality in heart failure.Recent FindingsHeart failure is associated with increased mortality. Telemonitoring and hemodynamic monitoring have been shown to reduce mortality rates in some studies but not others.SummaryFifty-two and five publications on telemonitoring and hemodynamic monitori...
Source: Current Emergency and Hospital Medicine Reports - April 30, 2019 Category: Emergency Medicine Source Type: research

Complications After Heart Transplantation in Adults: an Update
AbstractPurpose of ReviewThe goal of this review article is to highlight our understanding of potential complications after heart transplantation. We aim to discuss recent advances within the field that directly impact the management of heart transplant recipients. Our target audiences include cardiologists, emergency medicine, and internal medicine providers.Recent FindingsHeart transplantation remains definitive therapy for end-stage heart failure. Complications after transplant can be divided in to post-operative, early, and late. Complications are related to the differing physiology of the denervated transplant heart a...
Source: Current Emergency and Hospital Medicine Reports - April 22, 2019 Category: Emergency Medicine Source Type: research

Cardiovascular Safety of Gabapentinoids
The objective of this manuscript is to describe the cardiovascular effects of the gabapentinoids gabapentin and pregabalin.Recent FindingsThe most frequent adverse effects of gabapentin and pregabalin affect the central nervous system, such as somnolence and fatigue. Additionally, pregabalin, and a much lesser extent, gabapentin, may adversely affect the cardiovascular system. Pregabalin induces peripheral edema and may cause or exacerbate heart failure. Pregabalin use has been associated with QTc prolongation in patients taking other QTc –prolonging agents, although the relative contributions of pregabalin to QTc pr...
Source: Current Emergency and Hospital Medicine Reports - April 17, 2019 Category: Emergency Medicine Source Type: research

Ketamine for Acute Agitation
AbstractPurpose of ReviewThis review describes the use of ketamine for acutely agitated patients in the emergency care setting. Evidence for its efficacy will be reviewed and practical suggestions for using ketamine in this scenario will be presented.Recent FindingsThe available observational literature on the topic of ketamine for agitation was recently summarized in a systematic review. This review found that ketamine effectively and quickly sedates acutely agitated patients. However, it did raise some concerns about an increased intubation rate in patients administered ketamine.SummaryIn severely agitated patients, part...
Source: Current Emergency and Hospital Medicine Reports - February 6, 2019 Category: Emergency Medicine Source Type: research

Cannabinoid Hyperemesis Syndrome
AbstractPurpose of ReviewThis review describes the clinical presentation and treatment for cannabinoid hyperemesis syndrome (CHS). Typical treatment for nausea, vomiting, and abdominal pain may not be effective in patients with CHS. Alternative treatments have been suggested.Recent FindingsThe pathophysiology of CHS may be due to dysregulation of the endocannabinoid system. Two cannabinoid receptors (CB1, CB2) have been identified. Theories proposed to explain CHS including chronic stimulation of the CB1 receptor, binding of the CB1 receptor causing decreased gut motility, desensitization of CB1 receptors (these CB1 recept...
Source: Current Emergency and Hospital Medicine Reports - February 4, 2019 Category: Emergency Medicine Source Type: research

Necrotizing Soft Tissue Infections
AbstractPurpose of ReviewThe review discusses necrotizing soft tissue infections, including clinical manifestations, diagnosis and management.Recent FindingsThere has been an effort towards developing scoring systems to aid in the diagnosis of necrotizing soft tissue infections and this article reviews those in addition to their applicability. These scoring systems should primarily be used to aid in diagnosis and are not effective at ruling out necrotizing infections. Recent reviews regarding optimal antibiotics and IVIG are also discussed.SummaryNecrotizing soft tissue infections are challenging to diagnosis as they often...
Source: Current Emergency and Hospital Medicine Reports - February 1, 2019 Category: Emergency Medicine Source Type: research

Anticoagulation Levels and Bleeding After Emergency Department Extracorporeal Cardiopulmonary Resuscitation
AbstractPurpose of ReviewWe aimed to describe bleeding events associated with extracorporeal cardiopulmonary resuscitation (eCPR) using two institutional heparin protocols. In addition, we discuss current barriers to optimal anticoagulation in this critical population.Recent FindingsPatients initiated on venoarterial membrane oxygenation (VA-ECMO) are at risk of bleeding and thrombosis; both conditions can lead to severe morbidity or mortality. Intravenous heparin is the preferred form of anticoagulation for VA-ECMO. Prior studies have found elevated activated partial thromboplastin time (aPTT) may be an independent risk f...
Source: Current Emergency and Hospital Medicine Reports - January 19, 2019 Category: Emergency Medicine Source Type: research

Spine Pain Management
AbstractPurpose of ReviewSpine pain is one of the most common complaints presenting to the emergency department and represents significant healthcare cost. Evaluation and workup of these patients can be difficult, and a proper history and physical exam will minimize unnecessary tests.Recent FindingsNontraumatic spine pain is most often idiopathic or related to muscle or ligamentous strain. Although musculoskeletal mechanisms are most commonly responsible, there are very rarely, but importantly, life-threatening conditions which present as spine pain, and these must be ruled out. The presence of neurologic deficit renders a...
Source: Current Emergency and Hospital Medicine Reports - October 29, 2018 Category: Emergency Medicine Source Type: research

Intravenous and Oral Hyperammonemia Management
AbstractPurpose of ReviewHyperammonemia have significant morbidity and mortality. In this paper, we reviewed the latest research and evidence of both conventional and upcoming oral or intravenous treatments.Recent FindingsNew updates on the role of oral agents such as rifaximin, PEG, probiotics, glycerol phenylbutyrate, and zinc supplements in the management of both chronic hyperammonemia and overt hepatic encephalopathy have been discussed in this review. We discussed the recent findings on the role of branched-chain amino acids in patients with cirrhosis.SummaryRifaximin role has expanded as mono or combination therapy i...
Source: Current Emergency and Hospital Medicine Reports - October 2, 2018 Category: Emergency Medicine Source Type: research

Review of the Novel Agents for Hepatitis C Infection in the Emergency Department
AbstractPurpose of ReviewThe purpose of the study is to provide health care providers with general overview of the novel treatment strategies for patients infected with hepatitis C virus (HCV), monitoring for drug interactions, and dose modification in patients with renal impairment.Recent FindingsThe rapidly increasing demand for HCV infection treatment and the side effects associated with ribavirin (RBV) and peginterferon regimens led to the development of the novel direct acting antivirals (DAAs) and are RBV/peginterferon-free treatment in most cases. Several combinations, RBV-free regimens with different durations of t...
Source: Current Emergency and Hospital Medicine Reports - September 10, 2018 Category: Emergency Medicine Source Type: research