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

Updates on Sexually Transmitted Infections: Gonorrhea, Chlamydia, and Syphilis Testing and Treatment in the Emergency Department
AbstractPurpose of ReviewThis review describes current guidelines and research on screening, diagnostics, and treatment for sexually transmitted infections (STIs) seen in the emergency department (ED).Recent FindingsMany studies support less invasive testing for STIs, which in turn would encourage increased screening. The diagnosis of pelvic inflammatory disease (PID) is currently based on clinical findings and further research is needed to improve diagnostic accuracy. Current antibiotic treatment guidelines are based on numerous studies. Drug-resistant gonorrhea is an issue worldwide and alternative treatments are current...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2018 Category: Emergency Medicine Source Type: research

Hyperbaric Oxygen Therapy and Utilization in Infectious Disease
AbstractPurpose of ReviewThis review explores the multiple infectious processes in which the Undersea and Hyperbaric Medicine Society recommends hyperbaric oxygen as an adjunct to standard treatment to determine the benefit of including hyperbaric oxygen in standard treatment protocols.Recent FindingsWhile the utilization of hyperbaric oxygen (HBO) has been shown to improve outcomes, there is limited research comparing it to other therapies. There are numerous case reports and retrospective analyses of the use of HBO as adjunctive treatment, but randomized control trials are glaringly absent from recent literature.SummaryT...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2018 Category: Emergency Medicine Source Type: research

Emerging Infectious Diseases: a Review
AbstractPurpose of ReviewThis review highlights some of the recent concerning emerging infectious diseases, a number of them specifically that the World Health Organization has categorized as priorities for research.Recent FindingsEmerging and reemerging infectious diseases account for significant losses in not only human life, but also financially. There are a number of contributing factors, most commonly surrounding human behavior, that lead to disease emergence. Zoonoses are the most common type of infection, specifically from viral pathogens. The most recent emerging diseases in the USA areEmergomyces canadensis, the H...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2018 Category: Emergency Medicine Source Type: research

Stethoscope as a Vector for Infectious Disease
AbstractPurpose of ReviewTo discuss the current status of the stethoscope as a vector for infection and possible interventions to promote stethoscope disinfection.Recent FindingsAnywhere from 70 to 100% of stethoscopes are contaminated after a physical examination with bacterial counts of stethoscopes comparable to those of the physician ’s dominant hand. Disinfection with alcohol agents can reduce the number of pathogens and risk of transmission, which is recommended by guidelines. However, only 0–11% of healthcare providers disinfected their stethoscope before patient contact and 0–24% disinfected after...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2018 Category: Emergency Medicine Source Type: research

Advocating For Pediatric Rapid Response Worldwide
AbstractPurpose of ReviewGeneral pediatricians have been involved for decades in bringing health to the world ’s children with preventive and public health interventions. Building on this, this article seeks to explore the necessary concepts and components that would facilitate a rapid response for critically ill or injured pediatric patients to become a life-saving reality for all children.Recent FindingsIt has been shown that emergency care can be done practically, cost-effectively, and is necessary to save the lives of children who will, just like children in the USA, suffer from critical illness and injury as a m...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2018 Category: Emergency Medicine Source Type: research

Select Advances in Infectious Disease Chemotherapy: Review for Emergency Department Practitioners
This article provides the emergency department clinicians with a summary of novel antimicrobials and their relevance to the practice of clinical and emergency medicine, as well as highlighting recent research into the topic. (Source: Current Emergency and Hospital Medicine Reports)
Source: Current Emergency and Hospital Medicine Reports - September 1, 2018 Category: Emergency Medicine Source Type: research

Emergency Department Management of Acute Bacterial Skin and Soft Tissue Infections
AbstractPurpose of ReviewAcute skin infections are a common Emergency Department presentation. Changes in microbial resistance to antibiotics have resulted in changes in management of these infections. This paper seeks to highlight these changes in management of cellulitis and abscesses with the new emergence of methicillin-resistantStaphylococcal aureus.Recent FindingsSoft tissue infections are most commonly caused byStreptococcus andStaphylococcus but other microbes are present in specific environments and can cause infections when patients are exposed. Simple cellulitis can be treated with beta lactams; however, purulen...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2018 Category: Emergency Medicine Source Type: research

Accuracy of Medication Safety Report Severity Level Among Disciplines at a Tertiary Academic Medical Center
The objective of our analysis was to determine whether differences exist in the accuracy of reporter estimated incident severity level. This is a retrospective, quality assurance analysis of medication safety reports. Information collected included the total number of medication safety reports, reporter roles, reported severity level, and actual severity level. Accuracy of reporter severity was determined based on the difference between reported compared to the actual severity scored for each incident.Recent FindingsFour hundred forty-nine were included in the analysis. Reports were most commonly entered by nurses (71.3%) ...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2018 Category: Emergency Medicine Source Type: research

HIV Testing in the Emergency Department
AbstractPurpose of ReviewThis review explores data from the past 5  years with regard to HIV testing and diagnosis in the emergency department, as well downstream linkage to care and several adjuvant approaches. We offer perspectives on futures directions for care.Recent FindingsThere are many approaches to HIV testing in the ED. The largest overarching question is that of testing strategies (universal vs targeted, opt in vs out), where data is mixed and there is a lack of randomized control trials. Other studies address different aspects of ED testing, including where to integrate testing into ED workflow, and supple...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2018 Category: Emergency Medicine Source Type: research

Emergency Department Management of Acute Bacterial Skin and Soft Tissue Infections
AbstractPurpose of ReviewAcute skin infections are a common Emergency Department presentation. Changes in microbial resistance to antibiotics have resulted in changes in management of these infections. This paper seeks to highlight these changes in management of cellulitis and abscesses with the new emergence of methicillin-resistantStaphylococcal aureus.Recent FindingsSoft tissue infections are most commonly caused byStreptococcus andStaphylococcus but other microbes are present in specific environments and can cause infections when patients are exposed. Simple cellulitis can be treated with beta lactams; however, purulen...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2018 Category: Emergency Medicine Source Type: research

Infections in the Injection Drug Abuser
AbstractPurpose of ReviewIntravenous drug abuse (IVDA) represents a significant economic, social, and health burden to society and is one of the most dangerous ways to administer a drug, and medical management often falls on the shoulders of the emergency department provider. This review seeks to provide an update on the etiology, common infectious agents, and treatment modalities specific to IV drug abuse.Recent FindingsIV drug use conveys serious health hazards and in particular cutaneous, soft tissue, and systemic infections. Illicit drug use carries with it social stigma, and patients may be reluctant to admit to using...
Source: Current Emergency and Hospital Medicine Reports - August 29, 2018 Category: Emergency Medicine Source Type: research

Management of Cancer Pain
This article seeks to provide an update on the current knowledge and concepts in cancer pain management with an attempt to provide practical education for use in the emergency room.Recent FindingsPain presents in various ways, manifesting as either nociceptive or neuropathic types. Classification systems such as the DN4 questionnaire and the Zubrod scoring system have been established in an attempt to provide guidelines for the evaluation and treatment of cancer-associated pain and provide a quick and efficient way to evaluate pain in the ER setting and to guide treatment.SummaryThere are many options for pain control in t...
Source: Current Emergency and Hospital Medicine Reports - August 22, 2018 Category: Emergency Medicine Source Type: research

Challenges Encountered in the Emergency Department in the Unimmunized Pediatric Population
AbstractPurpose of ReviewThis review discusses unimmunized pediatric patients and the unique circumstances surrounding their evaluation and management in the emergency department in an era where many established guidelines are based on the assumption of a vaccinated patient.Recent FindingsWhile there have been increasing outbreaks of vaccine preventable diseases, there have been no recent significant studies or recommendations made to alter the evaluation and management of an non-vaccinated pediatric patient.SummaryGiven increasing vaccine hesitancy, it is prudent to be vigilant during the evaluation of an unimmunized pedi...
Source: Current Emergency and Hospital Medicine Reports - August 22, 2018 Category: Emergency Medicine Source Type: research

Management of Cancer Pain
This article seeks to provide an update on the current knowledge and concepts in cancer pain management with an attempt to provide practical education for use in the emergency room.Recent FindingsPain presents in various ways, manifesting as either nociceptive or neuropathic types. Classification systems such as the DN4 questionnaire and the Zubrod scoring system have been established in an attempt to provide guidelines for the evaluation and treatment of cancer-associated pain and provide a quick and efficient way to evaluate pain in the ER setting and to guide treatment.SummaryThere are many options for pain control in t...
Source: Current Emergency and Hospital Medicine Reports - August 22, 2018 Category: Emergency Medicine Source Type: research

Challenges Encountered in the Emergency Department in the Unimmunized Pediatric Population
AbstractPurpose of ReviewThis review discusses unimmunized pediatric patients and the unique circumstances surrounding their evaluation and management in the emergency department in an era where many established guidelines are based on the assumption of a vaccinated patient.Recent FindingsWhile there have been increasing outbreaks of vaccine preventable diseases, there have been no recent significant studies or recommendations made to alter the evaluation and management of an non-vaccinated pediatric patient.SummaryGiven increasing vaccine hesitancy, it is prudent to be vigilant during the evaluation of an unimmunized pedi...
Source: Current Emergency and Hospital Medicine Reports - August 22, 2018 Category: Emergency Medicine Source Type: research

A Review of Triple Therapy in Acute Coronary Syndromes
AbstractPurpose of ReviewThis review provides a summary of the new literature surrounding the concomitant use of anticoagulation with direct oral anticoagulants (DOACs) and antiplatelet agents following acute coronary syndromes (ACS) and percutaneous intervention (PCI).Recent FindingsThe American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA) and the American College of Chest Physicians (CHEST) provide weak recommendations for clinical situations in which patients require anticoagulation and dual antiplatelet therapy with aspirin and a P2Y12 inhibitor, also known as triple ther...
Source: Current Emergency and Hospital Medicine Reports - August 9, 2018 Category: Emergency Medicine Source Type: research

Accuracy of Medication Safety Report Severity Level Among Disciplines at a Tertiary Academic Medical Center
The objective of our analysis was to determine whether differences exist in the accuracy of reporter estimated incident severity level. This is a retrospective, quality assurance analysis of medication safety reports. Information collected included the total number of medication safety reports, reporter roles, reported severity level, and actual severity level. Accuracy of reporter severity was determined based on the difference between reported compared to the actual severity scored for each incident.Recent FindingsFour hundred forty-nine were included in the analysis. Reports were most commonly entered by nurses (71.3%) ...
Source: Current Emergency and Hospital Medicine Reports - August 1, 2018 Category: Emergency Medicine Source Type: research

Hyperbaric Oxygen Therapy and Utilization in Infectious Disease
AbstractPurpose of ReviewThis review explores the multiple infectious processes in which the Undersea and Hyperbaric Medicine Society recommends hyperbaric oxygen as an adjunct to standard treatment to determine the benefit of including hyperbaric oxygen in standard treatment protocols.Recent FindingsWhile the utilization of hyperbaric oxygen (HBO) has been shown to improve outcomes, there is limited research comparing it to other therapies. There are numerous case reports and retrospective analyses of the use of HBO as adjunctive treatment, but randomized control trials are glaringly absent from recent literature.SummaryT...
Source: Current Emergency and Hospital Medicine Reports - July 17, 2018 Category: Emergency Medicine Source Type: research