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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 16, 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 13, 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 12, 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 9, 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 3, 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 10, 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 medical ou...
Source: Current Emergency and Hospital Medicine Reports - October 10, 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 13, 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 12, 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 10, 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 6, 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 may be...
Source: Current Emergency and Hospital Medicine Reports - September 5, 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 28, 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 severe a...
Source: Current Emergency and Hospital Medicine Reports - August 23, 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 23, 2019 Category: Emergency Medicine Source Type: research