Comparison of emergency department to hospital antibiograms: Influence of patient risk factors on susceptibility
Traditional antibiograms use local resistance patterns and susceptibility data to guide empiric antimicrobial therapy selection. However, antibiograms are rarely unit-specific and do not account for patient-specific risk factors. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 22, 2019 Category: Emergency Medicine Authors: Jessica Miller, Amina George, Sarah E. Kozmic, Maya Beganovic, Sarah M. Wieczorkiewicz Source Type: research

Variations in access to specialty care for children with severe burns
Pediatric burns account for 120,000 emergency department visits and 10,000 hospitalizations annually. The American Burn Association has guidelines regarding referrals to burn centers; however there is variation in burn center distribution. We hypothesized that disparity in access would be related to burn center access. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 21, 2019 Category: Emergency Medicine Authors: Clifton Ewbank, Clifford C. Sheckter, Nicholus M. Warstadt, Elizabeth A. Pirrotta, Catherine Curtin, Christopher Newton, N. Ewen Wang Source Type: research

Protocol deviations in intravenous acetylcysteine therapy for acetaminophen toxicity
Hepatotoxicity secondary to acetaminophen overdose can be prevented with intravenous n-acetylcysteine (IV N-AC). The dosing schedule of IV N-AC is somewhat complex, consisting of a 21-hour regimen of three varying doses and infusion rates [1,2]. As a result, dosing and infusion-related errors may occur. We investigated the frequency of infusion-related errors associated with IV N-AC in the treatment of acetaminophen toxicity, and we sought to determine if protocol deviations had an impact on clinical outcomes. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 21, 2019 Category: Emergency Medicine Authors: Nadia I. Awad, Ann-Jeannette Geib, Akshay Roy, Craig Cocchio, Patrick J. Bridgeman Source Type: research

Evaluation and management of cauda equina syndrome in the emergency department
Cauda equina syndrome (CES) may be a devastating disease with the potential for significant patient morbidity. It is essential for emergency clinicians to be aware of how to effectively diagnose and manage this condition. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 20, 2019 Category: Emergency Medicine Authors: Brit Long, Alex Koyfman, Michael Gottlieb Source Type: research

Predictive value of capnography for severity of acute gastroenteritis in the emergency department
This study first aims to assess the utility of ETCO2 levels in evaluating the severity of dehydration in adult patients that present to the ED with acute gastroenteritis. AGE. Second, it intends to evaluate the correlation between ETCO2 and several metabolic parameters: creatinine, pH, bicarbonate (HCO3), and bases excessive (BE). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 20, 2019 Category: Emergency Medicine Authors: H üseyin Uzunosmanoğlu, Emine Emektar, Seda Dağar, Şeref Kerem Çorbacıoğlu, Yunsur Çevik Source Type: research

The utility of the speed bump sign for diagnosing acute appendicitis
This study was made in order to determine whether there is any evidence to support the practice of inquiring about pain over speed bumps in patient suspected to have acute appendicitis and to discover its predictive power as a diagnostic sign. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 20, 2019 Category: Emergency Medicine Authors: Mustafa Mahmood Eid, Maythem Al-Kaisy Source Type: research

Effects of emergency department boarding on mortality in patients with ST-segment elevation myocardial infarction
Patients with ST-segment elevation myocardial infarction (STEMI) are sometimes boarded in the emergency department (ED) after percutaneous coronary intervention (PCI). We evaluated the effects of direct and indirect admission to the CCU on mortality and the effect on length of stay (LOS) in patients with STEMI. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 19, 2019 Category: Emergency Medicine Authors: Jin Hee Jeong, Dong Hoon Kim, Tae Yun Kim, Changwoo Kang, Soo Hoon Lee, Sang Bong Lee, Seong Chun Kim, Yong Joo Park, Daesung Lim Source Type: research

Assessing the effectiveness of empiric antimicrobial regimens in cases of septic/infected abortions
Infected abortion is a life-threatening condition that requires immediate surgical and medical interventions. We aimed to assess the common pathogens associated with infected abortion and to test the microbial coverage of various empiric antimicrobial regimens based on the bacteriological susceptibility results in women with infected abortions. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 17, 2019 Category: Emergency Medicine Authors: Yuval Fouks, Ofri Samueloff, Ishai Levin, Ariel Many, Sharon Amit, Aviad Cohen Source Type: research

Gentle facemask ventilation during induction of anesthesia
To determine the level of inspiratory pressure minimizing the risk of gastric insufflation while providing adequate pulmonary ventilation. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 15, 2019 Category: Emergency Medicine Authors: Qingfu Zhang, Quanhong Zhou, Junfeng Zhang, Daqiang Zhao Source Type: research

Inaccurate haemoglobin measurement by blood gas analyzer may lead to severe adverse clinical consequences
I was most interested to read the recent very informative research paper by Altunik et al. which correlates measurement of sodium, potassium, haemoglobin (Hb), hematocrit and glucose values by blood gas analyzer (BGA) and by laboratory autoanalyzer (LAA) in over 30,000 patients [1]. As a Hematologist and Chief of Blood Transfusion at a large University Teaching Hospital, I was particularly interested to note that, although the correlation coefficient for Hb was 0.982, there was no acceptable agreement limit for Hb or for any of the other blood tests. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 14, 2019 Category: Emergency Medicine Authors: Philip T. Murphy Source Type: research

Ultrasound-guided analgesic injection for acromioclavicular joint separation in the emergency department
We present the first documented case of an emergency clinician treating the pain of an acute Acromioclavicular (AC) joint separation through ultrasound (US) guided injection of an anesthetic agent. A 41  year old male presented with an acute traumatic grade III AC joint separation after falling off a scooter, and his pain was not significantly improved with oral medication. The AC joint was located by US, and bupivacaine was injected into the joint effusion under US guidance, yielding near comple te resolution of pain. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 14, 2019 Category: Emergency Medicine Authors: Carlos Mikell, Jonathan Gelber, Arun Nagdev Source Type: research

Impact of CT scanner location on door to imaging time for emergency department stroke evaluation
Stroke is a potentially serious condition commonly diagnosed in the ED. Time to diagnosis can be crucial to maximizing outcome in a majority of ischemic stroke cases amenable to thrombolytic therapy. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 14, 2019 Category: Emergency Medicine Authors: William Bonadio Source Type: research

Emergency department opioid prescriptions decreased after legislation in New Jersey
In 2017, the US Department of Health and Human Services declared the opioid crisis a public health emergency [1]. Opioid overdose deaths have quadrupled in certain states over the past twenty years, and deaths are expected to rise by 147% from 2015 to 2025 [1]. On March 26, 2019, Purdue Pharma LP paid Oklahoma $270 million in a settlement for a claim of aggressive marketing oxycodone, and this lawsuit is probably the first of more than 1600 [2]. In response to the opioid epidemic, the Executive Office of the United States in March 19, 2018 proposed to cut nationwide opioid prescriptions by one-third within three years [3]....
Source: The American Journal of Emergency Medicine - August 13, 2019 Category: Emergency Medicine Authors: Todd Duppong, Alessandro Amato, Michael Silverman, Barnet Eskin, John R. Allegra Source Type: research

May hemoglobin measurement by blood gas analyzer lead to severe adverse clinical consequences? Reply to letter to the editor
Thanks for allowing us to respond to the letter to the editor regarding our article “Correlation between sodium, potassium, hemoglobin, hematocrit, and glucose values as measured by a laboratory autoanalyzer and a blood gas analyzer” [1]. The author of the letter to the editor was agree with the conclusion of our study which stated that the hemoglobin results measured by blood gas analyzer (BGA) didn't have acceptable agreement, although there was strong correlation. We also found that none of the levels of glucose, hematocrit, sodium and potassium had acceptable agreement limits. (Source: The American Journal ...
Source: The American Journal of Emergency Medicine - August 13, 2019 Category: Emergency Medicine Authors: G ökhan Aksel Source Type: research

Intravenous potassium solution boluses save a life from hypokalemic cardiac arrest
A 21-year-old Taiwanese man, 166  cm in height and 68 kg in weight, presented to the emergency department with generalized weakness, dizziness and vomiting in the morning. The patient had the same episode 1 year previously, at which time hyperthyroidism with thyrotoxic periodic paralysis was diagnosed. The patient had not tak en any medication within the past 2 months. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 8, 2019 Category: Emergency Medicine Authors: Jen-Kuei Liu, Shyh-Shyong Sim, Fu-Chien Hsieh, Yuan-Hui Wu Source Type: research

Toxicokinetics of hydroxychloroquine following a massive overdose
We report a patient with a massive hydroxychloroquine overdose manifested by profound hypokalemia and ventricular dysrhythmias and describe hydroxychloroquine toxicokinetics. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 6, 2019 Category: Emergency Medicine Authors: Jonathan de Olano, Mary Ann Howland, Mark K. Su, Robert S. Hoffman, Rana Biary Source Type: research

Nursing updates as a means to improve patient satisfaction
Patient satisfaction has been tied to trust in healthcare providers, treatment adherence, and clinical outcomes [1,2]. As a quality measure, there is increased administrative attention on emergency department (ED) patient satisfaction scores. Studies have shown that nurses can positively impact patient satisfaction with hourly bedside rounding and bedside handoffs [3,4]. However, studies are still needed to better understand interventions that can optimize patient satisfaction that complement nursing workflow in the ED. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 6, 2019 Category: Emergency Medicine Authors: Rohit B. Sangal, Frances Shofer, Erik Blutinger, Mira Mamtani Source Type: research

Impact of trauma level designation on survival of patients arriving with no signs of life to US trauma centers
This study examines impact of Trauma Levels on survival of patients arriving with “no signs of life” to US trauma centers. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 6, 2019 Category: Emergency Medicine Authors: Alik Dakessian, Rana Bachir, Mazen El Sayed Source Type: research

Shock, aortic occlusion and creamy plasma
Acute occlusion of the abdominal aorta is an extremely rare disease. A 31-year-old man with history of neuroblastoma of the left adrenal gland in childhood treated with radiotherapy, chemotherapy and surgery was known to have secondary arterial hypertension due to renal artery stenosis. He also had poor alimentary habits with excessive alcohol and massive sugar consumption. He presented to hospital for acute bilateral limb ischemia with complete paralysis. Abdominal CT-scan revealed abdominal aortic occlusion below the renal arteries, associated with severe pancreatitis (plasma lipase  = 1459 UI/l) (Fig. (Source: The...
Source: The American Journal of Emergency Medicine - August 6, 2019 Category: Emergency Medicine Authors: C écile Armougom, Hayate Chraka, Boris Boulanger, Jean Senemaud, Olivier Langeron, Nicolas Mongardon Source Type: research

Idiopathic acute eosinophilic pneumonia: A rare cause of hypoxic respiratory failure
Idiopathic Acute Eosinophilic Pneumonia (IAEP) is a life-threatening cause of hypoxic respiratory failure. IAEP is challenging to diagnose as it may mimic infectious pneumonia or acute respiratory distress syndrome. Distinguishing IAEP from these alternatives is important; the mainstay of treatment for IAEP is corticosteroids, a therapy which might not otherwise be indicated. Patients treated appropriately usually experience a full recovery. In this case report we describe the presentation, evaluation, and management of a 19-year old male who presented to the emergency department (ED) in respiratory failure from IAEP. (Sou...
Source: The American Journal of Emergency Medicine - August 5, 2019 Category: Emergency Medicine Authors: Kole H. Spaulding, Patrick C. Ng, Michael D. April Source Type: research

Hemodialysis for lamotrigine poisoning
We read with interest the recent paper by Agrawal and colleagues claiming a benefit for the use of hemodialysis (HD) in acute lamotrigine poisoning [1]. We commend the authors for attempting extracorporeal removal in a patient with prolonged severe toxicity in agreement with previously published guidance [2]. However, because of the lack of objective evidence of drug removal, the report fails to provide sufficient data to support the efficacy of HD in this case. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 4, 2019 Category: Emergency Medicine Authors: Sophie Gosselin, Marc Ghannoum, Robert S. Hoffman Tags: Correspondence Source Type: research

Randomized controlled trial to improve primary care follow-up among emergency department patients
Primary care (PC) follow-up for discharged emergency department (ED) patients provides patients with further medical attention. We conducted a pilot randomized controlled trial to determine whether using a freely-available physician appointment-booking website results in higher self-reported PC follow-up. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 2, 2019 Category: Emergency Medicine Authors: Rory J. Merritt, Paige Kulie, Andrew W. Long, Tina Choudhri, Melissa L. McCarthy Source Type: research

A multicenter randomized controlled trial of a modified Valsalva maneuver for cardioversion of supraventricular tachycardias
Valsalva maneuver is a recognized treatment for supraventricular tachycardia, but in clinical setting it has a low chance to achieve successful cardioversion. Studies suggested that the postural modification of valsalva maneuver may improve the rate of cardioversion. We further modified the maneuver and conduct a multicenter randomized controlled trial to test its efficacy. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 1, 2019 Category: Emergency Medicine Authors: Chaofeng Chen, Tsz Kin Tam, Shuai Sun, Yanyan Guo, Peng Teng, Dong Jin, Liujian Xu, Xingpeng Liu Source Type: research

Improving STEMI management in the emergency department: Examining the role of minority groups and sociodemographic characteristics
To evaluate whether a fast-track intervention program will reduce time-lags of patients with STEMI considering minority groups, various socioeconomic status (SES) and clinical risk factors. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 1, 2019 Category: Emergency Medicine Authors: Mor Saban, Tal Shachar, Rabia Salama, Aziz Darawsha Source Type: research

The detection of occult CO poisoning through noninvasive measurement of carboxyhemoglobin: A cross-sectional study
Carbon monoxide (CO) poisoning is one of the leading causes of preventable death in the world. Our primary objective was to identify and treat individuals who are unaware of their exposure to carbon monoxide in emergency departments (EDs). Our secondary goal was to reduce the costs of diagnosis and treatment by preventing unnecessary diagnostic testing in EDs. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 1, 2019 Category: Emergency Medicine Authors: Serhat Koyuncu, Oguzhan Bol, Tamer Ertan, Nurullah G ünay, Halil İbrahim Akdogan Source Type: research

Editorial Board
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 31, 2019 Category: Emergency Medicine Source Type: research

Nonfatal horse-related injuries treated in emergency departments in the United States, 1990 –2017
The objective of this study is to investigate the epidemiological features of horse-related injuries treated in emergency departments (EDs) in the United States. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 31, 2019 Category: Emergency Medicine Authors: Amy S. Acton, Christopher E. Gaw, Thitphalak Chounthirath, Gary A. Smith Source Type: research

A case of elusive cardiac dysrhythmia in high-risk syncope
We report the case of a 70-year old man with dizziness and convulsive syncope whose initial ECG showed a right bundle branch block, but then developed ventricular standstill and intermittent high-grade AV block while still in the ED. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 31, 2019 Category: Emergency Medicine Authors: Yijia Mu, Mark Supino Source Type: research

Assessment of “10 essential” preparedness among day-hikers on Mount Monadnock
Nearly 290 million people made recreational visits to United States national parks in 2014, an increase of almost 20 million annual visits from 2004 [1]. When catastrophe occurs in the wilderness, preparedness may help to mitigate morbidity and mortality. Comprehensive wilderness preparedness entails a combination of mental and physical attributes with the appropriate gear, creating the correct set of tools to survive in the wilderness. Appearing in 1974, the “10 essentials” of wilderness survival comprise a gear list that remains a popular guide in wilderness preparedness and a surrogate for overall preparedne...
Source: The American Journal of Emergency Medicine - July 31, 2019 Category: Emergency Medicine Authors: Nicholas J. Daniel, Samir B. Patel, Peter St. Marie, Elizabeth M. Schoenfeld Source Type: research

Emergency department monitor alarms rarely change clinical management: An observational study
Monitor alarms are prevalent in the ED. Continuous electronic monitoring of patients' vital signs may alert staff to physiologic decompensation. However, repeated false alarms may lead to desensitization of staff to alarms. Mitigating this could involve prioritizing the most clinically-important alarms. There are, however, little data on what ED monitor alarms are clinical meaningful. We evaluated whether and which ED monitor alarms led to observable changes in patients' ED care. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 30, 2019 Category: Emergency Medicine Authors: William Fleischman, Bethany Ciliberto, Nicole Rozanski, Vivek Parwani, Steven L. Bernstein Source Type: research

Evaluation of an emergency department buprenorphine induction and medication-assisted treatment referral program
The objective of this study was to describe a pragmatic approach to buprenorphine induction, referral to treatment, and assess follow-up rates. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 30, 2019 Category: Emergency Medicine Authors: Kevin A. Kaucher, Emily H. Caruso, D.O. Gannon Sungar, Lisa Gawenus, Katherine Hurlbut, Dayan Colon Sanchez, Kerry Broderick Source Type: research

Acute myocardial infarction in the setting of left bundle branch block: Chapman's sign
We present a case of 77-year-old Caucasian male with a known LBBB and coronary artery bypass surgery for coronary artery disease who presented to the emergency department with a chief complaint of chest pain and shortness of breath. The patient had recurrent chest pain despite using aspirin, nitroglycerine, and morphine. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 29, 2019 Category: Emergency Medicine Authors: Amr Idris, Mohamad Hatahet, Basel Edris Source Type: research

Redefining Minimal Traumatic Brain Injury (mTBI) delineates cost effective triage
Mild traumatic brain injury (mTBI) is defined as Glasgow Coma Score (GCS) of 14 or 15. Despite good outcomes, patients are commonly transferred to trauma centers for observation and/or neurosurgical consultation. The aim of this study is to assess the value of redefining mTBI with novel radiographic criteria to determine the appropriateness of interhospital transfer for neurosurgical evaluation. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 29, 2019 Category: Emergency Medicine Authors: Michael R. Arnold, Kyle W. Cunningham, Tyler G. Atkins, O'Hara K. Haley, Joe Bernard, Rachel B. Seymour, A. Britton Christmas, Ronald F. Sing Source Type: research

Comparison of two scores of short term serious outcome in COPD patients
Chronic Obstructive Pulmonary Disease (COPD) related visits to the emergency department have increased substantially during the past decade. An important challenge facing emergency physicians when treating COPD patients is deciding on disposition. The aim of this study was to evaluate Integrated Pulmonary Index scoring to guide the disposition decisions of emergency physicians by comparing its compatibility with Ottawa COPD Risk Score. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 27, 2019 Category: Emergency Medicine Authors: Abdullah Osman Kocak, Zeynep Cakir, Ilker Akbas, Sultan Tuna Akgol Gur, Muhammed Zubeyir Kose, Naz ım Onur Can, Emre Sengun, Omer Faruk Gemis Source Type: research

Utility of plain abdominal radiography in adult ED patients with suspected constipation
Abdominal radiographs are often obtained in ED patients with suspected constipation, although their utility in adults is not well understood. We sought to compare ED management when an abdominal radiograph is and is not obtained. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 27, 2019 Category: Emergency Medicine Authors: Brian E. Driver, Chaitanya Chittineni, Gautham Kartha, Jon B. Cole, Lauren R. Klein, Megan Rischall Source Type: research

Seat belt use among patients in motor vehicle collisions: Clinical and demographic factors
This study was undertaken to identify factors associated with noncompliance with seatbelt use among admitted patients following a motor vehicle crash. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 26, 2019 Category: Emergency Medicine Authors: Catherine A. Marco, Akpofure Peter Ekeh, Claire Hardman, Matthew Lovell, Ashley Brent, Joycelyn Akamune Source Type: research

Utilization of thromboelastography and a low molecular weight heparin anti-Xa assay for guidance in apixaban reversal: A case report
Reversal of oral factor Xa (FXa) inhibitors, such as apixaban, remains a controversial topic. However, the controversy goes beyond what reversal agent to utilize. Often times these patients present with an acute major bleed and are difficult to assess whether reversal is warranted or not. Furthermore, it is difficult to assess whether reversal was successful in a timely manner. A paucity of literature exists regarding the utilization of low molecular weight heparin (LMWH) anti-Xa assays and thromboelastography for identifying coagulopathies associated with oral FXa inhibitors. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 26, 2019 Category: Emergency Medicine Authors: Brian W. Gilbert, Tori R. Adams, Tessa R. Reynolds, David A. Moran, George J. Philip Source Type: research

Compensation models in emergency medicine: An ethical perspective
There is considerable diversity in compensation models in the specialty of Emergency Medicine (EM). We review different compensation models and examine moral consequences possibly associated with the use of various models. The article will consider how different models may promote or undermine health care's quadruple aim of providing quality care, improving population health, reducing health care costs, and improving the work-life balance of health care professionals. It will also assess how different models may promote or undermine the basic bioethical principles of beneficence, non-maleficence, respect for autonomy, and ...
Source: The American Journal of Emergency Medicine - July 26, 2019 Category: Emergency Medicine Authors: Daniel R. Martin, John C. Moskop, Kelly Bookman, Jesse B. Basford, Joel Martin Geiderman Source Type: research

Assessment of intravenous insulin dosing strategies for the treatment of acute hyperkalemia in the emergency department
Hyperkalemia, defined as a serum potassium above 5 milliequivalents per liter (mEq/L), is commonly encountered in emergency departments (ED) across the nation [1]. This accumulation is the result of either an increase in potassium uptake, decrease in excretion, or excessive potassium release from the intracellular space. Serum potassium is commonly used as a marker for electrolyte imbalances but does not account for total body potassium as the majority of concentration (30:1) exists within the intracellular space [2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 26, 2019 Category: Emergency Medicine Authors: Katherine P. Keeney, Chara Calhoun, Lindsey Jennings, Erin R. Weeda, Kyle A. Weant Source Type: research

Fear and paperwork: Evaluating barriers to safer prehospital care
Since the landmark 2000 Institute of Medicine publication To Err is Human: Building a Safer Health System, an increased focus has been placed on the understanding and mitigation of errors in healthcare [1]. Although EMS systems respond to nearly 37 million events per year, there remains a paucity of research into the nature and abatement of errors in EMS systems [2,3]. Adverse events have been found in nearly all areas of EMS, including transportation, procedures, medication administration, and medical decision making [2,4-10]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 26, 2019 Category: Emergency Medicine Authors: Benjamin W. Weston, Matthew Chinn, Tim J. Lenz, E. Brook Lerner, M. Riccardo Colella Source Type: research

Interleukin-6 improves infection identification when added to physician judgment during evaluation of potentially septic patients
This study assessed whether biomarkers of endothelial activation and/or inflammation could improve identification of infection among Emergency Department (ED) patients with organ dysfunction. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 25, 2019 Category: Emergency Medicine Authors: Daniel J. Henning, M. Kennedy Hall, Bjorn K. Watsjold, Pavan K. Bhatraju, Susanna Kosamo, Nathan I. Shapiro, W. Conrad Liles, Mark M. Wurfel Source Type: research

Point-of-care blood analysis of hypotensive patients in the emergency department
The aim of this study is to compare a point-of-care (POC) analysis, Enterprise POC (epoc), using the capillary blood obtained from skin puncture with conventional laboratory tests using arterial and venous blood in hypotensive patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 25, 2019 Category: Emergency Medicine Authors: Hyungoo Shin, Inhye Lee, Changsun Kim, Hyuk Joong Choi Source Type: research

Methods of laceration closure in the ED: A national perspective
Laceration closure is one of the most common procedures performed in the emergency department (ED). While sutures and staples have been the traditional wound closure device, topical skin adhesives (TSA) were introduced in the United States 20  years ago as a non-invasive alternative for simple, low-tension wounds. We determined which closure devices were used to close ED lacerations and explored patient and provider characteristics associated with choosing TSA. We also tested the hypothesis that use of TSA would be associated with shor ter ED length of stay (LOS) than sutures/staples. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 25, 2019 Category: Emergency Medicine Authors: Karalynn Otterness, Henry C. Thode, Adam J. Singer Source Type: research

Delusional parasitosis as presenting symptom of occipital lobe cerebrovascular accident
Delusional parasitosis manifests as a fixed, false belief that an individual is infested by living organisms. Primary delusional parasitosis is a psychiatric disorder with the delusion as an isolated manifestation, whereas secondary delusional parasitosis is a delusion occurring secondary to a psychiatric disorder, substance use, or medical illness. A 62-year-old woman with no psychiatric history presented to the Emergency Department with two to three months of “whole body itching” and seeing small insects crawling on her skin and in her hair. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 25, 2019 Category: Emergency Medicine Authors: Nathan L. Haas, Adam Nicholson, Mary R.C. Haas Source Type: research

Evaluation of infection rates with narrow versus broad-spectrum antibiotic regimens in civilian gunshot open-fracture injury
Civilian gunshot open-fracture injuries portray a significant health burden to patients. Use of antibiotics is endorsed by guideline recommendations for the prevention of post-traumatic infections, however, antimicrobial selection and their associated outcomes remains unclear. Therefore, we sought to compare infectious and other clinical outcomes between three antimicrobial cohorts in patients with gunshot-related fractures requiring operative intervention. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 23, 2019 Category: Emergency Medicine Authors: Jordan A. Woolum, Abby M. Bailey, Adam Dugan, Rahul Agrawal, Regan A. Baum Source Type: research

Differential impacts of inappropriate empirical therapy on ED patients with Staphylococcus aureus and streptococci bacteremia
Staphylococcus aureus (S. aureus) and streptococci are leading Gram-positive pathogens causing community-onset bacteremia. The comparisons of initial presentations and impacts of inappropriate empirical antimicrobial therapy (EAT) on clinical outcomes between the two pathogens are lacking. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 23, 2019 Category: Emergency Medicine Authors: Chung-Hsun Lee, Chao-Yung Yang, Chih-Chia Hsieh, Ming-Yuan Hong, Ching-Chi Lee Source Type: research

Sepsis is frequent in initially non-critical hypotensive emergency department patients and is associated with increased mortality
The objective of this study was to determine in initially non-critical hypotensive adult patients the proportion of sepsis and if septic patients had different outcome and clinical factors than non-septic patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 23, 2019 Category: Emergency Medicine Authors: Sean Coeckelenbergh, Marc Van Nuffelen, Christian M élot Source Type: research

Do-not-attempt resuscitation independently predict in-hospital mortality in septic patients
Sepsis patients require timely and appropriate treatment in an intensive care setting. However, “do-not-attempt resuscitation” (DNAR) status may affect physicians' priorities and treatment preferences. The aim of this study was to evaluate whether DNAR status affects the outcomes of septic patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 23, 2019 Category: Emergency Medicine Authors: An-Yi Wang, Cheng-Kuei Chang Source Type: research