Prehospital Shock Index to assess 28-day mortality for septic shock
In this study, we describe the association between prehospital shock index (SI) and mortality at day 28 of patients with SS initially cared for in the prehospital setting by a mobile intensive care unit (MICU). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - December 4, 2019 Category: Emergency Medicine Authors: Romain JOUFFROY, Jean Pierre TOURTIER, Papa GUEYE, Emmanuel BLOCH-LAINE, Vincent BOUNES, Guillaume DEBATY, Josiane BOULARAN, Pierre CARLI, Beno ît VIVIEN Source Type: research

The US Military Experience with THAM
Acidosis, a part of the lethal trauma triad, occurs frequently after major combat trauma. Tris-hydroxymethyl aminomethane (THAM) has been used to effectively treat acidosis in injured casualties. No research has been conducted assessing the safety of THAM in the military combat setting. We sought to describe the US military experience with THAM administration to battlefield injury subjects. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - December 3, 2019 Category: Emergency Medicine Authors: Gonzalo de Taboada, Mohamad Umar, Monica Casmaer, Lorne Blackbourne, Steve Schauer Source Type: research

Topical agents causing methemoglobinemia
We read with great interest the recent article by Lerner et al regarding EMLA induced methemoglobinemia published in your esteemed journal (1). Based on our previous experience, and recent available literature, we would like to mention a few additional comments in order to enhance the understanding of AJEM readers (2 –8). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 30, 2019 Category: Emergency Medicine Authors: Kamal Kant Sahu, Regina Brown, Ajay Kumar Mishra, Amos Lal, Susan V George Source Type: research

Spontaneous lung herniation after forceful coughing
Spontaneous lung herniation is a rare finding, most often the result of forceful coughing. Risk factors include obesity, male gender, tobacco use, and steroid use. Surgical repair is recommended due to increasing size of herniation and pain control. Life style modification, such as smoking cessation, is recommended in this patient population. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 30, 2019 Category: Emergency Medicine Authors: Cynthia L. Dahlkemper, W. Paul Greissinger Source Type: research

Priapism associated with pregabalin
Priapism is defined as a prolonged erection of the penis for at least 4 hours without sexual stimulation. It may occur in all age groups. Drugs are the most common cause in adults. A 64-year-old male patient was admitted to the emergency department with painful erection that had lasted for 2 days without sexual stimulation. Our patient had used pregabalin for around 1 year due to neuropathic pain. The dose of the drug was increased as his pain scaled up recently. Approximately 30cc of dark blood was drained from the corpus cavernosum with an 18 Gauge needle in the emergency department. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 30, 2019 Category: Emergency Medicine Authors: Yusuf Karanc ı Source Type: research

Corneal hydrops secondary to undiagnosed keratoconus
A 21-year old female presented to the emergency department with an abnormal appearing of her left eye after trivial trauma the previous day. A protruding, opaque appearing area was noted on the left cornea. The patient underwent visual acuity testing, fluorescein staining with slit lamp examination revealing a conical corneal protrusion with corneal stromal edema suggestive of corneal hydrops. Corneal hydrops is a rare complication of keratoconus and various corneal ectasias where aqueous humor can leak into the corneal stroma causing edema and protruding pockets of fluid. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 30, 2019 Category: Emergency Medicine Authors: Tim Cheung, Muhammad Durrani, Matthew Warner Source Type: research

Prophylactic antibiotics for anterior nasal packing in Emergency Department: A Systematic Review and Meta- Analysis of Clinically-Significant Infections
Patients presenting to emergency departments with spontaneous anterior epistaxis may undergo anterior nasal packing and sometimes receive systemic prophylactic antibiotics. There has not been sufficient evidence to support or refute this practice. The main objective of this study was to compare the likelihood of clinically significant infection (CSI) between patients with or without prophylactic antibiotics for anterior nasal packing due to spontaneous epistaxis. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 30, 2019 Category: Emergency Medicine Authors: Quincy K. Tran, Meboob A. Rehan, Daniel aase, Ann Matta, Ali Pourmand Source Type: research

CISNE versus MASCC: Identifying low risk febrile neutropenic patients
Febrile neutropenia though a dreaded complication of chemotherapy, not all patients need inpatient treatment. Risk score indices like MASCC and CISNE have been developed to identify low risk patients eligible for outpatient management. We undertook this study to compare the performances of MASCC and CISNE. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 29, 2019 Category: Emergency Medicine Authors: Ritin Mohindra, Roshan Mathew, Sakshi Yadav, Praveen Aggarwal Source Type: research

Ketamine for Emergency Sedation of Agitated Patients: A Systematic Review and Meta-Analysis
Prior studies suggest that ketamine is effective for acute agitation in the emergency department (ED) and prehospital settings. This systematic review and meta-analysis aims to evaluate the rate of sedation and need for airway management in patients given ketamine for management of acute agitation. Methods: We performed a systematic review of publications describing the use of ketamine to control agitation in the ED and prehospital settings. Studies were included if they included agitated patients, used ketamine to control agitation, occurred in the ED and prehospital setting and measured sedation status or need for airway...
Source: The American Journal of Emergency Medicine - November 29, 2019 Category: Emergency Medicine Authors: Natalie Sullivan, Chen Chen, Rebecca Siegel, Yan Ma, Ali Pourmand, Nataly Montano, Andrew Meltzer Source Type: research

Predictors of Linkage to Care for a Nontargeted Emergency Department Hepatitis C Screening Program
Hepatitis C (HCV) is the most common chronic blood-borne illness in the United States, estimated to affect 2.7 to 3.9 million persons [1,2]. A leading cause of end stage liver disease, hepatocellular carcinoma, and liver transplantation [2 –4], HCV is now responsible for more deaths annually in the U.S. than HIV, tuberculosis, and 58 other nationally reportable infectious diseases combined [5]. As an estimated three quarters of HCV-infected individuals in the U.S. were born between 1945 and 1965, the Centers for Disease Control and Prevention (CDC) and United States Preventive Services Task Force (USPSTF) issued reco...
Source: The American Journal of Emergency Medicine - November 29, 2019 Category: Emergency Medicine Authors: Joshua A. Blackwell, Joel B. Rodgers, Ricardo A. Franco, Stacey S. Cofield, Lauren A. Walter, James W. Galbraith, Erik P. Hess Source Type: research

The efficacy of Nigella sativa supplementation for asthma control: a meta-analysis of randomized controlled studies
The efficacy of Nigella sativa supplementation for asthma control remains controversial. We conduct a systematic review and meta-analysis to explore the influence of Nigella sativa supplementation on asthma control. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 29, 2019 Category: Emergency Medicine Authors: Anqiang Han, Danqin Shi Source Type: research

Interpreting Troponin in Renal Disease: A Narrative Review for Emergency Clinicians
Patients with chronic kidney disease (CKD)/end stage renal disease (ESRD) can experience several severe complications, including acute coronary syndrome (ACS). While troponin is the biomarker of choice for evaluation of ACS, interpretation of troponin in CKD/ESRD can be challenging (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 29, 2019 Category: Emergency Medicine Authors: Brit Long, Christopher N. Belcher, Alex Koyfman, Jonathan M. Bronner Source Type: research

The clinical characteristics of situational syncope in children and adults undergoing head-up tilt testing
Situational syncope is a subtype of neurally mediated syncope and associated with specific circumstances. This paper is to assess the clinical characteristics and underlying causes of situational syncope. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 29, 2019 Category: Emergency Medicine Authors: Runmei Zou, Shuo Wang, Ping Lin, Chunyan Hu, Yuwen Wang, Fang Li, Yi Xu, Cheng Wang Source Type: research

A patient with lower extremity weakness after recent endovascular repair of an abdominal aortic aneurysm
Thrombosis of an endovascular aortic repair (EVAR) is a devastating complication of a common surgical procedure that can lead to serious morbidity and mortality if not promptly recognized. This is the first case report of an EVAR graft thrombosis in the emergency medicine literature. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 28, 2019 Category: Emergency Medicine Authors: Jason R. West, Christopher S. Keller, Joel Lombardi Source Type: research

Squamous Epithelial Cell Presence Reduces Accuracy of Urinalysis for Prediction of Positive Urine Cultures
Diagnostic value of urinalysis specimens contaminated with squamous epithelial cells (SEC) from the genital surfaces is assumed to be limited compared to clean-catch samples. However, no studies have quantified the change in predictive value in the presence of SECs for individual urinalysis markers. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 28, 2019 Category: Emergency Medicine Authors: Patrick J. Maher, Karl D. Jablonowski, Lynne D. Richardson Source Type: research

A knack for “NAC”: treatment for heat stroke induced acute liver injury: A case report
We present a case of heat stroke resulting in acute liver injury (ALI) successfully treated with intravenous N-acetylcysteine (NAC). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 28, 2019 Category: Emergency Medicine Authors: Brian Monzon, Kathleen Hegarty, Megan A. Rech Source Type: research

Comments on Xuebijing in the treatment of patients with sepsis: A meta-analysis
Dear Editors: (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 28, 2019 Category: Emergency Medicine Authors: Zhuang Jieqin, Dai Xingzhen, Cai Hairong, Chen Bojun Source Type: research

The Critical Care Literature 2018
An emergency physician (EP) is often the first health care provider to evaluate, resuscitate, and manage a critically ill patient. In recent years, the annual hours of critical care delivered in emergency departments (EDs) across the United States increased more than 200% [1]. From 2001 to 2009, annual intensive care unit (ICU) admissions from United States EDs exceeded 2 million patients, an increase of almost 80% over that time period [1]. In addition to seeing more critically ill patients, EPs are often tasked with providing critical care long beyond the initial resuscitation period. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 28, 2019 Category: Emergency Medicine Authors: Michael E. Winters, Kami Hu, Joseph P. Martinez, Haney Mallemat, William J. Brady Source Type: research

Efficacy of the presence of an emergency physician in prehospital major trauma care: randomised control trial results are needed!
TO THE EDITOR: (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 28, 2019 Category: Emergency Medicine Authors: Romain Jouffroy, Beno ît Vivien Source Type: research

Diagnostic Value of CT Contrast Extravasation for Major Arterial Injury After Pelvic Fracture: A Meta-Analysis
We conducted a meta-analysis is to determine diagnostic performance of CT intravenous contrast extravasation (CE) as a sign of angiographic bleeding and need for angioembolization after pelvic fractures. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 28, 2019 Category: Emergency Medicine Authors: David Dreizin, Yuanyuan Liang, James Dent, Nabeel Akhter, Daniel Mascarenhas, Thomas M Scalea Source Type: research

Presentation and Outcomes of End Stage Liver Disease Patients Presenting with Septic Shock to the Emergency Department
Patients with end stage liver disease (ESLD) are particularly vulnerable to sepsis. ESLD patients are often excluded from controlled sepsis trials and more data are needed to guide the management of this population. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 28, 2019 Category: Emergency Medicine Authors: Enola Okonkwo, Nigel Rozario, Alan C. Heffner Source Type: research

Prevalence, documentation, and communication of incidental findings in focused assessment with sonography for trauma (FAST) examinations
As the focused assessment with sonography for trauma (FAST) examination becomes increasingly ubiquitous in the emergency department (ED), a parallel increase in incidental findings can also be expected. The purpose of this study was to determine the prevalence, documentation, and communication of incidental findings on emergency physician-performed FAST examinations. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 28, 2019 Category: Emergency Medicine Authors: Josephine Valenzuela, Bryan Stilson, Asad Patanwala, Richard Amini, Srikar Adhikari Source Type: research

In-Situ Simulation for Enhancing Teamwork in the Emergency Department
Medical professionals working in the emergency department (ED), a high-stress/high-acuity environment, often deviate from clinical guidelines and policies despite knowing of their existence [1]. Therefore, simulation-based learning activities are often used in the ED to improve communication and teamwork and familiarize ED personnel with existing protocols [2]. Prior to implementing this project, a needs assessment for ED simulation was conducted by the authors which showed a significant perceived knowledge gap among personnel in (1) adherence to ED guidelines, (2) inter-team communication and (3) dealing with difficult fa...
Source: The American Journal of Emergency Medicine - November 26, 2019 Category: Emergency Medicine Authors: Rana Sharara-Chami, Zavi Lakissian, Randa Farha, Hani Tamim, Nicholas Batley Source Type: research

Acute renal failure due to acute chromium poisoning after chromic acid burns
Word countfor the text: 495 (excluding title page, author contributions, funding, competing interests, references, and figure legend) (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 26, 2019 Category: Emergency Medicine Authors: Qingcheng Zhu, Bingxia Wang, Bingyu Ling, Joseph Walline, Dingyu Tan Source Type: research

Patient Motivation for Presenting to Emergency Department for Vaginal Bleeding in Early Pregnancy (VBEP)
Vaginal bleeding in early pregnancy (VBEP) is a common presentation to the emergency department. Between 1993 and 2003, there were greater than 500,000 emergency department (ED) visits per year in the United States.[1] Within the first trimester , 20- 40 % of women experience an episode of vaginal bleeding.[1]Persistent bleeding is associated with negative outcomes including spontaneous abortion, low birth weight, stillbirth, prenatal death, and premature birth.[1,2] (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 26, 2019 Category: Emergency Medicine Authors: Joshua Bucher, Bhavesh Mody, Meigra Chin, Lara West, Pamela Ohman-Strickland, Marisa Joel, John Fastenau, Jonathon McCoy Source Type: research

The authors respond: Sensitivity and specificity in serum testing for acute cholecystitis
CORRESPONDENCE (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 26, 2019 Category: Emergency Medicine Authors: A. Algin, U. Gulacti, İ. Inan, M.O. Erdogan, S. Colak, M. Sariaydin Source Type: research

Bacterial Pericarditis: A Pediatric Case Report
A 3 year old non-verbal male with autism presented to the Emergency Department for evaluation of pallor, grunting, and perceived abdominal pain. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 26, 2019 Category: Emergency Medicine Authors: Megan Donovan, Nadine Smith, Ryan Holton, Craig Shapiro Source Type: research

Effectiveness and safety of droperidol in a United States emergency department
Droperidol is a dopamine receptor antagonist that functions as an analgesic, sedative, and antiemetic. In 2001, the U.S. Food and Drug Administration required a black box warning in response to case reports of QT prolongation and potential fatal arrhythmias. The aim of this study was to evaluate the effectiveness and safety of droperidol in patients presenting to a United States Emergency Department (ED). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 25, 2019 Category: Emergency Medicine Authors: Charlene M. Gaw, Daniel Cabrera, M. Fernanda Bellolio, Alicia E. Mattson, Christine M. Lohse, Molly M. Jeffery Source Type: research

The Comparison of Early Identification Scores in Sepsis
We appreciate the review of our article [1] comparing Systemic Inflammatory Response Syndrome (SIRS), Sepsis-related Organ Failure Assessment (qSOFA), and the National Early Warning Score (NEWS) for the early identification of severe sepsis and septic shock (SS/SS) in the Emergency Department. However, the concerns raised were, in general, beyond the scope of our study. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 25, 2019 Category: Emergency Medicine Authors: Omar A. Usman, Asad A. Usman, Michael A. Ward Source Type: research

Focused Cardiac Ultrasound to Expedite Diagnosis of Pulmonary Hypertension in Children in the Emergency Department: A Case Series
Pulmonary hypertension (PH) is a rare but serious diagnosis in children and adolescents defined by increased pulmonary vascular resistance with pulmonary artery (PA) pressures greater than 25 mmHg [1]. Pediatric PH is pathophysiologically distinct from adult PH in that pediatric PH is typically secondary to long-term pulmonary overcirculation or chronic lung pathology. Common primary pediatric causes include congenital heart disease with intracardiac left-to-right shunting and Eisenmenger syndrome [2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 25, 2019 Category: Emergency Medicine Authors: Almaz S. Dessie, Stephanie Leung, Beth D'Amico, Kayleigh A. Fischer, Zachary Binder, Alyssa Abo Source Type: research

Impact of Endotracheal Tube Twisting on the Diagnostic Accuracy of Ultrasound for Intubation Confirmation
Ultrasound is a readily-available technique used to identify accurate placement of an endotracheal tube (ETT) after an intubation attempt. There is limited research on using manipulation of the ETT to improve the diagnostic accuracy of ETT location confirmation. Our study sought to directly assess whether ETT twisting during the standard grayscale technique influenced the accuracy of intubation confirmation by ultrasound. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 23, 2019 Category: Emergency Medicine Authors: Michael Gottlieb, Katharine Burns, Dallas Holladay, Mark Chottiner, Shital Shah, Stephen R. Gore Source Type: research

The Association of Chest Pain Duration and other Historical Features with Major Adverse Cardiac Events
We sought to determine if the duration of pain or other features of the history predict major adverse cardiac events (MACE) in patients with chest pain in the emergency department (ED). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 20, 2019 Category: Emergency Medicine Authors: Tony Zitek, Elizabeth Chen, Armando Gonzalez-Ibarra, Jessica Wire Source Type: research

Computed Tomography Tractography Accuracy in Detecting Organ and Peritoneal Violation in Torso penetrating Wounds: A Systematic Review and Meta-analysis
Penetrating torso wounds are commonly seen in trauma centres worldwide. In hemodynamically stable patients, with no clinical indication for exploratory laparotomy, diagnostic strategies are changing. It is shifted from invasive diagnostic methods, such as local wound exploration, diagnostic peritoneal lavage, and laparoscopy, to conservative imaging approaches[1]. Computed tomography (CT) has been introduced to evaluate organ injury and peritoneal violation. It is limited by being dependent on the radiologist [2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 19, 2019 Category: Emergency Medicine Authors: Ahmed Hagiga, Mariia Gultiaeva, David Shackleton, Mohamed Shaaban Source Type: research

Prospective Analysis of Alternative Services and Cost Savings of Avoidable Admissions from the Emergency Department
Each year, nearly $1.1 trillion – or a third of national health care expenditures – is spent on hospital care.[1] Wide variation in admission practices across individual providers and hospitals exists[2] and is often cited by payers and policymakers as evidence that many hospital admissions are unnecessary. More than 80% of un scheduled hospital admission decisions are made in the emergency department (ED),[3] yet, to date, there is paucity of research examining potentially avoidable admissions from the ED. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 19, 2019 Category: Emergency Medicine Authors: Taketo Watase, Karl Jablonowski, Amber Sabbatini Source Type: research

Ultrasound-guided analgesic injection for acromioclavicular joint – for better safety
Dear editor, (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 19, 2019 Category: Emergency Medicine Authors: Euigi Jung, Yu Chan Kye, Chanjong Park, Jungyoup Lee, Jeong Ryel Park, Kwang Ho Lee, Sunsook Kim, Dongsung Kim, Dongwook Kim Source Type: research

The author responds-pain control in AC joint separation
We appreciate the letter in regards to our recent publication on a strategy for pain control for patients with acute acromioclavicular (AC) joint separation. First, we agree that the in-plane technique allows for clear needle tip visualization, but this may not be possible in most patients with an AC separation. The distance from skin surface to AC joint is often less the 1-2 cm and there is very little surrounding tissue to perform a visualized in-plane technique. We have used the out-of-plane technique safely on numerous occasions for AC separations as well as other ultrasound-guided procedures (posterior tibial nerve bl...
Source: The American Journal of Emergency Medicine - November 19, 2019 Category: Emergency Medicine Authors: John Gelber, Arun Nagdev, Carlos Mikell Source Type: research

Some doubts on the meta-analysis of Xuebijing combined with ulinastation benefits patients with sepsis
Dear Editors: (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 19, 2019 Category: Emergency Medicine Authors: Zhuang Jieqin, Dai Xingzhen, Jin Zilin, Chen Yanhong, Zhang Haobo, Wu Qihua, Cai Hairong, Chen Bojun Source Type: research

Cardiac Involvement in Toluene Intoxication
Toluene is the most widely abused inhaled volatile drug because it is cheap and easy to find. This agent can be found in glue, paints, thinner and cleaning products. Toluene intoxication causes euphoria, excitability, disinhibition, impulsive behavior followed by central nervous system depression [1].Other than central nervous system; it can cause glomerulopathy, renal failure, hepatitis, syncope, bone demineralization, sudden sniffing death syndrome [2 –5]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 19, 2019 Category: Emergency Medicine Authors: Özge Turgay Yıldırım Source Type: research

Utility of ECGs in the Pediatric Emergency Department for Patients Presenting with a Seizure
Seizure is a common presenting complaint in the pediatric emergency department (ED). Initial diagnostic investigation beyond a thorough history and physical examination typically focuses on searching for reversible causes of a seizure, predisposing factors which may have precipitated a seizure, and diagnoses which could mimic seizures. Initial evaluation is variable based on the clinical scenario and available resourced in the ED, but is generally minimal, sometimes involving neuroimaging or biochemical evaluation [1,2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 19, 2019 Category: Emergency Medicine Authors: Anthony G Pompa, Peter LaRossa, Lee B. Beerman, Yoshimi Sogawa, Johanna Rosen, Gaurav Arora Source Type: research

Racial and Insurance Disparities Among Patients Presenting with Chest Pain in the US: 2009-2015
Nationally representative studies have shown significant racial and socioeconomic disparities in the triage and diagnostic evaluation of patients presenting to the emergency department (ED) with chest pain. However, these studies were conducted over a decade ago and have not been updated amidst growing awareness of healthcare disparities. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 19, 2019 Category: Emergency Medicine Authors: Amrita Mukhopadhyay, Robert D'Angelo, Ethan Senser, Kyle Whelan, Christina C. Wee, Kenneth J. Mukamal Source Type: research

Use of the Intubating Laryngeal Mask Airway in the Emergency Department: A Ten-year Retrospective Review
Extraglottic devices, such as the intubating laryngeal mask airway (ILMA), facilitate ventilation and oxygenation and are useful for emergency airway management, especially as rescue devices. In the operating room setting the ILMA has been highly successful. However, its performance in the ED has not been described. We sought to describe the indications for and success of the ILMA when used in the ED. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 19, 2019 Category: Emergency Medicine Authors: Brian E. Driver, Marc Martel, Tarissa Lai, Tracy A. Marko, Robert F. Reardon Source Type: research

Improved Emergency Medicine Physician Attitudes Towards Individuals with Opioid Use Disorder Following Naloxone Kit Training
Every day in the United States, 130 people die of opioid-related causes [1]. In 2017, there were 47,600 overdose deaths related to opioids, which accounted for approximately two-thirds of all drug overdose deaths that year [2]. Patients with opioid use disorder (OUD) who present to emergency departments are especially vulnerable, as they are at higher risk for fatal overdose, trauma and suicide, than patients not seen in emergency departments [4,5,32,33]. Despite the need for increased hospital engagement in mortality-reducing efforts, it stands that many physicians are unfamiliar with addiction treatment best practices an...
Source: The American Journal of Emergency Medicine - November 19, 2019 Category: Emergency Medicine Authors: Giselle Appel, Joseph J. Avery, Kaylee Ho, Zhanna Livshits, Rama B. Rao, Jonathan Avery Source Type: research

Clinical practice of pre-hospital analgesia: An observational study of 20,978 missions in Switzerland
Pain is a frequent problem faced by emergency medical services (EMS) in pre-hospital settings. This large observational study aims to assess the prevalence of sufficiently provided analgesia and to analyze the efficacy of different analgesics. Moreover, we evaluated if quality of analgesia changed with an emergency physician on scene or depended on paramedics ’ gender. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 18, 2019 Category: Emergency Medicine Authors: Greta Emilia Kiavialaitis, Stefan M üller, Julia Braun, Julian Rössler, Donat R. Spahn, Philipp Stein, Alexander Kaserer Source Type: research

Use of Femostop device in the setting of life threatening inguinal bleeding
Massive hemorrhage from the inguinal space is an indication for the use of the Femostop device in the emergency department. This case report describes a middle-aged male with metastatic and recurrent penile cancer status post inguinal lymph node dissection and chemoradiation with a nonhealing left groin wound with extension to the femoral vessels. The patient experienced massive bleeding from erosion of an open wound in left groin into femoral vein requiring massive transfusion. Direct pressure and pressure dressings were unable to control the bleeding present in the patient ’s left groin. (Source: The American Journ...
Source: The American Journal of Emergency Medicine - November 18, 2019 Category: Emergency Medicine Authors: John Cambron, Michael A. Miller Source Type: research

Emergency physician in prehospital major trauma care: It is still up to date
It was with great interest that we read the article by Hirano and colleagues [1]. The question of the presence of an emergency physician in the prehospital setting is a very important issue from both a strictly medical point of view and from an economic point of view. Nevertheless, we have some concerns about the trial. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 18, 2019 Category: Emergency Medicine Authors: Nicolas Cazes, Pascal Menot, Daniel Meyran Source Type: research

Use of Fomepizole, N-acetylcysteine, and Hemodialysis for Massive Acetaminophen Overdose
We present the use of a novel antidote cocktail of n-acetylcysteine, fomepizole, and hemodialysis to treat a massive acetaminophen ingestion. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 18, 2019 Category: Emergency Medicine Authors: Jordan A. Woolum, William B. Hays, Kripa H. Patel Source Type: research

End Stage Renal Disease Modifies the Effect of Targeted Temperature Management after Out-of-Hospital Cardiac Arrest
Kidney function can affect the permeability of the blood-brain barrier; thus, end-stage renal disease (ESRD) may alter the effects of targeted temperature management (TTM) on the neurological outcomes of out-of-hospital cardiac arrest (OHCA) patients. We aimed to investigate whether the interaction effect of TTM on outcomes after OHCA was observed among patients with and without ESRD. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 18, 2019 Category: Emergency Medicine Authors: Min Woo Kim, Jeong Ho Park, Young Sun Ro, Sang Do Shin, Kyoung Jun Song, Ki Jeong Hong, Joo Jeong, Tae Han Kim, Won Pyo Hong Source Type: research

Repeat head CT in mild traumatic brain injury is really necessary?
We pleasantly read the paper by Van Ornam et al.[1] who collected data on the management of 1126 patients with mild traumatic intracranial hemorrhage (GCS> 13). The authors highlighted a very important topic: the repeat head CT scans (RHCT) to assess for progression of traumatic injuries. There are relatively limited number of reports focused on timing of radiologic controls in MTBI with a positive initial CT scan. Consequently, clinicians are often in the difficult position between avoiding unnecessary examinations and ensuring the safest treatment of their patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 18, 2019 Category: Emergency Medicine Authors: Alba Scerrati, Gianluca Trevisi, Pasquale De Bonis, Annunziato Mangiola Source Type: research

Homeless Patients Tend to Have Greater Psychiatric Needs when Presenting to the Emergency Department,
Homeless patients tend to visit Emergency Departments (EDs) more frequently than the non-homeless population. The goal of this study was to assess differences in chief complaint, medical conditions, and disposition between homeless patients compared to non- homeless patients presenting to an urban ED. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 18, 2019 Category: Emergency Medicine Authors: Lauren E. Lamparter, A. Megan, Theresa Nguyen Source Type: research

Significant Elevations in Serum Lipase in the Emergency Department: When It is Not Pancreatitis!
To the Editor. Serum lipase levels are widely and exclusively used in the diagnosis of acute pancreatitis, as it is a central component of the Revised Atlanta Criteria. Significant elevations in serum lipase can however be found in association with other pathologies, without evidence of pancreatitis. The purpose of this short report is to provide a brief overview of the potential etiologies behind significant elevations in serum lipase levels in a tertiary care center in Lebanon. Using a retrospective cross-sectional study design conducted at the Emergency Department (ED) of the American University of Beirut Medical Center...
Source: The American Journal of Emergency Medicine - November 18, 2019 Category: Emergency Medicine Authors: Karine Kahil, Maan El Halabi, Halim Bou Daher, Luma Basma O. Rustom, Majd Marrache, Yervant Ichkhanian, Mazen El Sayed, Ala I. Sharara Source Type: research