Emergency department-based rapid response team for hospital visitors, employees, and ambulatory clinic patients
The hospital's rapid response team (RRT) provides evaluation, triage, and management to patients who unexpectantly require a higher level of medical care [1]. RRTs have been shown to reduce in-hospital cardiorespiratory arrests in both adult and pediatric populations [2,3]. RRTs are traditionally developed for hospitalized patients and don't account for the unexpected deterioration of visitors, employees, and ambulatory clinic patients within the hospital campus. Minimal literature has been published surrounding this topic, and no workflows have been described to date [5-7]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 27, 2020 Category: Emergency Medicine Authors: Evan Yanni, David Koterwas, Ee Tein Tay Source Type: research

Use of point of care ultrasound in the diagnosis of subgaleal hematoma following an episode of accidental pilotraction: A case report
We present the first case report describing the use of point of care ultrasound (POCUS) in diagnosing subgaleal hematoma (SGH) in a case of accidental pilotraction. We review the incidence of SGH caused by pilotraction and sonographic findings of SGH in the literature. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 27, 2020 Category: Emergency Medicine Authors: S. Kim, M. Rizvi Source Type: research

Non-COVID-19 admissions to the emergency department during the pandemic second wave in Italy: What is changed from the first wave?
We recently read with interest the articles written by Baugh et al. [1] and Nourazari et al. [2] regarding a significant decrease in hospital admissions through the Emergency Department (ED) during the COVID-19 pandemic in US. Similarly, many other studies have shown a significant reduction in worldwide ED visits related to different disciplines over the first weeks of the pandemic ( “first wave”) [3-5]. The general opinion is that patients were avoiding hospitals, because of the fear of being infected with SARS-CoV-2, highlighting both the overuse of EDs by low complexity cases that could be managed by general...
Source: The American Journal of Emergency Medicine - November 26, 2020 Category: Emergency Medicine Authors: Guglielmo Mantica, Niccol ò Riccardi, Carlo Terrone, Angelo Gratarola Source Type: research

Case series: Hyperdense basilar artery identified on unenhanced head CT in three cases of pediatric basilar artery occlusion
Acute basilar artery occlusion (BAO) is an easily missed, potentially devastating type of ischemic stroke. Children with BAO can present with a range of clinical symptoms, from headache, dizziness, nausea and/or vomiting [1-3] to profound alterations of consciousness, including locked-in syndrome and coma [2]. Typically in children with BAO, only an unenhanced head Computed Tomography (CT) is initially performed. When an obvious finding is not identified, such as intracranial hemorrhage, the unenhanced CT is rarely carefully further scrutinized by emergency physicians. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 26, 2020 Category: Emergency Medicine Authors: Jennifer K. Potter, Jonathan D. Clemente, Andrew W. Asimos Source Type: research

An extremely rare complication of acute pancreatitis: Intraventricular thrombus
Acute pancreatitis is a frequent reason for emergency admission, which has seen its numbers increase over the years. This condition has systemic, local, and vascular complications. A 73-year-old male patient presented to our emergency department complaining of abdominal pain, nausea, and vomiting. During imaging, intraventricular thrombus was discovered, and following completion of diagnostic testing, he was diagnosed with acute pancreatitis. Herein, we present the first case of intraventricular thrombus related to acute pancreatitis prothrombotic process in the literature. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 26, 2020 Category: Emergency Medicine Authors: Bu ğra İlhan, Halil Doğan, Göksu Bozdereli Berikol, Yasemin Gündoğmuş Uçar, İbrahim Sarbay Source Type: research

Evaluation for septic arthritis of the native adult knee is aided by multivariable assessment
Evaluation of suspected septic arthritis of the native adult knee is a common diagnostic dilemma. Pre-aspirate criteria predictive of septic arthritis do not exist for the adult knee and investigations of aspiration results (cell count, differential, gram stain and crystal analysis) have been limited to univariate analyses. Given numerous clinical variables inform the risk of septic arthritis, multivariable analysis that incorporates all clinically available information is critical to allowing accurate decision-making. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 25, 2020 Category: Emergency Medicine Authors: Adam Holzmeister, Joseph Frazzetta, Frank Feng Ning Yuan, Arien Cherones, Hobie Summers, Joseph Cohen, William D. Lack Source Type: research

Geographic information system technology: Implications for disaster and emergency management in Sweden
The idea of using coordinated data in community planning was introduced in Sweden as early as 1955 and resulted in production of the real estate register and registration books to ADB (Automatic Data Processing) in digital form. A new department was established with the task of producing a digital central point for each property and the digital coordinates of the houses from the property map. Furthermore, another department was formed to develop the use of the property coordinates and integration between registers, and in this way the internationally recognized project FRIS (Experiment with the Spatial Information System) ...
Source: The American Journal of Emergency Medicine - November 25, 2020 Category: Emergency Medicine Authors: Amir Khorram-Manesh, Krzysztof Goniewicz, Attila J. Hertelendy Source Type: research

Comments on “Inter-facility transfer for patients with acute large vessel occlusion stroke receiving mechanical thrombectomy.”
We read the recently-published article by Schevin et al. [1] with great interest. We commended the authors for looking into the work flow in Emergency Departments (ED) in patients with acute ischemia from large vessel occlusion (AIS-LVO) to assess where the longest delays to thrombectomy might occur. Unfortunately, this study is significantly underpowered to comment on patient outcomes. In this retrospective study of 95 patients undergoing mechanical thrombectomy (MT), the authors showed that patients' total ED length of stay and successful MT were not associated with good neurological outcome, defined as 90-day modified R...
Source: The American Journal of Emergency Medicine - November 25, 2020 Category: Emergency Medicine Authors: Quincy K. Tran, Nicholas Morris Source Type: research

The role of mesenchymal stem/stromal cells in the acute clinical setting
Accumulating evidence supports the use of mesenchymal stem/stromal cells (MSCs), particularly bone marrow derived, as a safe and promising biologic therapy for promoting tissue repair and regeneration in various chronic diseases and disorders. Despite growing evidence that MSCs are potent anti-inflammatory mediators that can provide substantial benefits in acute organ injury, there are limited clinical trials utilizing MSCs in acute care settings, such as in the emergency department (ED) or intensive care unit (ICU). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 24, 2020 Category: Emergency Medicine Authors: Courtney Premer, Ivonne H. Schulman, Jennifer S. Jackson Source Type: research

Lipid emulsion in theophylline and salbutamol overdose: Lipid sink theory (MS 25092)
The author responds: (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 24, 2020 Category: Emergency Medicine Authors: V.P. Chandrasekaran, Anand Parthasarathy, Balaji Muruga, Senthamil, Tharanesh Source Type: research

Physiological status monitoring with shock indices: context and precision equally matter!
We read with interest the recent article by Gupta and Alam highlighting a superior performance of shock index (SI=Heart rate (HR)/systolic blood pressure (SBP)) paediatric age-adjusted (SIPA) compared to the isolated performance of conventional haemodynamic parameters, in predicting higher degree of support (vasopressor requirement and mechanical ventilation) and early mortality in a septic cohort of 116 children [1]. While the study attributes such as a prospective design, use of age-specific SI cut-offs and an outcome centric approach are noteworthy, additional points mandate elucidation for a holistic comprehension of t...
Source: The American Journal of Emergency Medicine - November 24, 2020 Category: Emergency Medicine Authors: Rohan Magoon Source Type: research

Potential mechanisms underlying the effects of lipid emulsion against theophylline-induced toxicity
To the Editor: (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 24, 2020 Category: Emergency Medicine Authors: Soo Hee Lee, Ju-Tae Sohn Source Type: research

Real world utilization of Andexanet Alfa at a community hospital
Factor Xa inhibitors have been shown to be effective in the treatment and prevention of venous thromboembolism and the prevention of ischemic cerebral vascular accidents in those with atrial fibrillation [1-4]. However, acute and life-threatening hemorrhage has been associated with their use and can cause significant morbidity and mortality [ 1-4]. With the increasing use of the factor Xa inhibitors, the number of patients who may potentially need reversal of their anticoagulation due to life-threatening hemorrhage is expected to increase over the next several years. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 24, 2020 Category: Emergency Medicine Authors: Anthony Santarelli, Tyson Dietrich, Robert Sprague, Anthonia Ajao, John Ashurst Source Type: research

Use of both Fab and F(ab ’)2 fragment antivenom in a pediatric patient for treatment of a North American Crotalidae envenomation
Crotalidae envenomation has been managed successfully in emergency departments across the world with antivenom. Over the years, antivenom has evolved and newer agents have been studied with the possibility of eliminating maintenance antivenom therapy. Here we report a patient who had worsening platelet and fibrinogen concentrations, as well as complaints of swelling and pain at the site of a rattlesnake envenomation following an initial dose of F(ab ’) 2 AV (Crotalidae immune F(ab’) 2 (equine) [ANAVIP®]) Crotalidae antivenom. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 24, 2020 Category: Emergency Medicine Authors: Ashley M. Martin, George S. Wang, Kevin Poel Source Type: research

Inflammatory markers are poorly predictive of clinical outcomes among hospitalized patients with COVID-19
The objective of this study is to assess the prognostic capability of these tests in predicting clinical outcomes. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 24, 2020 Category: Emergency Medicine Authors: Brendan Barrett, Styve Pamphile, Fan Yang, Farnia Naeem, Jinsung Kim, Jayabhargav Annam, Rachel Borczuk, Shira Yellin, Carly Bass, Sabrina Fowler, Maykl Mosheyev, Yael Jessica Mayer, Benjamin W. Friedman Source Type: research

Characterizing pediatric emergency department visits during the COVID-19 pandemic
We determine how pediatric emergency department (ED) visits changed during the COVID-19 pandemic in a large sample of U.S. EDs. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 23, 2020 Category: Emergency Medicine Authors: Jesse M. Pines, Mark S. Zocchi, Bernard S. Black, Jestin N. Carlson, Pablo Celedon, Ali Moghtaderi, Arvind Venkat, For the US Acute Care Solutions Research Group Source Type: research

Shifting attention to an undervalued asset; the emergency department technician
US emergency departments are facing a number of operational challenges related to chronic shortages of registered nurses. Many of the tasks done by registered nurses can be safely and successfully delegated to the emergency department technician (EDT), particularly if a hospital's nursing and administrative leadership are affirmatively engaged in a process to professionalize and train their EDT workforce. This paper examines the state, Joint Commission on Accreditation of Healthcare Organizations, and Centers for Medicare& Medicaid Services regulatory landscape for the EDT, reviews the literature on how hospital's util...
Source: The American Journal of Emergency Medicine - November 23, 2020 Category: Emergency Medicine Authors: Robert Shesser, Mateen Ghassemi, Emily Sun, Amy Keim, Alex Marchak, Ali Pourmand, Ali Pourmand Source Type: research

Massive Vespa basalis stings induce an envenoming syndrome
Envenoming syndrome induced by massive Vespa basalis stings is a critical condition. Severe systemic reaction may present with hemolytic activity and rhabdomyolysis, leading diffuse alveolar hemorrhage, adult respiratory distress syndrome, coagulopathy, and multiple organs failure. In severe envenoming syndrome population, extracorporeal membrane oxygenation (ECMO) may be considered for unstable hemodynamic status. However, few studies reported ECMO in venom-induced disseminated intravascular coagulation patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 23, 2020 Category: Emergency Medicine Authors: Yao-Chen Wang, Chan-Yang Hsu, Yu-Long Chen, Po-Chen Lin, Meng-Yu Wu Source Type: research

Evaluation of metoprolol versus diltiazem for rate control of atrial fibrillation in the emergency department
The purpose of this study was to compare the effectiveness and safety of the metoprolol and diltiazem administration in the Emergency Department (ED) for rate control of supraventricular tachycardia. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 22, 2020 Category: Emergency Medicine Authors: Patrick McGrath, Brian Kersten, Maya R. Chilbert, Caroline Rusch, Megan Nadler Source Type: research

Painful finger lesions in a child
Case Report: A ten-year-old male with no significant past medical history presented to the emergency department with an isolated, non-pruritic rash on his finger pads bilaterally. He denied fever or systemic complaints. The patient did report swimming in a pool frequently over the past few days and frequently grabbing the concrete sides of the pool. Upon physical examination, the child was well appearing but with erythematous, non-tender and mildly edematous lesions affecting the palmar portion of the distal phalanges (Fig. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 22, 2020 Category: Emergency Medicine Authors: Gal Altberg, Norman Ng, Brady Kwong, Josh Greenstein, Barry Hahn Source Type: research

Effects of morphine on P2Y12 platelet inhibitors in patients with acute myocardial infarction: A meta-analysis
To explore the effects of morphine on P2Y12 platelet inhibitors in patients with acute myocardial infarction (AMI). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 20, 2020 Category: Emergency Medicine Authors: Ying Zhang, Na Wang, Qing Gu Source Type: research

Fever response to ibuprofen in viral and bacterial childhood infections
to compare the antipyretic effects of ibuprofen in febrile children with serious bacterial infections (SBI), and children with a presumed viral infection. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 20, 2020 Category: Emergency Medicine Authors: Gelernter Renana, Ophir Nimrod, Goldman Michael, Lazarovitch Zipora, Gamsu Shirly, Oren-Amit Adi, Breitbart Rachel, Barkan Perl Shiri, Kozer Eran, Youngster Ilan Source Type: research

External validation of the ACUTE HF score in patients hospitalized for acute decompensated heart failure
Recently, the ACUTE HF score has been developed as a new tool for predicting short and long term mortality in patients with acute heart failure (AHF). However, this.score has not yet been validated externally. The present study aimed to investigate the prognostic value of ACUTE HF score in a different patient cohort. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 20, 2020 Category: Emergency Medicine Authors: Kemal G ökçek, Aysel Gökçek, Birdal Yıldırım, Ethem Acar, Ömer Doğan Alataş, Ahmet Demir Source Type: research

Decreased hospital admissions through the emergency department during the COVID-19 pandemic
Emergency Department (ED) visits decreased significantly in the United States during the COVID-19 pandemic. A troubling proportion of this decrease was among patients who typically would have been admitted to the hospital, suggesting substantial deferment of care. We sought to describe and characterize the impact of COVID-19 on admissions, with a specific focus on diagnosis group, age, gender, and insurance coverage. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 19, 2020 Category: Emergency Medicine Authors: Sara Nourazari, Samuel R. Davis, Rachel Granovsky, Randolph Austin, Dean J. Straff, Joshua W. Joseph, Leon D. Sanchez Source Type: research

Analgesic efficacy of morphine sulfate immediate release vs. percocet for acute pain in the emergency department
Previous research demonstrated that administration of Morphine Sulfate Immediate Release (MSIR) results in similar analgesic efficacy to Oxycodone but with significantly lesser degrees of euphoria and reward. The purpose of this study sit to investigate if MSIR combined with Acetaminophen can serve as an opioid analgesic alternative to Oxycodone combined with acetaminophen (Percocet) for acute pain in the Emergency Department (ED). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 19, 2020 Category: Emergency Medicine Authors: Sergey Motov, Mahlaqa Butt, Aidin Masoudi, Jefferson Drapkin, Catsim Fassassi, Ashley Davis, Daniel Dove, Ankit Gohel, Michael Silver, Antonios Likourezos Source Type: research

Primaquine overdose in a toddler
We present a case of a toddler with an accidental primaquine overdose who had undiagnosed G6PD deficiency. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 19, 2020 Category: Emergency Medicine Authors: Timothy Visclosky, William Schaeffer, Elaine Pomeranz, Daphne Morrison Ponce Source Type: research

Prognostic performance of CHA ₂DS₂-VASc scores for predicting mortality among COVID-19 patients: A single pandemic center experience
In recent months, the outbreak of coronavirus disease 2019 (COVID-19) has placed a great strain on the health systems of many countries. Effective prognosis of the disease can play a key role in guiding their limited healthcare resources and ensuring the timely identification and intervention of cases with an elevated mortality risk. For this purpose, several prognostic models have been developed to predict the mortality risk in such patients [1,2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 18, 2020 Category: Emergency Medicine Authors: Vedat Çiçek, Tufan Çınar, Mert İlker Hayıroğul, Şahhan Kııçl, Süha Asal, Samet Yavuz, Murat Selçuk, Ahmet Lütfullah Orhan Tags: Correspondence Source Type: research

Treadmill injuries in children
Treadmills are a common and popular type of exercise equipment in United States households. According to the Sports& Fitness Industry Association, as of 2017, there were over 53 million users of treadmill (age 6  years and older) in the United States and total sales of home treadmills reached $999.8 million. Due to the SARS-COV-2 pandemic, with states closing non-essential services such as gyms, the number of homes with fitness equipment, including treadmills, has increased [1,2]. Having a treadmill in th e home [3], however, is not without risk for injuries [4], especially to young children [5,6]. (Source: The Ameri...
Source: The American Journal of Emergency Medicine - November 17, 2020 Category: Emergency Medicine Authors: Mark L. Waltzman, Lois K. Lee, Alexander Ozonoff, Jennifer Kupiec, Assaf Landschaft, Amir A. Kimia Source Type: research

Assessing geriatric patients with head injury in the emergency department using the novel level III trauma protocol
Intracranial injury in elderly patients presenting with minor head trauma is often overlooked in the emergency department (ED). Our suburban community-based level II trauma hospital developed and implemented the level III trauma protocol (L3TP) in January 2016 to better evaluate and diagnose intracranial injury in elderly patients presenting with minor head trauma after a fall. The L3TP requires that the ED physician immediately assess all patients meeting the following criteria 1) Age  ≥ 65 years old. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 17, 2020 Category: Emergency Medicine Authors: Benjamin Travers, Shanna Jones, Aveh Bastani, Michael Opsommer, Ali Beydoun, Patrick Karabon, David Donaldson Source Type: research

The influence of age and gender on delay to treatment and its association with survival after out of hospital cardiac arrest
The total number of cardiac arrest cases have been reported to be 350,000 cases/year in the US[1], and 275,000 cases/year in Europe[2]. In Sweden, with about 10 million inhabitants, about 6000 out of hospital cardiac arrests (OHCA) with attempted resuscitation are reported to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) annually, with a 10% survival rate at 30  days[3]. Factors involved in improving survival after OHCA include earlier recognition and shorter response times, improved cardiopulmonary resuscitation (CPR) techniques and post-resuscitation care [4-10]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 17, 2020 Category: Emergency Medicine Authors: Nooraldeen Al-Dury, Araz Rawshani, Thomas Karlsson, Johan Herlitz, Annica Ravn-Fischer Source Type: research

The efficacy of ginger for the treatment of migraine: A meta-analysis of randomized controlled studies
The efficacy of ginger for migraine remains controversial. We conduct a systematic review and meta-analysis to explore the influence of ginger versus placebo on treatment in migraine patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 17, 2020 Category: Emergency Medicine Authors: Liyan Chen, Zhiyou Cai Source Type: research

Sobering centers, emergency medical services, and emergency departments: A review of the literature
Acute alcohol intoxication accounts for a large proportion of potentially unnecessary emergency department visits and expenditure. Sobering centers are a cheaper alternative treatment option for alcohol intoxication and can provide an opportunity to treat the psychosocial aspects of alcoholism. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 17, 2020 Category: Emergency Medicine Authors: Brandon Marshall, Erin McGlynn, Andrew King Tags: Reviews Source Type: research

Delayed vertebral artery dissection after mild trauma in a motor vehicle collision
We present the case of a 42-year-old patient who presented to the emergency department with diaphoresis and a complaint of neck pain one month after a low speed motor vehicle collision. The patient was transferred to a stroke center where cerebral angiography showed severe vertebral artery stenosis with likelihood of dissection after a noncontrast CT was negative for hemorrhage. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 16, 2020 Category: Emergency Medicine Authors: Gregory Kacprzynski, Joshua Bucher, Gregory Nicholas Kacprzynski, Joshua Bucher Source Type: research

Pre-hospital infection control strategies during the epidemic period of COVID-19
During the 2020 COVID-19 epidemic, the Sino-French New City branch and Optical Valley branch of Wuhan Tongji Hospital were designated by the state as treatment hospitals for critically ill patients with novel coronavirus pneumonia in Wuhan, China. Additionally, the pre-hospital department of the Emergency Center of Tongji Hospital undertook the work of fever clinics in Hankou headquarters, Sino-French branch and Optical Valley branch, transporting COVID-19 patients to designated treatment areas for hospitalization. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2020 Category: Emergency Medicine Authors: Ping Hu Source Type: research

Duration of symptoms is the only predictor of testicular salvage following testicular torsion in children: A case-control study
Testicular torsion (TT) is an emergency requiring a prompt diagnosis and surgery to avoid irreversible changes and a complete loss of testis. The present study aimed to identify potential factors that may be predict a testicular salvage after TT in pediatric patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2020 Category: Emergency Medicine Authors: Zlatan Zvizdic, Amila Aganovic, Emir Milisic, Asmir Jonuzi, Denisa Zvizdic, Semir Vranic Source Type: research

Lactate dehydrogenase level as a COVID-19 severity marker
We read with great interest the article by Henry et al. [1] showed that elevated lactate dehydrogenase (LDH) values were associated with 6-fold increased odds of severe COVID-19 disease. Lactate dehydrogenase increases in the early stage of myocardial infarction as well as in states of hemolysis. It is most active in the liver, striated muscles, heart, kidneys, lungs, brain, and red blood cells (erythrocytes). In the case of cell damage, lactate dehydrogenase is released from inside them, its concentration and activity in the blood increase. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 14, 2020 Category: Emergency Medicine Authors: Lukasz Szarpak, Kurt Ruetzler, Kamil Safiejko, Michal Hampel, Michal Pruc, Luiza Kanczuga - Koda, Krzysztof Jerzy Filipiak, Milosz Jaroslaw Jaguszewski Source Type: research

The cost of waiting: Association of ED boarding with hospitalization costs
This study evaluates the relationship between ED boarding, ED characteristics and risk-adjusted hospitalization costs utilizing national publicly-reported measures. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 13, 2020 Category: Emergency Medicine Authors: Cristiana Baloescu, Jeremiah Kinsman, Shashank Ravi, Vivek Parwani, Rohit B. Sangal, Andrew Ulrich, Arjun K. Venkatesh Source Type: research

Sexually transmitted infections in the emergency department are not associated with holidays or school breaks
Young adults account for the majority of cases of sexually transmitted infections (STIs) in the US [1-4]. Sexuality may have seasonality. Mate-seeking internet searches are highest in winter and early summer, with sexual activity being highest in warmer months and lowest in colder months [5-8]. Peak sexual activity has been observed in April, with the lowest in December through February [7]. First coitus and condom use are highest in summer [7,9-11]. Testosterone levels in males are highest in late summer and fall, which correlate with increased sexual activity [6,12]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 13, 2020 Category: Emergency Medicine Authors: Michael M. Mohseni, Ronald B. Benard, Carolyn Mead-Harvey, Lanyu Mi, Rachel A. Lindor, Johnathan M. Sheele Source Type: research

Characteristics, clinical care, and disposition barriers for mental health patients boarding in the emergency department
Lack of mental health resources, such as inpatient psychiatric beds, has increased frequency and duration of boarding for mental health patients presenting to U.S. emergency departments (EDs). The purpose of this study is to describe characteristics of mental health patients with an ED length of stay of one week or longer and to identify barriers to their disposition. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 13, 2020 Category: Emergency Medicine Authors: Caroline M. Kraft, Paul Morea, Brittni Teresi, Timothy F. Platts-Mills, Natasha L. Blazer, Jane H. Brice, Angela K. Strain Source Type: research

The effect of diclofenac sodium intoxication on the cardiovascular system in rats
Diclofenac sodium (DS) is a widely used nonsteroidal anti-inflammatory drug. Although its high doses are known to cause toxic effects in many tissues including liver and kidney, the effects on the cardiovascular system (CVS) have not been fully elucidated yet. Therefore, this study aimed to investigate the effect of DS on CVS. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 13, 2020 Category: Emergency Medicine Authors: Turgut Dolanbay, Mustafa Makav, Huseyin Fatih Gul, Emin Karakurt Source Type: research

Chronic alcohol use does not protect against COVID-19 infection
Since the beginning of the coronavirus pandemic, there has been a concurrent global rise in misinformation about the prevention and treatment of coronavirus disease (COVID-19). Many of the proposed therapies, such as bathing or ingesting bleach, can result in significant harm with no evidence of clinical efficacy. One of the earliest myths suggested that frequent consumption of concentrated ethanol could kill the COVID-19 virus in the oropharynx, thereby preventing airborne transmission or treating active infection [1-3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 13, 2020 Category: Emergency Medicine Authors: Jacob A. Lebin, Anita Mudan, Alan H.B. Wu Source Type: research

Therapeutical plasma exchange for thrombotic thrombocytopenic purpura in the emergency department: A single center experience
Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening and easily misdiagnosed thrombotic microangiopathy disease. Few studies have reported the use of therapeutic plasma exchange (TPE) for TTP in emergency departments in China. The present study was a retrospective analysis of patients with TTP who were treated with TPE in our emergency intensive care unit (EICU). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 12, 2020 Category: Emergency Medicine Authors: Xiang-Min Li, Xiao-Ye Mo, Guo-Qing Huang, Fang-Jie Zhang Source Type: research

Therapeutical plasma exchange for thrombotic thrombocytopenic purpura in the emergengy department: A single center experience
Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening and easily misdiagnosed thrombotic microangiopathy disease. Few studies have reported the use of therapeutic plasma exchange (TPE) for TTP in emergency departments in China. The present study was a retrospective analysis of patients with TTP who were treated with TPE in our emergency intensive care unit (EICU). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 12, 2020 Category: Emergency Medicine Authors: Xiang-Min Li, Xiao-Ye Mo, Guo-Qing Huang, Fang-Jie Zhang Source Type: research

Syncope in a 14yo female with ventricular tachycardia; an atypical etiology
We present a 14 yo female in extremis with syncope at rest witnessed by her mother, found in ventricular tachycardia by EMS who challenged with IVF hydration and amiodarone. Consecutive adequate fluid challenges and antiarrhythmics in the emergency department failed requiring synchronized cardioversion for stabilization. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 11, 2020 Category: Emergency Medicine Authors: J. Lehman, B.T. Williams Source Type: research

Bacteriology of pediatric breast abscesses beyond the neonatal period
Limited data exist regarding the presentation and bacteriology of nonneonatal pediatric breast abscess. Objective: To determine the bacteriology and characteristic presentation of pediatric breast abscesses in a tertiary care center. Methods: Cross-sectional study of patients age 1  month to 21 years admitted to a pediatric Emergency Department (ED) between 1996 and 2018 with a breast abscess. Patients with pre-existing conditions were excluded. Records were reviewed to determine demographics, history, physical exam findings, wound culture results, imaging and ED dispositi on. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 11, 2020 Category: Emergency Medicine Authors: Eman Ansari, Marvin B. Harper, Assaf Landscahft, Rotem Kimia, Alexander Ozonoff, Amir A. Kimia Source Type: research

Racial and ethnic disparities in hospital observation in Maryland
Hospital observation is a key disposition option from the emergency department (ED) and encompasses up to one third of patients requiring post-ED care. Observation has been associated with higher incidence of catastrophic financial costs and has downstream effects on post-discharge clinical services. Yet little is known about the non-clinical determinants of observation assignment. We sought to evaluate the impact of patient-level demographic factors on observation designation among Maryland patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 11, 2020 Category: Emergency Medicine Authors: Cody Cichowitz, Gideon Loevinsohn, Eili Klein, Elizabeth Colantuoni, Panagis Galiatsatos, Jodi Rennert, Nathan Irvin Source Type: research

CK – What does it stand for?
In a recent edition of the American Journal of Emergency Medicine, Chan et al. describe two cases of weakness and elevated “creatinine kinase” (sic) as the initial presentation of coronavirus disease 2019 (COVID-19) [1]. The reference to “creatinine kinase” in the article title is repeated in the keywords and abstract, although in the main text the enzyme is simply referred to as “CK”. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 11, 2020 Category: Emergency Medicine Authors: Nick Flynn Source Type: research

Naloxone provision to emergency department patients recognized as high-risk for opioid use disorder
Patients with opioid use disorder (OUD) are at increased risk for overdose and death. Clinical practice guidelines and professional organization policy statements recommend providing naloxone to patients at risk for overdose. We sought to characterize fidelity to naloxone practice recommendations in a cohort of Emergency Department (ED) patients in whom opioid use disorder was suspected by the treating physician. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 10, 2020 Category: Emergency Medicine Authors: Bennett H. Lane, Michael S. Lyons, Uwe Stolz, Rachel M. Ancona, Richard J. Ryan, Caroline Freiermuth Source Type: research

MicroRNA-365 expression in the serum of patients with heart failure with reduced ejection fraction after myocardial infarction
MicroRNA-365 (miR-365) is a recently discovered cardiovascular disease cytokine that plays an important role in the inflammatory immune response, interacting with chemotactic macrophages, monocytes, T cells, B cells, and other cells responsible for the immune response. Recent studies have shown that miR-365 plays an important regulatory role in the pathogenesis of heart failure. MiR-365 excites the sympathetic nerves and stimulates AngII expression, induces smooth muscle actin, and promotes the proliferation and differentiation of vascular endothelial cells. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 10, 2020 Category: Emergency Medicine Authors: Hai-Bo Wu, Yun-Can Wang, Wen-Jing Yao, Yue-Tao Xie, Xue-Chao Wang, Rong-Pin Du Source Type: research

Author's reply: Diagnosing covid-19 associated Guillain-Barre syndrome
The acute onset and rapid progression (3  days) of neuropathic symptoms in both Case 1 and 3 is against the presentation of Typical Diabetic sensorimotor polyneuropathy which by definition are chronic in onset and slowly progressive [1]. Uremic polyneuropathy was not considered in Patient 3 as again the onset of Uremic polyneuropathy is insidious and slowly progressive over months unlike our case [2]. Albumino-cytological dissociation present in both cases is also a supporting laboratory feature of Guillain Barre Syndrome [3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 9, 2020 Category: Emergency Medicine Authors: Satyan Nanda, Rahul Handa, Atul Prasad, Rajiv Anand, Dhruv Zutshi Source Type: research