Complication of vasopressor infusion through peripheral venous catheter: A systematic review and meta-analysis
Vasopressors are mainstay treatment for patients in shock and are usually infused through central venous catheters (CVCs). However, CVCs are associated with risk of infection or delay from the needs of confirmation of placement. Infusing vasopressor through peripheral venous catheter (PIVs) could be an alternative in the Emergency Departments (ED) but data regarding complications is inconclusive. We performed a random-effects meta-analysis to assess literature involving prevalence of complications from infusing vasopressors via PIVs. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 25, 2020 Category: Emergency Medicine Authors: Quincy K. Tran, Gaurika Mester, Vera Bzhilyanskaya, Leenah Z. Afridi, Sanketh Andhavarapu, Zain Alam, Austin Widjaja, Brooke Andersen, Ann Matta, Ali Pourmand Source Type: research

Risk of self-contamination among healthcare workers in the COVID-19 pandemic
The SARS-CoV-2 pandemic presents a significant challenge for medical personnel. Since December 2019, when the first COVID-19 case was found in China, the incidence of the disease has grown to the size of a global pandemic. Currently 30,217,420 COVID-19 cases have been confirmed and the average mortality rate is around 3.1% (On September 18, 2020) [1]. The problem commonly raised in mass media is, apart from a large number of confirmed COVID-19 cases, the significant proportion of cases reported among healthcare workers (HCWs) [2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 25, 2020 Category: Emergency Medicine Authors: Katarzyna Barycka, Tomasz Torlinski, Krzysztof Jerzy Filipiak, Milosz Jaguszewski, Klaudiusz Nadolny, Lukasz Szarpak Source Type: research

Evaluation of the relationship between inpatient COVID-19 mortality and chest CT severity score
There is scarce data available on the prognostic application of chest CT. The main purpose of this study was to evaluate the performance of a semi-quantitative CT severity score in identifying the risk of mortality in COVID-19 patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 25, 2020 Category: Emergency Medicine Authors: Bita Abbasi, Reza Akhavan, Afshar Ghamari Khameneh, Behrouz Zandi, Donya Farrokh, Masoud Pezeshki Rad, Ali Feyzi Laein, Afrouz Darvish, Bijan Bijan Source Type: research

The Iowa less aggressive protocol: A mixed-methods study on the novel treatment protocol of atrial fibrillation
Atrial fibrillation is the most common cardiac dysrhythmia in the United States. Our aim was to determine if a novel protocol for management of atrial fibrillation was feasible to implement in an emergency department (ED). Interviews were conducted with ED physicians and physician assistants to identify themes in relation to the clinical use and impleon of the protocol. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 24, 2020 Category: Emergency Medicine Authors: Benjamin E. Christians, Christopher J. Solie, Morgan B. Swanson, Karisa K. Harland, Catherine Fairfield, Kelli L. Wallace, Nicholas M. Mohr Source Type: research

The index of oxygenation to respiratory rate as a prognostic factor for mortality in Sepsis
An index combining respiratory rate and oxygenation (ROX) has been introduced, and the ROX index is defined as the ratio of oxygen saturation by pulse oximetry/fraction of inspired oxygen to respiratory rate. In sepsis, hypoxemia and tachypnea are commonly observed. We performed this study to investigate the association between the ROX index and 28-day mortality in patients with sepsis or septic shock. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 23, 2020 Category: Emergency Medicine Authors: Che Uk Lee, You Hwan Jo, Jae Hyuk Lee, Joonghee Kim, Seung Min Park, Ji Eun Hwang, Dong Keon Lee, Inwon Park, Dong-Hyun Jang, Sang-Min Lee Source Type: research

Diagnostic modalities to determine ventriculoperitoneal shunt malfunction: A systematic review and meta-analysis
Ventriculoperitoneal (VP) shunt malfunction is an emergency. Timely diagnosis can be challenging because shunt malfunction often presents with symptoms mimicking other common pediatric conditions. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 22, 2020 Category: Emergency Medicine Authors: Aditi Jayanth, Roshanak Benabbas, Jennifer Chao, Richard Sinert Source Type: research

Racial/ethnic disparities in COVID-19 disease burden & mortality among emergency department patients in a safety net health system
We sought to examine racial and ethnic disparities in test positivity rate and mortality among emergency department (ED) patients tested for COVID-19 within an integrated public health system in Northern California. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 22, 2020 Category: Emergency Medicine Authors: Nana-Yaa Misa, Berenice Perez, Kellie Basham, Essence Fisher-Hobson, Brittany Butler, Kolette King, Douglas A.E. White, Erik S. Anderson Source Type: research

Non-respiratory presentations of COVID-19, a clinical review
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) is a highly infectious viral syndrome currently threatening millions of people worldwide. It is widely recognized as a disease of the pulmonary system, presenting with fever, cough, and shortness of breath. However, a number of extrapulmonary manifestations have been described in the literature. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 22, 2020 Category: Emergency Medicine Authors: Marya AlSamman, Amy Caggiula, Sangrag Ganguli, Monika Misak, Ali Pourmand Source Type: research

Septic arthritis due to non-tuberculous mycobacterium without effusion
Septic arthritis is an important but difficult to make diagnosis that leads to significant morbidity and mortality. Joint effusion is generally accepted to be a highly sensitive finding in septic arthritis, however final diagnosis requires synovial fluid studies. Without a significant joint effusion, it is difficult to obtain synovial fluid. In this case report, we describe the presentation and diagnosis of septic arthritis in the first MTP due to mycobacterium chelonae in a 69  year old man with a history of gout and immunosuppression due to a heart transplant. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 22, 2020 Category: Emergency Medicine Authors: Vivian Lam, Nik Theyyunni Source Type: research

Identifying cardiogenic shock in the emergency department
Cardiogenic shock is difficult to diagnose due to diverse presentations, overlap with other shock states (i.e. sepsis), poorly understood pathophysiology, complex and multifactorial causes, and varied hemodynamic parameters. Despite advances in interventions, mortality in patients with cardiogenic shock remains high. Emergency clinicians must be ready to recognize and start appropriate therapy for cardiogenic shock early. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 22, 2020 Category: Emergency Medicine Authors: Madison Daly, Brit Long, Alex Koyfman, Skyler Lentz Source Type: research

Differences in clinical characteristics and outcomes for blunt versus penetrating traumatic pulmonary pseudocysts
Traumatic pulmonary pseudocysts (TPPs) are under-reported in blunt trauma and rarely reported in penetrating trauma. Little is known about the impact of injury mechanism on the pathophysiology or the risk factors that predispose to worse patient outcomes. We hypothesized that blunt and penetrating TPPs have different clinical characteristics and outcomes. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 22, 2020 Category: Emergency Medicine Authors: Genna Beattie, Caitlin Cohan, Annie Tang, Eric Yasumoto, Gregory P. Victorino Source Type: research

May the neutrophil-to-lymphocyte ratio at admission predict the occurrence and the severity of ARDS after blunt chest trauma patients? A retrospective study
In blunt chest trauma patients, the activation of inflammatory response is thought to be one of the pathophysiological pathways leading to delayed acute respiratory distress syndrome(ARDS). The main objective of the study was to assess the performance of the neutrophil-lymphocyte ratio(NLR) for prediction of delayed ARDS. The secondary objective was to compare NLR in patients with traumarelated focal and non-focal ARDS. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 22, 2020 Category: Emergency Medicine Authors: Pierre Alexandre Favre, Louis de Molliens, Laurent Petit, Matthieu Biais, C édric Carrié Source Type: research

A response to “Role of hydrogen peroxide injection for penetrating abdominal injury increating CT Tractogram”
We applaud the efforts of VanFleet et al. [1] to use a novel approach for evaluating penetrating abdominal trauma. However, we are concerned that the authors neglect to describe the risks of using hydrogen peroxide in enclosed body cavities. Hydrogen peroxide can cause oxygen gas emboli in the venous and arterial circulation under these conditions. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 21, 2020 Category: Emergency Medicine Authors: Timothy C. Backus, Emily T. Cohen Source Type: research

Development and validation of a knowledge-driven risk calculator for critical illness in COVID-19 patients
We report a retrospective validation of the calculator on 145 consecutive patients admitted with COVID-19 to a single hospital in Israel. Despite considerable differences between the original and validation study populations, of 18 patients with critical illness, 17 were correctly identified (sensitivity: 94.4%, 95% CI, 72.7% –99.9%; specificity: 81.9%, 95% CI, 74.1%–88.2%). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 21, 2020 Category: Emergency Medicine Authors: Amos Cahan, Tamar Gottesman, Michal Tzuchman Katz, Roee Masad, Gal Azulay, Dror Dicker, Aliza Zeidman, Evgeny Berkov, Boaz Tadmor, Shaul Lev Source Type: research

Hydrogen peroxide injection to create an adbdominal CT Tractogram: A note of caution
To the Editor: (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 21, 2020 Category: Emergency Medicine Authors: Zoilo Madrazo, Jaime L ópez-Borao, Marta Alberich, Sebastiano Biondo Source Type: research

A response to “Role of hydrogen peroxide injection for penetrating abdominal injury in creating CT Tractogram”
We applaud the efforts of VanFleet et al. [1] to use a novel approach for evaluating penetrating abdominal trauma. However, we are concerned that the authors neglect to describe the risks of using hydrogen peroxide in enclosed body cavities. Hydrogen peroxide can cause oxygen gas emboli in the venous and arterial circulation under these conditions. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 21, 2020 Category: Emergency Medicine Authors: Timothy C. Backus, Emily T. Cohen Source Type: research

Inter-facility transfer for patients with acute large vessel occlusion stroke receiving mechanical thrombectomy
Mechanical thrombectomy (MT) is the preferred treatment for large vessel occlusion (LVO) ischemic stroke, and neurological outcome improves with earlier treatment. Patients with LVO frequently require inter-facility transfer to access MT but delays at transferring EDs may worsen neurological outcomes. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 20, 2020 Category: Emergency Medicine Authors: William L. Scheving, Michael Froehler, Kimberly Hart, Candace D. McNaughton, Michael J. Ward Source Type: research

Mobile phone ingestion requiring endoscopic retrieval
A 24-year-old male was brought to our emergency with complaints of abdominal pain for two days. There was a history of foreign body ingestion five days earlier, details of which he refused to reveal. After investigation with abdominal X ray and ultrasound, the foreign body was detected to be a mobile phone containing a battery. Clinical evaluation revealed no signs of lithium toxicity due to battery leak. The patient underwent endoscopy for removal of the mobile phone. The case shows the importance of thorough investigation and prompt attempt at endoscopic removal in the event of ingestion of foreign bodies containing batt...
Source: The American Journal of Emergency Medicine - September 19, 2020 Category: Emergency Medicine Authors: Vignan Kappagantu, Prakash Ranjan Mishra, Anupam Kumar Ranjan, Praveen Aggarwal, Ashish Agarwal, G. Bharath Source Type: research

The broader differential diagnosis of post partum headache
The broader differential diagnosis of postpartum headache, to which the authors of the case report have alluded, includes, not only the disorders cited by the authors as being the ones enumerated in Classical teaching in Emergency Medicine [1], but also the post partum headache of aortic dissection(AD) [2], reversible cerebral vasoconstrictor syndrome [3,4] non-aneurysmal subarachnoid hemorrhage [5] postpartum vertebral artery dissection [6], and internal carotid artery dissection [7]. Awareness of the full spectrum of that differential diagnosis will optimise the management of postpartum patients who present to the emerge...
Source: The American Journal of Emergency Medicine - September 19, 2020 Category: Emergency Medicine Authors: Oscar M.P. Jolobe Source Type: research

Failure of painful eye movements to respond to topical anesthetics supports the diagnosis of optic neuritis
Optic neuritis should be considered when eye pain is present, even in the context of a relatively normal eye exam. Eye pain without relief of pain with topical anesthetics such as Tetracaine should rule out external causes and other deeper eye pathology should be considered. MRI with gadolinium contrast is the best test used to definitively diagnose optic neuritis. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 18, 2020 Category: Emergency Medicine Authors: Dietrich Jehle, Mary Claire Lark, Clay O'Brien Source Type: research

Impact of creatinine screening on contrast-induced nephropathy following computerized tomography for stroke
This study sought to evaluate rates of acute kidney injury in patients undergoing contrast-enhanced computerized tomography for acute stroke in the emergency department (ED) before and after the cessation of creatinine screening. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 18, 2020 Category: Emergency Medicine Authors: Brent A. Becker, Thomas Yeich, Jonathan T. Jaffe, Samuel Sun, Yidong Chen, Teri Rebert, Barbara A. Stahlman Source Type: research

Corresponding letter to comment on: “Performance of cardiac troponins within the HEART score in predicting major adverse cardiac events at the emergency department”
We would like to thank the reader for the two points highlighted in the Comment on: “Performance of cardiac troponins within the HEART score in predicting major adverse cardiac events at the emergency department “. Our responses as below: (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 16, 2020 Category: Emergency Medicine Authors: Hong Jie Gabriel Tan, Fei Gao, Jack Wei Chieh Tan Source Type: research

Exploring digital methods to capture self-reported on-shift sentiment amongst academic emergency department physicians.
The struggles of working within busy Emergency Departments (ED) likely contribute to long-term well-being and burnout [1]. Studies have demonstrated the detrimental effects of burnout upon quality of care and individual well-being [2-4]. Effective well-being strategies stress early identification as a cornerstone to providing meaningful support and decreasing the long-term consequences associated with burnout [5]. Traditional approaches of measuring well-being do not reflect proactive, learning health systems designed to engage providers early and often [6,7]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 16, 2020 Category: Emergency Medicine Authors: Anish K. Agarwal, Lauren Hahn, Roy Rosin, Raina M. Merchant Source Type: research

Do manual chest compressions provide substantial ventilation during prehospital cardiopulmonary resuscitation?
Chest compressions have been suggested to provide passive ventilation during cardiopulmonary resuscitation. Measurements of this passive ventilatory mechanism have only been performed upon arrival of out-of-hospital cardiac arrest patients in the emergency department. Lung and thoracic characteristics rapidly change following cardiac arrest, possibly limiting the effectiveness of this mechanism after prolonged resuscitation efforts. Goal of this study was to quantify passive inspiratory tidal volumes generated by manual chest compression during prehospital cardiopulmonary resuscitation. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 16, 2020 Category: Emergency Medicine Authors: Maxim Vanwulpen, Martha Wolfskeil, Christophe Duchatelet, Sa ïd Hachimi-Idrissi Source Type: research

Ocular timolol as the causative agent for symptomatic bradycardia in an 89-year-old female
Bradycardia can present with variations of severity from asymptomatic to life threatening. In this paper we present the case of an 89-year-old female presenting with symptomatic bradycardia for whom the cause was found to be ophthalmic timolol which she had been taking for four years. Prompt recognition of potential causes of bradycardia is essential for correct selection of treatment and disposition. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 15, 2020 Category: Emergency Medicine Authors: John Rains, Jacob Kesterson Source Type: research

Effect of COVID-19 outbreak on the treatment time of patients with acute ST-segment elevation myocardial infarction
To explore the effect of COVID-19 outbreak on the treatment time of patients with ST-segment elevation myocardial infarction (STEMI) in Hangzhou, China. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 15, 2020 Category: Emergency Medicine Authors: Xin-yan Fu, Xiang-feng Shen, Yong-ran Cheng, Meng-Yun Zhou, Lan Ye, Zhan-hui Feng, Zhao Xu, Juan Chen, Ming-Wei Wang, Xing-wei Zhang Source Type: research

A comparison of physician-staffed helicopters and ground ambulances transport for the outcome of severe thoracic trauma patients
We retrospectively investigated prognostic factors for severe thoracic trauma patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) and ground ambulance using the Japan Trauma Data Bank (JTDB). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 15, 2020 Category: Emergency Medicine Authors: Yoshihiro Kushida, Kei Jitsuiki, Ken-ichi Muramatsu, Saya Ikegami, Hiroki Nagasawa, Ikuto Takeuchi, Hiromichi Ohsaka, Yasumasa Oode, Kazuhiko Omori, Youichi Yanagawa Source Type: research

Covid-19 associated Guillain-Barre Syndrome: Contrasting tale of four patients from a tertiary care centre in India
Globally, more than 12 million people have been infected with COVID −19 infection till date with more than 500,000 fatalities. Although, Covid-19 commonly presents with marked respiratory symptoms in the form of cough and dyspnoea, a neurotropic presentation has been described of late as well. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 15, 2020 Category: Emergency Medicine Authors: Satyan Nanda, Rahul Handa, Atul Prasad, Rajiv Anand, Dhruv Zutshi, Sujata K. Dass, Prabhjeet Kaur Bedi, Aarti Pahuja, Pankaj Kumar Shah, Bipan Sharma Source Type: research

Mucormycosis with orbital compartment syndrome in a patient with COVID-19
AbstractDuring the current pandemic of COVID-19, a myriad of manifestations and complications has emerged and are being reported on. We are discovering patients with COVID-19 are at increased risk of acute cardiac injury, arrythmias, thromboembolic complications (pulmonary embolism and acute stroke), and secondary infection to name a few. I describe a novel case of COVID-19 in a previously healthy 33-year-old female who presented for altered mental status and proptosis. She was ultimately diagnosed with mucormycosis and orbital compartment syndrome, in addition to COVID-19. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 15, 2020 Category: Emergency Medicine Authors: Amanda Werthman-Ehrenreich Source Type: research

Plastic blanket drowning kit: A protection barrier to immediate resuscitation at the beach in the Covid-19 era. A pilot study.
Introducing a new, simple and inexpensive portable equipment for lifeguards, consisting of a pre-assembled full-size plastic blanket with a mask and HEPA filter, which could offer significant time-saving advantages to reduce COVID-19 risk transmission in the first few minutes of CPR after water rescue, avoiding the negative impact of delayed ventilation. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 14, 2020 Category: Emergency Medicine Authors: Roberto Barcala-Furelos, David Szpilman, Cristian Abelairas-G ómez, Alejandra Alonso Calvete, María Domínguez Graña, Santiago Martínez-Isasi, José Palacios-Aguilar, Antonio Rodríguez-Núñez Source Type: research

Effectiveness and safety of small-bore tube thoracostomy ( ≤20 Fr) for chest trauma patients: A retrospective observational study
Tube thoracostomy is an important treatment for traumatic hemothorax and pneumothorax. The optimal tube diameter remains unclear. To reduce invasiveness, we use small-bore chest tubes ( ≤20 Fr) for all trauma patients for whom tube thoracostomy is indicated in our emergency department (ED). The aim of this study was to investigate the effectiveness and safety of small-bore tube thoracostomy for traumatic hemothorax or pneumothorax. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 14, 2020 Category: Emergency Medicine Authors: Toshinori Maezawa, Machi Yanai, Ji Young Huh, Koichi Ariyoshi Source Type: research

A case series of pediatric croup with COVID-19
We describe three previously healthy children, admitted from our emergency department (ED) to our free-standing children's hospital, as the first documented cases of croup as a manifestation of SARS-CoV-2 infection. All three cases (ages 11  months, 2 years, and 9 years old) presented with non-specific upper-respiratory-tract symptoms that developed into a barky cough with associated stridor at rest and respiratory distress. All were diagnosed with SARS-CoV-2 by polymerase chain reaction testing from nasopharyngeal samples that w ere negative for all other pathogens including the most common etiologies for croup. (So...
Source: The American Journal of Emergency Medicine - September 13, 2020 Category: Emergency Medicine Authors: April M.R. Venn, James M. Schmidt, Paul C. Mullan Source Type: research

A dangerous pandemic pair: Covid19 and adolescent mental health emergencies
The Covid19 pandemic continues to introduce uncertainty into many aspects of our lives. The mental health sequelae of discreet, time-limited disasters —earthquakes, hurricanes, fires—are well known. But the mental health sequelae of COVID-19, with its global, continuously waxing and waning presence, may look different. Studies examining the mental health toll of the pandemic in adults are now appearing from China, Spain and Italy, but little h as been documented regarding adolescents. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 13, 2020 Category: Emergency Medicine Authors: Robert L. Cloutier, Rebecca Marshaall Source Type: research

Usage of airway ultrasound as an assessment and prediction tool of a difficult airway management
We report a case of a 60-year-old man presenting to the emergency department with shortness of breath, hoarseness of voice and stridor. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 13, 2020 Category: Emergency Medicine Authors: Adi Osman, Chan Pei Fong, Kok Meng Sum, Azma Haryaty Ahmad Source Type: research

Elevated D-dimer levels on admission are associated with severity and increased risk of mortality in COVID-19: A systematic review and meta-analysis
In this systematic review and meta-analysis, we aimed to investigate the correlation of D-dimer levels measured on admission with disease severity and the risk of death in patients with coronavirus disease 2019 (COVID-19) pneumonia. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 13, 2020 Category: Emergency Medicine Authors: Baris Gungor, Adem Atici, Omer Faruk Baycan, Gokhan Alici, Fatih Ozturk, Sevil Tugrul, Ramazan Asoglu, Erdem Cevik, Irfan Sahin, Hasan Ali Barman Source Type: research

Characterizing COVID-19: A chief complaint based approach
The COVID-19 pandemic has inundated emergency departments with patients exhibiting a wide array of symptomatology and clinical manifestations. We aim to evaluate the chief complaints of patients presenting to our ED with either suspected or confirmed COVID-19 to better understand the clinical presentation of this pandemic. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 13, 2020 Category: Emergency Medicine Authors: Rimma Perotte, Gregory Sugalski, Joseph P. Underwood, Michael Ullo Source Type: research

COVID-19 pandemic is not the time of trial and error
There is an urgent need for an effective medication against the novel coronavirus disease (COVID-19), as it has and continues to have not only significant clinical and non-clinical impacts but also substantial huge economic and psychosocial impacts that have paralyzed the entire world. The severe acute respiratory coronavirus 2 (SARS-CoV-2) uses the angiotensin-converting enzyme 2 (ACE2) receptor to infect humans with many pathological mechanisms that lead to a wide range of clinical presentations [1,2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 13, 2020 Category: Emergency Medicine Authors: Kawthar Mohamed, Nima Rezaei Source Type: research

Barriers to medication adherence in the emergency department: A cross-sectional study
Medication nonadherence is a common problem that leads to increased healthcare utilization. It is unclear how patient insight and attitude towards their medications affect adherence in the ED. Furthermore, it is unclear how perceived medication importance differs between patients and ED physicians. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 13, 2020 Category: Emergency Medicine Authors: Arjun Banerjee, Elena Dreisbach, Cameron Smyres, Thomas Ence, Jesse Brennan, Christopher J. Coyne Source Type: research

Prehospital management of acute respiratory distress in suspected COVID-19 patients
In December 2019, coronavirus disease (COVID-19) emerged in China and became a world-wide pandemic in March 2020. Emergency services and intensive care units (ICUs) were faced with a novel disease with unknown clinical characteristics and presentations. Acute respiratory distress (ARD) was often the chief complaint for an EMS call. This retrospective study evaluated prehospital ARD management and identified factors associated with the need of prehospital mechanical ventilation (PMV) for suspected COVID-19 patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 13, 2020 Category: Emergency Medicine Authors: Romain Jouffroy, Sabine Lemoine, Cl ément Derkenne, Romain Kedzierewicz, Marine Scannavino, Kilian Bertho, Benoit Frattini, Frédéric Lemoine, Daniel Jost, Bertrand Prunet Source Type: research

Narrative communication to improve patient satisfaction with forgoing low value care
Per capita healthcare costs in the United States are higher than in any other country in the world [1]. Some initiatives, most notably Choosing Wisely, have attempted to address this problem by reducing the use of low value care [2]. These efforts may be complicated by patient concerns that they are being denied necessary interventions. Improved communication may help mitigate this concern. Traditionally, providers communicate with patients using probabilistic messages that emphasize risks and benefits. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 13, 2020 Category: Emergency Medicine Authors: Eden Engel-Rebitzer, Oluwarotimi Vaughan-Ogunlusi, Zachary Meisel Tags: Correspondence Source Type: research

MAGraine: Magnesium compared to conventional therapy for treatment of migraines
Due to the healthcare burden associated with migraines, prompt and effective treatment is vital to improve patient outcomes and ED workflow. This was a prospective, randomized, double-blind trial. Adults who presented to the ED with a diagnosis of migraine from August of 2019 to March of 2020 were included. Pregnant patients, or with renal impairment were excluded. Patients were randomized to receive intravenous magnesium, prochlorperazine, or metoclopramide. The primary outcome was change in pain from baseline on a numeric rating scale (NRS) evaluated at 30  min after initiation of infusion of study drug. (Source: The A...
Source: The American Journal of Emergency Medicine - September 13, 2020 Category: Emergency Medicine Authors: Manar Kandil, Sabrin Jaber, Dharati Desai, Stephany Nunez Cruz, Nadine Lomotan, Uzma Ahmad, Michael Cirone, Jaxson Burkins, Marc McDowell Source Type: research

What are the psychological consequences of playing the role of victim in terrorist attack exercise?
Effective cooperation between emergency responders (Police, Emergency Medical Services – EMS - and Fire Brigade) is essential during terrorist attacks [1-3]. Joint exercises mimicking real life conditions are conducted in order to reinforce this cooperation through scenarios played with actors. These exercises reproduce very realistic scenes where one may witness scenes of extreme v iolence. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 13, 2020 Category: Emergency Medicine Authors: Anna Ozguler, Karine Gauthier, Rudy Titreville, Charles Groizard, Michel Baer, Catherine Fleischel, Marc Grohens, Thomas Loeb Source Type: research

Improving EMS destination choice for pediatrics: Results of a novel pediatric destination decision tool pilot test
More than one million children are transported by emergency medical services (EMS) in the United States annually [1,2]. In the absence of protocolized destination guidance, EMS providers rely on their judgement and experience to choose among potential destinations. EMS providers frequently choose hospitals other than the closest, and both underestimation and overestimation of pediatric patient needs are common [3-5]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 12, 2020 Category: Emergency Medicine Authors: Kyle A. Fratta, Jennifer N. Fishe, Paige D. Anders, Jennifer F. Anders Source Type: research

Emergency department approach to spirituality care in the era of COVID-19
In the era of COVID-19, physical distancing measures have been widely implemented to limit viral transmission. Hospitals across the world have restricted visitation except under extenuating circumstances. Under these conditions, many critically ill patients are treated without the comfort of loved ones at the bedside; this can have negative outcomes for both patients and their family. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 12, 2020 Category: Emergency Medicine Authors: Ayal Pierce, Megan Hoffer, Bridget Marcinkowski, Rita Manfredi, Ali Pourmand Source Type: research

Predictors of receiving an emergency department naloxone prescription following an opioid overdose
Despite recent efforts to mitigate opioid-related mortality, opioid overdose fatalities continue to increase [1]. In addition to appropriate opioid prescribing and increased access to medications for opioid use disorder (OUD), naloxone is part of a multimodal approach to curbing opioid overdose deaths. Consequently, naloxone distribution programs have been increasingly integrated into the emergency department (ED) in an effort to better reach high-risk patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 12, 2020 Category: Emergency Medicine Authors: Jacob A. Lebin, Ly Huynh MSWc, Sophie C. Morse, Karl Jablonowksi, Jane Hall, Lauren K. Whiteside Source Type: research

Supervised classification techniques for prediction of mortality in adult patients with sepsis
Sepsis mortality is still unacceptably high and an appropriate prognostic tool may increase the accuracy for clinical decisions. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 11, 2020 Category: Emergency Medicine Authors: Andr és Rodríguez, Deibie Mendoza, Johana Ascuntar, Fabián Jaimes Source Type: research

The authors' response to “A more realistic relationship between covid 19 and hemopneumothorax”
Thank you for your comments on our case report and providing us with the opportunity to discuss the possible relationship between COVID-19 and hemopneumothorax. As new information about this disease surfaces daily, we as clinicians must strive to consider novel possibilities for pathophysiology. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 8, 2020 Category: Emergency Medicine Authors: Ann Long, Felipe Grimaldo Source Type: research

Outcomes of a novel ED observation pathway for mild traumatic brain injury and associated intracranial hemorrhage
Recent studies have shown that the majority of non-anticoagulated patients with small subdural or subarachnoid intracranial hemorrhage (ICH) in the setting of mild traumatic brain injury do not experience clinical deterioration or require neurosurgical intervention. We implemented a novel ED observation pathway to reduce unnecessary admissions among patients with ICH in the setting of mild TBI (complicated mild TBI, cmTBI). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 8, 2020 Category: Emergency Medicine Authors: Jennifer M. Singleton, Leslie A. Bilello, Tatiana Greige, Lakshman Balaji, Carrie D. Tibbles, Jonathan A. Edlow, Martina Stippler, Carlo L. Rosen Source Type: research

Utilization of a multidisciplinary emergency department sepsis huddle to reduce time to antibiotics and improve SEP-1 compliance
Sepsis is a significant public health crisis in the United States, contributing to 50% of inpatient hospital deaths. Given its dramatic health effects and implications in the setting of new CMS care guidelines, ED leaders have renewed focus on appropriate and timely sepsis care, including timely administration of antibiotics in patients at risk for sepsis. Modeling the success of multidisciplinary bedside huddles in improving compliance with appropriate care in other healthcare settings, a Sepsis Huddle was implemented in a large, academic ED, with the goal of driving compliance with standardized sepsis care as described i...
Source: The American Journal of Emergency Medicine - September 8, 2020 Category: Emergency Medicine Authors: Jonathan D. Sonis, Theodore I. Benzer, Lauren Black, Michael R. Filbin, Bryan D. Hayes, Kathryn A. Hibbert, Cassie Kraus, Ali S. Raja, Elizabeth Temin, Maria Vareschi, Benjamin A. White, Susan R. Wilcox, Emily L. Aaronson Source Type: research

A more realistic relationship between covid 19 and hemopneumothorax
Even though the recent report documented the occurrence of hemopneumothorax in a patient who tested positive for covid 19 infection [1], the most likely underlying cause of hemopneumothorax in this patient was rupture of a vascular bulla, also exemplified by one of the cases previously reported by Ng et al. [2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 8, 2020 Category: Emergency Medicine Authors: Oscar M.P. Jolobe Source Type: research