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Usefulness of chloride levels for fluid resuscitation in patients undergoing targeted temperature management after out-of-hospital cardiac arrest
In this study, we aimed to evaluate the associations between chloride levels on emergency department (ED) admission and neurologic outcomes by stratifying patients undergoing targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) into three groups (hyper/normo/hypochloremia); we also assessed the effect of changes in chloride levels from baseline over time on outcomes. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 15, 2021 Category: Emergency Medicine Authors: Taeyoung Kong, Yong Eun Chung, Hye Sun Lee, Je Sung You, Hyun Soo Chung, Incheol Park, Sung Phil Chung Source Type: research

Chloride in targeted temperature management: Where is the data?
Out of hospital cardiac arrest (OHCA) remains the leading cause of mortality in the World, with a documented good neurological outcome survival rate of less than 5% [1]. One therapeutic intervention that may increase the survival chances of these patients, as well as reasonable neurological outcomes, has been the early implementation of targeted temperature management (TTM) [2]. During the three phases of TTM, the patient is closely monitored in an attempt to avoid complications and improve their outcome. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 15, 2021 Category: Emergency Medicine Authors: Elizabeth Gamboa, Gabriel Cervera-Rodriguez, Joseph Varon Source Type: research

Modified HEART score to optimize risk stratification in cocaine-associated chest pain
We recently reported in this journal that the classification performance of the HEART score is inferior in patients presenting with cocaine associated chest pain (CACP), with 14% of those with CACP in the low risk group experiencing adverse cardiac events within 30 days of indexed admission, compared to 4% in the general chest pain population.1 This finding suggests that the HEART score, in its current form, has limited clinical utility in stratifying risk in those evaluated for CACP in the emergency department (ED). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 14, 2021 Category: Emergency Medicine Authors: Ziad Faramand, Christian Martin-Gill, Clifton Callaway, Salah Al-Zaiti Source Type: research

Effect of COVID19 on prehospital pronouncements and ED visits for stroke and myocardial infarction
In this study, our goal was to determine if there was an increase in prehospital ALS pronouncements and a decrease in ED visits for potentially serious conditions such as MI and stroke during the peak of the COVID-19 pandemic in northern NJ. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 14, 2021 Category: Emergency Medicine Authors: Nikhil Jain, Michael Berkenbush, David C. Feldman, Barnet Eskin, John R. Allegra Source Type: research

Lipid emulsion treatment as an antidote for chloroquine and hydroxychloroquine toxicity
Chloroquine and hydroxychloroquine, which have anti-malarial and anti-inflammatory effects, are used for treating malaria, rheumatoid arthritis, and systemic lupus erythematosus [1]. These drugs are quinine derivatives having similar cellular mechanisms behind their toxicities [1]. Because a toxic dose of chloroquine, which is a Vaughan –Williams Class IA antiarrhythmic, inhibits cardiac sodium, potassium, and calcium channels, it induces QT prolongation, QRS widening, and atrioventricular blockade, leading to hypotension and shock [2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 14, 2021 Category: Emergency Medicine Authors: Soo Hee Lee, Ju-Tae Sohn Source Type: research

Hyperbaric oxygen therapy mobilized circulating stem cells and improved delayed encephalopathy after acute carbon monoxide poisoning with up-regulation of brain-derived neurotrophic factor
BackgroundDelayed encephalopathy (DE) is the most severe complication after acute carbon monoxide (CO) poisoning, which seriously affects the outcome of patients and leads to a high disability rate. Prior studies have shown that hyperbaric oxygen (HBO2) therapy is therapeutic for DE due to reducing immune-mediated neuropathology and thus improving cognitive performance.MethodsIn our present perspective study, five DE patients were treated regularly with HBO2 therapy. The mini-mental state examination (MMSE) and Barthel index (BI) were intermittently collected during their hospitalization for mental and physical status eval...
Source: The American Journal of Emergency Medicine - January 14, 2021 Category: Emergency Medicine Authors: Lina Zhang, Qing Sun, Qun Xin, Jiangnan Qin, Lu Zhang, Di Wu, Guangkai Gao, Yujun Xia Source Type: research

Ketamine for acute suicidality in the emergency department: A systematic review
There are no emergent pharmaceutical interventions for acute suicidal ideation, a common presenting complaint in the ED. Ketamine is a NMDA agonist frequently used by ED physicians for sedation and analgesia. Prior evidence from studies conducted in inpatient psychiatry units suggests that ketamine may have a role in alleviating treatment-resistant depression as well as suicidal ideation. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 13, 2021 Category: Emergency Medicine Authors: Lindsay Maguire, Timothy Bullard, Linda Papa Source Type: research

Impact of COVID-19 pandemic on visits of an urban emergency department
The aim of this study was to reveal how the pandemic process affected the number of ED visits and the reasons for application. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 13, 2021 Category: Emergency Medicine Authors: G ülşah Çıkrıkçı Işık, Yunsur Çevik Source Type: research

Effect of antiplatelet treatments on patients with COVID-19 infection: A systematic review and meta-analysis
Despite the rationale that early anti-platelet would lower the risk of major organ dysfunction, the effectiveness of this approach remains controversial. Therefore, we perform a systematic review and meta-analysis to investigate the effect of antiplatelet treatments on patients with COVID-19 infection. An electronic search was carried out in Pubmed, Embase, Cochrane library, Web of Science, MEDLINE, Wanfang and China National Knowledge Infrastructure (CNKI). Meta-analysis and statistical analyses were completed with using the RevMan 5.3 and Stata 12.0. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 13, 2021 Category: Emergency Medicine Authors: Yushu Wang, Guangyu Ao, Basma Nasr, Xin Qi Source Type: research

Preparing emergency and disaster medicine physicians to lead future responses: Crisis leadership a core competency
We are grateful to Dr. Bala and colleagues for taking up the discussion, pointing out more gaps [1], and willing to continue this important topic [2]. In our opinion, additional attention also needs to be given to the preparation of emergency medicine (EM) and disaster medicine (DM) physicians to lead in times of crisis [3-5]. Effective responses to the pandemic have required emergency physicians to transcend clinical patient care responsibilities and provide leadership within their own departments, often stepping into much larger roles such as leading the COVID-19 response for an entire hospital or health system, developi...
Source: The American Journal of Emergency Medicine - January 13, 2021 Category: Emergency Medicine Authors: Attila J. Hertelendy, Krzysztof Goniewicz, Amir Khorram-Manesh Source Type: research

Congenital hypothyroidism presenting as myxedema coma in a teenager
We describe a case of congenital hypothyroidism presenting as myxedema coma in an immigrant teenager. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 12, 2021 Category: Emergency Medicine Authors: T. Christy Hallett, Barbara Solomon, Daisy A. Ciener Source Type: research

STAT vs. CAT: A pilot comparison after a video demonstration
Tourniquets demonstrate effective hemorrhage control, but layperson application finds difficulty and abysmal success rates as low as 17% [1-3]. The Committee on Tactical Combat Casualty Care (CoTCCC) helps standardize tourniquet recommendations for first responder application [4]. Recommended devices include the Combat Application Tourniquet (CAT, C-A-T Resources, LLC, Rock Hill, South Carolina), which can serve as reference for newer device evaluation (Fig. 1) [5]. Furthermore, the Department of Homeland Security-led “Stop the Bleed” bystander hemorrhage control education campaign has prominently recommended the CAT s...
Source: The American Journal of Emergency Medicine - January 11, 2021 Category: Emergency Medicine Authors: C.P.T. Brandon M. Carius, Ashley D. Tapia, Nguvan Uhaa, Sarah A. Johnson, Camaren M. Cuenca, Ryann S. Lauby, M.A.J. Steven G. Schauer Source Type: research

Assessing the confidence in network meta-analysis results
We applaud Zhao et al. [1] for attempting to address the comparative efficacy of amiodarone and lidocaine in cardiac arrest using a Bayesian (rather than frequentist) network meta-analytic (NMA) approach. A Bayesian NMA provides a posterior distribution of all relative treatment effects between the interventions in the network and allows for probability statements for a particular outcome such as, “there is X% probability that treatment C is better than B,” or “there is Y% probability that treatment D is the most efficacious out of treatments A,B,C,D, and E.” [2] The Bayesian approach may, therefore, be more approp...
Source: The American Journal of Emergency Medicine - January 11, 2021 Category: Emergency Medicine Authors: Ian S. de Souza, Robert Allen Source Type: research

COVID-19 testing for providers: Leading by example
This may sound like a broken record, but hospitals around the country are short-staffed and healthcare workers are paying the price [1]. An emergency medicine physician colleague at another institution recently confided that she felt terrible because she had to call in backup for a number of days while her COVID test was pending. Another had mild cold symptoms but needed a negative COVID test before working. When he called the hospital employee health COVID line, he was told to get testing in the community, which also took days. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 11, 2021 Category: Emergency Medicine Authors: David Greenky, Susan Wiltrakis Source Type: research

Electric scooter-related injuries: the desperate need for regulation
Our world is constantly changing. Modes of transportation are continuously being altered and refined to match the demands of the population. One growing problem is the integration of residential areas and new transportation infrastructures. Individuals may find themselves in the situation of being out of comfortable walking distance from their destination, but too close to drive the “last mile” phenomenon. As a result, electric scooters (e-scooters) have established their niche in the area of short-distance transportation. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 11, 2021 Category: Emergency Medicine Authors: Brendon Sen Crowe, Adel Elkbuli Source Type: research