Assessing the impact of CKD on outcomes in septic shock patients receiving standard Vs reduced initial fluid volume
To determine if following fluid resuscitation recommendations in the Surviving Sepsis Campaign guidelines affects hospital length of stay (LOS) in chronic kidney disease (CKD) patients who present to the emergency department with sepsis-induced hypotension or septic shock. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 26, 2020 Category: Emergency Medicine Authors: DevinM. Rice, Patrick D. Ratliff, W. Russ Judd, Samer A. Kseibi, Kip A. Eberwein Source Type: research

Unenhanced computed tomography (CT) utility for triage at the emergency department during COVID-19 pandemic
Unenhanced chest computed tomography (CT) can assist in the diagnosis and classification of coronavirus disease 2019 (COVID-19), complementing to the reverse-transcription polymerase chain reaction (RT-PCR) tests; the performance of which has yet to be validated in emergency department (ED) setting. The study sought to evaluate the diagnostic performance of chest CT in the diagnosis and management of COVID-19 in ED. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 26, 2020 Category: Emergency Medicine Authors: Ioannis Skalidis, Vinh Kim Nguyen, Hugo Bothorel, Lauriane Poli, Rui Ribeiro Da Costa, Alain Bigin Younossian, Nicole Petriccioli, Omar Kherad Source Type: research

Editorial Board
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 25, 2020 Category: Emergency Medicine Source Type: research

Toc
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 25, 2020 Category: Emergency Medicine Source Type: research

Info for authors
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 25, 2020 Category: Emergency Medicine Source Type: research

Quick cuts: A comparative study of two tools for ring tourniquet removal
Ring tourniquet occurs when a ring becomes entrapped due to swelling or trauma. As the finger expands the blood flow restriction causes additional swelling, which can lead to nerve damage and other complications. Ring tourniquet can be an emergency that requires rapid ring removal. Standard devices for ring removal have been described but rarely tested. We conducted a randomized study to compare removal time, user and participant satisfaction and complications between a motorized diamond disc ring cutter (MDDRC) and a ring cutter attached to trauma shears (TS). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 24, 2020 Category: Emergency Medicine Authors: Joseph Walter, Michael DeBoer, Jenny Koops, Lydia L. Hamel, Paula E. Rupp, Bjorn C. Westgard Source Type: research

Micropuncture kits for difficult vascular access
We would like to propose a technique using a 5-Fr micropuncture kit to obtain vascular access in critically ill patients who are at high risk for immediate procedural complications. The ability to obtain rapid vascular access, both arterial and venous, is a critical skill in emergency medicine [1]. Emergent vascular access may be challenging because of the patient's body habitus, anatomical deformities, agitation or altered mental status, intravascular volume loss, and hemodynamic status. These unpredictable factors turn an otherwise routine procedure into a lengthy and complicated one that exposes the patient to multiple ...
Source: The American Journal of Emergency Medicine - July 24, 2020 Category: Emergency Medicine Authors: Tim Montrief, Mark Ramzy, Brit Long Source Type: research

Incidence of prescription errors in patients discharged from the emergency department
The Emergency Department (ED) is known for its high rates of medication errors secondary to many characteristics such as unfamiliar patients, lack of continuity of care, increasing patient volumes, reliance on verbal orders, and fewer safety mechanisms. The purpose of this study was to quantify and characterize the medication errors that occur in patients discharged from the ED. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 24, 2020 Category: Emergency Medicine Authors: Haili Gregory, Morgan Cantley, Chara Calhoun, Gregory A. Hall, Andrew J. Matuskowitz, Kyle A. Weant Source Type: research

Signs of early cardiac tamponade induced by Minoxidil
Minoxidil is an antihypertensive that works by directly dilating peripheral vessels. This medication is typically reserved for patients with resistant hypertension, whose blood pressure remains above goal despite being on multiple agents. A rare but potentially dangerous side effect of Minoxidil is drug-induced pericardial effusion. Here we report a case of a patient who was taking Minoxidil and subsequently developed a large pericardial effusion, with concerns for impending cardiac tamponade. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 23, 2020 Category: Emergency Medicine Authors: Monique Oye, Melissa Oye, Aleem Ali Source Type: research

Dead in the air- The need to adapt to CoVID adaptations
During the recent CoVID-19 pandemic, airway management recommendations have been provided to decrease aerosolization and risk of viral spread to healthcare providers. High efficiency particulate air (HEPA) viral filters and adaptors are one way to decrease the risk of aerosolization during intubation. When placed proximal to the ventilator circuit, these viral filters and adaptors can create a significant amount of dead space, which in our smallest patients can significantly impact effective ventilation. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 23, 2020 Category: Emergency Medicine Authors: Nicholas A. Kuehnel, R.T. Rhonda Yngsdal-Krenz, Joshua M. Glazer Source Type: research

Optimizing emergency department care transitions to outpatient settings: A systematic review and meta-analysis
Suboptimal transitions from the emergency department (ED) to outpatient settings can result in poor care continuity, and subsequently higher costs to the healthcare system. We aimed to systematically review care transition interventions (CTIs) for adult patients to understand how effective ED-based CTIs are in reducing return visits to the ED and increasing follow-up visits with primary care physicians. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 22, 2020 Category: Emergency Medicine Authors: Fariba Aghajafari, Sayeeda Sayed, Nader Emami, Eddy Lang, Joanna Abraham Source Type: research

Medication shortages during the COVID-19 pandemic: Saving more than COVID lives
In the United States (US) alone, 3,302,194 cases and 135,171 deaths due to COVID-19 have been confirmed as of July 12th, 2020 [1]. To put this in perspective, from 2018 –2019, the CDC estimated there were approximately 35,500,000 cases and 34,200 deaths due to influenza [2]. These statistics correspond to a case-fatality ratio (CFR), the number of deaths divided by the total number of confirmed cases, that is nearly 40 times that of influenza in the case of COVID -19 (CFR 0.1% and 4.0%, respectively). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 22, 2020 Category: Emergency Medicine Authors: Brendon Sen-Crowe, Mark McKenney, Adel Elkbuli Source Type: research

Temporal trends in out-of-hospital cardiac arrest during the COVID-19 outbreak
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), responsible for the coronavirus disease 2019 (COVID-19), overwhelmed worldwide healthcare systems requiring abrupt changes in hospitals reorganization and human resources allocation. Recent literature data demonstrated a global reduction of hospitalizations for acute myocardial infarction [1] and urgent pacemaker implantations [2], mainly related to the fear of COVID-19 infection, with consequent development of life-threating complications due to delayed treatment. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 22, 2020 Category: Emergency Medicine Authors: Antonio Landi, Stefano De Servi Source Type: research

Flank pain and hematuria is not always a kidney stone
We present a case of a patient with hematuria and flank pain typical of nephrolithiasis who was diagnosed with a Page kidney causing secondary hypertension.A 50  year-old male with no significant past medical history presented to the Emergency Department with severe left-sided flank pain, vomiting, and blood-tinged urine. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 22, 2020 Category: Emergency Medicine Authors: Lisa Feit, Delna John, Nayla Delgado Torres, Richard Sinert Source Type: research

Systemic thrombolysis for refractory cardiac arrest due to presumed myocardial infarction
We report a case of successful resuscitation after protracted OHCA with suspected non-PE cardiac etiology, with favorable neurological outcome after empiric administration of systemic thrombolysis.A 47-year-old male presented to the emergency department (ED) after a witnessed OHCA with no bystander cardiopulmonary resuscitation (CPR). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 22, 2020 Category: Emergency Medicine Authors: Joseph A. Hamera, Noah B. Bryant, Mark S. Shievitz, David A. Berger Source Type: research

Pulmonary embolism in COVID-19: Clinical characteristics and cardiac implications
The thrombogenic potential of Covid-19 is increasingly recognised. We aim to assess the characteristics of COVID-19 patients diagnosed with pulmonary embolism (PE). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 22, 2020 Category: Emergency Medicine Authors: Jason Kho, Adam Ioannou, Koenraad Van den Abbeele, Amit K.J. Mandal, Constantinos G. Missouris Source Type: research

Strategies to prevent COVID-19 transmission in the emergency department of a regional base hospital in Korea: From index patient until pandemic declaration
This study aimed to describe the timely strategies used to prevent the spread of the emerging coronavirus disease 2019 (COVID-19) and present the activities performed in a regional base hospital in South Korea, from the identification of the index patient until the pandemic declaration. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 22, 2020 Category: Emergency Medicine Authors: Jong-Hak Park, Seong-Geun Lee, Sejoong Ahn, Joo Yeong Kim, Juhyun Song, Sungwoo Moon, Hanjin Cho Source Type: research

Early initiation of extracorporeal membrane oxygenation (ECMO) in emergency department to rescue severe diffuse alveolar hemorrhage —A case report
This article reports successful early initiation of veno-venous extracorporeal membrane oxygenation (V-V ECMO) in an emergency department to rescue an adult patient with diffuse alveolar hemorrhage caused by viral pneumonia. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 22, 2020 Category: Emergency Medicine Authors: Lei Zhang, Caiwei Lin, Lina Liu, Xudong Wang Source Type: research

The efficacy of tranexamic acid for brain injury
I have read the article titled “The efficacy of tranexamic acid for brain injury: A meta-analysis of randomized controlled trials” published by Chen et al. [1] with great interest. The authors conducted a meta-analysis to investigate the efficacy of tranexamic acid for traumatic brain injury. They collected six randomized con trolled trials (RCTs) and pooled risk ratios (RRs) (95% confidence intervals [CIs]) of tranexamic acid for mortality and growth of hemorrhagic mass were 0.91 (0.85 to 0.97) and 0.78 (0.61 to 0.99), respectively. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 22, 2020 Category: Emergency Medicine Authors: Tomoyuki Kawada Source Type: research

Dead in the air? Case report highlighting need to adapt to CoVID adaptations
During the recent CoVID-19 pandemic, airway management recommendations have been provided to decrease aerosolization and risk of viral spread to healthcare providers. High efficiency particulate air (HEPA) viral filters and adaptors are one way to decrease the risk of aerosolization during intubation. When placed proximal to the ventilator circuit, these viral filters and adaptors can create a significant amount of dead space, which in our smallest patients can significantly impact effective ventilation. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 22, 2020 Category: Emergency Medicine Authors: Nicholas A. Kuehnel, R.T. Rhonda Yngsdal-Krenz, Joshua M. Glazer Source Type: research

Removing a metallic corneal foreign body with a magnet
The removal of corneal foreign bodies is a common ophthalmologic procedure in the emergency department (ED) [1]. A cotton-tipped applicator, a needle, or a burr drill may be used for removal. However, the first of these only works for very superficial foreign bodies, and the other two may be anxiety-provoking for the physician and patient given the risk for significant damage to the eye [2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 22, 2020 Category: Emergency Medicine Authors: Tony Zitek, Sarah Dichter, Daniela Valenzuela, Jesus Seda Source Type: research

Carbon tetrachloride poisoning from an antique fire extinguisher
Household exposure to carbon tetrachloride (CCl4) is rare in the United States as it is no longer utilized due to concerns about toxicity. Prior to being phased out of regular use, CCl4 had been used as a component of fire extinguishers, cleaning agents, degreasing agents, and solvents [1]. CCl4 is a volatile liquid that causes hepatotoxicity by oxidative damage after it is activated via CYP2E1 metabolism (with CYP3A contributing at higher concentrations of CCl4) to a trichloromethyl radical [2,3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 22, 2020 Category: Emergency Medicine Authors: Christopher W. Meaden, Gabrielle Procoprio, Diane P. Calello, Lewis S. Nelson, Bruce Ruck, Amit Gupta, Jeena E. Jacob Source Type: research

Ceftriaxone by IV push
The only modification I made was to add change “patient” to “patients” at the end of the first sentence of the response. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 21, 2020 Category: Emergency Medicine Authors: Abdulkareem Agunbiade, Joanne C. Routsolias, Jordan Moskoff Source Type: research

Emergency department approach to gastric tube complications and review of the literature
Nasogastric and orogastric tubes (NGT/OGT) are commonly used in emergency and critical care settings, with indications including medicinal administration, gastric decompression, and enteral feeding. Previous studies have highlighted a variety of complications associated with tube placement. These range from minor occurrences such as nose bleeds and sinusitis, to more severe cases highlighting tracheobronchial perforation, tube knotting, asphyxia, pulmonary aspiration, pneumothorax, and even intracranial insertion. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 21, 2020 Category: Emergency Medicine Authors: Francis O'Connell, Justin Ong, Crystal Donelan, Ali Pourmand Tags: Case Report Source Type: research

Personal ventilation hood for protecting healthcare workers from aerosol-transmissible diseases
The surge in numbers of critically ill patients with COVID-19 can occur rapidly and challenge the finite burden of healthcare systems, especially the capacity of intensive care unit (ICU). Airborne infection isolation rooms with negative pressure are not universally available, particularly in resource-constraint countries. Moreover, the safety of the ICU practitioners' is compromised due to the shortage of personal protective equipment (PPE) and extensive environmental contamination. Although the current evidence points towards droplet precaution [1] rather than the airborne transmission of COVID-19, concerns of nosocomial...
Source: The American Journal of Emergency Medicine - July 20, 2020 Category: Emergency Medicine Authors: Connie Cai Ru Gan, Yu-Chi Tseng, Feng-You Lee, Kuan-I Lee Source Type: research

Emergency department approach to gastric tube complications: A case report and review of the literature
Nasogastric and orogastric tubes (NG/OGT) are commonly used in emergency and critical care settings, with indications including medicinal administration, gastric decompression, and enteral feeding. Previous studies have highlighted a variety of complications associated with tube placement. These range from minor occurrences such as nose bleeds and sinusitis, to more severe cases highlighting tracheobronchial perforation, tube knotting, asphyxia, pulmonary aspiration, pneumothorax, and even intracranial insertion. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 20, 2020 Category: Emergency Medicine Authors: Francis O'Connell, Justin Ong, Crystal Donelan, Ali Pourmand Source Type: research

Massive transfusion protocol in adult trauma population
Acute blood loss in trauma requires quick identification and action to restore circulating volume and save the patient. Massive transfusion protocols (MTPs) have become standard at Trauma Centers, in order to rapidly deliver blood products to bleeding patients. This literature review presents current standards of transfusion ratios, as well as insights into adjuncts during massive transfusions. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 20, 2020 Category: Emergency Medicine Authors: Evander Meneses, Dessy Boneva, Mark McKenney, Adel Elkbuli Source Type: research

Predictors of return visits to the emergency department among different age groups of older adults
To identify predictors of 30-day emergency department (ED) return visits in patients age 65 –79 years and age ≥ 80 years. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 20, 2020 Category: Emergency Medicine Authors: Lucas Oliveira J.E. Silva, Molly M. Jeffery, Ronna L. Campbell, Aidan F. Mullan, Paul Y. Takahashi, Fernanda Bellolio Source Type: research

Intravenous magnesium sulfate vs. morphine sulfate in relieving renal colic: A randomized clinical trial
This study was designed to compare the efficacy of magnesium sulfate vs morphine sulfate in renal colic relief as for analgesic effect as well as lack of morphine sulfate side effects when using magnesium sulfate. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 20, 2020 Category: Emergency Medicine Authors: Akram Zolfaghari Sadrabad, Soheila Azimi Abarghouei, Reza Farahmand Rad, Yahya Salimi Source Type: research

Association between emergency department chief complaint and adverse hospitalization outcomes: A simple early warning system?
Early identification of ED admissions at higher risk for acute decompensation could support earlier interventions and better allocation of scare hospital resources. Several risk stratification tools, such as qSOFA,1 Triage in Emergency Medicine Score, National Early Warning Score and others, identify patients at high risk of adverse hospital outcomes. These early warning scores have been suggested to perform more poorly than previously reported, require multiple data elements and often ignore adverse events other than mortality [1-4]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 20, 2020 Category: Emergency Medicine Authors: Kito Lord, Craig Rothenberg, Vivek Parwani, Emily Finn, Aamer Khan, John Sather, Andrew Ulrich, Sarwat Chaudhry, Arjun Venkatesh Source Type: research

Acute pain assessment and management depicted in medical television shows
Pain is a common complaint presenting to the emergency department (ED). However, it is well-studied that patients believe that the assessment and management of pain is inadequate [1-6]. Studies discussing pain assessment and management, including the Pain and Emergency Medicine Initiative (PEMI), a multicenter study that yielded no significant difference in the rates of pain medication administration, opioid or otherwise, between gender or racial groups [7]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 19, 2020 Category: Emergency Medicine Authors: Arshjot Khokhar, Rahul Gupta, Sue Boehmer, Robert Olympia Source Type: research

Publishing trends in the field of urgent care medicine from 2000 to 2020: A bibliometric analysis
With a steady rise in the number of urgent care centers in the United States and the establishment of urgent care medicine as a specialty, research in the field is likely to emerge. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 18, 2020 Category: Emergency Medicine Authors: Lauren A. McNickle, Kevin C. Chiang, Ellie M. McNulty, Robert P. Olympia Source Type: research

Cardiovascular complications in COVID-19
We read the article by Long et al. titled “Cardiovascular complications in COVID-19” published in the recent issue of American Journal of Emergency Medicine with immense interest [1]. We commend the authors on identifying Coronavirus Disease 2019 (COVID-19) associated cardiovascular complications including myocarditis, myocardial infarc tion, cardiomyopathy, dysrhythmias and venous thromboembolic events. However, we would like to highlight other possible cardiac complications which may also be observed with this disease. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 18, 2020 Category: Emergency Medicine Authors: Nausharwan Butt, Awais Arshid, Sarah Aftab Ahmad, Nauman Khalid, Waleed Tallat Kayani Source Type: research

Acute chloroquine and hydroxychloroquine toxicity: A review for emergency clinicians
Acute chloroquine and hydroxychloroquine toxicity is characterized by a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias and is associated with significant morbidity and mortality. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 18, 2020 Category: Emergency Medicine Authors: Alessandra Della Porta, Kasha Bornstein, Austin Coye, Tim Montrief, Brit Long, Mehruba Anwar Parris Source Type: research

Should COVID-19 patients be taken to an airborne infection isolation room without cardiopulmonary resuscitation?
This article states “We should, moreover, remember that in a hospital setting, all aerosol-generating procedures should be done in an airborne infection isolation room.” A doctor at our hospital who read this article said, “If a patient collapses at the entrance of the hospital, cardiopulmonary resuscitation (CPR ) should not be started there, but should be taken to the emergency department in the Red Zone and then CPR”. While it's important to prevent nosocomial infections and protect hospital staff, isn't it too detrimental for patients to be transferred to an airborne infection isolation room wit...
Source: The American Journal of Emergency Medicine - July 18, 2020 Category: Emergency Medicine Authors: Masanao Kobayashi, Mikako Shinchi, Yoshihiro Takeda Source Type: research

Multiple thromboemboli in Covid-19
I read with great interest the article titled “Abdominal pain in a patient with COVID-19 infection: A case of multiple thromboemboli” by Mahan et al. [1] in The American Journal of Emergency Medicine. The authors reported an interesting novel coronavirus disease (COVID-19) case with venous and arterial thromboembolic disease. There are some important issues that need to be clarified about this case report. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 18, 2020 Category: Emergency Medicine Authors: Furkan Ufuk Source Type: research

Ambulatory care, insurance, and avoidable emergency department utilization in North Carolina
To examine whether and how avoidable emergency department (ED) utilization is associated with ambulatory or primary care (APC) utilization, insurance, and interaction effects. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 18, 2020 Category: Emergency Medicine Authors: Carlene A. Mayfield, Marco Geraci, Brisa Urquieta de Hernandez, Michael Dulin, Jan M. Eberth, Anwar T. Merchant Source Type: research

Postpartum headache: A broader differential
A 40-year-old female presented to the ED with a history of intermittent headaches since a vaginal delivery 8  days prior. Her pregnancy was unremarkable and was not complicated by pre-eclampsia. She did not present with signs or symptoms consistent with postdural puncture headache or pre-eclampsia. Her delivery was not complicated by hypotension or post-partum hemorrhage. By chance, she was found to be h yponatremic and admitted to internal medicine for further work-up. She was diagnosed with postpartum lymphocytic adenohypophysitis and treated with steroids. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 17, 2020 Category: Emergency Medicine Authors: Anton Nikouline, David Carr Source Type: research

Pulmonary fibrosis in critical ill patients recovered from COVID-19 pneumonia: Preliminary experience
To investigate chest computed tomography (CT) findings associated with severe COVID-19 pneumonia in the early recovery period. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 17, 2020 Category: Emergency Medicine Authors: Yu Fang, Jun Zhou, Xun Ding, Gonghao Ling, Shanshan Yu Source Type: research

Usage analysis of ketorolac in the emergency department
Ketorolac (Toradol ®) is a non-steroidal anti-inflammatory medication (NSAID) used in the emergency department (ED) for acute and chronic pain. Routes of administration include intramuscular (IM), intravenous (IV), or oral (PO). The onset of action of parenteral ketorolac is about 10 min for both routes, and time t o peak effect about 75 to 150 min [1]. Compared to other NSAIDs, ketorolac has the highest dose related side effect profile, with adverse effects including gastrointestinal toxicity, bleeding, impaired platelet aggregation, and renal toxicity [2-5]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 17, 2020 Category: Emergency Medicine Authors: Joshua da Silva, Alexa Gingras Source Type: research

Ideal high sensitivity troponin baseline cutoff for patients with renal dysfunction
High-sensitivity cardiac troponin assays (hs-cTn) aid in diagnosis of myocardial infarction (MI). These assays have lower specificity for non-ST Elevation MI (NSTEMI) in patients with renal disease. Our objective was to determine an optimized cutoff for patients with renal disease. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 16, 2020 Category: Emergency Medicine Authors: Alexander T. Limkakeng, Julian Hertz, Reginald Lerebours, Maragatha Kuchibhatla, James McCord, Adam J. Singer, Fred S. Apple, William F. Peacock, Robert H. Christenson, Richard M. Nowak Source Type: research

Predictors of emergency department opioid administration and prescribing: A machine learning approach
This study aims to examine patient sociodemographic and ED clinical factors to comprehensively determine predictors of opioid administration during an ED visit (ED-RX) and prescribing upon discharge (DC-RX). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 16, 2020 Category: Emergency Medicine Authors: Molly McCann Pineo, Julia Ruskin, Rehana Rasul, Eugene Vortsman, Kristin Bevilacqua, Samantha S. Corley, Rebecca M. Schwartz Source Type: research

Is social distancing keeping patients from the ED?
In response to COVID-19, public health organizations issued recommendations to limit transmission. These recommendations include physical distancing, frequent hand hygiene, and use of personal protective equipment (PPE) [1,2]. In conjunction with state-level mandated shelter-in-place orders and the closure of schools and non-essential businesses, daily life in the U.S. has changed dramatically. We sought to characterize perceptions of public health recommendations and explore the decision to seek medical care for common symptoms. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 15, 2020 Category: Emergency Medicine Authors: Claire M. Sokas, Margaret T. Berrigan, Scott C. Fligor, Aaron J. Fleishman, Kristin E. Raven, James R. Rodrigue Source Type: research

Highest reported clearance of valproate by hemodialysis in massive overdose
Valproic acid (VPA) is a commonly prescribed anti-epileptic used therapeutically for a range of conditions including bipolar disorder and migraines. It is a small molecule with a low volume of distribution (0.22  L/kg). At therapeutic levels, protein binding of valproic acid is high (90 to 95%) [1]. However, in overdose protein binding becomes saturated and the percentage of free valproic acid increases substantially. At valproic acid levels of 1000 mg/L, protein binding has been shown to decrease to 15 %. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 14, 2020 Category: Emergency Medicine Authors: Alexander M. Sidlak, Samuel R. York, Adam J. Janicki, Anthony F. Pizon Source Type: research

Surge activation by the emergency department for COVID-19
In March 2020, the American College of Emergency Physicians (ACEP) published a national strategic plan for COVID-19, which provides general guidelines yet leaves logistical details for institutions to determine. Key capabilities from this plan provided a crucial foundation for a 16-day Emergency Department (ED) surge planning process at one pediatric institution. This paper describes critical milestones and lessons learned during this brief period, including derivation of criteria for ED surge activation, a full-scale surge drill, and the resultant ED surge protocol. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 14, 2020 Category: Emergency Medicine Authors: Anita R. Schmidt, Phung K. Pham, Deborah R. Liu, Bradley S. Goldberg Source Type: research

The new prognostic factor for pulmonary embolism: The ratio of monocyte count to HDL cholesterol
Aim of this study is to investigate effectiveness of the monocyte to HDL cholesterol ratio in patients diagnosed with pulmonary embolism for predicting intra-hospital mortality. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 14, 2020 Category: Emergency Medicine Authors: Akkan Avci, Serdar Biricik, Begum Seyda Avci, Onder Yesiloglu, Hilmi Erdem Sumbul, Ferhat Icme, Hasan Koca, Hayri Çınar, Mevlut Koc, Salim Satar Source Type: research

Pregnant patient in the emergency department: An observational investigation of predictive values of symptoms and lab measures in predicting culture confirmed urinary tract infection.
Many women in their first trimester present to the Emergency Department (ED) for evaluation. Urinalysis is a common test performed with these patients to evaluate for possible UTI. There are no clear results to determine if a patient requires antibiotic in the ED vs waiting for the culture result to start antibiotics. We prospectively studied a convenience sample of 198 women in their first trimester of pregnancy presenting to a community ED recording standard symptoms and lab analysis and then compared these results to the urine culture. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 14, 2020 Category: Emergency Medicine Authors: Gleb Gendel, Robert Nolan Source Type: research

Hepatic portal venous gas: A case report and analysis of 131 aatients using PUBMED and MEDLINE database
Hepatic portal pneumatosis has a high mortality rate, and whether surgical intervention is necessary remains controversial. This experiment retrospectively analyzed the etiology, treatment methods and prognosis of adult patients with hepatoportal pneumocele to provide a theoretical basis for the treatment of this disease. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 12, 2020 Category: Emergency Medicine Authors: Chun Liu, Chang-Hei Wu, Xiang-De Zheng, Jin-Ping Liu, Chang-Long Li, Jie-Yu Zhao, Qing Lan, Wen-Lai Zhou, Wen-Bin Li Source Type: research

Correlation of history and physical examination with imaging in traumatic near-shore aquatic head and spinal injury
It remains unclear whether clinicians can rely on specific symptoms and signs to detect or exclude serious head and spinal injury sustained during near-shore aquatic activities. Our study investigated patients' history of present illness (HPI) and physical examination (PE) for their utility in detecting serious head and spinal injury. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 12, 2020 Category: Emergency Medicine Authors: Tucker Lurie, Bradford Schwartz, Daniel Najafali, Priyanka Gandhi, Matthew Jackson, Quincy K. Tran Source Type: research

Hepatic portal venous gas: A case report and analysis of 131 patients using PUBMED and MEDLINE database
Hepatic portal pneumatosis has a high mortality rate, and whether surgical intervention is necessary remains controversial. This experiment retrospectively analyzed the etiology, treatment methods and prognosis of adult patients with hepatoportal pneumocele to provide a theoretical basis for the treatment of this disease. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 12, 2020 Category: Emergency Medicine Authors: Chun Liu, Chang-Wei Wu, Xiang-De Zheng, Jin-Ping Liu, Chang-Long Li, Jie-Yu Zhao, Qing Lan, Wen-Lai Zhou, Wen-Bin Li Source Type: research