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Associations between initial serum pH value and outcomes of pediatric out-of-hospital cardiac arrest
Pediatric out-of-hospital cardiac arrest (OHCA) is one of the most critical conditions seen in the emergency department (ED). Although initial serum pH value is reported to be associated with outcome in adult OHCA patients, the association is unclear in pediatric OHCA patients. Thus, we aimed to identify the association between initial pH value and outcome among pediatric OHCA patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - December 16, 2020 Category: Emergency Medicine Authors: Asami Okada, Yohei Okada, Kenji Kandori, Satoshi Nakajima, Nobunaga Okada, Tasuku Matsuyama, Tetsuhisa Kitamura, Narumiya Hiromichi, Ryoji Iiduka Source Type: research

Confounders in determining female authorship in the emergency medicine literature
In the article “First and last authorship by gender in emergency medicine publications- a comparison of 2008 vs 2018,” the authors conclude that women represent 28% of the academic emergency workforce and are proportionately represented as first authors [1]. However, this both fails to capture key data and fur ther lacks context, leaving the reader to surmise that a disparity does not exist when this is certainly not the case. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - December 16, 2020 Category: Emergency Medicine Authors: Jaclyn Jansen, Ryan McKenna, Alexandra Mannix Source Type: research

Subclavian artery aneurysmal rupture and left internal mammary artery extravasation secondary to advanced Marfan syndrome
This case highlights the unusual life-threatening findings found in a patient with Marfan syndrome (MFS) in the emergency department setting. MFS is a rare autosomal dominant disease that affects 1 in 3000 –5000 individuals and has a highly variable range of clinical severity.This case is a 63-year-old male with COPD, scoliosis, aortic and mitral valve replacements on warfarin, and MFS who presented with acute onset hemoptysis, tachypnea, and oxygen saturation of 77% on 4 l nasal cannula. Emergent chest computed tomography angiography (CTA) revealed both a contained rupture of a left subclavian artery aneurysm and acti...
Source: The American Journal of Emergency Medicine - December 16, 2020 Category: Emergency Medicine Authors: Alex U. Siegel, Alexandra Castro, Jacob Sechrist Source Type: research

Impact of a shelter-in-place order during the COVID-19 pandemic on the incidence of opioid overdoses
This study aims to assess the role of the COVID-19 pandemic on the incidence of opioid overdose before and after a SIP order. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - December 16, 2020 Category: Emergency Medicine Authors: Jennifer Rosenbaum, Nicole Lucas, Gregory Zandrow, Wayne A. Satz, Derek Isenberg, Joseph D'Orazio, Nina T. Gentile, Kraftin E. Schreyer Source Type: research

The safety of the sepsis fluid bolus for patients at increased risk of volume overload
Sepsis, caused by a dysregulated host response to infection, is a significant cause of mortality and morbidity affecting millions annually and killing one in four afflicted [1]. Guidelines recommend rapid intravenous (IV) fluid resuscitation of at least 30  mL/kg in septic patients in order to improve outcomes [1]. Many hospitals consider this intervention a core measure for which adherence is tracked. However, since fluid overload increases the risk of intubation [2], physicians are wary to aggressively fluid-resuscitate septic patients who are at risk of fluid-overload – namely, patients with congestive heart failure...
Source: The American Journal of Emergency Medicine - December 16, 2020 Category: Emergency Medicine Authors: Murtaza Akhter, Terence Potter, Jeffrey Stowell Source Type: research

A randomized controlled trial of adding intravenous corticosteroids to H1 antihistamines in patients with acute urticaria
We have read the original article entitled “A randomized controlled trial of adding intravenous corticosteroids to H1-antihistamines in patients with acute urticaria” by Palungwachira et al. published in American Journal of Emergency Medicine (2020 Feb 19. pii: S0735–6757(20)30098-X. doi:10.1016/j.ajem.2020.02.025) [1]. We would like t o congratulate the authors for this rational study, and to make some contributions on this subject. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - December 15, 2020 Category: Emergency Medicine Authors: Mustafa Arga, Özlem Cavkaytar, Hamdi Cihan Emeksiz Source Type: research

Barriers to point-of-care ultrasound utilization during cardiac arrest in the emergency department: a regional survey of emergency physicians
Though point-of-care ultrasound (POCUS) is recognized as a useful diagnostic and prognostic intervention during cardiac arrest (CA), critics advise caution. The purpose of this survey study was to determine the barriers to POCUS during CA in the Emergency Department (ED). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - December 15, 2020 Category: Emergency Medicine Authors: Mallika R. Singh, Jennifer S. Jackson, Mark A. Newberry, Cameron Riopelle, Vu Huy Tran, Leila L. PoSaw Source Type: research

Recreational ketamine-induced cholangiopathy and ulcerative cystitis
We report a case of a teenage patient with the rare simultaneous presentation of ketamine-induced cholangiopathy and ulcerative cystitis. Due to increased recreational and chronic ketamine use, cases of ketamine-induced cholangiopathy and ulcerative cystitis are likely to rise with the increased knowledge, awareness, and reporting of these entities by radiologists and emergency physicians. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - December 15, 2020 Category: Emergency Medicine Authors: David M. Vu, Katerina Freyre-Diaz, Oleg Opsha, Yekaterina Opsha Source Type: research

Time to first defibrillation and survival outcomes of out-of-hospital cardiac arrest with refractory ventricular fibrillation
This study aimed to determine whether the time to first defibrillation was associated with good neurological outcomes in OHCA patients with refractory ventricular fibrillation. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - December 14, 2020 Category: Emergency Medicine Authors: Stephen Gyung Won Lee, Jeong Ho Park, Young Sun Ro, Ki Jeong Hong, Kyoung Jun Song, Sang Do Shin Source Type: research

eccSOFA: SOFA illness severity score adapted to predict in-hospital mortality in emergency critical care patients
Boarding of ICU patients in the ED is increasing. Illness severity scores may help emergency physicians stratify risk to guide earlier transfer to the ICU and assess pre-ICU interventions by adjusting for baseline mortality risk. Most existing illness severity scores are based on data that is not available at the time of the hospital admission decision or cannot be extracted from the electronic health record (EHR). We adapted the SOFA score to create a new illness severity score (eccSOFA) that can be calculated at the time of ICU admission order entry in the ED using EHR data. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - December 14, 2020 Category: Emergency Medicine Authors: Kian Niknam, Jason Nesbitt, Tsuyoshi Mitarai, Matthew J.R. Nudelman, Alexandra June Gordon, Jennifer G. Wilson, Michael A. Kohn Source Type: research

Assessing the impact of resuscitation residents on the treatment of cardiopulmonary resuscitation patients
The objective of this study is to compare 30-day mortality between cardiac arrest patients with resuscitation resident (RR) involvement versus patients without. Our secondary outcome is to determine if RR involvement altered rates of initiating targeted temperature management (TTM). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - December 14, 2020 Category: Emergency Medicine Authors: David M. Lee, David A. Berger, Patrick A. Wloszczynski, Patrick Karabon, Lihua Qu, Michael J. Burla Source Type: research

D-Dimer as a potential biomarker for disease severity in COVID-19
This study seeks to determine the utility of D-dimer levels as a biomarker in determining disease severity and prognosis in COVID-19. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - December 14, 2020 Category: Emergency Medicine Authors: Mert Ozen, Atakan Yilmaz, Vefa Cakmak, Resad Beyoglu, Alten Oskay, Murat Seyit, Hande Senol Source Type: research

Medications for treatment of agitation in the emergency department: Let's not be too fast to conclude to a status quo
It was with great interest that we read the article by Schneider et al. [1]. The issue of managing agitation in the emergency department is important for every emergency physician. Although these situations are infrequent on a daily basis, they are of great systemic importance because they require a significant amount of human and logistical resources in an extremely urgent manner, often under threat of material or even physical violence towards the staff. The conclusions of the work of Schneider et al. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - December 14, 2020 Category: Emergency Medicine Authors: Nicolas Cazes, Aur élien Renard Tags: Correspondence Source Type: research

Post-arrest wide complex rhythm: What is the cause of death?
A 72-year-old man presented to the ED following witnessed cardiac arrest. After return of spontaneous circulation, an ECG was performed which demonstrated a wide complex rhythm with “shark fin” morphology. With careful examination it is possible to identify the J point and determine that the electrocardiogram (ECG) findings actually represent massive ST-elevation indicative of occlusion myocardial infarction (OMI). Initial troponin was undetectable. The patient underwent em ergent cardiac catheterization and had a 100% proximal LAD occlusion that was successfully stented. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - December 14, 2020 Category: Emergency Medicine Authors: Alexander Bracey, Pendell Meyers, Stephen W. Smith Source Type: research

Prognostic significance of cardiac troponin level in Covid-19 patients without known cardiovascular risk factors
The coronavirus disease 2019 (Covid-19) is an ongoing global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 primarily infects the lung epithelial cells via angiotensin-converting enzyme-2 (ACE-2) receptor [1], thereby causing respiratory signs and symptoms. Meanwhile, since ACE-2 is highly expressed in the cardiac myocytes, it is observed that the SARS-CoV-2 can also cause cardiac injury [2,3], thereby leading poor outcomes in Covid-19 cases. However, there is a very limited data about whether admission cardiac troponin levels are associated with a poor survival in Covid...
Source: The American Journal of Emergency Medicine - December 14, 2020 Category: Emergency Medicine Authors: Tufan Çınar, Mert İlker Hayıroğlu, Vedat Çiçek, Şahhan Kılıç, Süha Asal, Selami Doğan, Mehmet Şeker, Murat Selçuk, Mehmet Uzun, Ahmet Lütfullah Orhan Tags: Correspondence Source Type: research