Medications for Addiction Treatment Initiated from the Emergency Department: Ethical Considerations
Morbidity and mortality from opioid use disorder (OUD) remain at epidemic levels in the United States. In the 12-month period ending July 2018, approximately 46,000 people died from opioid overdose in the United States, approximately five deaths every hour.[1] The harms of OUD extend beyond the well-publicized overdose deaths. Aside from the tragic toll on families, patients experience social and medical sequelae of drug use. Among the medical sequelae is drug use-associated infective endocarditis, whose incidence has risen dramatically where opioid use disorder (OUD) is endemic; at least one state experienced a tenfold in...
Source: The American Journal of Emergency Medicine - November 16, 2019 Category: Emergency Medicine Authors: Kenneth D. Marshall, Arthur R. Derse, Kenneth V. Iserson, Nicholas Kluesner, Laura Vearrier Source Type: research

Serotonin Syndrome from Sertraline Monotherapy: A Case Report
We present a case of probable sertraline-induced SS. A 36-year-old male presented to the emergency department four times in one week with a constellation of autonomic and neuromuscular symptoms. He had been taking sertraline at a therapeutic dose for less than three months. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 16, 2019 Category: Emergency Medicine Authors: Kevin M. Duignan, Austin M. Quinn, Amy M. Matson Source Type: research

Spontaneous brain arteriovenous malformation rupture with atrioventricular block in a pediatric patient
This case reports 9 year-old-female with atrioventricular block and seizure. Careful evaluation, including electrocardiogram (ECG) and computerized tomography (CT) revealed a high-grade atrioventricular block and spontaneous brain arteriovenous malformation (AVM) rupture. The patient had complete resolution of her bradycardia and AV block following atropine. This case is to our knowledge the first description of a pediatric spontaneous brain AVM rupture presenting with high degree AV block responsive to intravenous atropine. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 16, 2019 Category: Emergency Medicine Authors: DO. Matthew Cully Source Type: research

Acute ST Elevation Myocardial Infarction due to Allergic Reaction, Kounis syndrome: A Case Report and Review of the Emergency Management
Kounis syndrome is defined by the occurrence of an acute coronary syndrome (ACS) in the setting of an allergic, hypersensitivity or anaphylactic condition. Degranulation of mast cells and platelet activation leading to the release of multiple inflammatory mediators are thought to make the arterial circulation susceptible to acute cardiac events. It is an often underdiagnosed entity in the emergency setting, due to lack of awareness among emergency providers. Identifying Kounis syndrome is critical, since managing ACS differs from that of a classical acute myocardial infarction. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 16, 2019 Category: Emergency Medicine Authors: Eva Rajha, Ahmad Didi, Habib Dakik, Afif Mufarrij Source Type: research

Aortic dissection in a 19  year old male without risk factors
Thoracic aortic dissection (TAD) is a fatal and rare disease that affects 0.003% of the population [1]. Early diagnosis is critical because there is 1 –2% mortality per hour after symptom onset in those in whom the problem goes unrecognized [2]. The presentation of TAD is usually chest and or back pain [3]. However, signs and symptoms associated with TAD can be variable, potentially complicating the diagnosis of this rare and deadly disease [4,5 ]. The aortic dissection detection risk score (ADD-RS) with D-dimer (ADvISED trials [6]) has recently been proposed as a decision rule to help guide the workup of TAD in low ...
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Ahmad Aalam, John Lafleur Tags: Case Report Source Type: research

Critical pancreatitis management associated with hypertriglyceridemia in pregnancy in emergency service
Because of the variable clinical features of acute pancreatitis, it is difficult to make a differential diagnosis in patients presenting with abdominal pain in emergency departments. Acute pancreatitis due to severe hypertriglyceridemia during pregnancy is rare but due to the increased risk of maternal and fetal mortality, diagnosis and treatment options should be known and should be performed in the emergency department, which is the first admission site.In this case report, we present a 20-year-old woman with 19  weeks pregnant who presented to the emergency department with abdominal pain and whose biochemistry para...
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Dilay Satilmi ş, Ömer Faruk Türkoğlu, Ramazan Güven, Başar Cander Source Type: research

Aortic dissection in a 19  year old male without risk factors, case report and selective review of the literature
Thoracic aortic dissection (TAD) is a fatal and rare disease that affects 0.003% of the population [1]. Early diagnosis is critical because there is 1 –2% mortality per hour after symptom onset in those in whom the problem goes unrecognized [2]. The presentation of TAD is usually chest and or back pain [3]. However, signs and symptoms associated with TAD can be variable, potentially complicating the diagnosis of this rare and deadly disease [4,5 ]. The aortic dissection detection risk score (ADD-RS) with D-dimer (ADvISED trials [6]) has recently been proposed as a decision rule to help guide the workup of TAD in low ...
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Ahmad Aalam, John Lafleur Source Type: research

National trends in U.S. emergency department visits for chief complaint of hypertension (2006 –15)
Hypertension is one of the most common chronic illnesses among adults in the United States. While poor hypertension control is a risk factor for many emergent conditions, asymptomatic hypertension is rarely an emergency. Despite this, patients may present to the emergency department (ED) with a chief complaint of hypertension, and there may be significant variability in the management of these patients. Our objective was to characterize national trends in ED visits for chief complaint of hypertension between 2006 and 2015. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Peter M. Mullins, Phillip D. Levy, Maryann Mazer-Amirshahi, Jesse M. Pines Source Type: research

Risk factors for bowel resection among patients with incarcerated groin hernias: A meta-analysis
Groin hernia repair is the most common elective operation performed worldwide with over 20 million operations per year [1]. The rate of hernia surgery varies from 10 per 10  000 people in the United Kingdom to 28 per 10 000 people in the United States [2]. Around 5–15% of hernia patients have incarceration, of which approximately 15% of cases may evolve into bowel necrosis requiring bowel resection [3]. Patients with bowel necrosis have a significantly longer hos pitalization and a higher postoperative complications, which varied from 6% to 43% [4–7], with a mortality rate of 1–7% [4,6]. (Source: The ...
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Peng Chen, Libin Huang, Wenming Yang, Diao He, Xueting Liu, Yong Wang, Yongyang Yu, Lie Yang, Zongguang Zhou Source Type: research

Acute intentional caffeine overdose treated preemptively with hemodialysis
Caffeine is the most commonly used central nervous system stimulant. While it has a high LD50 (150 –200 mg/kg), when ingested in significant quantity, caffeine can lead to severe and even lethal side effects. Manifestation of toxicity include tachyarrhythmias, seizures, and metabolic derangements which can eventually lead to cardiovascular collapse and death. Studies have shown that lethal dos es of caffeine (80–100 μg/mL) can be seen with the ingestion of approximately 10 g of caffeine. Due to the low number of reported cases, there is no consensus on the standard of care for treatment of sus...
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Benjamin A. Kohl, Kuljit Kaur, Nathan Dincher, Jessica Schumann, Tara Carachilo, Christopher Komurek Source Type: research

Isotretinoin-induced pruritic erythematous lesions and acute chest pain in a 15-year-old girl
We report a case of a 15-year-old girl given isotretin oin for severe acne vulgaris who developed pruritic erythematous lesions and chest pain 5 min after taking the first dose 20 mg of isotretinoin. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Ömer Doğan Alataş, Emine Tugba Alataş Source Type: research

External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP)
We validated prior emergency department (ED) assessments of the chest pain score accelerated diagnostic pathway (EDACS-ADP) in Korean patients. This score is designed to discriminate patients at a low risk of a major adverse cardiac event (MACE) from those with a potentially more serious condition. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Yo Sep Shin, Shin Ahn, Youn-Jung Kim, Seung Mok Ryoo, Chang Hwan Sohn, Won Young Kim Source Type: research

Risk factors for bowel resection among patients with incarcerated hernias: A meta-analysis
Groin hernia repair is the most common elective operation performed worldwide with over 20 million operations per year[1]. The rate of hernia surgery varies from 10 per 10000 people in the United Kingdom to 28 per 10000 people in the United States[2]. Around 5% –15% of hernia patients have incarceration, of which approximately 15% of cases may evolve into bowel necrosis requiring bowel resection[3]. Patients with bowel necrosis have a significantly longer hospitalization and a higher postoperative complications, which varied from 6% to 43%[4–7], with a mortality rate of 1%–7%[4,6]. (Source: The American J...
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Peng Chen, Libin Huang, Wenming Yang, Diao He, Xueting Liu, Yong Wang, Yongyang Yu, Lie Yang, Zongguang Zhou Source Type: research

Urolithiasis diagnosis with CHOKAI rule; are we there yet?
Dear Editor, (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Mohammad Jalili, Hadi Mirfazaelian Source Type: research

Delirium-informed Care in Emergency Departments: Diagnosis and Beyond
Delirium, an acute global brain dysfunction, has been reported to affect more than 10% of the patients in emergency departments (EDs) [1]. Although patients with delirium are more susceptible to adverse outcomes including mortality and cognitive decline, they are often mis- or under-diagnosed in wards and EDs [2 –4]. Additionally, only a limited number of researches have focused on delirium in EDs. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Hidetaka Tamune Source Type: research

Year-to-Year Trends in Emergency Medicine Morbidity and Mortality Cases
The objective of this study was to determine if M&M conferences can reduce repetitive error making demonstrated by a shift of the incidence of cases presented at M&M by chief complaint (CC) and experience of attendings. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Jason J. Lewis, Eric C. Hyder, Carlo Rosen, Richard E. Wolfe, Victor Novack, Shamai A. Grossman Source Type: research

Not a fungi to be with: shiitake mushroom flagellate dermatitis
We report the case of a patient who developed a striking linear flagellate dermatitis without urticaria three days after returning from a trip from Tokyo where he had eaten shiitake mushrooms. The rash resolved after two weeks with topical corticosteroids and antihistamines given for symptomatic relief. Shiitake dermatitis is thought to be either a toxic or hypersensitivity reaction to lentinan, a heat-inactivated polysaccharide found in the cell walls of shiitake mushrooms. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Randeep S. Heer, Neil B. Patel, Amit K.J. Mandal, Fiona Lewis, Constantinos G. Missouris Source Type: research

A Rare Massive Presentation of Catamenial Hemothorax
We present a case of a 32-year-old woman who presented with prolonged worsening dyspnea and was found to have a massive hemothorax on evaluation. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Akhilesh Somani, Saran Pillai, Munam Maryam, Anoop Chakrapani Source Type: research

Wooden Chest Syndrome: Beware of Opioid Antagonists, NOT Just Agonists
In a constantly increasing world of opioid addiction, naloxone has become a topic of great discussion and use. With seemingly minimal side effects, naloxone has become one of the most wellknown and widely used reversal agents for opioid intoxication. While more common effects of using naloxone include agitation, abdominal cramps, piloerection, diarrhea, nausea, and yawning, lesser known side effects involve muscle spasms, flushing, hyperreflexia in neonates, and seizures. This case study demonstrates a side effect of rigidity secondary to IV naloxone that h asnot previously been documented. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Rykiel Levine, Sergio Veliz, Daniel Singer Source Type: research

Vaginal Cuff Dehiscence – a potential surgical emergency
We present the case of a 40 year old female with a chief compliant of vaginal bleeding and severe abdominal pain after sexual intercourse. She was s/p total laparoscopic hysterectomy 3 months earlier. The history and physical exam were concerning for vaginal cuff dehiscence (VCD). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Ethan Sterk, Keven Stonewall Source Type: research

Treatment of acute naloxone-precipitated opioid withdrawal with buprenorphine
Naloxone is a frequently utilized and effective treatment to reverse the life-threatening effects of illicit opioid intoxication. Excessive naloxone dosing in these circumstances, however, may lead to naloxone-precipitated opioid withdrawal in individuals with opioid dependence. Buprenorphine, a partial mu-opioid agonist, is increasingly utilized in the Emergency Department (ED) for the treatment of opioid withdrawal syndrome but little is known regarding its utility in cases of naloxone-precipitated opioid withdrawal. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Neeraj Chhabra, Steven E. Aks Source Type: research

Isotretinoin-induced pruriticerythematous lesions and acute chest pain in a 15-year-old girl
We report a case of a 15-year-old girl given isotretinoin for severe acne vulgaris who developed pruriticerythematous lesions and chest pain 5 min after taking the first dose 20 mg of isotretinoin. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Ömer Doğan Alataş, Emine Tuba Alataş Source Type: research

Acute intentional caffeine overdose treated preemptively with hemodialysis,
Caffeine is the most commonly used central nervous system stimulant. While it has a high LD50 (150-200 mg/kg), when ingested in significant quantity, caffeine can lead to severe and even lethal side effects. Manifestation of toxicity include tachyarrhythmias, seizures, and metabolic derangements which can eventually lead to cardiovascular collapse and death. Studies have shown that lethal doses of caffeine (80-100 ug/mL) can be seen with the ingestion of approximately 10 g of caffeine. Due to the low number of reported cases, there is no consensus on the standard of care for treatment of suspected caffeine overdose. (Sourc...
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Benjamin A. Kohl, Kuljit Kaur, Nathan Dincher, Jessica Schumann, Tara Carachilo, Christopher Komurek Source Type: research

Weight-Based versus Non-Weight-Based Diltiazem Dosing in the Setting of Atrial Fibrillation with Rapid Ventricular Response
There is conflicting evidence to support the superiority of weight-based (WB) dosing of intravenous (IV) diltiazem over non-weight-based (NWB) dosing strategies in the management of atrial fibrillation (AFib) with rapid ventricular response (RVR). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Sara M. Ward, Jennifer Radke, Chara Calhoun, Jeffrey Caporossi, Gregory A. Hall, Andrew J. Matuskowitz, Erin R. Weeda, Kyle A. Weant Source Type: research

Cr ıtıcal pancreatıtıs management assocıated wıth hypertrıglycerıdemıa ın pregnancy ın emergency servıce
Because of the variable clinical features of acute pancreatitis, it is difficult to make a differential diagnosis in patients presenting with abdominal pain in emergency departments. Acute pancreatitis due to severe hypertriglyceridemia during pregnancy is rare but due to the increased risk of maternal and fetal mortality, diagnosis and treatment options should be known and should be performed in the emergency department, which is the first admission site.In this case report, we present a 20-year-old woman with 19 weeks pregnant who presented to the emergency department with abdominal pain and whose biochemistry parameters...
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Dilay Sat ılmış, Ömer Faruk Türkoğlu, Ramazan Güven, Başar Cander Source Type: research

Bromism: an overlooked and elusive toxidrome from chronic dextromethorphan abuse
A 47 year old woman presented to the emergency department for an intentional overdose of an over the counter cough suppressant. She had been seen multiple times over the last several months with the same presentation. Her work up revealed a significantly elevated chloride level (125 mmol/L, normal 98-107) as well as an anion gap of 1. She denied any other co-ingestions, including other over the counter medications or alcohol, and was otherwise asymptomatic. She was given fluids and supportive care. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Sarah Monks, Justin Myers, May Yen Source Type: research

The comparison of early identification scores in sepsis
To the editor, (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Yisong Cheng, Yu Jia, Dongze Li Source Type: research

Quality of Physician Care Coordination During Inter-Facility Transfer for Cardiac Arrest Patients
We sought to evaluate whether the quality of coordination between physicians transferring comatose cardiac arrest survivors to a high-volume cardiac arrest center for targeted temperature management (TTM) was associated with timeliness of care. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: S. Neil Holby, Daniel Mu ñoz, Sean P. Collins, Timothy J. Vogus, Cathy A. Jenkins, Dandan Liu, Michael J. Ward Source Type: research

The Feasibility of a Novel Method of Bystander CPR Training: A Pilot Study
This study sought to determine the efficacy of a training model developed to rapidly and effectively train large numbers of individuals on hands-only CPR. Thirty minute training sessions were developed to introduce hands-only CPR to faculty at a university, with questionnaires assessing confidence and knowledge of CPR. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Rebecca M. Kappus, Gary McCullough Source Type: research

National Trends in U.S. Emergency Department Visits for Chief Complaint of Hypertension (2006-15)
Hypertension is one of the most common chronic illnesses among adults in the United States. While poor hypertension control is a risk factor for many emergent conditions, asymptomatic hypertension is rarely an emergency. Despite this, patients may present to the emergency department (ED) with a chief complaint of hypertension, and there may be significant variability in the management of these patients. Our objective was to characterize national trends in ED visits for chief complaint of hypertension between 2006-2015. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Peter M. Mullins, Phillip D. Levy, Maryann Mazer-Amirshahi, Jesse M. Pines Source Type: research

Aortic dissection in a 19 year old male without risk factors, case report and selective review of the literature
Thoracic aortic dissection (TAD) is a fatal and rare disease that affects 0.003% of the population.[1] Early diagnosis is critical because there is 1-2% mortality per hour after symptom onset in those in whom the problem goes unrecognized.[2] The presentation of TAD is usually chest and or back pain.[3] However, signs and symptoms associated with TAD can be variable, potentially complicating the diagnosis of this rare and deadly disease.[4,5] The aortic dissection detection risk score (ADD-RS) with D-dimer (ADvISED trials[6]) has recently been proposed as a decision rule to help guide the workup of TAD in low risk patients...
Source: The American Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Ahmad Aalam, John Lafleur Source Type: research

Letter to the editor
We were dismayed to read the on-line preprint of the paper by Whei Jung and Dr. Joonghee Kim, exploring the association of physician gender on first-pass success during emergency endotracheal intubation. We understand that the authors subsequently submitted a revision with a broader analysis and a more nuanced discussion of any gender variables. However, we still wish to voice our concerns about papers that seek to associate physician gender with patient relevant outcomes. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 8, 2019 Category: Emergency Medicine Authors: Eve Purdy, Samantha A Batt-Rawden, Jae Won Joh, S. Luckett-Gatopoulos, Alim Pardhan, Saroo Sharda, Menaka Pai Source Type: research

A word for equity: the long road ahead
It was with great interest that we read the article by Jung and Kim entitled “Does physician gender have a significant impact on first-pass success rate of emergency endotracheal intubation?” [1]. Although, the aim of the study was undoubtedly noble, a first consideration would be in relation to the hypothesis for the non-inferiority design. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 8, 2019 Category: Emergency Medicine Authors: Laura Lorenzon, Gaya Spolverato, Isabella Frigerio, Domenico D'Ugo Source Type: research

Comparison of high-flow nasal cannula oxygen therapy and conventional reserve-bag oxygen therapy in carbon monoxide intoxication: A pilot study
High-flow nasal cannula oxygen (HFNC) creates a positive pressure effect through high-flow rates compared to conventional oxygen therapy. The purpose of this human pilot study is to compare the effects of HFNC and conventional oxygen therapy on the rate of carbon monoxide (CO) clearance from the blood in patients with mild to moderate CO poisoning. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 6, 2019 Category: Emergency Medicine Authors: Young-Min Kim, Hyun-Jo Shin, Dong-won Choi, Ji-Min Kim, Suk-Woo Lee, Seong-Hae Jeong, Hoon Kim Source Type: research

Reply to “Urolithiasis diagnosis with CHOKAI rule; are we there yet?”
Dear Editor: (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 5, 2019 Category: Emergency Medicine Authors: Hiroki Fukuhara, Masaki Nakane, Norihiko Tsuchiya Source Type: research

How much change in pain score does really matter to patients?
The goal of this study was to determine the minimal change in pain score recognized by patients as meaningful known as minimal clinically important difference (MCID). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 5, 2019 Category: Emergency Medicine Authors: Maryam Bahreini, Arash Safaie, Hadi Mirfazaelian, Mohammad Jalili Source Type: research

Acute perforated appendicitis after blunt abdominal trauma: A report from a 7-year-old
We report here a case of acute perforated appendicitis after a blunt abdominal trauma caused by a horse hoof kick to the abdomen in a 7-year-old boy. We also discussed the potential pathophysiologic mechanisms behind and reviewed the literature on this rare condition. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 1, 2019 Category: Emergency Medicine Authors: Zlatan Zvizdic, Irmina Pasic-Sefic, Semir Vranic Source Type: research

A Technical Dilemma: Single Shot or Continuous Injection for Novel Plane
Dear Editor; (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 1, 2019 Category: Emergency Medicine Authors: Ali Ahiskalioglu, Ahmet Murat Yayik, Muhammed Enes Aydin Source Type: research

On first-pass, twitter response is inferior to expectations
This article has been met with significant criticism on social media and many of the comments have fallen outside of what one might consider professional discourse. After a brief review of the social media response, in just less than 24  h on Twitter, we found 862 tweets, 168 retweeted, 123 comments with 17% including lewd and profane language which is disappointing and unbecoming to emergency medicine as an academic community. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 1, 2019 Category: Emergency Medicine Authors: K. Ogle, C. Roche, A. Pourmand Tags: Correspondence Source Type: research

Acute perforated appendicitis after blunt abdominal trauma: A report from a 7-year-old boy and literature review
We report here a case of acute perforated appendicitis after a blunt abdominal trauma caused by a horse hoof kick to the abdomen in a 7-year-old boy. We also discussed the potential pathophysiologic mechanisms behind and reviewed the literature on this rare condition. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 1, 2019 Category: Emergency Medicine Authors: Zlatan Zvizdic, Irmina Pasic-Sefic, Semir Vranic Source Type: research

(MS21362) A technical dilemma: Single shot or continuous injection for novel plane blocks?
Dear Editor; (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 1, 2019 Category: Emergency Medicine Authors: Ali Ahiskalioglu, Ahmet Murat Yayik, Muhammed Enes Aydin Source Type: research

Rhomboid Intercostal block for multiple rib fractures: should we add a continuous infusion?
To the Editor, (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 1, 2019 Category: Emergency Medicine Authors: Emanuele Piraccini, Thierry Claude Bagaphou, Roberto Righetti Source Type: research

Can Emoji ’s Assess Patients’ Mood and Emotion in the Emergency Department? An Emoji Based Study
Interpersonal communication has been drastically altered due to innovations in technology [1]. Emojis are currently an undeniable part of the world ’s communication language. Emojis are pictographs commonly used in Internet, electronic, and text messages and they are utilized by 92% of the online population [2]. They represent emotional and personality nuances which would be present in face-to-face communication [3]. Emojis may be a tool that can effectively and efficiently evaluate a patient’s mood in a busy ED setting. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 31, 2019 Category: Emergency Medicine Authors: A. Pourmand, T. Quan, SB. Amini, N. Sikka Source Type: research

Emergent complication of assisted reproductive technology: clinical analysis of 17 pregnant women with adnexal torsion
The purpose of this study was to evaluate the clinical symptoms, surgical management, and outcomes of pregnanct women with adnexal torsion due to assisted reproductive technology. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 24, 2019 Category: Emergency Medicine Authors: Yu Sun, Guofang Feng, Yanling Fu, Jiali You, Miao Li, Yimin Zhu Source Type: research

Is lactic acidosis predictive of outcomes in pediatric diabetic ketoacidosis?
The objective of this study was to investigate the significance and prevalence of lactic acidosis in pediatric diabetic ketoacidosis (DKA) presenting to the emergency department. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 24, 2019 Category: Emergency Medicine Authors: Matthew Cully, Amy D. Thompson, Andrew D. DePiero Source Type: research

Inhaled Budesonide for the Prevention of Acute Mountain Sickness: A Meta-Analysis of Randomized Controlled Trials
Altitude induces acute mountain sickness (AMS), which can affect the health or limit the activities of 15% to 80% of climbers and workers. Budesonide has been applied to prevent AMS. However, its prophylactic efficacy is controversial. Our purpose was to conduct a meta-analysis to assess whether budesonide qualifies as a prophylaxis for AMS. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 23, 2019 Category: Emergency Medicine Authors: Zhu Xiong, Liu Yunrui, Li Na, He Qing Source Type: research

Atomized intranasal vs intravenous fentanyl in severe renal colic pain management: A randomized single-blinded clinical trial
Pain is one of the most common complaints of patients referred to emergency departments [1]. Kidney stones affect approximately 1 in 11 people in the United States increasing to 1 in 5 among highest-risk groups [2]. The prevalence of renal stones has been reported as 5.7% in Iran. However, this rate may be influenced by age, sex, weight, diet and underlying diseases [3]. Accordingly, the prevalence of kidney stones increased in the late twentieth and through the twenty-first centuries. This has been attributed to a variety of factors including environmental changes, alterations in dietary habits, and increased prevalence o...
Source: The American Journal of Emergency Medicine - October 23, 2019 Category: Emergency Medicine Authors: Narjes Nazemian, Mehdi Torabi, Moghaddameh Mirzaee Source Type: research

Refusal of Emergency Medical Care: An Analysis of Patients Who Left Without Being Seen, Eloped, and Left Against Medical Advice
This study was undertaken to identify patient perspectives and reasons for refusal of care. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 23, 2019 Category: Emergency Medicine Authors: Catherine A. Marco, Morgan Bryant, Brock Landrum, Brenden Drerup, Mitchell Weeman Source Type: research

The Role of Repeat head CT in Patients with Mild Traumatic Intracranial Injury
We appreciate the comments by (Trevisi and Scerrati [1]) regarding timing of repeat head CT scan (RHCT) in patients with mild traumatic intracranial hemorrhage in our paper [2] published in AJEM It had been our practice to perform RHCT at 6  h to ensure that there had been no interval progression, unless the patient had a coagulopathy that required reversal; in those cases a RHCT was done once there was documented correction of the bleeding disorder (in our cohort this meant either vitamin K, and FFP or PCC) or a platelet transfusion . (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 14, 2019 Category: Emergency Medicine Authors: Pierre Borczuk Source Type: research

The efficacy of tranexamic acid for brain injury: A meta-analysis of randomized controlled trials
Tranexamic acid shows some treatment efficacy for traumatic brain injury. This systematic review and meta-analysis is conducted to investigate the efficacy of tranexamic acid for traumatic brain injury. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 14, 2019 Category: Emergency Medicine Authors: Hongshen Chen, Muhu Chen Source Type: research