The comparison of two prediction models for ureteral stones: CHOKAI and STONE scores
Renal colic is an emergency symptom characterized by sudden onset of intense pain secondary to urinary stone disease. It is the most common urologic disease of patients seeking help in the emergency department (ED) [1]. The overall prevalence of urinary stone disease is reported as 14% in Turkey [2]. In the United States, over 1 million patients are examined and treated for renal colic every year [3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 3, 2020 Category: Emergency Medicine Authors: A.K. Rohat, Erdem Kurt, Çağdaş Şenel Source Type: research

Identifying and quantifying robust risk factors for mortality in critically ill patients with COVID-19 using quantile regression
Many laboratory indicators form a skewed distribution with outliers in critically ill patients with COVID-19, for which robust methods are needed to precisely determine and quantify fatality risk factors. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 2, 2020 Category: Emergency Medicine Authors: Zeqiang Linli, Yinyin Chen, Guoliang Tian, Shuixia Guo, Yu Fei Source Type: research

Association of acute kidney injury with the severity and mortality of SARS-CoV-2 infection: A meta-analysis
we aimed to explore the relationship of acute kidney injury (AKI) with the severity and mortality of coronavirus disease 2019 (COVID-19). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 1, 2020 Category: Emergency Medicine Authors: Lichen Ouyang, Yeli Gong, Yan Zhu, Jie Gong Source Type: research

SARS-CoV-2 pharmacologic therapies and their safety/effectiveness according to level of evidence
There is a pressing need for COVID-19 transmission control and effective treatments. We aim to evaluate the safety and effectiveness of SARS-CoV-2 pharmacologic therapies as of August 2, 2020 according to study level of evidence. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 1, 2020 Category: Emergency Medicine Authors: Amanda Baroutjian, Carol Sanchez, Dessy Boneva, Mark McKenney, Adel Elkbuli Source Type: research

Novel biomarkers of oxidative stress as predictive indicators of neurological outcome after out-of-hospital cardiopulmonary arrest
This study was conducted to evaluate the utility of BAP and d-ROM in the prediction of patient outcomes after OHCPA. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 31, 2020 Category: Emergency Medicine Authors: Kouhei Ishikawa, Yoshiaki Inoue, Yuka Sumi, Yutaka Kondo, Ken Okamoto, Tanaka Hiroshi Source Type: research

Does prolonged emergency department length of stay(EDLOS) affect the outcomes of acute ischemic stroke patients?
The effect of emergency department length of stay (EDLOS) on outcomes of patients with acute ischemic stroke (AIS) remains largely unexamined. We aimed to investigate the association between EDLOS and outcomes in AIS patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 31, 2020 Category: Emergency Medicine Authors: Yan Wu, Xuechun Wu, Hong Pan, Yafang Zhu, Yan Qin, Yongrong Sun, Chun-Feng Liu, Yongjun Cao, Rongfang Shi, Xia Zhang Source Type: research

Toxic boost: Acute, reversible neurotoxicity after ingestion of methylcyclopentadienyl manganese tricarbonyl (MMT) mistaken for an energy drink
We present the case of a 54-year-old man who developed seizures and altered mental status after drinking 12  oz. of MMT-containing NOS Octane Booster Racing Formula. Due to label similarities, he mistook this for the NOS High Performance energy drink. The patient was intubated due to persistent seizures despite benzodiazepine treatment and admitted to the intensive care unit. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 31, 2020 Category: Emergency Medicine Authors: Antonia Nemanich, Betty Chen, Matthew Valento Source Type: research

Among numerous causes of high troponin values, we should not forget severe arterial hypertension
The recent paper from Long and colleagues reminds us of the multiple causes of increased cardiac troponin (cTn) concentration in the emergency department (ED) setting [1]. It is useful to update the recommendations for the optimal means of interpreting high cTn because it is a major method in diagnosing acute myocardial infarction (AMI), particularly AMI without ST elevation (NSTEMI). cTn is far more beneficial; it is capable of detecting myocardial injury/necrosis which increases cTn concentration in a number of diseases, and cTn can assist in diagnosis and risk stratification [2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 30, 2020 Category: Emergency Medicine Authors: Goran P. Koracevic Source Type: research

Neutrophil-to-lymphocyte ratio can predict hospitalization as well as mortality in emergency department
We read the article “Neutrophil to lymphocyte ratio is associated with in-hospital mortality in older adults admitted to the emergency department” by Song et al. [1] with interest. The authors hypothesized that an elevated Neutrophil to lymphocyte ratio (NLR) at admission to the emergency department (ED) increases the risk of in-hospital mortality in older adults. In the current study, optimal NLR cutoff value for predicting in-hospital mortality was 3.88, which had 82.14% sensitivity and 52.86% specificity (95% confidence interval 0.669–0.759, area under the curve: 0.714) in older patients admitted to ED...
Source: The American Journal of Emergency Medicine - August 30, 2020 Category: Emergency Medicine Authors: K ıvanç Karaman, Yunus Emre Özlüer, Yalçın Gölcük, Ahmet Demir Source Type: research

D-dimer can help differentiate suspected pulmonary embolism patients that require anti-coagulation
Determine whether D-dimer concentration in the absence of imaging can differentiate patients that require anti-coagulation from patients who do not require anti-coagulation. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 30, 2020 Category: Emergency Medicine Authors: Jatin Narang, Amy S. Nowacki, Spencer S. Seballos, Philip R. Wang, Sharon E. Mace Source Type: research

Intravenous insulin for the management of non-emergent hyperglycemia in the emergency department
There is currently no consensus regarding the necessity of emergency department (ED) glucose reduction to manage hyperglycemia in patients presenting without a hyperglycemic emergency. Known consequences of intravenous (IV) insulin administration include hypoglycemia, hypokalemia, and increased ED length of stay. The primary objective of this study was to assess the impact of IV regular insulin on glucose reduction and ED length of stay in patients presenting to the ED with non-emergent hyperglycemia. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 29, 2020 Category: Emergency Medicine Authors: Lauren J. Koscal, Erin R. Weeda, Andrew J. Matuskowitz, Kyle A. Weant Source Type: research

Epidemiology of fatal snakebites in the United States 1989 –2018
In this study we review the epidemiology of fatal snakebites. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 29, 2020 Category: Emergency Medicine Authors: Spencer C. Greene, Jason Folt, Kimberly Wyatt, Nicklaus P. Brandehoff Source Type: research

The implications of covid 19-related pneumomediastinum
The occurrence of spontaneous pneumomediastinum in a patient with covid 19 infection [1] is reminiscent of the occurrence of pneumomediastinum in a 64-year old woman with severe acute respiratory syndrome(SARS), as reported by Tak-Sun et al. in 2004 [2]. In the latter instance the occurrence of pneumomediastinum was associated with chest pain and new T wave inversion over the precordial leads. Creatine kinase and troponin levels, however, were normal. Echocardiography and coronary angiography also showed no abnormalities [2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 29, 2020 Category: Emergency Medicine Authors: Oscar M.P. Jolobe Source Type: research

Surgical results in penile fracture: Our single center experience
In this study, we aimed to determine the effectiveness of surgical treatment in penile fracture and its effect on complications. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 29, 2020 Category: Emergency Medicine Authors: Fatih Kursat Yilmazel, Emre Sam, Mehmet Sefa Altay, Ahmet Emre Cinislioglu, Emel Sam, Orhan Delice, Ibrahim Karabulut Source Type: research

Non-invasive zero-heat-flux technology compared with traditional core temperature measurements in the emergency department
Core temperatures (Tcore) are often invasive, and can be underutilized. Peripheral temperatures are easier to obtain, but are often less accurate. A zero-heat-flux thermometer (ZHF) is a non-invasive method to obtain core temperatures (TZHF), and has been accurate when compared to Tcore in the operating room. We aimed to determine whether TZHF accurately and reliably measures Tcore in emergency department (ED) patients when compared to rectal, bladder or esophageal temperatures. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 28, 2020 Category: Emergency Medicine Authors: Danielle Hart, Megan Rischall, Kyle Durgin, Matthew Donoghue, Thanh Pham, Thomas Wyatt, Jamie Stang, Paige DeVries, Brian Driver Source Type: research

Forty years of emergency medicine research: Uncovering research themes and trends through topic modeling
Topic identification can facilitate knowledge curation, discover thematic relationships, trends, and predict future direction. We aimed to determine through an unsupervised, machine learning approach to topic modeling the most common research themes in emergency medicine over the last 40  years and summarize their trends and characteristics. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 28, 2020 Category: Emergency Medicine Authors: Thomas Porturas, R. Andrew Taylor Source Type: research

Tranexamic acid for gastrointestinal bleeding: A systematic review with meta-analysis of randomized clinical trials
This study, therefore, aimed to determine whether or not tranexamic acid should be used in gastrointestinal bleeding management through systematic review and meta-analysis. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 28, 2020 Category: Emergency Medicine Authors: Po-Lin Lee, Kai-Suan Yang, Hong-Wei Tsai, Sen-Kuang Hou, Yi-No Kang, Chun-Chao Chang Source Type: research

Validity of a five-level prehospital triage system in Japan: A cohort study
This study aimed to validate the five-level triage system. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 28, 2020 Category: Emergency Medicine Authors: Atsushi Yamamoto, Akira Kuriyama, Tetsunori Ikegami Source Type: research

Emergency department medication dispensing reduces return visits and admissions
Return visits to the emergency department (ED) and subsequent readmissions are common for patients who are unable to fill their prescriptions. We sought to determine if dispensing medications to patients in an ED was a cost-effective way to decrease return ED visits and hospital admissions for skin and soft tissue infections (SSTIs). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 28, 2020 Category: Emergency Medicine Authors: Andrea Blome, Caroline Kaigh, Claire Shaffer, Emily Peoples, Wayne A. Satz, Eun Kim, George Baby, Karen Stauffer, Kraftin E. Schreyer Source Type: research

Assessment of dynamic changes in cardiac function during resuscitation of patients with suspected septic shock: A prospective, observational, cohort study
To describe changes in cardiac function throughout the course of resuscitation of patients with suspected septic shock. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 27, 2020 Category: Emergency Medicine Authors: Nikolai Schnittke, Jessica Schmidt, Umang Barvalia, Kevin Emmerich, Pierre Kory, Sara Damewood Source Type: research

Misplaced tracheoesophageal voice prosthesis: A case of foreign body aspiration
We describe management of a patient with laryngectomy presenting with aspiration of a tracheoesophageal voice prosthesis (TEP). The TEP was not initially seen in chest radiography; however, computed tomography showed it within the right lower bronchus. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 27, 2020 Category: Emergency Medicine Authors: Abia-Trujillo David, Tatari Mehmet, Venegas-Borsellino Carla, Hoffman Ryan, Fox Hannah, Fernandez-Bussy Isabel, Guru Pramod Source Type: research

Mycoplasma pneumonia and atypical acute hemorrhagic edema of infancy
We report an atypical presentation of AHEI in a 1 year 5 months old boy starting initially over the trunk and back, then spreading to the face and extremities. Mycoplasma pneumonia IgM was found to be positive. The ras h resolved spontaneously within two weeks. Herein we present a case of Mycoplasma induced AHEI with an atypical clinical presentation followed by a review of the literature. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 27, 2020 Category: Emergency Medicine Authors: Elie Saliba, Alain Sayad, Lama Alameddine, Kim El-Haddad, Zeina Tannous Source Type: research

Severe prolonged agitation due to intranasal naloxone overexposure
Naloxone is a frequently administered, life-saving medication. In the setting of the opioid crisis, there are efforts to increase naloxone availability to the general public. In this setting, it is important to ensure that the lay public has instructions for proper administration of naloxone [1]. The presented case details a severe reaction to inappropriate administration of naloxone, highlighting the need for naloxone prescribers to teach how, when, and how much naloxone should be administered in the setting of opioid overdose. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 27, 2020 Category: Emergency Medicine Authors: Daniel S. Brenner, Andrew I. Stolbach, Juliana Zschoche, Leah Bright Source Type: research

Non-invasive core temperature measurements in the emergency department: Where is the data?
Fever remains one of the most common patient complaints in the Emergency Department (ED), accounting for 15% of visits in the elderly and 5% in adult population [1]. Promptly identifying febrile patients in the ED can have a significant impact in medical management by allowing a diagnostic workup, starting early-goal-directed therapy, and ultimately favoring a positive outcome [2]. Temperature measurement in an ED patient should be done through a method that accurately and reliably correlates with core temperature (Tcore) [1,3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 27, 2020 Category: Emergency Medicine Authors: Alan Araiza, Melanie Duran, Joseph Varon Source Type: research

Early predictors of mortality for moderate to severely ill patients with Covid-19
Determining the factors affecting the mortality and clinical conditions of the patients with Covid-19 are indispensable needs in developing patient treatment algorithms. We aimed to determine the parameters that can predict the mortality of moderate to severely ill patients with laboratory confirmed Covid-19. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 27, 2020 Category: Emergency Medicine Authors: G ökhan Aksel, Mehmet Muzaffer Islam, Abdullah Algin, Serkan Emre Eroğlu, Gökselin Beleli Yaşar, Enis Ademoğlu, Ümit Can Dölek Source Type: research

Impact of COVID-19 on professional and personal responsibilities of Massachusetts physicians
State and city-level stay-at-home orders/advisories during the COVID-19 pandemic are an essential part of the public health response. These advisories directly and indirectly impact the professional and personal lives of physicians [1]. Before the pandemic, gender differences in work-life balance were present [2,3], and pandemic related impacts will potentially exacerbate these inequities. Physician organizations have focused on physician wellness in the face of this pandemic. To target interventions, it is important to understand the pandemic-related impacts on physician work and life [4]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 27, 2020 Category: Emergency Medicine Authors: Kelsey A. Miller, Rebekah Mannix, Gillian Schmitz, Michael C. Monuteaux, Lois Lee Source Type: research

Efficacy of methylene blue in a murine model of amlodipine overdose
Amlodipine overdoses have significant cardiac toxicity and are difficult to treat. Methylene blue has potential as a treatment for overdoses. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 27, 2020 Category: Emergency Medicine Authors: Lisandra E. de Castro Br ás, Cecile L. Baccanale, Lex Eccleston, Trey Sloan, Jason C. St Antoine, Steven Matthew-Lewis Verzwyvelt, Peggy Pittman, Dorcas O'Rourke, William J. Meggs Source Type: research

The prognostic value of HEART score in patients with cocaine associated chest pain: An age-and-sex matched cohort study
HEART score is widely used to stratify patients with chest pain in the emergency department but has never been validated for cocaine-associated chest pain (CACP). We sought to evaluate the performance of HEART score in risk stratifying patients with CACP compared to an age- and sex-matched cohort with non-CACP. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 26, 2020 Category: Emergency Medicine Authors: Ziad Faramand, Christian Martin-Gill, Stephanie O. Frisch, Clifton Callaway, Salah Al-Zaiti Source Type: research

Effect of the abdominal aortic and junctional tourniquet on chest compressions in a swine model of ventricular fibrillation
Mortality for out-of-hospital cardiac arrest is high when traditional chest compressions are used without adjuncts. The abdominal aortic and junctional tourniquet (AAJT) is a device with a wedge-shaped air bladder that occludes the aortic bifurcation, augmenting blood flow to the heart and brain. Previously, the addition of AAJT during chest compression led to an increase in rate of survival in a model of traumatic cardiac arrest. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 26, 2020 Category: Emergency Medicine Authors: Christopher W. Hewitt, Matthew A. Pombo, Perry Blough, Maria G. Castaneda, Thomas J. Percival, Jason Rall Source Type: research

Adding eye protection to universal masking reduces COVID-19 among frontline emergency clinicians to the level of community spread
Healthcare workers (HCWs) in the emergency departments (EDs) are at high risk to contract COVID-19. There is consensus in the medical community that universal masking reduces infection rates of HCWs [1-3]. N-95 respirator masks or surgical masks, eye protection, and physical distancing of>1  m or more have all been shown to decrease transmission of SARS-CoV-2 and the related coronaviruses SARS-CoV-1 (SARS) and Middle East respiratory syndrome (MERS) [1]. There has only been one report thus far adding eye protection to universal masking, with no transmission to HCWs who added face shi elds in India during home visits [...
Source: The American Journal of Emergency Medicine - August 26, 2020 Category: Emergency Medicine Authors: Edward S. Hawkins, Baruch S. Fertel, McKinsey R. Muir, Stephen W. Meldon, Fernando J. Delgado, Courtney M. Smalley Source Type: research

COVID-19: Optimizing healthcare provider wellness and posttraumatic growth
SARS-2003, H1N1 Influenza 2009, MERS-2012, and now the COVID-2019 pandemic disrupt society in unpredictable ways [1]. Responses to COVID-19 include remote schooling, limited gatherings and suspension of economic activity [2]. Major stressors lead to diverse outcomes, negative and positive. Individuals who lose loved ones, suffer intimate partner violence, serve in violent military operations, and suffer from serious medical conditions can ultimately become stronger. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 26, 2020 Category: Emergency Medicine Authors: Martin Huecker, Jacob Shreffler, Daniel Danzl Source Type: research

A coronavirus disease 2019 (COVID-19) patient with bilateral orchitis: A case report
We describe a novel case of SARS-CoV2 bilateral orchitis in a previously healthy 37-year-old male who presented for testicular pain with constitutional symptoms. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 26, 2020 Category: Emergency Medicine Authors: Rachel E. Bridwell, Daniel R. Merrill, Sean A. Griffith, Jesse Wray, Joshua J. Oliver Source Type: research

Thrombolysis during CPR
Editor – Hamera et al. reported the successful cardiopulmonary resuscitation (CPR) of a 47-year-old patient with out-of-hospital cardiac arrest (OHCA) after administration of intravenous tissue plasminogen activator (t-PA) [1]. This well written case report relights the topic on systemic thrombolysis dur ing CPR. Thrombolytics may rapidly induce reduction of plasma viscosity by cleavage of fibrinogen [2]. Under the restricted conditions of ongoing CPR thrombolysis enhances microcirculation, improves coronary perfusion and most notably ameliorates cerebral reperfusion [3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 24, 2020 Category: Emergency Medicine Authors: W. Lederer Source Type: research

Outpatient treatment of pulmonary embolism: A single center 4-year experience
Pulmonary embolus (PE) is associated with significant utilization of health resources. As patients can be risk-stratified, there is an opportunity for a subset of patients to be safely treated without hospitalization, thus reducing the associated costs of treatment. Our aim was to describe the population, treatment strategies, complications, and outcomes associated with outpatient management of PE following treatment in the ED. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 22, 2020 Category: Emergency Medicine Authors: Anne Huyler, Casey Z. MacVane, Tania Strout, Andrew D. Perron Source Type: research

Prehospital end-tidal CO2 as an early marker for transfusion requirement in trauma patients
Objective: Below normal end-tidal carbon dioxide measurement (ETCO2) is associated with worse outcomes in sepsis and trauma patients as compared to patients with normal ETCO2. We sought to determine if ETCO2 can be used in the prehospital setting to predict transfusion requirement, operative hemorrhage control, or mortality in the first 24  h after admission for trauma.Methods: This is a retrospective cohort study at a suburban, academic Level 1 Trauma Center. Patients were sequentially identified as prehospital trauma alerts from a single EMS system which requires, per policy, ETCO2 for all traumas. (Source: The America...
Source: The American Journal of Emergency Medicine - August 22, 2020 Category: Emergency Medicine Authors: Bryan R. Wilson, John Bruno, Marcus Duckwitz, Natalie Akers, Donald Jeanmonod, Rebecca Jeanmonod Source Type: research

A snapshot of emergency department volumes in the “epicenter of the epicenter” of the COVID-19 pandemic
[hospital name masked for blind review] was one of the first and hardest hit hospitals in the coronavirus disease 2019 (COVID-19) pandemic, prompting politicians to dub it the “epicenter of the epicenter” of the crisis [1]. Emergency department (ED) clinicians anecdotally noted increased patient volumes as early as late February 2020, which rose precipitously before dropping to strikingly low levels, though patients who continued to present generally seemed more serio usly ill than usual. This paper quantifies [hospital] ED volumes from early March to late May 2020 and compares them to corresponding 2019 volume...
Source: The American Journal of Emergency Medicine - August 22, 2020 Category: Emergency Medicine Authors: Nicola Feldman, Rikki Lane, Laura Iavicoli, Veronica Delgado, Phillip Fairweather, Stuart Kessler, Suzanne Bentley Source Type: research

Acute necrotizing encephalopathy: A case report
We report a previously healthy two-year-old boy who presented to our emergency department (ED) after a seizure in the setting of fever and diarrhea. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 22, 2020 Category: Emergency Medicine Authors: Evan L. Jackson, Wesley Eilbert, Amber M. Hathcock Source Type: research

Diversity and inclusion among U.S. emergency medicine residency programs and practicing physicians: Towards equity in workforce
Emergency Medicine is a unique field in which patient populations often comprise a wide-variety of racial, ethnic, socioeconomic, and gender backgrounds. US Census Bureau projections predict that minority groups will comprise more than half of the population by the year 2044 [1]. Such projections indicate the need for a proportionate increase in diversity in the field of medicine. Increased diversity within medicine brings benefits to underserved and multicultural patient populations through reduction of health disparities and improved outcomes [2-8]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 22, 2020 Category: Emergency Medicine Authors: Tori Ehrhardt, Aaron Shepherd, Kyle Kinslow, Mark McKenney, Adel Elkbuli Source Type: research

U.S. alcohol associated traffic injuries and fatalities from 2014 to 2018
This study aims to evaluate an association between blood alcohol concentration (BAC) and number of crash injuries and fatalities from 2014 to 2018 in the U.S. Additionally, we aim to recommend solutions to reduce alcohol-impaired driving related injuries and fatalities. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 21, 2020 Category: Emergency Medicine Authors: Sabrina Gill, Mason Sutherland, Mark McKenney, Adel Elkbuli Source Type: research

More on Heyde ’s syndrome (Referencing MS. 24019)
We agree that finding a loud systolic murmur in a patient with a history of gastrointestinal bleeding and anemia should raise the suspect of Heyde ’s syndrome [1]. Physical examination has been historically viewed as a stand-alone tool in patient care and there is consensus that a well-performed cardiac examination and auscultation are cost-effective and have an excellent sensitivity and specificity for recognizing aortic stenosis or other v alve disorders even in this era with increasing demand for sophisticated imaging techniques. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 21, 2020 Category: Emergency Medicine Authors: Giuseppe Famularo, Marzia Marrollo Source Type: research

Adoption of 2016 EpiPen administration instructions by pediatric emergency department staff
Anaphylaxis is a severe allergic reaction affecting 1 –5% of the United States population [1,2,3]. Patients and caregivers of young patients with anaphylaxis should receive instruction on proper epinephrine autoinjector (EAI) use [5]. To prevent injuries, EAI users must hold the device against the thigh for the minimum recommended time and receive co unseling on restraining young children. Previously, the EpiPen (Mylan, Canonsburg, PA) label recommended 10-second injection. In 2016 [8], this was revised to 3-second injection following studies demonstrating safe one-second administration, along with instructions to ho...
Source: The American Journal of Emergency Medicine - August 21, 2020 Category: Emergency Medicine Authors: Miriam Samstein, Timmy Li, Michael Cassara, Artemio Jongco Source Type: research

Gender-based differences of copeptin alone or combined with troponin for early rule-out of non-ST-elevation myocardial infarction
Little is known about the role of gender in the dual biomarker strategy using copeptin and troponin for the early rule-out of non-ST-elevation myocardial infarction (NSTEMI). We aimed to evaluate gender-based differences on copeptin levels, combined negative predictive value (NPV) and predictors of copeptin elevation at admission. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 21, 2020 Category: Emergency Medicine Authors: Kris G. Vargas, Milos Tajsic, Ardashel Latsuzbaia, Sascha Bastian, Tijana Andric, Mona Kassem, Bernhard J äger, Kurt Huber Source Type: research

Thromboelastometry-guided anticoagulation reversal in a patient with ventricular assist device with intracranial hemorrhage
We present a case of a 42-year-old male with a VAD and on warfarin who presented to the emergency department with ICH necessitating anticoagulant reversal. An attenuated dose of 15  units/kg of 4-factor prothrombin complex-concentrates (4F-PCC) was given and the patient’s coagulation profile was subsequently assessed using rotational thromboelastometry (ROTEM®) to determine appropriateness of reversal. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 21, 2020 Category: Emergency Medicine Authors: Veronica A. Bonderski, Josue Portillo, Lydia Sharp, Megan A. Rech Source Type: research

Intravenous thiamine for septic shock: A meta-analysis of randomized controlled trials
The efficacy of intravenous thiamine to treat septic shock remains controversial. We conduct a systematic review and meta-analysis to explore the impact of intravenous thiamine on treatment efficacy of septic shock. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 20, 2020 Category: Emergency Medicine Authors: Xiangfeng Qian, Zhe Zhang, Feng Li, Longchuan Wu Source Type: research

Erector spinae block versus serratus anterior block in chest wall trauma, which is better?
Dear editor, (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 19, 2020 Category: Emergency Medicine Authors: Andrew Houghton Source Type: research

Digital health innovation to integrate palliative care during the COVID-19 pandemic
The novel coronavirus (SARS-CoV-2) pandemic has raised difficult questions about how we will allocate hospital resources as the volume of severely ill patients threatens to exceed conventional capacity [1,2]. As emergency physicians, we are skilled at performing intubations and other critical life-saving procedures when patients arrive to us in extremis. However, palliative care is not as readily available in most emergency departments [3,4]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 19, 2020 Category: Emergency Medicine Authors: Lucinda Lai, Rintaro Sato, Kei Ouchi, Adam B. Landman, Haipeng Mark Zhang Source Type: research

Emergent reversal of oral factor Xa inhibitors with four-factor prothrombin complex concentrate
Controversy exists regarding first-line use of the recently approved reversal agent andexanet alfa due to limitations of the ANEXXA-4 study, thrombotic risks, and high medication acquisition cost. The purpose of this study was to evaluate the safety and effectiveness of 4F-PCC for the reversal of emergent oral fXa inhibitor-related bleeding. Furthermore, we aimed to evaluate a subgroup using strict ANNEXA-4 patient selection criteria. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 19, 2020 Category: Emergency Medicine Authors: Louis Lipari, Sam Yang, Brian Milligan, Joseph Blunck Source Type: research

Severe sepsis and septic shock in patients transported by prehospital services versus walk in patients to the emergency department
Sepsis is a leading cause of death in the hospital for which aggressive treatment is recommended to improve patient outcomes. It is possible that sepsis patients brought in by emergency medical services (EMS) have a unique advantage in the emergency department (ED) which could improve sepsis bundle compliance. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 19, 2020 Category: Emergency Medicine Authors: Angelica Loza-Gomez, Erik Hofmann, Chun NokLam, Michael Menchine Source Type: research

Cancer is associated with coronavirus disease (COVID-19) severity and mortality: A pooled analysis
Coronavirus disease 2019 (COVID-19) is a rapidly escalating pandemic that has spread to many parts of the world. As such, there is urgent need to identify predictors of clinical severity in COVID-19 patients. This may be useful for early identification of patients who may require life-saving interventions. In this meta-analysis, we evaluated whether malignancies are associated with a significantly enhanced odds of COVID-19 severity and mortality. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 19, 2020 Category: Emergency Medicine Authors: Isaac Cheruiyot, Vincent Kipkorir, Brian Ngure, Musa Misiani, Jeremiah Munguti Source Type: research

Splenic volvulus of a wandering spleen
Wandering spleen is a rare condition in which the spleen is not anchored properly, due to congenital or acquired weakness of the splenic ligaments. This allows the spleen to migrate to any portion of the abdomen or pelvis, and can cause complications, including a splenic volvulus. The presentation of splenic volvulus of a wandering spleen ranges from mild pain to a surgical emergency. Splenic volvulus of a wandering spleen can cause significant morbidity and mortality, and often warrants surgical intervention. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 18, 2020 Category: Emergency Medicine Authors: William J. Schaeffer, S.M. Jafar Mahmood, Sarah A. Vermillion, Raphael Sweet, Nathan L. Haas Source Type: research