Response to “The wider implications of AD-related AR and pulmonary edema”
We really appreciate the response from the readers regarding the implications of acute aortic regurgitation (AR) and pulmonary edema in the diagnosis of aortic dissection. As mentioned by the authors, AR, whenever present, is an important clue to the diagnosis of aortic dissection. This is most likely if the AR is new-onset. Even in patients without clear history or previous physical examination records of AR murmur (as is commonly encountered at the emergency room), the identification of AR murmur on auscultation should raise the suspicion of specific etiologies such as aortic dissection. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 14, 2018 Category: Emergency Medicine Authors: Wei-Tien Chang, Wan-Ching Lien, Wen-Jone Chen Tags: Correspondence Source Type: research

Prehospital advanced cardiac life support by EMT with a smartphone-based direct medical control for nursing home cardiac arrest
To compare the survival to discharge between nursing home (NH) cardiac arrest patients receiving smartphone-based advanced cardiac life support (SALS) and basic life support (BLS). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 14, 2018 Category: Emergency Medicine Authors: Changsun Kim, Hyuk Joong Choi, Hyungjun Moon, Giwoon Kim, Choungah Lee, Jin Sung Cho, Seongjung Kim, Kyoungmi Lee, Hanjoo Choi, Wonjung Jeong Source Type: research

Relative tachycardia is associated with poor outcomes in post-cardiac arrest patients regardless of therapeutic hypothermia
To investigate whether the relationship between heart rate and neurological outcome is independent of therapeutic hypothermia (TH) and whether heart rate is related to hemodynamic instability post-cardiac arrest. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 14, 2018 Category: Emergency Medicine Authors: Jung-In Ko, Kyung Su Kim, Gil Joon Suh, Kyuseok Kim, Woon Yong Kwon, Jonghwan Shin, You Hwan Jo, Yoon Sun Jung, Taegyun Kim, So Mi Shin Source Type: research

Emergency department utilization by newly pregnant adolescents: A community-based study
Teen pregnancy and birth rates in the United States remain among the highest of industrialized nations, with approximately 25% of girls becoming pregnant before age 20 [1]. Early diagnosis of pregnancy in this age group is of utmost importance. Adolescents are at an increased risk for many complications during pregnancy such as high blood pressure, anemia, having low birthweight babies and premature birth, and adolescents also tend to have lower rates of prenatal care [2, 3]. Delayed or absence of prenatal care for pregnant adolescents has been shown to correlate with higher rates of preterm birth, increased infant mortali...
Source: The American Journal of Emergency Medicine - June 13, 2018 Category: Emergency Medicine Authors: Lindsey Ouellette, Stephanie Wigstadt, Adam Nicholson, Angela Zamarripa, Jeffrey Jones Source Type: research

Optimal sequence of surgical procedures for hemodynamically unstable patients with pelvic fracture: A network meta-analysis
The mortality rate of patients with hemodynamic instability due to severe pelvic fracture remains substantial and massive transfusion happens frequently. Angio-embolization, external fixation and preperitoneal pelvic packing of the pelvis are the main managements used to control bleeding in these patients. In this paper, we aimed at characterizing the rationale of these surgical managements, and placed them in optimal management algorithm to compose a new guideline. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 13, 2018 Category: Emergency Medicine Authors: Jingli Tang, Zhanying Shi, Juzheng Hu, Hao Wu, Chengzhi Yang, Guoping Le, Jinmin Zhao Source Type: research

“I'm pregnant?” Emergency department utilization by newly pregnant adolescents: A community-based study
Teen pregnancy and birth rates in the United States remain among the highest of industrialized nations, with approximately 25% of girls becoming pregnant before age 20 [1]. Early diagnosis of pregnancy in this age group is of utmost importance. Adolescents are at an increased risk for many complications during pregnancy such as high blood pressure, anemia, having low birthweight babies and premature birth, and adolescents also tend to have lower rates of prenatal care [2, 3]. Delayed or absence of prenatal care for pregnant adolescents has been shown to correlate with higher rates of preterm birth, increased infant mortali...
Source: The American Journal of Emergency Medicine - June 13, 2018 Category: Emergency Medicine Authors: Lindsey Ouellette, Stephanie Wigstadt, Adam Nicholson, Angela Zamarripa, Jeffrey Jones Source Type: research

Supraglottic airway device placement by respiratory therapists
Respiratory Therapists (RTs) are some of the first staff to arrive at in-hospital incidents where cardiopulmonary resuscitation (CPR) is needed, yet at some facilities, their ability to intubate is limited by hospital scope of practice. During the intubation process, CPR is often interrupted which could potentially increase the likelihood of adverse patient outcomes. Training RTs to secure the airway using non-intubation methods may reduce or eliminate time for CPR interruptions and allow for earlier continuous/uninterrupted chest compressions. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 13, 2018 Category: Emergency Medicine Authors: David J. Heegeman, William D. Rosandick, Rachel H. Boehning-Anderson, Andrew R. Woltmann Source Type: research

Synchronous urinothorax and uroperitoneum
Urinothorax was first described in 1968 by Corriere et al. as the presence of urine in the pleural cavity due to retroperitoneal leakage of accumulated urine. Herein, we present a female patient, who complained of dyspnea due to urinothorax. This is the first case of urinothorax that developed so tardive after radiotherapy and was diagnosed due to high clinical evidence despite the negative scintigraphy. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 12, 2018 Category: Emergency Medicine Authors: Natalia Vallianou, Victoria Gennimata, Fotis Constantinou, Dimitrios Karamanolakis, Alkiviades Grigorakis Tags: Case Report Source Type: research

Paramedic determination of appropriate emergency department destination
Freestanding emergency departments (FSED) are equipped to care for most emergencies, but do not have all the resources that hospital-based emergency departments (ED) offer. As the number of FSEDs grows rapidly, emergency medical services (EMS) must routinely determine whether a FSED is an appropriate destination. Inappropriate triage may delay definitive care, potentially increasing morbidity, mortality, and resource utilization. We sought to evaluate paramedics' ability in determining whether a FSED is the most appropriate destination. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 12, 2018 Category: Emergency Medicine Authors: Charles W. Hwang, Desmond E. Fitzpatrick, Torben K. Becker, Jason M. Jones Source Type: research

A rare case of synchronous urinothorax and uroperitoneum
Urinothorax was first described in 1968 by Corriere et al. as the presence of urine in the pleural cavity due to retroperitoneal leakage of accumulated urine. Herein, we present a female patient, who complained of dyspnea due to urinothorax. This is the first case of urinothorax that developed so tardive after radiotherapy and was diagnosed due to high clinical evidence despite the negative scintigraphy. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 12, 2018 Category: Emergency Medicine Authors: Natalia Vallianou, Victoria Gennimata, Fotis Constantinou, Dimitrios Karamanolakis, Alkiviades Grigorakis Source Type: research

Comparison of clinical risk scores for triaging high-risk chest pain patients at the emergency department
Many of the clinical risk scores routinely used for chest pain assessment have not been validated in patients at high risk for acute coronary syndrome (ACS). We performed an independent comparison of HEART, TIMI, GRACE, FRISC, and PURSUIT scores for identifying chest pain due to ACS and for predicting 30-day death or re-infarction in patients arriving through Emergency Medical Services (EMS). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 8, 2018 Category: Emergency Medicine Authors: Salah S. Al-Zaiti, Ziad Faramand, Mohammad Alrawashdeh, Susan M. Sereika, Christian Martin-Gill, Clifton Callaway Source Type: research

N-terminal pro-brain natriuretic peptide and prediction of coronary artery dilatation in hyperacute phase of Kawasaki disease
This study aimed to investigate the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and CAD in patients with the hyperacute phase ( ≤4 days of fever) of KD. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 8, 2018 Category: Emergency Medicine Authors: Jae Yun Jung, Eun Mi Ham, Hyuksool Kwon, Young Ho Kwak, Do Kyun Kim, Jin Hee Lee, Jin Hee Jung Source Type: research

Injuries associated with hoverboard use: A review of the National Electronic Injury Surveillance System
Hoverboards have become popular since they became available in 2015. We seek to provide an estimate of the number of injuries in the United States for 2015 and 2016, and to evaluate differences between adult and pediatric injury complexes. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 8, 2018 Category: Emergency Medicine Authors: Cody McIlvain, Galadima Hadiza, Theodore J. Tzavaras, Gregory S. Weingart Source Type: research

QSOFA score in identifying the septic patients according to Sepsis 1.0 or Sepsis 2.0, putting new wine into old bottles?
We read the interesting article by Barbara et al. [1], who conducted a retrospective chart review study and found that emergency medical services (EMS) patients with positive quick sequential organ failure assessment (qSOFA) were more likely to be septic upon admission to the emergency department (ED). Though this study sounds scientific, we still have some questions and different views after reading the article [1]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 7, 2018 Category: Emergency Medicine Authors: Xianshi Zhou, Fanwei Wu Source Type: research

Acute infectious aortitis presenting as pyelonephritis
A 65-years-old man with poorly controlled type 2 diabetes presented to the emergency department with a 2-week history of new-onset fever, dysuria, back and abdominal pain. The patient had lumbar facets corticosteroid infiltration 6  months ago. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 7, 2018 Category: Emergency Medicine Authors: Goran Rimac, Alexandre Lafleur Source Type: research

Rhabdomyolysis in a patient complicated with hypopituitarism and multiple organ dysfunction syndrome and the literature review
Muscular symptoms, including stiffness, myalgia, cramps, and fatigue, are present in the majority of the patients with hypopituitarism, adrenal insufficiency and hypothyroidism, but rhabdomyolysis, the rapid breakdown of skeletal muscle, is a rare manifestation. In most patients who develop rhabdomyolysis, precipitating factors, such as strenuous exercise or use of lipid-lowering drugs, can be identified. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 7, 2018 Category: Emergency Medicine Authors: Chuan Zhou, Shichao Lai, Yong Xie, Su Zhang, Yiping Lu Source Type: research

The wider implications of AD-related AR and pulmonary oedema
When aortic dissection (AD) presents with aortic regurgitation (AR) and pulmonary edema the coexistence of chest pain should be sufficient to raise the index of suspicion for AD, as was the case in the recent report [1]. Even when chest pain is initially attributed to acute myocardial infarction(AMI) [2,3], and the electrocardiogram is supportive of that diagnosis, the coexistence of AR and either pulmonary edema [2] or pulmonary congestion [3] should still raise awareness of AD, given the fact that AD could be an underlying cause of both AMI [4] and AR [1]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 6, 2018 Category: Emergency Medicine Authors: Oscar M.P. Jolobe Source Type: research

Gastric ultrasonography in evaluating NPO status of pediatric patients in the emergency department
Pulmonary aspiration of gastric contents is uncommon but still considered a potential risk in patients who may require emergent intubation or procedural sedation [1, 2]. This normally occurs during induction, which tends to be technically variable for pediatric patients. The incidence of pulmonary aspiration is about four to ten times higher in pediatric populations than adults [3, 4]. Typically, preprocedural fasting time is recommended and used to determine the risk of aspiration. The American Society of Anesthesiology (ASA) 2011 Practice Guidelines recommends at least a 2-hour wait for clear fluids and 6  h for solid ...
Source: The American Journal of Emergency Medicine - June 6, 2018 Category: Emergency Medicine Authors: Aftab M. Azad, Hamad A. Al Madi, Shaik Farid Abdull Wahab, Hamid Shokoohi, Ye Jin Kang, Andrew S. Liteplo Source Type: research

Step right up! Healthcare provider weight estimation vs. a professional weight guesser
Bedside estimation of patient weight is commonly utilized in the emergency department where the patient is either too ill, obtunded, or comatose to communicate. However, there is a lack of evidence on the accuracy of visual weight estimation of the adult patient in the ED. Medications dosed based on the patient's weight introduce error. When inaccurate medication errors occur, dosing could be sub therapeutic or [1]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 6, 2018 Category: Emergency Medicine Authors: J. Orlando, V.A. LaBond Source Type: research

Effectiveness of the “timed up and go” (TUG) and the chair test as screening tools for geriatric fall risk assessment in the ED
We sought to evaluate the effectiveness of the “Timed Up and Go” (TUG) and the Chair test as screening tools in the Emergency Department (ED), stratified by sex. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 6, 2018 Category: Emergency Medicine Authors: Richard B. Chow, Andre Lee, Bryan G. Kane, Jeanne L. Jacoby, Robert D. Barraco, Stephen W. Dusza, Matthew C. Meyers, Marna Rayl Greenberg Source Type: research

Molecular diagnosis and outcome in patients with sepsis: Are emergency clinicians ready for it?
Sepsis remains a common clinical condition encountered in patients presenting to the emergency department (ED) [1]. Many of these patients are diagnosed in the ED and then transferred to other areas of the hospital. The allocation of beds and resources for such patients is directly related to the severity of illness they present. A variety of predictors of outcome have been developed in the ED, in an attempt to properly allocate these sepsis patient resources, as well as placing them in the adequate monitoring units (i.e., intensive care unit, telemetry, regular ward) [2, 3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 5, 2018 Category: Emergency Medicine Authors: Daryelle S. Varon, Joseph Varon Source Type: research

Evaluation of tranexamic acid in trauma patients: A retrospective quantitative analysis
Tranexamic acid (TXA) has been shown to decrease mortality in adult trauma patients with or at significant risk of hemorrhage when administered within 3  h of injury. The use and appropriateness of TXA in adult trauma patients presenting to Royal Columbian Hospital (RCH) was investigated. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 5, 2018 Category: Emergency Medicine Authors: Michelle Ng, Jerrold Perrott, Sarah Burgess Source Type: research

Trauma team activation criteria and outcomes of geriatric trauma: 10  year single centre cohort study
With the aging population, the number of older patients with multiple injuries is increasing. The aim of this study was to understand the patterns and outcomes of older patients admitted to a major trauma centre in Hong Kong from 2006 to 2015, and investigate the performance of the trauma team activation (TTA) criteria for these elderly patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 5, 2018 Category: Emergency Medicine Authors: Kevin Kei-ching Hung, Janice H.H. Yeung, Catherine S.K. Cheung, Ling-yan Leung, Raymond C.H. Cheng, N.K. Cheung, Colin A. Graham Source Type: research

Circulating lncRNA NEAT1 correlates with increased risk, elevated severity and unfavorable prognosis in sepsis patients
To investigate the correlation of circulating long non-coding RNA nuclear-enriched abundant transcript 1 (lncRNA NEAT1) expression with disease risk, severity, prognosis and inflammatory cytokine levels in sepsis patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 4, 2018 Category: Emergency Medicine Authors: Qinghe Huang, Cuiyu Huang, Yan Luo, Fuyun He, Rongfang Zhang Source Type: research

Successful treatment of massive thrombosis in different locations with prolonged thrombolytic therapy: A life-saving intervention
Venous thrombosis is recognized as one of the most important complications of nephrotic syndrome (NS). In patients with NS, venous thrombosis may develop in the renal veins, the deep veins of the lower limb, and the inferior vena cava. Here, we describe a case report of an NS patient with multiple venous thrombosis in the right renal vein, the left iliac vein, the vena cava inferior, the right atrium, and the pulmonary arteries. Moreover, we describe the successful treatment of multiple venous thrombosis with prolonged thrombolytic treatment in spite of an increased risk of bleeding due to renal biopsy. (Source: The Americ...
Source: The American Journal of Emergency Medicine - June 3, 2018 Category: Emergency Medicine Authors: Ibrahim Rencuzogullari, Metin Ca ğdaş, Suleyman Karakoyun, Yavuz Karabağ, Tufan Çınar Source Type: research

Blood lactate measurement within the emergency department: A two-year retrospective analysis
We evaluate in this retrospective cohort, the clinical situations leading emergency physicians to take a blood lactate sample, the prevalence of hyperlactatemia and its impact on short-term adverse outcome. ED patients requiring a blood lactate measurement (BLM) during a two-year period were included. Early patients' outcomes were extracted and discharge diagnoses were classified into 12 diagnostic categories. A total of 118,737 patients were analyzed. A BLM was carried out in 13,089 of them. Surprisingly, the proportion of patients having a BLM was higher in those admitted for seizure (31.4%) than in those admitted for in...
Source: The American Journal of Emergency Medicine - June 2, 2018 Category: Emergency Medicine Authors: Julie Contenti, Celine Occelli, Fabien Lemoel, Patricia Ferrari, Jacques Levraut Source Type: research

Sick and unsheltered: Homelessness as a major risk factor for emergency care utilization
Homelessness is a critical public health issue and socioeconomic epidemic associated with a disproportionate burden of disease and significant decrease in life expectancy. We compared emergency care utilization between individuals with documented homelessness to those enrolled in Medicaid without documented homelessness. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 2, 2018 Category: Emergency Medicine Authors: Stas Amato, Flavia Nobay, David Petty Amato, Beau Abar, David Adler Source Type: research

National unintentional carbon monoxide poisoning estimates using hospitalization and emergency department data
Unintentional non-fire-related (UNFR) carbon monoxide (CO) poisoning is a leading cause of poisoning in the US and a preventable cause of death. We generated national estimates of accidental CO poisoning and characterized the populations most at risk.UNFR CO poisoning cases were assessed using hospitalization and emergency department (ED) data from the Healthcare Costs and Utilization Project National Inpatient Sample and Nationwide Emergency Department databases. We used hospitalization data from 2003 to 2013 and ED data from 2007 to 2013. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 2, 2018 Category: Emergency Medicine Authors: Dorothy Stearns, Kanta Sircar Source Type: research

Eye injury from electrical weapon probes: Mechanisms and treatment
While generally reducing morbidity and mortality, TASER ® electrical weapons have risks associated with their usage, including burn injuries and head and cervical trauma associated with uncontrolled falls. The primary non-fatal complications appear to significant eye injury but no analysis of the mechanisms or suggested treatments has been published. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 2, 2018 Category: Emergency Medicine Authors: Mark W. Kroll, Mollie B. Ritter, Eric A. Kennedy, Nora K. Siegal, Roman Shinder, Michael A. Brave, Howard E. Williams Source Type: research

The intracranial number of foreign bodies as a predictor of mortality after penetrating brain injury
Penetrating brain injury (PBI) is the most lethal form of traumatic brain injury, which is a leading cause of mortality. PBI has a mortality rate of 23% –93% and 87%–100% with poor neurological status. Despite the use of various prognostic factors there is still a need for a specific prognostic factor for early prediction of mortality in PBI to reduce mortality and provide good outcomes with cost-effective surgical treatments. The aim of this st udy was to investigate the predictive value of the number of intracranial foreign bodies (FBs) on mortality in PBI in the Emergency Department. (Source: The American Jo...
Source: The American Journal of Emergency Medicine - June 2, 2018 Category: Emergency Medicine Authors: Mustafa Bolatkale, Ahmet Cagdas Acara Source Type: research

The risk of snow sport injury in pediatric patients
We describe injury patterns of pediatric snow sport participants based on age, activity at the time of injury, and use of protective equipment. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 2, 2018 Category: Emergency Medicine Authors: Robert J. McLoughlin, Jonathan Green, Pradeep Nazarey, Michael P. Hirsh, Muriel Cleary, Jeremy T. Aidlen Source Type: research

Novel information and communication technology system to improve surge capacity and information management in the initial hospital response to major incidents
The initial response of local hospitals to major incidents involving natural and anthropogenic hazards is crucial [1-6]. When a major incident is recognized by a hospital's headquarters, it is necessary to increase medical surge capacity and capability before external supports arrive. Thus, the hospital must communicate a variety of information to multiple staff, including those who are off-duty [1, 7]; staffing is key to increasing surge capacity [8-12]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 2, 2018 Category: Emergency Medicine Authors: Mami Yamada, Taka-aki Nakada, Shota Nakao, Eiji Hira, Koichiro Shinozaki, Rui Kawaguchi, Yasuaki Mizushima, Tetsuya Matsuoka Source Type: research

Editorial Board
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2018 Category: Emergency Medicine Source Type: research

Table of Contents
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2018 Category: Emergency Medicine Source Type: research

Information for Authors
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2018 Category: Emergency Medicine Source Type: research

When it is not just DKA; diabetic ketoacidosis as a first presentation of pancreatic adenocarcinoma
Pancreatic cancer is the fourth leading cause of cancer related-deaths in the United States among both men and women. About 55,000 patients in the United States are diagnosed with cancer of the exocrine pancreas annually [1]. Early symptoms of pancreatic cancer are vague and nonspecific, meaning the majority of cases is diagnosed at an advanced, incurable stage [2]. The link between diabetes mellitus and pancreatic cancer remains controversial, with epidemiological studies showing a bidirectional relationship [3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2018 Category: Emergency Medicine Authors: Danny Markabawi, Divya Kondapi, Vikrant Tambe, Rahul Seth Source Type: research

Misconceptions in acute heart failure diagnosis and Management in the Emergency Department
Acute heart failure (AHF) accounts for a significant number of emergency department (ED) visits, and the disease may present along a spectrum with a variety of syndromes. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2018 Category: Emergency Medicine Authors: Brit Long, Alex Koyfman, Eric J. Chin Tags: Reviews Source Type: research

The controversial role of dual sequential defibrillation in shockable cardiac arrest
In the United States, over 350,000 cardiac arrests occur outside of the hospital and 209,000 occur in the hospital. Shockable rhythms such as ventricular fibrillation (VF) have a survival rate of 20 –30% outside of the hospital setting. Dual Sequential Defibrillation (DSD) has demonstrated success in terminating VF that is refractory to multiple attempts using a single defibrillator. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2018 Category: Emergency Medicine Authors: A. Pourmand, J. Galvis, D. Yamane Source Type: research

Posterior reversible encephalopathy syndrome in a pregnant patient without eclampsia or preeclampsia: A case report
Posterior Reversible Encephalopathy syndrome (PRES) is a rare neurologic disorder characterised by vasogenic edema in occipital and parietal lobes on MR. Patients usually complain about headache, visual disturbance, seizure and altered mental status. We repot a case of PRES seen in a pregnant patient. Although pre-eclampsia and eclampsia are among the common causes of this syndrome in this case patient was normotensive and no proteinuria was present. To our knowledge this is the first PRES case presented of a pregnant patient without eclampsia or pre-eclampsia. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 30, 2018 Category: Emergency Medicine Authors: H üseyin Acar, Kadriye Acar Source Type: research

Medicaid work requirements: Bad for emergency medicine
In January 2018, the Centers for Medicare and Medicaid Services (CMS) announced a waiver program for states to experiment with work requirements for “working-age, able-bodied” beneficiaries as a prerequisite for enrollment in Medicaid [1]. These requirements would conceivably be met by either completing a certain threshold of working hours or participating in “community engagement activity” including job training, education or volunteeri ng. In announcing the program [2], CMS pointed to evidence from the public health literature supporting the premise that employment is a net positive for overall he...
Source: The American Journal of Emergency Medicine - May 30, 2018 Category: Emergency Medicine Authors: Nicholas Gavin Source Type: research

A non-traumatic, rapid-onset headache that is as dangerous as subarachnoid hemorrhage (SAH) seen in the emergency department
A 36  yo male with multiple non-traumatic, rapid-onset headaches had Emergency Department visits on days 3 and 10 after onset of symptoms. He is a social smoker and drinker. CT head imaging was negative. An MRI/MRA was obtained. The image represents multiple foci of vasoconstriction and dilation in med ium and large cerebral vessels consistent with Reversible Cerebral Vasoconstriction Syndrome (RCVS). Multiple rapid-onset headaches and “string of beads” on MRA imaging are pathognomonic for RCVS, which has a 4:1 female to male ratio. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 30, 2018 Category: Emergency Medicine Authors: Matthew M. Palilonis, Jeanne L. Jacoby Source Type: research

Retention of cricothyrotomy skills by paramedics using a wire guided technique
Cricothyrotomy may be necessary for airway management when a patient's airway cannot be maintained through standard techniques such as oral airway placement, blind insertion airway device, or endotracheal intubation. Wire-guided cricothyrotomy is one of many techniques used to perform a cricothyrotomy. Although there is some controversy over which cricothyrotomy technique is superior, there is no published data regarding long term retention rates. The purpose of this study is to determine whether ground based paramedics can be taught and are able to retain the skills necessary to successfully perform a wire-guided cricothy...
Source: The American Journal of Emergency Medicine - May 30, 2018 Category: Emergency Medicine Authors: J.A. March, M.J. Kiemeney, J. De Guzman, J.D. Ferguson Source Type: research

Reversible posterior encephalopathy syndrome in a pregnant patient without eclampsia or preeclampsia: A case report
Posterior Reversible Encephalopathy syndrome (PRES) is a rare neurologic disorder characterised by vasogenic edema in occipital and parietal lobes on MR. Patients usually complain about headache, visual disturbance, seizure and altered mental status. We repot a case of PRES seen in a pregnant patient. Although pre-eclampsia and eclampsia are among the common causes of this syndrome in this case patient was normotensive and no proteinuria was present. To our knowledge this is the first PRES case presented of a pregnant patient without eclampsia or pre-eclampsia. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 30, 2018 Category: Emergency Medicine Authors: H üseyin Acar, Kadriye Acar Source Type: research

Mean platelet volume and the ratio of mean platelet volume to platelet count in the diagnosis of acute appendicitis
Mean platelet volume (MPV) is an inflammatory marker. Recent studies have shown that there is a negative correlation between platelet count (PC) and MPV and that the ratio of these two values may be more meaningful. The aim of our study was to investigate the diagnostic value of MPV and the MPV/PC ratio in acute appendicitis. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 30, 2018 Category: Emergency Medicine Authors: Serdar Birick, H üseyin Narcı, Güllü Akbaydoğan Dündar, Cüneyt Ayrık, Mehmet Özgür Türkmenoğlu Source Type: research

Other aspects of nitrous oxide-related neuromyelopathy
The point is well made that the “work-up” of suspected nitrous oxide (NO2) myelopathy should include, not only serum vitamin B12 (i.e., cobalamin) measurement, but also documentation of serum homocysteine, methylmalonic acid (MMA), and folate levels [1]. The rationale is that some patients in whom cobalamin derangements are im plicated in the aetiopathogenesis of NO2-related neurotoxicity may, nevertheless, have serum cobalamin levels within the normal range [2]. In one such patient (case 1) NO2-related neuropathy was initially mistaken for Guillain-Barre syndrome, arguably because there was no concurrent spina...
Source: The American Journal of Emergency Medicine - May 30, 2018 Category: Emergency Medicine Authors: Oscar M.P. Jolobe Source Type: research

Pulmonary thromboembolism after carbon monoxide poisoning
Carbon monoxide (CO) poisoning is known to increase thrombotic tendency, and the risk of deep vein thrombosis in individuals who have experienced CO poisoning is higher than in the general population. However, there are a few reports describing cases of pulmonary thromboembolisms (PTE) secondary to CO poisoning. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 29, 2018 Category: Emergency Medicine Authors: Yoonje Lee, Tae Ho Lim, Hyunggoo Kang, Jaehoon Oh, Byuk Sung Ko Tags: Case Report Source Type: research

Fournier's Gangrene Masking as Perineal and Scrotal Cellulitis
Fournier's gangrene (FG) is a serious and life threatening emergency. Jean Alfred Fournier, a French venereologist, described it in 1883 as an unexplained fulminating gangrene of the male genitalia. He noted it as a rapidly progressive scrotal infection that was primarily seen in young healthy males with no identifiable etiology [1]. More recently, the clinical perspective considers FG to be a polymicrobial subset of necrotizing fasciitis affecting the genital region. The disease is now known to affect both genders and a wide range of ages [2,3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 29, 2018 Category: Emergency Medicine Authors: Jeneba Abass-Shereef, Mitch Kovacs, Erin L. Simon Source Type: research

The utility of point-of-care ultrasound in targeted automobile ramming mass casualty (TARMAC) attacks
As terrorist actors revise their tactics to outmaneuver increasing counter-terrorism security measures, a recent trend toward less-sophisticated attack methods has emerged. Most notable of these “low tech” trends are the Targeted Automobile Ramming MAss Casualty (TARMAC) attacks. Between 2014 and November 2017, 18 TARMAC attacks were reported worldwide, resulting in 181 deaths and 679 injuries. TARMAC attack-related injuries are unique compared to accidental pedestrian trauma and other causes of mass casualty incidents (MCI), and therefore they require special consideration. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 29, 2018 Category: Emergency Medicine Authors: Hamid Shokoohi, Ali Pourmand, Keith Boniface, Rebecca Allen, Bruno Petinaux, Babak Sarani, James P. Phillips Source Type: research

Shock index predicted mortality in geriatric patients with influenza in the emergency department
This study was conducted to clarify this issue. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 29, 2018 Category: Emergency Medicine Authors: Jui-Yuan Chung, Chien-Chin Hsu, Jiann-Hwa Chen, Wei-Lung Chen, Hung-Jung Lin, How-Ran Guo, Chien-Cheng Huang Source Type: research

Effects of an emergency transfer coordination center on secondary overtriage in an emergency department
This study aimed to investigate whether an emergency transfer coordination center (ETCC) could reduce the risk of SO among patients who were transferred to a tertiary ED by emergency medical services. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 29, 2018 Category: Emergency Medicine Authors: Eung Nam Kim, Min Joung Kim, Je Sung You, Hye Jung Shin, In Cheol Park, Sung Phil Chung, Ji Hoon Kim Source Type: research