Understanding the perception of workload in the emergency department and its impact on medical decision making
Workload in healthcare has been widely studied [1-3]. Perceived workload [4] of clinicians is often linked to burnout, clinical errors, patient safety [5] and satisfaction [6]. Quantifying perceived workload in the Emergency Department (ED) is especially challenging due to varying volumes of patients and time-sensitive tasks [7-9]. Different aspects of perceived workload [10] in the ED impact medical decision making (MDM), leading to delays in treatment [11] and diagnostic errors [12,13]. The NASA Task Load Index (NASA-TLX) is an assessment tool that quantifies perceived workload [14] in various healthcare settings [15-19]...
Source: The American Journal of Emergency Medicine - July 15, 2019 Category: Emergency Medicine Authors: Miranda Prints, Daniela Fishbein, Ryan Arnold, Eric Stander, Kristen Miller, Tracy Kim, Muge Capan Source Type: research

Implementation of a pilot electronic stroke outcome reporting system for emergency care providers
Emergency department (ED) providers and clinicians find that feedback on acute stroke patients is rewarding, valuable to professional development, and helpful for practice improvement. However, feedback is rarely provided, particularly for patients with stroke. Here we describe the implementation of an electronic stroke outcome reporting tool for providing feedback to ED providers. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 11, 2019 Category: Emergency Medicine Authors: William L. Scheving, Joseph M. Ebersole, Michael Froehler, Donald Moore, Kiersten Brown-Espaillat, James Closser, Wesley H. Self, Michael J. Ward Source Type: research

The impact of burnout syndrome on practitioners working within rural healthcare systems
Burnout syndrome (BOS) affects up to 50% of healthcare practitioners. Limited data exist on BOS in paramedics/firstresponders, or others whose practice involves trauma. We sought to assess the impact of BOS in practitioners of rural healthcare systems involved in the provision of trauma care within West Virginia.Methods: A 3-part survey was distributed at two regional trauma conferences in 2018. The survey consisted of 1) Demographic/occupational items, 2) The Mini Z Burnout Survey, and 3) elements measuring the impact, and supportive infrastructure to prevent and/or manage BOS. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 9, 2019 Category: Emergency Medicine Authors: Audis Bethea, Damayanti Samanta, Maher Kali, Franck C. Lucente, Bryan K. Richmond Source Type: research

Suicide and the creation of evidence-based guidelines: the ACEP perspective
The American College of Emergency Physicians, as well as most emergency physicians, recognize that suicide is a national epidemic [1]. Suicide is the 10th leading cause of death for all ages combined [1], and from 1999 to 2016, suicide rates rose by 28% nationally [2]. Most patients have seen a physician prior to their suicide [3,4], and many of these patients have seen this physician in the emergency department (ED) [5-7]. In fact, “mental disorders” was the 9th leading diagnosis made in emergency department patients in 2015 [8]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 9, 2019 Category: Emergency Medicine Authors: Paul D. Kivela Source Type: research

Association between hyperoxemia and mortality in patients treated by eCPR after out-of-hospital cardiac arrest
Assess whether elevated oxygen partial arterial pressure (PaO2) measured after the initiation of extra-corporeal cardiopulmonary resuscitation (eCPR), is associated with mortality in patients suffering from refractory out-of-hospital cardiac arrest (rOHCA). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 8, 2019 Category: Emergency Medicine Authors: M. Halter, R. Jouffroy, A. Saade, P. Philippe, P. Carli, B. Vivien Source Type: research

An impact analysis of the NEXUS Chest CT clinical decision rule
The NEXUS Chest CT clinical decision rules (CDRs) have been proposed to safely guide selective chest CT use in blunt trauma evaluation. We conducted a cost-effectiveness analysis of the NEXUS Chest CT CDR to determine its impact on missed injuries, cost, and radiation exposure. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 8, 2019 Category: Emergency Medicine Authors: Ralph Wang, Matthew J. Niedzwiecki, Daniel Nishijima, Robert M. Rodriguez Source Type: research

Age shock index, shock index, and modified shock index for predicting postintubation hypotension in the emergency department
Hypotension after emergent ETI is a relatively common complication during and after emergency airway management. We aimed to evaluate SI, MSI, and age SI to predict PIH in patients who presented to the emergency department. Moreover, which factors would be better for predicting the event or similar to the others. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 8, 2019 Category: Emergency Medicine Authors: Kyoungmi Lee, Jun Sung Jang, Jihye Kim, Young Ju Suh Source Type: research

Severe toxicity following inhalational exposure to N, N-diethyl-meta-toluamide (DEET)
We reported a patient with severe toxicity following inhalational exposure to an insect repellant containing 98% DEET. After discussion with Dr. Nikiforov, it was confirmed that the source of DEET was not a home insect fogger but rather a continuous spray repellant. Although designed for application to the skin and clothing, the patient used the spray indoors in a small enclosed mobile home. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 8, 2019 Category: Emergency Medicine Authors: Erica M. Tavares, Bryan S. Judge, Jeffrey S. Jones Source Type: research

Safety preempted: When EMTALA and restraining orders collide
A patient has been stalking Dr. Smith, an emergency physician at St. Mary's Hospital, for months. His stalking behavior has included frequent phone calls and e-mails. The patient has come to the emergency department at Saint Mary's during shifts worked by Dr. Smith several times. He has been in the emergency department 15 times in the last six months for vague complaints. Extensive medical work-ups have been negative. The patient frequently leaves against medical advice. He has been seen by multiple consultants including psychiatry, who diagnosed him with malingering and gave no other psychiatric diagnosis. (Source: The Am...
Source: The American Journal of Emergency Medicine - July 8, 2019 Category: Emergency Medicine Authors: Michael R. MacIntyre, Jacob M. Appel Source Type: research

Identifying and minimizing abuse of emergency call center services through technology
To identify and minimize unnecessary calls to emergency numbers and to assess the effectiveness of call-tracking technology in addressing the problem. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 8, 2019 Category: Emergency Medicine Authors: Oren Blushtein Adv, Maya Siman Tov, Racheli Magnezi Source Type: research

Combining qSOFA criteria with initial lactate levels: Improved screening of septic patients for critical illness
To determine if the addition of lactate to Quick Sequential Organ Failure Assessment (qSOFA) scoring improves emergency department (ED) screening of septic patients for critical illness. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 4, 2019 Category: Emergency Medicine Authors: Brigitte M. Baumann, John C. Greenwood, Kristin Lewis, Thomas J. Nuckton, Bryan Darger, Frances S. Shofer, Dawn Troeger, Soo Y. Jung, J. Hope Kilgannon, Robert M. Rodriguez Source Type: research

An analysis of the pediatric casualties undergoing massive transfusion in Iraq and Afghanistan
We report the characteristics of pediatric casualties associated with undergoing massive transfusion at US military treatment facilities during combat operations in Iraq and Afghanistan. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 4, 2019 Category: Emergency Medicine Authors: Steven G. Schauer, Abigail R. Wheeler, Michael D. April, Hannah L. Gale, Tyson E. Becker, Guyon J. Hill, Matthew A. Borgman Source Type: research

Hand injuries associated with reaching into a snow blower to clear clogged snow
Hand injuries represent the most common and potentially serious injuries associated with the use of snow blowers. Little research has been conducted on a national scale to examine these types of injuries. Therefore, the purpose of the study was to examine hand injuries among patients treated in an emergency department (ED) related to attempting to clear snow out of a clogged snow blower. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 3, 2019 Category: Emergency Medicine Authors: Bart Hammig, Ches Jones Source Type: research

Impact of wait time during a first pediatric emergency room visit on likelihood of revisit in the next year
Pediatric emergency departments (ED) develop strategies to decrease wait time. Yet, lowering wait times may incite patients to come back, and increase patient volume. We aim to determine if wait time in a first visit influenced the likelihood of a revisit to the same setting. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 3, 2019 Category: Emergency Medicine Authors: Olivier Drouin, Antonio D'Angelo, Jocelyn Gravel Source Type: research

Drone-related injuries treated at emergency departments
A personal or consumer drone is a remotely-controlled unmanned aircraft system (UAS) or unmanned aerial vehicle (UAV) designed for the mass market. Such devices have become increasingly popular. By early 2018, the total number of drones, including consumer drones, registered with the United States (US) Federal Aviation Administration (FAA) had exceeded one million [1]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 3, 2019 Category: Emergency Medicine Authors: Mathias B. Forrester Source Type: research

Avocado-related knife injuries: Describing an epidemic of hand injury
Recent media reports have described knife injuries sustained while preparing avocados; however, this rise has not been reported in the literature. The purpose of this study is to describe, quantify, and trend emergency department (ED) encounters associated with avocado-related knife injuries. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 2, 2019 Category: Emergency Medicine Authors: Kevin X. Farley, Matthew Aizpuru, Susanne H. Boden, Eric R. Wagner, Michael B. Gottschalk, Charles A. Daly Source Type: research

Comparison between new modified external rotation method and external rotation method for reduction of ASD
Dislocation of the shoulder joint is common and is mainly anterior. Several reduction methods have been described and the external reduction method (ERM) is one of the newest. We modified the ERM by making some additions in hopes to develop a less painful, quick and simple method. The aim of this study was to compare the new modified external rotation reduction method (MERM) with ERM in acute anterior shoulder dislocations (ASD). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 2, 2019 Category: Emergency Medicine Authors: Mehmet Akcimen, Cihan Bedel Source Type: research

Implementation of an adult code sepsis protocol and its impact on SEP-1 core measure perfect score attainment in the ED
The objective of this study was to determine the impact of an Adult Code Sepsis Protocol on the rate of SEP-1 perfect score attainment (PSA) among patients who presented to the emergency department (ED) with severe sepsis or septic shock, as defined by the Centers for Medicare and Medicaid Services (CMS). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 2, 2019 Category: Emergency Medicine Authors: Philip L. Whitfield, Patrick D. Ratliff, Lisa L. Lockhart, Dan Andrews, Kelsey L. Komyathy, Mark A. Sloan, Jeremy C. Leslie, William R. Judd Source Type: research

Unusual cause of septic pulmonary emboli: Infected iliac aneurysm with suppurative thrombophlebitis
We present a case of SPE caused by an infected iliac arterial aneurysm complicated with suppurative thrombophlebitis of the inferior vena cava due to Klebsiella pneumoniae. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 2, 2019 Category: Emergency Medicine Authors: Keisuke Maeda, Toshihisa Ichiba, Masako Hata, Tomohiro Taniguchi, Kazunori Seo, Hiroshi Naitou Source Type: research

Does Overall Cervical Spine Pathology Relate to the Clinical Heterogeneity of Chronic Whiplash?
There remains limited evidence for the clinical importance of most imaging findings in whiplash. However, it is possible the type and number of findings on Computed Tomography (CT) may contribute to prognostic recovery models. The purpose is to interpret cervical spine pathologies in the context of known factors influencing recovery. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 1, 2019 Category: Emergency Medicine Authors: James M. Elliott, Todd B. Parrish, David M. Walton, Amy J. Vassallo, Joel Fundaun, Marie Wasielewski, D. Mark Courtney Source Type: research

Does acute pathology relate to clinical outcomes in chronic whiplash?
There remains limited evidence for the clinical importance of most imaging findings in whiplash. However, it is possible the type and number of findings on Computed Tomography (CT) may contribute to prognostic recovery models. The purpose is to interpret cervical spine pathologies in the context of known factors influencing recovery. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 1, 2019 Category: Emergency Medicine Authors: James M. Elliott, Todd B. Parrish, David M. Walton, Amy J. Vassallo, Joel Fundaun, Marie Wasielewski, D. Mark Courtney Source Type: research

The influence of sertraline on depressive disorder after traumatic brain injury: A meta-analysis of randomized controlled studies
Sertraline showed some potential in alleviating depressive disorder after traumatic brain injury. This systematic review and meta-analysis was conducted to investigate the efficacy of sertraline on the treatment of depressive disorder after traumatic brain injury. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 29, 2019 Category: Emergency Medicine Authors: Caibin Gao, Qiang Fu, Beibei Chen, Zhongtao Liu, Qingjiu Zhou, Zhenfu Jiang Source Type: research

Emergency department recommendations for suicide prevention in adults: The ICAR2E mnemonic and a systematic review of the literature
Caring for suicidal patients can be challenging, especially in emergency departments without easy access to mental health specialists. The American College of Emergency Physicians and the American Foundation for Suicide Prevention appointed a working group to create an easy-to-use suicide prevention tool for ED providers. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 26, 2019 Category: Emergency Medicine Authors: Michael P. Wilson, Christine Moutier, Lisa Wolf, Kimberly Nordstrom, Travis Schulz, Marian E. Betz Source Type: research

Editorial Board
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 25, 2019 Category: Emergency Medicine Source Type: research

Toc
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 25, 2019 Category: Emergency Medicine Source Type: research

Info for authors
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 25, 2019 Category: Emergency Medicine Source Type: research

The effects of emergency department crowding on triage and hospital admission decisions
Emergency department (ED) crowding is a recognized issue and it has been suggested that it can affect clinician decision-making. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 25, 2019 Category: Emergency Medicine Authors: Wanyi Chen, Benjamin Linthicum, Nilay Tanik Argon, Thomas Bohrmann, Kenneth Lopiano, Abhi Mehrotra, Debbie Travers, Serhan Ziya Source Type: research

Neighborhood-level stroke hot spots within major United States cities
Identifying communities at high risk of stroke is an important step in improving systems of stroke care. Stroke is known to show spatial clustering at the state and county levels, but it is not known if clusters are present within city boundaries. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 25, 2019 Category: Emergency Medicine Authors: Daniel A. Dworkis, James Marvel, Nerses Sanossian, Sanjay Arora Source Type: research

Cardiomegaly on chest radiographs as a predictor of heart disease in the pediatric population
Cardiomegaly on chest radiographs (CXR) in pediatric patients leads to multiple tests. We aimed to determine the positive predictive value (PPV) of cardiomegaly on CXR in predicting subsequent heart disease and to assess the utility of obtaining a B-type Natriuretic Peptide level (BNP) and/or electrocardiogram (EKG) in such patients. We hypothesized that an echocardiogram may not be appropriate in all cases of cardiomegaly on CXR, particularly in a patient with a normal EKG and BNP level. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 25, 2019 Category: Emergency Medicine Authors: Soham Dasgupta, Michael Kelleman, Timothy Slesnick, Matthew Oster Source Type: research

Role of high-dose intravenous nitrates in hypertensive acute heart failure
Patients with hypertensive acute heart failure (HAHF) can decompensate rapidly and require immediate medical attention; the use of high-dose nitroglycerin is a topic of growing interest in this patient population. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 25, 2019 Category: Emergency Medicine Authors: Kellie Wang, Kathryn Samai Source Type: research

Use of the PEPTEST ™ tool for the diagnosis of GERD in the Emergency Department
Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders in the general population, with a prevalence of 8.8% –25.9% in Europe [1]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 25, 2019 Category: Emergency Medicine Authors: Angela Saviano, Carmine Petruzziello, Mattia Brigida, Ilaria Tersigni, Alessio Migneco, Andrea Piccioni, Luisa Saviano, Marcello Covino, Francesco Franceschi, Veronica Ojetti Source Type: research

Differences in coagulopathy and massive transfusion strategy based on trauma type
Trauma is the sixth most common cause of mortality worldwide but is the most common cause of death in individuals under 35  years of age [1]. In trauma patients, hemorrhage (exsanguinating) is responsible for 30%–40% of all deaths, especially within 6 h of arrival [2] and mortality among trauma patients requiring massive transfusion (MT) for exsanguinating hemorrhage is>50% [3]. Exsanguinating hemorrhage is associated with trauma-induced coagulopathy, and both coagulopathy and hemorrhage contribute to trauma –associated mortality [4,5]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 25, 2019 Category: Emergency Medicine Authors: Kota Hoshino, Mamiko Naito, Yoshihiko Nakamura, Yuhei Irie, Takeshi Nishida, Taisuke Kitamura, Hiroyasu Ishikura Source Type: research

Concordance between blood and cerebrospinal fluid cultures in meningitis
To examine the association between cerebrospinal fluid (CSF) cultures and blood cultures in patients with suspected bacterial or fungal meningitis. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 25, 2019 Category: Emergency Medicine Authors: Ryan J. Phillips, Kyle M. Watanabe, Jeffrey R. Stowell, Murtaza Akhter Source Type: research

Pneumatosis intestinalis and pneumoretroperitoneum post steroid use in a patient with superior mesenteric artery syndrome
Pneumatosis intestinalis (PI) refers to the presence of gas within the wall of the small or large intestine. PI can be both asymptomatic and life-threatening. The patient was a 50-year-old man with previous cervical spine abscess and osteomyelitis post debridement 4  years ago, with a heroin abuse history. He presented with abdominal distension ongoing for 4 days and vomiting for 3 times with fluid content. Abdominal computed tomography revealed pneumatosis with pneumoretroperitoneum.A surgeon was contacted and antibiotic treatment was started. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 24, 2019 Category: Emergency Medicine Authors: Ching-I Lee, Yen-Hung Wu Source Type: research

Quick-SOFA score  ≥ 2 predicts prolonged hospital stay in geriatric patients with influenza infection
The quick Sepsis-Related Organ Failure Assessment (qSOFA) score was designed to predict mortality among sepsis patients. However, it has never been used to identify prolonged length of hospital stay (pLOS) in geriatric patients with influenza infection. We conducted this study to clarify this issue. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 24, 2019 Category: Emergency Medicine Authors: Chien-Chun Yeh, Yen-An Chen, Chien-Chin Hsu, Jiann-Hwa Chen, Wei-Lung Chen, Chien-Cheng Huang, Jui-Yuan Chung Source Type: research

Fibrinogen level on admission is a predictive marker of the need for massive blood transfusion after pelvic fracture
This study aimed to evaluate the usefulness of coagulation biomarkers as predictors of the need for massive transfusion (MT) in patients with pelvic fractures. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 24, 2019 Category: Emergency Medicine Authors: Naoki Notani, Masashi Miyazaki, Shozo Kanezaki, Toshinobu Ishihara, Tomonori Sakamoto, Testsutaro Abe, Masashi Kataoka, Hiroshi Tsumura Source Type: research

What do I do with this stuff now? Drug retention and disposal practices among ED patients
Misuse of opioids (e.g., the “opioid epidemic”) and antibiotics (e.g., the “antibiotic resistance crisis”) has become priority public health concerns. Opioid overdose has increased approximately three fold since 2000 [1]. Many opioid prescriptions are not being used as directed and proper disposal methods are frequently not being used, resulting in patient and household risk [2]. With regard to antibiotics, the CDC approximates that 2 million people/year become sick with antibiotic resistant ailments in the U.S. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 22, 2019 Category: Emergency Medicine Authors: Ashley Holub, Caitlin C. Abar, Michael Kamali, Kenneth Conner, Beau Abar Source Type: research

Clinician burnout and its association with team based care in the Emergency Department
Recent work has noted the alarming prevalence of clinician burnout among providers, particularly among acute care physicians [1]. Burnout is characterized by emotional exhaustion, physical fatigue, and cognitive weariness, which may lead to feelings of depersonalization and reduced accomplishment [2]. The consequences of burnout are broad and has been shown to adversely influence both clinician well-being and patient care outcomes [3,4]. An emerging body of literature has found that aspects of the acute care environment may play a role in moderating the effects of burnout among emergency providers. (Source: The American Jo...
Source: The American Journal of Emergency Medicine - June 21, 2019 Category: Emergency Medicine Authors: Bernard P. Chang, Kenrick Dwain Cato, Mary Cassai, Lorna Breen Source Type: research

Changing U.S. guidelines on lidocaine for stable monomorphic ventricular tachycardia: Have emergency medical services kept pace?
U.S. guidelines for the treatment of stable monomorphic wide-complex tachycardia (WCT)/ventricular tachycardia (VT) have evolved over the years to reflect accumulating evidence. Dynamic recommendations for lidocaine are illustrative. In the 1985 Standards and Guidelines for Emergency Cardiac Care, the consensus of multidisciplinary experts stated: “In hemodynamically stable patients with ventricular tachycardia, the first approach is antiarrhythmic therapy such as lidocaine” [1]. In the ensuing 20 years, the indication for lidocaine for stable monomorphic VT was limited and the recommendation weakened. (Sourc...
Source: The American Journal of Emergency Medicine - June 21, 2019 Category: Emergency Medicine Authors: Daphne D. Le, Ashley S. Abraham, David R. Vinson Source Type: research

The impact of a multidisciplinary algorithmic approach to acute lower gastrointestinal bleeding
Acute lower gastrointestinal bleeding (LGIB) is associated with significant morbidity and mortality and is a leading cause for presentation to the emergency department (ED) [1-4]. LGIB is responsible for>160,000 hospitalizations in the US every year, costing nearly $1.5 billion annually [3]. Standardized treatment algorithms for LGIB have been associated with improved outcomes [4,5]. We therefore sought to improve the care of patients presenting to our ED with LGIB by developing and testing a standardized, multidisciplinary evaluation and management algorithm. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 21, 2019 Category: Emergency Medicine Authors: Matthew Petersile, Mustafa Haroon, Dimitri Belkin, Adlin Pinheiro, Janice Weinberg, Hemant K. Roy, Brian C. Jacobson Source Type: research

Optimizing the month of the year backwards test for delirium screening of older patients in the emergency department
Different scoring methods exist for the Month of the Year Backward Test (MBT), which is designed to detect inattention, the core feature of delirium. When used as a part of the modified Confusion Assessment Method for the Emergency Department (mCAM-ED), each error in the MBT scores one point. Because this scoring procedure is complex, we aimed to simplify the scoring method of the MBT. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 21, 2019 Category: Emergency Medicine Authors: Wolfgang Hasemann, Florian F. Grossmann, Roland Bingisser, Martina Hafner, Dieter Breil, Reto W. Kressig, Christian H. Nickel Source Type: research

Citalopram overdose and severe serotonin syndrome in an intermediate metabolizing patient
We report a case of citalopram overdose in an intermediate CYP2C19 metabolizer complicated by severe serotonin syndrome. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 21, 2019 Category: Emergency Medicine Authors: Rachel F. Schult, Anna J. Morris, Lindsey Picard, Timothy J. Wiegand Source Type: research

Successful use of the two-tube approach for the treatment of phenobarbital poisoning without hemodialysis
Half-life of the antipsychotic vegetamin is very long, partially due to the presence of phenobarbital, and mortality due to phenobarbital poisoning is high. Here, we present the case of a 22-year-old female admitted to the emergency department with disturbed consciousness due to vegetamin overdose. Her blood phenobarbital level was elevated to 123  μg/ml. Phenobarbital undergoes enterohepatic circulation, and its retention in the intestine causes its blood levels to remain sustained. The utility of hemodialysis for drug poisoning has been previously reported; however, its efficiency is not yet established and its effi...
Source: The American Journal of Emergency Medicine - June 21, 2019 Category: Emergency Medicine Authors: Atsushi Tanikawa, Seki Satoshi, Takuya Yasuda, Eiju Hasegawa Source Type: research

Pelvic organ prolapse: An unusual cause of small bowel obstruction
We present the rare case of a small bowel obstruction secondary to pelvic organ prolapse (POP). A 77-year-old female presented with four days of abdominal pain, nausea, and vomiting. She had a history of abdominal hysterectomy with bilateral salpingo-opherectomy and a mildly symptomatic cystocele. She was found to have an enterocele causing small bowel obstruction. The enterocele was manually reduced and subsequently managed non-operatively with a pessary. Prior case reports of small bowel obstructions secondary to POP required emergent surgical intervention. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 21, 2019 Category: Emergency Medicine Authors: K. Hope Wilkinson, Arielle Thomas, Jillian Theobald Source Type: research

Multiple intubation attempts in the emergency department and in-hospital mortality: A retrospective observational study
Multiple intubation attempts in the Emergency Department (ED) have been associated with adverse events, but no study examined the influence of multiple intubation attempts on survival during hospitalization. Our aim was to compare one or more intubation attempts in the ED with risk of morbidity and mortality during hospitalization. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 20, 2019 Category: Emergency Medicine Authors: Syunsuke Yamanaka, Ran D. Goldman, Tadahiro Goto, Hiroyuki Hayashi Source Type: research

Multiple boluses of alteplase followed by extracorporeal membrane oxygenation for massive pulmonary embolism
We present the case of a patient with massive PE who received two boluses of alteplase fo r recurrent cardiac arrest, followed by initiation of ECMO. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 19, 2019 Category: Emergency Medicine Authors: Irene Li, Arielle Filiberti, Robert Mokszycki, Gayle Galletta Source Type: research

Point-of-care ultrasound diagnosis of small bowel-small bowel vs ileocolic intussusception
Identification of intussusception is feasible with emergency department (ED) point-of-care ultrasound (PoCUS) due to its ease-of-use and high accuracy. Little is known about the clinical characteristics and outcomes of small bowel-small bowel intussusception (SB-SBI) relative to ileocolic intussusception (ICI) identified by PoCUS. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 17, 2019 Category: Emergency Medicine Authors: Brian L. Park, Joni E. Rabiner, James W. Tsung Source Type: research

Simply influenza A (H3N2)-associated encephalitis with seizure
Influenza-associated acute encephalopathy (IAE) is more prevalent in children than in adults and often results in neurological sequelae or even death. Diagnosis of IAE is difficult as clinical presentation varies significantly and the influenza virus is rarely detected in cerebrospinal fluid. Moreover, seizures in adults due to influenza infection are rare. Herein, we describe the case of an adult presenting with both acute encephalitis and seizures.A 38-year-old female was admitted to the emergency department with acute respiratory symptoms and fever, followed by quick progression to stupor within 24  h. (Source: The Am...
Source: The American Journal of Emergency Medicine - June 16, 2019 Category: Emergency Medicine Authors: Hao-Tang Yuan, Tsung-Han Ho, Jiunn-Tay Lee, Po-Chuan Chen, Chih-Wei Wang, Fu-Chi Yang Tags: Case Report Source Type: research

A rare case of influenza A (H3N2)-associated encephalitis with seizure
Influenza-associated acute encephalopathy (IAE) is more prevalent in children than in adults and often results in neurological sequelae or even death. Diagnosis of IAE is difficult as clinical presentation varies significantly and the influenza virus is rarely detected in cerebrospinal fluid. Moreover, seizures in adults due to influenza infection are rare. Herein, we describe the case of an adult presenting with both acute encephalitis and seizures.A 38-year-old female was admitted to the emergency department with acute respiratory symptoms and fever, followed by quick progression to stupor within 24  h. (Source: The Am...
Source: The American Journal of Emergency Medicine - June 16, 2019 Category: Emergency Medicine Authors: Hao-Tang Yuan, Tsung-Han Ho, Jiunn-Tay Lee, Po-Chuan Chen, Chih-Wei Wang, Fu-Chi Yang Source Type: research

Characterization of emergency department abandonment using a real-time location system
Patients who present to emergency departments (EDs) for evaluation but are noted to have left without being seen (LWBS) are potentially at great risk. Governmental agencies, such as the Centers for Medicare and Medicaid, as well as hospitals and health organizations, are examining the factors which drive LWBS, including accurately quantifying patient tolerance to wait times and targeting interventions to improve patient tolerance to waiting. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 15, 2019 Category: Emergency Medicine Authors: Jenna M. Geers, Kalyan S. Pasupathy, Kimberly K. Lovik, Janet L. Finley, Thomas R. Hellmich, Gomathi Marisamy, David M. Nestler, Annie T. Sadosty, Mustafa Y. Sir, Heather A. Heaton Source Type: research