Abdominal pain in a patient with COVID-19 infection: A case of multiple thromboemboli
We present the case of a 61-year-old woman with clinically significant venous and arterial thromboemboli in the setting of COVID-19 infection requiring tissue plasminogen activator (tPA). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 25, 2020 Category: Emergency Medicine Authors: Keenan Mahan, Christopher Kabrhel, Andrew J. Goldsmith Source Type: research

To the Editor
We read the article “Intradermal sterile water injection (ISWI) versus diclofenac sodium in acute renal colic pain: A randomized controlled trial” by Moussa et al. [1] with interest. The authors aimed to evaluate the efficacy and safety of 0.5 cm3 ISWI compared with an intramuscular injection of 75 mg diclofena c sodium and with a placebo (intracutaneous injections of 0.5 cm3 isotonic saline) to relieve the pain of patients who presented to the Emergency Department (ED) with acute renal colic. They concluded that both modalities, ISWI and diclofenac sodium injections, equally relieved pain and maintained ...
Source: The American Journal of Emergency Medicine - May 25, 2020 Category: Emergency Medicine Authors: Yalcin Golcuk, Ahmet Dem ır, Birdal Yıldırım, Ethem Acar Source Type: research

Whole bowel irrigation in dapsone intoxication with persistent methemoglobinemia: A case report
We describe a case of a 17-year-old girl who was admitted 4  h after ingesting 5 g of dapsone. She presented methemoglobinemia (39%) and showed clinical signs of toxicity (cyanosis and altered mental status) despite mechanical ventilation. Multiple activated charcoal dosis and methylene blue infusions were performed. Notwithstanding initial improvement, a pattern of peaks and valleys was observed in serial methemoglobinemia measurements, with cyclic states of hypoxemia. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 23, 2020 Category: Emergency Medicine Authors: Indalecio Carboni Bisso, Nicol ás Gemelli, Maria Paula Cordero, Cecilia Barrios, Daniel Pina Source Type: research

An unusual cause of chest pain: Exercise induced sternal fracture in a young man
This case report describes a 26-year-old male who presented with anterior chest pain after weightlifting at the gym. Point-of-care ultrasound was used to diagnose a sternal fracture, which was then confirmed on CT scan. This rare mechanism of sports related sternal fracture is discussed, as well as a review of the literature. The use of ultrasound for this application is also explored. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 23, 2020 Category: Emergency Medicine Authors: Seth N.P. Davis, J. Scott Delaney, Laurie Robichaud Source Type: research

Thromboelastography for prediction of hemorrhagic transformation in patients with acute ischemic stroke
Thromboelastography (TEG) provides a rapid assessment of the hemostatic processes of a patient in emergency settings. There are limited data on TEG as a predictive tool for hemorrhagic transformation in patients with acute ischemic stroke. We investigated whether TEG values on admission could predict hemorrhagic transformation in patients with acute ischemic stroke. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 23, 2020 Category: Emergency Medicine Authors: Gina Yu, Youn-Jung Kim, Sang-Beom Jeon, Won Young Kim Source Type: research

Prognostic utilization of models based on the APACHE II, APACHE IV, and SAPS II scores for predicting in-hospital mortality in emergency department
This study was designed to evaluate and compare the prognostic value of the APACHE II, APACHE IV, and SAPSII scores for predicting in-hospital mortality in the ED on a large sample of patients. Earlier studies in the ED setting have either used a small sample or focused on specific diagnoses. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 23, 2020 Category: Emergency Medicine Authors: Zahra Rahmatinejad, Fariba Tohidinezhad, Hamidreza Reihani, Fatemeh Rahmatinejad, Ali Pourmand, Ameen Abu-Hanna, Saeid Eslami Source Type: research

Features of COVID-19 post-infectious cytokine release syndrome in children presenting to the emergency department
The 2019 coronavirus disease (COVID-19) has not appeared to affect children as severely as adults. However, approximately 1  month after the COVID-19 peak in New York City in April 2020, cases of children with prolonged fevers abruptly developing inflammatory shock-like states have been reported in Western Europe and the United States.This case series describes four previously healthy children with COVID-19 infection c onfirmed by serologic antibody testing, but negative by nasopharyngeal RT-PCR swab, presenting to the Pediatric Emergency Department (PED) with prolonged fever (5 or more days) and abrupt onset of hemodyna...
Source: The American Journal of Emergency Medicine - May 23, 2020 Category: Emergency Medicine Authors: Temima Waltuch, Prakriti Gill, Lauren E. Zinns, Rachel Whitney, Julia Tokarski, James W. Tsung, Jennifer E. Sanders Source Type: research

Critical medication shortages further dwindling hospital resources during COVID-19
The coronavirus disease 2019 (COVID-19) pandemic has impacted millions of people worldwide and created a shortage of healthcare resources [1,2]. The need for personal protective equipment (PPE), ventilators, hospital beds, and frontline medical professionals to care for patients with COVID-19 and protect medical professionals is well publicized [1]. In response, field hospitals were established to supplement hospitals already operating above surge capacity and various manufacturers started making PPE and ventilators. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 23, 2020 Category: Emergency Medicine Authors: Natalija M. Farrell, Bryan D. Hayes, Judith A. Linden Source Type: research

The alveolar-arterial gradient, pneumonia severity scores and inflammatory markers to predict 30-day mortality in pneumonia
The objective of this study was to evaluate the association of elevated alveolar-arterial oxygen (A-a O2) gradient with risk of mortality in hospitalized patients with community-acquired pneumonia (CAP). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 22, 2020 Category: Emergency Medicine Authors: Sema Avci, Gokhan Perincek Source Type: research

The neutrophil-to-lymphocyte ratio has feasible predictive value for hospital mortality in patients with small bowel obstruction in the emergency department
The neutrophil-to-lymphocyte ratio (NLR) is an effective predictor of mortality in patients with various conditions. To the best of our knowledge, there have been no previous studies on the NLR as a prognostic marker for small bowel obstruction (SBO), especially on admission to the emergency department (ED). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 22, 2020 Category: Emergency Medicine Authors: Jung Bong Yun, Sun Hwa Lee Source Type: research

CPAP use in carbon monoxide poisoning: Response to concerns
We are very pleased with the interest shown in our article, entitled “Comparison of non-invasive CPAP with mask use in carbon monoxide poisoning” [1]. First, I should clarify that this study did not include examining the amount of continuous positive airway pressure (CPAP) to be applied according to the initial carboxyhemoglobin (COHb) level. Our aim was to compa re the efficacy of CPAP and a non-rebreather mask in reducing blood COHb levels in carbon monoxide (CO) poisoning and determine which method decreased these levels faster. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 22, 2020 Category: Emergency Medicine Authors: Kas ım Turgut, Erdal Yavuz Source Type: research

Intrinsic plus hand: A rare case of painful flexion and extension of his fingers
Intrinsic plus hand describes a rare and painful contracture of the intrinsic hand muscles with excessive flexion at the metacarpophalangeal joints and extension at the interphalangeal joints. Resulting from many causes to include trauma and neurologic injury, intrinsic plus hand can involve any number of fingers. Emergency department (ED) assessment should include evaluation for cerebrovascular injury, infection, compartment syndrome, and deep vein thrombosis (DVT). Conservative splinting is generally unsuccessful and ultimately requires operative intervention. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 22, 2020 Category: Emergency Medicine Authors: Brandon M. Carius, Curt R. Canine, Brit Long Source Type: research

Characteristics and prognosis of acute type A aortic dissection with negative D-dimer result
Evidence regarding the characteristics and prognosis in acute type A aortic dissection (AAD) patients with negative D-dimer result is limited. We aimed to investigate the characteristics and prognosis in AAD patients with negative D-dimer result. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 22, 2020 Category: Emergency Medicine Authors: Guifang Yang, Wen Peng, Yang Zhou, Huaping He, Xiaogao Pan, Yuzhong Cai, Xiangping Chai Source Type: research

Retinal detachment with subretinal and vitreous hemorrhages causing secondary angle closure glaucoma diagnosed with ultrasound
A 90-year-old female with a past medical history of trigeminal neuralgia and age-related macular degeneration (AMD) presented with a four-day history of a left-sided headache, nausea, and vomiting. Regarding her left eye, she reported intermittent flashes of light over the past month and complete vision loss for four days. She denied a history of diabetes, hypertension, anticoagulant use, or ocular trauma. Her ocular history included the use of reading glasses and bilateral cataract surgery forty-five years ago. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 22, 2020 Category: Emergency Medicine Authors: Michael B. Holbrook, Daniel Kaitis, Lily Van Laere, Jeffrey Van Laere, Chris Clark Source Type: research

Reply to correspondence: Intradermal sterile water injection (ISWI) versus diclofenac sodium in acute renal colic pain: A randomized controlled trial. MS 23153
We thank the authors for their comments on our recent article “Intradermal sterile water injection (ISWI) versus diclofenac sodium in acute renal colic pain: A randomized controlled trial” [1]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 22, 2020 Category: Emergency Medicine Authors: Mohamad Moussa, Athanasios G. Papatsoris, Mohamed Abou Chakra Tags: Correspondence Source Type: research

Patients with mild traumatic brain injury receiving direct oral ancoagulants in Emergency Department: a necessary discussion
We are grateful for the opportunity to reply to the comment on our manuscript, “Risk factors associated with intracranial bleeding and neurosurgery in patients with mild traumatic injury who are receiving direct oral anticoagulants.” (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 21, 2020 Category: Emergency Medicine Authors: Gianni Turcato, Arian Zaboli, Elisabetta Zorzi, Norbert Pfeifer, Antonio Maccagnani, Antonio Bonora Source Type: research

RE: “Risk factors associated with intracranial bleeding and neurosurgery in patients with mild traumatic injury who are receiving direct oral anticoagulants”
We are grateful for the opportunity to reply to the comment on our manuscript, “Risk factors associated with intracranial bleeding and neurosurgery in patients with mild traumatic injury who are receiving direct oral anticoagulants.” (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 21, 2020 Category: Emergency Medicine Authors: Turcato Gianni, Zaboli Arian, Zorzi Elisabetta, Pfeifer Norbert, Maccagnani Antonio, Bonora Antonio Source Type: research

Neuroleptic malignant syndrome in patients with COVID-19
We report the first two cases of Coronavirus Disease 2019 (COVID-19) who were receiving intensive care including favipiravir, and were clinically diagnosed with neuroleptic malignant syndrome (NMS) to focus attention on NMS in COVID-19 management. Case 1: A 46-year-old-man with acute respiratory distress syndrome (ARDS) caused by COVID-19 infection was being administered favipiravir. Fentanyl, propofol, and rocuronium were also given. On day 3, midazolam administration was initiated for deep sedation. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 21, 2020 Category: Emergency Medicine Authors: Mitsuhito So, Toru Hifumi, Shutaro Isokawa, Masato Shimizu, Norio Otani, Shinichi Ishimatsu Source Type: research

Silent hypoxia: A harbinger of clinical deterioration in patients with COVID-19
We present a case of a 72-year-old male with COVID-19 syndrome who presented to the emergency department with minimal symptoms but low peripheral oxygen saturation readings. The patient deteriorated over the following days and even tually died as a result of overwhelming multi-organ system failure. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 21, 2020 Category: Emergency Medicine Authors: R. Gentry Wilkerson, Jason D. Adler, Nirav G. Shah, Robert Brown Source Type: research

When should we measure biomarkers in patients with atrial fibrillation to predict recurrences?
Atrial fibrillation (AF) is the most frequent arrhythmia and electrical cardioversion (ECV) is a common process to revert to sinus rhythm in the Emergency Department but it has a high recurrence rate (71 –84%) [1]. AF recurrences are probably related with anatomical and electrophysiological phenomena involving atrial myocardium. NT-proBNP, galectin-3, ST2, urate, C reactive protein, high sensitivity troponin T and fibrinogen are Biomarkers (BM) that have been implicated in these processes in other cardiac diseases. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 21, 2020 Category: Emergency Medicine Authors: Ana Merino-Merino, Ruth Saez-Maleta, Ricardo Salgado-Aranda, Daniel AlKassam-Martinez, Virginia Pascual-Tejerina, Javier Martin-Gonz ález, Javier Garcia-Fernandez, Jose-Angel Perez-Rivera Source Type: research

Emergency department analgesia in patients with traumatic injuries on outpatient buprenorphine
Moderate to severe acute pain occurs in 91% of traumatic injury patients presenting to the emergency department (ED) and suboptimal analgesia is common [1-3]. Timely and adequate pain control is crucial, as inadequate management has been associated with increased morbidity and development of chronic pain, post-traumatic stress disorder, anxiety, and depression [4]. Intravenous (IV) opioids are routinely used for treatment of acute pain in trauma patients, but increasing outpatient use of buprenorphine for opioid use disorder (OUD) and chronic pain poses a new challenge to traditional pain management strategies [5]. (Source...
Source: The American Journal of Emergency Medicine - May 21, 2020 Category: Emergency Medicine Authors: Emma L. Chee-How, Nicole M. Acquisto, Jennifer Iuppa Melaragno, Kate Kokanovich, Justin Foster, Rachel F. Schult Source Type: research

A NEWS-L score to a NEWS+L score
With great interest, I read an article by Dundar et al. which evaluated lactate and NEWS-L in critically ill geriatric emergency department patients. [1] As an inventor of a NEWS-L score, I am very glad because this recently introduced score is tested its performance in other populations and settings. I appreciate the authors very much for their efforts. And I would like to ask the authors one tiny thing. At first, I introduced this new score which incorporated the National Early Warning Score (NEWS) and serum lactate level and I named it a NEWS-L score. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 21, 2020 Category: Emergency Medicine Authors: Sion Jo Source Type: research

A reply to Turcato et al.
We read with great enthusiasm the article entitled, “Risk factors associated with intracranial bleeding and neurosurgery in patients with mild traumatic brain injury who are receiving direct oral anticoagulants” by Turcato et al. [1] While we appreciate their work and effort to shed light on this extremely important topic we must highlight some k ey concepts that we believe may alter the manuscripts interpretation. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 21, 2020 Category: Emergency Medicine Authors: Brian W. Gilbert, Brady Dively, Jacob A. Reeder, George J. Philip Source Type: research

Interfacility transports by emergency medical services in the United States: Estimates from the National Hospital Ambulatory Medical Care Survey
To describe characteristics of encounters in U.S. emergency departments (EDs) brought by interfacility transport by emergency medical services (EMS) from other EDs or urgent care settings. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 21, 2020 Category: Emergency Medicine Authors: Sriram Ramgopal Source Type: research

Comparison of non-invasive CPAP with mask use in carbon monoxide poisoning: Some concerns about methodology
We have read with great interest this article where two options for the clinical control of carbon monoxide poisoning are analyzed, with great clinical repercussions and effects on the prognosis of this type of poisoning [1]. It may be a good treatment option in emergency departments, especially in patients with comorbidity such as heart failure [2]. However, there is not much data on the use of continuous positive airway pressure (CPAP) in these patients in the literature, but we think that the differences in CPAP application in general may cause a difference in treatment response. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 20, 2020 Category: Emergency Medicine Authors: Berrin Er, Antonio M. Esquinas Source Type: research

Hypoglycemic cardiac arrest and rapid return-of-spontaneous circulation (ROSC) with dextrose – A case report
We present a case of return of spontaneous circulation in a patient with cardiac arrest after administration of dextrose for hypoglycemia. Routine administration of dextrose to patients in cardiac arrest has been shown to be associated with increased mortality and worse neurological outcomes. However, this case reminds the clinician to consider hypoglycemia in patients with cardiac arrest, and to attempt correcting a low blood glucose if noted . (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 18, 2020 Category: Emergency Medicine Authors: Joan Rui Shan Fun, Michael Yih Cong Chia Source Type: research

The geriatric emergency literature 2019
Geriatric Emergency Medicine is an important frontier for study and innovation by emergency practitioners. The rapid growth of this patient population combined with complex medical and social needs has prompted research ranging from which tests and screening tools are most effective for geriatric evaluation to how we can safely manage pain in the elderly or address goals of care in the Emergency Department. This review summarizes emergency medicine articles focused on the older patient population published in 2019, which the authors consider critical to the practice of geriatric emergency medicine. (Source: The American Jo...
Source: The American Journal of Emergency Medicine - May 17, 2020 Category: Emergency Medicine Authors: Danya Khoujah, Nicole Cimino-Fiallos Source Type: research

HHV 6 –7 reactivation causing Pityriasis Rosea and labyrinthitis
Pityriasis Rosea (PR) and labyrinthitis are most commonly caused by viral infections. PR presents with a characteristic rash while labyrinthitis presents with vertigo, tinnitus and hearing loss. However, the coexistence of PR and Labyrinthitis remains an uncommon event. Human Herpes Virus (HHV) 6 and 7, are common infections in childhood, and their reactivation causes Pityriasis Rosea. But these viruses are not known to have any involvement with the inner ear or the 8th cranial nerve (CN). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 16, 2020 Category: Emergency Medicine Authors: Mahmoud el- Hussein, Chady el- Tawil, Ramzi Nakhle, Naji Souaiby Source Type: research

The top 100 most cited articles on rhabdomyolysis: A bibliometric analysis
Over the past few decades, the incidence of Rhabdomyolysis (RM) has significantly increased. The prognosis is substantially worse if renal failure develops. Many problems remain to be addressed regarding the pathogenesis, prevention, and treatment of RM. The purpose of this study was to identify and characterize the top 100 most cited publications regarding rhabdomyolysis (RM) by performing a bibliometric analysis. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 16, 2020 Category: Emergency Medicine Authors: Chao Liu, Qian Yuan, Zhi Mao, Pan Hu, Kun Chi, Xiaodong Geng, Quan Hong, Xuefeng Sun Source Type: research

Assessing mortality outcomes of beta-lactam-allergic patients presenting with sepsis
To determine the impact of reported beta-lactam allergies on in-hospital mortality and other clinical outcomes in patients who presented with severe sepsis or septic shock. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 16, 2020 Category: Emergency Medicine Authors: Kelsey L. Komyathy, William R. Judd, Patrick D. Ratliff, Robert E. Hughes Source Type: research

Neurologic complications of COVID-19
Much of the focus regarding the global pandemic of coronavirus disease of 2019 (COVID-19) has been on the cardiovascular, pulmonary, and hematologic complications. However, neurologic complications have arisen as an increasingly recognized area of morbidity and mortality. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 16, 2020 Category: Emergency Medicine Authors: Rachel Bridwell, Brit Long, Michael Gottlieb Source Type: research

Value-based syncope evaluation and management: Perspectives of health care professionals on readiness, barriers and enablers
Syncope is a common condition seen in the emergency department. Given the multitude of etiologies, research exists on the evaluation and management of syncope. Yet, physicians' approach to patients with syncope is variable and often not value based. The 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients with Syncope includes a focus on unnecessary medical testing. However, little research assesses implementation of the guidelines. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 16, 2020 Category: Emergency Medicine Authors: Jing Li, Vedant Gupta, Susan S. Smyth, Amy Cowley, Gaixin Du, Matthew Sirrine, Seth Stearley, Romil Chadha, Vikas Bhalla, Mark Williams Source Type: research

Nitrous oxide inhalant abuse and massive pulmonary embolism in COVID-19
A patient presented to the emergency department with altered mental status and lower extremity weakness in the setting of nitrous oxide inhalant abuse and Coronavirus Disease-2019 (COVID-19) infection. He subsequently developed hypotension and severe hypoxia, found to have a saddle pulmonary embolus (PE) with right heart strain requiring alteplase (tPA). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 15, 2020 Category: Emergency Medicine Authors: Melanie F. Molina, Ahad A. Al Saud, Abdullah A. Al Mulhim, Andrew S. Liteplo, Hamid Shokoohi Source Type: research

Neurotoxicity secondary to local tetracaine use
Systemic reactions from local tetracaine use are often an anomaly – not only is tetracaine short-acting and quickly metabolized by the pseudocholinesterase system leading to very limited systemic uptake, but most adverse reactions are usually associated with dental or spinal anesthesia. Furthermore, reactions to local anesthetics manifest in standard allergy-typ e reactions. When local anesthetics lead to nervous or cardiac system abnormalities, it is termed a local anesthetic systemic toxicity – an event with an incidence currently estimated to be 0.03%. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 15, 2020 Category: Emergency Medicine Authors: Ayomide Adeleye, Lydia Sharp, Megan A. Rech Source Type: research

Suture removal by emergency department patients
According to the 2016 National Hospital Ambulatory Medical Care (NHAMC) Survey, there were an estimated 145 million visits to emergency departments (ED) during 2016 [1]. Anywhere from approximately 7 to 9 million lacerations are treated each year in EDs [2]. For each injury that requires sutures, there are a wide variety of wound closure materials, and which material is used depends on many factors. These factors may include the location of the wound, amount of tension on wound edges, provider preference, and patient factors [2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 15, 2020 Category: Emergency Medicine Authors: Lindsey Ouellette, Allison Brown, Nadia Nikroo, Samir Yassin, Kyle Beasley, Noelle Kraus, Justin Houseman, Jeffrey Jones Source Type: research

Effect of previous emergency psychiatric consultation on suicide re-attempts – A multi-center observational study
The emergency department (ED) is one of the first gateways when suicide attempt patients seek health care services. The purpose of this study was to analyze the hypothesis that people who received emergency psychiatric services in previous suicide attempts will have a lower mortality rate in current ED visits owing to subsequent suicide attempts. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 15, 2020 Category: Emergency Medicine Authors: Jeong Min Son, Joo Jeong, Young Sun Ro, Wonpyo Hong, Ki Jeong Hong, Kyoung-Jun Song, Sang Do Shin Source Type: research

Anaphylaxis induced bradycardia, renal failure, AV-nodal blockade, shock, and hyperkalemia: A-BRASH in the emergency department
The emergency department (ED) is responsible for managing a variety of acute illnesses including undifferentiated shock. A newer less recognized syndrome termed BRASH – bradycardia, renal failure, AV-node blockers, shock and hyperkalemia – is a cycle of synergy between hyperkalemia and AV-blockade that can result in shock. This entity is more common amongst the elderly, considering polypharmacy and co-morbid diseases. Some cases have an inciting trigger of hy povolemia. Anaphylaxis is a potentially lethal form of shock that most emergency physicians (EP) treat in the ED. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 15, 2020 Category: Emergency Medicine Authors: Stefan Flores Source Type: research

COVID-19 infection with extensive thrombosis: A case of phlegmasia cerulea dolens
Reports have been published from multiple countries regarding increased thrombus formation in COVID-19 patients, especially critically ill patients. These include DVT formation as well as pulmonary embolism and stroke. Currently, the exact mechanism as to why COVID-19 patients are at higher risk for thrombotic complications has not been determined. It has been thought to be due to endothelial injury, blood stasis or a hypercoagulable state [1]. To our knowledge this is the first reported case of phlegmasia cerulea dolens in a patient diagnosed with COVID-19. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 15, 2020 Category: Emergency Medicine Authors: Michael H. Morales, Candace L. Leigh, Erin L. Simon Source Type: research

Obesity is not associated with increased difficulty placing peripheral IVs in trauma activation patients
Previous studies have identified obesity as a risk factor for difficult IV access, but this has not been studied in the acute trauma setting. The primary objective was to determine if obesity is associated with increased difficulty placing peripheral IVs in trauma patients. Secondary analysis evaluated IV difficulty and associations with nursing self-competence ratings, trauma experience, and patient demographics. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 15, 2020 Category: Emergency Medicine Authors: Aaron Nathan Barksdale, Matthew Goede, Scott Madden, Abraham Campos, Robin High Source Type: research

Spontaneous subcutaneous emphysema: An uncommon presentation of a common disease
A 16-year-old female, non-smoker, presented to the Emergency Department (ED) with sudden onset swelling over the face, neck, chest, and upper abdomen for 2  days. She had history of intermittent low-grade fever and dry cough for 1 month prior to the presentation. There was no history of exposure to any organic or inorganic particulate. Primary survey was normal, except low oxygen saturation (SpO2) of 93% which improved to 99% with 6 L/min of oxyg en by face mask. On examination, there was swelling over the face, neck and torso with crepitus palpated all over the swollen area. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 15, 2020 Category: Emergency Medicine Authors: Savan Pandey, Ankit Kumar Sahu, Ramkumar Sreenivasan, Meera Ekka Source Type: research

A rare case of myxedema ascites and uncommon complication of ischemic colitis
We present a rare case of myxedema ascites in an elderly female and highlight the importance of early diagnosis and management. We also present ischemic colitis in the same patient, which has not been reported thus far in literature as a complication of myxedema ascites. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 14, 2020 Category: Emergency Medicine Authors: Sana Riaz, Pujitha Kudaravalli, Michelle Bernshteyn, Umair Masood, Sriharsha Gowtham, Chilsia Shaffi, Anuj Sharma, Kanish Mirchia, Nuri Ozden Source Type: research

Place of prefilled syringes in COVID-19 patient based on current evidence
Effective implementation of both basic and advanced life support in children and adults requires rapid and accurate performing of all procedures, including the administration of drugs in appropriate doses and at the right time. Preparation of drugs for resuscitation when wearing personal protective equipment resulting from the COVID-19 pandemic may pose many problems related to limitation of movement range and speed of action of medical personnel. Mistakes in preparation of drugs for resuscitation occur even under typical conditions, without wearing protective clothing, visors and goggles and result from rush and action un...
Source: The American Journal of Emergency Medicine - May 11, 2020 Category: Emergency Medicine Authors: Kobi Ludwin, Krzysztof J. Filipiak, Milosz Jaguszewski, Michal Pruc, Michal Paprocki, Jacek Smereka, Lukasz Szarpak, Marek Dabrowski, Michael Czekajlo Source Type: research

COVID-19 in healthcare workers
Risk of coronavirus infections among medical personnel. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 10, 2020 Category: Emergency Medicine Authors: Michal Pruc, Dawid Golik, Lukasz Szarpak, Ishag Adam, Jacek Smereka Source Type: research

Prehospital sedation with ketamine vs. midazolam: Repeat sedation, intubation, and hospital outcomes
Emergency medical service (EMS) providers often encounter acutely agitated patients who can pose serious threats to themselves, bystanders, and EMS, Fire, and Law Enforcement personnel [1]. Severe, acute, undifferentiated agitation can be a symptom of drug ingestion or underlying medical or psychiatric disorders, and not all agitated patients respond similarly to chemical sedation [2]. Conventionally, paramedics treat agitated patients in the prehospital settings with benzodiazepines to calm the patient sufficiently to complete medical assessment and care. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 10, 2020 Category: Emergency Medicine Authors: Dustin Holland, Nancy Glober, Shawn Christopher, Evan Zahn, Thomas Lardaro, Dan O'Donnell Source Type: research

Vital sign thresholds predictive of death in the combat setting
This study measures the vital sign values predictive of mortality among combat casualties in Iraq and Afghanistan. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 10, 2020 Category: Emergency Medicine Authors: Michael D. April, Tyson E. Becker, Andrew D. Fisher, Jason F. Naylor, Steven G. Schauer Source Type: research

Non –Covid-19 clinical research in the era of pandemic
The Covid-19 pandemic has seized the medical landscape and drained national and local resources. The day-to-day clinical practice of our research hospitals has been disrupted by the relentless spread of this disease, which has had a secondary effect on our ability to perform clinical research. As we innovate and accommodate in the treatment of the disease, will clinical researchers also be able to adapt to life in the age of Covid-19? Unfortunately, there are no real-time data that show what stratagems and best practices are applicable to research in the shadow of this pandemic. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 10, 2020 Category: Emergency Medicine Authors: Onyinyechi F. Eke, Christina C. Morone, Andrew Liteplo, Hamid Shokoohi Source Type: research

Weakness and elevated creatinine kinase as the initial presentation of coronavirus disease 2019 (COVID-19)
COVID-19 is a global public health emergency with more than one million positive cases across the globe. COVID-19 has a multifaceted presentation. We are herein to report two cases of SARS-CoV-2 induced rhabdomyolysis with an initial presentation of weakness and elevated creatinine kinase (CK). Both patients had no respiratory symptoms, they only complained of generalized weakness and were found to have elevated CK. Routine chest X-ray showed bilateral infiltrates in both cases and subsequently reverse-transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 was positive. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 10, 2020 Category: Emergency Medicine Authors: Kok Hoe Chan, Iyad Farouji, Amany Abu Harnoud, Jihad Slim Source Type: research

Respiratory protection among healthcare workers during cardiopulmonary resuscitation in COVID-19 patients
We have read with great interest the article Hwang et al. [1]. Although this is a simulation study, it shows that the N95 respirator did not provide adequate protection against respiratory infections during chest compression. The current SARS-CoV-2 pandemic poses a significant challenge for medical personnel, especially in the field of emergency medicine [2]. Following its initial outbreak on December 31, 2019, in Wuhan, a central city in China, COVID-19 has spread around the globe affecting almost all countries. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 10, 2020 Category: Emergency Medicine Authors: Kurt Ruetzler, Jacek Smereka, Kobi Ludwin, Lukasz Szarpak Source Type: research

Risk of coronavirus infections among medical personnel
Infections from the coronavirus group are a very important problem among medical personnel. This affects both the continuity of work of medical services, due to the compulsory quarantine of infected persons and their abandonment of work, and the insufficient number of employees to replace them in their tasks and duties. Due to the current situation of the COVID-19 pandemic, we can predict how the morbidity of health care workers will develop based on data on other viruses from the coronavirus group. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 10, 2020 Category: Emergency Medicine Authors: Michal Pruc, Dawid Golik, Lukasz Szarpak, Ishag Adam, Jacek Smereka Source Type: research

Management of acute ischemic stroke in patients with COVID-19 infection: Insights from an international panel
A corona virus (SARS-CoV-2) has infected 986,776 persons as of April 2nd, 2020 over a period of 4  months. There is a possibility that Coronavirus Disease 2019 (COVID-19) infection increases the risk of stroke similar to other respiratory tract infections [1]. Approximately 5% of hospitalized patients with COVID-19 infection suffer from stroke with over 80% of them being ischemic stroke [2]. T he reported mortality is 39% in patient with stroke [2] and COVID-19 infection which is much higher than the mortality observed in patients with stroke without COVID-19 infection [3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 10, 2020 Category: Emergency Medicine Authors: Adnan I. Qureshi, Foad Abd-Allah, Fahmi Alsenani, Emrah Aytac, Afshin Borhani-Haghighi, Alfonso Ciccone, Camilo R. Gomez, Erdem Gurkas, Chung Y. Hsu, Vishal Jani, Liqun Jiao, Adam Kobayashi, Jun Lee, Jahanzeb Liaqat, Mikael Mazighi, Rajsrinivas Parthasara Source Type: research