Septic arthritis in a patient after tonsillectomy: A case report
We present a rare case of septic arthritis in a 6-year-old female of the ankle 3  days following tonsillectomy. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 2, 2020 Category: Emergency Medicine Authors: Stephen G. Chong, Jesse Wray, Rachel E. Bridwell, Eric Chin Source Type: research

Association of response time interval with neurological outcomes after out-of-hospital cardiac arrest according to bystander CPR
This study intended to find out how association between response time interval (RTI) and good neurological outcome is affected by bystander CPR. We hypothesized that bystander CPR will ensure positive effect in relationship between RTI and clinical outcome. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 2, 2020 Category: Emergency Medicine Authors: Sungbae Moon, Hyun Wook Ryoo, Jae Yun Ahn, Dong Eun Lee, Sang Do Shin, Jeong Ho Park Source Type: research

Acute myocarditis associated with COVID-19 infection
We present the case of a 20-year-old male patient without previous history of cardiovascular disease who was admitted to our hospital with a new onset febrile sensation and chest pain. Chest computed tomography revealed a subpleural consolidation with a halo of ground-glass opacification. Blood tests revealed elevated levels of markers of myocyte necrosis (troponin I and creatine kinase –MB). Nasopharyngeal swab was positive for COVID-19. Cardiac MRI showed myocardial edema and late gadolinium enhancement compatible with myocarditis associated with COVID-19 infection. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 2, 2020 Category: Emergency Medicine Authors: Muhammed Said Be şler, Halil Arslan Source Type: research

Feasibility of bystander-administered naloxone delivered by drone to opioid overdose victims
Currently, ≤5% of bystanders witnessing an opioid overdose (OD) in the US administer antidote to the victim. A possible model to mitigate this crisis would be a system that enables 9-1-1 dispatchers to both rapidly deliver naloxone by drone to bystanders at a suspected opioid OD and direct them to administer it while awaiting EMS arrival. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 2, 2020 Category: Emergency Medicine Authors: Joseph P. Ornato, Alan X. You, Gray McDiarmid, Lori Keyser-Marcus, Aaron Surrey, James Humble, Sirisha Dukkipati, Lacy Harkrader, Shane R. Davis, Jacob Moyer, David Tidwell, Mary Ann Peberdy Source Type: research

Comparison of topical capsaicin and topical piroxicam in the treatment of acute trauma-induced pain: A randomized double-blind trial
This study aimed to compare the analgesic efficacy of topical capsaicin and topical piroxicam in acute musculoskeletal injuries. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 2, 2020 Category: Emergency Medicine Authors: Abdullah Osman Kocak, Sinem Dogruyol, Ilker Akbas, Tugba Sanalp Menekse, Sultan Tuna Akgol Gur, Meryem Betos Kocak, Bora Cekmen, Serhat Orun, Zeynep Cakir Source Type: research

Editorial Board
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Source Type: research

Toc
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Source Type: research

Info for authors
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Source Type: research

Case report of effective intranasal cooling in an 80  year old patient with heatstroke
Intranasal cooling by the evaporation of perflourcarbon is almost exclusively used for the induction of therapeutic hypothermia in post-resuscitation care. This method has proven to be effective and safe. This case presents a successful application to a patient with external heatstroke. The 80  year old male patient was found in deep coma (GCS 4) by emergency medical services (EMS) showing a core temperature around 42 °C. Despite of preclinical physical cooling, the patient showed a persistent temperature of 41.5 °C upon reaching the emergency department. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Authors: Randi Manegold, David Fistera, Carola Holzner, Joachim Risse Source Type: research

Bodybuilding supplements leading to copper toxicity, encephalopathy, fulminant hepatic failure and rhabdomyolysis
We present a case report of a 32-year-old bodybuilder using myriad nutritional, performance-enhancing, and weight-loss supplements with life-threatening encephalopathy, hepatic failure, rhabdomyolysis, and copper toxicity mimicking Wilson's disease. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Authors: John R. Richards, Pieter H. Scheerlinck, Kelly P. Owen, Daniel K. Colby Source Type: research

Emergency department operations in a large health system during COVID-19
The coronavirus disease 2019 (COVID-19) pandemic has strained healthcare systems through increased care complexity, need for staff and patient safety, and surges in patients suspected or known to be infected with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2). Previous infectious disease outbreaks and natural disasters have altered clinical operations and ED performance in different manners depending on the disaster type and duration. During the 2009 H1N1 Influenza pandemic, total ED patient visits increased [1], and measures of ED performance such as patient length of stay (LOS), waiting time, left without be...
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Authors: Brett A. Cohen, Emily G. Wessling, Peter T. Serina, Daniel S. Cruz, Howard S. Kim, Danielle M. McCarthy, Timothy M. Loftus Source Type: research

Battle against COVID-19: Efficacy of Convalescent Plasma as an emergency therapy
Convalescent Plasma (CP) is a form of adaptive immunization. It is an indirect way to protect a susceptible individual by providing immunity against a specific pathogen. Currently, the outbreak of highly infectious respiratory illness, i.e., novel coronavirus (COVID-19), has so far affected 2,471,136 individuals and has caused 169,006 deaths (WHO situation report-93; April 22, 2020). The USA alone reported 695,353 infected cases with the highest number of fatalities (n  = 37,602). The outbreak is so dangerous that it has affected the entire world (213 countries/areas/territories). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Authors: Saurabh Kumar, Vinit Sharma, Kanu Priya Source Type: research

Implementation of an emergency department discharge opioid taper protocol
In 2018, there were 51.4 opioid prescriptions per 100 persons in the US [1]. Recurrent opioid use can occur following emergency department (ED) opioid prescribing [2-7]. Prescribing variations among emergency physicians include amount, frequency of prescribing, and clinical decision making [5,8,9]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Authors: Gillian A. Beauchamp, Joshua Rosentel, Ali Yazdanyar, Erin Farber, Joseph Levi, Lexis T. Laubach, Samantha B. Esposito, Sarah Iqbal, Richard S. MacKenzie, David M. Richardson Tags: Correspondence Source Type: research

REVERT the diagnosis - Modified Valsalva manoeuvre as a method to differentiate supraventricular tachycardia from atrial flutter
A 77-year-old female patient went to the family physician complaining of palpitations, which she had been experiencing for approximately 12  h. She also felt fatigue after walking short distances. She did not complain of chest pain. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Authors: Steffen Grautoff Source Type: research

Are television medical dramas bad for our image?
The popularity of medical television (TV) dramas is well-established, and emergency medicine educators are beginning to recognize the power of medical media to impact public attitudes, beliefs, and expectations. Previous studies have shown that medical dramas often depict the fictional physicians in questionable, outlandish or dangerous scenarios [1,2]. However, it has also been noted that patients may view these dramas as credible portrayals of medical interventions, thus leading them to view real-world doctors as courageous [3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Authors: Lindsey Ouellette, Haley Ritter, Michael Shaheen, Alexander Brown, Virginia Huynh, Amanda Fleeger, Tiffany Fleeger, Jeffrey S. Jones Source Type: research

How would you like your COVID-19? From a host with mild course disease, or from a severe one?
The clinical course of COVID-19 presents a broad spectrum, being asymptomatic in some individuals while following a severe course and resulting in mortality in others. It is known that such factors as age and chronic diseases can result in a different clinical courses in individuals, however, variable clinical courses among the similar individuals in terms of age and chronic diseases are also seen. Other possible factors affecting the course of the disease that are mostly speculative or under investigation are genetic factors and the origin of transmission or possible subtype of novel coronavirus. (Source: The American Jou...
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Authors: Adnan Yamanoglu, Pinar Ye şim Akyol, Hüseyin Acar, Nalan Gokce Celebi Yamanoglu, Fatih Esad Topal, Ahmet Kayalı Source Type: research

Intranasal ketamine for acute pain management in children: A systematic review and meta-analysis
To assess the efficacy and safety of intranasal analgesic-dose ketamine as compared to intranasal fentanyl for pediatric acute pain. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Authors: Lucas Oliveira J. e Silva, John Y. Lee, Fernanda Bellolio, James L. Homme, Jana L. Anderson Tags: Reviews Source Type: research

Case report of effective intranasal cooling in an 80  year old patient with heatstroke
Intranasal cooling by the evaporation of perflourcarbon is almost exclusively used for the induction of therapeutic hypothermia in post-resuscitation care. This method has proven to be effective and safe (Busch et al., 2010); [1]. This case presents a successful application to a patient with external heatstroke. The 80  year old male patient was found in deep coma (GCS 4) by emergency medical services (EMS) showing a core temperature around 42 °C. Despite of preclinical physical cooling, the patient showed a persistent temperature of 41.5 °C upon reaching the emergency department. (Source: The American Journa...
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Authors: Randi Manegold, David Fistera, Carola Holzner, Joachim Risse Source Type: research

To-go medications as a means to treat discharged emergency department patients during COVID-19
The Coronavirus Disease 2019 (COVID-19) pandemic has created unique challenges for emergency care providers and patients alike. While the rise in COVID-19 patients requiring inpatient care has led to overcrowding in some emergency departments (ED), discharging stable patients from the ED has also become more complicated in the COVID-19 era [1]. Prior to COVID-19, patients often used EDs for low acuity conditions (e.g., asthma, cellulitis, urinary tract infection) that are treatable with short courses of outpatient medications. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Authors: Melanie F. Molina, Anita N. Chary, Joshua J. Baugh, Stephanie Ludy, Paul Ginart, Farah Z. Dadabhoy, Margaret E. Samuels-Kalow, Jonathan E. Slutzman, Ali S. Raja, Bryan D. Hayes Source Type: research

High dose vitamin C induced methemoglobinemia and hemolytic anemia in glucose-6-phosphate dehydrogenase deficiency
Investigational use of intravenous vitamin C has been on the rise, but its side effects may be underreported. A 75-year-old woman presented with acute onset of jaundice, dark urine and shortness of breath after receiving 30  g of vitamin C infusion as an unconventional therapy for her hemifacial spasm. Diagnosis of methemoglobinemia and hemolytic anemia was made clinically and confirmed on laboratory tests. She recovered with supportive treatment and packed cell transfusion. Her previously unrecognised underlying con dition of glucose-6-phosphate dehydrogenase (G6PD) deficiency was confirmed months after the initial pres...
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Authors: Yat Hei Lo, Ka Leung Mok Source Type: research

Psychiatric emergency department volume during Covid-19 pandemic
One commonly reported phenomenon in the first months of the Covid-19 era in the United States has been the reduction in emergency department (ED) visits and hospitalizations of patients with heart attacks, strokes and other acute, non-Covid illnesses [1]. Less is known about whether and how the number of patients presenting to EDs for psychiatric problems has changed. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Authors: Matthew N. Goldenberg, Vivek Parwani Source Type: research

The impact of COVID-19 on suicidal ideation and alcohol presentations to emergency departments in a large healthcare system
Behavioral health (BH) complaints, including suicidal ideation (SI) and alcohol, are common in US Emergency Departments (EDs), [1-3]. The CDC published data in 2018 demonstrating a 25% overall increase in ED visits for SI and/or self-directed violence [4]. Additionally, the CDC reported that 24.5% of the population  > 12 years old engaged in binge alcohol use in 2017 [5]. A public health crisis occurred with the onset of novel coronavirus 2019 (COVID-19). Current “stay at home” orders have reduced human contact through social distancing [6]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 1, 2020 Category: Emergency Medicine Authors: Courtney M. Smalley, Donald A. Malone, Stephen W. Meldon, Bradford L. Borden, Erin L. Simon, McKinsey R. Muir, Baruch S. Fertel Source Type: research

In-hospital mortality of STEMI patients: A comparison of transportation modes to PCI and non-PCI centers
In the clinical spectrum of ACS, ST elevation myocardial infarction (STEMI) is a life-threating medical condition that requires early, intensive treatment [1]. In particular, emergency medical services (EMS) have a crucial role in improving the management and ultimate clinical outcome of such patients [2,3]. However, some studies revealed that the overall mortality of patients who are transported via EMS is worse than it is for patients who use other transportation modes [4,5]. It was concluded that even though door-to-balloon time (DBT) was significantly shorter for patients who were transported by EMS, such STEMI patient...
Source: The American Journal of Emergency Medicine - May 29, 2020 Category: Emergency Medicine Authors: Tufan Çınar, Veysel Ozan Tanık, Barış Şimşek, Barış Güngör, Gönül Zeren, Can Yücel Karabay Source Type: research

Outcomes of extracorporeal membrane oxygenation support for patients with COVID-19: A pooled analysis of 331 cases
Recently in this journal Chavez et al. [1] reviewed the current state of COVID-19, they noted that the role of extracorporeal membrane oxygenation (ECMO) was yet to established. Indeed, other authors have gone so far as to issue caution on the use of ECMO at all as a rescue therapy for severe acute, hypoxemic respiratory failure secondary to the coronavirus disease 2019 (COVID-19) [2]. An early pooled analysis of 17 patients receiving ECMO for COVID-19 suggests a mortality rate of 94.1% [3]. Extracorporeal Life Support Organisation (ELSO) members currently report 470 confirmed COVID-19 positive ECMO runs; however, mortalit...
Source: The American Journal of Emergency Medicine - May 28, 2020 Category: Emergency Medicine Authors: Thomas M. Melhuish, Ruan Vlok, Christopher Thang, Judith Askew, Leigh White Source Type: research

Herpes associated erythema multiforme: A retrospective study
Erythema multiforme (EM), an acute dermatologic condition frequently encountered in the Emergency Department, classically presents with a targetoid rash. We reviewed all recent EM cases seen at the LAC-USC County Hospital in order to ascertain the proportion of Herpes associated EM (HAEM) cases and to inform the diagnostic workup of these patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 28, 2020 Category: Emergency Medicine Authors: Michelle Hao, Peter Zang, Melanie Miller, Lauren Cutler, Scott Worswick Source Type: research

Morgagni hernia and accessory liver lobe torsion in an adult
Accessory liver lobe (ALL) is a rare congenital anomaly of the liver and is related to the focal excessive development of liver tissue. Accessory liver lobe torsion (ALLT) is a rare condition that can present with acute abdominal pain. Delay in diagnosis can lead to life-threatening complications such as sepsis and systemic inflammatory response syndrome. Imaging methods, especially computed tomography (CT), are of great importance for prompt diagnosis of acute abdominal pain causes, and CT images should be carefully examined. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 28, 2020 Category: Emergency Medicine Authors: Furkan Ufuk, Sevda Y ılmaz Source Type: research

Earlier and widespread screening for SARS-CoV-2 is needed for first responders
First responders are at high risk of repeated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure, work in close proximity with team members, and interface with vulnerable populations. Individuals working in a firehouse are often sharing living and dining quarters, making risk levels comparable to that of household contacts. While several hospitals have offered testing to first responders, the extent of transmission in this population and the adequacy of passive outreach is unclear. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 28, 2020 Category: Emergency Medicine Authors: Olive Tang, Benjamin F. Bigelow, Morgan J. Katz Source Type: research

Esmolol in the management of pre-hospital refractory ventricular fibrillation: A systematic review and meta-analysis
Esmolol has been proposed as a viable adjunctive therapy for pre-hospital refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 28, 2020 Category: Emergency Medicine Authors: Dennis Miraglia, Lourdes A. Miguel, Wilfredo Alonso Source Type: research

Dog leash-related injuries treated at emergency departments
Although dog ownership may provide health benefits, interactions with dogs and their leashes can result in injuries. The intent of this study was to describe dog leash-related injuries treated at United States (US) emergency departments (EDs). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 28, 2020 Category: Emergency Medicine Authors: Mathias B. Forrester Source Type: research

The depiction of major disasters in emergency department-associated medical television shows
The objective of this study was to describe major disasters depicted in a select number of emergency department (ED)-associated medical television shows and compare these depictions with ten major U.S. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 27, 2020 Category: Emergency Medicine Authors: Liza Gergenti, Adrienne Caiado, Lynnette Lacek, Robert P. Olympia Source Type: research

A rare case of septic Sacroiliitis caused by Serratia marcescens
Septic sacroiliitis is a rare and difficult to diagnose infection of the sacroiliac joints [1-3]. Septic sacroiliitis represents 1 –2% of all cases of septic arthritis and the incidence is exceedingly low with only 1–2 cases per year being diagnosed [4,5]. Symptoms of septic sacroiliitis include fever, lower back pain, referred hip pain, and weight-bearing difficulty [6]. Risk factors include trauma, pregnancy, intravenous (IV) drug use, endocarditis, and immunosuppression [7]. Complications resulting from septic sacroiliitis include septic shock, psoas muscle abscess, iliopsoas abscess, long-term joint deformi...
Source: The American Journal of Emergency Medicine - May 27, 2020 Category: Emergency Medicine Authors: Erin L. Simon, Ethan G. Wainblat, Jessica Krizo, Courtney M. Smalley, Baruch S. Fertel Source Type: research

Predictive factors for acute brain lesions on magnetic resonance imaging in acute carbon monoxide poisoning
This study was conducted to identify the risk factors associated with acute brain lesions on MRI after acute CO poisoning and to help select patients who need acute-phase brain MRI after acute CO poisoning in the emergency department (ED). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 27, 2020 Category: Emergency Medicine Authors: Jang Hyo Kim, Areum Durey, Seung Baik Han, Ji Hye Kim Source Type: research

Lung ultrasound monitoring in patients with COVID-19 on home isolation
Many patients with COVID-19, the clinical illness caused by SARS-CoV-2 infection, exhibit mild symptoms and do not require hospitalization. Instead, these patients are often referred for 14-days of home isolation as symptoms resolve. Lung ultrasound is well-established as an important means of evaluating lung pathology in patients in the emergency department and in intensive care units. Ultrasound is also being used to assess admitted patients with COVID-19. However, data on the progression of sonographic findings in patients with COVID-19 on home isolation is lacking. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 27, 2020 Category: Emergency Medicine Authors: Hamid Shokoohi, Nicole M. Duggan, Gonzalo Garc ía-de-Casasola Sánchez, Marta Torres-Arrese, Yale Tung-Chen Source Type: research

60-day major adverse cardiac events in emergency department patients with non-low modified HEART scores
A low (0 –3) History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score reliably identifies ED chest pain patients who are low risk for near-term major adverse cardiac events (MACE). To optimize sensitivity, many clinicians employ a modified HEART score by repeating troponin measurements and excluding patients with abnormal troponin values or ischemic electrocardiograms (ECGs). The residual MACE risk among patients with otherwise non-low (>4) modified HEART scores is thus likely much lower than when non-low original HEART scores. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 27, 2020 Category: Emergency Medicine Authors: Dustin G. Mark, Jie Huang, Chris J. Kennedy, David R. Vinson, Dustin W. Ballard, Mary E. Reed, the Kaiser Permanente CREST Network Investigators Source Type: research

A new frontier in pelvic fracture pain control in the ED: Successful use of the pericapsular nerve group (PENG) block
The pericapsular nerve group (PENG) block is a novel ultrasound-guided regional anesthesia technique derived from recent anatomic studies detailing the sensory innervation of the hip. Targeting these terminal sensory branches, the PENG block was originally developed as a potentially more effective block for perioperative hip fracture anesthesia, with the added benefit of preserving motor function. Subsequent research with higher volumes of local anesthetic demonstrated the successful utilization of PENG block for perioperative acetabular fractures. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 27, 2020 Category: Emergency Medicine Authors: Josh Luftig, Andrea Dreyfuss, Daniel Mantuani, Kaitlen Howell, Angela White, Arun Nagdev Source Type: research

A review of guidelines on anticoagulation reversal across different clinical scenarios – Is there a general consensus?
Anticoagulation is key to the treatment/prevention of thromboembolic events. The primary complication of anticoagulation is serious or life-threatening hemorrhage, which may necessitate prompt anticoagulation reversal; this could also be required for nonbleeding patients requiring urgent/emergent invasive procedures. The decision to reverse anticoagulation should weigh the benefit –risk ratio of supporting hemostasis versus post-reversal thrombosis. We appraise the available guidelines/recommendations for vitamin K antagonist (VKA) and direct oral anticoagulant (DOAC) reversal in the management of major bleeding, and...
Source: The American Journal of Emergency Medicine - May 27, 2020 Category: Emergency Medicine Authors: Truman J. Milling, Charles V. Pollack Source Type: research

Insurance expansion associated with reduced use of emergency psychiatric services
The introduction of the Affordable Care Act (ACA) in 2010 allowed states to expand the availability of public insurance to their citizens [1]. Thirty-five states ultimately adopted insurance expansion. It was widely anticipated that the law would alter utilization of medical services. One of the surprising changes has been an increase in the utilization of emergency department (ED) services for medical [2,3] and substance abuse services [4,5]. This increase occurred despite an increase in utilization of outpatient and preventative services, but not for non-substance-related mental health services [6]. (Source: The American...
Source: The American Journal of Emergency Medicine - May 27, 2020 Category: Emergency Medicine Authors: Rif S. El-Mallakh, Brenda Goetz, Mohammed Nuru, Ryan Weegens, Urooj Yazdani, Christina Terrell Source Type: research

Clinical Utility of Carnett and closed eye sign in emergency department
Carnett's sign (CAR) and Closed Eye sign (CE) have been suggested for use in the emergency department setting in the management of abdominal pain. The present study sought to determine the sensitivity/specificity of CAR and CE for pathological CT findings as a primary outcome and for subsequent hospital admission or surgical intervention as secondary outcomes in a community emergency department setting. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 27, 2020 Category: Emergency Medicine Authors: Michael A. Darracq Source Type: research

Safety of push-dose phenylephrine in adult ICU patients
Vasopressor medications are used to increase blood pressure in hypotensive, intensive care unit (ICU) patients. Typically, vasopressors are administered as continuous intravenous (IV) infusions. Due to the quick onset and short half-life of vasopressor medications, these infusions are able to be quickly titrated to a target blood pressure. However, the administration of continuous infusions can be delayed because of the time required to compound and deliver the medications. Recent evidence even suggests that infusion dead space can delay medication administration by several minutes [1]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 27, 2020 Category: Emergency Medicine Authors: Brian A. Kurish, Cesar Alaniz, James T. Miller, Nicholas Farina Source Type: research

Wearing a N95 mask increases rescuer's fatigue and decreases chest compression quality in simulated cardiopulmonary resuscitation
This study was designed to investigate whether the use of N95 mask affects rescuer's fatigue and chest compression quality during cardiopulmonary resuscitation (CPR). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 26, 2020 Category: Emergency Medicine Authors: Yu Tian, Xiaopeng Tu, Xianlong Zhou, Jiangtao Yu, Shan Luo, Liping Ma, Chang Liu, Yan Zhao, Xiaoqing Jin Source Type: research

Dexmedetomidine and worsening hypoxemia in the setting of COVID-19: A case report
Emergency department management of hypoxemia in the setting of COVID-19 is riddled with uncertainty. The lack of high-quality research has translated to an absence of clarity at the bedside. With disease spread outpacing treatment consensus, provider discretion has taken on a heightened role. Here, we report a case of dexmedetomidine use in the setting of worsening hypoxemia, whereby oxygenation improved and intubation was avoided. Well known pharmacologic properties of the drug, namely the lack of respiratory depression and its anti-delirium effects, as well as other possible physiologic effects, suggest potential benefit...
Source: The American Journal of Emergency Medicine - May 26, 2020 Category: Emergency Medicine Authors: John Stockton, Cameron Kyle-Sidell Source Type: research

An updated meta-analysis of AST and ALT levels and the mortality of COVID-19 patients
This study is extremely interesting. The authors observed that several biomedical m arkers such as albumin, blood urea nitrogen, creatinine, creatinine kinase, hypersensitive cardiac troponin I (hs-cTnI) and lactate dehydrogenase (LDH) were positively associated with the risk of mortality in coronavirus disease 2019 (COVID-19) patients based on four published studies. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 26, 2020 Category: Emergency Medicine Authors: Ying Wang, Li Shi, Yadong Wang, Haiyan Yang Source Type: research

Do-it-yourself slime: A novel cause of pediatric burns
“Slime” is a popular do-it-yourself craft among children and teenagers. As its popularity increases, reports of injuries from using homemade slime have been recorded in the literature. The most common adverse effect seems to be a mild contact dermatitis. The case presented introduces an uncommon serious adverse event from exposure to slime products which ultimately required operative management. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 26, 2020 Category: Emergency Medicine Authors: Karla Guzman, Isabel Brea Source Type: research

Defending the front lines during the COVID-19 pandemic: Protecting our first responders and emergency medical service personnel
This is the first wave of COVID-19, indicating an impending second wave set to emerge in the coming winter [1]. Along with the concern for additional outbreaks, studies are showing inconclusive evidence regarding the effectiveness of antibody-mediated immunity in those recovered from COVID-19 [2]. The possibility of reinfection combined with another wave of COVID-19 further supports the need to protect our frontlines. The number of COVID-19 cases continues to rise to 1,053,036 infected people and a quarter-million deaths [3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 26, 2020 Category: Emergency Medicine Authors: Haley Ehrlich, Mark McKenney, Adel Elkbuli Source Type: research

Coronavirus disease 2019 (COVID-19) and ischemic colitis: An under-recognized complication
COVID-19 has spread worldwide, with more than 2.5 million cases and over 80,000 deaths reported by the end of April 2020. In addition to pulmonary symptoms, gastrointestinal symptoms have been increasingly recognized as part of the disease spectrum. COVID-19-associated coagulopathy has recently emerged as a major component of the disease, leading to high morbidity and mortality. Ischemic colitis has been reported to be associated with a hypercoagulable state. To our knowledge, there have not been any case reports of COVID-19 associated with ischemic colitis. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 26, 2020 Category: Emergency Medicine Authors: Kok Hoe Chan, Su Lin Lim, Ahmad Damati, Siva Prasad Maruboyina, Leena Bondili, Amany Abu Hanoud, Jihad Slim Source Type: research

COVID-19 laboratory testing issues and capacities as we transition to surveillance testing and contact tracing
As of May 19, 2020, 11,834,508 COVID-19 tests have been performed in the US resulting in 1,523,534 (12.9%) confirmed cases [1]. The actual number of infected Americans is much larger. Antibody seroprevalence testing in Santa Clara County, California, estimates those infected between 2.49% –4.16% implying actual infections 50–85-fold larger than confirmed cases [2]. Another study concluded that undiagnosed COVID cases represent the infection source of 79% of documented cases [3]. Accurate testing will be crucial to controlling and understanding this pandemic. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 26, 2020 Category: Emergency Medicine Authors: Brendon Sen-Crowe, Mark McKenney, Adel Elkbuli Source Type: research

Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis
Coronavirus disease 2019 (COVID-19) infection has now reached a pandemic state, affecting more than a million patients worldwide. Predictors of disease outcomes in these patients need to be urgently assessed to decrease morbidity and societal burden. Lactate dehydrogenase (LDH) has been associated with worse outcomes in patients with viral infections. In this pooled analysis of 9 published studies (n  = 1532 COVID-19 patients), we evaluated the association between elevated LDH levels measured at earliest time point in hospitalization and disease outcomes in patients with COVID-19. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 26, 2020 Category: Emergency Medicine Authors: Brandon Michael Henry, Gaurav Aggarwal, Johnny Wong, Stefanie Benoit, Jens Vikse, Mario Plebani, Giuseppe Lippi Source Type: research

Rapid outdoor non-compression intubation (RONCI) of cardiac arrests to mitigate COVID-19 exposure to emergency department staff
The COVID-19 pandemic has introduced numerous challenges for Health Care Professionals including exposing Emergency Department (ED) staff to the SARS-CoV-2 virus during Cardiopulmonary Resuscitation (CPR). Recent guidelines from the American Heart Association (AHA) prioritize early intubation with viral filter placement to minimize hospital staff exposure. We propose a novel technique for rapid outdoor non-compression intubation (RONCI) of cardiac arrest patients while en route from the ambulance bay to the resuscitation bay to further decrease the risk of viral aerosolization. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 26, 2020 Category: Emergency Medicine Authors: Brad Kinney, Richard Slama Source Type: research

Social determinants and emergency department utilization: Findings from the Veterans Health Administration
Social determinants of health (SDH) are strong predictors of morbidity and mortality but health care systems struggle to integrate documentation of SDH into health records in ways that can be used for health services research. Given the impact of social factors on health, it is important to examine the relationship with emergency department (ED) utilization. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - May 26, 2020 Category: Emergency Medicine Authors: Camille I. Davis, Ann Elizabeth Montgomery, Melissa E. Dichter, Laura D. Taylor, John R. Blosnich Source Type: research

Intradermal sterile water injection in acute renal colic
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 diclofenac 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 mai...
Source: The American Journal of Emergency Medicine - May 25, 2020 Category: Emergency Medicine Authors: Yalcin Golcuk, Ahmet Demir, Birdal Y ıldırım, Ethem Acar Source Type: research