COVID-19 in pregnancy and the puerperium: A review for emergency physicians
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a novel virus responsible for causing the novel coronavirus disease of 2019 (COVID-19). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 31, 2020 Category: Emergency Medicine Authors: Marina N. Boushra, Alex Koyfman, Brit Long Source Type: research

Hardening hospital defences as a counter-terrorism medicine measure
Since the early 1980's, over 100 terrorist attacks have targeted healthcare facilities around the globe. [1] The vulnerability of hospitals as “soft targets,” defined as publicly accessible locations unprotected or vulnerable to terrorist attacks, is historically well documented, and remains a significant issue in modern day counter-terrorism considerations. [2] “Hardening” these targets is essential to lessen the vulnerability and impact of attack, and is part of the mitigation strategies included in a newly emerging healthcare initiative, Counter-Terrorism Medicine (CTM) [3]. (Source: The American...
Source: The American Journal of Emergency Medicine - October 29, 2020 Category: Emergency Medicine Authors: Derrick Tin, Alexander Hart, Gregory R. Ciottone Source Type: research

The value of using the HEART score among cocaine associated chest pain patients in the emergency department - A closer look
At present, the HEART score shows great value in risk stratifying chest pain patients in the Emergency Department (ED). Patients with HEART scores of 0 –3 are considered low risk for acute coronary syndrome (ACS), and thus can be safely discharged from ED with low probability of short-term major adverse cardiac events (MACE) [1]. The HEART score enables better differentiation of low risk ACS among the general ED patient population, but its value among special patient populations remains uncertain. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 28, 2020 Category: Emergency Medicine Authors: Katherine A. Holmes, Rachel A. Posey, Hao Wang Source Type: research

Assessment of ED triage of anaphylaxis patients based on the Emergency Severity Index
To describe the emergency department (ED) triage of anaphylaxis patients based on the Emergency Severity Index (ESI), assess the association between ESI triage level and ED epinephrine administration, and determine characteristics associated with lower acuity triage ESI assignment (levels 3 and 4). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 28, 2020 Category: Emergency Medicine Authors: Daniel Chiang, Justine M. Ade, Xiao-wei Liu, Fernanda Bellolio, Christine M. Lohse, Benjamin J. Sandefur, Ronna L. Campbell Source Type: research

Adapted Diving Mask (ADM) device as respiratory support with oxygen output during COVID-19 pandemic
At the end of 2019, several cases of pneumonia were identified in Wuhan (Hubei, China) [1], caused by a new Orthocoronavirinae, commonly known as coronavirus, from the Coronaviridae family. In January 2020, there was a public health emergency declaration [2] and, as of March 2020, a pandemic [3,4]. At present, more than 2 million cases have been confirmed globally (2.160.2017 April 18th) [5-9]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: C. Bibiano-Guillen, B. Arias-Arcos, C. Collado-Escudero, M. Mir-Montero, F. Corella-Montoya, J. Torres-Macho, M.J. Buend ía-Garcia, R. Larrainzar-Garijo Source Type: research

Care intensity of spontaneous intracranial hemorrhage: Effectiveness of the critical care resuscitation unit
Patients with spontaneous intracranial hemorrhage (sICH) and elevated intracranial pressure (ICP) are associated with higher mortality rates, which are estimated to be between 35% and 52% [1]. These patients are also susceptible to increased risk of death associated with blood pressure variability [2-4] because cerebral perfusion pressure is dependent on mean arterial pressure (MAP) [5]. Patients with sICH are also at high risk to develop acute kidney injury (AKI) because of pre-existing hypertensive nephropathy [6], low estimated glomerular filtration rate upon admission [7]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: Laura Tiffany, Daniel J. Haase, Kimberly Boswell, Mary Ellen Dietrich, Daniel Najafali, Joshua Olexa, Jeffrey Rea, Mayga Sapru, Thomas Scalea, Quincy K. Tran Source Type: research

Hollow adrenal gland sign on dual-phase contrast-enhanced CT in critically ill patients with sepsis
We aimed to describe the clinical manifestations of patients with sepsis who had the hollow adrenal gland sign (HAGS) during the acute phase of resuscitation and evaluated its value in predicting in-hospital mortality. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: Jong Eun Park, Gun Tak Lee, Jiyeong Lee, Young-Min Kim, Tae Gun Shin, Se Uk Lee, Taerim Kim, Hee Yoon, Won Chul Cha, Sung Yeon Hwang Source Type: research

Unscheduled Care Access in the United States-A Tale of Two Emergency Departments
Rural communities face challenges in accessing healthcare services due to physician shortages and limited unscheduled care capabilities in office settings. As a result, rural hospital-based Emergency Departments (ED) may disproportionately provide acute, unscheduled care needs. We sought to examine differences in ED utilization and the relative role of the ED in providing access to unscheduled care between rural and urban communities. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: Arjun K. Venkatesh, Margaret B. Greenwood-Ericksen, Hao Mei, Craig Rothenberg, Zhenqiu Lin, Harlan M. Krumholz Source Type: research

Cardiogenic shock due to acute severe ischemic mitral regurgitation
We present a 69-year-old women with an inferior STEMI and cardiogenic shock due to acute ischemic MR who delayed presenting to hospital due to the fear of COVID-19. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: Andre Briosa e Gala, Jonathan Hinton, Rohit Sirohi Source Type: research

The case for an Australian Disaster Reserve Force
The black summer bushfires and the current COVID-19 pandemic have accelerated the establishment of Disaster Medicine (DM) into a mainstream medical subspecialty. The systematic healthcare flaws exposed by these two unprecedented events have reiterated the importance of disaster prevention, mitigation, preparedness, response, and recovery. As a result, there have been calls for changes to Australia's disaster management system and specifically for greater involvement of the Australian Defense Force (ADF) to combat this existential national security threat [1]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: Derrick Tin, Alexander Hart, Gregory R. Ciottone Source Type: research

Pulse oximeter plethysmograph waveform and automated oscillometric sphygmomanometer for ankle-brachial index measurement
There are limited non-invasive methods to assess lower extremity arterial injuries in the emergency department (ED) and pre-hospital setting. The ankle-brachial index (ABI) requires careful auscultation by Doppler, an approach made difficult in noisy environments. We sought to determine the agreement of the ABI measured using the pulse oximeter plethysmograph waveform (Pleth) with auscultation by Doppler in a controlled setting. A secondary outcome sought to examine the agreement of ABI by automated oscillometric sphygmomanometer (AOS) with Doppler. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: Cosby G. Arnold, J. Richard Walker, E. Jeffrey Metter, Shane Young, Mark F. Brady Source Type: research

First and last authorship by gender in emergency medicine publications- a comparison of 2008 vs. 2018
Recently, investigators reported that there remain substantial disparities in the proportion of women within emergency medicine (EM) who have achieved promotion to higher academic rankings, received grant funding, and attained departmental leadership positions. In 2007, women were first authors on 24% of EM-based peer-reviewed articles. Currently, 28% of the academic EM physician workforce is comprised of women. The goal of this study was to identify whether the proportion of female first authors of original research published in three U.S.-based EM journals increased in 2018 as compared to 2008. (Source: The American Jour...
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: Johnlukas Webb, John Cambron, K. Tom Xu, Michael Simmons, Peter Richman Source Type: research

Predicting emergency department volumes: A multicenter prospective study
Emergency department overcrowding, defined as patient volume in excess of capacity, is associated with medical errors, delays in care, and an increased mortality rate for patients waiting to be seen [1,2]. Accurately anticipating emergency department volumes could facilitate more efficient allocation of resources that limit overcrowding, and potentially improve patient outcomes. Such forecasting tools are not readily available, and previously published tools were based on retrospective data [3-5]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: Michael Fralick, Joshua Murray, Muhammad Mamdani Source Type: research

Injury rates per mile of travel for electric scooters versus motor vehicles
This study determined the vehicle-miles-traveled (VMT)-based injury rate for stand-up, dockless electric rental scooters (e-scooters), and compare it with the VMT-based injury rate for motor vehicle travel. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: Kevin Rix, Nora J. Demchur, David F. Zane, Lawrence H. Brown Source Type: research

The niche of artificial intelligence in trauma and emergency medicine
Artificial intelligence (AI) can process data into algorithms via pattern recognition and display useful information [1-3]. In emergency medicine (EM), AI has shown its potential in field triage, within the ED, and after patient discharge [1-3]. Understanding the current applications and limitations of AI in trauma and EM can expand its utility and function to further patient care and resource allocation. As several studies have demonstrated, AI can process and learn from previous years' data to calculate common periods of high trauma volumes, allowing EDs the advantage of preparation [1-3]. (Source: The American Journal o...
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: Haley Ehrlich, Mark McKenney, Adel Elkbuli Source Type: research

Development and verification of a predictive nomogram to evaluate the risk of complicating ventricular tachyarrhythmia after acute myocardial infarction during hospitalization: A retrospective analysis
The purpose of this study was to establish a nomogram to predict the risk of complicating ventricular tachyarrhythmia (VTA) in patients with acute myocardial infarction (AMI) during hospitalization and to verify the accuracy of the model. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: Xifeng Zheng, Ruina Huang, Guangyan Liu, Zhen Jia, Kai Chen, Yan He Source Type: research

T-wave inversions in inferior ST-elevation myocardial infarction - A case of “inferior Wellens sign”
Although T-wave inversions are nonspecific, in the appropriate clinical setting, the pattern of negative biphasic T-waves or T-wave inversion in V2-V3 can indicate critical stenosis of the left anterior descending coronary artery (i.e. “anterior Wellens sign”). Recently tall T-waves in V2-V3 have been reported in association with posterior reperfusion (i.e.“posterior Wellens sign”). Less commonly, negative biphasic T-waves or T-wave inversions in the inferior leads have been reported in association with critical stenosis o f the right coronary artery (RCA) or left circumflex artery (LCx). (Source: T...
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: Sylvia Alejandra Pi ña-Paz, Amandeep Singh Source Type: research

Association between prehospital prognostic factors and out-of-hospital cardiac arrest: Effect of rural –urban disparities
Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis and a highly variable survival rate. Few studies have focused on outcomes in rural and urban groups while also evaluating underlying diseases and prehospital factors for OHCAs. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: Ying-Chen Hsu, Wei-Ting Wu, Jyun-Bin Huang, Kuo-Hsin Lee, Fu-Jen Cheng Source Type: research

The Emperor Has No Clothes – Medical Journals and Experts Must Stand Up and Condemn the Federal Pandemic Response
The New England Journal of Medicine, in an unprecedented move, published an editorial statement in the October 8, 2020, issue condemning the federal pandemic response [1]. The article pointed out that the tragedy of the pandemic could have been avoided with an appropriate federal response and leadership [1]. The editors note that the United States has had more covid19 infections and deaths than any other country in the world, including countries with much larger populations. As of the date of publication, over 7.5 million Americans had been infected with the coronavirus and over 200,000 had died [1]. (Source: The American ...
Source: The American Journal of Emergency Medicine - October 27, 2020 Category: Emergency Medicine Authors: Darren P. Mareiniss Source Type: research

Dexmedetomidine in COVID-19: probing promises with prudence!
I read with interest the recent article featured in the journal by Stockton and Kyle-Sidell, wherein they report an improved oxygenation and avoidance of intubation with the use of dexmedetomidine (DEX) in a COVID-19 patient with worsening hypoxemia [1]. As outlined in the index case, DEX infusion can augment compliance to non-invasive ventilation in COVID-19 patients given it's analgesic-sedative profile with minimal respiratory depression and, anti-delirium and opioid-benzodiazepine-sparing potential. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 26, 2020 Category: Emergency Medicine Authors: Rohan Magoon Source Type: research

Comparative efficacy of therapeutics for traumatic musculoskeletal pain in the emergency setting: A network meta-analysis
Musculoskeletal pain control is essential in the management of trauma patients in the emergency department (ED). Here, we performed a network meta-analysis of the use of analgesics to manage traumatic musculoskeletal pain. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 26, 2020 Category: Emergency Medicine Authors: B.S. Xinbo Yin, Xiaokai Wang, Caiyun He Source Type: research

The flea's knees: A unique presentation of cat scratch disease
A 4-year-old girl presented to the emergency department with right leg pain and associated limp for one day. There was no trauma or injury; she had no fever or recent illness. Her exam was notable for tenderness and swelling to the right knee, most prominent in the popliteal region. Initial laboratory testing was unremarkable except for a mildly elevated C-reactive protein. She had normal radiographs of the right lower extremity. A soft tissue ultrasound demonstrated popliteal lymphadenopathy, a rare finding in children. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 24, 2020 Category: Emergency Medicine Authors: Jacob M. Begres, Courtney W. Mangus Source Type: research

Multisystem inflammatory syndrome in children associated with novel coronavirus SARS-CoV-2: Presentations to a pediatric emergency department in Michigan
The SARS-CoV-2 is a respiratory virus of the coronavirus family responsible for a global pandemic since December 2019. More than 35 million people have been affected with the novel coronavirus disease (COVID-19), with more than one million deaths worldwide. Michigan was one of the top three states in the United States that was severely affected by the SAR-CoV-2 pandemic with more than 7000 deaths in adults and greater than 145,000 confirmed infections. However, compared to adults, the majority of children until recently were either asymptomatic or had a mild illness with SARS-CoV-2. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 24, 2020 Category: Emergency Medicine Authors: Usha Sethuraman, Nirupama Kannikeswaran, Jocelyn Ang, Adam Singer, Jason Miller, Rita Haddad, Curt Stankovic Source Type: research

A multifaceted intervention improves antibiotic stewardship for skin and soft tissues infections
Assess the effectiveness of a multifaceted stewardship intervention to reduce frequency and duration of inappropriate antibiotic use for emergency department (ED) patients with skin and soft tissue infections (SSTI). We hypothesized the antibiotic stewardship program would reduce antibiotic duration and improve guideline adherence in discharged SSTI patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 23, 2020 Category: Emergency Medicine Authors: Larissa May, Megan H. Nguyen, Renee Trajano, Daniel Tancredi, Elmar R. Aliyev, Benjamin Mooso, Chance Anderson, Susan Ondak, Nuen Yang, Stuart Cohen, Jean Wiedeman, Loren G. Miller Source Type: research

Aggressive versus conservative fluid resuscitation in septic hemodialysis patients
Sepsis and bacterial infections are common in patients with end-stage renal disease (ESRD). We aimed to compare patients with ESRD on hemodialysis presenting to hospital with severe sepsis or septic shock who received (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 23, 2020 Category: Emergency Medicine Authors: Kartikeya Rajdev, Lazer Leifer, Gurkirat Sandhu, Benjamin Mann, Sami Pervaiz, Shubham Lahan, Abdul Hasan Siddiqui, Saad Habib, Bino Joseph, Suzanne El-Sayegh Source Type: research

Implementation of a geriatric emergency department program using a novel workforce
Over 1 million Veterans ≥65 years old visit the emergency department (ED) at Veterans Affairs Medical Centers (VAMCs) each year and account for over 40% of all annual ED visits, well above the national average of 18% at non-VA medical centers [1]. Caring for older adults in the ED presents unique challenges such as pol ymorbidity, impaired cognition, and functional impairment [2]. Comprehensive Geriatric ED programs that employ multi-touch interventions have been described and are associated with less decline in functional status and decreased post-ED acute care utilization [2,3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 23, 2020 Category: Emergency Medicine Authors: Jill M. Huded, Albert Lee, Colleen M. McQuown, Sunah Song, Mustafa S. Ascha, Denise M. Kresevic, Gerald E. Maloney, Todd I. Smith Source Type: research

Burnout amongst emergency healthcare workers during the COVID-19 pandemic: A multi-center study
Burnout is a major healthcare issue [1] which has intensified with additional stressors arising from the ongoing 2019 Novel Coronavirus (COVID-19) pandemic [2,3]. Emergency Department (ED) healthcare workers (HCWs) have had one of the highest incidences of burnout [4-6] even prior to the pandemic. Being at the frontline in direct contact with patients suspected or confirmed to have a COVID-19 infection exacerbates this [7]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 23, 2020 Category: Emergency Medicine Authors: Wei Ping Daniel Chor, N.G. Wei Ming, Lenard Cheng, Wangmin Situ, Jun Wei Chong, N.G. Ling Ying Abigail, Pek Ling Mok, Ying Wei Yau, Ziwei Lin Source Type: research

Transport of awake hypoxemic probable COVID 19 patients in the prone position
We aimed to investigate the effects of transport with prone position on hypoxemia in hypoxemic and awake probable COVID 19 pneumonia patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 23, 2020 Category: Emergency Medicine Authors: İshak Şan, Çağdaş Yıldırım, Burak Bekgöz, Emin Gemcioğlu Source Type: research

Tranexamic acid for ACE inhibitor induced angioedema – A case report
We describe a patient who presented to the emergency department with ACEI-AE who was successfully treated with TXA. This case suggests that TXA may be a beneficial treatment modality in the management of ACEI-AE and warrants further investigation. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 20, 2020 Category: Emergency Medicine Authors: Kellie Wang, Haden Geiger, Andre McMahon Source Type: research

After a century, Epinephrine's role in cardiac arrest resuscitation remains controversial
Epinephrine is recommended in contemporary educational efforts by the American Heart Association (AHA) as central to adult Advanced Cardiac Life Support (ACLS). However, the International Liaison Committee on Resuscitation (ILCOR) 2019 recommendations update describes large evidentiary gaps for epinephrine use in cardiopulmonary resuscitation, highlighting that clinical and experimental evidence do not support the current AHA recommendations. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 20, 2020 Category: Emergency Medicine Authors: Kasha Bornstein, Brit Long, Alessandra Della Porta, Guy Weinberg Source Type: research

Pancreaticopleural fistula, a rare mediastinal emergency: A case report
A pancreaticopleural fistula (PPF) is a rare condition that causes thoracic symptoms such as dyspnea and chest pain secondary to exudative pleural effusions. While PPF is a very rare complication with only 52 cases reported between 1960 and 2007, they typically occur in patients who are male, middle aged, and have a history of chronic alcohol use and chronic pancreatitis (Aswani and Hira, 2015; Francisco et al., n.d.; Valeshabad et al., 2018; Ali et al., 2009 [1-4]). The fistula between the pancreas and pleural cavity causes large, rapidly accumulating, and recurrent pleural effusions which cause symptoms that can be diffi...
Source: The American Journal of Emergency Medicine - October 20, 2020 Category: Emergency Medicine Authors: Montane B. Silverman, Joshua J. Oliver, Christopher N. Belcher, Jesse Wray, Rachel E. Bridwell Source Type: research

The feasibility of bedside transvaginal ultrasonography in non-pregnant women in the emergency department
Pelvic and abdominal pain in female patients is frequently encountered by emergency physicians (EP). Although the history and physical exam are cornerstones of patient evaluation, the bimanual exam has important limitations and may not be useful for certain pathologies even under optimal conditions [1-3], or when performed by the most skilled physicians [4]. Hence, transabdominal and transvaginal pelvic ultrasonography are frequently performed in women with pelvic pain in our Emergency Department (ED). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 20, 2020 Category: Emergency Medicine Authors: Anst Gelin, Brian E. Driver, Kayla L. Whitson, Krista R. Carlson, Barrett Wagner, Lauren Klein, Stephen W. Smith, Robert F. Reardon Source Type: research

Reverse shock index multiplied by Glasgow coma scale as a predictor of massive transfusion in trauma
Previous studies have identified that the reverse shock index multiplied by the Glasgow Coma Scale score (rSIG) is a good predictor of mortality in trauma patients. However, it is unknown if rSIG has utility as a predictor for massive transfusion (MT) in trauma patients. The present study evaluated the ability of rSIG to predict MT in trauma patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 20, 2020 Category: Emergency Medicine Authors: Young Tark Lee, Byung Kwan Bae, Young Mo Cho, Soon Chang Park, Chang Ho Jeon, Up Huh, Dae-Sup Lee, Sung-Hwa Ko, Dong-Man Ryu, Il Jae Wang Source Type: research

The heart of the matter at molecular level
At the molecular level two potentially modifiable risk factor for worsening of congestive heart failure(CHF) have now been brought to the attention of clinicians dealing with the syndrome of CHF. Iron deficiency(ID), with or without anaemia, is one such risk factor [1,2]. In the prospective study by Kleber et al., mortality risk was evaluated in 455 CHF patients who had been diagnosed with ID using the criterion of mean corpuscular haemoglobin concentration of 330  g/L or less. In comparison with 1119 iron-replete CHF counterparts, the ID subgroup were characterised by increased mortality(Hazard Ratio 1.7, 95% Confidence...
Source: The American Journal of Emergency Medicine - October 20, 2020 Category: Emergency Medicine Authors: Oscar M.P. Jolobe Source Type: research

Short- and intermediate-term effects of a hospital-integrated walk-in clinic on emergency department-visits and case mix
Emergency department (ED) admissions have been rising over the last decades, especially in countries without any effective gate-keeping functions. Integration of walk-in clinics into the hospital might reduce ED-visits. Over a longer period, however, the additional service of a walk-in clinic might attract even more patients, nullifying an initial decrease in patients for the ED. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 20, 2020 Category: Emergency Medicine Authors: Verena Fuhrmann, Harald Herkner, Anton N. Laggner, Dominik Roth Source Type: research

Prehospital lactate clearance is associated with reduced mortality in patients with septic shock
Assessment of disease severity in patients with septic shock (SS) is crucial in determining optimal level of care. In both pre- and in-hospital settings, blood lactate measurement is broadly used in combination with the clinical evaluation of patients as the clinical picture alone is not sufficient for assessing disease severity and outcomes. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 17, 2020 Category: Emergency Medicine Authors: Romain Jouffroy, Teddy L éguillier, Basile Gilbert, Jean Pierre Tourtier, Emmanuel Bloch-Laine, Patrick Ecollan, Vincent Bounes, Josiane Boularan, Papa Gueye-Ngalgou, Valérie Nivet-Antoine, Jean-Louis Beaudeux, Benoit Vivien Source Type: research

The differential diagnosis of the association of STEMI-like ST segment elevation and hypotension
Like Daly et al., I agree that the differential diagnosis of cardiogenic shock should be wide-ranging [1]. However, I would go further to suggest that clinicians should be on the alert for “red flags” in the clinical presentation so as to expedite timely diagnosis and treatment. Red flags can sometimes be identified in the subgroup of patients who have the association of STEMI-like ST segment elevation and hypotension, when the underlying cause is not acute myocardial infarction ( AMI). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 16, 2020 Category: Emergency Medicine Authors: Oscar M.P. Jolobe Source Type: research

Diagnostic accuracy of lactate levels after initial fluid resuscitation as a predictor for 28  day mortality in septic shock
The aim of the study was to investigate the diagnostic accuracy of initial and post-fluid resuscitation lactate levels in predicting 28  day mortality. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 15, 2020 Category: Emergency Medicine Authors: Gun Tak Lee, Sung Yeon Hwang, Jong Eun Park, Ik Joon Jo, Won Young Kim, Sung Phil Chung, You Hwan Jo, Gil Joon Suh, Sung-Hyuk Choi, Tae Gun Shin, for the Korean Shock Society (KoSS) investigators Source Type: research

Impact of Covid-19 outbreak on clinical presentation of patients admitted for acute heart failure in India
Acute Heart Failure (AHF) is a life-threatening, rapid onset or worsening of sign and/or symptoms of heart failure (HF) which often requires urgent hospitalization for rapid evaluation and treatment. It may present as de novo or, more frequently, as a result of acute decompensation of chronic heart failure (ADHF). Apart from the economic burden on patient and health care system, each AHF related hospitalization is associated with significant increases in 12-month rehospitalization and mortality rate (44% and 17% in ESC-HF pilot study; 30.2 and 30.8% in Trivandrum Heart Failure Registry) Maggioni et al. (Source: The America...
Source: The American Journal of Emergency Medicine - October 15, 2020 Category: Emergency Medicine Authors: Rahul Choudhary, Jai Bharat Sharma, Surender Deora, Atul Kaushik, Sanjeev Sanghvi, Rohit Mathur Source Type: research

Diagnostic accuracy of lactate levels after initial fluid resuscitation as a predictor for 28  day mortality in septic shock
The aim of the study was to investigate the diagnostic accuracy of initial and post-fluid resuscitation lactate levels in predicting 28  day mortality. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 15, 2020 Category: Emergency Medicine Authors: Gun Tak Lee, Sung Yeon Hwang, Jong Eun Park, Ik Joon Jo, Won Young Kim, Sung Phil Chung, You Hwan Jo, Gil Joon Suh, Sung-Hyuk Choi, Tae Gun Shin, for the Korean Shock Society (KoSS) investigators Source Type: research

Cardiovascular diseases burden in COVID-19: Systematic review and meta-analysis
High rate of cardiovascular disease (CVD) have been reported among patients with novel coronavirus disease (COVID-19). Meanwhile there were controversies among different studies about CVD burden in COVID-19 patients. Hence, we aimed to study CVD burden among COVID-19 patients, using a systematic review and meta-analysis. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 15, 2020 Category: Emergency Medicine Authors: Amirhossein Hessami, Amir Shamshirian, Keyvan Heydari, Fatemeh Pourali, Reza Alizadeh-Navaei, Mahmood Moosazadeh, Saeed Abrotan, Layla Shojaei, Sogol Sedighi, Danial Shamshirian, Nima Rezaei Source Type: research

Posterior reversible encephalopathy syndrome associated with Henoch Schonlein Purpura in a pediatric patient
Henoch Schonlein Purpura is a rare hypersensitivity vasculitis that is commonly associated with pediatric patients. It typically presents with purpuric rash to the lower extremities, abdominal pain and microscopic hematuria; however, it may also be associated with intussusception, glomerulonephritis and hypertension. Posterior Reversible Encephalopathy Syndrome is a poorly understood, rare condition associated with cerebral edema and segmental vasoconstriction. Typically characterized by headaches, seizures, and visual changes, which is presumed to be associated with rapid increases in blood pressure. (Source: The American...
Source: The American Journal of Emergency Medicine - October 15, 2020 Category: Emergency Medicine Authors: Derek J. Fikse, Phillip M. Grenz, Scott M. Wheatley, Kimberly L. Fugok Source Type: research

Cardiopulmonary resuscitation during the COVID-19 pandemic: Maintaining provider and patient safety
In this report we aim to summarize the known outcomes of COVID-19 patients who received CPR, review the current guidelines for infected patients, and discuss the ethical implications. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 14, 2020 Category: Emergency Medicine Authors: Brendon Sen-Crowe, Mason Sutherland, Mark McKenney, Adel Elkbuli Source Type: research

Can emergency department patients safely remove their own sutures at home?
Annually, approximately 7 to 9 million lacerations are treated in emergency departments (ED) in the United States [1]. While it has been found that patients tend to prefer absorbable sutures, some individuals have tissue reaction to subcutaneous polyglactin [2]. For each injury that requires closure, patients treated with nonabsorbable sutures are generally referred to their medical care provider to have those sutures removed. For patients who are uninsured, unable to access an urgent care facility or lacking a primary care provider, the medical care to remove sutures often occurs in the same ED where the laceration repair...
Source: The American Journal of Emergency Medicine - October 13, 2020 Category: Emergency Medicine Authors: Allison Brown, Nadia Nikroo, Samir Yassin, Kyle Beasley, Noelle Kraus, Justin Houseman, Jeffrey Jones Source Type: research

Elevated cardiac biomarkers may be effective prognostic predictors for patients with COVID-19: A multicenter, observational study
This study aimed to investigate whether the elevated cardiac biomarkers could become effective prognostic predictors for COVID-19 patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 13, 2020 Category: Emergency Medicine Authors: Jie Yang, Xuelian Liao, Wanhong Yin, Bo Wang, Jirong Yue, Lang Bai, Dan Liu, Ting Zhu, Zhixin Huang, Yan Kang, Study of 2019 Novel Coronavirus Pneumonia Infected Critically Ill Patients in Sichuan Province (SUNRISE) Group Source Type: research

Cardiac rupture with conservative treatment and survival in takotsubo cardiomyopathy
The patient reported by Yu et al may have been been unique in having survived conservative treatment of free wall myocardial rupture in the in the context of ST segment elevation myocardial infarction(STEMI) [1]. However, in the context of takotsubo cardiomyopathy(TTC), which can be a close mimic of STEMI, 3 patients have been reported with clinical and echocardiographic stigmata strongly suggestive of myocardial rupture[2,3,4], and all three were successfully managed without recourse to cardiac surgery. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 12, 2020 Category: Emergency Medicine Authors: Oscar M.P. Jolobe Source Type: research

Studying outcome predictors of drowning at the scene: Why do we have so few answers?
Identification of predictors of outcome at the scene of drowning events could guide prevention, care and resource utilization. This review aimed to describe where, what and how scene predictive factors have been evaluated in drowning outcome studies. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 10, 2020 Category: Emergency Medicine Authors: William Koon, Tessa Clemens, Joost Bierens, Linda Quan Source Type: research

Estimating maximum patient throughput at an ED scanner: Is three patients per hour the magic number?
Computed tomography (CT) is a critical imaging modality in the emergency department (ED). Many patient evaluations hinge on CT results, and throughput at the scanner is integral to overall department flow. However, the throughput of a CT scanner is affected by many factors. To run efficiently, image orders need to be placed promptly, lab orders often need to be placed and resulted (i.e. creatinine, hCG), results need to be communicated, scans need to be protocoled, patients need to be transported and scanned, and CT images need to be interpreted. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 10, 2020 Category: Emergency Medicine Authors: Bryan A. Stenson, Joshua W. Joseph, Peter S. Antkowiak, Robin B. Levenson, David T. Chiu, Leon D. Sanchez Source Type: research

An analysis of sex diversity in ACGME emergency medicine fellowships
While gender diversity in the field of emergency medicine has been improving, gender inequity still remains an issue. Women account for 50% of the population and 50% of medical school graduates yet they remain underrepresented in the field of emergency medicine [1]. Previous studies have demonstrated that despite a rise in the number of emergency medicine residency training programs a concordant rise in female residents has not been observed [2]. In 2018, only 35.4% of emergency medicine trainees were female [3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 10, 2020 Category: Emergency Medicine Authors: Benjamin Partiali, Sandra Oska, Danielle Turner-Lawrence Source Type: research

Blood urea nitrogen to albumin ratio is a predictor of in-hospital mortality in older emergency department patients
In this study, we aimed to evaluate the first measured blood urea nitrogen (BUN)/albumin ratio in the emergency department (ED) as a predictor of in-hospital mortality in older ED patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 9, 2020 Category: Emergency Medicine Authors: Zerrin Defne Dundar, Kadir Kucukceran, Mustafa Kursat Ayranci Source Type: research