Off the Shelf: Rapid Deployment of an Emergency Department Telemedicine Platform Using Readily Available Consumer Products
For 20  years, telemedicine has been waiting in the wings for its time in the spotlight. The Coronavirus Disease 2019 (COVID-19) pandemic, with its emphasis on personal protective equipment (PPE) and reducing high-risk contacts, was the catalyst needed to bring telemedicine into mainstream consciousness a nd acceptance. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 21, 2020 Category: Emergency Medicine Authors: Jason Lowe, Sam Shen Tags: Computers in Emergency Medicine Source Type: research

Comparing Diazepam Plus Fentanyl With Midazolam Plus Fentanyl in the Moderate Procedural Sedation of Anterior Shoulder Dislocations: A Randomized Clinical Trial
The reduction of shoulder dislocation requires adequate procedural sedation and analgesia. The mixture of midazolam and fentanyl is reported in the literature, but long-acting benzodiazepines in conjunction with fentanyl are lacking. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 21, 2020 Category: Emergency Medicine Authors: Mohammad Afzalimoghaddam, Maryam Feyiz Khademi, Hadi Mirfazaelian, Pooya Payandemehr, Ehsan Karimialavijeh, Alireza Jalali Tags: Brief Reports Source Type: research

Low-Voltage Electricity –Associated Burn Damage of Lung Parenchyma: Case Report and Literature Review
We report a case of bilateral lung injury with pulmonary hemorrhage after exposure to low-voltage electricity. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 21, 2020 Category: Emergency Medicine Authors: Chi-Wei Chen, Yen-Ko Lin, Yung-Sung Yeh, Chao-Wen Chen, Tzu-Yin Lin, Sheng-Huang Chang Tags: Clinical Communications: Adult Source Type: research

Consider Going Decaf: An Intentional Caffeine Overdose in the Emergency Department
Caffeine (1,3,7-trimethylxanthine) is a naturally occurring compound found in plants and is the most utilized drug in the world. An estimated 89% of U.S. citizens and 80% of people worldwide consume caffeine on a regular basis. The prevalence of caffeine supplementation by individuals has been increasing in body-weight regulation (e.g., weight loss, body building). When used in excessive amounts it can precipitate serious health consequences, including death. Given this, and the ease of accessibility, caffeine has been seen in intentional overdose. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 20, 2020 Category: Emergency Medicine Authors: Scott Meester, Christopher Hogrefe Tags: Selected Topics: Toxicology Source Type: research

Diabetic Ketoacidosis as a Delayed Immune-Related Event after Discontinuation of Nivolumab
Nivolumab, an anti-programmed cell death-1 (PD-1) monoclonal antibody with immune checkpoint inhibitory activity, represents a novel treatment for several cancers. Immune checkpoint inhibitors cause side effects, known as immune-related adverse events (irAEs) or delayed immune-related events (DIRE), after immunotherapy discontinuation. Type 1 diabetes mellitus (T1DM) and diabetic ketoacidosis have been reported to develop as an irAE during the treatment with nivolumab. Here, we report on a patient who developed T1DM and diabetic ketoacidosis after discontinuation of treatment with nivolumab as a DIRE. (Source: The Journal ...
Source: The Journal of Emergency Medicine - October 20, 2020 Category: Emergency Medicine Authors: Soichiro Mae, Akira Kuriyama, Hiromi Tachibana Tags: Selected Topics: Oncological Emergencies Source Type: research

Utility of Point-of-Care Ultrasound in the Diagnosis of Idiopathic Intracranial Hypertension in the Emergency Department
Emergency physicians are frequently required to identify and triage patients with increased intracranial pressure (ICP). Idiopathic intracranial hypertension (IIH) is a possible cause that must be considered. Its prognosis depends on prompt recognition and treatment, and progression of the disease can lead to permanent vision loss and considerable morbidity. Point-of-care ultrasound can rapidly identify elevated ICP. Measurements of the optic nerve sheath diameter (ONSD) and optic disc elevation (ODE) can act as surrogates for ICP. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 20, 2020 Category: Emergency Medicine Authors: Samantha C. Huo, Ryan C. Gibbons, Thomas G. Costantino Tags: Ultrasound in Emergency Medicine Source Type: research

Merging Patches, an Atypical Presentation of Disseminated Cutaneous Lyme Disease: A Case Report
Lyme disease, spread by the Ixodes tick, is typically associated with a single “bull's eye rash” that emergency physicians are comfortable recognizing and treating during the summer months when this disease is most prevalent. However, Lyme disease can also present in disseminated forms that are more difficult to diagnose. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 19, 2020 Category: Emergency Medicine Authors: Cristian Toarta, Isaac Bogoch, David Carr Tags: Clinical Communications: Adult Source Type: research

Oncologic Emergencies: Palliative Care in the Emergency Department Setting
Palliative care is an essential component of emergency medicine, as many patients with terminal illness will present to the emergency department (ED) for symptomatic management at the end of life (EOL). (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 19, 2020 Category: Emergency Medicine Authors: Drew A. Long, Alex Koyfman, Brit Long Tags: Selected Topics: Oncological Emergencies Source Type: research

Point-of-Care Ultrasound Diagnosis of Cesarean Scar Ectopic Pregnancy: A Case Series
A cesarean scar pregnancy (CSP) is a clinically important form of ectopic pregnancy that carries a high risk of maternal morbidity and mortality. As the rate of cesarean sections has risen, this diagnosis is becoming an increasingly important consideration for providers caring for patients in early pregnancy. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 19, 2020 Category: Emergency Medicine Authors: Allison Zanaboni, Mark Magee, Ryan Charles Gibbons, Thomas G. Costantino Tags: Ultrasound in Emergency Medicine Source Type: research

A 6-Month-Old With Left Chest Protrusion
A 6-month-old female with a history significant for in utero repair of a myelomeningocele, prematurity, and hydrocephalus after ventriculoperitoneal shunt presented to the emergency department with a 1-day history of a protruding left chest. She had no difficulty breathing and no recent trauma or illnesses. The mother stated that the child was born with 2 healed scars and 1 laceration. Her vital signs were within normal limits and she had 3 healed 1 –2 cm scars lateral to her left nipple. Examination findings are shown in Figure 1. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 19, 2020 Category: Emergency Medicine Authors: Mylinh T. Nguyen, Kathryn H. Pade, Atim Uya Tags: Visual Diagnosis in Emergency Medicine Source Type: research

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A recent trend in academic emergency medicine residencies is to encourage education and experience in “global” medicine. While “global” could include medicine in London or Vienna, it usually refers to resource-limited areas of the world that were previously called developing countries. Having spent some time in these areas, I can attest that there is a paucity of good reference material and WiFi can be spotty or nonexistent. Paul S. Auerbach, arguably the father of wilderness medicine, has written a 2-volume textbook that is the perfect reference for practicing in “resource-limited” or &...
Source: The Journal of Emergency Medicine - October 17, 2020 Category: Emergency Medicine Authors: Edward J. Otten Tags: Book and Other Media Review Source Type: research

Traumatic Brain Injury in Patients Receiving Direct Oral Anticoagulants
Emergency departments (EDs) are faced with a growing number of patients with traumatic brain injury (TBI) using direct oral anticoagulants (DOACs). However, there remains uncertainty about the bleeding risk, rate of hematoma expansion, and the efficacy of reversal strategies in these patients. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 14, 2020 Category: Emergency Medicine Authors: Juliette A.L. Santing, Crispijn L. Van den Brand, Korn é Jellema Tags: Original Contributions Source Type: research

Empyema Necessitans Diagnosed by Point-of-Care Ultrasound
Empyema necessitans is a rare complication of pleural empyema characterized by the dissection of pus through the soft tissues of the chest wall and eventually through the skin. The skin manifestation may appear as a superficial abscess. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 13, 2020 Category: Emergency Medicine Authors: Daniel Elyashiv, Evan Avraham Alpert, Nadav Granat Tags: Ultrasound in Emergency Medicine Source Type: research

A Man with a Knife in His Mouth
Transoral penetrating craniocerebral injury is a very rare type of head and neck trauma. Here, I present a man who attempted suicide by stabbing himself in his mouth with a kitchen knife. Most emergency medical centers have very limited experience with this uncommon injury. Hemodynamically stable patients require extended diagnostic procedures to plan the final surgical procedure, but unstable patients usually require urgent surgical exploration with a surgical airway. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 13, 2020 Category: Emergency Medicine Authors: So Eun Kim Tags: Visual Diagnosis in Emergency Medicine Source Type: research

Using ECG-To-Activation Time to Assess Emergency Physicians ’ Diagnostic Time for Acute Coronary Occlusion
There is no quality metric for emergency physicians ’ diagnostic time for acute coronary occlusion. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 13, 2020 Category: Emergency Medicine Authors: Jesse T.T. McLaren, Monika Kapoor, Soojin L. Yi, Lucas B. Chartier Tags: Original Contributions Source Type: research

Abstracts from the 2020 Oncological Emergencies Conference at MD Anderson in Houston, TX
(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 12, 2020 Category: Emergency Medicine Source Type: research

Emergency Department Associated Cancer Diagnoses Fraught with Poor Outcomes, with Associated Socioeconomic and Racial Disparities
An estimated 20-50% of cancers are diagnosed during an emergency department (ED) visit. Studies have demonstrated that patients diagnosed with cancer in the ED have more advanced disease and lower socioeconomic status. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 12, 2020 Category: Emergency Medicine Authors: Nick R. Pettit, Elisa Sarmiento, Jeffrey A. Kline Source Type: research

Emergency Department Chest Imaging Utilization in Patients with  Cancer
Overutilization of computed tomography (CT) is a growing concern in emergency medicine, particularly in patients with cancer. While previous studies have attempted to characterize the rates of CT use in this population, there are little data available about the comparative yield of this modality compared to conventional radiography (x-ray) and how it affects clinical decision-making. Our aim was to determine whether CT imaging of the chest more frequently identified clinically significant results as compared to chest radiography (CXR) in patients with cancer. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 12, 2020 Category: Emergency Medicine Authors: Jonathon Stewart, Austin Schoeffler, Patrick Sylvester, Joshua Aalberg, Jeffery M. Caterino, Jason J. Bischof Source Type: research

Barriers to Non-opioid Pain Management in the Cancer Patient Presenting to the Emergency Department
Acute pain is the presenting complaint of over half of all patients presenting to the MD Anderson Oncologic Emergency Department. The majority of these patients receive opioid analgesics, yet the prescribing of narcotics in the emergency department has been cited as a major contributor to the current opioid epidemic that is claiming more than 115 lives a day (1). Multi-focal health system interventions to reduce opioid overprescribing have been highly successful, with one study showing a 58% reduction across 44,000 clinical encounters over a 6 month period (2). (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 12, 2020 Category: Emergency Medicine Authors: Adriana Wechsler Source Type: research

A Hybrid Model of Acute Cancer Care from a Hospital-based Acute Care Clinic and the Emergency Department: A Descriptive Study
Emergency department (ED) visits by patients with cancer are increasing. New care delivery models are emerging to address the demand for acute care for patients with cancer. A Cancer Hospital and the affiliated ED implemented a novel care model in January 2016 whereby cancer patients are able to contact a nursing hotline, and based on their symptoms are triaged to the ED or to the Cancer Hospital ’s Acute Care Clinic (ACC) for further evaluation. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 12, 2020 Category: Emergency Medicine Authors: Jason J. Bischof, Montika Bush, Rayad Bin Shams, Frances A. Collichio, Timothy F. Platts-Mills Source Type: research

Characterizing hyperglycemia in cancer patients with diabetes in an Emergency Center
Hyperglycemia in the general patient population evaluated in emergency center (EC) has been published in previous studies, though data on how systematic EC hyperglycemia management affects patient outcomes is still lacking. There is no clear characterization of the prevalence of diabetes and hyperglycemia in the cancer patient population that is evaluated through emergency center. In this retrospective chart review, we review the characteristics of patients with diabetes who present to the emergency center with hyperglycemia as defined by glucose ≥200 mg/dL. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 12, 2020 Category: Emergency Medicine Authors: Sonali Thosani, Veronica Brady Source Type: research

Emergency Department Patients with Cancer: How Do Outcomes at National Cancer Institute Designated Hospitals Compare to the General Population?
Patients with cancer seek emergency care for a myriad of complex reasons. National Cancer Institute (NCI) designated hospitals and their affiliated EDs treat these patients at a higher frequency and may be more prepared to manage oncologic emergencies. We designed a study to investigate if there is a difference in outcomes when patients are seen at an NCI affiliated ED versus a general ED. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 12, 2020 Category: Emergency Medicine Authors: Rahul V. Nene, Jesse J. Brennan, Edward M. Castillo, Renee Y. Hsia, Christopher J. Coyne Source Type: research

Retrospective Chart Review of Emergency Department Patients with Cancer and Non-Neutropenic Fever
This report ’s objective is to characterize key clinical outcomes of non-neutropenic febrile patients with cancer presenting to an academic, Comprehensive Cancer Center affiliated ED. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 12, 2020 Category: Emergency Medicine Authors: Jason J. Bischof, Patrick J. Sylvester, Jennifer A. Frey, Julie Stephens, Becca Hammond, Joshua Garmatter, Jeffrey M. Caterino Source Type: research

Nationwide Analysis of Emergency Department Visits for Pulmonary Embolism in Cancer Patients
Cancer patients are at increased risk of thrombotic complications and pulmonary embolism (PE) constitutes the second leading cause of death in this population. We performed a retrospective study of ED visits with PE, using the Nationwide Emergency Department Sample (NEDS) Database for the year 2016. We sought to compare rates of hospitalizations from ED, as well, as inpatient outcomes including mortality between cancer and non-cancer patients with pulmonary embolism. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 12, 2020 Category: Emergency Medicine Authors: Prasanth Lingamaneni, Sheeba Ba Aqeel, Shweta Gupta Source Type: research

Outcomes of Tumor Lysis Syndrome (TLS) in Solid and Hematologic Cancers: A Nationwide Analysis
Tumor lysis syndrome (TLS) is an oncologic emergency and a well-known complication of rapidly proliferating hematologic malignancies. Over the past decades, it has been increasingly described in solid tumors. We performed a retrospective study of TLS patients using the Nationwide Emergency Department Sample (NEDS) Database for the year 2016. We sought to compare outcomes between patients with solid and hematologic cancers. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 12, 2020 Category: Emergency Medicine Authors: Prasanth Lingamaneni, Sheeba Ba Aqeel, Shweta Gupta Source Type: research

Emergency Management of Catheter Associated Venous Thromboembolism in Cancer Patients
Implantable vascular devices, such as peripherally inserted central catheters (PICC) increase the risk of venous thromboembolism (VTE). Emergency department management of catheter associated VTE remains unclear and questions remain about whether the catheter needs to be immediately removed, can continue to be used, and what therapy is optimal, often in the setting of thrombocytopenia. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 12, 2020 Category: Emergency Medicine Authors: D.N. Lipe, E. Rajha, A. Al-Breiki, T.W. Rice Source Type: research

Interleukin-6 as a Potential Predictor of Neurologic Outcomes in Cardiac Arrest Survivors Who Underwent Target Temperature Management
Serum interleukin-6 (IL-6) is a cytokine released in response to an inflammatory stimulus or tissue injury. IL-6 levels are known to increase in patients with brain injury. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 12, 2020 Category: Emergency Medicine Authors: Jun Young Chong, Hong Joon Ahn, Jung Soo Park, Yeonho You, Jin Hong Min, Wonjoon Jeong, Yongchul Cho, Sung Uk Cho, Se Kwang Oh, Chang Shin Kang, Jaekwang Lee Tags: Brief Report Source Type: research

A Case of COVID-19 Diagnosed At Home with Portable Ultrasound and Confirmed with Home Serology Test
The COVID-19 pandemic has pushed us to find better ways to accurately diagnose what can be an elusory disease, preferably in a way that limits exposure to others. The potential for home diagnosis and monitoring could reduce infectious risk for other patients and healthcare providers, limit use of finite hospital resources and enable better social distancing/isolation practices. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 12, 2020 Category: Emergency Medicine Authors: Amir Aminlari, Faith Quenzer, Stephen Hayden, Jennifer Stone, Charles Murchison, Colleen Campbell Tags: Emergency Forum Source Type: research

Acute Cerebellar Ataxia in COVID-19 infection; a case report.
The outbreak of Coronavirus disease 2019 (COVID-19) has been widely reported to cause symptoms such as fever, cough, sore throat, fatigue and shortness of breath. Neurological complications have not been widely reported without associated respiratory symptoms. These neurological manifestations have been found mostly in the elderly1. There has been no report of ataxia or COVID-19 cerebellitis in the young adult population without associated respiratory symptoms. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 9, 2020 Category: Emergency Medicine Authors: Adriana Povlow, Andrew J. Auerbach Tags: Selected Topics: Neurological Emergencies Source Type: research

Parasitic Soft Tissue Infection Diagnosed by Point-of-Care Ultrasound
We present a case of parasite infestation diagnosed and localized by POCUS in the ED. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 6, 2020 Category: Emergency Medicine Authors: Amir Aminlari, Ian Grover, Stephen Hayden, Bryan Bisanz, Cole Nelson, Colleen Campbell Tags: Visual Diagnosis in Emergency Medicine Source Type: research

Critically Ill Health Care-Associated Urinary Tract Infection: Broad vs. Narrow Antibiotics in the Emergency Department Have Similar Outcomes
Urinary tract infection (UTI) is the second most common infection requiring intensive care unit (ICU) admission in emergency department (ED) patients. Optimal empiric management for health care-associated (HCA) UTI is unclear, particularly in the critically ill. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 6, 2020 Category: Emergency Medicine Authors: Kirstin J. Kooda, Maria Rudis, Kristin Mara, Casey Clements, Fernanda Bellolio Tags: Original Contributions Source Type: research

Point-of-Care Ultrasound for Submassive Pulmonary Embolism
Pulmonary embolism (PE) is a common and potentially fatal diagnosis that must be considered in the emergency department (ED) setting in patients presenting with chest pain or shortness of breath. PE accounts for approximately 100,000 deaths annually in the United States and, according to some studies, this rate is increasing (1). Although computed tomography pulmonary angiography (CTPA) is the gold standard imaging modality for the diagnosis of PE, point-of-care ultrasound (POCUS) is often more readily available and can be used to quickly obtain critical information regarding global cardiac function and direct management. ...
Source: The Journal of Emergency Medicine - October 6, 2020 Category: Emergency Medicine Authors: Amanda N. Quach, Stephen C. Hightower, William D. Goldenberg, Jason J. Lopez Tags: Visual Diagnosis in Emergency Medicine Source Type: research

Characteristics and Outcomes for Delayed Diagnosis of Concussion in Pediatric Patients Presenting to the Emergency Department
Concussions are common pediatric injuries. Previous studies have found concussed youth may be underdiagnosed in the emergency department (ED), but outcomes for those with delayed diagnosis have yet to be described. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 6, 2020 Category: Emergency Medicine Authors: Daniel J. Corwin, Kristy B. Arbogast, Rebecca A. Haber, Kevin W. Pettijohn, Mark R. Zonfrillo, Matthew F. Grady, Christina L. Master Tags: Original Contributions Source Type: research

Clinical Effects of Pediatric Clonidine Exposure: A Retrospective Cohort Study at a Single Tertiary Care Center
Pediatric clonidine ingestions frequently result in emergency department visits and admission for cardiac monitoring. Detailed information on the clinical course and specifically time of vital sign abnormalities of these patients is lacking. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 6, 2020 Category: Emergency Medicine Authors: Michael S. Toce, Eli Freiman, Katherine A. O ’Donnell, Michele M. Burns Tags: Selected Topics: Toxicology Source Type: research

Multisystem Inflammatory Syndrome in Children (MIS-C) in an Adolescent that Developed Coronary Aneurysms: A Case Report and Review of the Literature
A small subset of pediatric patients develop a rare syndrome associated with Coronavirus Disease 2019 (COVID-19) infection called multisystem inflammatory syndrome in children (MIS-C). This syndrome shares characteristics with Kawasaki disease. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 30, 2020 Category: Emergency Medicine Authors: Cole Nelson, Paul Ishimine, Stephen R. Hayden, Matthew Correia, Gabriel Wardi Tags: Clinical Communications: Pediatric Source Type: research

Celebrating Peter Rosen ’s Legacy
As many of you no doubt know by now, Peter Rosen (Figure 1) passed away at his home in Tucson late last year. I was on a plane returning from a trip to India and the Asian Congress in Emergency Medicine when he passed. I swear that I felt a small shimmer in the force that evening, and my phone blew up with supportive messages and condolences as soon as I landed back in the United States. What a surreal feeling to know that your friend had passed while you were incommunicado in the air. In this issue, I wanted to gather some reflections from some of his friends and people he trained, and put them together in a small tribute...
Source: The Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Stephen R. Hayden Tags: Humanities and Medicine Source Type: research

Elevated Methemoglobin Levels in a Patient Treated with Hydroxocobalamin After Suspected Cyanide Exposure
Cyanide (CN) toxicity commonly occurs during enclosed-space fires. Historically, the first step in treating CN toxicity utilized amyl nitrite and sodium nitrite to induce methemoglobinemia, which can be dangerous in this population. Hydroxocobalamin (OHCob), which binds to CN to form the nontoxic metabolite cyanocobalamin, is now the first-line antidote for CN toxicity, and has the advantage of not inducing methemoglobinemia. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Emily Kiernan, Joseph E. Carpenter, Camille A. Dunkley, David Koch, Brent W. Morgan, Alaina R. Steck, Brian Patrick Murray Tags: Selected Topics: Toxicology Source Type: research

Value Utilization of Emergency Medical Services Air Transport in Acute Ischemic Stroke
Determining whether a patient has a time-critical medical condition requiring helicopter Emergency Medical Services (HEMS) transportation is a challenge with acute ischemic stroke (AIS). Although HEMS is largely accepted as improving outcomes in time-sensitive conditions, overtriage of patients ineligible for acute stroke therapies places patients and providers at unnecessary risk and wastes limited health care resources. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Amelia K. Adcock, Joseph Minardi, Scott Findley, Deb Daniels, Michelle Large, Martha Power Tags: Selected Topics: Aeromedical Emergencies Source Type: research

Emergency Point-of-Care Ultrasound Diagnosis of a Femoral Artery Pseudoaneurysm
We report a case of a patient with delayed pseudoaneurysm diagnosis that was ultimately diagnosed with bedside ultrasound. Importantly, our case demonstrates a patient who had a left-sided atherectomy and angioplasty with microcatheter access of the right femoral artery. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Danielle Marie Canter, Mary Ann Difranco, Kevin Landefeld, Christine Butts, Nicole L. Kaban Tags: Ultrasound in Emergency Medicine Source Type: research

A Blacktip Reef Shark Bite to the Hand in the Remote Solomon Islands
Solomon Islands is a country in the South Pacific Ocean with excellent scuba diving, particularly among its remote islands that can be accessed by liveaboard dive boats. Blacktip reef sharks (Carcharhinus melanopterus) are found throughout the island nation and rarely attack humans. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Daniel Popa, Nancy Beach, Charlotte Sadler Tags: Selected Topics: Wound Care Source Type: research

Hoarseness for 1  Week
A 73-year-old woman presented to the emergency department with a 1-week history of hoarseness, dysphagia, and dyspnea. On physical examination, she had jugular vein distension, a harsh systolic murmur at the left upper sternal border, and a significant splitting of S2. Flexible laryngoscopy revealed left vocal cord paralysis (Figure  1A). Chest x-ray study revealed cardiomegaly and dilatation of the main pulmonary artery (Figure 1B). Chest computed tomography showed aneurysmal dilatation of the main pulmonary artery up to 50.8 mm (normative pulmonary artery diameter of 29 mm in men and 27 mm in wom...
Source: The Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Chun-Yen Kuo, Wei-Kung Chen, Chun-Hung Chen Tags: Visual Diagnosis in Emergency Medicine Source Type: research

Grilling 101: A Case of Ingested Grill Brush Bristle
We describe a case of an unusual and unexpected foreign body as the etiology for sore throat. Our patient developed throat pain after eating hamburgers prepared on a grill. She was found to have a grill brush bristle lodged in her vallecula. Because of their small size, brush bristles can be difficult to diagnose and, if left untreated, tend to imbed in surrounding tissues, leading to significant complications. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Authors: Jennifer M. White, Robin N. Boeck, Andrew J. Kienstra Tags: Visual Diagnosis in Emergency Medicine Source Type: research

Incremental Risk of Intracranial Hemorrhage After Mild Traumatic Brain Injury in Patients on Antiplatelet Therapy: Systematic Review and Meta-Analysis
Mild traumatic brain injury (TBI) is a common event and antiplatelet therapy might represent a risk factor for bleeding. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Authors: Elisa M. Fiorelli, Viviana Bozzano, Mattia Bonzi, Silvia V. Rossi, Giorgio Colombo, Gaia Radici, Tiberio Canini, Hayato Kurihara, Giovanni Casazza, Monica Solbiati, Giorgio Costantino Tags: Clinical Review Source Type: research

Association Between Mode of Transportation and Outcomes of Adult Trauma Patients With Blunt Injury Across Different Prehospital Time Intervals in the United States: A Matched Cohort Study
Helicopter Emergency Medical Services (HEMS) dispatch currently depends on predefined protocols, on first responders ’ initial assessment, or on medical direction decision in some states. National guidelines do not provide recommendations concerning prehospital time criteria. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Authors: Jure Colnaric, Rana Bachir, Mazen J. El Sayed Tags: Selected Topics: Aeromedical Emergencies Source Type: research

Pulsus Alternans on Atrial Flutter That Ceased After Cardioversion
We report a case of pulsus alternans on pulse oximetry caused by a trial flutter that ceased after cardioversion. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 27, 2020 Category: Emergency Medicine Authors: Satoshi Yoshikawa, Takeshi Ueda, Emi Yamashita Tags: Visual Diagnosis in Emergency Medicine Source Type: research

Acute Angle-Closure Glaucoma Secondary to Vitreous Hemorrhage Diagnosed with the Aid of Point-of-Care Ultrasound
Acute angle-closure glaucoma (AACG) caused by vitreous hemorrhage is a rare complication of intravitreal injection that often leads to permanent vision loss without prompt treatment. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 27, 2020 Category: Emergency Medicine Authors: Andrew Jersey, Leland Perice, Nicole Li, Jennifer Johnson, Tina Dulani Tags: Ultrasound in Emergency Medicine Source Type: research

Impact of the COVID-19 pandemic on Emergency Department use: focus on patients requiring urgent revascularization.
The novel coronavirus (2019-nCOV) appeared in China and precipitously extended across the globe. As always, natural disasters or infectious disease outbreaks have the potential to cause emergency department (ED) volume changes. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 25, 2020 Category: Emergency Medicine Authors: M.O.N.T.A.G.N.O.N. Romain, R.O.U.F.F.I.L.A.N.G.E. Louis, A.G.A.R.D. Geoffray, B.E.N.N.E.R. Patrick, C.A.Z.E.S. Nicolas, R.E.N.A.R.D. Aur élien Tags: Administration of Emergency Medicine Source Type: research

Positive Tests for Lyme Disease and Emergency Department Visits for Bell's Palsy Patients
Etiologies for Bell's palsy include herpes viruses and Lyme disease, with highest incidence in the colder and warmer months, respectively. In New Jersey, a Lyme-endemic area, the months with the most Lyme disease (80% of cases) are May through October ( “Lyme months”). (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 21, 2020 Category: Emergency Medicine Authors: Adrian Pacheco, Olivia Rutler, Isamar Valenzuela, David Feldman, Barnet Eskin, John R. Allegra Tags: Original Contributions Source Type: research

Static Ultrasound Guidance VS. Anatomical Landmarks for Subclavian Vein Puncture in the Intensive Care Unit: A Pilot Randomized Controlled Study
Subclavian vein puncture is commonly used in the intensive care unit (ICU) but is associated with complications. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 21, 2020 Category: Emergency Medicine Authors: Qingyu Wang, Jiming Cai, Zhiwei Lu, Qun Zhao, Yufang Yang, Li Sun, Qun He, Shaoyi Xu Tags: Ultrasound in Emergency Medicine Source Type: research

Effectiveness of Sodium Bicarbonate Administration on Mortality in Cardiac Arrest Patients: A Systematic Review and Meta-analysis
The 2010 Advanced Cardiac Life Support guidelines stated that routine sodium bicarbonate (SB) use for cardiac arrest patients was not recommended. However, SB administration during resuscitation is still common. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 21, 2020 Category: Emergency Medicine Authors: Kai-Hsiang Wu, Chih-Yao Chang, Yi-Chuan Chen, Chia-Peng Chang, Cheng-Ting Hsiao, Hsu-Huei Weng Tags: Clinical Reviews Source Type: research