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The locked-in syndrome: posterior stroke in the ED
We present this report and brief review as it is unusual to watch locked-in syndrome evolve in the ED. Providers should be aware of the presenting symptoms and the differential diagnosis for bulbar muscle weakness as well as the management of posterior stroke.
Source: The American Journal of Emergency Medicine - May 22, 2013 Category: Emergency Medicine Authors: Corey Goldberg, Stephen Topp, Christopher Hopkins Tags: Case Reports Source Type: research

A Serious Diagnosis Lacking Common Symptoms
​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; & AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regi...
Source: The Case Files - May 28, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Ditch the Machine to Improve Accuracy in Blood Pressure Measurement and Diagnostics
Conclusion For the patient in this case, the decision to forego the convenience of a machine in favor of the skills of a knowledgeable paramedic was lifesaving. Much like the comparison often drawn between the old-fashioned barbell and more sophisticated exercise machines, newer, more complex, and more expensive might make a process more comfortable, but doesn’t always equate to superior results. As we surrender more and more of our hands-on skills to the ease of automated technology, we risk more than the loss of the aptitudes that form the foundation of sound patient assessment—we place our patients in jeopardy of mi...
Source: JEMS Special Topics - October 24, 2018 Category: Emergency Medicine Authors: Mark Rock, NRP Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

Clinical Performance Measures that Matter —Are You Ready?
Conclusion The future will belong to those who can prove value. The use of a clinical performance dashboard and comparisons to national data will help to ensure that when the payers come knocking on our doors looking for "proof" that what we do enhances patient care and improves patient outcome, we’ll have an answer! This is the first in a yearlong series of articles developed by the Academy of International Mobile Healthcare Integration (AIMHI).The AIMHI article series is developed in partnership with JEMS to help educate EMS agencies on the hallmarks and attributes of high-performance/high-value EMS system de...
Source: JEMS Special Topics - December 11, 2018 Category: Emergency Medicine Authors: Wayne C. Harbour, NRP Tags: Exclusive Articles Operations Administration and Leadership Source Type: news

European Resuscitation Council Guidelines 2021: First aid
The European Resuscitation Council has produced these first aid guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics include the first aid management of emergency medicine and trauma. For medical emergencies the following content is covered: recovery position, optimal positioning for shock, bronchodilator administration for asthma, recognition of stroke, early aspirin for chest pain, second dose of adrenaline for anaphylaxis, management of hypoglycaemia, oral rehydration solutions for treating exertion-related dehydration, manage...
Source: Resuscitation - March 24, 2021 Category: Emergency Medicine Authors: David A. Zideman, Eunice M. Singletary, Vere Borra, Pascal Cassan, Carmen D. Cimpoesu, Emmy De Buck, Therese Dj ärv, Anthony J. Handley, Barry Klaassen, Daniel Meyran, Emily Oliver, Kurtis Poole Source Type: research

Sudden Death in High School Athletes: A Case Series Examining the Influence of Sickle Cell Trait
We present a case series of fatal ECAST in high school athletes aged 14 to 16 years. All 3 athletes experienced collapse during practice sessions with muscle pain or weakness. Upon evaluation at the hospital, the athletes had a significant metabolic acidosis that did not respond as expected to fluid resuscitation. Admitting diagnoses for the athletes included exertional heat stroke or dehydration. All 3 athletes had profound rhabdomyolysis leading to acute renal failure, worsening metabolic acidosis, and hyperkalemia. They rapidly progressed to disseminated intravascular coagulation, multiorgan system failure, and death. T...
Source: Pediatric Emergency Care - February 1, 2022 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Acute Aortic Emergencies—Part 2 Aortic Dissections
Patients with aortic disease are some of the highest acuity patients that emergency clinicians encounter. Dissection is the most common aortic catastrophe and involves separation of the aortic layers in a longitudinal fashion leading to diminished perfusion and systemic ischemia. Characteristics of pain, branch vessel involvement, and incidence lead to an understanding of patient presentation, morbidity, and mortality. Diagnosis, selection of diagnostic studies, the degree of preoperative ischemia, and risk of operative mortality can be accomplished using validated clinical decision tools. Emergency interventions are guide...
Source: Advanced Emergency Nursing Journal - January 1, 2013 Category: Emergency Medicine Tags: Cases of Note Source Type: research

Management of Apixaban-Associated Subdural Hematoma: A Case Report on the Use of Factor Eight Inhibitor Bypassing Activity
Conclusions: Factor VIII inhibitor bypassing activity may be a viable, nonspecific reversal agent for life-threatening bleeding associated with apixaban.
Source: Critical Care Medicine - May 16, 2015 Category: Emergency Medicine Tags: Online Case Report Source Type: research

Neurological disorders in the emergency centre of the Douala General Hospital, Cameroon: A cross-sectional study
Conclusion Neurological disorders are common in the emergency centre of the DGH. Aetiologies are diverse and in-hospital mortality is high. This highlights the need to organize neurologist calls at the EC and/or to improve the human resources capacity through regular training and evaluation.
Source: African Journal of Emergency Medicine - July 11, 2015 Category: Emergency Medicine Source Type: research

Raising the bar for exclusion of acute venous thromboembolism in the emergency department
Conclusion Retrospective application of an age adjusted d-dimer cut point for exclusion of VTE in ths cohort significantly increased specificity with limited impact on sensitivity. Caveats include those patients with longstanding symptoms and those with isolated distal deep vein thrombosis. UK centres should consider further local validation and trial adoption.
Source: Emergency Medicine Journal - November 23, 2015 Category: Emergency Medicine Authors: Horner, D., Wells, S., Bonnici, K., Reeves, N., Parris, R. Tags: Drugs: cardiovascular system, Pain (neurology), Stroke, Venous thromboembolism, Clinical diagnostic tests RCEM FREE PAPERS Source Type: research

Short answer question: a distracting ECG
Part 1 A 76-year-old man with a past medical history of chronic obstructive pulmonary disease is brought to the emergency department (ED) with suspected sepsis. He is a smoker of 15 cigarettes per day who has an exercise tolerance of approximately 30 m. He saw his general practitioner who treated him with antibiotics and steroids. He has rung for an ambulance complaining of increasing shortness of breath and back pain. His initial vital signs were: BP 100/87 mm Hg, HR 120 bpm, RR 24 breaths per minute, oxygen saturations 100% on room air and normal temperature. He appeared sweaty and clammy, but his hea...
Source: Emergency Medicine Journal - December 23, 2015 Category: Emergency Medicine Authors: Lyddon, K., Thevendra, M., Jang Tags: Tachyarrhythmias, Cardiomyopathy, Drugs: infectious diseases, Pneumonia (infectious disease), TB and other respiratory infections, Echocardiography, Pain (neurology), Stroke, Hypertension, Acute coronary syndromes, Percutaneous intervention, Pain (palliat Source Type: research

Perceived Appropriateness of Shared Decision‐Making in the Emergency Department: A Survey Study
ConclusionsAcceptance of SDM among emergency physicians appears to be strong across management categories (diagnostic testing, treatment, and disposition) and in a variety of clinical scenarios. SDM is perceived by most EPs to be medicolegally protective.This article is protected by copyright. All rights reserved.
Source: Academic Emergency Medicine - January 25, 2016 Category: Emergency Medicine Authors: Marc A. Probst, Hemal K. Kanzaria, Dominick L. Frosch, Erik P. Hess, Gary Winkel, Ka Ming Ngai, Lynne D. Richardson Tags: Original Contribution Source Type: research

Perceived Appropriateness of Shared Decision-Making in the Emergency Department: A Survey Study.
CONCLUSIONS: Acceptance of SDM among emergency physicians appears to be strong across management categories (diagnostic testing, treatment, and disposition) and in a variety of clinical scenarios. SDM is perceived by most EPs to be medicolegally protective. This article is protected by copyright. All rights reserved. PMID: 26806170 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - January 25, 2016 Category: Emergency Medicine Authors: Probst MA, Kanzaria HK, Frosch DL, Hess EP, Winkel G, Ngai KM, Richardson LD Tags: Acad Emerg Med Source Type: research

Analgesia in Neurocritical Care: An International Survey and Practice Audit*
Conclusions: Opiates and acetaminophen are preferred analgesic agents, and gabapentin is a contextual third choice, in neurocritically ill patients. Other agents are rarely prescribed. The discordance in physician self-reports and objective audits suggest that pain management optimization studies are warranted.
Source: Critical Care Medicine - April 16, 2016 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Refractory thrombotic thrombocytopenic purpura following acute pancreatitis
Publication date: Available online 11 August 2016 Source:Journal of Acute Disease Author(s): Ebisa Bekele, Bethel Shiferaw, Alexandra Sokolova, Arpan Shah, Phillip Saunders, Alida Podrumar, Javed Iqbal Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder with an estimated incidence of 4–5 cases per million people per year. It is characterized by small-vessel platelet-rich thrombi that cause thrombocytopenia, microangiopathic hemolytic anemia and organ damage. There are reports in literature that TTP and acute pancreatitis are associated, indicating each can be the cause of the other. However, acute pancrea...
Source: Journal of Acute Disease - August 11, 2016 Category: Emergency Medicine Source Type: research

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