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Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine

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https://www.readbyqxmd.com/read/30421565/antiviral-medications-for-the-prevention-of-post-herpetic-neuralgia-after-herpes-zoster-infection
#1
Daniel S Kowalsky, Allan B Wolfson
Post herpetic neuralgia (PHN) is a condition of persistent, refractory pain in an area previously affected by an acute herpes zoster infection. Age remains an important risk factor for the development of PHN, with 40% of patients older than 50 years and 75% of patients 75 years and older developing PHN after an initial episode of shingles.1 Persistent pain can lead to significant long-term problems such as depression, altered activities of daily living, and anorexia.1 Prior systematic reviews have suggested that treatment with antivirals within 72 hours of the onset of rash may reduce the incidence or duration of PHN...
November 12, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30421517/topical-antibiotics-for-clinical-and-microbiological-cure-of-bacterial-conjunctivitis
#2
Daniel S Kowalsky, Allan B Wolfson
Acute bacterial conjunctivitis is an infective condition frequently resulting in mucopurulent ocular discharge, bulbar and palpebral injection, and discomfort.. It may be difficult to differentiate between viral and bacterial conjunctivitis on clinical grounds, and swabbing eyes for cultures is not considered clinically practical. Therefore, although most cases are self-limited, antibiotics are typically given based on the belief that they decrease time to recovery, reduce sight-threatening complications, and reduce the rate of relapse...
November 12, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30421477/corticosteroids-for-preventing-post-herpetic-neuralgia-after-herpes-zoster-infection
#3
Daniel S Kowalsky, Allan B Wolfson
Post-herpetic neuralgia is a painful condition of persistent chronic pain following acute reactivation of varicella zoster virus. The review defines PHN as persisting or recurring pain at the site of shingles at least one month after the onset of the acute rash. The incidence of shingles increases with age, almost doubling in each decade after 50 years of age. Of these cases, roughly 20% go on to develop PHN, with age again being the strongest risk factor.1 The pain of PHN is frequently debilitating and can significantly affect quality of life...
November 12, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30414344/emergency-medical-services-administration-of-systemic-corticosteroids-for-pediatric-asthma-a-statewide-study-of-emergency-department-outcomes
#4
LETTER
Jennifer N Fishe, Shiva Gautam, Phyllis Hendry, Kathryn V Blake, Leslie Hendeles
For children with an asthma exacerbation, systemic corticosteroids (CS) administered in the emergency department (ED) decrease hospital admission rates and ED length-of-stay (LOS).1-4 Time-dependent effects favor earlier CS administration, ideally within the first hour of ED arrival.2,3 Only one pediatric study has examined if earlier, EMS administration of CS improves patient outcomes.5 That study found decreased hospital admission rates and ED LOS after adding dexamethasone to intravenous (IV) methylprednisolone as options for pediatric asthma...
November 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30408269/single-maintenance-and-reliever-therapy-smart-regimen-for-management-of-persistent-asthma
#5
Arjun Mohan, Gregory D Kearney, Andrew C Miller
Asthma is a chronic respiratory disease affecting 235 million people worldwide,1 burdening both patients, their families, and society in terms of lost work and school, lessened quality-of-life, avoidable emergency department (ED) visits, hospitalizations, and deaths. Data from the Centers for Disease Control and Prevention report that asthma affects roughly 8% of the U.S. population (approximately 26 million people), accounting for 2 million ED visits, 480,000 hospitalizations, and 3,400 deaths annually with an economic burden of about $82 billion...
November 8, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30408266/climate-change-and-health-an-urgent-call-to-academic-emergency-medicine
#6
Renee N Salas, Jonathan E Slutzman, Cecilia Sorensen, Jay Lemery, Jeremy J Hess
There is consensus among 97% of scientists that anthropogenic climate change is occurring and international agreement of the grave threat it poses.1,2 A Lancet Commission declared climate change "the biggest global health threat of the 21st century" with "potentially catastrophic risk to human health."3,4 Emergency medicine (EM) is already on the frontlines as climate change directly affects our patients, clinical practice, and emergency departments (EDs). This presents EM with a profound leadership opportunity to join our colleagues in the house of medicine to improve health and save lives...
November 8, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30393902/pediatric-emergency-care-research-networks-a-research-agenda
#7
Michael J Stoner, Prashant Mahajan, Silvia Bressan, Samuel H F Lam, Corrie E Chumpitazi, Aaron E Kornblith, Seth W Linakis, Damian Roland, Stephen B Freedman, Lise E Nigrovic, Kurt Denninghoff, Paul Ishimine, Nathan Kuppermann
BACKGROUND: Pediatric emergency care research networks have evolved substantially over the past 2 decades. Some networks are specialized in specific areas (e.g. sedation, simulation) while others study a variety of medical and traumatic conditions. Given the increased collaboration between pediatric emergency research networks, the logical next step is the development of a research priorities agenda to guide global research in emergency medical services for children (EMSC). OBJECTIVES: An international group of pediatric emergency network research leaders was assembled to develop a list of research priorities for future collaborative endeavors within and between pediatric emergency research networks...
November 4, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30382605/a-machine-learning-approach-to-predicting-need-for-hospitalization-for-pediatric-asthma-exacerbation-at-the-time-of-emergency-department-triage
#8
Shilpa J Patel, Daniel B Chamberlain, James M Chamberlain
OBJECTIVES: Pediatric asthma is a leading cause of emergency department (ED) utilization and hospitalization. Earlier identification of need for hospitalization could triage patients more efficiently to high- or low-resource ED tracks. While past prediction models and asthma scores have relied solely on clinical data to predict asthma disposition in children, inclusion of other types of data might improve prediction models. Our objective was to compare the performance of four common machine-learning approaches, incorporating clinical data available at the time of triage with information about weather, air pollution, neighborhood characteristics, and community viral load to predict need for hospitalization in pediatric asthma...
November 1, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30381877/evaluation-of-a-screening-tool-for-child-sex-trafficking-among-patients-with-high-risk-chief-complaints-in-a-pediatric-emergency-department
#9
Sheri-Ann O Kaltiso, V Jordan Greenbaum, Maneesha Agarwal, Courtney McCracken, April Zmitrovich, Elizabeth Harper, Harold K Simon
OBJECTIVES: The objective was to apply and evaluate a screening tool to identify victims of child sex trafficking (CST) in a pediatric emergency department (PED) population. METHODS: This prospective, observational study was conducted from July 2017 to November 2017 at the PED of a free-standing, inner-city children's hospital. Patients 10 to 18 years of age presenting with chief complaints related to high-risk social or sexual behaviors were recruited in a representative convenience sampling...
October 31, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30381864/tracking-assault-injured-drug-using-youth-in-longitudinal-research-follow-up-methods
#10
Jessica S Roche, Michael J Clery, Patrick M Carter, Aaron Dora-Laskey, Maureen A Walton, Quyen M Ngo, Rebecca M Cunningham
OBJECTIVES: Violence is one of the leading causes of death among youth ages 14 to 24. Hospital- and emergency department (ED)-based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidence-based best practices. Retention of study participants is key to evaluations, although little literature exists regarding optimizing follow-up methods for violently injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hard-to-reach participants...
October 31, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30378718/i-can-t-imagine-doing-what-you-do
#11
Jillian Nickerson
As a fourth year Emergency Medicine resident, I have noticed that we don't "save lives" as often as I expected. My non-medical friends tell me, "I can't imagine going to work and having someone's life in my hands." They are talking about what they see on TV, where a patient comes in to the Emergency Department (ED) coding and walks out skipping, a sore misunderstanding of our success rate with cardiac arrest. In that sense, we don't "save lives" all that often at all. This article is protected by copyright...
October 31, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30375082/assessing-risk-of-future-suicidality-in-emergency-department-patients
#12
Krista Brucker, Carter Duggan, Joseph Niezer, Kyle Roseberry, Helen Le-Niculescu, Alexander B Niculescu, Jeffrey A Kline
BACKGROUND: Emergency departments (ED) are the first line of evaluation for patients at risk and in crisis, with or without overt suicidality (ideation, attempts). Currently employed triage and assessments methods miss some of the individuals who subsequently become suicidal. The Convergent Functional Information for Suicidality (CFI-S) 22-item checklist of risk factors, which does not ask directly about suicidal ideation, has demonstrated good predictive ability for suicidality in previous studies in psychiatrict patients but has not been tested in the real-world setting of EDs...
October 30, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30375128/ed-chest-pain-rules-follow-your-heart
#13
Michael A Kohn, Andrew Worster
The HEART Score is yet another clinical prediction tool to identify emergency department (ED) chest pain patients who are at low risk for a short-term major cardiac event (MACE).(1) The acronym is clever; HEART: History (H), electrocardiogram (ECG, E), Age (A), Risk Factors (R), and Troponin (T). Each of the five variables is assigned 2 points for convincing evidence, 1 point for partial evidence, and 0 points for no convincing evidence. Another older clinical prediction tool, the TIMI (thrombolysis in myocardial infarction) risk score(2), also includes history, ECG, age, risk factors, and cardiac biomarker findings, but the scoring system is less finely divided; each variable has 2 values, not 3...
October 29, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30375097/prognostic-accuracy-of-the-heart-score-for-prediction-of-major-adverse-cardiac-events-in-patients-presenting-with-chest-pain-a-systematic-review-and-meta-analysis
#14
Shannon M Fernando, Alexandre Tran, Wei Cheng, Bram Rochwerg, Monica Taljaard, Venkatesh Thiruganasambandamoorthy, Kwadwo Kyeremanteng, Jeffrey J Perry
OBJECTIVE: The HEART score has been proposed for Emergency Department (ED) prediction of major adverse cardiac events (MACE). We sought to summarize all studies assessing the prognostic accuracy of the HEART score for prediction of MACE in adult ED patients presenting with chest pain. METHODS: We searched MEDLINE, PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews from inception through May 2018, and included studies using the HEART score for the prediction of short-term MACE in adult patients presenting to the ED with chest pain...
October 29, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30372569/-full-stomach-despite-the-wait-point-of-care-gastric-ultrasound-at-the-time-of-procedural-sedation-in-the-pediatric-emergency-department
#15
Julie Leviter, Dale W Steele, Erika Constantine, James G Linakis, Siraj Amanullah
OBJECTIVES: To use gastric point-of-care ultrasound (POCUS) to: assess gastric contents and volume, summarize the prevalence of "full stomach," and explore the relationship between fasting time and gastric contents at the time of procedural sedation. METHODS: This was a prospective study of patients aged 2-17 years fasting prior to procedural sedation. A single sonographer scanned each patient's gastric antrum in 2 positions: supine with the upper body elevated (SUBE) and right lateral decubitus (RLD)...
October 29, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30370989/factors-associated-with-pediatric-non-transport-in-a-large-ems-system
#16
Sriram Ramgopal, Sylva Owusu-Ansah, Christian Martin-Gill
BACKGROUND: Pediatric patients attended to by emergency medical services (EMS) but not transported to the hospital are an at-risk population. We aimed to evaluate risk factors associated with non-transport by EMS in pediatric patients. METHODS: We reviewed medical records of 24 agencies in a regional EMS system in Southwestern Pennsylvania between January 1, 2014 and December 31, 2017. We abstracted demographics (age, gender, medical complaint, median household income by ZIP code, race, ethnicity), clinical characteristics (abnormal vital signs by age, procedures done) and transport characteristics...
October 29, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30368986/lung-protective-ventilation-for-acute-respiratory-distress-syndrome
#17
Maida Hafiz, Jennifer Stahl
Acute respiratory distress syndrome (ARDS) is a type of acute, diffuse, and inflammatory lung injury. The Berlin definition (2012) includes the following ARDS criteria: a) onset within one week of a known clinical insult, b) bilateral opacities consistent with pulmonary edema, c) respiratory failure not fully explained by cardiac failure or fluid overload, and d) ratio of partial pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2) of less than 300 mm Hg at a positive end expiratory pressure (PEEP) of 5 cm H2 O...
October 28, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30368981/randomized-placebo-controlled-trial-of-droperidol-and-ondansetron-for-adult-emergency-department-patients-with-nausea
#18
Robert Meek, Michaela J Mee, Diana Egerton-Warburton, Andis Graudins, Alastair Meyer, Pourya Pouryahya, Gabriel Blecher, James Fahey, Sallyanne Crow
OBJECTIVE: To separately compare effectiveness of intravenous (IV) droperidol 1.25 mg and ondansetron 8 mg IV with 0.9% saline placebo for adult emergency department (ED) patients with nausea. A novel primary outcome measure, expected to aid clinical interpretation of reported results, was employed. METHODS: A randomised controlled trial was conducted at the three EDs of Monash Health, Melbourne, Australia. Design was to demonstrate superiority of the active drugs over placebo...
October 28, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30353946/a-research-agenda-to-advance-pediatric-emergency-care-through-enhanced-collaboration-across-emergency-departments
#19
Isabel Barata, Marc Auerbach, Oluwakemi Badaki-Makun, Lee Benjamin, Madeline M Joseph, Moon O Lee, Kim Mears, Emory Petrack, Dina Wallin, Paul Ishimine, Kurt R Denninghoff
In 2018, the Society for Academic Emergency Medicine (SAEM) and the journal Academic Emergency Medicine (AEM) convened a consensus conference entitled, "Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps." This article is the product of the breakout session: Enhancing collaboration in pediatric emergency care (PEM practice in non-children's hospitals). This subcommittee consisting of emergency medicine, pediatric emergency medicine, and quality improvement experts, as well as a patient advocate identified main outcome gaps in the care of children in the EDs in the following areas: variations in pediatric care and outcomes, pediatric readiness, and gaps in knowledge translation...
October 24, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30343530/multicenter-analysis-of-transport-destinations-for-pediatric-prehospital-patients
#20
E Brooke Lerner, Jonathan R Studnek, Nicole Fumo, Anjishnu Banerjee, Igli Arapi, Lorin R Browne, Daniel G Ostermayer, Stacy Reynolds, Manish I Shah
BACKGROUND: Although all emergency departments (ED) should be ready to treat children, some may have illnesses or injuries that require higher-level pediatric resources that are not available at all hospitals. There are no national guidelines for EMS providers about when to directly transport children to hospitals with higher-level pediatric resources, with the exception of severe trauma. Variability exists in EMS protocols about when children warrant transport to hospitals with higher-level pediatric care...
October 21, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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