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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/30240039/emergency-department-procedural-sedation-practice-limitations-a-statewide-california-acep-survey
#1
Ellen T Reibling, Steven M Green, Tammy Phan, Elena Lopez-Gusman, Lizveth Fierro, Andrew Davis, Thomas Sugarman, Marc Futernick
OBJECTIVES: We wished to estimate the frequency and describe the nature of emergency department (ED) procedural sedation restrictions in the State of California. METHODS: We surveyed medical directors for all licensed EDs statewide regarding limitations on procedural sedation practice. Our primary outcome was the frequency of restrictions on procedural sedation, defined as an inability to administer moderate sedation, deep sedation, and typical ED sedative agents in accordance with American College of Emergency Physicians (ACEP) guidelines...
September 21, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30240032/development-of-a-novel-computerized-clinical-decision-support-system-to-improve-adolescent-sexual-health-care-provision
#2
Melissa K Miller, Cynthia Mollen, Kelli Behr, M Denise Dowd, Elizabeth Miller, Catherine L Satterwhite, Stephani Stancil, Nancy Allen, Jeffery Michael, P Charles Inboriboon, Andrew Park, Kathy Goggin
OBJECTIVE: To develop an acceptable clinical decision support (CDS) system to facilitate evidence-based sexual health care for adolescents in the emergency department (ED). METHODS: In this multi-phased iterative process, we engaged an expert group to synthesize evidence on a wide range of sexual health services (e.g., contraception, condoms, identification and treatment of previously diagnosed sexually transmitted infection). We created a computerized questionnaire and embedded our decision-tree, utilizing patient-entered responses to create tailored, evidence-based recommendations, and embedded links to study-related resources such as the emergency contraception (EC) Quick Guide...
September 21, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30239069/the-emergency-medicine-specimen-bank-an-innovative-approach-to-biobanking-in-acute-care
#3
Jessica L Saben, Shelby K Shelton, Andrew J Hopkinson, Brandon J Sonn, Eleanor B Mills, Makayla Welham, Megan Westmoreland, Richard Zane, Adit A Ginde, Kelly Bookman, Justin Oeth, Mark Chavez, Michael DeVivo, Alison Lakin, John Heldens, Laurie Blumberg Romero, Michael J Ames, Emily R Roberts, Matthew Taylor, Kristy Crooks, Stephen J Wicks, Kathleen C Barnes, Andrew A Monte
The Emergency Medicine Specimen Bank (EMSB) was developed to facilitate precision medicine in acute care. The EMSB is a biorepository of clinical health data and biospecimens collected from all adult, English- or Spanish-speaking individuals who are able and willing to provide consent and are treated at the UCHealth - University of Colorado Hospital Emergency Department (UCH-ED). The EMSB is the first acute care biobank that seeks to enroll all patients, with all conditions who present to the ED. Acute care biobanking presents many challenges that are unique to acute care settings such as providing informed consent in a uniquely stressful and fast-paced environment and collecting, processing, and storing samples for tens of thousands of patients per year...
September 21, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30230665/physician-assisted-death-ethical-implications-for-emergency-physicians
#4
R Derse, John C Moskop, Norine A McGrath, Laura E Vearrier, Elizabeth P Clayborne, Rebecca R Goett, Walter E Limehouse, John J Lynch
Physician-assisted death (PAD) has long been a strongly debated moral and public policy issue in the United States (US), and an increasing number of jurisdictions have legalized this practice under certain circumstances. In light of changing terminology, laws, public and professional attitudes, and the availability of published data about the practice, we review key concepts and terms in the ongoing PAD debate, moral arguments for and against PAD, the current legal status of PAD in the US and in other nations, and data on the reported experience with PAD in those US jurisdictions where it is a legal practice...
September 19, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30222234/moving-beyond-diagnostic-accuracy-with-systematic-reviews-and-meta-analyses
#5
Shahriar Zehtabchi, Daniel Michael Fatovich
In this issue of the Academic Emergency Medicine, Viau et al.1 assess the yield of computed tomography (CT) of the head among patients presenting with syncope. The systematic review included a total of 17 studies (15 retrospective chart reviews and 2 prospective) that included adult ED patients presenting with the chief complaint of syncope or those admitted to the hospital for syncope. Approximately half of these ED patients underwent head CT with a 1.2% and 3.8% yield of serious intracranial conditions identified in admitted patients and emergency department patients, respectively...
September 17, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30222233/racism-is-not-a-factor-in-door-to-ecg-times-of-patients-with-symptoms-of-acute-coronary-syndrome-a-prospective-observational-study
#6
Martha H Mackay, Pamela A Ratner, Gerry Veenstra, Frank X Scheuermeyer, Maja Grubisic, Krishnan Ramanathan, Craig Murray, Karin H Humphries
BACKGROUND: Investigators have identified important racial-identity/ethnicity-based differences in some aspects of acute coronary syndrome (ACS) care and outcomes (time to presentation, symptoms, receipt of coronary angiography/revascularization, repeat revascularization, mortality). Patient-based differences such as pathophysiology and treatment-seeking behaviour account only partly for these outcome differences. We sought to investigate whether there are racial-identity/ethnicity-based variations in the initial emergency department (ED) triage and care of patients with suspected ACS in Canadian hospitals...
September 17, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30222232/accuracy-of-dementia-screening-instruments-in-emergency-medicine-a-diagnostic-meta-analysis
#7
Christopher R Carpenter, Jay Banerjee, Daniel Keyes, Debra Eagles, Linda Schnitker, David Barbic, Susan Fowler, Michael A LaMantia
Cognitive dysfunction in older adults includes mild cognitive impairment, dementia, and delirium in addition to traumatic brain injury, intoxication, and central nervous system infections also encountered in younger populations. Delirium is an acute and reversible disturbance in attention with multiple potential precipitants, while mild cognitive impairment is an early form of Alzheimer's disease with memory and language problems only manifest with formal testing.1,2 On the other hand, dementia represents a chronic neurodegenerative disease that impairs executive functioning, memory, orientation, and judgment...
September 17, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30222227/a-social-emergency-medicine-approach-to-the-implementation-of-sexual-and-reproductive-health-interventions-in-the-emergency-department
#8
Andreia B Alexander, Mary A Ott
As emergency physicians, we have all experienced the moment when we look at the patient board and the chief complaint "pregnancy test" pops up. The first thing we think to ourselves is, "Would have been cheaper to pick one up at the store." Upon chart review we see that this 19-year-old female, Jenny, has been in our ED 3 times in the past 2 years with the same request. Twice she was diagnosed with a sexually transmitted infection (STI), and this time her pregnancy test is positive. You personally saw her during one of the visits and referred her to OB/GYN (she was not able to make the visit)...
September 17, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30207622/hot-off-the-press-sgem-226-i-want-a-new-drug-one-that-doesn-t-cause-an-adverse-drug-event
#9
Christopher Bond, Justin Morgenstern, Corey Heitz, William K Milne
Adverse drug events are a significant cause of emergency department (ED) visits in North America, and are frequently misdiagnosed. Despite evidence supporting improved health care outcomes for ED patients who have a pharmacist-led medication review, EDs do not have sufficient clinical pharmacists to perform medication reviews on all patients. The study reviewed in this article aimed to validate clinical decision rules for use by clinical pharmacists and physicians to prioritize ED patients with adverse drug events...
September 12, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30194902/adherence-to-pediatric-cardiac-arrest-guidelines-across-a-spectrum-of-fifty-emergency-departments-a-prospective-in-situ-simulation-based-study
#10
Marc Auerbach, Linda Brown, Travis Whitfill, Janette Baird, Kamal Abulebda, Ambika Bhatangar, Riad Lutfi, Marcie Gawel, Barbara Walsh, Khoon-Yen Tay, Megan Lavoie, Vinay Nadkarni, Robert Dudas, David Kessler, Jessica Katznelson, Sandeep Ganghadaran, Melinda Fiedor Hamilton
BACKGROUND AND OBJECTIVES: Pediatric out-of-hospital cardiac arrest survival outcomes are dismal (<10%). Care that is provided in adherence to established guidelines has been associated with improved survival. Lower mortality rates have been reported in higher volume hospitals, teaching hospitals and trauma centers. The primary objective of this paper was to explore the relationship of hospital characteristics, such as annual pediatric patient volume, to adherence to pediatric cardiac arrest guidelines during an in situ simulation...
September 8, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30194791/a-pediatric-emergency-department-intervention-to-increase-contraception-initiation-among-adolescents
#11
Erin F Hoehn, Holly Hoefgen, Lauren S Chernick, Jenna Dyas, Landon Krantz, Nanhua Zhang, Jennifer L Reed
PURPOSE: The pediatric emergency department (PED) provides care for adolescents at high risk of unintended pregnancy, but little is known regarding the efficacy of PED-based pregnancy prevention interventions. The objectives of this PED-based pilot intervention study were to (1) assess the rate of contraception initiation after contraceptive counseling and appointment facilitation in the PED during the study period (2) identify barriers to successful contraception initiation and (3) determine adolescent acceptability of the intervention...
September 8, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30182458/antivirals-in-combination-with-corticosteroids-for-the-treatment-of-acute-bell-s-palsy
#12
Roberto C Portela, Andrew C Miller
Idiopathic facial paralysis (aka Bell's Palsy) is the most common cause of unilateral facial paralysis.1 Maximal disability occurs within 48-72 hours, with symptoms involving both the upper and lower face.1 Patients may exhibit flattening of the forehead and nasolabial fold on the affected side, with the forehead remaining flat on the affected side when the patient raises his/her eyebrows. Additional symptoms may include poor eyelid closure, eye pain, blurred vision, posterior auricular pain, otalgia, hyperacusis, and taste disturbances...
September 4, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30156361/nebulized-terbutaline-ipratropium-bromide-vs-terbutaline-alone-in-acute-exacerbation-of-copd-requiring-noninvasive-ventilation-a-randomized-double-blind-controlled-trial
#13
Kaouthar Beltaief, Mohamed Amine Msolli, Asma Zorgati, Adel Sekma, Marwen Fakhfakh, Maryem Ben Marzouk, Hamdi Boubaker, Mohamed Habib Grissa, Mehdi Methamem, Riadh Boukef, Asma Belguith, Wahid Bouida, Semir Nouira
BACKGROUND: Short-acting beta2 -agonists are the mainstay of treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the emergency department. It is still unclear whether the addition of short-acting anticholinergics is clinically more effective care compared to treatment with beta2 -agonists alone in patients with hypercapnic AECOPD. OBJECTIVE: To evaluate whether combining ipratropium bromide (IB) to terbutaline reduces hospital and ICU admission rates compared to terbutaline alone in AECOPD hypercapnic patients...
August 29, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30155937/accuracy-and-interobserver-reliability-of-the-simplified-pulmonary-embolism-severity-index-versus-the-hestia-criteria-for-patients-with-pulmonary-embolism
#14
Carlos Andrés Quezada, Behnood Bikdeli, Tomás Villén, Deisy Barrios, Edwin Mercedes, Francisco León, Diana Chiluiza, Esther Barbero, Roger D Yusen, David Jimenez
OBJECTIVES: To assess and compare the accuracy and interobserver reliability of the simplified Pulmonary Embolism Severity Index (sPESI) and the Hestia criteria for predicting short-term mortality in patients with pulmonary embolism (PE). METHODS: This prospective cohort study evaluated consecutive eligible adults with PE diagnosed in the Emergency Department (ED) at a large, tertiary, academic medical center in the era January 1, 2015 - December 30, 2017. We assessed and compared sPESI and Hestia criteria prognostic accuracy for 30-day all-cause mortality after PE diagnosis, and their interobserver reliability for classifying patients as low-risk or high-risk...
August 29, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30144216/when-enough-is-not-enough-screening-brief-intervention-and-referral-to-treatment-for-hepatitis-c-in-patients-presenting-to-the-emergency-department
#15
Lindsay Yoder, Raj Vuppalanchi
Chronic hepatitis C viral (HCV)infection is the most common blood-borne infection affecting at least 3.5 million people in the USA.1 HCV is a public health threat as it can lead to cirrhosis, liver decompensation with variceal bleeding, ascites, hepatic encephalopathy, hepatocellular carcinoma or death.2 The World Health Organization (WHO) estimates that 399,000 individuals died from cirrhosis or hepatocellular carcinoma caused by HCV infection in 2015. This article is protected by copyright. All rights reserved...
August 24, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30129102/ultrasound-assisted-lumbar-punctures-a-systematic-review-and-meta-analysis
#16
Michael Gottlieb, Dallas Holladay, Gary D Peksa
BACKGROUND: Lumbar punctures (LPs) are a common procedure in Emergency Medicine. However, studies have found failed procedure rates can be as high as 50%. Ultrasound has been suggested to improve success rates by visually identifying the location and trajectory for the LP procedure. This systematic review and meta-analysis was performed to determine whether the use of ultrasound improved the rate of successful LP performance. METHODS: PubMed, CINAHL, Scopus, LILACS, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all randomized controlled trials comparing the success rates of ultrasound-assisted LP with landmark-based LP...
August 21, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30118582/randomized-clinical-trial-of-iv-acetaminophen-as-an-analgesic-adjunct-for-older-adults-with-acute-severe-pain
#17
Andrew K Chang, Polly E Bijur, Ashar Ata, Caron Campbell, Scott Pearlman, Deborah White, Andrew Chertoff, Andrew Restivo, E John Gallagher
OBJECTIVES: Older adults are at risk for undertreatment of pain. We examined IV acetaminophen as an analgesic adjunct to IV opioids in the care of older emergency department (ED) patients with acute severe pain. METHODS: This was a randomized clinical trial conducted in two emergency departments in the Bronx, New York. Eligible adults aged 65 years and older with acute severe pain were randomized to 0.5 mg IV hydromorphone and 1 gram IV acetaminophen or 0.5 mg IV hydromorphone and 100 cc normal saline placebo...
August 17, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30118563/co-administration-of-probiotics-with-prescribed-antibiotics-for-preventing-clostridium-difficile-diarrhea
#18
Ahmed S I Hamed, Andrew C Miller
Clostridium difficile (C. difficile) colitis is an opportunistic infection that occurs in individuals whose normal gut microbiota has been disrupted. Antibiotics can disturb the normal intestinal microflora, thereby reducing pathogen resistance to the gram-positive, anaerobic, spore-forming bacillus. When a person takes antibiotics, good germs that protect against infection are destroyed for several months.1 During this time, patients can get sick from C. difficile, a gram-positive anaerobic spore-forming bacillus picked up from contaminated surfaces or spread from a health care provider's hands...
August 17, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30112784/measured-steps-evidence-based-anti-trafficking-efforts-in-the-e-d
#19
Makini Chisolm-Straker
Human trafficking was defined in the United States in 2000, with the Trafficking Victims Protection Act (TVPA). Studies demonstrate that clinicians are seeing trafficked persons and emergency departments (ED) are among their most frequented healthcare sites.,, These studies were of survivors reporting their healthcare experiences while being trafficked, some of which occurred before the TVPA; EDs have been serving trafficked persons as patients long before the government named the problem. This is not surprising...
August 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30112782/high-diagnostic-uncertainty-and-inaccuracy-in-adult-emergency-department-patients-with-dyspnea-a-national-database-analysis
#20
Katherine M Hunold, Jeffrey M Caterino
Dyspnea is the second leading cause for visit among the twenty million annual US emergency department (ED) visits in patients aged ≥65 years old and is most commonly caused by pneumonia, acute exacerbations of chronic obstructive pulmonary disease (COPD), and heart failure in older adults.1,2 Despite its frequency and substantial associated morbidity and mortality,3 diagnosing the cause of dyspnea in an older adult poses substantial challenges to the emergency physician. This article is protected by copyright...
August 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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