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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/29136314/syncope-prognosis-based-on-emergency-department-diagnosis-a-prospective-cohort-study
#1
Cristian Toarta, Muhammad Mukarram, Kirtana Arcot, Soo-Min Kim, Sarah Gaudet, Marco L A Sivilotti, Brian H Rowe, Venkatesh Thiruganasambandamoorthy
OBJECTIVE: Relatively little is known about outcomes after disposition among syncope patients assigned various diagnostic categories during emergency department (ED) evaluation. We sought to measure the outcomes among these groups within 30 days of the initial ED visit. METHODS: We prospectively enrolled adult syncope patients at six EDs and excluded patients with pre-syncope, persistent mental status changes, intoxication, seizure, and major trauma. Patient characteristics, ED management, diagnostic impression (presumed vasovagal, orthostatic, cardiac, or other/unknown) at the end of the ED visit and physicians' confidence in assigning the etiology were collected...
November 14, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29131477/a-risk-assessment-score-and-initial-high-sensitivity-troponin-combine-to-identify-low-risk-of-acute-myocardial-infarction-in-the-emergency-department
#2
John W Pickering, Dylan Flaws, Stephen W Smith, Jaimi Greenslade, Louise Cullen, William Parsonage, Edward Carlton, A Mark Richards, Richard Troughton, Christopher Pemberton, Peter M George, Martin P Than
OBJECTIVES: Early discharge of patients with presentations triggering assessment for possible acute coronary syndrome is safe when clinical assessment indicates low-risk, biomarkers are negative, and electrocardiograms (ECGs) are non-ischemic. We hypothesized that the Emergency Department Assessment of Chest Pain Score (EDACS) combined with a single measurement of high-sensitivity cardiac troponin (hs-cTn) could allow early discharge of a clinically meaningful proportion of patients. METHODS: We pooled data from 4 patient cohorts from New Zealand and Australia presenting to an ED with symptoms suggestive of ACS...
November 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29125679/topical-tranexamic-acid-compared-with-anterior-nasal-packing-for-treatment-of-epistaxis-in-patients-taking-antiplatelet-drugs-randomized-controlled-trial
#3
Reza Zahed, Mohammad Hossain Mousavi Jazayeri, Asieh Naderi, Zeinab Naderpour, Morteza Saeedi
OBJECTIVE: We evaluated the efficacy of topical application of the injectable form of tranexamic acid (TXA) compared with anterior nasal packing (ANP) for the treatment of epistaxis in patients taking antiplatelet drugs (Aspirin, Clopidegrol or both) who presented to the emergency department (ED). METHODS: A randomized, parallel group clinical trial was conducted at 2 EDs. A total of 124 participants were randomized to receive topical TXA (500 mg in 5 ml) or ANP, 62 patients per group...
November 10, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29125665/firearms-and-suicide-finding-the-right-words
#4
Marian E Betz
As emergency physicians, we're used to asking patients about sensitive topics. We overcame discomfort by practicing questions like "Do you have sex with men, women or both?" until the words flowed smoothly. In lectures, I urge providers to counsel suicidal patients about firearm access, given that reducing lethal means access can save lives.(1,2) But early on, I didn't know how to talk about firearms without offending my patients. This article is protected by copyright. All rights reserved.
November 10, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29105238/comparing-state-wide-and-single-center-data-to-predict-high-frequency-emergency-department-utilization-among-patients-with-asthma-exacerbation
#5
Margaret E Samuels-Kalow, Mohammad K Faridi, Janice A Espinola, Jean E Klig, Carlos A Camargo
BACKGROUND: Previous studies examining high-frequency ED utilization have primarily used single-center data, potentially leading to ascertainment bias if patients visit multiple centers. The goals of this study were (1) to create a predictive model to prospectively identify patients at risk of high-frequency ED utilization for asthma, and (2) to examine how that model differed using state-wide versus single-center data. METHODS: To track ED visits within a state, we analyzed 2011-2013 data from the New York State Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD)...
November 4, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29105207/early-recurrence-of-first-unprovoked-seizures-in-children
#6
Leah R Goldberg, Catherine G Kernie, Kathleen Lillis, Jonathan Bennett, Gregory Conners, Charles G Macias, James Callahan, Cigdem Akman, W Allen Hauser, Nathan Kuppermann, Peter S Dayan
OBJECTIVES: The risk of early seizure recurrences after first unprovoked seizures in children is largely unknown. We aimed to determine the rate of seizure recurrence within 14 days of first, unprovoked seizures in children and identify associated risk factors. Secondarily, we aimed to determine the risk of recurrence at 48 hours and 4 months. METHODS: We conducted a secondary analysis of a multicenter cohort study of children 29 days-18 years with first, unprovoked seizures...
November 4, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29077240/training-and-assessing-critical-airway-breathing-and-hemorrhage-control-procedures-for-trauma-care-live-tissue-versus-synthetic-models
#7
Danielle Hart, Robert Rush, Gregory Rule, Joseph Clinton, Gregory Beilman, Shilo Anders, Rachel Brown, Mary Ann McNeil, Troy Reihsen, Jeffrey Chipman, Robert Sweet
INTRODUCTION: Optimal teaching and assessment methods and models for emergency airway, breathing and hemorrhage interventions are not currently known. The University of Minnesota Combat Casualty Training consortium (UMN CCTC) was formed to explore the strengths and weaknesses of synthetic training models (STMs) versus Live tissue (LT) models. In this study, we compare the effectiveness of best in class STMs versus an anesthetized caprine (goat) model for training and assessing 7 procedures: Junctional hemorrhage control, Tourniquet (TQ) placement, Chest seal, Needle thoracostomy (NCD), Nasopharyngeal airway (NPA), Tube thoracostomy, and Cricothyrotomy (Cric)...
October 27, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29077231/disseminating-and-sustaining-emergency-department-innovations-for-older-adults-good-ideas-deserve-better-policies
#8
Alexander X Lo, Kevin Biese
Older adults often visit the emergency department (ED) with chief complaints that understate or detract from their true complex health care needs. These needs are frequently missed because addressing them requires a time-consuming effort that is antithetical to the (necessarily) rapid, complaint-specific protocols of the ED. Key ED performance indices (e.g., length of stay; through-put) also create a disincentive against undertaking comprehensive geriatric assessments when not clearly germane to the chief complaint...
October 27, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29077228/air-ambulance-delivery-and-administration-of-4-factor-prothrombin-complex-concentrate-is-feasible-and-decreases-time-to-anticoagulation-reversal
#9
Claire Vines, Stephanie J Tesseneer, Robert D Cox, Damon A Darsey, Kristin Carbrey, Michael A Puskarich
OBJECTIVES: To evaluate the feasibility, safety, and preliminary efficacy of four-factor prothrombin complex concentrate (4-factor PCC) administration by an air ambulance service prior to or during transfer of patients with warfarin-associated major hemorrhage to a tertiary care center for definitive management (interventional arm) compared to patients receiving 4-factor PCC following transfer by air ambulance or ground without 4-factor PCC treatment (conventional arm). METHODS: Retrospective chart review of patients presenting to a large academic medical center...
October 27, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29071804/contributions-of-academic-emergency-medicine-programs-to-us-healthcare-summary-of-the-aaaem-aacem-benchmarking-data
#10
Martin A Reznek, James J Scheulen, Cathi A Harbertson, Kevin A Kotkowski, Gabor D Kelen, Gregory A Volturo
OBJECTIVES: The societal contribution of emergency care in the United States has been described. The role and impact of academic emergency departments (EDs) has been less clear. Our report summarizes the results of a benchmarking effort specifically focused on academic emergency medicine (EM) practices. METHODS: From October through December of 2016, the Academy of Academic Administrators of Emergency Medicine (AAAEM) and the Association of Academic Chairs of Emergency Medicine (AACEM) jointly administered a benchmarking survey to allopathic, academic departments and divisions of emergency medicine...
October 26, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29071767/communicating-value-in-simulation-cost-benefit-analysis-and-return-on-investment
#11
Carl V Asche, Minchul Kim, Alisha Brown, Antoinette Golden, Torrey A Laack, Javier Rosario, Christopher Strother, Vicken Y Totten, Yasuharu Okuda
Value-based health care requires a balancing of medical outcomes with economic value. Administrators need to understand both the clinical and economic effects of potentially expensive simulation programs to rationalize the costs. Given the often-disparate priorities of clinical educators relative to health care administrators, justifying the value of simulation requires the use of economic analyses few physicians have been trained to conduct. Clinical educators need to be able to present thorough economic analyses demonstrating returns on investment and cost effectiveness to effectively communicate with administrators...
October 26, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29044938/hot-off-the-press-prehospital-advanced-cardiac-life-support-for-out-of-hospital-cardiac-arrest
#12
Corey Heitz, Justin Morgenstern, William K Milne
This retrospective cohort study examined the rate of survival to hospital discharge among adult patients with out of hospital cardiac arrest (OHCA), comparing patients who received care only from basic cardiac life support (BCLS) trained emergency medical service (EMS) crews to patients who had an advanced cardiac life support (ACLS) trained EMS crew on scene at some point during the resuscitation. There was no difference in the primary outcome of rate of survival to hospital discharge (10.9% with ACLS care and 10...
October 16, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29044739/peripheral-intravenous-cannula-insertion-and-use-in-the-emergency-department-an-intervention-study
#13
Tracey Hawkins, Jaimi H Greenslade, Jessica Suna, Julian Williams, Matthew Jensen, Maria Donohue, Elizabeth Ho, Christopher Van Hise, Diana Egerton-Warburton, Louise Cullen
OBJECTIVES: To examine cannulation practice and effectiveness of a multi-modal intervention to reduce peripheral intravenous cannula (PIVC) insertion in emergency department (ED) patients. METHODS: A prospective before and after study and cost analysis was conducted at a single tertiary ED in Australia. Data were collected 24 hours a day for two weeks pre- and post-implementation of a multi-modal intervention. PIVC placement and utilization within 24 hours were evaluated in all eligible patients...
October 16, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29024269/fluid-resuscitation-in-patients-with-severe-burns-a-meta-analysis-of-randomized-controlled-trials
#14
Yuan Kao, El-Wui Loh, Chien-Chin Hsu, Hung-Jung Lin, Chien-Cheng Huang, Yun-Yun Chou, Chieh-Chun Lien, Ka-Wai Tam
OBJECTIVES: Fluid resuscitation is the mainstay treatment to reconstitute intravascular volume and maintain end-organ perfusion in patients with severe burns. The use of a hyper-osmotic or iso-osmotic solution in fluid resuscitation to manage myocardial depression and increased capillary permeability during burn shock has been debated. We conducted a systematic review and meta-analysis to compare the efficacies of hyper-osmotic and iso-osmotic solutions in restoring hemodynamic stability after burn injuries...
October 11, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28992364/behavioral-changes-in-children-after-emergency-department-procedural-sedation
#15
Jean I Pearce, David C Brousseau, Ke Yan, Keri R Hainsworth, Raymond G Hoffmann, Amy L Drendel
OBJECTIVE: The purpose of this study was to determine the proportion of children undergoing procedural sedation for fracture reduction in the emergency department (ED) observed to experience negative post-discharge behaviors. Predictors of negative behaviors were evaluated, including anxiety. METHODS: This was a prospective cohort study of children receiving intravenous ketamine sedation for ED fracture reduction. The child's anxiety prior to sedation was measured with the Modified Yale Preoperative Anxiety Scale...
October 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28990334/what-s-next-for-acute-heart-failure-research
#16
Sean P Collins, Phillip D Levy, Gregory J Fermann, Michael M Givertz, Jennifer M Martindale, Peter S Pang, Alan B Storrow, Deborah D Diercks, G Michael Felker, Gregg C Fonarow, David J Lanfear, Daniel J Lenihan, JoAnn M Lindenfeld, W Frank Peacock, Douglas M Sawyer, John R Teerlink, Javed Butler
Each year over one million patients with acute heart failure (AHF) present to a United States emergency department (ED). The vast majority are hospitalized for further management. The length of stay and high postdischarge event rate in this cohort have changed little over the past decade. Therapeutic trials have failed to yield substantive improvement in postdischarge outcomes; subsequently, AHF care has changed little in the past 40 years. Prior research studies have been fragmented as either "inpatient" or "ED-based...
October 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28990246/excited-delirium-a-systematic-review
#17
Philippe Gonin, Nicolas Beysard, Bertrand Yersin, Pierre-Nicolas Carron
STUDY OBJECTIVE: We aimed to clarify the definition, epidemiology, and pathophysiology of excited delirium syndrome (ExDS) and to summarize evidence-based treatment recommendations. METHODS: We conducted a systematic literature search of MEDLINE, Ovid, Web of Knowledge, and Cochrane Library for articles published to March 18, 2017. We also searched the grey literature (Google Scholar) and official police or medical expert reports to complete specific epidemiological data...
October 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28981996/clinical-vignettes-inadequate-to-assess-impact-of-implicit-bias-concerning-limitations-of-a-systematic-review
#18
Elizabeth A Samuels, Dowin H Boatright, Leon Sanchez, Sheryl Heron, Aisha T Liferidge, Taneisha Wilson, Ava Pierce, Alden Landry, Lisa Moreno-Walton, Jeffrey Druck, Joel Moll, Bernard Lopez
We are writing in response to Dehon et al's article "A Systematic Review of the Impact of Physician Implicit Racial Bias on Clinical Decision Making"(1) in the August 2017 issue of Academic Emergency Medicine. As members of SAEM's Academy of Diversity and Inclusion in Emergency Medicine, we believe it is imperative to pursue research on the impact of bias and discrimination on clinical practice and healthcare outcomes. While we commend Dr. Dehon and her colleagues for their effort to assess the impact of implicit bias on clinical decision-making, we do not think that the evidence reviewed supports the breadth of their conclusions...
October 5, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28977717/a-collaborative-in-situ-simulation-based-pediatric-readiness-improvement-program-for-community-emergency-departments
#19
Kamal Abulebda, Riad Lutfi, Travis Whitfill, Samer Abu-Sultaneh, Kellie J Leeper, Elizabeth Weinstein, Marc A Auerbach
BACKGROUND: More than 30 million children are cared for across 5,000 US emergency departments each year (ED). Most of these EDs are not facilities designed and operated solely for children. A web-based survey provided a national and state-by-state assessment of pediatric readiness and noted a national average score was 69 on a 100-point scale. This survey noted wide variations in ED readiness with scores ranging from 61 in low-pediatric-volume EDs to 90 in the high-pediatric-volume EDs...
October 4, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28975679/an-emergency-department-observation-unit-is-a-feasible-setting-for-multidisciplinary-geriatric-assessments-in-compliance-with-the-geriatric-emergency-department-guidelines
#20
Lauren T Southerland, Anthony J Vargas, Lalitha Nagaraj, Tanya R Gure, Jeffery M Caterino
BACKGROUND: The Geriatric Emergency Department Guidelines recommend providing multidisciplinary geriatric assessment in the Emergency Department (ED), but these assessments can be difficult to coordinate and may prolong length of stay. Patients who need longer than a typical ED stay can be placed in an ED Observation Unit (Obs Unit). We investigated the effects of offering multidisciplinary assessments for ED patients in an Obs Unit. METHODS: Evaluation by a geriatric hospital consultation team, physical therapist, case manager, and/or pharmacist was made available to all Obs Unit patients...
October 4, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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