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Annals of Emergency Medicine

David McD Taylor, Celene Y L Yap, Jonathan C Knott, Simone E Taylor, Georgina A Phillips, Jonathan Karro, Esther W Chan, David C M Kong, David J Castle
STUDY OBJECTIVE: We aim to determine the most efficacious of 3 common medication regimens for the sedation of acutely agitated emergency department (ED) patients. METHODS: We undertook a randomized, controlled, double-blind, triple-dummy, clinical trial in 2 metropolitan EDs between October 2014 and August 2015. Patients aged 18 to 65 years and requiring intravenous medication sedation for acute agitation were enrolled and randomized to an intravenous bolus of midazolam 5 mg-droperidol 5 mg, droperidol 10 mg, or olanzapine 10 mg...
October 10, 2016: Annals of Emergency Medicine
Scott N Lucyk, Lewis S Nelson
No abstract text is available yet for this article.
October 10, 2016: Annals of Emergency Medicine
Andrew Kestler, Jane Buxton, Gray Meckling, Amanda Giesler, Michelle Lee, Kirsten Fuller, Hong Quian, Dalya Marks, Frank Scheuermeyer
STUDY OBJECTIVE: Although the World Health Organization recommends take-home naloxone to address the increasing global burden of opioid-related deaths, few emergency departments (EDs) offer a take-home naloxone program. We seek to determine the take-home naloxone acceptance rate among ED patients at high risk of opioid overdose and to examine factors associated with acceptance. METHODS: At a single urban ED, consecutive eligible patients at risk of opioid overdose were invited to complete a survey about opioid use, overdose experience, and take-home naloxone awareness, and then offered take-home naloxone...
October 10, 2016: Annals of Emergency Medicine
Andrew J Wyman, Bruce N Mayes, Jackeline Hernandez-Nino, Nigel Rozario, Sandra K Beverly, Andrew W Asimos
STUDY OBJECTIVE: Seizures account for 1.2% of all emergency department (ED) visits, with 24% of those representing first-time seizures. Our primary goal is to determine whether obtaining an electroencephalogram (EEG) in the ED after a first-time seizure can identify individuals appropriate for initiation of anticonvulsant therapy on ED discharge. Our secondary goals are to determine the association of historical and clinical seizure features with epileptic EEGs and to determine the interobserver agreement for the EEG interpretation...
October 10, 2016: Annals of Emergency Medicine
Michael Gottlieb, Basem Khishfe
No abstract text is available yet for this article.
October 5, 2016: Annals of Emergency Medicine
Brian E Driver, Robert F Reardon
Some patients are agitated and unable to tolerate conventional preoxygenation methods, including face mask oxygen or noninvasive positive-pressure ventilation. Sedation with ketamine for preoxygenation, also known as delayed sequence intubation, is a technique that can be used to achieve preoxygenation in this patient population. No complications of delayed sequence intubation have previously been reported. A 60-year-old woman presented with acute hypoxic respiratory failure. Despite application of high-flow oxygen (60 L/min) with a nonrebreather face mask, her oxygen saturation remained at 93%...
September 27, 2016: Annals of Emergency Medicine
Daniel W Spaite, Chengcheng Hu, Bentley J Bobrow, Vatsal Chikani, Bruce Barnhart, Joshua B Gaither, Kurt R Denninghoff, P David Adelson, Samuel M Keim, Chad Viscusi, Terry Mullins, Duane Sherrill
STUDY OBJECTIVE: Survival is significantly reduced by either hypotension or hypoxia during the out-of-hospital management of major traumatic brain injury. However, only a handful of small studies have investigated the influence of the combination of both hypotension and hypoxia occurring together. In patients with major traumatic brain injury, we evaluate the associations between mortality and out-of-hospital hypotension and hypoxia separately and in combination. METHODS: All moderate or severe traumatic brain injury cases in the preimplementation cohort of the Excellence in Prehospital Injury Care study (a statewide, before/after, controlled study of the effect of implementing the out-of-hospital traumatic brain injury treatment guidelines) from January 1, 2007, to March 31, 2014, were evaluated (exclusions: <10 years, out-of-hospital oxygen saturation ≤10%, and out-of-hospital systolic blood pressure <40 or >200 mm Hg)...
September 27, 2016: Annals of Emergency Medicine
Young Sun Ro, Sang Do Shin, Yu Jin Lee, Seung Chul Lee, Kyoung Jun Song, Hyun Wook Ryoo, Marcus Eng Hock Ong, Bryan McNally, Bentley Bobrow, Hideharu Tanaka, Helge Myklebust, Tonje Søraas Birkenes
STUDY OBJECTIVE: We study the effect of a nationwide dispatcher-assisted cardiopulmonary resuscitation (CPR) program on out-of-hospital cardiac arrest outcomes by arrest location (public and private settings). METHODS: All emergency medical services (EMS)-treated adults in Korea with out-of-hospital cardiac arrests of cardiac cause were enrolled between 2012 and 2013, excluding cases witnessed by EMS providers and those with unknown outcomes. Exposure was bystander CPR categorized into 3 groups: bystander CPR with dispatcher assistance, bystander CPR without dispatcher assistance, and no bystander CPR...
September 18, 2016: Annals of Emergency Medicine
Ralph C Wang, Rebecca Smith-Bindman, Evans Whitaker, Jersey Neilson, Isabel Elaine Allen, Marshall L Stoller, Jahan Fahimi
STUDY OBJECTIVE: Tamsulosin is recommended for patients receiving a diagnosis of a ureteral stone less than 10 mm who do not require immediate urologic intervention. Because of conflicting results from recent meta-analyses and large randomized controlled trials, the efficacy of tamsulosin is unclear. We perform a systematic review and meta-analysis to investigate the effect of tamsulosin on stone passage in patients receiving a diagnosis of ureteral stone. METHODS: MEDLINE, EMBASE, and CENTRAL databases were searched without language restriction through November 2015 for studies assessing the efficacy of tamsulosin and using a double-blind, randomized, controlled trial design...
September 7, 2016: Annals of Emergency Medicine
David L Schriger, Brian Raffetto, Claire Drolen, Richelle J Cooper
STUDY OBJECTIVE: We determine how peer review affects the quality of published data graphs and how the appointment of a graphics editor affects the quality of graphs in an academic medical journal. METHODS: We conducted an observational time-series analysis to quantify the qualities of data graphs in original manuscripts and published research articles in Annals of Emergency Medicine from 2006 to 2012. We retrospectively analyzed 3 distinct periods: before the use of a graphics editor, graph review after a manuscript's acceptance, and graph review just before the first request for revision...
September 7, 2016: Annals of Emergency Medicine
Barrett R Park, Damon R Kuehl
We report a case of traumatic arterial hemorrhage from the posterior urethral artery, refractory to traditional hemostatic technique, and successfully managed with intraurethral thrombin hemostatic matrix (FloSeal [Baxter Healthcare Corporation, Deerfield, Illinois, US]). We believe that this demonstrates a safe, effective therapy for urethral hemorrhage that may be accomplished by Emergency Physicians and may preclude the need for more invasive hemorrhage control strategies.
September 3, 2016: Annals of Emergency Medicine
Joseph B Miller, Lisa H Merck, Charles R Wira, William J Meurer, Jon W Schrock, Jason T Nomura, Matthew S Siket, Tracy E Madsen, David W Wright, Peter D Panagos, Christopher Lewandowski
Large vessel ischemic stroke is a leading cause of morbidity and mortality throughout the world. Recent advances in endovascular stroke treatment are changing the treatment paradigm for these patients. This concepts article summarizes the time-dependent nature of stroke care and evaluates the recent advancements in endovascular treatment. These advancements have significant implications for out-of-hospital, hospital, and regional systems of stroke care. Emergency medicine clinicians have a central role in implementing these systems that will ensure timely treatment of patients and selection of those who may benefit from endovascular care...
September 3, 2016: Annals of Emergency Medicine
Baruch S Krauss, Gary Andolfatto, Benjamin A Krauss, Rebecca J Mieloszyk, Michael C Monuteaux
STUDY OBJECTIVE: We describe the characteristics of and predictors for apnea and clinical interventions during emergency department (ED) procedural sedation. METHODS: High-resolution data were collected prospectively, using a convenience sample of ED patients undergoing propofol or ketofol sedation. End tidal CO2 (etco2), respiratory rate, pulse rate, and SpO2 were electronically recorded in 1-second intervals. Procedure times, drug delivery, and interventions were electronically annotated...
August 20, 2016: Annals of Emergency Medicine
Jennifer H Chao, Richard Sinert
No abstract text is available yet for this article.
August 20, 2016: Annals of Emergency Medicine
David L Schriger
No abstract text is available yet for this article.
August 20, 2016: Annals of Emergency Medicine
Yunru Huang, JoAnne E Natale, Jamie L Kissee, Parul Dayal, Jennifer L Rosenthal, James P Marcin
STUDY OBJECTIVE: Among children requiring hospital admission or transfer, we seek to determine whether insurance is associated with the decision to either admit locally or transfer to another hospital. METHODS: This cross-sectional study used Healthcare Cost and Utilization Project 2012 Nationwide Emergency Department Sample. Pediatric patients receiving care in emergency departments (EDs) who were either admitted or transferred were included. Clinical Classifications Software was used to categorize patients into noninjury diagnostic cohorts...
August 20, 2016: Annals of Emergency Medicine
Scott M Dresden, Emilie S Powell, Raymond Kang, Megan McHugh, Andrew J Cooper, Joe Feinglass
STUDY OBJECTIVE: We examine emergency department (ED) use and hospitalizations through the ED after Patient Protection and Affordable Care Act (ACA) health insurance expansion in Illinois, a Medicaid expansion state. METHODS: Using statewide hospital administrative data from 2011 through 2015 from 201 nonfederal Illinois hospitals for patients aged 18 to 64 years, mean monthly ED visits were compared before and after ACA implementation by disposition from the ED and primary payer...
August 17, 2016: Annals of Emergency Medicine
Tomer Begaz, David Elashoff, Tristan R Grogan, David Talan, Breena R Taira
STUDY OBJECTIVE: The effect of clinician screening of patients in the emergency department (ED) waiting room is unclear. This study aims to determine the effect of initiating laboratory and imaging studies from the ED waiting room on time in a bed, total ED time, and likelihood of patients leaving before completion of service. METHODS: This was a prospective, randomized, controlled trial evaluating 1,659 nonpregnant adults with a chief complaint of abdominal pain, conducted in a public hospital ED when all ED beds were occupied and patients were in the waiting room awaiting definitive evaluation...
August 12, 2016: Annals of Emergency Medicine
Brian E Driver, Matthew E Prekker, Rebecca L Kornas, Ellen K Cales, Robert F Reardon
STUDY OBJECTIVE: Recent data suggest that emergency airway preoxygenation with a bag-valve-mask (BVM) device (held with a tight mask seal but without squeezing the bag) is superior to a nonrebreather (NRB) mask at standard oxygen flow rates. We seek to determine whether preoxygenation with an NRB mask with flush rate oxygen (>40 L/min by fully opening a standard oxygen flowmeter) is noninferior to BVM device with standard-flow oxygen (15 L/min). We also seek to compare the efficacy of preoxygenation with NRB mask at flush rate oxygen with both NRB mask with oxygen at 15 L/min and simple mask at flush rate oxygen...
August 10, 2016: Annals of Emergency Medicine
Nizhoni Denipah, Christopher M Dominguez, Erik P Kraai, Tania L Kraai, Paul Leos, Darren Braude
Paradoxical vocal fold motion disorder, also commonly termed vocal cord dysfunction, is a poorly understood cause of acute upper airway obstruction. Patients with paradoxical vocal fold motion frequently present to the emergency department (ED) with acute respiratory distress and stridor. Lack of familiarity with this disorder may lead to delayed diagnosis or misdiagnosis and unnecessary intubations or surgical airway procedures. Although long-term management of paradoxical vocal fold motion is well described, there is a paucity of information about acute evaluation and management...
August 10, 2016: Annals of Emergency Medicine
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