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Journal of Emergency Medicine

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https://www.readbyqxmd.com/read/29789175/macrolide-resistance-in-cases-of-community-acquired-bacterial-pneumonia-in-the-emergency-department
#1
John P Haran, Gregory A Volturo
BACKGROUND: Emergency physicians are under pressure to prescribe an antibiotic early in the treatment course of a patient with community-acquired pneumonia (CAP). Macrolides are recommended first-line empirical therapy for the outpatient treatment of CAP in patients without associated comorbidities; however, resistance rates to macrolides in the United States are on the rise. OBJECTIVE: This review considers macrolide use for CAP in the emergency department by reviewing the microbiologic environment in the United States and whether macrolides can overcome in vitro resistance during actual clinical use...
May 19, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29784474/point-of-care-ultrasound-differentiation-of-lung-consolidation-and-normal-thymus-in-pediatric-patients-an-educational-case-series
#2
Cynthia A Gravel, Richard G Bachur
BACKGROUND: There is a growing body of evidence to support the utility of lung point-of-care ultrasound (POCUS) in pediatric patients with multiple pulmonary pathologies, particularly pneumonia. As we increase our use of lung POCUS for pediatric patients with respiratory complaints, we must be mindful of the normal anatomy and sonographic findings within the pediatric chest and aware of how to distinguish normal findings (e.g., thymus) from pathologic findings (e.g., consolidation). CASE REPORTS: We report four cases of pediatric patients who presented to the Emergency Department with respiratory complaints for which POCUS was able to distinguish lung consolidation and normal thymus in the anterior chest...
May 18, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29784473/tailbone-pain-from-coccyx-injuries-on-water-slides-a-case-series
#3
Patrick M Foye, Dena M Abdelshahed, Evish Kamrava, Renee Enriquez, Gerard J D'Onofrio
BACKGROUND: Water slides and rides are increasingly popular attractions at amusement parks. There has been some documentation of various patterns of injury associated with these rides, most notably vaginal injuries caused by water jets. But we find no previous medical publications reporting the association between water slides/rides with coccydynia (coccyx pain) and tailbone injuries. CASE REPORT: Our purpose in this case report was to assess for an association between water slides/rides with injuries to the coccyx causing coccyx pain...
May 18, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29776702/naloxone-use-among-emergency-department-patients-with-opioid-overdose
#4
Catherine A Marco, William Trautman, Alexander Cook, Dennis Mann, Jordan Rasp, Oswald Perkins, Michael Ballester
BACKGROUND: Emergency department (ED) visits for unintentional opioid overdoses have increased dramatically. Naloxone hydrochloride (Narcan®) is an opioid antagonist commonly used to treat these overdoses. OBJECTIVE: This study was undertaken to identify experiences regarding naloxone use among ED patients with opioid overdose. METHODS: This prospective survey study was conducted at an urban level I trauma center. A survey was administered to eligible ED patients after unintentional opioid overdose...
May 16, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29776701/nonstandard-advance-directives-in-emergency-medicine-what-should-we-do
#5
Kenneth V Iserson
BACKGROUND: Critically ill or injured emergency department or prehospital patients who lack decision-making capacity sometimes present with a non-standard advance directive, such as a "Do Not Resuscitate" tattoo or medallion. Emergency clinicians must immediately address the question of whether to withhold treatment based on what may or may not be a valid patient directive. DISCUSSION: Advance directives have been standardized for a good reason. Emergency department or prehospital healthcare providers must be able to immediately interpret and act on them without needing a legal interpretation...
May 16, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29776700/assessment-of-the-utility-of-ordering-a-troponin-in-low-and-intermediate-risk-patients-presenting-to-the-emergency-department-with-supraventricular-tachycardia-a-retrospective-chart-review
#6
David Noorvash, Rosemarie Ramos, Linda Hatch, Andrew Muck, Adriana Segura Olson
BACKGROUND: A troponin assay is commonly sent for patients presenting to emergency departments (EDs) with supraventricular tachycardia (SVT). Multiple studies suggest that elevated troponin levels do not predict coronary artery disease in these patients. Patients with elevated troponins are more likely to have additional cardiac testing, which can lead to increased health care costs and unnecessary invasive procedures. OBJECTIVE: Our objective was to evaluate low- to intermediate-risk patients (HEART [history, electrocardiography, age, risk factors and troponin] Score 1-6) presenting to the ED with SVT...
May 15, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29776699/response-to-highlighting-the-potential-value-of-capnography-in-acute-stroke
#7
LETTER
Brit Long, Alex Koyfman, Michael A Vivirito
No abstract text is available yet for this article.
May 15, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29773480/must-i-respond-if-my-health-is-at-risk
#8
Kenneth V Iserson
BACKGROUND: Widespread epidemics, pandemics, and other risk-prone disasters occur with disturbing regularity. When such events occur, how should, and will, clinicians respond? The moral backbone of medical professionals-a duty to put the needs of patients first-may be sorely tested. DISCUSSION: It is incumbent on health care professionals to ask what we must do and what we should do if a dangerous health care situation threatens both ourselves and our community...
May 14, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29773479/emergency-department-diagnosis-of-septic-pulmonary-embolism-due-to-infectious-endocarditis-using-bedside-ultrasound
#9
Jason Arthur, Juvenal Havyarimana, Ashley Booth Norse
BACKGROUND: Septic pulmonary embolism (SPE) is a rare disorder caused by metastasis of infectious thrombi to the lungs. Most commonly, this occurs as a result of infectious endocarditis. This clinical entity may easily be confused for more common and less mortal diagnoses such as pneumonia, bronchitis, or pulmonary embolism. CASE REPORT: A 47-year-old woman presented in respiratory distress with a complaint of cough productive of rusty sputum, shortness of breath, and pleuritic chest pain...
May 14, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29764723/frailty-assessment-to-help-predict-patients-at-risk-of-delirium-when-consulting-the-emergency-department
#10
Marianne Giroux, Marie-Josée Sirois, Valérie Boucher, Raoul Daoust, Émilie Gouin, Mathieu Pelletier, Simon Berthelot, Philippe Voyer, Marcel Émond
BACKGROUND: Delirium is underdiagnosed in seniors at emergency departments (EDs) even though it is a frequent complication and is associated with functional and cognitive decline. As frailty is an independent predictor of adverse events in seniors, screening for frailty in EDs may help identify those at risk of delirium. OBJECTIVES: To assess if screening older patients for frailty in EDs could help identify those at risk of delirium. METHODOLOGY: This study was part of the multicenter prospective cohort INDEED study...
May 12, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29759657/no-radiographic-safe-margin-found-in-the-easy-ij-internal-jugular-vein-procedure
#11
Ryan N McCarter, Siamak Moayedi, Michael D Witting
BACKGROUND: The Easy IJ procedure involves placement of a 4.8-cm intravenous catheter into the internal jugular (IJ) vein using ultrasound guidance. It is not known whether this needle length has the potential to cause a pneumothorax. OBJECTIVE: The objective of this study was to determine if a radiographic "safe margin" exists. We hypothesized that an average margin of ≥2 cm would exist between the catheter tip and the pleura. METHODS: Operators used a central approach to the IJ vein...
May 11, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29759656/well-being-among-emergency-medicine-resident-physicians-results-from-the-abem-longitudinal-study-of-emergency-medicine-residents
#12
Debra G Perina, Catherine A Marco, Rebecca Smith-Coggins, Terry Kowalenko, Mary M Johnston, Anne Harvey
BACKGROUND: The Longitudinal Study of Emergency Medicine Residents (LSEMR) conducted by the American Board of Emergency Medicine queries a randomized cohort of emergency medicine (EM) residents. It is designed to identify residents' perceptions of their training, sources of stress, well-being level, and career choice satisfaction over time. OBJECTIVES: This study utilizes LSEMR to identify resident well-being levels, career satisfaction, factors producing stress, and whether a specific cohort is more stressed than the overall respondent group...
May 11, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29753569/first-presentation-with-psychotic-symptoms-to-the-emergency-department
#13
Yousef Etlouba, Abdullah Laher, Feroza Motara, Muhammed Moolla, Nazeema Ariefdien
BACKGROUND: Mental health conditions account for 52.8 million (4.9-6.3%) emergency department (ED) visits in the United States. Psychotic conditions are responsible for approximately 10% of all mental health presentations. OBJECTIVE: We aimed to determine the underlying etiology and characteristics of patients presenting to the ED with a first episode of psychotic symptoms. METHODS: Medical records of 159 African, Asian, white, and mixed-race patients were prospectively reviewed...
May 10, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29753571/subway-related-trauma-an-urban-public-health-issue-with-a-high-case-fatality-rate
#14
Simon G Rodier, Charles J DiMaggio, Stephen Wall, Vasiliy Sim, Spiros G Frangos, Patricia Ayoung-Chee, Marko Bukur, Manish Tandon, S Rob Todd, Gary T Marshall
BACKGROUND: Between 1990 and 2003, there were 668 subway-related fatalities in New York City. However, subway-related trauma remains an understudied area of injury-related morbidity and mortality. OBJECTIVE: The objective of this study was to characterize the injuries and events leading up to the injuries of all patients admitted after subway-related trauma. METHODS: We conducted a retrospective case series of subway-related trauma at a Level I trauma center from 2001 to 2016...
May 9, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29753570/xanthogranulomatous-pyelonephritis-a-complicated-febrile-urinary-tract-infection-detected-by-point-of-care-ultrasound-in-the-emergency-department
#15
Ryan Gibbons, Nicole Leonard, Mark Magee, Allison Zanaboni, Jessica Patterson, Thomas Costantino
BACKGROUND: Febrile urinary tract infections (UTIs) include a spectrum of pathologies from uncomplicated pyelonephritis to urosepsis, including xanthogranulomatous pyelonephritis (XGP). Most febrile UTIs are treated with antibiotics alone, but studies indicate nearly 12% of cases of presumed simple pyelonephritis require emergent urologic intervention. How to identify these individuals, while limiting unnecessary advanced imaging and delays in diagnosis, challenges all emergency providers...
May 9, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29753568/severe-delayed-postpartum-hemorrhage-after-cesarean-section
#16
Nirav Patel, Michael Radeos
BACKGROUND: Severe secondary or delayed postpartum hemorrhage (PPH) is rare and affects 0.23-3% of all pregnancies. It happens between 24 hours to 12 weeks postdelivery. These PPHs occur more often during normal vaginal delivery; only a small subset of these PPHs occur after cesarean section. The top differential diagnoses of both primary and secondary PPH are different, and as a result, the management may be different. Although uterine atony causes 80% of primary PPHs, extensive literature review exposed the rarity of it in the setting of secondary PPH...
May 9, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29752150/timing-of-cholecystectomy-in-acute-cholecystitis
#17
Arasi Thangavelu, Steven Rosenbaum, Devi Thangavelu
BACKGROUND: Cholecystitis is an inflammation of the gallbladder that most commonly occurs as a result of obstruction of the cystic duct by gallstones. The current standard of treatment for acute cholecystitis is cholecystectomy. OBJECTIVE: Our goal was to discuss the benefits of and compare early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy in the treatment of acute cholecystitis. MATERIALS AND METHODS: A Medline literature search was performed dating from January 1982 to July 2015...
May 8, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29748058/unusual-aspect-of-posterior-reversible-encephalopathy-syndrome-in-an-elderly-adult
#18
Benjamin Hebant, Omar Bennani
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) classically occurs in patients presenting with a sudden increase of arterial pressure or eclampsia, but the range of etiologies is very wide. Although the mechanisms underlying PRES remain unclear, research suggests that when the extent of hypertension exceeds the threshold of cerebral blood flow autoregulation, this induces blood-brain barrier disruption that leads to brain edema. Unusual presentations on magnetic resonance imaging (MRI) are possible, including the involvement of frontal or temporal lobes, cerebellar hemispheres, basal ganglia, brainstem, or deep white matter...
May 7, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29748057/massive-bleeding-from-inferior-mesenteric-vein-with-hypovolemic-shock-a-rare-complication-of-acute-pancreatitis
#19
Sun Hwa Lee, Seong Jong Yun, Seokyong Ryu, Seung Woon Choi, Hye Jin Kim, Tae Kyung Kang, Sung Chan Oh, Suk Jin Cho
BACKGROUND: Acute pancreatitis may cause massive intra-abdominal bleeding as vascular complications caused by the erosion of a major pancreatic or peripancreatic vessel. In terms of treatment, the differentiation between arterial bleeding and venous bleeding using abdominal computed tomography (CT) angiography is important. In addition, hypovolemic shock caused by bleeding from the inferior mesenteric vein (IMV) in acute pancreatitis has not been reported. CASE REPORT: A 58-year-old man presented to our emergency department with complaints of abdominal pain of 10 hours' duration...
May 7, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29748056/an-unusual-cause-of-tension-pneumoventricle
#20
Yen-Ho Lai, Ping-Hong Lai
No abstract text is available yet for this article.
May 7, 2018: Journal of Emergency Medicine
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