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Journal of Emergency Medicine

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https://www.readbyqxmd.com/read/28916124/male-with-sudden-onset-abdominal-pain
#1
Erica Simon, Jared Cohen, Brit Long
No abstract text is available yet for this article.
September 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28916123/reverse-takotsubo-cardiomyopathy-and-cardiogenic-shock-associated-with-methamphetamine-consumption
#2
Omar Chehab, Adam Ioannou, Akshat Sawhney, Alexandra Rice, Simon Dubrey
BACKGROUND: Reverse Takotsubo cardiomyopathy is characterized by transient myocardial hypokinesia affecting predominantly the basal myocardial wall. It is a rare variant of Takotsubo cardiomyopathy affecting younger patients. CASE REPORT: We report a case of a young man who having consumed methamphetamines presented with cardiogenic shock and severe left ventricular systolic dysfunction, affecting predominantly the basal segments with sparing of the apex. After inotropic support, the left ventricular ejection fraction improved...
September 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28916122/myasthenia-gravis-and-crisis-evaluation-and-management-in-the-emergency-department
#3
Jamie Roper, M Emily Fleming, Brit Long, Alex Koyfman
BACKGROUND: Myasthenia gravis (MG) is an uncommon autoimmune disorder affecting the neuromuscular junction and manifesting as muscle weakness. A multitude of stressors can exacerbate MG. When symptoms are exacerbated, muscle weakness can be severe enough to result in respiratory failure, a condition known as myasthenic crisis (MC). OBJECTIVE: This review discusses risk factors, diagnosis, management, and iatrogenic avoidance of MC. DISCUSSION: MC can affect any age, ethnicity, or sex and can be precipitated with any stressor, infection being the most common...
September 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28916121/controversies-in-corticosteroid-use-for-sepsis
#4
Brit Long, Alex Koyfman
BACKGROUND: Severe sepsis and septic shock are potentially deadly conditions managed in the emergency department (ED). Management centers on source control, fluid resuscitation, broad-spectrum antimicrobials, and vasopressors as needed. The use of corticosteroids is controversial. OBJECTIVE: To evaluate the evidence behind corticosteroid therapy in patients with septic shock. DISCUSSION: Septic shock is associated with severe mortality and morbidity...
September 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28916120/does-early-and-appropriate-antibiotic-administration-improve-mortality-in-emergency-department-patients-with-severe-sepsis-or-septic-shock
#5
Robert Sherwin, Michael E Winters, Gary M Vilke, Gabriel Wardi
BACKGROUND: Severe sepsis and septic shock remain significant public health concerns. Appropriate emergency department management includes early recognition, hemodynamic resuscitation, source control, and prompt antibiotic administration. Current international guidelines strongly recommend administration of early and appropriate antibiotics for patients with severe sepsis and septic shock. Interestingly, a recent Cochrane Review found insufficient evidence to provide a similar recommendation on antibiotic administration...
September 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28911989/u-47700-a-clinical-review-of-the-literature
#6
Kerry Anne Rambaran, Steven W Fleming, Jie An, Samantha Burkhart, Jakub Furmaga, Kurt C Kleinschmidt, A Michael Spiekerman, Saeed K Alzghari
BACKGROUND: U-47700 is a synthetic opioid developed by The Upjohn Company in the 1970s, which has recently appeared in the news and medical literature due to its toxicity. Currently, there are no clinical trial data assessing the safety of U-47700. OBJECTIVE: To describe the signs and symptoms of ingestion, laboratory testing, and treatment modalities for U-47700 intoxication. DISCUSSION: We searched PubMed, Embase, Web of Science, and EBSCO for articles using the term "U-47700" and "47700...
September 11, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28899594/delayed-detection-of-spontaneous-bilateral-tubal-ectopic-pregnancies-after-methotrexate-treatment
#7
Nicole E Brown, Shereen A Singer, Joe Suyama
BACKGROUND: Bilateral tubal ectopic pregnancies are a rare subset of ectopic pregnancy that can pose a diagnostic dilemma for clinicians. There is no distinct clinical presentation for bilateral tubal ectopic pregnancies, although they are typically associated with assistive reproductive techniques. In addition, there is no single diagnostic feature to help clinicians delineate bilateral tubal ectopic pregnancies from other types of ectopic pregnancy prior to passing the discriminatory zone (such as heterotopic pregnancy or twin ectopic [two gestational sacs in one tube])...
September 9, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28886979/development-of-a-prediction-model-for-diagnosis-of-acute-poisoning-in-patients-with-altered-mental-status-and-absent-history-of-alcohol-drug-ingestion
#8
Robert Camilleri
BACKGROUND: Diagnosis of acute poisoning in patients with altered mental status and absent history is a challenging diagnostic problem in clinical practice. OBJECTIVE: The aims of the study were to develop a simple clinical tool to stratify risk of acute poisoning in patients with altered mental states and no history of alcohol/drug ingestion, and develop a prediction model using initial observations from which a simple risk score could be derived. METHODS: The study was carried out on non-trauma patients aged 15 years and older admitted with altered mental states and no history of alcohol or drug ingestion...
September 5, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28882638/delayed-onset-of-atrial-fibrillation-and-ventricular-tachycardia-after-an-automobile-lightning-strike
#9
Dorian Drigalla, Shannon E Essler, C Keith Stone
BACKGROUND: Lightning strike is a rare medical emergency. The primary cause of death in lightning strike victims is immediate cardiac arrest. The mortality rate from lightning exposure can be as high as 30%, with up to 70% of patients left with significant morbidity. CASE REPORT: An 86-year-old male was struck by lightning while driving his vehicle and crashed. On initial emergency medical services evaluation, he was asymptomatic with normal vital signs. During his transport, he lost consciousness several times and was found to be in atrial fibrillation with intermittent runs of ventricular tachycardia during the unconscious periods...
September 4, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28882637/successful-retrograde-intubation-after-failed-fiberoptic-intubation-and-percutaneous-cricothyrotomy
#10
Stephanie Brenman, Sachin Gupta, Stephanie Tseeng
BACKGROUND: An obstructive neck lesion presents an airway challenge for any emergency physician. Retrograde intubation is an infrequently used airway alternative that can be employed in the difficult airway algorithm that requires little training and is less invasive than surgical cricothyrotomy. CASE REPORT: We report a case of a 31-year-old male patient who presented with respiratory distress progressing to respiratory failure from upper airway obstruction. The patient had significant tracheal thickening at the level of the thyroid gland based on a computed tomography report from 3 weeks prior to his presentation...
September 4, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28874304/effect-of-cricoid-pressure-on-the-insertion-efficacy-of-six-supraglottic-devices-a-crossover-randomized-simulation-trial
#11
Fumihiro Ohchi, Nobuyasu Komasawa, Ryosuke Mihara, Kazuo Hattori, Toshiaki Minami
BACKGROUND: No study has ever compared the efficacy of various types of supraglottic devices (SGDs) for securing the airway under cricoid pressure. OBJECTIVE: This study aimed to evaluate the efficacy of six SGDs, LMA-ProSeal (ProSeal), LMA-Classic (Classic), Laryngeal Tube (LT), LMA-Supreme (Supreme), air-Q (air-Q), and i-gel (i-gel), in airway management under cricoid pressure using a manikin. METHODS: Fifteen novice doctors and 16 experienced doctors used the six SGDs under cricoid or sham pressure on an adult manikin...
September 2, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28874303/airway-management-in-an-infant-with-a-large-supraglottic-mass-after-failed-fiberoptic-intubation
#12
Rajeev Sharma, Vidit Kaushal, Mohit Tyagi, Ashish Mittal
BACKGROUND: Fiberoptic bronchoscope-guided tracheal intubation is the gold standard for managing patients with supraglottic growths. In infants with a large and overhanging epiglottis, the success of fiberoptic-guided intubation relies heavily on the available space between the inferior surface of the epiglottis and the posterior pharyngeal wall or, more specifically, the superior surface of the supraglottic growth. CASE REPORT: We describe the inability to negotiate the tip of the fiberscope between the epiglottis and the supraglottic growth and the successful use of direct laryngoscopy to improve the available space along with the usefulness of "bubbling of air" to locate the glottic opening in an infant...
September 2, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28874302/psychiatric-emergencies-for-physicians-clinical-management-and-approach-to-distinguishing-pheochromocytoma-from-psychiatric-and-thyrotoxic-diseases-in-the-emergency-department
#13
Albert Leung, Leslie Zun, Kimberly Nordstrom, Michael P Wilson
No abstract text is available yet for this article.
September 2, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28870390/how-do-we-balance-the-long-term-health-of-a-patient-with-the-short-term-risk-to-the-physician
#14
Michael B Weinstock, Amal Mattu, Erik P Hess
BACKGROUND: There is a wide variation in practice patterns among emergency medicine physicians; many factors weigh into the medical decision-making process including the health of the patient as well as short-term risk to the physician. OBJECTIVE: The objective of our discussion is to illustrate specific scenarios where medical decisions are focused on the physician's short-term risk, then to propose an approach to shifting the balance to the patient's long-term health...
September 1, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28847677/laceration-management
#15
Scott L Mankowitz
BACKGROUND: Traumatic lacerations to the skin represent a fairly common reason for seeking emergency department care. Although the incidence of lacerations has decreased over the past decades, traumatic cutaneous lacerations remain a common reason for patients to seek emergency department care. OBJECTIVE: Innovations in laceration management have the potential to improve patient experience with this common presentation. DISCUSSION: Studies have confirmed that delays in wound closure rarely confer increased rates of infection, although comorbidities such as diabetes, chronic renal failure, obesity, human immunodeficiency virus, smoking, and cancer should be considered...
August 25, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28843461/a-new-rule-for-terminating-resuscitation-of-out-of-hospital-cardiac-arrest-patients-in-japan-a-prospective-study
#16
(no author information available yet)
BACKGROUND: The American Heart Association and European Resuscitation Council guidelines for cardiopulmonary resuscitation present rules for termination of resuscitation (TOR) in cases of out-of-hospital cardiac arrest (OHCA). In Japan, only doctors are legally allowed TOR in OHCA cases. OBJECTIVE: This study aimed to develop a new TOR rule that suits the actual situations of the Japanese emergency medical services system. METHODS: Five different combinations of the TOR rule criteria were compared regarding specificity and positive predictive value (PPV) for 1-month survival with unfavorable neurologic outcomes...
August 23, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28843460/safety-threats-during-the-care-of-infants-with-hypoglycemic-seizures-in-the-emergency-department-a-multicenter-simulation-based-prospective-cohort-study
#17
Barbara M Walsh, Sandeep Gangadharan, Travis Whitfill, Marcie Gawel, David Kessler, Robert A Dudas, Jessica Katznelson, Megan Lavoie, Khoon-Yen Tay, Melinda Hamilton, Linda L Brown, Vinay Nadkarni, Marc Auerbach
BACKGROUND: Errors in the timely diagnosis and treatment of infants with hypoglycemic seizures can lead to significant patient harm. It is challenging to precisely measure medical errors that occur during high-stakes/low-frequency events. Simulation can be used to assess risk and identify errors. OBJECTIVE: We hypothesized that general emergency departments (GEDs) would have higher rates of deviations from best practices (errors) compared to pediatric emergency departments (PEDs) when managing an infant with hypoglycemic seizures...
August 23, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28844404/uncomplicated
#18
Meghan G Liroff
No abstract text is available yet for this article.
August 22, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28838565/a-case-of-methemoglobinemia-successfully-treated-with-hyperbaric-oxygenation-monotherapy
#19
Youngmo Cho, Sung Wook Park, Sang-Kyoon Han, Hyung Bin Kim, Seok Ran Yeom
BACKGROUND: Methylene blue is the first-line therapy for methemoglobinemia, but it can be intermittently unavailable due to production issues. For this clinical scenario, alternative treatment options need to be explored. Hyperbaric oxygenation (HBO) is conventionally applied as an adjunctive therapy during the systemic administration of methylene blue. Currently, little is known regarding the effects of HBO monotherapy in methemoglobinemia. We report a case of methemoglobinemia that was successfully treated with HBO monotherapy...
August 21, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28838564/psychiatric-emergencies-for-clinicians-emergency-department-management-of-cocaine-related-presentations
#20
Jagoda Pasic, Paul Zarkowski, Kimberly Nordstrom, Michael P Wilson
No abstract text is available yet for this article.
August 21, 2017: Journal of Emergency Medicine
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