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Journal of Emergency Medicine

Scott L Mankowitz, Pat Regenberg, Janina Kaldan, Jon B Cole
BACKGROUND: Rapid tranquilization of agitated patients can prevent injuries and expedite care. Whereas antipsychotics and benzodiazepines are commonly used for this purpose, ketamine has been suggested as an alternative. OBJECTIVE: The aim of this systematic review is to determine the safety and effectiveness of ketamine to sedate prehospital and emergency department (ED) patients with undifferentiated agitation. METHODS: Studies and case series of patients receiving ketamine for agitation were included...
September 6, 2018: Journal of Emergency Medicine
Shawna D Bellew, Katie L Johnson, Micah D Nichols, Tobias Kummer
BACKGROUND: Treatment for epistaxis includes application of intranasal vasoconstrictors. These medications have a precaution against use in patients with hypertension. Given that many patients who present with epistaxis are hypertensive, these warnings are commonly overridden by clinical necessity. OBJECTIVE: Our aim was to determine the effects of intranasal vasoconstrictors on blood pressure. METHODS: We conducted a single-center, randomized, double-blind, placebo-controlled trial from November 2014 through July 2016...
September 5, 2018: Journal of Emergency Medicine
Filippo Numeroso, Gianluigi Mossini, Giuseppe Lippi, Gianfranco Cervellin
BACKGROUND: There are a limited number of studies on the short-term prognosis of syncopal patients, and those available are heterogeneous and often have considered events without a clear relationship with the syncopal episode as serious outcomes. OBJECTIVE: The aim of this study was to identify the incidence of short-term true outcomes of a syncopal episode, only considering those occurring after a reasonable period of time, with a plausible causal relationship with index syncope as well as syncopal recurrences causing major trauma...
September 3, 2018: Journal of Emergency Medicine
Ravindra Kumar Garg, Neeraj Kumar, Shweta Pandey, Imran Rizvi, Ravi Uniyal, Hardeep Singh Malhotra
No abstract text is available yet for this article.
September 3, 2018: Journal of Emergency Medicine
Nicholas M Studer, Pedro F Lucero
No abstract text is available yet for this article.
September 3, 2018: Journal of Emergency Medicine
Evan Avraham Alpert, Giora Weiser, Deganit Kobliner, Eran Mashiach, Tarif Bader, Eran Tal-Or, Ofer Merin
BACKGROUND: Medical response to world disasters has too often been poorly coordinated and nonprofessional. To improve this, several agencies, led by the World Health Organization (WHO), have developed guidelines to provide accreditation for Foreign Medical Teams (FMTs). There are three levels, with the highest known as FMT Type-3 providing outpatient as well as inpatient surgical emergency care in addition to inpatient referral care. In November 2016, the WHO certified the Israel Defense Forces Field Hospital as the first FMT Type-3...
September 1, 2018: Journal of Emergency Medicine
Maame Yaa A B Yiadom, Conor M McWade, Koku Awoonor-Williams, Ebenezer Appiah-Denkyira, Rachel T Moresky
BACKGROUND: Ghana is a developing country that has strategically invested in expanding emergency care services as a means of improving national health outcomes. OBJECTIVES: Here we present Ghana as a case study for investing in emergency care to achieve public health benefits that fuel for national development. DISCUSSION: Ghana's health leadership has affirmed emergency care as a necessary adjunct to its preexisting primary health care model...
September 1, 2018: Journal of Emergency Medicine
Sara Hussain, Shabbir Hussain, Sahar Hussain
No abstract text is available yet for this article.
September 1, 2018: Journal of Emergency Medicine
Jessica A Shuen, Michael P Wilson, Allyson Kreshak, Samuel Mullinax, Jesse Brennan, Edward M Castillo, Corinne Hinkle, Gary M Vilke
BACKGROUND: Novel means of emergency department (ED) post-discharge communication-telephone callbacks and text messages-are increasingly being utilized to facilitate patient-oriented outcomes, such as ED revisits, patient adherence, and satisfaction. OBJECTIVE: The primary measure of interest is the rate of ED revisits in the week after discharge. The secondary measures of interests are rate of primary medical doctor (PMD) or specialist physician contact in the week after discharge and patient satisfaction...
September 1, 2018: Journal of Emergency Medicine
Eric D Wicks, Alex E White, Sh'Rae Marshall, Christopher J Hadley, Christopher C Dodson
BACKGROUND: Humerus fractures caused by the throwing motion are extremely rare. They have been reported mostly in recreational adult athletes in their third or later decades of life. A pediatric thrower's fracture is even less common, with few reported cases. The pediatric version of this fracture is located in the proximal to midshaft humerus, distinguishing it from the adult type, which occurs in the middle to distal shaft. CASE REPORT: A 12-year-old male pitcher experienced a "snap" in his right arm while throwing a pitch in a baseball game...
September 1, 2018: Journal of Emergency Medicine
William Berrigan, Roderick Geer, James S Jelnick, Jonathan E Davis, Robert Bunning
No abstract text is available yet for this article.
August 30, 2018: Journal of Emergency Medicine
Scott A Simpson, Chelsie Monroe
BACKGROUND: Psychiatric presentations are common in emergency departments (EDs), but the standard of care for treatment remains poorly defined. We introduced standards for emergency psychiatric evaluations that included obtaining collateral information, writing a safety plan for discharging patients, identifying the next best provider, and alerting that provider to the patient's visit. OBJECTIVE: We sought to demonstrate the feasibility and clinical impact of implementing standards for emergency psychiatric evaluations...
August 28, 2018: Journal of Emergency Medicine
Samuel H F Lam, Adam Sivitz, Kiyetta Alade, Stephanie J Doniger, Mark O Tessaro, Joni E Rabiner, Alexander Arroyo, Edward M Castillo, Caroline A Thompson, Mingan Yang, Rakesh D Mistry
BACKGROUND: Point-of-care ultrasound (POCUS) can potentially help distinguish cellulitis from abscess, which can appear very similar on physical examination but necessitate different treatment approaches. OBJECTIVE: To compare POCUS guidance vs. clinical assessment alone on the management of pediatric skin and soft tissue infections (SSTI) in the emergency department (ED) setting. METHODS: Children ages 6 months to 18 years presenting to participating EDs with SSTIs ≥ 1 cm were eligible...
August 28, 2018: Journal of Emergency Medicine
Ashley McCaskill, Chandler Finney Inabinet, Kristl Tomlin, Judith Burgis
BACKGROUND: Prepubertal genital bleeding can be caused by a variety of etiologies including trauma, infection, structural, hematologic disorders, precocious puberty, and malignancy. Urethral prolapse can be seen in prepubescent girls due to a relative estrogen deficiency. Urethral prolapse classically presents with urethral mass and vaginal bleeding, often associated with constipation. CASE REPORT: A healthy 6-year-old White girl presented to the Pediatric Emergency Department (ED) with vaginal bleeding for 1 day preceded by a few months of constipation...
August 28, 2018: Journal of Emergency Medicine
Nicola Malagutti, Andrea Di Laora, Carlo Barbetta, Elisabetta Groppo, Valeria Tugnoli, Elisabetta Sette, Luigi Astolfi, William Beswick, Michela Borin, Andrea Ciorba, Stefano Pelucchi, Francesco Stomeo, Marco Contoli
BACKGROUND: Dyspnea secondary to acute upper airways airflow limitation (UAAFL) represents a clinical emergency that can be difficult to recognize without a suitable history; even when etiology is known, parameters to assess the severity are unclear and often improperly used. OBJECTIVES: The aim of this study was to assess the role of peripheral oxygen saturation (SpO2 ) as a predictor of severity of upper airway obstruction. METHODS: The authors propose an experimental model of upper airway obstruction by a progressive increase of UAAFL...
August 28, 2018: Journal of Emergency Medicine
Kevin Ting, Venkatachalam Mulukutla, Wayne J Franklin, Wilson W Lam
BACKGROUND: Anomalous coronary artery origins appear in roughly 1% of coronary angiograms, and up to 15% of syncope and sudden cardiac death events can be attributed to anomalous coronaries. Patients with an anomalous coronary artery arising from the opposite sinus may initially present with syncope and electrocardiographic findings of ischemia. CASE REPORT: We describe a case in which an adolescent male presented with exercise-induced angina and syncope, and his initial electrocardiogram (ECG) showed diffuse ST-segment depression with ST-segment elevation in lead aVR...
August 27, 2018: Journal of Emergency Medicine
Brian Ferguson, Justin Geralds, Jessica Petrey, Martin Huecker
BACKGROUND: Malpractice in emergency medicine is of high concern for medical providers, the fear of which continues to drive decision-making. The body of evidence evaluating risk specific to emergency physicians is disjointed, and thus it remains difficult to derive cohesive themes and strategies for risk minimization. OBJECTIVE: This review evaluates the state of malpractice in emergency medicine and summarizes a concise approach for the emergency physician to minimize risk...
August 27, 2018: Journal of Emergency Medicine
Akanksha Agrawal, Mohammad Nour Zabad, Sandeep Dayanand, Georgios Lygouris, Christian Witzke
BACKGROUND: Acute pericardial pathologies, such as pericardial effusion, pericarditis, and cardiac tamponade, have been reported rarely in patients presenting as ST-elevation myocardial infarction (STEMI). We present a series of 3 patients with STEMI, where an undiagnosed pericardial effusion led to pericardial tamponade and subsequent cardiocirculatory collapse. CASE REPORTS: This is a case series of 3 patients, all women, aged 72, 64, and 54 years who presented to the emergency department with chest pain or syncope and were found to have STEMI with hemodynamic instability...
August 24, 2018: Journal of Emergency Medicine
Kun-Yu Lee, Hao-Chien Chao, Sai-Wai Ho
No abstract text is available yet for this article.
August 24, 2018: Journal of Emergency Medicine
Michael S Pulia, Rebecca J Schwei, Brian W Patterson, Michael D Repplinger, Maureen A Smith, Manish N Shah
BACKGROUND: The optimal approach to outpatient antibiotic use after surgical drainage of abscesses is unclear given conflicting clinical trial results. OBJECTIVE: Our primary objective was to evaluate the real-world effectiveness of outpatient antibiotic prescribing after surgical drainage of cutaneous abscesses on reducing treatment failure. METHODS: We performed a retrospective observational study using data extracted from the electronic health record of a single academic health care system...
August 24, 2018: Journal of Emergency Medicine
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