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Open Access Emergency Medicine: OAEM

Keith M Porter, Anthony D Dayan, Sara Dickerson, Paul M Middleton
Methoxyflurane is an inhaled analgesic administered via a disposable inhaler which has been used in Australia for over 40 years for the management of pain associated with trauma and for medical procedures in children and adults. Now available in 16 countries worldwide, it is licensed in Europe for moderate to severe pain associated with trauma in conscious adults, although additional applications are being made to widen the range of approved indications. Considering these ongoing developments, we reviewed the available evidence on clinical usage and safety of inhaled analgesic methoxyflurane in trauma pain and in medical procedures in both adults and children...
2018: Open Access Emergency Medicine: OAEM
Samina Ali, Aaron Moodley, Amrita Bhattacharjee, Eddie Chang, Allison Kabaroff, Kevin Lobay, Dominic Allain
Objectives: Croup is one of the most common childhood respiratory illnesses. Early dexamethasone administration in croup can improve patient outcomes. The objective of this study was to assess the clinical impact of prehospital administration of dexamethasone to children with croup. Methods: A medical record review that included children between 6 months and 6 years, who were brought via emergency medical services (EMS) to the emergency department (ED) with a final diagnosis of croup, between January 2010 and December 2012, was conducted...
2018: Open Access Emergency Medicine: OAEM
Tjokorda Gde Bagus Mahadewa, Nyoman Golden, Anne Saputra, Christopher Ryalino
Background: Traumatic brain injury (TBI) is a common healthcare problem related to disability. An easy-to-use trauma scoring system informs physicians about the severity of trauma and helps to decide the course of management. The purpose of this study is to use the combination of both physiological and anatomical assessment tools that predict the outcome and develop a new modified prognostic scoring system in TBIs. Patients and methods: A total of 181 subjects admitted to the emergency department (ED) of Sanglah General Hospital were documented for both Marshall CT scan classification score (MCTC) and Revised Trauma Score (RTS) upon admission...
2018: Open Access Emergency Medicine: OAEM
Siriwimon Tantarattanapong, Nuraianee Arwae
Objective: The aim of this study was to identify factors associated with perforated acute appendicitis in geriatric patients at the emergency department (ED). Patients and methods: The medical records of 223 consecutive patients aged >60 years with acute appendicitis between 2006 and 2017 were retrospectively reviewed. Patients were grouped into those with perforated and non-perforated appendicitis. A comparison was made between the two groups in regard to baseline characteristics, clinical presentation, physical examination, time from onset of symptoms to ED arrival, time from ED arrival to operation, postoperative complications, hospital length of stay, and mortality...
2018: Open Access Emergency Medicine: OAEM
Mathilde Stærk, Kasper G Lauridsen, Troels Mygind-Klausen, Bo Løfgren
Introduction: Guideline implementation is essential to improve survival following cardiac arrest. This study aimed to investigate awareness, expected time frame, and strategy for implementation of the European Resuscitation Council (ERC) Guidelines 2015 in Danish hospitals. Methods: All public, somatic hospitals with a cardiac arrest team in Denmark were included. A questionnaire was sent to hospital resuscitation committees one week after guideline publication...
2018: Open Access Emergency Medicine: OAEM
Adam J Kruse, Andrew S Nugent, Andrew R Peterson
Purpose: Traumatic brain injury (TBI) is a significant cause of death and disability in the United States. Many patients with TBI are initially treated in the emergency department (ED), but there is no evidence-based method of detecting or grading TBI in patients who have normal structural neuroimaging. This study aims to evaluate the validity of two common sideline concussion tests. The Concussion Symptom Severity Score (CSSS) and modified Balance Error Scoring System (mBESS) tests are well-validated sideline tests for concussion, but have not been validated in the setting of non-sport-related concussion, in settings other than the sideline or athletic training room or in moderate or severe TBI...
2018: Open Access Emergency Medicine: OAEM
Ar-Aishah Dadeh, Banjaparat Nuanjaroan
Objective: To examine the initial level of lactate to predict sustained return of spontaneous circulation (ROSC) in nontraumatic out-of-hospital cardiac arrest (OHCA) patients. Materials and methods: This was a 30-month retrospective cohort study in an emergency department (ED) of a tertiary care hospital. The inclusion criteria were adult nontraumatic OHCA patients who came to the ED with ongoing chest compression. The primary outcome was initial serum lactate level at the ED to predict sustained ROSC in nontraumatic OHCA...
2018: Open Access Emergency Medicine: OAEM
Ki Hoon Kim, Sang Hyun Park
Perforation is the rarest complication of the duodenal diverticulum (DD), but it is the most serious complication. Mortality rate was reported up to 30%, which may be related to diagnostic delay because the symptoms of the perforated DD are vague and nonspecific. Therefore, accurate diagnosis is important to improve the clinical outcome. Surgical treatment was considered as the standard therapeutic option. However, surgical intervention may increase morbidity and mortality due to surgical complications. Therefore, nonoperative management can be considered in some patients with perforated diverticulum who have stable vital signs without generalized peritonitis, or in elderly patients with comorbidities...
2018: Open Access Emergency Medicine: OAEM
Mostafa A Abolfotouh, Mohamed A Hussein, Sameh M Abolfotouh, Alanoud Al-Marzoug, Suliman Al-Teriqi, Abeer Al-Suwailem, Ra'ed A Hijazi
Background: The aim of this study was to describe the pattern of traumatic injuries and determine the predictors of inhospital mortality in patients admitted to the emergency department. Patients and methods: This is a retrospective cohort study of 3,786 patients with traumat injuries admitted to the emergency department of King Abdulaziz Medical City, Riyadh, Saudi Arabia, between January 2012 and December 2014. Data on patient characteristics, trauma characteristics and outcomes were extracted from medical records...
2018: Open Access Emergency Medicine: OAEM
Gabriella F Pogorzelski, Taline Aal Silva, Thamara Piazza, Tomás M Lacerda, Fernando Ac Spencer Netto, Amaury Cesar Jorge, Péricles Ad Duarte
Background: Trauma is a major cause of hospital admissions and is associated with manifold complications and high mortality rates. However, data on intensive care unit (ICU) admissions are scarce in developing and low-income countries, where its incidence has been increasing. Objectives: To analyze epidemiological and clinical factors and outcomes in adult trauma patients admitted to the ICU of a public teaching hospital in a developing country as well as to identify risk factors for complications in the ICU...
2018: Open Access Emergency Medicine: OAEM
Laurence Pincet, Gabriele Lecca
Background: Non-cardiogenic pulmonary edema (NCPE) after intravenous (iv) administration of non-ionic radiocontrast media (RCM) is a rare but life-threatening complication. In a context of emergency, its diagnosis is difficult. Case report: We report the case of a 55-year-old woman who developed an acute pulmonary edema following iv infusion of non-ionic, low-osmolar RCM during abdominal CT scan. She needed a 24-hour hospitalization in intensive care unit for an acute hypoxemic dyspnea...
2018: Open Access Emergency Medicine: OAEM
Tjokorda Gde Bagus Mahadewa, Tjokorda Gde Agung Senapathi, Made Wiryana, I Gusti Ngurah Mahaalit Aribawa, Ketut Yudi Arparitna, Christopher Ryalino
Background: Assessing consciousness in traumatic brain injury is important because it also determines the treatment option, which will influence patients' outcome. A tool used to objectively assess consciousness level is the bispectral index (BIS) monitor, which was originally designed to monitor the depth of anesthesia. Glasgow Outcome Scale-Extended (GOS-E) provides a measuring tool to assess traumatic brain injury (TBI) outcome. The goal of this study was to assess the correlation between GOS-E scores with BIS values in patients with TBI who underwent craniotomy...
2018: Open Access Emergency Medicine: OAEM
Olivier Kubwimana
Background: Globally, there has been an increase in injuries as a major cause of death. This burden is mainly due to an increase in road traffic injuries, and it poses an enormous burden in low- and middle-income countries. Musculoskeletal and head injuries are the most prevalent ones, which has led to an overcrowding of traumatic surgical emergencies. Methodology: An unrestricted search was done in different research databases for articles published in English between January 2005 and November 2017 focusing on traumatic surgical emergencies...
2018: Open Access Emergency Medicine: OAEM
German Devia Jaramillo, Jenny Torres Castillo, Freddy Lozano, Angélica Ramírez
Introduction: The use of central venous catheters (CVCs) in the emergency room (ER) is a valuable tool for the comprehensive management of critically ill patients; however, the positioning of these devices is not free of complications. Currently, the use of ultrasound is considered a useful and safe tool to carry out these procedures, but in Colombia, the number of emergency departments providing this tool is scarce and there is no literature describing the experience in our country. Objective: The objective of this study was to describe the experience regarding placement of ultrasound-guided CVCs by emergency physicians in an institution in Bogotá, as well as the associated complications...
2018: Open Access Emergency Medicine: OAEM
Edward C Jauch, David Y Huang, Allison J Gardner, Julie L Blum
Background: The timely evaluation and initiation of treatment for acute ischemic stroke (AIS) is critical to optimal patient outcomes. However, clinical practice often falls short of guideline-established goals. Hospitals in rural regions of the USA, and notably those in the Stroke Belt, are particularly challenged to meet timing goals since the vast majority of primary stroke centers (PSCs) are concentrated in urban academic institutions. Methods: Between May 2015 and May 2017, emergency department (ED) teams from 5 non-PSC hospitals in the Stroke Belt participated in a quality improvement (QI) initiative...
2018: Open Access Emergency Medicine: OAEM
Mohamud A Verjee, Robert Crone, Grigory Ostrovskiy
Airline travel is more affordable than ever and likely safer than ever too. Within half a day, a passenger can be on the other side of the world. However, medical care in-flight has been an issue for those with medical conditions and for those who fall sick during a journey. While airlines have the advice of multiple recognized organizations on needs and standards of care, in-flight emergencies occur at various levels. An emergency medical kit (EMK) together with trained cabin crew can be very effective at resolving the minor problems that arise and reducing the risk of escalation...
2018: Open Access Emergency Medicine: OAEM
Nitin Kaushik, Victor S Khangulov, Matthew O'Hara, Ramy Arnaout
Objective: Laboratory tests are an important contributor to treatment decisions in the emergency department (ED). Rapid turnaround of laboratory tests can optimize ED throughout by reducing the length of stay (LOS) and improving patient outcomes. Despite evidence supporting the effect of shorter turnaround time (TAT) on LOS and outcomes, there is still a lack of large retrospective studies examining these associations. Here, we evaluated the effect of a reduction in laboratory TAT on ED LOS using retrospective analysis of Electronic Health Records (EHR)...
2018: Open Access Emergency Medicine: OAEM
Shaikha Al Jawder, Eiman AlJishi, Shaikhah Al-Otaibi, Mohammed S Al-Shahrani
A 51-year-old woman, who intentionally ingested a massive dose of ~60 g of valproic acid which she was using as a mood stabilizer for bipolar affective disorder, presented within 30 minutes of ingestion to the emergency department. The patient was asymptomatic and was immediately started on decontamination therapy with activated charcoal (AC). Drug serum levels, liver functions, and ammonia levels were tested and followed up during treatment. Due to the massive ingestion and continuous rise in serum drug levels, the patient received regular multiple doses of AC, as well as l-carnitine for liver protection...
2018: Open Access Emergency Medicine: OAEM
Mineji Hayakawa
Sepsis and septic shock are frequently complicated by disseminated intravascular coagulation (DIC), which decreases the survival rate of patients with sepsis. In the past, large international randomized controlled trials (RCTs) using physiological anticoagulants for sepsis-induced DIC were not performed; however, RCTs have been conducted for sepsis and/or septic shock. In these trials, physiological anticoagulants did not show any beneficial effects compared with placebo for the treatment of sepsis and/or septic shock...
2018: Open Access Emergency Medicine: OAEM
Charles R Caffrey, Patrick M Lank
Patients can use numerous drugs that exist outside of existing regulatory statutes in order to get "legal highs." Legal psychoactive substances represent a challenge to the emergency medicine physician due to the sheer number of available agents, their multiple toxidromes and presentations, their escaping traditional methods of analysis, and the reluctance of patients to divulge their use of these agents. This paper endeavors to cover a wide variety of "legal highs," or uncontrolled psychoactive substances that may have abuse potential and may result in serious toxicity...
2018: Open Access Emergency Medicine: OAEM
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