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EM Articles

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214 papers 1000+ followers Papers relevant to emergency medicine
By Emma Sizemore MD/MPH student at Emory University going into EM
Aaron Brody, Tahsin Rahman, Brian Reed, Scott Millis, Brian Ference, John M Flack, Phillip D Levy
BACKGROUND: Poor blood pressure (BP) control is a primary risk factor for target organ damage in the heart, brain, and kidney. Uncontrolled hypertension is common among emergency department (ED) patients, particularly in underresourced settings, but it is unclear what role ED providers should play in the management of chronic antihypertensive therapy. OBJECTIVES: The objective was to evaluate the safety and efficacy of prescribing antihypertensive therapy from the ED...
May 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Calvin A Brown, Aaron E Bair, Daniel J Pallin, Ron M Walls
STUDY OBJECTIVE: We describe the operators, techniques, success, and adverse event rates of adult emergency department (ED) intubation through multicenter prospective surveillance. METHODS: Eighteen EDs in the United States, Canada, and Australia recorded intubation data onto a Web-based data collection tool, with a greater than or equal to 90% reporting compliance requirement. We report proportions with binomial 95% confidence intervals (CIs) and regression, with year as the dependent variable, to model change over time...
April 2015: Annals of Emergency Medicine
Susan H Watts, E David Bryan, Patrick M Tarwater
OBJECTIVES: As the U.S. economy began its downward trend in 2008, many citizens lost their jobs and, ultimately, their employer-sponsored health care insurance. The expectation was that many of the newly uninsured would turn to emergency departments (EDs) for their health care. This study was undertaken to determine, first, if changes in the insurance status of the general population were reflected in the ED insurance payer mix and, second, whether there was evidence of an increased reliance on the ED as a continuing source of health care for any payer group(s)...
January 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Elif Yaka, Serkan Yılmaz, Nurettin Özgür Doğan, Murat Pekdemir
OBJECTIVES: The aim of this study was to compare the performance of the Glasgow-Blatchford and the AIMS65 scoring systems as early risk assessment tools for accurately identifying patients with upper gastrointestinal (GI) bleeding who are at a low risk of requiring clinical interventions, including emergency endoscopy. The secondary objective was to compare their performance regarding relevant clinical outcomes. METHODS: Data were collected prospectively over a 2-year period in the emergency department of a university hospital...
January 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Alexander Sasha Dubrovsky, Anna Kempinska, Ilana Bank, Elise Mok
STUDY OBJECTIVE: The primary objective of this study is to assess the accuracy of point-of-care ultrasonography compared with blinded orthopedic assessment of fluoroscopy in determining successful realignment of pediatric forearm fractures. The secondary objective is to determine the rate of agreement of ultrasonography and fluoroscopy in real-time by the treating physician. METHODS: A cross-sectional study was conducted in children younger than 18 years and presenting to an academic emergency department with forearm fractures requiring realignment of a single bone...
March 2015: Annals of Emergency Medicine
David Slessor, Simon Hunter
STUDY OBJECTIVE: The role of emergency department (ED) thoracotomy after blunt trauma is controversial. The objective of this review is to determine whether patients treated with an ED thoracotomy after blunt trauma survive and whether survivors have a good neurologic outcome. METHODS: A structured search was performed with MEDLINE, EMBASE, CINAHL, and PubMed. Inclusion criteria were ED thoracotomy or out-of-hospital thoracotomy, cardiac arrest or periarrest, and blunt trauma...
March 2015: Annals of Emergency Medicine
Scott D Weingart, N Seth Trueger, Nelson Wong, Joseph Scofi, Neil Singh, Soren S Rudolph
STUDY OBJECTIVE: We investigate a new technique for the emergency airway management of patients with altered mental status preventing adequate preoxygenation. METHODS: This was a prospective, observational, multicenter study of patients whose medical condition led them to impede optimal preintubation preparation because of delirium. A convenience sample of emergency department and ICU patients was enrolled. Patients received a dissociative dose of ketamine, allowing preoxygenation with high-flow nonrebreather mask or noninvasive positive pressure ventilation (NIPPV)...
April 2015: Annals of Emergency Medicine
Tracy E Madsen, Anthony M Napoli
BACKGROUND: Early antibiotics reduce mortality in patients with severe sepsis and septic shock. Recent work demonstrated that women experience greater delays to antibiotic administration, but it is unknown if this relationship remains after adjusting for factors such as source of infection. OBJECTIVES: The objective was to investigate whether gender and/or source of infection are associated with delays to antibiotics in patients with severe sepsis or septic shock...
December 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
R Vohra, C Rangan, R Bengiamin
BACKGROUND: Crotaline snakebites are routinely assessed with serial external examinations. We sought to correlate external findings with changes observed on ultrasound imaging. METHODS: This was a prospective, observational study of consecutive rattlesnake envenomation in patients treated at a single hospital in central California. Information recorded for each case included clinical data, gross external examination, and ultrasound images of tissue edema, localized fluid collections, and video footage of muscle fasciculations...
November 2014: Clinical Toxicology
M St-Onge, P-A Dubé, S Gosselin, C Guimont, J Godwin, P M Archambault, J-M Chauny, A J Frenette, M Darveau, N Le Sage, J Poitras, J Provencher, D N Juurlink, R Blais
CONTEXT: Calcium channel blocker poisoning is a common and sometimes life-threatening ingestion. OBJECTIVE: To evaluate the reported effects of treatments for calcium channel blocker poisoning. The primary outcomes of interest were mortality and hemodynamic parameters. The secondary outcomes included length of stay in hospital, length of stay in intensive care unit, duration of vasopressor use, functional outcomes, and serum calcium channel blocker concentrations...
November 2014: Clinical Toxicology
Tyler W Barrett, Cathy A Jenkins, Wesley H Self
STUDY OBJECTIVE: In the United States, nearly 70% of emergency department (ED) visits for atrial fibrillation result in hospitalization. The incidence of serious 30-day adverse events after an ED evaluation for atrial fibrillation remains low. This study's goal was to prospectively validate our previously reported Risk Estimator Decision Aid for Atrial Fibrillation (RED-AF) model for estimating a patient's risk of experiencing a 30-day adverse event. METHODS: This was a prospective cohort study, which enrolled a convenience sample of ED patients presenting with atrial fibrillation...
January 2015: Annals of Emergency Medicine
Susan E Farrell, Gloria J Kuhn, Wendy C Coates, Phillip H Shayne, Jonathan Fisher, Lauren A Maggio, Michelle Lin
OBJECTIVES: The objective was to critically appraise and highlight methodologically superior medical education research articles published in 2013 whose outcomes are pertinent to teaching and education in emergency medicine (EM). METHODS: A search of the English-language literature in 2013 querying Education Resources Information Center (ERIC), PsychINFO, PubMed, and Scopus identified 251 EM-related studies using hypothesis-testing or observational investigations of educational interventions...
November 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Terrell S Caffery, J Nelson Perret, Mandi W Musso, Glenn N Jones
OBJECTIVE: The purpose of this study was to determine if patients with nontraumatic causes of elevated intracranial pressure (ICP) could be identified by ultrasound measurement of optic nerve sheath diameter (ONSD). It was hypothesized that an ONSD greater than or equal to 5 mm would identify patients with elevated ICP. METHOD: This was a prospective observational trial comparing ONSD with ICP measured by opening pressure manometry on lumbar puncture (LP). The cohort consisted of a convenience sample of adult patients presenting to the emergency department, requiring LP...
December 2014: American Journal of Emergency Medicine
Eric Boccio, Benjamin Wie, Susan Pasternak, Anabella Salvador-Kelly, Mary Frances Ward, Jason D'Amore
OBJECTIVE: Certain patient populations may be unable to communicate their needs in the emergency department (ED) setting, and the ability to communicate varies between age groups. We aim to determine if there are differences in pain management of acute long-bone fracture (ALBF) among age groups presenting to the ED. METHODS: This study was a retrospective chart review of a consecutive sample of subjects over 13 months. Fracture site, subject age, arrival time, whether pain medication was administered, and time to initial administration were recorded...
December 2014: American Journal of Emergency Medicine
Charles V Pollack
Venous thromboembolism (VTE) is a disease spectrum that ranges from deep vein thrombosis (DVT) to pulmonary embolism (PE). Rapid diagnosis and treatment of VTE by emergency care providers are critical for decreasing patient mortality, morbidity, and the incidence of recurrent events. Recent American College of Chest Physicians guidelines recommend initial treatment with unfractionated heparin, low-molecular weight heparin, or fondaparinux overlapped with warfarin for a minimum of 5 days for the treatment of VTE in most cases...
December 2014: American Journal of Emergency Medicine
Sandra L Peake, Anthony Delaney, Michael Bailey, Rinaldo Bellomo, Peter A Cameron, D James Cooper, Alisa M Higgins, Anna Holdgate, Belinda D Howe, Steven A R Webb, Patricia Williams
BACKGROUND: Early goal-directed therapy (EGDT) has been endorsed in the guidelines of the Surviving Sepsis Campaign as a key strategy to decrease mortality among patients presenting to the emergency department with septic shock. However, its effectiveness is uncertain. METHODS: In this trial conducted at 51 centers (mostly in Australia or New Zealand), we randomly assigned patients presenting to the emergency department with early septic shock to receive either EGDT or usual care...
October 16, 2014: New England Journal of Medicine
Daniel A Waxman, Michael D Greenberg, M Susan Ridgely, Arthur L Kellermann, Paul Heaton
BACKGROUND: Many believe that fear of malpractice lawsuits drives physicians to order otherwise unnecessary care and that legal reforms could reduce such wasteful spending. Emergency physicians practice in an information-poor, resource-rich environment that may lend itself to costly defensive practice. Three states, Texas (in 2003), Georgia (in 2005), and South Carolina (in 2005), enacted legislation that changed the malpractice standard for emergency care to gross negligence. We investigated whether these substantial reforms changed practice...
October 16, 2014: New England Journal of Medicine
Steve Goodacre, John W Stevens, Abdullah Pandor, Edith Poku, Shijie Ren, Anna Cantrell, Vincent Bounes, Arantxa Mas, Didier Payen, David Petrie, Markus Soeren Roessler, Gunther Weitz, Laurent Ducros, Patrick Plaisance
OBJECTIVES: This meta-analysis aimed to determine the effectiveness of prehospital continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP) in acute respiratory failure. METHODS: Fourteen electronic databases and research registers were searched from inception to August 2013. Randomized or quasi-randomized controlled trials that reported mortality or intubation rate for prehospital CPAP or BiPAP were selected and compared to a relevant comparator in patients with acute respiratory failure...
September 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Hind Beydoun, Alison Teel, Chris Crowder, Suraj Khanal, Bruce M Lo
BACKGROUND: Evidence linking alcohol use to injury outcomes remains inconclusive, with prehospital and police department-based studies showing negative effects and hospital-based studies showing no effect or better outcomes. OBJECTIVE: The purpose of this study was to examine the relationship of blood alcohol concentration (BAC) with injury characteristics and outcomes among trauma patients admitted to a major teaching hospital. In an effort to mitigate selection and confounding bias, propensity scoring methodology was applied, by which trauma patients were randomly assigned to high- and low-BAC groups...
October 2014: Journal of Emergency Medicine
George Sakellaris, Evangelos Blevrakis, Ioannis Petrakis, Anastasia Dimopoulou, Olga Dede, Nikolaos Partalis, Athanasios Alegakis, Chrysa Seremeti, Anna Maria Spanaki, George Briassoulis
BACKGROUND: Acute coagulopathy associated with trauma has been recognized for decades and is a constituent of the "triad of death" together with hypothermia and acidosis. STUDY OBJECTIVE: The aim of this study was to determine to what extent coagulopathy is already established upon emergency department (ED) admission and the association with the severity of injury, impaired outcome, and mortality. METHODS: Ninety-one injured children were admitted to the ED in our hospital...
November 2014: Journal of Emergency Medicine
2014-09-17 18:32:01
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