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(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Tags: Online Material Source Type: journals

Author IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Tags: Online Material Source Type: journals

Contents IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Tags: Online Material Source Type: journals

Calendar of EventsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Tags: Abstracts Source Type: journals

Acute Stroke Symptoms: Comparing Women and Men: Lisabeth LD, Brown DL, Hughes R, Majersik JJ, Morgenstern LB. Stroke 2009;40:2031–6Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This retrospective study from the University of Michigan Hospital examined the prevalence of traditional vs. non-traditional stroke and transient ischemic attack (TIA) symptoms as they are reported by women vs. men. Over a 3-year period, emergency department and admission logs were tracked and interviews were conducted with each patient or his or her proxy if a patient was unable to participate. Preceding symptom information was collected and classified as traditional or non-traditional based on the American Stroke Association's published stroke warning signs. Traditional symptoms included hemi-body numbness, diplopia, oth...
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Authors: Margaret Sande Tags: Abstracts Source Type: journals

Effect of a Housing and Case Management Program on Emergency Department Visits and Hospitalizations among Chronically Ill Homeless Adults: A Randomized Trial: Sadowski LS, Kee RA, VanderWeele TJ, et al. JAMA 2009;301:1771–8Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This randomized controlled trial examined the effect of a housing and case management intervention on resource usage among homeless adults with chronic medical illnesses. The primary outcomes were hospitalizations, hospital days, and emergency department visits in an 18-month intervention period. Patients were enrolled on hospital discharge, and randomized to receive either housing and regular case management or usual care, consisting most often of transport to a shelter and general case management services. A sample size of 200 per group was dictated by funding limits. Analysis was based on intention to treat. The primary...
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Authors: Marlow Macht Tags: Abstracts Source Type: journals

Population-Based Study of Risk and Predictors of Stroke in the First Few Hours After a TIA: Chandratheva A, Mehta Z, Geraghty OC, et al. Neurology 2009;72:1941–7Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The Stroke Prevention Research Unit at Oxford University evaluated 1247 patients who presented with a transient ischemic attach (TIA) or stroke for the first time. These patients were then followed to determine the risk of recurrent stroke within 24 h. The time analyses were performed from two separate points: time of onset of TIA and time from which the patient first called for medical attention. Additionally, the investigators correlated the data with ABCD scores, a validated clinical risk prediction tool for assessment of TIAs. Thirty-five of the 1247 patients had recurrent strokes within 24 h. However, 488 patients had...
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Authors: Elisa M. Dannemiller Tags: Abstracts Source Type: journals

Utility of D-Dimer Measurement for Screening of Acute Cardiovascular Disease in the Emergency Setting: Tokia Y, Kusama Y, Kodani E, et al. J Cardiol 2009;53:334–40Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This prospective observational trial from Tokyo studied several questions surrounding the usefulness of rapid D-dimer testing to diagnose acute cardiovascular disease in patients presenting to the emergency department (ED). They classified acute cardiovascular disease (ACVD) as either acute coronary syndromes (ACS) including acute myocardial infarction and unstable angina, or large vessel disease including acute aortic dissection, impending aortic aneurysm rupture, pulmonary thromboembolism, thrombophlebitis, deep venous thrombosis, or arterial occlusion. They first examined D-dimer levels in patients with confirmed acute ...
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Authors: Colleen Foster Tags: Abstracts Source Type: journals

Population-Based Study of Risk and Predictors of Stroke in the First Few Hours after a TIA: Chandratheva A, Mehta Z, Geraghty OC, et al. Neurology 2009;72:1941–7Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Although it is known that the risk of stroke in the week after a transient ischemic attack (TIA) is approximately 10%, this prospective study tracked the incidence of stroke in the first 24 h after TIA. In addition, the authors sought to determine the efficacy of the ABCD2 risk score in predicting stroke recurrence. Over nearly a 5-year period, the Oxford Vascular Study comprising 91,105 individuals was used to track patients presenting with TIA or stroke to Oxford area hospitals, urgent open-access TIA clinics, and accident and emergency departments. Local hospital and private general practitioner office record searches w...
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Authors: Margaret Sande Tags: Abstracts Source Type: journals

Aspirin vs Anticoagulation in Carotid Artery Dissection: Georgiadis D, Arnold M, von Buedingen HC, et al. Neurology 2009;72:1810–5Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This prospective, non-randomized cohort study enrolled 298 consecutive patients from 1987 to 2005 with spontaneous internal carotid artery dissection, and compared those treated with systemic anticoagulants to those treated with aspirin alone. The authors assessed the incidences of ischemic events, symptomatic intracranial bleeding, and major extracranial bleeding at 3 months after the dissection. On enrollment, dissection was confirmed by magnetic resonance imaging or digital subtraction angiography. Outcomes were assessed by neurological examination at 3 months in 97% of patients, and by structured telephone interview in...
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Authors: Marlow Macht Tags: Abstracts Source Type: journals

Improved Patient Survival Using a Modified Resuscitation Protocol for Out of Hospital Cardiac Arrest: Graza AG, Gratton MC, Salomone JA, et al. Circulation 2009;119:2597–604Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The Emergency Medical System in Kansas City, MO implemented a revised cardiac arrest protocol in 2006 after their cardiac arrest survival rates showed no improvement over the past decade in spite of automatic external defibrillators. The revised protocol aimed to improve coronary perfusion pressure through more effective chest compressions. The logic is based on the three-phase time-dependent model for cardiac arrest resuscitation where quality chest compressions can increase the myocardium adenosine triphosphate, reversing the acidic environment created by ischemia that is not favorable to cardioversion. The study used th...
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Authors: Elisa Dannemiller Tags: Abstracts Source Type: journals

Evaluation of the Accuracy of Different Methods Used to Estimate Weights in the Pediatric Population: So TY, Farrington E, Abasher RF. Pediatrics 2009;123:e1045–51Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In conclusion, the authors stated that the Broselow tape is the most accurate weight-estimation method among most patients aged ≤ 10 years old, but acknowledge that better methods are needed for overweight children, especially in light of increasing rates of childhood obesity. They also concluded that new models, such as the two developed during this study, could be more accurate, but require additional validation. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Authors: Colleen Foster Tags: Abstracts Source Type: journals

Corticosteroids in the Treatment of Severe Sepsis and Septic Shock in Adults: A Systematic Review: Annane D, Bellissant E, Bollaert PE, et al. JAMA 2009;301:2362–75Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The authors of this systematic review evaluated the effects of corticosteroids on 28-day all-cause mortality in patients with severe sepsis and septic shock, and as a secondary objective they investigated the effects of a lower total daily dose of 300 mg or less of hydrocortisone (or equivalent) and a treatment duration of at least 5 days on patients' outcomes. Additional secondary outcomes included intensive care unit length of stay, shock reversal, and serious adverse events (e.g., gastrointestinal bleeding, superinfection, hyperglycemia, hypernatremia, and neuromuscular weakness). Studies were identified from research d...
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Authors: Margaret Sande Tags: Abstracts Source Type: journals

Do Presenting Symptoms Explain Sex Differences in Emergency Department Delays Among Patients with Acute Stroke? Gargano JW, Wehner S, Reeves MJ. Stroke 2009;40:1114–20Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This cohort study reviewed 1922 acute stroke cases at 15 different Michigan hospitals, comparing time to physician examination (“door-to-doctor”) and time to computed tomography scan (“door-to-image”) for men and women. Data were abstracted from a statewide stroke registry, and individual symptoms were aggregated into five stroke warning signs: numbness/weakness, confusion/speech, vision, walking/dizziness/balance, and headache. The authors' intent was to test whether different presentations could account for sex differences in time intervals. Suspected strokes were identified by screening for any mention of stroke...
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Authors: Marlow Macht Tags: Abstracts Source Type: journals

Prediction of Mortality and Major Cardiac Events by Exercise Echocardiography in Patients with Normal Exercise Electrocardiographic Testing: Bouzas-Mosquera A, Peterio J, Alvarez-Garcia N, et al. J Am Coll Cardiol 2009;53:1981–90Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Given that exercise-induced wall motion abnormalities appear earlier in myocardial ischemia than ST-segment changes, this study evaluated the use of exercise echocardiography (EE) to predict outcomes in patients with known or suspected coronary artery disease (CAD) and normal exercise electrocardiogram (ECG) testing. The study examined 4004 patients with known or suspected CAD and ECG changes at rest who had no evidence of myocardial ischemia during exercise ECG testing. The investigators divided these 4004 patients into two groups: history of CAD and no history of CAD. Among the subgroup of patients with no history of CAD...
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Authors: Elisa M. Dannemiller Tags: Abstracts Source Type: journals

Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons with Severe Alcohol Problems: Larimer ME, Malone DK, Garner MD, et al. JAMA 2009;301:1349–57Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This observational study based in Washington evaluated the impact on public services usage and public cost data over a 1-year period after providing housing to homeless individuals with alcohol abuse problems. It also compared self-reported severity and frequency of alcohol usage for these individuals during this time. There were 126 subjects identified from a rank-ordered list of chronically homeless people that had incurred the highest total costs in 2004 for the area. All identified individuals were offered housing on a first-come-first-served basis in a “Housing First” (HF) program, which provides housing without a...
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Authors: Colleen Foster Tags: Abstracts Source Type: journals

American Academy of Emergency MedicineEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Tags: Public Health in Emergency Medicine Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Source Type: journals

Partial ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Source Type: journals

Issue HighlightsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - November 1, 2009 Category: Emergency Medicine Source Type: journals

List of Reviewers for Volumes 36 and 37, 2009Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Neal Abarbanell, md Fort Pierce, Florida (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - October 22, 2009 Category: Emergency Medicine Tags: Abstracts Source Type: journals

Foreign Body Aspiration After High-Velocity TraumaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Dr. Susan Wilcox: Today's case is that of a 19-year-old woman who was an unrestrained driver ejected after a high speed motor vehicle crash (MVC). She was traveling approximately 40 mph when her car ran off the road. The Emergency Medical Services crew found her lying on the ground about 15 feet from the car, alert but combative, with obvious facial bruising. Due to a concern for head and facial trauma, the crew performed a rapid sequence intubation at the scene with a 6.0-mm endotracheal tube (ETT). She was hemodynamically stable and easily ventilated during transport to our Level I trauma center Emergency Department (ED)...
Source: The Journal of Emergency Medicine - October 19, 2009 Category: Emergency Medicine Authors: Susan R. Wilcox, Christian Arbelaez, Eric S. Nadel, David F.M. Brown Tags: Case Presentations of the Harvard Affiliated Emergency Medicine Residencies Source Type: journals

Calendar of EventsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Tags: Abstracts Source Type: journals

Information Sheets for Patients with Acute Chest Pain: Randomised Controlled Trial: Arnold J, Goodacre S, Bath P, Price J. BMJ 2009;338:b541Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In this single-center trial from England, 700 consecutive patients with undifferentiated chest pain after diagnostic work-up were randomized to receive verbal advice vs. verbal advice plus a standardized information sheet. The authors noted that patients who received verbal advice plus an information sheet had lower mean anxiety scores as measured by the hospital anxiety and depression scale (7.61 vs. 8.63, difference 1.02; 95% confidence interval 0.20–1.84). The authors also noted a trend toward decreased depression by this same standardized scale. However, addition of a standardized information sheet to standard verbal...
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: Chris Davis Tags: Abstracts Source Type: journals

Impact of Admission Glucose Level and Presence of Diabetes Mellitus on Mortality in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome Treated Conservatively: Dziewierz A, Giszterowicz D, Siudak Z, et al. Am J Cardiol 2009;103:954–8Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study out of Poland utilized the Krakow registry of acute coronary syndromes, a prospective, multi-center, observational registry designed to examine epidemiology, in-hospital management, and outcomes of patients with acute coronary syndrome (ACS) in Krakow, Poland, to assess the impact of admission glucose level on the mortality of patients with non-ST-segment elevation ACS. The study includes 763 patients with admission glucose data and non-ST-segment elevation ACS. These patients were stratified into five groups based on blood glucose concentration: 24.2% had admission glucose levels of < 5 mmol/L (90 mg/dL), 50.6%...
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: Ryan Paterson Tags: Abstracts Source Type: journals

A Week-by-Week Analysis of the Low-Risk Criteria for Serious Bacterial Infection in Febrile Neonates: Schwartz S, Raveh D, Toker O, et al. Arch Dis Child 2009;94:287–92Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In this study, SBI was diagnosed in 87/449 (19%) of febrile neonates, 14 of which qualified as low risk of SBI (low risk criteria [LRC]+); 6.2% of LRC+ neonates were later identified to have SBI. The negative predictive value of the low risk criteria to exclude SBI was 93% (95% confidence interval 90.1–96.4%). Thus, the low risk criteria for SBI may not safely be relied upon to exclude SBI in febrile neonates, and these children should continue to be admitted, cultured, and be given antibiotics. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: David Thompson Tags: Abstracts Source Type: journals

How (Un)useful is the Pelvic Ring Stability Examination in Diagnosing Mechanically Unstable Pelvic Fractures in Blunt Trauma Patients? Shlamovitz GZ, Mower WR, Bergman J, et al. J Trauma 2009;66:815–20Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This retrospective chart review study sought to describe test characteristics of pelvic physical examination in detecting pelvic fractures in blunt trauma patients. All blunt trauma patients meeting criteria for trauma team activation between January 2003 and February 2005 were enrolled. Any patient without pelvic imaging was excluded. Charts were reviewed for documentation of pelvic stability, tenderness, or deformity. These results were compared with pelvic X-ray or computed tomography findings. Of 1502 patients, 115 had documented pelvic fractures. Of these, 34 had unstable fractures defined as Tile class B or C. The pe...
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: Shay Krier Tags: Abstracts Source Type: journals

Effect of Trauma Center Designation on Outcome in Patients with Severe Traumatic Brain Injury: DuBose JJ, Browder T, Inaba K, et al. Arch Surg 2008;143:1213–7Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study from Los Angeles County Hospital is a retrospective assessment of the National Trauma Data Bank. It evaluated the effect of American College of Surgeons (ACS) trauma center designation on outcomes in patients with isolated severe brain injury. Patients with a head acute injury score (AIS) ≥ 3 and no other body region AIS ≥ 3 were included in the analysis. A total of 16,035 patients who met the study criteria were admitted to 126 ACS Level I or II trauma centers over a 5-year period. Overall mortality was 9.6% in Level I and 13.9% in Level II facilities (p < 0.001). Overall complication rates were lower in Le...
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: Michael Zieske Tags: Abstracts Source Type: journals

Increasing Prevalence and Associated Risk Factors for Methicillin Resistant Staphylococcus Aureus Bacteriuria: Routh JC, Alt AL, Ashley RA, Kramer SA, Boyce TG. J Urol 2009;181:1694–8Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This retrospective review from the Mayo Clinic looked at urine culture data from 1997 and 2007 to ascertain prevalence of methicillin-resistant Staphylococcus aureus (MRSA) as a cause of bacteriuria and determine if there are specific risk factors that may predispose patients to MRSA bacteriuria. Hospital charts were reviewed and 7100 and 9985 positive urine cultures were identified from 1997 and 2007, respectively. Patients with urine cultures positive for MRSA in 2007 were compared with two other random cohorts of patients, one with cultures positive for methicillin-sensitive Staphylococcus aureus (MSSA) and another with...
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: Ryan Paterson Tags: Abstracts Source Type: journals

Unfractionated Heparin for Treatment of Sepsis: A Randomized Clinical Trial (The HETRASE Study) Jaimes F, De La Rosa G, Morales C, et al. Crit Care Med 2009;37:1185–96Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This prospective, randomized, double-blind, placebo-controlled single-center study sought to identify differences in mortality, length of stay, and change in multiple organ dysfunction (MOD) score in septic patients treated with low-dose continuous heparin in addition to conventional treatment. The rationale behind this therapeutic trial is that in sepsis, anticoagulant factors such as activated Protein C and antithrombin are depleted; heparin activates antithrombin, resulting in less thrombin and fibrin formation. In 319 patients admitted for sepsis in Columbia, there were no statistically significant differences in lengt...
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: David Thompson Tags: Abstracts Source Type: journals

Effect of Topical Alkane Vapocoolant Spray on Pain with Intravenous Cannulation in Patients in Emergency Departments: Randomised Double Blind Placebo Controlled Trial: Hijazi R, Taylor D, Richardson J. BMJ 2009;338:b215Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study from Australia randomized 201 emergency department (ED) patients to either water spray or alkane vapocoolant spray to the skin before intravenous (i.v.) cannulation. The main outcome measures were discomfort from the spray and pain from the cannula insertion, both measured on visual analog scales. Exclusion criteria included non-English speaking, moderate to severe pain, skin disease, known allergy, neuropathy, other anesthetics, parenteral analgesia within 4 h, severe illness, and need for urgent i.v. access. Patients received a 2-s spray from a distance of 12 cm after site prep with alcohol wipe. Efforts were ...
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: Shay Krier Tags: Abstracts Source Type: journals

The Utility of Early End-Tidal Capnography in Monitoring Ventilation Status After Severe Injury: Warner KJ, Cuschieri J, Garland D, et al. J Trauma 2009;66:26–31Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In conclusion, the authors noted that capnography is not an appropriate surrogate for blood gas analysis in the trauma setting. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: Chris Davis Tags: Abstracts Source Type: journals

Proximal Humeral Fracture as a Risk Factor for Subsequent Hip Fractures: Clinton J, Franta A, Polissar NL, et al. J Bone Joint Surg Am 2009;91:503–11Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study from the University of Washington evaluated the risk of a subsequent hip fracture after a humeral fracture. The authors reviewed data from the Study of Osteoporotic Fractures over a 10-year period. A total of 8049 white women who were age 65 years or older and had no history of hip or humeral fracture were included in the cohort. All were able to walk, were community dwelling, and had not had a bilateral hip replacement. Among this group, 321 women sustained a proximal humeral fracture. Forty-four (13.7%) of them had a subsequent hip fracture. Only 9.6% of women who did not sustain a proximal humeral fracture su...
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: Michael Zieske Tags: Abstracts Source Type: journals

Treatment of Stable Atrial Fibrillation in the Emergency Department: A Population-Based Comparison of Electrical Direct-Current Versus Pharmacological Cardioversion or Conservative Management: Dankner R, Shahar A, Novikov I, et al. Cardiology 2009;112:270–8Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This single-center, retrospective comparison analysis of treatment modalities for atrial fibrillation (AF) looked at the success rates and short-term complications of three approaches for the treatment of hemodynamically stable AF in Israel. All AF-related admissions during a 1-year period were reviewed, and 374 patients meeting eligibility criteria were included in the study. The treatment modalities of direct-current cardioversion (DCC), pharmacological, or “wait-and-watch” were compared, and interventions were deemed successful if they resulted in the return to sinus rhythm. Of the 374 patients studied, 85 (22.7%) u...
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: Ryan Paterson Tags: Abstracts Source Type: journals

Predictors for Good Cerebral Performance Among Adult Survivors of Out-of-Hospital Cardiac Arrest: Abe T, Yasuharu T, Ishimatsu S. Resuscitation 2009;80:431–6Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study highlights important predictors of neurologic outcomes after cardiac arrest so that in the future, resuscitative efforts can best be targeted toward patients who are most likely to benefit. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: David Thompson Tags: Abstracts Source Type: journals

Effect of Prehospital Triage on Revascularization Times, Left Ventricular Function, and Survival in Patients with ST-Elevation Myocardial Infarction: Sivagangabalan G, Ong A, Narayan A, et al. Am J Cardiol 2009;103:907–12Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This prospective study from Australia details outcomes in patients with ST-elevation myocardial infarction (STEMI) depending on triage mode. The modes include direct presentation to a hospital with catheterization facilities, direct presentation to community emergency departments (ED), and ambulance-based triage using transmission of 12-lead electrocardiograms (ECG) to the interventional facility. In the ambulance-based triage group, emergency physicians interpreted the transmitted ECG and when STEMI was identified, the ambulance was routed directly to the hospital with interventional capacity. Only angiographically confir...
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: Shay Krier Tags: Abstracts Source Type: journals

Prehospital Delay in Patients with Acute Coronary Syndromes (from the Global Registry of Acute Coronary Events [GRACE]) Goldberg RJ, Spencer FA, Fox KA, et al. Am J Cardiol 2009;103:598–603Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
It is widely accepted that coronary reperfusion treatment strategies are time dependent. Considerable success has been achieved in decreasing door-to-treatment time; however, less success has been noted in decreasing prehospital delay in patients experiencing acute myocardial infarction (AMI). This retrospective multinational study recruited data from 44,695 patients with acute coronary syndrome (ACS) in 14 countries from 2000 to 2006. ACS was defined as the spectrum of ST-segment elevation AMI, non-ST-segment elevation AMI, and unstable angina. The authors noted significant geographic variation in prehospital delay. Speci...
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: Chris Davis Tags: Abstracts Source Type: journals

Effect of Timing and Duration of a Single Chest Compression Pause on Short-Term Survival Following Prolonged Ventricular Fibrillation: Walcott GP, Melnick SB, Walker RG, et al. Resuscitation 2009;80:458–62Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study from the University of Alabama evaluated the effect of pauses in chest compressions around the time of defibrillation on resuscitation outcome. Utilizing 48 swine, the authors studied four groups with various pauses and analyzed survival at 4 h post induction of ventricular fibrillation. The first group (G2000) of animals had a 40-s compression pause beginning 20 s before and ending 20 s after defibrillation. The second group (A1) had a 20-s pause just before defibrillation. The third (A2) and fourth (A3) groups had 20- and 10-s pauses, respectively, ending 30 s before defibrillation. The final group (B) did not...
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Authors: Michael Zieske Tags: Abstracts Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Source Type: journals

Partial ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Source Type: journals

Issue HighlightsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - September 22, 2009 Category: Emergency Medicine Source Type: journals

The Measurement of Time to First Antibiotic Dose for Pneumonia in the Emergency Department: A White Paper and Position Statement Prepared for the American Academy of Emergency MedicineEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: Given inconsistent evidence to demonstrate that improving TFAD in CAP improves outcomes or that TFAD is associated with antibiotic overuse, a Class C indication has been assigned (not acceptable/not appropriate) for ED TFAD measurement. The American Academy of Emergency Medicine recommends that measurement of TFAD in CAP be discontinued. (Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - August 31, 2009 Category: Emergency Medicine Authors: Jesse M. Pines, Joshua A. Isserman, Patrick B. Hinfey Tags: American Academy of Emergency Medicine Source Type: journals

Dyspnea and Multiple Pulmonary NodulesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Dr. Adam Levine: Today's case is that of a 67-year-old man, a retired physician of Indian origin, who was referred to the emergency department (ED) by his primary care physician for a 2-day history of increasing shortness of breath and an outpatient computed tomography (CT) scan that showed multiple pulmonary nodules. The patient stated that he was well until 2 months previously, when he acutely developed lower back pain. His primary care physician ordered magnetic resonance imaging (MRI) of the lumbar spine, which showed L2/3 spinal stenosis. The patient subsequently received steroid injections on two occasions. Of note, ...
Source: The Journal of Emergency Medicine - August 31, 2009 Category: Emergency Medicine Authors: Veeru Kasivisvanathan, Adam Levine, Ramanathan Kasivisvanathan, David F.M. Brown, Eric S. Nadel Tags: Case Presentations of the Harvard Affiliated Emergency Medicine Residencies Source Type: journals

Calendar of EventsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The Journal of Emergency Medicine)
Source: The Journal of Emergency Medicine - July 31, 2009 Category: Emergency Medicine Tags: Abstracts Source Type: journals

Oral Vitamin K Versus Placebo to Correct Excessive Anticoagulation in Patients Receiving Warfarin: Crowther MA, Ageno W, Garcia D, et al. Ann Intern Med 2009;150:293–300Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This multi-center, randomized, double-blinded placebo-controlled trial out of Canada examined whether low-dose oral vitamin K reduced bleeding events over a 90-day period in patients with warfarin-associated coagulopathy. The authors enrolled 724 non-bleeding patients with an international normalized ratio (INR) value of 4.5–10.0 and randomized them to receive either 1.25 mg of oral vitamin K or placebo. Bleeding events were the primary outcome measurement, with thromboembolism and death being secondary outcome measurements. Although administration of vitamin K decreased the INR by a mean of 2.8 1 day after treatment (co...
Source: The Journal of Emergency Medicine - July 31, 2009 Category: Emergency Medicine Authors: Gary Witt Tags: Abstracts Source Type: journals

Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions: White DB, Katz MH, Luce JM, et al. Ann Intern Med 2009;150:132–8Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article discussed the principles of decision-making when allocating scarce resources in the event of a public health epidemic. The allocation of both vaccines and ventilators during an influenza pandemic was used as an example to compare several standards that might provide guidance when facing these difficult decisions. Scoring measures for short- and long-term survival were reviewed in parallel with the ethical principles of modern medical practice to determine basic guidelines for prioritizing care. The authors suggested that it is important to consider not only the total number of lives saved, but also the number ...
Source: The Journal of Emergency Medicine - July 31, 2009 Category: Emergency Medicine Authors: Michael Prendergast Tags: Abstracts Source Type: journals

The Effects of Trauma Center Care, Admission Volume, and Surgical Volume on Paralysis After Traumatic Spinal Cord Injury: Macias CA, Rosengart MR, Puyana JC, et al. Ann Surg 2009;249:10–7Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This retrospective review of patients diagnosed with traumatic spinal cord injury (TSCI) examined the effects of trauma center designation, admission volume, and surgical volume on rates of paralysis. The authors examined state hospital discharge data and the expanded modified Medicare Provider Analysis and Review (MEDPAR) across seven states encompassing 7246 admissions. Hospitals were classified as either trauma centers (TC), (if they met criteria for a Level I or II TC), or as non-TC hospitals. It was found that only 57.9% of patients received care at a TC, with the probability of admission to a TC decreasing as distanc...
Source: The Journal of Emergency Medicine - July 31, 2009 Category: Emergency Medicine Authors: Maggie DiGeronimo Tags: Abstracts Source Type: journals

Survival With Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma: Kragh JF, Walters TJ, Baer DG, et al. Ann Surg 2009;249:1–7Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This prospective survey evaluated the practice of emergency tourniquet use in either the prehospital setting or the emergency department (ED) at a combat support hospital in Baghdad. Over the 7-month study period in 2006, 232 (8%) of the 2838 patients with major limb trauma had 428 tourniquets applied on 309 injured limbs. The patients were evaluated for shock via weak or absent radial pulses and were assessed for survival rates and limb outcome. Casualties that had indications for tourniquet use but did not receive them were also evaluated. Prehospital tourniquets were applied in 194 patients, of which 22 died (11% mortal...
Source: The Journal of Emergency Medicine - July 31, 2009 Category: Emergency Medicine Authors: Erica Douglass Tags: Abstracts Source Type: journals

Vicks VapoRub Induces Mucin Secretion, Decreases Ciliary Beat Frequency, and Increases Tracheal Mucus Transport in the Ferret Trachea: Abanses JC, Arima S, Rubin BK. Chest 2009;135:143–8Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This animal study out of the Wake Forest School of Medicine measured the effect of Vicks VapoRub® (VVR; Proctor & Gamble, Cincinnati, OH) on ferret airway inflammation and mucociliary function. First, the authors excised trachea specimens from healthy ferrets, applied VVR and measured mucin secretion, mucociliary transport velocity, and ciliary beat frequency. Secondly, intubated ferrets, both healthy and those exposed to bacterial endotoxin (lipopolysaccharide, inducing airway inflammation) were exposed to inhaled placebo or VVR. Mucin secretion and lung water were then measured. In the in vitro VVR-exposed group, mucin ...
Source: The Journal of Emergency Medicine - July 31, 2009 Category: Emergency Medicine Authors: Gary Witt Tags: Abstracts Source Type: journals