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The American journal of emergency medicine
Centrum Philadelphia]
The American journal of emergency medicine

Centrum Philadelphia]

0735-6757

The American journal of emergency medicine/Journal The American journal of emergency medicine
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    Drug reaction with eosinophilia and systemic symptoms: An emergency medicine focused review

    Gottlieb M.Figlewicz M.R.Rabah W.Buddan D....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug reaction associated with potentially severe morbidity and mortality. Objective: This narrative review evaluates the pathogenesis, diagnosis, and management of DRESS for emergency clinicians. Discussion: DRESS is a severe hypersensitivity reaction which can involve multiple organ systems, including the skin, lymphatic system, lungs, kidneys, and heart. Treatment is primarily supportive care combined with removal of the offending agent and initiation of corticosteroids. Additional options include cyclophosphamide, cyclosporine, intravenous immunoglobulin, and N-acetylcysteine. Conclusion: It is important for the emergency clinician to be aware of the diagnosis and management of DRESS in order to best optimize care for these patients.
      原文链接:
    • NSTL
    • Elsevier

    Are patients with chronic pain less satisfied with their emergency room management than non-chronic pain patients?

    Galinski M.Robledo J.-B.Tellier E.Catoire P....
    3页
      原文链接:
    • NSTL
    • Elsevier

    The use of the word “quiet” in the emergency department is not associated with patient volume: A randomized controlled trial

    Geller J.E.Strickland P.O.Bucher J.T.
    3页
      原文链接:
    • NSTL
    • Elsevier

    Justice in emergency medicine

    Iserson K.V.
    2页
      原文链接:
    • NSTL
    • Elsevier

    Risk factors for inadequate sedation after endotracheal intubation in the pediatric emergency department

    Edmunds K.J.Byczkowski T.Frey M.Boyd S....
    6页
      原文链接:
    • NSTL
    • Elsevier

    High risk and low prevalence diseases: Hemophilia emergencies

    Alblaihed L.Dubbs S.B.Koyfman A.Long B....
    7页
    查看更多>>摘要：? 2022Introduction: Hemophilia is a bleeding disorder due to coagulation pathway factor deficiency that is associated with significant morbidity and mortality. Objective: This review highlights the pearls and pitfalls of the emergency department (ED) evaluation of hemophilia, including diagnostic procedures, imaging, and management based on current evidence. Discussion: Hemophilia is marked by deficiency in factor VIII (in hemophilia A) or IX (in hemophilia B), which may result in severe bleeding. The severity of the disease depends upon factor levels. Patients with severe deficiency most commonly present in the first two years of life. Severe bleeding may include intracranial hemorrhage, retroperitoneal bleeding, large hematomas, bleeding within the chest or abdomen/pelvis, and subacute or delayed postpartum bleeding. ED management is the immediate replacement of clotting factors based on the suspicion of bleed rather than the confirmation of one. The doses for factor concentrate replacement to achieve factor levels of 100% are 50 U/kg for FVIII and 100 U/kg for FIX. The development of inhibitors can complicate the clinical picture and treatment possibilities. Consultation with the hematology specialist is recommended to assist with evaluation and management. Conclusion: Emergency physician knowledge of hemophilia, including the presentation, evaluation, and management, can improve the care of these patients.
      原文链接:
    • NSTL
    • Elsevier

    Use of the pleth variability index in children with obstructive respiratory disease

    Demir G.Berksoy E.Bardak S.Elibol P....
    5页
    查看更多>>摘要：? 2022 Elsevier Inc.Introduction: The phenomenon of pulsus paradoxus (PP) develops at varying rates in relation to the severity of the disease in obstructive respiratory tract disease. The Pleth Variability Index (PVI) is the measurement value of perfusion index changes that occur with ventilation, which are determined during at least one respiratory cycle. Therefore, noninvasive measurement of PVI can help in the measurement of PP. The current study aims to determine the role of PVI measurements before and after bronchodilator therapy during admission to the hospital in children with obstructive respiratory tract disease. Methods: Age, gender, Pulmonary Index Score (PIS), and PVI data of patients aged 2–18 years who applied to the pediatric emergency department with signs of obstructive respiratory tract disease were recorded in triage. The PVI and PIS scores of the patients, who were divided into three groups according to their clinical severity scores, were recorded before and after bronchodilator treatment, and they were compared to the PVI values according to the disposition results. Results: A total of 133 patients were included in this prospective, single-center study. The PVI values before and after treatment were significantly higher in patients with severe disease compared to the mild and moderate groups (p < 0.001). Post-treatment PVI values were significantly lower than pre-treatment values in all clinical severity groups (p < 0.001). While a total of 95 (71.43%) patients were discharged from the emergency department, 31 (23.31%) patients were admitted to the relevant department, and seven (5.26%) patients were admitted to the pediatric intensive care unit. The PVI values before and after treatment were significantly higher in the hospitalized group compared to the group discharged from the emergency department (p < 0.001). The areas under the ROCs were 0.940, 0.865, and 0.843 for the PVI measurements in patients with severe disease, moderate disease, and hospitalization (p < 0.001). Conclusions: Automated PVI measurement can be used as a noninvasive, rapid, and objective tool in the emergency department triage of patients admitted to the pediatric emergency department with signs of asthma attack or reactive respiratory tract disease.
      原文链接:
    • NSTL
    • Elsevier

    Tranexamic acid – A narrative review for the emergency medicine clinician

    Wang K.Santiago R.
    12页
    查看更多>>摘要：? 2022 Elsevier Inc.Introduction: Over the last decade, tranexamic acid (TXA) has been incorporated into treatment algorithms for a multitude of emergent conditions and the evidence surrounding its role in emergency medicine continues to evolve. Objective: The objective of this literature review is to provide an evidence-based approach to the utilization of TXA in the emergency department. Discussion: The most robust trials suggest TXA may offer a modest improvement in mortality in patients at risk of significant bleeding from trauma, but is not beneficial in spontaneous intracranial hemorrhage or gastrointestinal bleeding. The role of TXA in other clinical scenarios is less clear and requires clinical judgment. Conclusion: Tranexamic acid appears to be a reasonable adjunct for the emergency medicine clinician to consider in the management of many hemorrhagic conditions and angiotensin converting enzyme inhibitor-induced angioedema. Additional high-quality research in these areas is needed to further identity patients who may benefit most from TXA.
      原文链接:
    • NSTL
    • Elsevier

    Low initial in-hospital end-tidal carbon dioxide predicts poor patient outcomes and is a useful trauma bay adjunct

    Portelli Tremont J.N.Caldas R.A.Cook N.Udekwu P.O....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.Introduction: Appropriate triage of the trauma patient is critical. Low end-tidal carbon dioxide (ETCO2) is associated with mortality and hemorrhagic shock in trauma, but the relationship between low ETCO2 and important clinical variables is not known. This study investigates the association of initial in-hospital ETCO2 and patient outcomes, as well as the utility of ETCO2 as a predictive aid for blood transfusion. Methods: Adult patients who presented to a Level One trauma center from 2019 to 2020 were eligible. Trauma bay ETCO2 measured by side-stream capnography was prospectively obtained for all trauma activations at time of initial evaluation. Using the Liu method of cut point estimation, patients were stratified as having low (≤29.5 mmHg) or normal ETCO2 (>29.5 mmHg). Multivariable regression was used to estimate the association of low ETCO2 with patient outcomes. Results: A total of 955 patients underwent initial in-hospital ETCO2 measurement. Median time from arrival to ETCO2 measurement was 4 min. Among admitted patients (N = 493), 48.9% had low ETCO2. Compared to patients with normal ETCO2, those with low ETCO2 were older (median age 53 vs 46, p = 0.01) and more likely to have the highest trauma activation (27.4% vs 19.8%, p = 0.048). There was no difference in head injury. After adjustment, patients with low ETCO2 had greater odds of blood transfusion (OR 4.65, 95%CI 2.0–10.7), mortality (OR 5.10, 95%CI 1.1–24.9), inferior disposition (OR 1.64, 95%CI 1.1–2.6), and complications (OR 3.35, 95%CI 1.5–7.4). ETCO2 was more predictive of early blood transfusion than Shock Index (area under ROC = 67.6% vs 58.2%). Conclusions: Low trauma bay ETCO2 remains significantly associated with inferior clinical outcomes after adjustment. In comparison to other triage tools, low ETCO2 values may be more predictive of the need for blood transfusion. Further studies are needed to evaluate the role of ETCO2 as a decision making tool for early trauma management.
      原文链接:
    • NSTL
    • Elsevier

    Opioid usage and COVID-19 prognosis: A systematic review and meta-analysis

    Ao G.Li A.Wang Y.Li J....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.The COVID-19 pandemic continues to have profound health, social, psychological, and economic ramifications. Infection by COVID-19 has been of concern in people who use opioids, as opioid use has been known to mediate immunosuppression and is associated with respiratory depression and end-organ damage. With differing modalities of opioid usage, the association between opioids and COVID-19 outcomes is not well understood. We performed a comprehensive systematic search of seven health science databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Data, up to December 15, 2021. We identified a total of five related articles, which were included in this study. The meta-analysis showed that opioids have a significant association with ICU admission for COVID-19 patients (OR = 5.41, 95%CI: 1.85 to 15.79, P = 0.002). Use of opioids was also associated with higher mortality among patients with COVID-19 compared to non-users (OR = 2.74, 95%CI: 1.34 to 5.62, P = 0.034), while use of opioids was not significantly associated with need for mechanical ventilation (OR = 3.68, 95%CI: 0.85 to 15.90, P = 0.081). Furthermore, the adjusted analysis indicated that COVID-19 patients with a history of opioid use were more likely to be admitted to the ICU (OR = 3.57, 95%CI: 3.05 to 4.17, P<0.001) and have higher mortality rates (OR = 1.72, 95%CI: 1.09 to 2.72, P = 0.02), while there was no significant association with need for mechanical ventilation (OR = 2.09, 95%CI: 0.77 to 5.64, P = 0.146). Significant heterogeneity existed across the included studies. Patients using opioids with COVID-19 were at higher risk of ICU admission and mortality. Prospective studies are required to confirm these findings.
      原文链接:
    • NSTL
    • Elsevier