首页期刊导航|The American journal of emergency medicine
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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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    Outcome of cardiopulmonary resuscitation with different ventilation modes in adults: A meta-analysis

    Tang Y.Sun M.Zhu A.
    10页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: The optimal airway management strategy for cardiac arrest remains unclear. This study aimed to compare the effects of different initial airway interventions on improving clinical outcomes based on the 2010 cardiopulmonary resuscitation (CPR) guidelines and later. Methods: We searched PubMed, EMBASE, and the Cochrane Library for CPR articles tailored to each database from October 19, 2010, to July 31, 2021, to compare endotracheal intubation (ETI), supraglottic airway (SGA), or bag-valve-mask ventilation (BMV). The initial results and long-term results were investigated by meta-analysis. Results: Twenty-five articles (n = 196,486) were included. The ROSC rate in the ETI group (ES = 0.49, 95% CI: 0.38–0.59) was significantly higher than that in the SGA group (ES = 0.27, 95% CI: 0.20–0.34) and BMV group (ES = 0.24, 95% CI: 0.17–0.31). The rate of ROSC upon admission to the hospital in the ETI group (ES = 0.27, 95% CI: 0.13–0.42) was significantly higher than that in the SGA group (ES = 0.18, 95% CI: 0.13–0.23) and BMV group (ES = 0.16, 95% CI: 0.10–0.22). Compared with the BMV group (ES = 0.09, 95% CI: 0.04–0.14) and the SGA group (ES = 0.08, 95% CI: 0.05–0.10), the ETI group (ES = 0.14, 95% CI: 0.10–0.17) had a higher discharge rate, but all of the groups had the same neurological outcome (ETI group [ES = 0.06, 95% CI: 0.04–0.08], BMV group [ES = 0.05, 95% CI: 0.03–0.08] and SGA group [ES = 0.04, 95% CI: 0.03–0.05]). Conclusions: Opening the airway is significantly associated with improved clinical outcomes, and the findings suggest that effective ETI based on mask ventilation should be implemented as early as possible once the patient has experienced cardiac arrest.
      原文链接:
    • NSTL
    • Elsevier

    High risk and low prevalence diseases: Tubo-ovarian abscess

    Bridwell R.E.Koyfman A.Long B.
    6页
    查看更多>>摘要：? 2022Introduction: Tubo-ovarian abscess (TOA) is a rare but serious condition that carries with it a high rate of morbidity and even mortality. Objective: This review highlights the pearls and pitfalls of TOA, including diagnosis, initial resuscitation, and management in the emergency department (ED) based on current evidence. Discussion: TOA is associated with pelvic inflammatory disease (PID) as well as intrauterine devices, uterine procedures, multiple sexual partners, diabetes mellitus, and immunocompromised states. While usually arising from a gynecologic infection, TOA can be associated with a gastrointestinal source. History and physical examination are limited, demonstrating predominantly lower abdominal pain, but a minority of patients will present with vaginal symptoms. Half of patients will exhibit systemic illness to include fever, nausea, and vomiting. Laboratory evaluation may reveal elevations in white blood cell count and other inflammatory markers. Transvaginal ultrasound and computed tomography (CT) may be utilized for diagnosis, though CT has higher sensitivity and can differentiate this disease from similarly presenting gastrointestinal pathology. Initial medical management includes antibiotics. Surgical intervention is indicated in those who fail initial medical therapy, which is more likely in those with bilateral abscesses, large abscesses, and older patients. Conclusions: An understanding of TOA can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
      原文链接:
    • NSTL
    • Elsevier

    Outcomes of patients discharged from the pediatric emergency department with abnormal vital signs

    Kazmierczak M.Thompson A.D.DePiero A.D.Selbst S.M....
    5页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: Vital signs (VS) are used to triage and identify children at risk for severe illness. Few studies have examined the association of pediatric VS at emergency department (ED) discharge with patient outcomes. Objective: To determine if children discharged from the ED with abnormal VS have high rates of return visits, admission or adverse outcomes. Methods: We conducted a retrospective cohort study of children discharged from 2 pediatric EDs with abnormal VS between July 2018–June 2019. We queried electronic health records (EHR) for children ages 0–18 years discharged from the ED with abnormal last recorded VS. VS were considered erroneously entered and thus excluded from analysis if heart rate was <30 or ≥ 300, respiratory rate was 0 or ≥ 100 or oxygen saturation was <50. Patients who were declared deceased at index visit were excluded. Demographic, clinical, and outcome data including return visits within 48 h and adverse outcomes after the initial ED discharge were obtained. Results: Of the 97,824 children evaluated in the EDs during the study period, 17,661 (18.1%) were discharged with abnormal VS. 404 (2.28%) returned to the ED, of which 95 (23.5%) were admitted for the same chief complaint within 48 h. In comparison, the 48-h return rate for children discharged with normal VS was 2.45% (p = 0.219). Children discharged with abnormal VS were more likely to return if they had 2 or more abnormal VS (OR 1.6; 95% CI 1.23–2.07), were less than 3 years old (OR 1.69, 95% CI 1.39–2.06) or their initial acuity level was high (OR 1.34; 95% CI 1.1–1.63). Higher initial acuity level and age less than 3 years were also associated with admission at revisit (OR 2.58; 95% CI 1.59–4.2; OR 2.20, 95% CI 1.36–3.55). Four of the children who returned required PICU admission, but none died, required CPR or endotracheal intubation. Conclusion: Although many children were discharged from the ED with abnormal VS, few returned and required admission. Having 2 or more abnormal VS, age less than 3 years and higher acuity increased odds of revisit. Few children suffered serious adverse outcomes.
      原文链接:
    • NSTL
    • Elsevier

    A scoping review of qualitative studies on pre-hospital analgesia administration and practice

    Teoh S.E.Loh C.Y.L.Chong R.I.H.Yaow C.Y.L....
    10页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: Pain is an exceedingly common complaint in the pre-hospital setting. Despite advancements in organizational protocols and guidelines, many emergency medical services (EMS) systems still fail to provide optimal pain management. This scoping review thus aimed to map the body of qualitative literature pertaining to factors influencing pre-hospital analgesia administration and practice in order to clarify concepts and understanding as well as to identify any knowledge gaps. Methods: The review protocol was guided by the framework outlined by Arksey and O'Malley and ensuing recommendations made by Levac and colleagues. Five databases were searched from inception till October 26, 2021, namely MEDLINE, EMBASE, CINAHL, The Cochrane Library, and Scopus. The search strategy was developed in consultation with a medical information specialist. A total of 5848 records were screened by abstract and title by four independent researchers. 199 records were included for full text review. From these, 15 articles were eligible for thematic analysis based on pre-defined inclusion criteria. Results: Included studies found that practitioner, patient, and environmental factors influenced the administration and practice of pre-hospital analgesia. Key barriers included the difficulty in assessing pain, poor inter-professional relationship, knowledge deficits, stress and anxiety, and miscellaneous factors, such as concerns over drug-seeking behaviours. Some possible solutions were proposed, and pre-hospital EMS systems and healthcare institutions could consider bridging some of these gaps. There was a notable paucity of Asian studies, and a variety of EMS settings with different protocols and workflows were examined, hence systemic factors including guidelines and legislations cannot and should not be generalized across every healthcare system. Conclusion: The factors influencing pre-hospital analgesia administration and practice remain incompletely understood. Existing tools and practice guidelines were also inadequate. This scoping review provided an overarching perspective of the extant literature, highlighting some of the significant barriers, enablers, and areas for further research.
      原文链接:
    • NSTL
    • Elsevier

    Impact of COVID-19 on emergency department management of stroke and STEMI. A narrative review

    Banfield W.H.Elghawy O.Dewanjee A.Brady W.J....
    7页
    查看更多>>摘要：? 2022 Elsevier Inc.The novel coronavirus of 2019 (COVID-19) has resulted in a global pandemic; COVID-19 has resulted in significant challenges in the delivery of healthcare, including emergency management of multiple diagnoses, such as stroke and ST-segment myocardial infarction (STEMI). The aim of this study was to identify the impacts of the COVID-19 pandemic on emergency department care of stroke and STEMI patients. In this study a review of the available literature was performed using pre-defined search terms, inclusion criteria, and exclusion criteria. Our analysis, using a narrative review format, indicates that there was not a significant change in time required for key interventions for stroke and STEMI emergent management, including imaging (door-to-CT), tPA administration (door-to-needle), angiographic reperfusion (door-to-puncture), and percutaneous coronary intervention (door-to-balloon). Potential future areas of investigation include how emergency department (ED) stroke and STEMI care has adapted in response to different COVID-19 variants and stages of the pandemic, as well as identifying strategies used by EDs that were successful in providing effective emergency care in the face of the pandemic.
      原文链接:
    • NSTL
    • Elsevier

    Evaluating atrial fibrillation artificial intelligence for the emergency department, statistical and clinical implications

    Kaminski A.E.Albus M.L.Ball C.T.White L.J....
    5页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: An artificial intelligence (AI) algorithm has been developed to detect the electrocardiographic signature of atrial fibrillation (AF) present on an electrocardiogram (ECG) obtained during normal sinus rhythm. We evaluated the ability of this algorithm to predict incident AF in an emergency department (ED) cohort of patients presenting with palpitations without concurrent AF. Methods: This retrospective study included patients 18 years and older who presented with palpitations to one of 15 ED sites and had a 12?lead ECG performed. Patients with prior AF or newly diagnosed AF during the ED visit were excluded. Of the remaining patients, those with a follow up ECG or Holter monitor in the subsequent year were included. We evaluated the performance of the AI-ECG output to predict incident AF within one year of the index ECG by estimating an area under the receiver operating characteristics curve (AUC). Sensitivity, specificity, and positive and negative predictive values were determined at the optimum threshold (maximizing sensitivity and specificity), and thresholds by output decile for the sample. Results: A total of 1403 patients were included. Forty-three (3.1%) patients were diagnosed with new AF during the following year. The AI-ECG algorithm predicted AF with an AUC of 0.74 (95% CI 0.68–0.80), and an optimum threshold with sensitivity 79.1% (95% Confidence Interval (CI) 66.9%–91.2%), and specificity 66.1% (95% CI 63.6%–68.6%). Conclusions: We found this AI-ECG AF algorithm to maintain statistical significance in predicting incident AF, with clinical utility for screening purposes limited in this ED population with a low incidence of AF.
      原文链接:
    • NSTL
    • Elsevier

    Mental health emergency department visits: An exploration of case definitions in North Carolina

    LeMasters K.Cox M.E.Fliss M.Seibert J....
    4页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: Mental health (MH) disorders comprise a high disease burden and have long-lasting impacts. To improve MH, it is important to define public health MH surveillance. Methods: We compared MH related definitions using ICD-10-CM codes: The Council of State and Territorial Epidemiologists' (CSTE) surveillance indicators for all MH, mood or depressive, schizophrenic, and drug/alcohol-induced disorders; and North Carolina's (NC) syndromic surveillance system's definition for anxiety/mood/psychotic disorders, and suicide/self-harm. We compared code definitions and frequent codes in 2019 emergency department (ED) data for those age ≥ 10 years. Results: CSTE's definition resulted in over one million MH-related visits (23% of all ED visits) and NC's definitions in 451,807 MH-related visits (9% of all ED visits). Using CSTE's broadest definition, nicotine use was the most common visit type; using NC's definitions, it was major depressive disorder. Conclusions: Standardizing population-level MH indicators benefits surveillance efforts. Given its prevalence, efforts should focus on documenting MH to improve treatment and prevention.
      原文链接:
    • NSTL
    • Elsevier

    Ability of pain scoring scales to differentiate between patients desiring analgesia and those who do not in the emergency department

    Schweizer L.Sieber R.Nickel C.H.Minotti B....
    7页
    查看更多>>摘要：? 2022 Elsevier Inc.Background and Importance: Pain is one of the most reasons for a visit to an emergency department (ED). Pain scores as the verbal rating scale (VRS) or numerical rating scale (NRS) are used to determine pain management. While it is crucial to measure pain levels, it is equally important to identify patients who desire pain medication, so that adequate provision of analgesia can occur. Objective: To establish the association between pain scores on the NRS and VRS, and the desire for, and provision of, pain medication. Design, settings and participants: Retrospective monocentric observational cohort study of ED patients presenting with painful conditions. Outcomes measure and analysis: The primary outcome was to establish for each pain score (NRS and/or VRS), those patients who desired, and were ultimately provided with, pain medication, and those who did not. Secondary outcomes included establishing the prediction of pain scores to determine desire of pain medication, and the correlation between NRS and VRS when both were reported. Main Results: 130,279 patients were included for analysis. For each patient who desired pain medication, pain medication was provided. Proportion of patients desiring pain medication were 4.1–17.8% in the pain score range 0.5–3.5, 31.9–63.4% in the range 4–6.5, and 65–84.6% in the range 7–10. The prediction probability of pain scores to determine desire for pain medication was represented with an AUROC of 0.829 (95% CI 0.826–0.831). The optimal threshold predicting the desire for pain medication would be a pain score of 4.25, with sensitivity 0.86, and specificity 0.68. For the 7835 patients with both NRS and VRS scores available, the Spearman-Rho coefficient assessing correlation was 0.946 (p < 0.001). Conclusions: Despite guidelines currently recommending pain medication in patients with a NRS score > 4, we found a discrepancy between pain scores and desire for pain medication. Results of this large retrospective cohort support that the desire for pain medication in the ED might not be derived from a pain score alone.
      原文链接:
    • NSTL
    • Elsevier

    Clinical update on COVID-19 for the emergency clinician: Cardiac arrest in the out-of-hospital and in-hospital settings

    Long B.Brady W.J.Chavez S.Gottlieb M....
    10页
    查看更多>>摘要：? 2022 Elsevier Inc.Introduction: Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. Its impact on the health and welfare of the human population is significant; its impact on the delivery of healthcare is also considerable. Objective: This article is another paper in a series addressing COVID-19-related updates to emergency clinicians on the management of COVID-19 patients with cardiac arrest. Discussion: COVID-19 has resulted in significant morbidity and mortality worldwide. From a global perspective, as of February 23, 2022, 435 million infections have been noted with 5.9 million deaths (1.4%). Current data suggest an increase in the occurrence of cardiac arrest, both in the outpatient and inpatient settings, with corresponding reductions in most survival metrics. The frequency of out-of-hospital lay provider initial care has decreased while non-shockable initial cardiac arrest rhythms have increased. While many interventions, including chest compressions, are aerosol-generating procedures, the risk of contagion to healthcare personnel is low, assuming appropriate personal protective equipment is used; vaccination with boosting provides further protection against contagion for the healthcare personnel involved in cardiac arrest resuscitation. The burden of the COVID-19 pandemic on the delivery of cardiac arrest care is considerable and, despite multiple efforts, has adversely impacted the chain of survival. Conclusion: This review provides a focused update of cardiac arrest in the setting of COVID-19 for emergency clinicians.
      原文链接:
    • NSTL
    • Elsevier

    Optimal temperature in targeted temperature management without automated devices using a feedback system: A multicenter study

    Kong T.You J.S.Lee H.S.Jeon S....
    9页
    查看更多>>摘要：? 2022 Elsevier Inc.Purpose: Targeted temperature management (TTM) at 32 °C–36 °C improves patient outcomes following out-of-hospital cardiac arrest (OHCA). TTM using automated temperature management devices with feedback systems (TFDs) is recommended, but the equipment is often unavailable. This study aimed to investigate therapeutic relations between targeted temperatures and TFDs on the outcomes of OHCA patients with TTM. Methods: This multicenter study analyzed nontraumatic OHCA registry data between October 2015 and June 2020 from 29 institutions. Patients were classified into four groups based on targeted temperatures and TFD implementation: TTM at 33 °C with TFD (33TFD), TTM at 36 °C with TFD (36TFD), TTM at 33 °C without TFD (33NTFD), and TTM at 36 °C without TFD (36NTFD). Clinical outcomes were survival till hospital discharge and neurological status at discharge. Results: A total of 938 patients were included in the analysis. There was an independent association between the 33NTFD patients with the least survival and the worst neurological outcomes among the four groups after adjustment for covariates. However, no significant differences were observed in survival and neurological outcomes among the 33TFD, 36TFD, and 36NTFD groups after adjusting for covariates. Compared to 33NTFD, 36NTFD patients exhibited significantly higher adjusted ORs for survival and favorable neurological status at hospital discharge. Conclusion: In OHCA patients receiving TTM without TFDs, the adjusted predicted probability of survival and good neurological outcomes at hospital discharge was greater for TTM at 36 °C than that at 33 °C. This suggests that a TTM of 36 °C rather than 33 °C is associated with more favorable clinical outcomes if TFDs are unavailable.
      原文链接:
    • NSTL
    • Elsevier