Kiesha N. Fraser, Maybelle M. Kou, John M. Howell, Kaidi T. Fullerton, Charles Sturek
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.016
Published online: November 18 2013
xApproximately 14 000 pediatric out-of-hospital arrests occur annually. With this significant number and the diversity in the training backgrounds of medical providers, correct choice and placement of defibrillator pads are imperative to ensure maximum efficacy.
Stuart J. Netherton, Kevin Lonergan, Dongmei Wang, Andrew McRae, Eddy Lang
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.002
Published online: May 12 2014
xComputerized physician order entry (CPOE) offers the potential for safer, faster patient care, as well as greater use of evidence-based therapy via built-in decision support. However, the effectiveness of CPOE in yielding these benefits has shown mixed results in the emergency department (ED) setting. Our objective was to evaluate the impact of CPOE implementation on analgesic prescribing and dosing practices for renal colic presentations.
Muzeyyen Uzel, Nese Colak Oray, Basak Bayram, Tuncay Kume, Mehmet Can Girgin, Ozgur Doylan, Ercument Saritabak, Sedat Yanturali
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.003
Published online: May 12 2014
xDifferential diagnosis of seizure is critical in patients presented to emergency department (ED) with altered mental status or loss of consciousness. Although electroencephalogram is important for the diagnosis of seizures, its use in EDs is limited. The level of ischemia-modified albumin (IMA) increases in conditions of ischemic distress such as acute coronary syndrome, pulmonary embolism, and mesenteric ischemia. No studies exist in literature regarding the increase of IMA levels parallel to increased seizure activity in adults.
Marcela González-Del Vecchio, Eleonora Bunsow, Carlos Sánchez-Carrillo, Eugenia Garcia Leoni, Marta Rodríguez-Créixems, Emilio Bouza
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.007
Published online: May 12 2014
xPatients with septic episodes whose blood cultures turn positive after being sent home from emergency departments (EDs) are recognized as having occult bloodstream infections (BSI). The incidence, etiology, clinical circumstances, and outcome of occult BSI in children are well known, but, to our knowledge, data in adult patients are scarce. We analyzed the episodes of occult BSI in adult patients at our institution.
Chen-June Seak, Kuang-Hung Hsu, Yon-Cheong Wong, Chip-Jin Ng, David Hung-Tsang Yen, Joanna Chen-Yeen Seak, Chen-Ken Seak
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.016
Published online: May 19 2014
xThis study aimed to investigate the prognostic factors of adult patients with hepatic portal venous gas (HPVG) in the emergency department (ED) to facilitate clinical decision making by emergency physicians.
Benjamin W. Friedman, Binoy Mistry, Jason R. West, Andrew Wollowitz
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.017
Published online: May 20 2014
xElevated blood pressure (BP) and headache have long been linked in the medical literature, although data on association are conflicting. We used previously collected data to address these related aims: (1) using the National Hospital Ambulatory Medical Care Survey (NHAMCS), we determined whether elevated BP is more likely in patients who present to an emergency department (ED) with headache than in patients who present with other complaints; (2) using data collected in 3 ED-based migraine clinical trials, we determined the association between improvement in headache pain and improvement in BP among patients who present to an ED with migraine and elevated BP; (3) using the data from the migraine clinical trials, we also determined if an elevated baseline BP identifies a group of patients less likely to respond to standard migraine treatment.
Yun-Xia Chen, Chun-Sheng Li
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.025
Published online: May 23 2014
xTo evaluate the prognostic performance of lactate in septic patients in the emergency department (ED) and investigate how to add lactate to the traditional score systems.
Ryan P. Bodkin, Nicole M. Acquisto, Joshua M. Zwart, Sean P. Toussaint
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.036
Published online: May 31 2014
xDetection of accurate temperature in the emergency department (ED) is integral for assessment, treatment, and disposition. The primary objective was to compare temperature measurements from noninvasive temperature devices in the adult ED. The secondary objective was to evaluate the discrepancy between febrile and afebrile patients.
Kuan-Han Wu, Chien-Hung Wu, Shih-Yu Cheng, Wen-Huei Lee, Chia-Te Kung
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.033
Published online: May 31 2014
xThe objective of the study is to examine the epidemiologic data of closed malpractice medical claims against emergency departments (EDs) in Taiwanese civil courts and to identify high-risk diseases.
Huiyun Xiang, Krista Kurz Wheeler, Jonathan Ira Groner, Junxin Shi, Kathryn Jo Haley
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.038
Published online: June 2 2014
xThere is evidence that regionalized trauma care and appropriate triage of major trauma patients improve patient outcomes. However, the national rate of undertriage and diagnoses of undertriaged patients are unknown.
Mouhssine Bendahou, Frédéric Khiami, Khaled Saïdi, Cécile Blanchard, Michel Scepi, Bruno Riou, Sylvie Besch, Pierre Hausfater
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.054
Published online: June 12 2014
xAnkle sprain is a frequently encountered traumatic injury in emergency departments and is associated with important health expenses. However, the appropriate care of this traumatic injury remains a matter of debate. We tested the hypothesis that compression stockings speed up recovery from ankle sprain.
Shervin Farahmand, Said Shiralizadeh, Mohammad-Taghi Talebian, Shahram Bagheri-Hariri, Mona Arbab, Hamed Basirghafouri, Morteza Saeedi, Mojtaba Sedaghat, Habibolla Mirzababai
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.051
Published online: June 12 2014
xIntravenous morphine has been used as a common method of pain control in emergency care. Nebulized fentanyl is also an effective temporary substitute. This study was designed to compare the effectiveness of nebulized fentanyl with intravenous (IV) morphine on management of acute limb pain.
Ozgur M. Araz, Dan Bentley, Robert L. Muelleman
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.052
Published online: June 12 2014
xEmergency department (ED) visits increase during the influenza seasons. It is essential to identify statistically significant correlates in order to develop an accurate forecasting model for ED visits. Forecasting influenza-like–illness (ILI)-related ED visits can significantly help in developing robust resource management strategies at the EDs.
Mary E. Smyrnioudis, Dorcas P. O’Rourke, Matthew D. Rosenbaum, Kori L. Brewer, William J. Meggs
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.002
Published online: June 12 2014
xPressure immobilization bandages delay mortality for 8 hours after coral snake envenomation, but long-term efficacy has not been established.
Wei Gu, Qian Zhang, WenPeng Yin, ChunSheng Li
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.004
Published online: June 12 2014
xPostresuscitation immunologic dysfunction contributes to the low survival rate after successful resuscitation, but its mechanism remains poorly understood. The mitochondrial apoptosis pathway is initiated by the Bcl-2/Bax-controlled and caspase-3–mediated pathway, this study investigated whether mitochondrial pathway-mediated splenic lymphocyte apoptosis is involved in the postresuscitation immunosuppression in a porcine model of cardiac arrest.
Jiraporn Sri-On, Yuchiao Chang, David P. Curley, Carlos A. Camargo Jr., Joel S. Weissman, Sara J. Singer, Shan W. Liu
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.001
Published online: June 12 2014
xHospital crowding and emergency department (ED) boarding are large and growing problems. To date, there has been a paucity of information regarding the quality of care received by patients boarding in the ED compared with the care received by patients on an inpatient unit. We compared the rate of delays and adverse events at the event level that occur while boarding in the ED vs while on an inpatient unit.
Priyanka Vakkalanka, William F. Rushton, Lewis S. Hardison, Matthew C. Bishop, Doris M. Haverstick, Christopher P. Holstege
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.011
Published online: June 13 2014
xThe objective of this study was to determine if signs of clinical intoxication were present in patients who had transfer urine drug screens (UDS) performed and to determine the proportion of patients with UDS orders who were actually transferred to another facility.
Sungwoo Moon, Bentley J. Bobrow, Tyler F. Vadeboncoeur, Wesley Kortuem, Marvis Kisakye, Comilla Sasson, Uwe Stolz, Daniel W. Spaite
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.019
Published online: June 24 2014
Open AccessxWe aimed to determine if there are differences in bystander cardiopulmonary resuscitation (BCPR) provision and survival to hospital discharge from out-of-hospital cardiac arrest (OHCA) occurring in Hispanic neighborhoods in Arizona.
Khajista Qazi, Hashim M. BinSalleeh, Ubaid H. Shah, Najwa AlGhamedi, Hani Tamim, Mohamed Mubasher, Faris Alrasheed, Abdulrahman Alkanhal, Saleh A. AlTamimi
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.018
Published online: June 26 2014
xThe objective of the study is to determine the efficacy of oral granisetron (a long-acting 5-HT3 receptor antagonist) in stopping vomiting subsequent to discharge from emergency department (ED), in 6-month-old to 8-year-old patients with gastroenteritis-related vomiting and dehydration, who had failed an initial trial of oral rehydration (ORT).
Daesung Lim, Soo Hoon Lee, Dong Hoon Kim, Dae Seub Choi, Hoon Pyo Hong, Changwoo Kang, Jin Hee Jeong, Seong Chun Kim, Tae-Sin Kang
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.020
Published online: June 26 2014
xThe spiral computed tomography (CT) with the advantage of low radiation dose, shorter test time required, and its multidimensional reconstruction is accepted as an essential diagnostic method for evaluating the degree of injury in severe trauma patients and establishment of therapeutic plans. However, conventional sequential CT is preferred for the evaluation of traumatic brain injury (TBI) over spiral CT due to image noise and artifact. We aimed to compare the diagnostic power of spiral facial CT for TBI to that of conventional sequential brain CT.
Philip Craven, Orhan Cinar, David Fosnocht, Jessica Carey, Adrienne Carey, LeGrand Rogers, Kajsa Vlasic, Troy Madsen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.026
Published online: July 1 2014
xHispanic ethnicity has been reported as an independent risk factor for oligoanalgesia in the emergency department (ED).
Arvind Venkat, Uchenna Onyekwere, John M. O’Neill, Gajanan G. Hegde, Jennifer Shang, Sunder Kekre, Thomas P. Campbell
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.029
Published online: July 1 2014
xWe sought to determine whether racial disparities exist in emergency physician professional services reimbursement from insurance. We hypothesized that insured adult African American emergency department (ED) visits are reimbursed at a lower level than White visits.
Maryann Mazer-Amirshahi, Kayla Dewey, Peter M. Mullins, John van den Anker, Jesse M. Pines, Jeanmarie Perrone, Lewis Nelson
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.001
Published online: July 10 2014
xAlthough not recommended as first line therapy by consensus guidelines, opioid analgesics are commonly used to treat headaches. This study evaluates trends in opioid use for headaches in US emergency departments (EDs).
Eric M. Rottenberg
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.005
Published online: June 12 2014
xA recent systematic review and meta-analysis of randomized controlled trials of adrenaline use during resuscitation of out-of-hospital cardiac arrest found no benefit of adrenaline in survival to discharge or neurological outcomes. It did, however, find an advantage of standard dose adrenaline (SDA) over placebo and high dose adrenaline over SDA in overall survival to admission and return of spontaneous circulation (ROSC), which was also consistent with previous reviews. As a result, the question that remains is "Why is there no difference in the rate of survival to discharge when there are increased rates of ROSC and survival to admission in patients who receive adrenaline?" It was suggested that the lack of efficacy and effectiveness of adrenaline may be confounded by the quality of cardiopulmonary resuscitation (CPR) during cardiac arrest, which has been demonstrated in animal models.
John W. Stevenson, Alicia B. Minns, Craig Smollin, Timothy E. Albertson, F. Lee Cantrell, Christian Tomaszewski, Richard F. Clark
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.031
Published online: April 30 2014
xCharacterize clinical presentations and outcomes of dabigatran and rivaroxaban exposures reported to a poison control system.
Carlos Henrique Miranda, André Schmidt, Antônio Pazin-Filho
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.053
Published online: May 12 2014
xMultiple shocks of the implantable cardioverter/defibrillator (ICD) can cause myocardial injury, contributing to the progression of underlying heart disease. The aim was to evaluate if the elevation of troponin I after multiple ICD shocks has impact on the prognostic of these patients.
Lauren T. Southerland, Daniel S. Richardson, Jeffrey M. Caterino, Alex C. Essenmacher, Robert A. Swor
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.005
Published online: May 10 2014
xFractures in older adults are a commonly diagnosed injury in the emergency department (ED). We performed a retrospective medical record review to determine the rate of return to the same ED within 72 hours (returns) and the risk factors associated with returning.
Jared Strote, Marilyn Walsh, Daniel Auerbach, Thomas Burns, Patrick Maher
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.023
Published online: May 21 2014
xLaw enforcement restraint–related death is frequently associated with excited delirium syndrome (ExDS). Because such deaths are rare, the pathophysiology underlying ExDS deaths remains unknown, making identification of high-risk situations challenging. This study describes the medical conditions and situations surrounding restraint of individuals identified by law enforcement to be experiencing ExDS.
Veena Manivannan, Robert J. Hyde, Daniel G. Hankins, M. Fernanda Bellolio, Martin G. Fedko, Wyatt W. Decker, Ronna L. Campbell
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.014
Published online: May 19 2014
xAnaphylaxis is a potentially life-threatening allergic reaction that may require emergency medical system (EMS) transport. Fatal anaphylaxis is associated with delayed epinephrine administration. Patient outcome data to assess appropriateness of EMS epinephrine administration are sparse.
Sebnem Eren Cevik, Tanju Tasyurek, Ozlem Guneysel
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.019
Published online: May 20 2014
xIntravenous lipid emulsion (ILE) is a lifesaving treatment of lipophilic drug intoxications. Not only does ILE have demonstrable efficacy as an antidote to local anesthetic toxicity, it is also effective in lipophilic drug intoxications. Our case series involved 10 patients with ingestion of different types of lipophilic drugs. Intravenous lipid emulsion treatment improved Glasgow Coma Scale or blood pressure and pulse rate or both according to the drug type. Complications were observed in 2 patients (minimal change pancreatitis and probable ILE treatment–related fat infiltration in lungs).
Elissa M. Schechter-Perkins, Elisa Koppelman, Patricia M. Mitchell, Jake R. Morgan, Randie Kutzen, Mari-Lynn Drainoni
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.034
Published online: May 31 2014
xUnderstanding differences between patients who accept and decline HIV testing is important for developing methods to reduce decliner rates among patients at risk for undiagnosed HIV. The objectives of this study were to determine the rates of acceptance and reasons for declining, and to determine if differences exist in patient or visit characteristics between those who accept and decline testing.
Eric D. Manheimer, Glenn Pacio, Kevin J. Ferrick
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.015
Published online: June 19 2014
xSyncope is a frequent presenting complaint in the emergency department and is associated with significant medical costs. We examined the utility of inpatient evaluation of syncope for patients in whom a diagnosis was not established in the emergency department. We retrospectively reviewed consecutive patients presenting with syncope to an urban tertiary care medical center. A diagnosis was not established after initial evaluation in the emergency department in 171 of 230 patients admitted. Inhospital evaluation led to a diagnosis in 26 patients.
Ping-Yuan Chen, Ching-Hung Chang, Chien-Chin Hsu, Yu-Ying Liao, Kuo-Tai Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.036
Published online: July 1 2014
xThe objective of this study was to describe the characteristics of patients presenting to the emergency department with cardiac symptoms subsequently diagnosed to have systemic lupus erythematosus (SLE).
Adam J. Singer, Maria Taylor, Debra LeBlanc, Justin Williams, Henry C. Thode Jr.
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.027
Published online: July 1 2014
xEarly recognition and treatment of sepsis improves outcomes. We determined the effects of bedside point-of-care (POC) lactate measurement on test turnaround time, time to administration of IV fluids and antibiotics, mortality, and ICU admissions in adult ED patients with suspected sepsis. We hypothesized that bedside lactate POC testing would reduce time to IV fluids and antibiotics.
Toru Hifumi, Akihiko Yamamoto, Motohide Takahashi, Yuichi Koido, Kenya Kawakita, Yasuhiro Kuroda
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.008
Published online: June 12 2014
xWe read with interest the article titled “A case of tetanus infection in an adult with a protective tetanus antibody level” by Vollman et al [1]. The authors reported a mild case of tetanus infection despite a markedly higher protective antibody level (8.4 IU/mL). However, there are several serious concerns raised in the study.
Kristan E. Vollman, Nicole M. Acquisto, Ryan P. Bodkin
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.009
Published online: June 12 2014
xWe thank Dr Hifumi et al for continuing discussion regarding our recent case report of tetanus infection despite a protective tetanus antibody level [1].
Gaetano Rea, Maria D’Amato, Giorgia Ghittoni
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.053
Published online: June 11 2014
xThe case presentation by Aspler et al [1] seems to be biased by the lack of correspondence of the shown image; more importantly, it appears to display the limitations of thoracic ultrasound in the diagnosis of pneumothorax more than its merits.
A. Aspler, M.B. Stone
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.044
Published online: April 4 2014
xThe readers’ letter highlights accurately that the article by Aspler et al [1] raises challenges around the real-time diagnosis of pneumothorax with ultrasound.
Hasan Tahsin Gozdas, Oguz Karabay
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.009
Published online: May 19 2014
xWe read recently the published case report in your journal by Vollman et al [1] with great interest. The authors described an interesting case that developed mild tetanus infection despite protective antibody level. The last booster vaccination is stated to have been administered 13 years before presentation. The high tetanus antibody level, measured after 10 days of exposure when the clinical symptoms appeared, however, may not be protective. This tetanus antibody level might be related to the recent natural infection [2].
Kristan E. Vollman, Nicole M. Acquisto, Ryan P. Bodkin
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.049
Published online: June 4 2014
xWe thank Dr Gozdas for opening discussion regarding our recent case report of tetanus infection despite a protective tetanus antibody level [1]. We agree that the increased level of tetanus antibody may be somewhat attributed to the active tetanus infection. However, the accepted level of protective tetanus antibody must also be discussed.
Subramanian Senthilkumaran, Narendra Nath Jena, Chidambaram Ananth, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.010
Published online: May 19 2014
xWe read the article by Cannon et al [1] with great interest. The authors have hypothesized that the troponin leak was secondary to methemoglobinemia resulting in tissue hypoxia that may lead to stress ischemia. Apart from this, we believe that this would be also due to the complex medication regimen of this patient. Increased use of drugs has raised concern about the risks of polypharmacy particularly in the patients with multiple coexisting conditions for whom benefits and adverse effects are unpredictable, which deserve particular attention.
Robert D. Cannon, Michael Wagner, Jeanne L. Jacoby
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.011
Published online: May 19 2014
xWe thank the writers for their thoughtful comments on our recent case report which suggested that drug-induced methemoglobinemia caused an elevated troponin level [1]. They bring up a very important point regarding the pharmacodynamic relationship between statins and diltiazem. We agree that pharmacodynamic drug interactions are often unrecognized or underrecognized by clinicians, and a contribution of the statin-diltiazem relationship in the development of a troponin leak cannot be excluded.
John F. Kragh Jr., John Steinbaugh, Donald L. Parsons, Robert L. Mabry, Bijan S. Kheirabadi, Michael A. Dubick
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.020
Published online: May 20 2014
xWith hemorrhage being the primary cause of mortality on the battlefield [1-3], wound-packing practice by US military medics in the wars since September 11, 2001, has changed from a conservative to an assertive approach. The foremost emphasis changed from preventing contamination to controlling hemorrhage. As no specific hemostatic dressings were available at the start of the wars, after such dressings were fielded, medics changed their approach by packing wounds with more gauze earlier in casualty care and deeper into subfascial cavitary wounds as a way to control hemorrhage.
Sevket Balta, Mustafa Aparci, Cengiz Ozturk, Sait Demirkol, Turgay Celik
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.032
Published online: May 23 2014
xWe have read the article “Red cell distribution width (RDW) as a predictor of mortality in organophosphate insecticide (OPI) poisoning” by Kang et al [1]. They aimed to investigate the relationship between the RDW and 30-day mortality during OPI poisoning. They concluded that RDW is an independent predictor of 30-day mortality in patients with OPI poisoning. This study gives important information on this clinically relevant condition. Thanks to the authors for their contribution.
Tzu-Meng Yang, Yuan Kao, Chia-Ti Wang, Min-Hsien Chung, Hung-Jung Lin, Shio-Jean Lin, How-Ran Guo, Shih-Bin Su, Chien-Cheng Huang, Chien-Chin Hsu
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.027
Published online: May 23 2014
xThe role of collaborative team building in health care is increasingly recognized as a means to ensure that patient care is timely, coordinated, patient-centered, and cost-effective [1]. The Agency for Healthcare Research and Quality developed TeamSTEPPS, which teaches team members how to communicate and cooperate effectively through systemic training to reduce the possibility of medical errors and improve the prognosis of patients and the satisfaction of hospital staff [2]. In 2010, the American Heart Association published new cardiopulmonary resuscitation guidelines stating that advanced cardiac life support (ACLS) should include training in teamwork [3].
Murat Enis Ardıç, Sadiye Yolcu, Önder Tomruk, Burak Gün, Bülent Erdur, Vermi Değerli, Ismet Parlak
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.035
Published online: May 31 2014
xAttention deficit hyperactivity disorder (ADHD) is one of the most common childhood brain disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity [1].
Adam Frisch, Samarjit Das, Joshua C. Reynolds, Fernando De la Torre, Jessica K. Hodgins, Jestin N. Carlson
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.040
Published online: May 31 2014
xApproximately 360000 persons suffer out-of-hospital cardiac arrest (OHCA) annually in the United States [1], and high-quality cardiopulmonary resuscitation (CPR) is the cornerstone of prehospital resuscitation [2]. Real-time feedback devices improve CPR quality [3] but are typically an accessory to the monitor/defibrillator and not available to the lay public. Instead, the lay public is taught to “push hard and fast” without any provision for real-time feedback to optimize performance [4]. Bystander CPR provides a key link in the chain of survival [5]: communities with higher rates of bystander CPR enjoy commensurate improvements in OHCA survival [2,6], and 1 additional life is saved for every 30 OHCA victims who receive bystander CPR [7].
Elva A. Van Devender
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.037
Published online: May 31 2014
xThe establishment of clinical pharmacists in the emergency department (ED) is an innovative practice implemented by a growing number of health systems within the past decade. Various studies have been published on the value of clinical pharmacy services in the ED. Pharmacists practicing in the ED setting have been shown to improve drug therapy, decrease medication costs, prevent adverse drug events, promote medication safety, and provide for overall continuity of care [1-5]. However, despite the evidence, a 2005 survey by the American Society of Health System Pharmacists found that only 3.5% of hospitals surveyed have pharmacists assigned to the ED for any period [6].
Yusuf Emrah Eyi, Ibrahim Arziman, Umit Kaldirim, Salim Kemal Tuncer
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.007
Published online: June 12 2014
xWith great interest, we have read the article, “Dislocation of a total hip arthroplasty: acute management in the emergency room” by Fillingham et al [1]. We appreciate the authors sharing their enlightening study. We believe that one of the causes of reduction failure is a lack of peripheral nerve blocks or procedural sedation. We would like to contribute information about fascia iliaca compartment block to make the reduction of hip dislocations easier for the authors of this study.
Wan-Ching Lien, Hsiu-Po Wang, Kao-Lang Liu, Chien-Jen Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.006
Published online: June 12 2014
xAppendicitis is one of the most common abdominal emergencies. Immediate appendectomy has been the standard treatment [1]. However, recent evidence suggests that nonoperative management (NOM) can be an alternative treatment [2,3]. Little is known about why adult patients and surgeons select operative or nonoperative treatment. A retrospective case-control study was conducted in the emergency department (ED) of the National Taiwan University Hospital between January 2003 and December 2009, to define factors that influence both adult patient and surgeon when opting for immediate appendectomy or NOM, matching on age, sex, and appendicitis types.
