Human Carbon Monoxide Factory Karin Howe, David Griffen, Cassie Jaeger
DOI: http://dx.doi.org/10.1016/j.ajem.2016.04.008
Publication stage: In Press Accepted Manuscript
The American Journal of Emergency Medicine
Published online: April 8 2016
x Methylene chloride is a common occupational exposure. A metabolic product of methylene chloride is carbon monoxide (CO) and toxicity can lead to increased carboxyhemoglobin (COHb) levels. The half-life of COHb is prolonged in methylene chloride toxicity as the conversion to CO can last several hours beyond the exposure. In addition, methylene chloride can be stored in tissues, particularly adipose tissue, and converted to CO over time. The following case demonstrates that patients exposed to methylene chloride can essentially become CO factories with the production of CO within the body continuing long after exposure to the toxin.
Comparison of two intravascular access techniques when using CBRN-PPE: A randomized crossover manikin trial Lukasz Szarpak, Zenon Truszewski, Jacek Smereka, Marcin Madziała, Lukasz Czyzewski
DOI: http://dx.doi.org/10.1016/j.ajem.2016.03.046
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: March 21 2016
x Rapid intravascular access is critical procedure in many emergency situations [1]. Gold standard of intravascular access in emergency scenarios it is still intravenous access. However, there are situations where intravenous (IV) access is difficult, or even impossible. Such situations can include hypovolemic shock or cardiac arrest, in which veins are collapsed [2]. Difficulties in access can also make use of personal protective equipment, including wearing chemical. Biological, radiological and nuclear (CBRN) protective equipment.
Transitional care clinics for follow-up and primary care linkage for patients discharged from the ED Kailyn Elliott, Jared W. Klein, Anirban Basu, Amber K. Sabbatini
DOI: http://dx.doi.org/10.1016/j.ajem.2016.03.029
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: March 15 2016
x Transitional care clinics (TCCs) represent one strategy to facilitate follow-up and primary care linkage for patients with no regular source of care who are discharged from the emergency department (ED). We assessed factors associated with completion of TCC follow-up among these patients and characterized their subsequent ED use.
Bradycardia and hypotension after synthetic cannabinoid use: a case series Erin M. Kane, Jeremiah S. Hinson, Candice D. Jordan, Karolina Paziana, Nicholas J. Sauber, Richard E. Rothman, Andrew I. Stolbach
DOI: http://dx.doi.org/10.1016/j.ajem.2016.03.007
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: March 4 2016
x Cardiotoxicity secondary to synthetic cannabinoid use has been reported to manifest with tachycardia and hypertension. We present here a case series of three patients who developed bradycardia and hypotension after synthetic cannabinoid use.
A randomized crossover trial comparing the C-MAC and Macintosh laryngoscopes for face-to-face intubation in a manikin Łukasz Szarpak, Zenon Truszewski, Robert Gałązkowski, Togay Evrin, Łukasz Czyzewski
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.003
The American Journal of Emergency Medicine , Vol. 34 , Issue 5 ,
Published online: February 12 2016
x The ability to intubate the patient is one of the key skills they should possess as paramedics
[1,2]
. Standard endotracheal intubation (ETI), when patient is lying on his back and intubation is located behind the patient's head, is one of the most commonly used techniques for ETI
[3,4]
. However, the technique of intubation is not always possible; therefore, paramedics should be able to intubate using other techniques. Face-to-face (FTF) intubation technique is usually performed in EMS when patient is found in a position that makes the performance of standard intubation difficult, such as when a patient is trapped in a seated position in a car
[5]
.
Should laryngeal tubes or masks be used for out-of-hospital cardiac arrest patients? Torben K. Becker, Michael Bernhard
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.033
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: January 26 2016
x We read with interest the prospective, cluster-randomized, and open-label study by Ono et al. [1] evaluating airway management using the laryngeal tube (LT) and the laryngeal mask airway (LM) in out-of-hospital cardiac arrest patients in Japan. However, we have questions about the author’s methodological approach.
A prehospital screening tool utilizing end-tidal carbon dioxide predicts sepsis and severe sepsis Christopher L. Hunter, Salvatore Silvestri, George Ralls, Amanda Stone, Ayanna Walker, Linda Papa
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.017
The American Journal of Emergency Medicine , Vol. 34 , Issue 5 ,
Published online: January 20 2016
x To determine the utility of a prehospital sepsis screening protocol utilizing systemic inflammatory response syndrome (SIRS) criteria and end-tidal carbon dioxide (ETCO2 ).
Paramedic assessment and treatment of upper airway obstruction in pediatric patients: an exploratory analysis by the Children's Safety Initiative-Emergency Medical Services Matthew Hansen, Garth Meckler, William Lambert, Caitlin Dickinson, Kathryn Dickinson, Jeanne-Marie Guise
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.082
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 30 2015
x Croup, asthma, and anaphylaxis are potentially life-threatening pediatric emergencies. These medical conditions have distinct yet effective treatments. Croup causes upper airway obstruction, although virally mediated edema of the upper airway. Nebulized epinephrine, via its α -1 effect of vasoconstriction, is a highly effective treatment for upper airway obstruction caused by croup [1–5]. Asthma causes lower airway obstruction and is treated with albuterol whose β -2 mechanism causes relaxation of the lower airways [6].
The long spine board does not reduce lateral motion during transport—a randomized healthy volunteer crossover trial David A. Wampler, Chloe Pineda, Joan Polk, Emily Kidd, Dale Leboeuf, Marti Flores, Mike Shown, Chetan Kharod, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.078
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: December 29 2015
x For thirty years, emergency medical services agencies have emphasized limiting spinal motion during transport of the trauma patient to the emergency department. The long spine board (LSB) has been the mainstay of spinal motion restriction practices, despite the paucity of data to support its use. The purpose of this study was to determine reduction in lateral motion afforded by the LSB in comparison to the stretcher mattress alone.
Interaction of the diabetes mellitus and cardiac diseases on survival outcomes in out-of-hospital cardiac arrest Dayea Beatrice Jang, Sang Do Shin, Young Sun Ro, Kyoung Jun Song, Ki Ok Ahn, Seung Sik Hwang, Young Taek Kim, Sung Ok Hong, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.076
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: December 29 2015
x Diabetes mellitus (DM) and cardiac disease (CD) both likely effect out-of-hospital cardiac arrest (OHCA) survival, but the effect of their relationship on survival outcomes is unclear. This study aims to investigate whether the association of DM and OHCA outcomes differ in patients with and without CD.
Outcomes of non–STEMI patients transported by emergency medical services vs private vehicle Mary Colleen Bhalla, Jennifer Frey, Sarah Dials, Kristin Baughman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.070
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 24 2015
x Non–ST-segment elevation myocardial infarctions (NSTEMIs) are more common but less studied than ST-segment elevation myocardial infarctions (STEMIs) treated by emergency medical services (EMS).
The first-door-to-balloon time delay in STEMI patients undergoing interhospital transfer Jeong Ho Park, Ki Ok Ahn, Sang Do Shin, Won Chul Cha, Hyun Wook Ryoo, Young Sun Ro, Taeyun Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.058
The American Journal of Emergency Medicine , Vol. 34 , Issue 5 ,
Published online: December 22 2015
x Interhospital transfer delays for ST-elevation myocardial infarction (STEMI) patients requiring primary percutaneous coronary intervention (PCI) may be shortened by improved regional care systems. We evaluated the transfer process and first door-to-balloon (D1toB) time in STEMI patients who underwent interhospital transfer for primary PCI.
Ethical and regulatory challenges in advancing prehospital research: focus on sepsis Carmen C. Polito, Jonathan E. Sevransky, Neal W. Dickert
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.007
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 12 2015
x There are a variety of barriers to conducting prehospital, emergency research. Practical challenges include the fact that ambulances function essentially as mobile “laboratories,” the relatively short amount of time patients spend in the prehospital environment, and local variation in Emergency Medical Services (EMS) protocols and practices. All of these challenges complicate attempts to measure and detect a treatment effect. Similarly, real challenges exist regarding processes for informed consent [1,2].
Is 15 minutes an appropriate resuscitation duration before termination of a traumatic cardiac arrest? A case-control study Cheng-Yu Chien, Yi-Chia Su, Chi-Chun Lin, Chan-Wei Kuo, Shen-Che Lin, Yi-Ming Weng
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.004
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 11 2015
x Previous guidelines suggest up to 15 minutes of cardiopulmonary resuscitation (CPR) accompanied by other resuscitative interventions before terminating resuscitation of a traumatic cardiac arrest. The current study evaluated the duration of CPR according to outcome using the model of a county-based emergency medical services (EMS) system in Taiwan.
The prehospital and hospital costs of emergency care for frequent ED patients Robert G. Solberg, Brandy L. Edwards, Jeffrey P. Chidester, Debra G. Perina, William J. Brady, Michael D. Williams
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.066
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 4 2015
x Frequent emergency department (ED) use has been identified as a cause of ED overcrowding and increasing health care costs. Studies have examined the expense of frequent patients (FPs) to hospitals but have not added the cost Emergency Medical Services (EMS) to estimate the total cost of this pattern of care.
Subject Index
DOI: http://dx.doi.org/10.1016/S0735-6757(15)00997-3
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published in issue: December 2015
A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics. A randomized, crossover, manikin study Lukasz Szarpak, Zenon Truszewski, Lukasz Czyzewski, Tomasz Gaszynski, Antonio Rodríguez-Núñez
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.060
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: November 23 2015
x Prehospital tracheal intubation by paramedics during cardiopulmonary resuscitation (CPR) in children is challenging. The potential role of new intubation devices during CPR is unclear. Our objective was to assess the impact of CPR (with and without chest compressions [CCs]) on the success and time to intubation (TTI) with the Macintosh laryngoscope vs the McGrath video laryngoscope on a pediatric manikin.
Extracorporeal CPR and therapeutic hypothermia for out-of-hospital cardiac arrest in a patient with congenital long QT syndrome Jun Wan Lee, Seung Woo Yoo, Won Joon Jeong, Seung Ryu, Youn Ho Yoo, In Sool Yoo, Sang Il Park, Joon Hyung Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.061
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: November 20 2015
x Out-of-hospital cardiac arrest is uncommon in children. Survival until hospital discharge and probability of having no neurologic complications remain poor. Inherited arrhythmia syndromes are characterized by genetic heterogeneity and variable penetrance. Congenital long QT syndrome is one of the causes of sudden death in the young, caused by mutations in genes encoding ion channels in the control of ventricular repolarization. We report a case of extracorporeal cardiopulmonary resuscitation and therapeutic hypothermia in a 13-year-old adolescent presenting out-of-hospital cardiac arrest from congenital long QT syndrome.
The impact of a freestanding ED on a regional emergency medical services system Benjamin J. Lawner, Jon Mark Hirshon, Angela C. Comer, Jose V. Nable, Jeffrey Kelly, Richard L. Alcorta, Laura Pimentel, Christina L. Tupe, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.042
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: November 18 2015
x The objective of the study is to examine the effect of the opening of a freestanding emergency department (FED) on the surrounding emergency medical services (EMS) system through an examination of EMS system metrics such as ambulance call volume, ambulance response times, and turnaround times.
Prehospital activated charcoal use in antipsychotic overdose Joseph Villarreal, Christopher A. Kahn, James V. Dunford, Edward M. Castillo, Richard F. Clark
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.057
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 3 2015
x We recently published a retrospective review of our prehospital administration of activated charcoal (AC) with a focus on transport times [1]. We report a further review of our experience with prehospital AC, now focusing specifically on its use in antipsychotic overdose.
