The latest medical research on Emergency Medicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about emergency medicine gathered by our medical AI research bot.

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Early Screening for PTSD and Depression among Injured Emergency Department Patients: A Feasibility Study.

Academic Emergency Medicine

Despite the risk of developing posttraumatic stress disorder (PTSD) and associated comorbidities after physical injury, few Emergency Departments (ED) in the United States screen for the presence of psychological symptoms and conditions. Barriers to systematic screening could be overcome by using a tool that is both comprehensive yet brief. This study aimed to determine 1) the feasibility of screening for posttraumatic sequelae among adults with minor injury in the ED, and 2) the relationship between ED screening and later psychological symptoms and poor quality of life (QOL) at 6 weeks post-injury.

In the EDs of two Level 1 trauma centers, we enrolled injured patients (n = 149) who reported serious injury and/or life threat in the past 24 hours. Subjects completed the Posttraumatic Adjustment Scale (PAS) to screen for PTSD and depression in the ED, and 6 weeks later they completed assessments for symptoms of PTSD, depression, and Trauma-Specific QOL (T-QoL).

Our retained sample at 6 weeks was 84 adults (51.2% male; M age = 33); 38% screened positive (+) for PTSD, and 76% screened positive for depression in the ED. Controlling for age, hospital admission, and ED pain score, regression analyses revealed that a (+) ED screen for both PTSD and depression was significantly associated with 6 weeks PTSD (p = 0.027, 95% confidence interval [CI] = 0.92-15.14) and depressive symptoms (p = 0.001, 95% CI = 2.20-7.74), respectively. Further, a (+) ED screen for depression (p = 0.043, 95% CI= -16.66 to -0.27) and PTSD (p = 0.015, 95% CI = -20.35 to -2.24) was significantly associated with lower T-QoL.

These results suggest that it is feasible to identify patients at risk for post-injury sequelae in the ED; screening for mental health risk may identify patients in need of early intervention and further monitoring. This article is protected by copyright. All rights reserved.

An evaluation of the Swiss staging model for hypothermia using hospital cases and case reports from the literature.

Scandinavian Journal of

The Swiss staging model for hypothermia uses clinical indicators to stage hypothermia and guide the management of hypothermic patients. The proposed temperature range for clinical stage 1 is < 35-32 °C, for stage 2 is < 32-28 °C, for stage 3 is < 28-24 °C, and for stage 4 is below 24 °C. Our previous study using 183 case reports from the literature showed that the measured temperature only corresponded to the clinical stage in the Swiss staging model in approximately 50% of cases. This study, however, included few patients with moderate hypothermia. We aimed to expand this database by adding cases of hypothermic patients admitted to hospital to perform a more comprehensive evaluation of the staging model.

We retrospectively included patients aged ≥18 y admitted to hospital between 1.1.1994 and 15.7.2016 with a core temperature below 35 °C. We added the cases identified through our previously published literature review to estimate the percentage of those patients who were correctly classified and compare the theoretical with the observed temperature ranges for each clinical stage.

We included 305 cases (122 patients from the hospital sampling and the 183 previously published). Using the theoretically derived temperature ranges for clinical stages resulted in 185/305 (61%) patients being assigned to the correct temperature range. Temperature was overestimated using the clinical stage in 55/305 cases (18%) and underestimated in 65/305 cases (21%); important overlaps in temperature existed among the four stage groups. The optimal temperature thresholds for discriminating between the four stages (32.1 °C, 27.5 °C, and 24.1 °C) were close to those proposed historically (32 °C, 28 °C, and 24 °C).

Our results provide further evidence of the relationship between the clinical state of patients and their temperature. The historical proposed temperature thresholds were almost optimal for discriminating between the different stages. Adding overlapping temperature ranges for each clinical stage might help clinicians to make appropriate decisions when using clinical signs to infer temperature. An update of the Swiss staging model for hypothermia including our methodology and findings could positively impact clinical care and future research.

Pre-hospital emergent intubation in trauma patients: the influence of etomidate on mortality, morbidity and healthcare resource utilization.

Scandinavian Journal of

Due to its favorable hemodynamic characteristics and by providing good intubation conditions etomidate is often used for induction of general anesthesia in trauma patients. It has been linked to temporary adrenal cortical dysfunction. The clinical relevance of this finding after a single-dose is still lacking appropriate evidence.

This retrospective multi-centre study is based on merged data from a German Helicopter Emergency Medical Service (HEMS) database and a large trauma patient registry. All trauma patients who were intubated prior to hospital admission with a documented Injury Severity Score ≥ 9 between 2008 and 2012 were eligible for analysis. The primary endpoint was hospital mortality. Other outcome measures were organ failures, sepsis, length of ventilation, as well as length of stay in hospital and ICU.

One thousand six hundred ninety seven patients were enrolled into the study. Seven hundred sixty two patients received etomidate and 935 patients received other induction agents. The in-hospital mortality was similar in both groups (18.9% versus 18.2%; p = 0.71). Incidences of organ failures and sepsis were not increased in the etomidate group. However, health care resource utilization parameters were prolonged (after adjusting: + 1.3 days for ICU length of stay, p = 0.062; + 0.8 days for length of ventilation, p = 0.15; + 2,7 days for hospital length of stay, p = 0.034). A multivariable logistic regression analysis did not identify etomidate as an independent predictor of hospital mortality (OR: 1.10, 95% CI: 0.77-1.57; p = 0.60).

This is the largest trial investigating outcome data for trauma patients who had received a single-dose of etomidate for induction of anesthesia. The use of etomidate did not affect mortality. The influence on morbidity and health care resource utilization remains unclear.

Psychiatric-Related Revisits to the Emergency Department Following Rapid Expansion of Community Mental Health Services.

Academic Emergency Medicine

Repeat visits (revisits) to Emergency Departments (EDs) for psychiatric care reflect poor continuity of care and impose a high financial cost. We test whether rapid expansion of Community Health Centers (CHCs)-which provide regional, low-cost primary care-correspond with fewer repeat psychiatric-related ED visits (PREDVs).

We obtained repeated cross-sectional time series data for 7.8 million PREDVs from the State Emergency Department Database for four populous US states (California, Florida, North Carolina and New York) from 2006 to 2011. We specified as the outcome variable the count of repeat visits per ED visitor with a psychiatric diagnosis. We retrieved aggregate-level mental health visits at CHCs from the Uniform Data System. Negative binomial regression methods controlled for individual-level confounders, county health-system and sociodemographic attributes, year fixed effects and county fixed effects.

The risk of a repeat PREDV decreases with a county-level increase in mental health patients seen at CHCs (incidence rate ratio: 0.986, 95% CI: 0.98 to 0.99). Conversion of this rate ratio to the number of revisits averted indicates 34,000 fewer repeat PREDVs in these four states statistically associated with a 1% expansion in CHC mental health visits. Exploratory analyses find that revisits decline for relatively mild/moderate illnesses (e.g. mood, anxiety disorders) but not for severe illnesses (e.g. schizophrenia/psychoses).

An increase in mental health services at CHCs corresponds with a modest decline in repeat PREDVs. This decline concentrates among those with less severe mental illnesses. This article is protected by copyright. All rights reserved.

Emergency Medicine in the #MeToo Era.

Academic Emergency Medicine

Sexual harassment is a serious threat to a safe and productive workplace. The Emergency Department (ED) environment poses unique threats, including...

The Impact of Plasma-Derived Microvesicles from a Femoral Fracture Animal Model on Osteoblast Function.

Shock

The role of microvesicles (MVs) in transcellular signal transduction has been demonstrated in different studies. However, the potential modulatory ...

High-Sensitivity Troponin T Predicts Postoperative Cardiogenic Shock Requiring Mechanical Circulatory Support in Patients with Valve Disease.

Shock

Cardiogenic shock is a very serious postoperative complication in patients undergoing heart valve surgery. Mechanical circulatory support is a recognized method of treating patients with this complication. The aim of the presented study was to assess the usefulness of selected biomarkers in predicting the occurrence of postoperative cardiogenic shock requiring mechanical circulatory support.

This prospective study was conducted on a group of 712 patients undergoing heart valve surgery. The primary end-point at the intra-hospital follow-up was postoperative cardiogenic shock requiring mechanical circulatory support.

The postoperative cardiogenic shock requiring mechanical circulatory support occurred in 20 patients. At multivariate analysis high-sensitivity Troponin T measured immediately after surgery (OR 1.006; 95% CI 1.002-1.013; p 0.009) remained independent predictor of the primary end point.

The postoperative hs-TnT can be used to predict a postoperative cardiogenic shock requiring mechanical circulatory support.

The Use of Tranexamic acid (TXA) for The Management of Haemorrhage In Trauma Patients In The Prehospital Environment: Literature Review and Descriptive Analysis of Principal Themes.

Shock

Tranexamic acid (TXA) is an anti-fibrinolytic agent used to prevent traumatic exsanguination. It was first introduced to clinical practice for the ...

Hydrocortisone, Ascorbic acid and Thiamine (HAT) Therapy Decreases Oxidative Stress, Improves Cardiovascular Function and Improves Survival in Murine Sepsis.

Shock

A small clinical trial showed HAT therapy improved survival but no studies have been reported in animal models to examine potential mechanisms.

Sepsis was induced in female mice using the cecal ligation and puncture (CLP) model. Physiologic parameters including heart rate (HR), pulse distension (PD) and respiratory rate (RR) were measured non-invasively at baseline, 6 and 24 hours post CLP. These measurements stratified mice into predicted to live (Live-P) or die (Die-P). Mice were randomized to receive HAT therapy or vehicle. Oxidative stress was measured in peritoneal exudative cells 24 hours after CLP.

HR, PD, and RR all declined within the first 6 hours of sepsis and were significantly lower in the Die-P mice compared Live-P. HR 6 hours post-CLP best predicted mortality and continued to decline between 6 and 24 hours post CLP. Oxidative stress in peritoneal cells harvested 24 hours post CLP (determined by 8 isoprostaglandin F2α and protein carbonyl derivatives) was significantly higher in the Die-P mice. HAT therapy was initiated 7 hours post-CLP after mortality prediction and stratification. HAT significantly reduced oxidative stress in the Die-P mice without altering these parameters in the Live-P mice. HAT treatment prevented the decline in HR, again only in the Die-P mice. Mice treated with HAT therapy had significantly better survival.

Physiologic parameters accurately predicted mortality. Die-P mice had significant oxidative stress compared to Live-P. HAT therapy significantly decreased oxidative stress, increased HR and improved survival in the Die-P mice. These data suggest that HAT exerts a beneficial effect through reducing oxidative stress and improving cardiovascular function.

Temporal Trends and Clinical Outcomes Associated with Vasopressor and Inotrope Use In The Cardiac Intensive Care Unit.

Shock

The use of norepinephrine may be associated with better outcomes in some patients with shock. We sought to determine whether norepinephrine was associated with lower mortality in unselected cardiac intensive care unit (CICU) patients compared to other vasopressors, and whether patterns of vasopressor and inotrope usage in the CICU have changed over time.

We retrospectively evaluated consecutive adult patients admitted to a tertiary care hospital CICU from January 1, 2007, to December 31, 2015. Vasoactive drug doses were quantified using the peak Vasoactive-Inotropic Score (VIS). Temporal trends were assessed using the Cochran-Armitage trends test and multivariable logistic regression was used to determine predictors of hospital mortality.

We included 10,004 patients with a mean age of 67 ± 15 years; vasoactive drugs were used in 2,468 (24.7%) patients. Use of norepinephrine increased over time, while dopamine utilization decreased (p < 0.001 for trends). After adjustment for illness severity and other variables, the peak VIS was a predictor of hospital mortality across the entire population (unit OR 1.013, 95% CI 1.009-1.017, p < 0.001) and among patients receiving vasoactive drugs (OR 1.018, 95% CI 1.013-1.022, p < 0.001). Among patients receiving vasoactive drugs, norepinephrine was associated with a lower risk of hospital mortality (OR 0.66, 95% CI 0.49-0.90, p = 0.008) after adjustment for illness severity and peak VIS.

Vasoactive drug use in CICU patients has a dose-dependent association with short-term mortality. Use of norepinephrine in CICU patients is associated with decreased odds of death when compared to other vasoactive drugs.

Measuring Intubation in the Emergency Department: Is it time to include End-tidal Carbon Dioxide to Determine the Onset of Apnea?

Academic Emergency Medicine

Dr. Driver and colleagues (1) conducted a well-designed study to determine the effect of the administration of a neuromuscular-blocking agent befor...

Multicenter Comparison of Non-supine versus Supine Positioning During Intubation in the Emergency Department: A National Emergency Airway Registry (NEAR) Study.

Academic Emergency Medicine

Head-up positioning for preoxygenation and ramping for morbidly obese patients are well accepted techniques, but the effect of head-up positioning with full torso elevation for all intubations is controversial. We compared first-pass success, adverse events, and glottic view between supine (SP) and non-supine (NSP) positioning for emergency department (ED) patients undergoing orotracheal intubation.

We performed a retrospective analysis of prospectively collected data for ED intubations over a two-year period from 25 participating centers in the National Emergency Airway Registry (NEAR). We compared characteristics and outcomes for adult patients intubated orotracheally in SP and NSP positions with either a direct or video laryngoscope. We report odds ratios (OR) with 95%CI for categorical variables and interquartile ranges with 95%CI for continuous variables. Our primary outcome was first-attempt intubation success and secondary outcomes were glottic views and peri-intubation adverse events.

Of 11,480 total intubations, 5.8% were performed in NSP. The NSP group included significantly more obese patients (OR 2.2 [95% CI 1.9-2.6]) and patients with a suspected difficult airway (OR 1.8 [95% CI 1.6-2.2]). First-pass success (adjusted OR 1.1 [95% CI 0.9-1.4]) and overall rate of grade I glottic views (OR =1.1 [95% CI 0.9-1.2]) were similar between groups while NSP had a significantly higher rate of grade I views when direct laryngoscopy was employed (OR = 1.27 [95% CI 1.04-1.54]). NSP was associated with higher odds of any adverse event (OR 1.4 [95% CI 1.1-1.7]).

ED providers utilized SP in most ED intubations but were more likely to use NSP for patients who were obese or in whom they predicted a difficult airway. We found no differences in first-pass success between groups but total adverse events were more likely in NSP. A randomized trial comparing patient positioning during intubation in the ED is warranted. This article is protected by copyright. All rights reserved.