Validation of a Novel, Rapid Sepsis Diagnostic for Emergency Department Use.

Objectives: To assess the in vitro IntelliSep test, a microfluidic assay that quantifies the state of immune activation by evaluating the biophysical properties of leukocytes, as a rapid diagnostic for sepsis.

Design: Prospective cohort study.

Setting: Five emergency departments (EDs) in Louisiana, Missouri, North Carolina, and Washington.

Football Saturday: are collegiate football stadiums adequately prepared to handle spectator emergencies?

Background: Mass gatherings are a commonly occurring event, especially on college campuses. Any mass gathering gives rise to possible small- or large-scale emergencies. Mass gathering medicine is an integral part of emergency medical services (EMS).

Delayed-onset Angioedema Following a Snakebite in a Patient on ACE Inhibitors: A Case Report.

Introduction: Angiotensin converting enzyme inhibitors (ACEI) are a common class of medications prescribed to patients for hypertension. Anti-hypertensive use is not normally considered an important factor when treating patients with crotalid envenomations; however, in combination with the venom in this patient, it may have resulted in angioedema.

Case Report: A 65-year-old male on ACEI presented to his community emergency department following a snake envenomation to his thumb.

CPR in correctional facilities: a missed opportunity?

In the incarcerated population, the largest ethnic and racial group is Black people. Heart disease is known as the leading causes of death in the United States which can lead to cardiac arrest. Layperson cardiopulmonary resuscitation (CPR) has been shown to provide a benefit and increase likelihood of return of spontaneous circulation (ROSC).

Leftover narcotic analgesics among emergency department patients and methods of disposal.

Objective: Given the increase in narcotic addiction and diversion, understanding how patients use their opioid prescriptions and store or dispose of any remainders is important. We set out to determine the frequency in which patients had leftover opioid quantities from prescriptions received in the emergency department (ED). In addition, we sought to describe patients' reasons for taking or not taking all of their prescribed medications and their strategies to manage and/or dispose of any excess or leftovers.

Novel, Inexpensive Portable Respiratory Protection Unit (PRPU) for Healthcare Workers.

Introduction: Given concern for increased aerosolization during intubation of patients with severe acute respiratory syndrome coronavirus, we sought to create a portable, inexpensive, and easily constructed device to help protect healthcare workers.

Methods: A respiratory protection unit can be constructed in approximately 30 minutes and for less than 50 United States dollars in materials, using polyvinylchloride pipe and automobile collision wrap.

Conclusion: This device provides possible increased protection during video laryngoscopy and can easily be replicated.

A Full Uterus: Hematometra from Cervical Scarring.

A 29-year-old female presented with abdominal pain, nausea, and vomiting. She reported no menstrual period for one year. She did report monthly episodes of severe cramping.

Endometriosis: An Unusual Cause of Bilateral Pneumothoraces.

A 27-year-old female presented to the emergency department with sudden onset shortness of breath. A diagnosis of bilateral catamenial pneumothoraces was made following chest radiograph. Catamenial pneumothorax is a recurrent spontaneous pneumothorax that occurs in 90% of affected women 24-48 hours after the onset of their menstruation; 30-50% of cases have associated pelvic endometriosis.

Prehospital amputation: An experimental comparison of techniques.

Objective: Prehospital limb amputation is a rare but potentially life-saving intervention. When patients cannot be extricated due to limb entrapment or have hemodynamic compromise that precludes a prolonged extrication, they may benefit from an emergent prehospital amputation. The objective was to experimentally compare three prehospital amputation techniques on porcine legs.

Extravasation from a Misplaced Intraosseous Catheter.

A 75-year old female presented in cardiac arrest with a right tibial intraosseous (IO) catheter through which prehospital medications were administered. The catheter, which had been placed by emergency medical services, was noted in the emergency department to be misplaced and was removed. Due to extravasation of the medications, the patient suffered localized tissue necrosis and eventually required skin grafting.

Use of Emergency Department Pharmacists in Emergency Medicine Resident Milestone Assessment.

Introduction: The use of competency-based milestones for emergency medicine (EM) was mandated by the Accreditation Council for Graduate Medical Education in 2013. However, clinical competency committees (CCC) may lack diverse, objective data to assess these new competencies. To remedy the lack of objective data when assessing the pharmacotherapy sub-competency (PC5) we introduced a unique approach that actively involves departmental clinical pharmacists in determining the milestone level achieved by the resident.

Simulation-based Remediation in Emergency Medicine Residency Training: A Consensus Study.

Introduction: Resident remediation is a pressing topic in emergency medicine (EM) training programs. Simulation has become a prominent educational tool in EM training and been recommended for identification of learning gaps and resident remediation. Despite the ubiquitous need for formalized remediation, there is a dearth of literature regarding best practices for simulation-based remediation (SBR).

Death by Disimpaction: A Bradycardic Arrest Secondary to Rectal Manipulation.

Rectal examination and fecal disimpaction are common procedures performed in the Emergency Department on a daily basis. Here, we report a rare case of a patient suffering a cardiac arrest and ultimately death likely due to rectal manipulation. A 66-year-old male presented to the Emergency Department (ED) with a complaint of abdominal distention and constipation.

Lipid emulsion therapy given intraosseously in massive verapamil overdose.

Intravenous fat emulsion (IFE) therapy has been widely used in the emergency department (ED) for treating various medication overdoses. The standard recommended route to administer IFE therapy is intravenously through a peripheral or central vein. No reports of intraosseous (IO) administration in humans could be found in the literature after a brief search.