Sex Differences in Neurological Emergencies Presenting to Multiple Urban Level 1 Trauma Centers.

Previous studies have suggested that there are sex differences in the treatment and outcome of neurological emergencies; however, research identifying the role these sex differences play in the management of neurological emergencies is lacking. More knowledge of the way sex factors into the pathophysiology of neurological emergencies will be helpful in improving outcomes for these patients. The aim of this cross-sectional study was to assess the prevalence and management of neurological emergencies while evaluating sex differences in the diagnosis and treatment of these emergencies.

Age and sex differences in blood product transfusions and mortality in trauma patients at a level I trauma center.

Objectives: Hemorrhage is a common complication of trauma. We evaluated age and sex differences in treatment with blood product transfusions and massive transfusions as well as in-hospital mortality following trauma at a Level 1 Trauma Center.

Methods: This cross-sectional study evaluated trauma data from a Level 1 trauma center registry from January 2013 to December 2017.

Does a change in end-tidal carbon dioxide level predict high altitude mountain sickness?

Background: It is postulated that lack of hypoxic ventilatory response is a predictor for AMS. End-tidal carbon dioxide (ETCO) is an accurate, noninvasive surrogate measure of ventilation.

Objectives: We sought to determine if changes in baseline ETCO predicts the development of AMS.

Evaluation of Glial and Neuronal Blood Biomarkers Compared With Clinical Decision Rules in Assessing the Need for Computed Tomography in Patients With Mild Traumatic Brain Injury.

Importance: In 2018, the combination of glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase (UCH-L1) levels became the first US Food and Drug Administration-approved blood test to detect intracranial lesions after mild to moderate traumatic brain injury (MTBI). How this blood test compares with validated clinical decision rules remains unknown.

Objectives: To compare the performance of GFAP and UCH-L1 levels vs 3 validated clinical decision rules for detecting traumatic intracranial lesions on computed tomography (CT) in patients with MTBI and to evaluate combining biomarkers with clinical decision rules.

The utility of transcutaneous carbon dioxide measurements in the emergency department: A prospective cohort study.

Background: Rapid identification of patients with occult injury and illness in the emergency department can be difficult. Transcutaneous carbon dioxide (TCO) and oxygen (TO) measurements may be non-invasive surrogate markers for the identification of such patients.

Objectives: To determine if TCO or TO are useful adjuncts for identifying severe illness and the correlation between TCO, lactate, and end tidal carbon dioxide (ETCO).

A Randomized Controlled Trial of Novel Loop Drainage Technique Versus Standard Incision and Drainage in the Treatment of Skin Abscesses.

Objectives: The objective was to compare the failure rate of incision and drainage (I&D) with LOOP technique versus I&D with standard packing technique in adults and children presenting to the emergency department (ED) with subcutaneous abscess.

Methods: This prospective, randomized controlled trial (NCT03398746) enrolled a convenience sample of patients presenting to two Level 1 trauma centers over 12 months with skin abscesses. Of 256 patients screened, 217 patients were enrolled, 109 randomized to I&D with packing (50%) and 108 (50%) to I&D with LOOP.

Splenic Laceration Post Colonoscopy: A Rare Complication.

Background: The number of colonoscopies performed in the United States is increasing each year. Although the procedure is generally safe and effective, complications can arise. Splenic laceration is an extremely rare complication of colonoscopy.

Endotracheal tube placement confirmation: 100% sensitivity and specificity with sustained four-phase capnographic waveforms in a cadaveric experimental model.

Background: Waveform capnography is considered the gold standard for verification of proper endotracheal tube placement, but current guidelines caution that it is unreliable in low-perfusion states such as cardiac arrest. Recent case reports found that long-deceased cadavers can produce capnographic waveforms. The purpose of this study was to determine the predictive value of waveform capnography for endotracheal tube placement verification and detection of misplacement using a cadaveric experimental model.

The LOOP technique: a novel incision and drainage technique in the treatment of skin abscesses in a pediatric ED.

Objective: This study assesses outcome in pediatric patients with skin abscess using the LOOP compared to the standard incision and drainage (I&D) with packing method.

Methods: This retrospective study used ICD-9 codes to identify pediatric patients aged 0 to 17 years with a skin abscess presenting to a level I pediatric trauma emergency department (ED). Patients requiring surgical debridement were excluded; as were patients with abscesses on the face, scalp, hands or feet.

Digital images taken with a mobile phone can assist in the triage of neurosurgical patients to a level 1 trauma centre.

We investigated whether head CT images captured using a mobile phone would be of sufficient quality for neurosurgeons at a level 1 trauma centre to make decisions about whether to transfer patients from referring hospitals. All patients who had been transferred from outside facilities with reported intracranial pathology during 2008 were identified. Two emergency medicine physicians selected 1-3 images from the hospital archive that best represented the pathology described by the radiologist and the medical record.

A case of spontaneous pneumomediastinum and epidural pneumatosis in a young woman in the Emergency Department.

Background: Pneumomediastinum is a relatively rare, yet typically benign, clinical condition that usually presents in young men.

Objective: This report will describe a relatively rare event of pneumomediastinum with epidural extension in a young woman and will discuss the etiology, clinical manifestations, and treatment options for this condition.

Case Report: The patient presented to the Emergency Department (ED) with typical symptoms of shortness of breath and chest pain, but was found on computed tomography to have epidural pneumatosis.

Molar Pregnancy with False Negative β-hCG Urine in the Emergency Department.

This case describes an atypical presentation of molar pregnancy in an emergency department patient with abdominal pain and vaginal bleeding. The patient demonstrated clinical features of hydatidiform mole, including acute discharge of a large, grape-like vesicular mass, despite multiple negative urine pregnancy tests. These false-negative qualitative human chorionic gonadotropin assays were likely caused by the "high-dose hook effect" and may have delayed proper care of the patient, who displayed pulmonary choriocarcinoma at the time of diagnosis.

Can paramedics accurately identify patients who do not require emergency department care?

Objective: To determine whether paramedics can identify patients contacting 9-1-1 who do not require emergency department (ED) care.

Methods: The setting was an urban county with a two-tiered, dual response to 9-1-1 calls comprising eight local fire departments with advanced life support capabilities and a private advanced life support 9-1-1 agency with primary transport responsibilities (approximately 39,000 of the 78,000 total system patient transports in this county per year). The study population consisted of consecutive patients transported by a private transporting paramedic agency.