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.

Emergency Medical Service Providers' Perspectives towards Management of the Morbidly Obese.

Objective: Obesity is a growing epidemic in the United States with increasing burden to the health care system. Management and transport of the morbidly obese (MO) pose challenges for Emergency Medical Services (EMS) providers. Though equipment and resources are being directed to the transport of the obese, little research exists to guide these efforts.

Impact of an electronic medical record system on emergency department discharge instructions for patients with hypertension.

Background: Uncontrolled hypertension is associated with significant patient morbidity and health care costs. Many patients evaluated in the emergency department (ED) do not regularly consult health care providers and have socioeconomic barriers to receiving primary care. Hypertension screening and counseling has been advocated as a routine part of ED care.

Occipital lobe epilepsy presenting as Charles Bonnet syndrome.

Charles Bonnet syndrome describes visual field or acuity loss with complex hallucinations. This typically occurs in the elderly with preexisting visual impairment. We describe a patient who presented to the emergency department with acute hemianopsia and intermittent complex hallucinations.

Course of untreated high blood pressure in the emergency department.

Introduction: No clear understanding exists about the course of a patient's blood pressure (BP) during an emergency department (ED) visit. Prior investigations have demonstrated that BP can be reduced by removing patients from treatment areas or by placing patients supine and observing them for several hours. However, modern EDs are chaotic and noisy places where patients and their families wait for long periods in an unfamiliar environment.

Agreement between emergency medical services and expert blood pressure measurements.

Background: Emergency Medical Services (EMS)-measured blood pressures (BPs) are utilized for administering medications in the field and for triage decisions. Retrospective work has demonstrated poor agreement between EMS and Emergency Department (ED) BP but has lacked a valid, reliable reference standard.

Study Objectives: To compare EMS BP measurements with those of trained research assistants (RA) and observe measurement technique for sources of error.

Barriers to screening and intervention for ED patients at risk for undiagnosed or uncontrolled hypertension.

Objectives: We describe clinician-reported knowledge of the Joint National Committee (JNC7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure definitions of Stage I hypertension; perceived causes of elevated blood pressure; barriers to blood pressure re-assessment; risk of adverse events associated with the elevated blood pressure.

Methods: Health care providers from five emergency departments completed a questionnaire assessing knowledge of blood pressure criteria for hypertension, perceived causes of elevated blood pressures, barriers to re-assessment, and perceived risk of an adverse event at one year in a patient within three defined systolic and diastolic blood pressure ranges. Descriptive statistics were used to analyze the data.

An Internet misadventure: bloodroot salve toxicity.

Introduction: Bloodroot (Sanguinaria canadensis) is a perennial flowering plant native to North America. Sanguinarine, a benzylisoquinoline alkaloid, is a powerful escharotic contained in the root. Herbalists prescribe bloodroot for multiple conditions including skin lesions and sore throats.

Evaluation, management, and referral of elderly emergency department patients with elevated blood pressure.

Objectives: To determine blood pressure (BP) reassessment rates and to describe the evaluation and outpatient referral rates of elderly emergency department (ED) patients with elevated BP.

Methods: This was a retrospective cohort of patients who were at least 60 years, presented with a systolic BP of at least 140 mmHg or diastolic BP at least 90 mmHg, and were discharged from the ED. BP measurements, ancillary testing, and discharge instructions were obtained from a random selection of medical records.

Provider self-report and practice: reassessment and referral of emergency department patients with elevated blood pressure.

Background: We attempted to identify patient factors associated with blood pressure (BP) reassessment and to compare health-care provider self-reported reassessment and referral to actual practice in an emergency department (ED) setting.

Methods: Provider reassessment and referral practices were determined through systematic review of 1,250 medical records at five EDs. Medical records were included if patients were > or =18 years, nonpregnant, presented with a systolic (SBP) > or =140 or diastolic BP (DBP) > or =90 mm Hg, and discharged.

Utility of routine testing for patients with asymptomatic severe blood pressure elevation in the emergency department.

Study Objective: Recommendations for the treatment of emergency department (ED) patients with asymptomatic severely elevated blood pressure advise assessment for occult, acute hypertensive target-organ damage. This study determines the prevalence of unanticipated, clinically meaningful test abnormalities in ED patients with asymptomatic severely elevated blood pressure.

Methods: This was a prospective observational study at 3 urban academic EDs.

Analysis of the psychoactive terpenoid salvinorin A content in five Salvia divinorum herbal products.

Study Objective: To determine the content of the hallucinogen salvinorin A in a variety of Salvia divinorum herbal products and to compare the content with the label claims of potency and purity.

Design: Laboratory analysis.

Setting: University-affiliated laboratory.

Emergency medicine research directors and research programs: characteristics and factors associated with productivity.

Background: Periodic surveys of research directors (RDs) in emergency medicine (EM) are useful to assess the specialty's development and evolution of the RD role.

Objectives: To assess associations between characteristics and research productivity of RDs and EM programs.

Methods: A survey of EM RDs was developed using the nominal group technique and pilot tested.

Evaluation and treatment of patients with severely elevated blood pressure in academic emergency departments: a multicenter study.

Study Objective: Current guidelines advise that emergency department (ED) patients with severely elevated blood pressure be evaluated for acute target organ damage, have their medical regimen adjusted, and be instructed to follow up promptly for reassessment. We examine factors associated with performance of recommended treatment of patients with severely elevated blood pressure.

Methods: Observational study performed during 1 week at 4 urban, academic EDs.

The validity of emergency department triage blood pressure measurements.

Objective: Automated blood pressure (ABP) devices are ubiquitous at emergency department (ED) triage. Previous studies failed to evaluate ABP devices against accepted reference standards or demonstrate triage readings as accurate reflections of blood pressure (BP). This study evaluated ED triage measurements made using an ABP device and assessed agreement between triage BP and BP taken under recommended conditions.