Journal of the American College of Emergency Physicians open
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J Am Coll Emerg Physicians Open · Feb 2021
Novice emergency physician ultrasonography of optic nerve sheath diameter compared to ophthalmologist fundoscopic evaluation for papilledema.
The purpose of this study is to determine the sensitivity and specificity of novice emergency physician-performed point-of-care ultrasound diagnosis of papilledema using optic nerve sheath diameter (ONSD) against ophthalmologist-performed dilated fundoscopy. This observational study retrospectively analyzed results of ultrasound-measured ONSD of emergency department (ED) patients with suspected intracranial hypertension from a period spanning June 2014 to October 2017. ⋯ Sonographic measurement of ONSD by emergency physicians has low sensitivity but high specificity for detection of papilledema compared to ophthalmologist-conducted fundoscopy.
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J Am Coll Emerg Physicians Open · Feb 2021
Understanding timely STEMI treatment performance: A 3-year retrospective cohort study using diagnosis-to-balloon-time and care subintervals.
From the perspective of percutaneous coronary intervention (PCI) centers, locations of ST-segment elevation myocardial infarction (STEMI) diagnosis can include a referring facility, emergency medical services (EMS) transporting to a PCI center, or the PCI center's emergency department (ED). This challenges the use of door-to-balloon-time as the primary evaluative measure of STEMI treatment pathways. Our objective was to identify opportunities to improve care by quantifying differences in the timeliness of STEMI treatment mobilization based on the location of the diagnostic ECG. ⋯ Diagnosis-to-balloon-time and its care subintervals are complementary to the traditional door-to-balloon-times as measures of the STEMI treatment process. Together, they highlight opportunities to improve timely identification among ED-diagnosed patients, use of out-of-hospital cath lab activation for EMS-identified patients, and encourage pathways for referred patients to bypass PCI center EDs.
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J Am Coll Emerg Physicians Open · Feb 2021
The impact of COVID-19 on statewide EMS use for cardiac emergencies and stroke in Massachusetts.
To evaluate the impact of coronavirus disease 2019 (COVID-19) on emergency medical services (EMS) use for time-sensitive medical conditions. We examined EMS use for cardiac arrest, stroke, and other cardiac emergencies across Massachusetts during the peak of the COVID-19 pandemic, evaluating their relationship to statewide COVID-19 incidence and a statewide emergency declaration. ⋯ EMS use for certain time-sensitive conditions decreased after a statewide emergency declaration, irrespective of actual COVID-19 incidence, suggesting the decrease was related to perception instead of actual case counts. These findings have implications for public health messaging. Measures must be taken to clearly inform the public that immediate emergency care for time-sensitive conditions remains imperative.
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J Am Coll Emerg Physicians Open · Feb 2021
The "double eights mask brace" improves the fit and protection of a basic surgical mask amidst COVID-19 pandemic.
The COVID-19 pandemic has resulted in widespread shortages of personal protective equipment, including N95 respirators. Although basic surgical facemasks are more commonly available, their efficacy is limited due primarily to their poor face seal. This pilot study examined the impact of a rubber band mask brace on a basic surgical mask, as determined by quantitative fit testing. ⋯ Of the 11 subjects included in the analysis, across a range of body habitus and N95 mask fit types, all passed the quantitative fit test when the mask brace was anchored on either face shield or with a paperclip. This data suggests that although the brace does not create an N95 equivalent in terms of filtration, it would offer improved protection from airborne viruses when worn with a basic surgical mask.
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J Am Coll Emerg Physicians Open · Dec 2020
Comparison of preadministered and coadministered lidocaine for treating pain and distress associated with intranasal midazolam administration in children: A randomized clinical trial.
Pain and distress associated with intranasal midazolam administration can be decreased by administering lidocaine before intranasal midazolam (preadministered lidocaine) or combining lidocaine with midazolam in a single solution (coadministered lidocaine). We hypothesized coadministered lidocaine is non-inferior to preadministered lidocaine for decreasing pain and distress associated with intranasal midazolam administration. ⋯ Pain and distress associated with intranasal midazolam administration were similar when using coadministered or preadministered lidocaine, but our non-inferiority determination was inconclusive. Administration of intranasal lidocaine by itself was associated with a measurable degree of pain and distress.Keywords: intranasal, midazolam, anxiolysis, sedation, emergency department, emergency medicine, pain, distress, pediatric, lidocaine, laceration.