Role Of Emergency Medicine Research Articles

Sodium bicarbonate - known medication, new prospects?

Critical conditions frequently involve disturbances in blood gas analysis and electrolyte imbalances. Sodium bicarbonate has seen expanded medical use in recent years. The European Resuscitation Council (ERC) Guidelines endorse sodium bicarbonate for hyperkalemia, malignant hyperthermia, and specific drug intoxications. Its potential roles in treating intracranial hypertension and symptomatic hyponatremia are also being explored. However, its application in emergency departments (ED) remains inconsistent, particularly in profound metabolic acidosis cases. We conducted a review of sodium bicarbonate’s therapeutic uses. The evolving understanding of sodium bicarbonate's role in emergency medicine and intensive care highlights both its potential applications and associated risks. While not universally beneficial, especially in lactic acidosis, it may aid specific patient subgroups, such as those with acute kidney injury. Its use in hyperkalemia, intracranial hypertension and diabetic ketoacidosis (DKA) also presents mixed results, with potential benefits in particular contexts. Further large-scale, randomized controlled trials are needed to develop precise guidelines, ensuring its safe and effective use tailored to individual patient needs.

Deep learning and AI in reducing magnetic resonance imaging scanning time: advantages and pitfalls in clinical practice.

Magnetic resonance imaging (MRI) is a powerful imaging modality, but one of its drawbacks is its relatively long scanning time to acquire high-resolution images. Reducing the scanning time has become a critical area of focus in MRI, aiming to enhance patient comfort, reduce motion artifacts, and increase MRI throughput. In the past 5 years, artificial intelligence (AI)-based algorithms, particularly deep learning models, have been developed to reconstruct high-resolution images from significantly fewer data points. These new techniques significantly enhance MRI efficiency, improve patient comfort and lower patient motion artifacts. Improving MRI throughput with lower scanning duration increases accessibility, potentially reducing the need for additional MRI machines and associated costs. Several fields can benefit from shortened protocols, especially for routine exams. In oncologic imaging, faster MRI scans can facilitate more regular monitoring of cancer patients. In patients suffering from neurological disorders, rapid brain imaging can aid in the quick assessment of conditions like stroke, multiple sclerosis, and epilepsy, improving patient outcomes. In chronic inflammatory disease, faster imaging may help in reducing the interval between imaging to better check therapy outcomes. Additionally, reducing scanning time could effectively help MRI to play a role in emergency medicine and acute conditions such as trauma or acute ischaemic stroke. The purpose of this paper is to describe and discuss the advantages and disadvantages of introducing deep learning reconstruction techniques to reduce MRI scanning times in clinical practice.

The Role of Emergency Medicine in Intimate Partner Violence: A Scoping Review of Screening, Survivor Resources, and Barriers.

At the front line of our medical system and population health, emergency medicine (EM) settings serve as a commonly perceived place for safety. Survivors of intimate partner violence (IPV) may present to the emergency department (ED) with injuries, illness, or specifically to seek help for IPV. In 2018, the U.S. Preventive Services Task Force (USPSTF) recommended screening women of reproductive age for IPV across all healthcare settings. Our objective was to examine the application of IPV interventions, resource allocation, and persistent barriers for screening within the EM setting following the USPSTF recommendation. This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). Our initial search of two major databases, PubMed and CINAHL, found 259 articles. After screening for inclusion and exclusion criteria, 15 articles met the full study criteria. Inconsistencies in screening women for IPV in EM are still prevalent. No study used the same validated IPV screening tool and four did not specify the tool. Significant barriers to screening included time constraints, patient acuity, language barriers, staff education, and inability to connect patients to resources. There is a need for more consistent IPV screening in the EM setting, which may include the development of a standardized, inclusive screening tool, as well as additional research and sharing of best practices. Advancement of IPV identification must go beyond a recommendation with greater awareness and education changes at all levels: personal, institutional, and policy.

Real-Time Electronic Patient Portal Use Among Emergency Department Patients

Patients with inequitable access to patient portals frequently present to emergency departments (EDs) for care. Little is known about portal use patterns among ED patients. To describe real-time patient portal usage trends among ED patients and compare demographic and clinical characteristics between portal users and nonusers. In this cross-sectional study of 12 teaching and 24 academic-affiliated EDs from 8 health systems in California, Connecticut, Massachusetts, Ohio, Tennessee, Texas, and Washington, patient portal access and usage data were evaluated for all ED patients 18 years or older between April 5, 2021, and April 4, 2022. Use of the patient portal during ED visit. The primary outcomes were the weekly proportions of ED patients who logged into the portal, viewed test results, and viewed clinical notes in real time. Pooled random-effects models were used to evaluate temporal trends and demographic and clinical characteristics associated with real-time portal use. The study included 1 280 924 unique patient encounters (53.5% female; 0.6% American Indian or Alaska Native, 3.7% Asian, 18.0% Black, 10.7% Hispanic, 0.4% Native Hawaiian or Pacific Islander, 66.5% White, 10.0% other race, and 4.0% with missing race or ethnicity; 91.2% English-speaking patients; mean [SD] age, 51.9 [19.2] years). During the study, 17.4% of patients logged into the portal while in the ED, whereas 14.1% viewed test results and 2.5% viewed clinical notes. The odds of accessing the portal (odds ratio [OR], 1.36; 95% CI, 1.19-1.56), viewing test results (OR, 1.63; 95% CI, 1.30-2.04), and viewing clinical notes (OR, 1.60; 95% CI, 1.19-2.15) were higher at the end of the study vs the beginning. Patients with active portal accounts at ED arrival had a higher odds of logging into the portal (OR, 17.73; 95% CI, 9.37-33.56), viewing test results (OR, 18.50; 95% CI, 9.62-35.57), and viewing clinical notes (OR, 18.40; 95% CI, 10.31-32.86). Patients who were male, Black, or without commercial insurance had lower odds of logging into the portal, viewing results, and viewing clinical notes. These findings suggest that real-time patient portal use during ED encounters has increased over time, but disparities exist in portal access that mirror trends in portal usage more generally. Given emergency medicine's role in caring for medically underserved patients, there are opportunities for EDs to enroll and train patients in using patient portals to promote engagement during and after their visits.

Non-invasive imaging in acute decompensated heart failure with preserved ejection fraction.

Non-invasive imaging plays an increasingly important role in emergency medicine, given the trend towards smaller, portable ultrasound devices, the integration of ultrasound imaging across diverse medical disciplines, and the growing evidence supporting its clinical benefits for the patient. Heart failure with preserved ejection fraction (HFpEF) provides a compelling illustration of the impactful role that imaging plays in distinguishing diverse clinical presentations of heart failure with numerous associated comorbidities, including pulmonary, renal, or hepatic diseases. While a preserved left ventricular ejection fraction might misguide the clinician away from diagnosing cardiac disease, there are several clues provided by cardiac, vascular, and lung ultrasonography, as well as other imaging modalities, to rapidly identify (decompensated) HFpEF. Congestion remains the primary reason why patients with heart failure (irrespective of ejection fraction) seek emergency care. Furthermore, comprehensive phenotyping is becoming increasingly important, considering the development of targeted treatments for conditions exhibiting HFpEF physiology, such as cardiac amyloidosis. Timely recognition in such cases has lasting implications for long-term outcomes.

An [illustrative] update on pediatric emergency medicine ultrasound: part 1 - trauma and thoracic applications.

Point-of-care ultrasound (POCUS) plays an essential role in emergency medicine, providing a range of diagnostic and procedural modalities. It does not involve any ionizing radiation and can improve procedural accuracy and safety. The role of POCUS in the care of pediatric patients differs somewhat from that of adult patients, as there are a range of conditions specific to infants and children. The technical background of pediatric POCUS and its current applications for trauma and thoracic scanning are reviewed and illustrated in this first article of this series.

Role of emergency medicine in addressing the health needs of the LGBT+ community

Role of emergency medicine in addressing the health needs of the LGBT+ community

Application of Compensation Rules in the Four-quadrant Graphical Tool for Arterial Blood Gas Interpretation: A Cross-sectional Study

Introduction: Arterial Blood Gas (ABG) interpretation plays an indispensable role in emergency medicine and the care of intensive care patients, yet it remains a challenging task. Although several graphical methods exist for ABG interpretation, they are not commonly used at the bedside. The existing graphs are complicated, difficult to understand, and unable to diagnose many disorders. In previous research articles, the current author developed and published a four-quadrant graphical tool for ABG interpretation. The tool incorporates compensation rules, which are crucial for identifying changes resulting from compensations or the presence of a second primary acid-base disorder. Aim: To develop a method for applying compensation rules in a four-quadrant graphical tool to interpret ABG reports for complex acid-base disorders in clinical practice. Materials and Methods: This cross-sectional study was conducted at Shri Sathya Sai Medical College and Research Institute, Chennai, Tamil Nadu, India, from November 2022 to April 2023. A total of 232 ABG samples were utilised, and the values of pH, pCO2, HCO3, Standard HCO3, and Standard Base Excess (SBE) were recorded. These values were classified according to different acid-base disorders. Three derived ratios were calculated using the values of pCO2, bicarbonate, and standard bicarbonate, as these ratios change in various acid-base disorders and provide clues for differentiating between different acid-base disturbances. A four-quadrant graph method was constructed using the values of SBE, pCO2, and these ratios. Subsequently, compensation rules were applied to this graph method. Results: The four-quadrant method facilitated the easy identification of different acid-base disorders, and the application of compensation rules further simplified the identification of mixed or compensatory acid-base disorders. Conclusion: The application of compensation rules in this four- quadrant graphical tool for ABG interpretation distinguishes this tool as a unique method among existing approaches. This tool offers an optimal and simplified approach for interpreting ABG results for complex acid-base disturbances, making it highly suitable for clinical practice at the bedside.

Winter Walk.

Winter Walk is a photo essay meant to be an inspirational commentary on emergency medicine's role in meeting the needs of our most vulnerable patients. Oftentimes, the social determinants of health, now well reviewed in the modern medical school curriculum, become intangible concepts that get lost amongst the busy environment of the emergency department. The photos within this commentary are striking and will move readers in various ways. The authors hope that these powerful images generate a mix of emotion that ultimately motivates emergency physicians to embrace the emerging role in addressing the social needs of our patients both inside and outside the emergency department.

Dynamic Duo: The Synergistic Relationship between Surgeons and Anesthesiologists in Emergency Medicine

Surgeons and anesthesiologists play a critical role in emergency medicine, where timely intervention can mean the difference between life and death. The success of emergency medical interventions often relies heavily on the coordinated efforts of these two professions, who work in close collaboration to provide safe and effective care. Surgeons perform the necessary surgical procedures, while anesthesiologists administer anesthesia and monitor the patient’s vital signs throughout the procedure. In this paper, we explore the vital role of surgeons and anesthesiologists in emergency medicine. We review the various situations where their expertise is needed, such as trauma cases, organ failure, and life-threatening infections. We also examine the challenges and opportunities for collaboration that exist in emergency medicine, including the need for effective communication, teamwork, and coordination. Moreover, we highlight the importance of advanced training and experience for both professions, as they face unique challenges and stressors in emergency situations. We discuss the need for ongoing education and professional development to ensure that they are equipped with the knowledge and skills

Airway Management for the Critically Ill Patient in the Emergency Department

Airway management is both a fundamental skill and resuscitative treatment that has taken a prominent role in emergency medicine. In the past few decades there have been many advancements in airway management particularly in critically ill patients. Technology has been developed and adapted to provide improved visualization for endotracheal intubation as well as supportive strategies for oxygenation and optimization of medications. In this review we will discuss the current practices and literature in airway management of critically ill patients including medication optimization and airway visualization techniques for first pass success.

Critical Point-of-care Ultrasound Diagnosis of Fournier's Gangrene: A Case Report.

IntroductionFournier’s gangrene is a severe, necrotizing, and potentially fatal, soft tissue infection of the perineum that can be difficult to diagnose clinically. Point-of-care ultrasound (POCUS) has established a critical role in emergency medicine as a quick diagnostic tool due to its safety, accuracy, and cost effectiveness.Case ReportWe present a case in which POCUS was used to rapidly confirm diagnosis in an unstable, severely septic patient presenting to the emergency department with Fournier’s gangrene.ConclusionPoint-of-care ultrasound can be used to make the diagnosis of Fournier’s gangrene in critical patients when other diagnostic modalities are not feasible due to a patient’s clinical state.

Emergency Medicine's Role in the Crossroads of Social Revolution and the COVID-19 Pandemic.

Emergency Medicine's Role in the Crossroads of Social Revolution and the COVID-19 Pandemic.

Medical errors during COVID-19 pandemic: the role of emergency medicine

Objective: Nowadays, many countries all over the world are involved with COVID-19 and the number of new cases and deaths are on a rise. The role of emergency medicine and physician-led triage is important in this period. We report some near missed cases in our academic center related to this pandemic. Case Presentation: We report 5 cases that missed triage or received delayed diagnosis because of COVID-19 suspicion. Some cases are life threatening. Conclusion: Although COVID-19 is the main health concern these days, other critical conditions should be considered. Stabilizing patients before transferring them between hospitals should be the essential goal of emergency department whether the patient is Corona virus infected or not. And before any intervention, the safety of healthcare workers must be ensured.

Emergency and intensive care medicine aspects of COVID-19 infections

Klinisches ProblemDie COVID-19-Pandemie hat in kürzester Zeit zu einer Anpassung des deutschen Gesundheitswesens an die gegebenen Herausforderungen geführt. Während der kassenärztliche Bereich die Betreuung von gering symptomatischen Patienten mit niedrigem Risiko übernimmt, richten die Krankenhäuser ihre Ressourcen zielgerichtet auf die Versorgung von schwer erkrankten COVID-19-Patienten aus.Aufgaben der Notfall- und IntensivmedizinDie Notfallmedizin hat die Aufgabe, Verdachtsfälle rasch zu detektieren, die Schwere der Krankheit einzustufen sowie die notwendige Initialtherapie einzuleiten. Zudem müssen die Patientenströme in das Krankenhaus so gelenkt werden, dass eine optimale Versorgung stattfindet, ohne eine Infektionsgefährdung für Mitpatienten und Gesundheitspersonal. Insbesondere bei älteren und vorerkrankten Patienten weist eine COVID-19-Infektion eine hohe Letalität auf, wenn sich ein Organversagen entwickelt. Trotz optimaler intensivmedizinischer Therapie bleibt die Letalität in diesen Fällen hoch.Neue TherapieverfahrenDie frühestmögliche Detektion einer SARS-CoV-2-Infektion ist die Hauptaufgabe der Notfallmedizin. Die Intensivmedizin übernimmt die Behandlung des SARS-CoV-2-induzierten Organversagens, wobei das Lungenversagen bei diesen Patienten differenzierter Beatmungstherapien bedarf.DiagnostikAls Virusnachweis wird eine Polymerase-Kettenreaktion (PCR) auf SARS-CoV‑2 durchgeführt, ergänzt um eine Thoraxsonographie, ein Thoraxröntgenbild und eine Thorax-Computertomographie. Die radiologische Diagnostik hilft auch bei der Beurteilung des COVID-19-Pneumonie-Typs.Empfehlung für die PraxisDie SARS-CoV-2-Diagnose ist nur durch den Virusnachweis in der PCR bewiesen. Die frühzeitige sonographische und radiologische ergänzt die Diagnostik und erlaubt die Differenzialtherapie für eine COVID-19-Pneumonie.

Hypertension Management in Emergency Departments.

BACKGROUNDElevated blood pressure (BP) is pervasive among patients that visit emergency departments (EDs) for their care.METHODSIn this review article, we outline the current approach to the management of these individuals and highlight the crucial role emergency medicine clinicians play in reducing the morbidity associated with elevated BP.RESULTSWe highlight the critical importance of immediate treatment when elevated BP contributes to new or worsening end-organ injury but emphasize that such hypertensive emergencies are rare. For the vast majority of patients with elevated BP in the ED who do not have new or worsening end-organ injury from elevated BP, immediate BP reduction within the ED is not recommended or safe. Nonetheless, within weeks after an ED visit, there is a pressing need to improve the care of patients with elevated or previously undiagnosed hypertension. For many, it may be their only regular point of engagement with the healthcare system. To address this, we present novel perspectives that envision a new role for emergency medicine in chronic hypertension management—one that acknowledges the significant population-level gaps in BP control that contribute to disparities in cardiovascular disease and sets the stage for future changes in systems-based practice.CONCLUSIONSEmergency medicine plays a key and evolving role in reducing morbidity associated with elevated BP.

Self reported involvement in emergency medicine among GPs in Norway

Objective: To examine general practitioners’ (GPs’) perception of their role in emergency medicine and participation in emergency services including ambulance call outs, and the characteristics of the GPs and casualty clinics associated with the GPs’ involvement in emergency medicine.Design: Cross-sectional online survey.Setting: General practice.Subjects: General practitioners in Norway (n = 1002).Main outcome measures: Proportion of GPs perceiving that they have a large role in emergency medicine, regularly being on call, and the proportion of ambulance callouts with GP participation.Results: Forty six percent of the GPs indicated that they play a large role in emergency medicine, 63 percent of the GPs were regularly on call, and 28 percent responded that they usually took part in ambulance call outs. Multivariable logistic regression analyses indicated that these outcomes were strongly associated with participation in multidisciplinary training. Furthermore, the main outcomes were associated with traits commonly seen at smaller casualty clinics such as those with an absence of nursing personnel and extra physicians, and based on the distance to the hospital.Conclusion: Our findings suggest that GPs play an important role in emergency medicine. Multidisciplinary team training may be important for their continued involvement in prehospital emergencies.Key Points Health authorities and other stakeholders have raised concerns about general practitioner’s (GPs) participation in emergency medicine, but few have studied opinions and perceptions among the GPs themselves. • Norwegian GPs report playing a large role in emergency medicine, regularly being on call, and taking part in selected ambulance call outs. • A higher proportion of GPs who took part in team training perceived themselves as playing a large role in emergency medicine, regularly being on call, and taking part in ambulance call outs. • These outcomes were also associated with attributes commonly seen at smaller casualty clinics.

Poisonings in Germany : Poisons Centres, Medical Management and National Monitoring

Illnesses caused by exposure to extracorporeal artificial substances play a major role in emergency medicine, family medicine, and environmental medicine. The current situation of medical poisoning management and national reporting of poisonings in Germany are described. The information and data presented here are derived from a literature review and from stakeholder interviews. Eight poison centres (PCs) offer consultation supporting the diagnosis and treatment of poisoning cases in Germany today. Furthermore, those affected, their relatives and first aiders contact these German PCs, mainly because of asuspected poisoning. German PCs are also contacted by those affected and by institutions in other situations when expert toxicological judgement is needed, especially in cases with an environmental background. Often, interpretation of analytical laboratory results of body fluid samples or environmental samples are requested, or reference to environmental medicine treatment facilities is made. The PCs and the German Federal Institute for Risk Assessment (BfR) cooperate on the national reporting of the risks of poisoning for the population. In addition, the BfR collects and evaluates poisoning reports from German medical doctors that have been directly submitted. Apilot project on anational monitoring of poisonings should collate future case reports. Anextensive and current overview of poisonings in Germany is aprerequisite for the identification of unsafe products and to fully comply with the international reporting needs of the German Federal Government in the case of chemical outbreaks and the resulting suspected cases.

The Prescription Opioid Epidemic: Social Media Responses to the Residents’ Perspective Article

In June 2014, Annals of Emergency Medicine collaborated with the Academic Life in Emergency Medicine (ALiEM) blog-based Web site to host an online discussion session featuring the Annals Residents' Perspective article "The Opioid Prescription Epidemic and the Role of Emergency Medicine" by Poon and Greenwood-Ericksen. This dialogue included a live videocast with the authors and other experts, a detailed discussion on the ALiEM Web site's comment section, and real-time conversations on Twitter. Engagement was tracked through various Web analytic tools, and themes were identified by content curation. The dialogue resulted in 1,262 unique page views from 433 cities in 41 countries on the ALiEM Web site, 408,498 Twitter impressions, and 168 views of the video interview with the authors. Four major themes about prescription opioids identified included the following: physician knowledge, inconsistent medical education, balance between overprescribing and effective pain management, and approaches to solutions. Free social media technologies provide a unique opportunity to engage with a diverse community of emergency medicine and non-emergency medicine clinicians, nurses, learners, and even patients. Such technologies may allow more rapid hypothesis generation for future research and more accelerated knowledge translation.

Emergency Medicine's Role in the Management of a Respiratory Illness Multiple Casualty Incident

Emergency Medicine's Role in the Management of a Respiratory Illness Multiple Casualty Incident