Current Issue: Volume 17 Issue 6

Endemic Infections

Dengue, Zika and Chikungunya: Emerging Arboviruses in the New World

Jessica Patterson, MD et al.

The arboviruses that cause dengue, chikungunya, and Zika illnesses have rapidly expanded across the globe in recent years, with large-scale outbreaks occurring in Western Hemisphere territories in close proximity to the United States (U.S.). In March 2016, the Centers for Disease Control and Protection (CDC) expanded its vector surveillance maps for A. aegypti and A. albopictus, the mosquito vectors for these arboviruses.

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Characterization of Chemical Suicides in the United States and Its Adverse Impact on Responders and Bystanders

Ayana R. Anderson, MPH

A suicide trend that involves mixing household chemicals to produce hydrogen sulfide or hydrogen cyanide, commonly referred to as a detergent, hydrogen sulfide, or chemical suicide is a continuing problem in the United States (U.S.). Because there is not one database responsible for tracking chemical suicides, the actual number of incidents in the U.S. is unknown. To prevent morbidity and mortality associated with chemical suicides, it is important to characterize the incidents that have occurred in the U.S.

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Healthcare Utilization

Alternative Destination Transport? The Role of Paramedics in Optimal Use of the Emergency Department

Michael M. Neeki, DO, MS et al.

Alternative destination transportation by emergency medical services (EMS) is a subject of hot debate between those favoring all patients being evaluated by an emergency physician (EP) and those recognizing the need to reduce emergency department (ED) crowding. This study aimed to determine whether paramedics could accurately assess a patient’s acuity level to determine the need to transport to an ED.

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Healthcare Utilization

Utility of Chest Radiography in Emergency Department Patients Presenting with Syncope

Matthew L. Wong, MD, MPH et al.

Syncope has myriad etiologies, ranging from benign to immediately life threatening. This frequently leads to over testing. Chest radiographs (CXR) are among these commonly performed tests despite their uncertain diagnostic yield. The objective is to study the distribution of normal and abnormal chest radiographs in patients presenting with syncope, stratified by those who did or did not have an adverse event at 30 days

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Prehospital Care

Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport

Joseph Tennyson, MD et al.

Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow.

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Education

Blog and Podcast Watch: Neurologic Emergencies

Andrew Grock, MD et al.

The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of neurologic emergencies from the AIR series.

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Education

Pilot Point-of-Care Ultrasound Curriculum at Harvard Medical School: Early Experience

Joshua S. Rempell, MD, MPH et al.

Point-of-care ultrasound (POCUS) is expanding across all medical specialties. As the benefits of US technology are becoming apparent, efforts to integrate US into pre-clinical medical education are growing. Our objective was to describe our process of integrating POCUS as an educational tool into the medical school curriculum and how such efforts are perceived by students.

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Use of Physician Concerns and Patient Complaints as Quality Assurance Markers in Emergency Medicine

Kiersten L. Gurley, MD et al.

The value of using patient- and physician-identified quality assurance (QA) issues in emergency medicine remains poorly characterized as a marker for emergency department (ED) QA. The objective of this study was to determine whether evaluation of patient and physician concerns is useful for identifying medical errors resulting in either an adverse event or a near-miss event.

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Adapting the I-PASS Handoff Program for Emergency Department Inter-Shift Handoffs

Author Affiliation James A. Heilman, MD Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon Moira Flanigan, BS Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon Anna Nelson, MD, PhD Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon Tom Johnson, MD, PhD Oregon Health & Science University, […]

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Critical Care

First Report of Survival in Refractory Ventricular Fibrillation After Dual-Axis Defibrillation and Esmolol Administration

Kevin M. Boehm, DO, MSc et al.

here is a subset of patients who suffer a witnessed ventricular fibrillation (VF) arrest and despite receiving reasonable care with medications (epinephrine and amiodarone) and multiple defibrillations (3+ attempts at 200 joules of biphasic current) remain in refractory VF (RVF), also known as electrical storm. The mortality for these patients is as high as 97%. We present the case of a patient who, with a novel approach, survived RVF to outpatient follow up.

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Critical Care

Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement

Rahul Vaidya, MD et al.

The use of a noninvasive pelvic circumferential compression device (PCCD) to achieve pelvic stabilization by both decreasing pelvic volume and limiting inter-fragmentary motion has become commonplace, and is a well-established component of Advanced Trauma Life Support (ATLS) protocol in the treatment of pelvic ring injuries. The purpose of this study was to evaluate the following: 1) how consistently a PCCD was placed on patients who arrived at our hospital with unstable pelvic ring injuries; 2) if they were placed in a timely manner; and 3) if hemodynamic instability influenced their use.

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Critical Care

Autoinjectors Preferred for Intramuscular Epinephrine in Anaphylaxis and Allergic Reactions

Ronna L. Campbell, MD, PhD et al.

Epinephrine is the treatment of choice for anaphylaxis. We surveyed emergency department (ED) healthcare providers regarding two methods of intramuscular (IM) epinephrine administration (autoinjector and manual injection) for the management of anaphylaxis and allergic reactions and identified provider perceptions and preferred method of medication delivery.

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Diagnostic Acumen

Rapid Diagnosis of Rhabdomyolysis with Point-of-Care Ultrasound

Alicia Nassar, BS et al.

It is important to rapidly diagnosis and treat rhabdomyolysis in order to decrease morbidity and mortality. To date there are no reports in the emergency medicine literature on the use of point-of-care ultrasound in the diagnosis of rhabdomyolysis.

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Diagnostic Acumen

E-cigarette Blast Injury: Complex Facial Fractures and Pneumocephalus

Benjamin A. Archambeau, DO et al.

Electronic cigarettes (also known as e-cigarettes or e-cigs) are becoming a popular method of recreational nicotine use over recent years. The growth of new brands and devices has been outpacing the FDA’s ability to regulate them. As a result, some of these devices fail without warning, most likely from malfunction of the lithium-ion batteries that are in close proximity to volatile compounds within the device.

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Diagnostic Acumen

Large Posterior Communicating Artery Aneurysm: Initial Presentation with Reproducible Facial Pain Without Cranial Nerve Deficit

Stacie Zelman, MD et al.

Unruptured posterior communicating artery (PCOM) aneurysms can be difficult to diagnose and, when large (≥ 7mm), represent a substantial risk to the patient. While most unruptured PCOM aneurysms are asymptomatic, when symptoms do occur, clinical manifestations typically include severe headache (HA), visual acuity loss, and cranial nerve deficit. This case report describes an atypical initial presentation of a large unruptured PCOM aneurysm with symptoms mimicking trigeminal neuralgia, without other associated cranial nerve palsies or neurologic deficits.

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Diagnostic Acumen

Spermatic Cord Anesthesia Block: An Old Technique Re-imaged

Jeffrey Gordon, MD et al.

Spermatic cord anesthesia block (SCAB) is a useful technique for providing anesthesia to males with scrotal pain. This technique has been described and published in the urology and anesthesia literature for more than 40 years. Initially described as a blind injection, anesthesia of the spermatic cord provides pain control to the scrotal contents. The technique can easily be performed under ultrasound guidance by emergency physicians and should be considered a useful option when seeking to provide pain relief to male patients with scrotal pain.

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Ultrasound Detection of Patellar Fracture and Evaluation of the Knee Extensor Mechanism in the Emergency Department

Kiersten Carter, MD et al.

Traumatic injuries to the knee are common in emergency medicine. Bedside ultrasound (US) has benefits in the rapid initial detection of injuries to the patella. In addition, US can also quickly detect injuries to the entire knee extensor mechanism, including the quadriceps tendon and inferior patellar ligament, which may be difficult to diagnose with plain radiographs.

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Role of Ultrasound in the Identification of Longitudinal Axis in Soft-Tissue Foreign Body Extraction

Al Lulla, MD et al.

Identification and retrieval of soft-tissue foreign bodies (STFB) poses significant challenges in the emergency department. Prior studies have demonstrated the utility of ultrasound (US) in identification and retrieval of STFBs, including radiolucent objects such as wood. We present a case of STFB extraction that uses US to identify the longitudinal axis of the object. With the longitudinal axis identified, the foreign body can be excised by making an incision where the foreign body is closest to the skin. The importance of this technique as it pertains to minimizing surrounding tissue destruction and discomfort for patients has not been previously reported.

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

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Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: editor@westjem.org

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.