学术急诊医学 (AEM) 是学术急诊医学协会 (SAEM) 的官方月刊，发布与急诊医学的实践、教育进步和调查相关的信息。它是急诊医学专业的第二大同行评审科学期刊。AEM 的目标是推进急诊医学的科学、教育和临床实践，为学术急诊医学界发声，以及促进 SAEM 的目标和目标。世界各地的会员和非会员都依赖该杂志获取与急诊医学相关的转化医学，以及临床新闻、案例研究等。每期都包含与研究、教育进步相关的信息, 和急诊医学实践。主题多种多样，包括临床前研究、临床主题、卫生政策和教育方法。SAEM 成员的研究对期刊的科学内容和发展做出了重大贡献。

Academic Emergency Medicine (AEM) is the official monthly journal of the Society for Academic Emergency Medicine (SAEM), dedicated to publishing information related to the practice, educational advancements, and research in emergency medicine. As the second-largest peer-reviewed scientific journal in the field of emergency medicine, AEM aims to advance the science, education, and clinical practice of emergency medicine, provide a voice for the academic emergency medicine community, and promote the goals of SAEM. Members and non-members from around the world rely on this journal for translational medicine related to emergency medicine, as well as clinical news and case studies. Each issue includes information related to research and educational advancements, covering a diverse range of topics such as preclinical research, clinical topics, health policy, and educational methods. Research from SAEM members has made significant contributions to the scientific content and development of the journal.

《学术急诊医学》(Academic Emergency Medicine, AEM) 是学术急诊医学协会(SAEM)的官方月刊，专注于发布与急诊医学实践、教育进步和研究相关的信息。作为急诊医学领域的第二大同行评审科学期刊，AEM旨在推动急诊医学的科学研究、教育和临床实践，为学术急诊医学界发声，并促进SAEM的目标。来自世界各地的会员和非会员都依赖该杂志获取与急诊医学相关的转化医学、临床新闻和案例研究等信息。每期内容涵盖研究和教育进步的最新动态，以及急诊医学实践的多样主题，包括临床前研究、临床主题、卫生政策和教育方法。SAEM成员的研究对期刊的科学内容和发展做出了重要贡献。

Academic Emergency Medicine

ACADEMIC EMERGENCY MEDICINE 2012; 19: 421–429 © 2012 by the Society for Academic Emergency Medicine Abstract Objectives: This study assessed the feasibility of an investigational vagus nerve stimulation (VNS) device for treating acute asthma exacerbations in patients not responding to at least 1 hour of initial standard care therapy. Methods: This was a prospective, nonrandomized study of patients treated in the ED for moderate to severe acute asthma (forced expiratory volume in 1 second [FEV 1 ] 25% to 70% of predicted). Treatment entailed percutaneous placement of an electrode near the right carotid sheath and 60 minutes of VNS and continued standard care. VNS voltage was adjusted to perceived improvement, muscle twitching, or adverse events (AEs). All AEs, vital signs, FEV 1 , perceived work of breathing (WOB), and final disposition were recorded. Results: Twenty‐five subjects were enrolled. There were no serious AEs and no significant changes in vital signs. No subject required terminating VNS. One patient had minor bleeding from the procedure, and one had a hematoma and withdrew prior to VNS. AEs related to VNS were temporary and included cough (1 of 24), swallowing difficulty (2 of 24), voice change (2 of 24), and muscle twitching (14 of 24). These resolved when VNS ended. The FEV 1 improved at 15 minutes (median = 15.8%, 95% confidence interval [CI] = 9.3% to 22.4%), 30 minutes (median = 21.3%, 95% CI = 8.1% to 36.5%), and 60 minutes (median = 27.5%, 95% CI = 11.3% to 43.5%). WOB improved at 15 minutes (median = 53.9%, 95% CI = 33.7% to 73.9%), 30 minutes (median = 69.1%, 95% CI = 56.4% to 81.8%), and 60 minutes (median = 81.0%, 95% CI = 68.5% to 93.5%). Conclusions: Percutaneous VNS did not result in serious AEs and was associated with improvements in FEV 1 and perceived dyspnea. Percutaneous VNS appears to be feasible for use in the treatment of moderate to severe acute asthma in patients unresponsive to initial standard care treatment.

James R. Miner

Lawrence M. Lewis

Giselle S. Mosnaim

Joseph Varon

Daniel Theodoro

Thomas J. Hoffmann

Feasibility of Percutaneous Vagus Nerve Stimulation for the Treatment of Acute Asthma Exacerbations

经皮迷走神经刺激治疗急性哮喘加重的可行性

Kurt A. Smith

Kevin High

Sean P. Collins

Wesley H. Self

A Preprocedural Checklist Improves the Safety of Emergency Department Intubation of Trauma Patients

术前清单提高急诊科创伤患者插管安全性的研究

ACADEMIC EMERGENCY MEDICINE 2012; 19:265–273 © 2012 by the Society for Academic Emergency Medicine Abstract Objectives: This study was performed to evaluate the burn wound–healing efficacy of crocodile oil from Crocodylus siamensis by employing deep second‐degree burns in a Wistar rat model. Methods: Twenty‐four rats were assigned equally into four groups using a random‐number table, and two burns were created on the dorsum of each animal except for the sham group. The three treatment groups received with saline solution (12 burns, served as negative control), silver sulfadiazine (12 burns, served as positive control), or crocodile oil (12 burns). Silver sulfadiazine cream was used as standard care, and the treatments were repeated twice daily for 28 days. After day 28 the animals were euthanized and the wounds were removed for quantitative real‐time polymerase chain reaction, histologic, and immunohistochemical study. Results: Crocodile oil accelerated the wound‐healing process as indicated by a significant decrease in wound closure time in comparison to the burn control and silver sulfadiazine treatment groups. Histologic results showed well‐organized and distributed skin structure and collagen deposition in the animals treated with crocodile oil. Transforming growth factor‐β1 (TGF‐β1), a key cytokine promoting scarring, was also observed to play a role in the burn wound healing. Immunohistochemical staining results showed the negative expression of TGF‐β1 and Smad3 in the 28‐days‐postburn skin of crocodile oil group versus positive in the epidermis of burn controls. Compared to the burn control group, expressions of TGF‐β1 and Smad3 mRNA decreased significantly (p &lt; 0.01) in the 28‐days‐postburn skin of the crocodile oil group. Conclusions: Our results showed that crocodile oil could enhance cutaneous burn wound healing and reduce scar formation in rats, which might be related to TGF‐β1/Smad3 signaling.

Hua‐Liang Li

Li‐Ping Chen

Yong‐Hua Hu

Yan Qin

Ge Liang

You‐Xiong Xiong

Qing‐Xi Chen

Crocodile Oil Enhances Cutaneous Burn Wound Healing and Reduces Scar Formation in Rats

鳄鱼油促进大鼠皮肤烧伤伤口愈合并减少瘢痕形成

Abstract Objectives The Centers for Disease Control and Prevention's field triage guidelines (FTG) are routinely used by emergency medical services personnel for triaging injured patients. The most recent (2011) FTG contains physiologic, anatomic, mechanism, and special consideration steps. Our objective was to systematically review the criteria in the mechanism and special consideration steps that might be predictive of serious injury or need for a trauma center. Methods We conducted a systematic review of the predictive utility of mechanism and special consideration criteria for predicting serious injury. A research librarian searched in Ovid Medline, EMBASE, and the Cochrane databases for studies published between January 2011 and February 2021. Eligible studies were identified using a priori inclusion and exclusion criteria. Studies were excluded if they lacked an outcome for serious injury, such as measures of resource use, injury severity scores, mortality, or composite measures using a combination of outcomes. Given the heterogeneity in populations, measures, and outcomes, results were synthesized qualitatively focusing on positive likelihood ratios (LR+) whenever these could be calculated from presented data or adjusted odds ratios (aOR). Results We reviewed 2418 abstracts and 315 full‐text publications and identified 42 relevant studies. The factors most predictive of serious injury across multiple studies were death in the same vehicle (LR+ 2.2–7.4), ejection (aOR 3.2–266.2), extrication (LR+ 1.1–6.6), lack of seat belt use (aOR 4.4–11.3), high speeds (aOR 2.0–2.9), concerning crash variables identified by vehicle telemetry systems (LR+ 4.7–22.2), falls from height (LR+ 2.4–5.9), and axial load or diving (aOR 2.5–17.6). Minor or inconsistent predictors of serious injury were vehicle intrusion (LR+ 0.8–7.2), cardiopulmonary or neurologic comorbidities (LR+ 0.8–3.1), older age (LR+ 0.6–6.8), or anticoagulant use (LR+ 1.1–1.8). Conclusions Select mechanism and special consideration criteria contribute positively to appropriate field triage of potentially injured patients.

Joshua R. Lupton

Cynthia Davis‐O'Reilly

Rebecca M. Jungbauer

Craig D. Newgard

Mary E. Fallat

Joshua B. Brown

N. Clay Mann

Gregory J. Jurkovich

Eileen Bulger

Mark L. Gestring

E. Brooke Lerner

Roger Chou

Annette M. Totten

Mechanism of injury and special considerations as predictive of serious injury: A systematic review

损伤机制及特殊考虑作为严重损伤预测因素的系统综述

In their response to our article on sequence order for rapid sequence intubation drugs, Bourke and Douglas raised concerns about the risk of awake paralysis in patients who receive a paralytic before a sedative agent. This is likely the main reason behind the extremely low rate of using neuromuscular blockade agent first.1 We agree that awake paralysis can be a traumatic experience. However, as acknowledged by the authors, the references on psychotrauma induced by the recall of paralysis sensation are indeed from other settings and focus on longer durations of general anesthesia, rather than the very short period involved in emergency intubation.2-4 Because sedatives reportedly act faster than paralytic (15–45 s vs. 50–70s), the estimated theoretical duration of awake paralysis during the intubation procedure is only a few seconds. To our knowledge, no reference suggests that such a brief period of awake paralysis could induce psychotrauma. Furthermore, in the trial by Driver et al.,5 recall of intubation procedure (not overall recall of awake paralysis) occurred in 13/225 (5.8%) patients who underwent sedative first and in 17/618 (2.8%) patients who underwent neuromuscular blocking agent first. This results in a 3% lower risk for neuromuscular blocking agent first. Although this was only a point estimate, and not the primary focus of this study, the possibility that the effect is actually inversed is unlikely. That being said, we agree that absence of evidence does not equate to evidence of absence, and future studies assessing the effect of sequence order should indeed include an evaluation of both rate of paralysis awareness and its subsequent risk of posttraumatic stress disease. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Yonathan Freund

Response to Bourke and Douglas

对Bourke和Douglas的回应

The article titled "Associations between Emergency Severity Index and patient experience of care in the emergency department" by Mathews et al.1 was reviewed with great interest. This study examined the relationship between triage classification and patient experience across several dimensions of care. The study reported that for getting timely care, patients triaged as emergent responded 9.7 percentage points more positively than patients triaged as nonurgent, whereas urgent patients did not differ significantly from nonurgent. It seems that this 9.7-percentage-points-better experience for emergent patients needs further explanation. Readers may assume that this 10-percentage-points difference guarantees quality of care for emergent patients. Although this 10-percentage-points difference compared to other nonurgent patients is significant, it is not enough to meet the expectations of the quality of care in the emergency department (ED). A 10% increase means that for every 10 patients assigned to the emergent level, only one emergent patient had a better experience than nonurgent patients in getting timely care. Although this trend is good, it indicates that a significant portion of urgent and nonurgent patients also report getting timely care. In addition, urgent patients gave a higher score in overall rating of the ED (4.9 vs. 5.36) and a willingness to recommend the ED to others (5.98 vs. −0.26) compared to emergent patients. It may be concluded that the waiting time for urgent patients may not be long enough than emergent patients. A fact to bear in mind is the mission of ED is to provide care and treatment to critically ill patients in first priority.2 Almost 90% of EDs suffer from overcrowding in some periods, but about 40% of EDs experience overcrowding daily and are mostly faced with a shortage of resources.3 Overcrowding may also cause a lot of fatigue among the staff because the number of nonemergent patients is high and thus it may reduce the quality of care for critically ill patients.4 Since 80% of ED patients are nonemergent patients,5 the quality criteria among emergent patients are ignored mostly in studies conducted on the quality of ED care and it deserve more attention. Therefore, in the overcrowding era, EDs probably cannot provide a better experience of timely treatment for all patients and therefore they must prioritize critically ill patients. Thus, small differences in providing timely care and treatment between emergent patients and nonurgent patients can give a warning sign that the quality of care for critically ill patients may be at serious risk. The efforts to increase the satisfaction of urgent patients could reduce the quality of care and treatment of critically ill patients and their tendency to recommend the ED to other nonurgent patients (−0.26). However, a limitation is that we do not know how long the patients expected to get care timely and whether the key parts of the care were provided to the patients at the very beginning or only got a part of the care quickly. The author declares no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Amir Mirhaghi

Ten‐percentage‐points difference is not enough for a better experience in getting timely care for emergent patients

急诊患者及时就医体验的提升，十分百分点的差距并不足够

In reply: We thank the authors for their thoughtful response to the Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4) guideline with respect to the management of alcohol use disorder (AUD) in the emergency department (ED). The authors highlight two issues that they believe are morally injurious to ED care teams. Firstly, they do not agree with our good practice statements related to prescribing anticraving medications for patients with AUD. They contend that the outpatient resources we suggest (an addiction medicine or primary care physician or other health care provider) may not be feasible in all settings and are morally injurious because we "may be setting another standard that we cannot meet due to circumstances beyond our control." Secondly, the authors frame individuals with AUD as "unwilling participants" in their care and assert that ED staff "should not be expected to handle this level of violence and aggression." We see patients with other chronic health conditions who decline our help. This should not prevent us from providing care for the willing. We sympathize with the authors regarding providing care in health systems not equipped to address our patients' true needs. Sadly, AUD is but one of several conditions we see regularly without being able to control timely access to ongoing and essential follow-up care. This is the unfortunate reality of our work. We did consider the feasibility, equity, costs, and acceptability of our recommendations as part of our extensive evidence to decision framework process (please see their Appendixes S3, S4, and S5). While each practice environment will have its own challenges, on balance, our recommendations are reasonable and actionable and will improve patient outcomes without adding significantly to clinician workload. Every patient, regardless of their diagnosis, deserves our compassion and support. Where safe and effective treatments exist, we must offer them. Moral distress and compassion fatigue are real problems in emergency medicine; however, watching patients die from a treatable condition due to our inaction may the most morally distressing thing we can do, especially when effective and available treatments are available. The authors refer to the "severity of disease" as an additional impairment for follow-up; however, offering no treatment to patients with severe AUD surely cannot be a moral option. Do we turn our backs on patients with end stage cancer? Patients with AUD in the ED face high mortality rates,1 and rates of ED visits for AUD are increasing.2 Lack of prescribing knowledge for anticraving medications and variability in practice among those that do know how to prescribe3 result in many ED patients with AUD never being offered this safe and effective evidence-based treatment.4 We hope that our guidelines will streamline the process of initiating treatment and hopefully, over time, reduce the number of patients re-presenting to ED's for the same diagnosis. Moral injury is a complex concept. Within the health care context, it is commonly understood to manifest when work conditions prevent physicians from providing their best care.5 As providers, we can only control what we do in our own departments, and our recommendations equip emergency medicine providers with the ability to provide the care that AUD patients need. Offering treatment for a chronic, deadly yet treatable medical condition creates hope for both providers and patients.6 The alternative further creates hopelessness and burnout for providers. Changing the course of AUD patients is rewarding, and it builds compassion in those who provide this care.6, 7 The antidote for moral distress is compassion and hope not inaction and stigma. Society for Academic Emergency Medicine. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Bjug Borgundvaag

Hasan Sheikh

<scp>GRACE</scp>‐4 letter to the editor “Opening invisible wounds” response

《GRACE》-4 致编辑的信“揭开看不见的伤口”回应

Patrick Maher

Ryan LaFollette

Colin F. Greineder

Paul I. Musey

Acad Emerg Med

Algorithmic identification of overlapping abstract submissions at the Society for Academic Emergency Medicine annual meeting

《算法识别学术急诊医学学会年会重叠的摘要提交》

Elyssia M. Bourke

Ned W. R. Douglas

Effect of administration sequence of induction agents on first‐attempt failure during emergency intubation

诱导剂给药顺序对急诊插管首次尝试失败的影响

Abstract Background Uncontrolled hemorrhage is a leading cause of preventable death in trauma. Tourniquets (TQs) are commonly used to control bleeding in the prehospital setting, although their application is associated with risks. Therefore, this study aimed to identify complications arising from TQ use and to examine contributing risk factors. Methods This retrospective observational study reviewed the medical records of adult trauma casualties (&gt;18 years) hospitalized at Chaim Sheba Medical Center (SMC) between 2010 and 2020 who had a TQ applied in the prehospital setting. The primary outcome was the rate and type of complications. Logistic regression analyses identified risk factors using demographic, injury, and clinical data. Results From 2010 to 2020, a total of 84 trauma casualties with documented prehospital TQ application were hospitalized at SMC. Of these, 20 (23.81%) experienced TQ‐related complications, including local infection, compartment syndrome, and thromboembolism. The average TQ application time was 44.2 min, with no significant difference between those with and without complications. However, significant differences were noted in the mechanism of injury (MOI), wound contamination levels, indications for TQ application, and initial blood test results ( p &lt; 0.05). Logistic regression analyses revealed length of stay (LOS) and injuries from falls were significantly associated with the development of complications. Conclusions This study found that a significant trauma in prehospital settings requiring TQ application is associated with a high rate of complications. Early complications, including local infections and compartment syndrome, were more frequent, whereas late complications like thromboembolism and muscle atrophy were less common. The findings suggest that factors such as the MOI and wound contamination may contribute to these complications, yet after applying multivariate regression, LOS and falls were the only variables found to be significantly associated with the development of complications. These findings underscore the need for further research comparing casualties with and without TQ application.

Mor Rittblat

Sami Gendler

Nir Tsur

Irina Radomislensky

Arnona Ziv

Moran Bodas

The cost of saving lives: Complications arising from prehospital tourniquet application

拯救生命的代价：院前止血带应用引发的并发症

Abbreviation	Acad Emerg Med
Journal Impact	3.36
Quartiles(Global)	EMERGENCY MEDICINE(Q1)

ISSN	1069-6563, 1553-2712
h-index	142

Publication Information	Publisher: Wiley-Blackwell，Publishing cycle: Monthly，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1994，Proportion of original research papers: 72.63%，Self Citation Rate:8.80%， Gold OA Rate: 16.28%
Average review cycle	网友分享经验：一般,3-8周
Average recruitment ratio	网友分享经验：较易

Academic Emergency Medicine

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