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01; 95% confidence interval -4.20 to -1.83; p<0.001). Median length of stay was 2.61h for the TPI group and 4.63h for the control group (p<0.001). More patients in the control group (47.4%) were discharged home with an opioid compared with the TPI group (2.9%) (p<0.001).

TPI is an effective method for managing myofascial pain in the emergency department. This study indicates it may improve pain compared with conventional methods, reduce length of stay in the emergency department, and reduce opioid prescriptions on discharge.

TPI is an effective method for managing myofascial pain in the emergency department. This study indicates it may improve pain compared with conventional methods, reduce length of stay in the emergency department, and reduce opioid prescriptions on discharge.

Deaths caused by recreational drug abuse have increased considerably in recent years. Therapeutic hypothermia offers the potential to improve neurological outcomes in post-resuscitation patients.

A 19-year-old man was brought to our emergency department after suffering out-of-hospital ventricular fibrillation (VF) cardiac arrest. He was resuscitated at our emergency department again due to VF. Urine analysis showed high levels of amphetamine and 3,4 methylenedioxymethamphetamine (MDMA) (ecstasy). The patient was intubated, sedated, and ventilated. Within 1h after the return of spontaneous circulation and hemodynamic stabilization, therapeutic hypothermia was initiated for neurologic protection. An external-cooling device was used for cooling. He was maintained at 33

C for 72h. selleck The patient was weaned from the ventilator and extubated on day 5. He was discharged from the hospital on the day 10 with good cerebral performance. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? Initiation of early therapeutiwith good cerebral performance. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? Initiation of early therapeutic hypothermia within 1 h after return of spontaneous circulation might contribute to better neurologic outcome in patients who suffer VF cardiac arrest. We suggest that early therapeutic hypothermia may be considered in patients who suffer out-of-hospital cardiac arrest due to MDMA and amphetamine intoxications.

The novel coronavirus SARS-CoV-2 has caused a pandemic, overwhelming health care systems around the world. Hospitals around the world, including the United States, have been struggling to adapt to the influx of patients with COVID-19, the illness caused by SARS-CoV2, given limited resources and high demand for medical care.

This article seeks to provide emergency physicians with a guide to sonographic findings in COVID-19 and an algorithm by which point-of-care lung ultrasound may assist emergency physicians caring for these patients during the SARS-CoV-2 pandemic.

The studies currently being published have established a typical set of ultrasound findings in COVID-19. Point-of-care lung ultrasound is rapid and accessible in most emergency departments in the United States, and even in many resource-poor settings.

Point-of-care ultrasound provides numerous benefits to emergency providers caring for patients with COVID-19, including decreasing resource utilization, assisting in diagnosis, guiding management of the critically ill patient, and aiding in rapid triage of patients under investigations for COVID-19.

Point-of-care ultrasound provides numerous benefits to emergency providers caring for patients with COVID-19, including decreasing resource utilization, assisting in diagnosis, guiding management of the critically ill patient, and aiding in rapid triage of patients under investigations for COVID-19.MicroRNAs (miRs) are powerful regulators of CNS development and diseases. Plasma and cerebrospinal fluid (CSF) miRs have recently been implicated as potential new sources for biomarker development. Previously we showed that miR-124-3p, an essential miR for neuronal identity, is highly abundant in neuronal exosomes and its expression decreases in spinal cord of ALS model SOD1G93A mice. In the current study, we found a disease associated reduction of miR-124-3p levels specifically in spinal neurons using in situ hybridization. By employing our recently developed exosome reporter mice in combination with sciatic nerve injections, we observed an increased association of miR-124-3p with spinal motor neuron-derived exosomes in SOD1G93A mice, even at the pre-symptomatic stage. Sciatic nerve injection delivered miR-124-3p is also more frequently localized outside of spinal motor neurons in SOD1G93A mice. Subsequent quantitative analysis of miR-124-3p levels in CSF exosomes from ALS patients found a significant correlation between CSF exosomal miR-124-3p levels and disease stage (indicated by the ALSFRS-R score) of (male) ALS patients. These results provide preliminary evidence to support the potential use of CSF exosomal miR-124-3p as a disease stage indicator in ALS.A clinical scenario is presented, from which a structured clinical question arises In asthmatic children or adolescents with exacerbation symptoms, does the use of inhaled corticosteroids (newly instituted or base dose increased) reduce the risk of exacerbations that require systemic steroids and/or hospitalization? To answer it, we carried out a bibliographic search, with selection, evaluation and graduation of the evidence, following GRADE criteria. We did not find sufficient evidence to consider intermittent inhaled steroids as an alternative to maintenance inhaled steroids to avoid exacerbations that require the use of systemic steroids. The use of a combination of inhaled steroids with formoterol, as a rescue treatment at the onset of symptoms, is only effective when used by patients with this maintenance treatment, compared to those who only have inhaled steroids and rescue with beta2-agonists of short action; when patients already take maintenance combined therapy, combined rescue does not reduce the risk. In patients with asthma attacks attended in the emergency department, inhaled steroids compared to placebo reduce the risk of admission, but not when compared to systemic corticosteroids.