The critical care literature 2023.

The number of critically ill patients that present to emergency departments across the world continues to rise. In fact, the proportion of critically ill patients in emergency departments is now higher than pre-COVID-19 pandemic levels. [1] The emergency physician (EP) is typically the first physician to evaluate and resuscitate the critically ill patient. Given the continued shortage of intensive care unit (ICU) beds, persistent staff shortages, and overall inefficient hospital throughput, EPs are often tasked with providing intensive care to these patients long beyond the initial resuscitation phase. Prolonged boarding of critically ill patients in the ED is associated with increased ICU and hospital length of stay, increased adverse events, ED staff burnout, decreased patient and family satisfaction, and, most importantly, increased mortality. [2-5]. As such, it is imperative for the EP to be knowledgeable about recent literature in resuscitation and critical care medicine, so that critically ill ED patients can continue to receive the best, most up-to-date evidence-based care. This review summarizes important articles published in 2023 that pertain to the resuscitation and management of select critically ill ED patients. Topics included in this article include cardiac arrest, post-cardiac arrest care, septic shock, rapid sequence intubation, severe pneumonia, transfusions, trauma, and critical procedures.

The critical care literature 2022.

The number of critically ill patients that present to emergency departments across the world has risen steadily for nearly two decades. Despite a decrease in initial emergency department (ED) volumes early in the COVID-19 pandemic, the proportion of critically ill patients is now higher than pre-pandemic levels [1]. The emergency physician (EP) is often the first physician to evaluate and resuscitate a critically ill patient. In addition, EPs are frequently tasked with providing critical care long beyond the initial resuscitation. Prolonged boarding of critically ill patients in the ED is associated with increased duration of mechanical ventilation, increased intensive care unit (ICU) length of stay, increased hospital length of stay, increased medication-related adverse events, and increased in-hospital, 30-day, and 90-day mortality [2-4]. Given the continued increase in critically ill patients along with the increases in boarding critically ill patients in the ED, it is imperative for the EP to be knowledgeable about recent literature in resuscitation and critical care medicine, so that critically ill patients continue to receive evidence-based care. This review summarizes important articles published in 2022 that pertain to the resuscitation and management of select critically ill ED patients. These articles have been selected based on the authors review of key critical care, resuscitation, emergency medicine, and medicine journals and their opinion of the importance of study findings as it pertains to the care of the critically ill ED patient. Topics covered in this article include cardiac arrest, post-cardiac arrest care, rapid sequence intubation, mechanical ventilation, fluid resuscitation, and sepsis.

High risk and low prevalence diseases: Myocarditis.

INTRODUCTION: Myocarditis is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE: This review highlights the pearls and pitfalls of myocarditis, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION: Myocarditis is an inflammatory syndrome of myocardium, most often resulting from a viral infection, that can cause life-threatening cardiovascular collapse. It has a highly variable presentation and no widely available specific diagnostic test, making it a challenging diagnosis. Emergency clinicians should obtain an electrocardiogram and perform bedside ultrasound to assess cardiac function. Treatment in the ED is largely supportive, focusing on resuscitation, cardiovascular support, cardiology specialist consultation, and appropriate disposition. CONCLUSIONS: An understanding of myocarditis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.

Human-algorithm interactions help explain the spread of misinformation.

Human attention biases toward moral and emotional information are as prevalent online as they are offline. When these biases interact with content algorithms that curate social media users' news feeds to maximize attentional capture, moral and emotional information are privileged in the online information ecosystem. We review evidence for these human-algorithm interactions and argue that misinformation exploits this process to spread online. This framework suggests that interventions aimed at combating misinformation require a dual-pronged approach that combines person-centered and design-centered interventions to be most effective. We suggest several avenues for research in the psychological study of misinformation sharing under a framework of human-algorithm interaction.

Malaria: A focused review for the emergency medicine clinician.

INTRODUCTION: Malaria is a potentially fatal parasitic disease transmitted by the Anopheles mosquito. A resurgence in locally acquired infections has been reported in the U.S. OBJECTIVE: This narrative review provides a focused overview of malaria for the emergency clinician, including the epidemiology, presentation, diagnosis, and management of the disease. DISCUSSION: Malaria is caused by Plasmodium and is transmitted by the Anopheles mosquito. Disease severity can range from mild to severe. Malaria should be considered in any returning traveler from an endemic region, as well as those with unexplained cyclical, paroxysms of symptoms or unexplained fever. Patients most commonly present with fever and rigors but may also experience cough, myalgias, abdominal pain, fatigue, vomiting, and diarrhea. Hepatomegaly, splenomegaly, pallor, and jaundice are findings associated with malaria. Although less common, severe malaria is precipitated by microvascular obstruction with complications of anemia, acidosis, hypoglycemia, multiorgan failure, and cerebral malaria. Peripheral blood smears remain the gold standard for diagnosis, but rapid diagnostic tests are available. Treatment includes specialist consultation and antimalarial drugs tailored depending on chloroquine resistance, geographic region of travel, and patient comorbidities. Supportive care may be required, and patients with severe malaria will require resuscitation. Most patients will require admission for treatment and further monitoring. CONCLUSION: Emergency medicine clinicians should be aware of the presentation, diagnosis, evaluation, and management of malaria to ensure optimal outcomes.

Emergency medicine updates: Atrial fibrillation with rapid ventricular response.

INTRODUCTION: Atrial fibrillation (AF) may lead to stroke, heart failure, and death. When AF occurs in the context of a rapid ventricular rate/response (RVR), this can lead to complications, including hypoperfusion and cardiac ischemia. Emergency physicians play a key role in the diagnosis and management of this dysrhythmia. OBJECTIVE: This paper evaluates key evidence-based updates concerning AF with RVR for the emergency clinician. DISCUSSION: Differentiating primary and secondary AF with RVR and evaluating hemodynamic stability are vital components of ED assessment and management. Troponin can assist in determining the risk of adverse outcomes, but universal troponin testing is not required in patients at low risk of acute coronary syndrome or coronary artery disease - especially patients with recurrent episodes of paroxysmal AF that are similar to their prior events. Emergent cardioversion is indicated in hemodynamically unstable patients. Rate or rhythm control should be pursued in hemodynamically stable patients. Elective cardioversion is a safe option for select patients and may reduce AF symptoms and risk of AF recurrence. Rate control using beta blockers or calcium channel blockers should be pursued in those with AF with RVR who do not undergo cardioversion. Anticoagulation is an important component of management, and several tools (e.g., CHA2DS2-VASc) are available to assist with this decision. Direct oral anticoagulants are the first-line medication class for anticoagulation. Disposition can be challenging, and several risk assessment tools (e.g., RED-AF, AFFORD, and the AFTER (complex, modified, and pragmatic) scores) are available to assist with disposition decisions. CONCLUSION: An understanding of the recent updates in the literature concerning AF with RVR can assist emergency clinicians in the care of these patients.

People Think That Social Media Platforms Do (but Should Not) Amplify Divisive Content.

Recent studies have documented the type of content that is most likely to spread widely, or go "viral," on social media, yet little is known about people's perceptions of what goes viral or what should go viral. This is critical to understand because there is widespread debate about how to improve or regulate social media algorithms. We recruited a sample of participants that is nationally representative of the U.S. population (according to age, gender, and race/ethnicity) and surveyed them about their perceptions of social media virality (n = 511). In line with prior research, people believe that divisive content, moral outrage, negative content, high-arousal content, and misinformation are all likely to go viral online. However, they reported that this type of content should not go viral on social media. Instead, people reported that many forms of positive content-such as accurate content, nuanced content, and educational content-are not likely to go viral even though they think this content should go viral. These perceptions were shared among most participants and were only weakly related to political orientation, social media usage, and demographic variables. In sum, there is broad consensus around the type of content people think social media platforms should and should not amplify, which can help inform solutions for improving social media.

Algorithm-mediated social learning in online social networks.

Human social learning is increasingly occurring on online social platforms, such as Twitter, Facebook, and TikTok. On these platforms, algorithms exploit existing social-learning biases (i.e., towards prestigious, ingroup, moral, and emotional information, or 'PRIME' information) to sustain users' attention and maximize engagement. Here, we synthesize emerging insights into 'algorithm-mediated social learning' and propose a framework that examines its consequences in terms of functional misalignment. We suggest that, when social-learning biases are exploited by algorithms, PRIME information becomes amplified via human-algorithm interactions in the digital social environment in ways that cause social misperceptions and conflict, and spread misinformation. We discuss solutions for reducing functional misalignment, including algorithms promoting bounded diversification and increasing transparency of algorithmic amplification.

Are People Generous When the Financial Stakes Are High?

How generous are people when making consequential financial decisions in the real world? We took advantage of a rare opportunity to examine generosity among a diverse sample of adults who received a gift of U.S. $10,000 from a pair of wealthy donors, with nearly no strings attached. Two-hundred participants were drawn from three low-income countries (Indonesia, Brazil, and Kenya) and four high-income countries (Australia, Canada, the United Kingdom, and the United States) as part of a preregistered study. On average, participants spent over $6,400 on purchases that benefited others, including nearly $1,700 on donations to charity, suggesting that humans exhibit remarkable generosity even when the stakes are high. To address whether generosity was driven by reputational concerns, we asked half the participants to share their spending decisions publicly on Twitter, whereas the other half were asked to keep their spending private. Generous spending was similar between the groups, in contrast to our preregistered hypothesis that enhancing reputational concerns would increase generosity.

Mapping moral language on US presidential primary campaigns reveals rhetorical networks of political division and unity.

During political campaigns, candidates use rhetoric to advance competing visions and assessments of their country. Research reveals that the moral language used in this rhetoric can significantly influence citizens' political attitudes and behaviors; however, the moral language actually used in the rhetoric of elites during political campaigns remains understudied. Using a data set of every tweet (N=139,412) published by 39 US presidential candidates during the 2016 and 2020 primary elections, we extracted moral language and constructed network models illustrating how candidates' rhetoric is semantically connected. These network models yielded two key discoveries. First, we find that party affiliation clusters can be reconstructed solely based on the moral words used in candidates' rhetoric. Within each party, popular moral values are expressed in highly similar ways, with Democrats emphasizing careful and just treatment of individuals and Republicans emphasizing in-group loyalty and respect for social hierarchies. Second, we illustrate the ways in which outsider candidates like Donald Trump can separate themselves during primaries by using moral rhetoric that differs from their parties' common language. Our findings demonstrate the functional use of strategic moral rhetoric in a campaign context and show that unique methods of text network analysis are broadly applicable to the study of campaigns and social movements.

The role of political devotion in sharing partisan misinformation and resistance to fact-checking.

Online misinformation is disproportionality created and spread by people with extreme political attitudes, especially among the far-right. There is a debate in the literature about why people spread misinformation and what should be done about it. According to the purely cognitive account, people largely spread misinformation because they are lazy, not biased. According to a motivational account, people are also motivated to believe and spread misinformation for ideological and partisan reasons. To better understand the psychological and neurocognitive processes that underlie misinformation sharing among the far-right, we conducted a cross-cultural experiment with conservatives and far-right partisans in the Unites States and Spain (N = 1,609) and a neuroimaging study with far-right partisans in Spain (N = 36). Far-right partisans in Spain and U.S. Republicans who highly identify with Trump were more likely to share misinformation than center-right voters and other Republicans, especially when the misinformation was related to sacred values (e.g., immigration). Sacred values predicted misinformation sharing above and beyond familiarity, attitude strength, and salience of the issue. Moreover, far-right partisans were unresponsive to fact-checking and accuracy nudges. At a neural level, this group showed increased activity in brain regions implicated in mentalizing and norm compliance in response to posts with sacred values. These results suggest that the two components of political devotion-identity fusion and sacred values-play a key role in misinformation sharing, highlighting the identity-affirming dimension of misinformation sharing. We discuss the need for motivational and identity-based interventions to help curb misinformation for high-risk partisan groups. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Ebola virus disease: A review for the emergency medicine clinician.

INTRODUCTION: Ebolavirus, the causative agent of Ebola virus disease (EVD) has been responsible for sporadic outbreaks mainly in sub-Saharan Africa since 1976. EVD is associated with high risk of transmission, especially to healthcare workers during patient care. OBJECTIVE: The purpose of this review is to provide a concise review of EVD presentation, diagnosis, and management for emergency clinicians. DISCUSSION: EVD is spread through direct contact, including blood, bodily fluids or contact with a contaminated object. Patients may present with non-specific symptoms such as fevers, myalgias, vomiting, or diarrhea that overlap with other viral illnesses, but rash, bruising, and bleeding may also occur. Laboratory analysis may reveal transaminitis, coagulopathy, and disseminated intravascular coagulation. The average clinical course is approximately 8-10 days with an average case fatality rate of 50%. The mainstay of treatment is supportive care, with two U.S. Food and Drug Administration-approved monoclonal antibody treatments (Ebanga and Inmazeb). Survivors of the disease may have a complicated recovery, marked by long-term symptoms. CONCLUSION: EVD is a potentially deadly condition that can present with a wide range of signs and symptoms. Emergency clinicians must be aware of the presentation, evaluation, and management to optimize the care of these patients.

Overperception of moral outrage in online social networks inflates beliefs about intergroup hostility.

As individuals and political leaders increasingly interact in online social networks, it is important to understand the dynamics of emotion perception online. Here, we propose that social media users overperceive levels of moral outrage felt by individuals and groups, inflating beliefs about intergroup hostility. Using a Twitter field survey, we measured authors' moral outrage in real time and compared authors' reports to observers' judgements of the authors' moral outrage. We find that observers systematically overperceive moral outrage in authors, inferring more intense moral outrage experiences from messages than the authors of those messages actually reported. This effect was stronger in participants who spent more time on social media to learn about politics. Preregistered confirmatory behavioural experiments found that overperception of individuals' moral outrage causes overperception of collective moral outrage and inflates beliefs about hostile communication norms, group affective polarization and ideological extremity. Together, these results highlight how individual-level overperceptions of online moral outrage produce collective overperceptions that have the potential to warp our social knowledge of moral and political attitudes.

Mimics of Monkeypox: Considerations for the emergency medicine clinician.

INTRODUCTION: Mpox, formerly known as monkeypox, is a public health emergency most commonly presenting with a painful rash and several systemic findings. However, there are several conditions that may mimic its presentation. OBJECTIVE: This narrative review provides a focused overview of mpox mimics for emergency clinicians. DISCUSSION: Mpox is a global health emergency. The disease is primarily spread through contact, followed by the development of a centrifugally-spread rash that evolves from macules to papules to vesicles to pustules. This is often associated with lymphadenopathy and fever. As the rash is one of the most common presenting signs of the infection, patients mpox may present to the emergency department (ED) for further evaluation. There are a variety of mimics of mpox, including smallpox, varicella, primary and secondary syphilis, acute retroviral syndrome, and genital herpes simplex virus. CONCLUSION: Knowledge of mpox and its mimics is vital for emergency clinicians to differentiate these conditions and ensure appropriate diagnosis and management.

Diagnosis and management of arrhythmogenic right ventricular cardiomyopathy.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder of the myocardium that can lead to ventricular arrhythmia and sudden cardiac death. The condition has been identified as a significant cause of arrhythmic death among young people and athletes, therefore, early recognition of the disease by emergency clinicians is critical to prevent subsequent death. The diagnosis of ARVC can be very challenging and requires a systematic approach. This publication reviews the pathophysiology, classification, clinical presentations, and appropriate approach to diagnosis and management of ARVC.

Dysrhythmias associated with COVID-19: Review and management considerations.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is known to affect the cardiovascular system. Cardiac manifestations in COVID-19 can be due to direct damage to the myocardium and conduction system as well as by the disease's effect on the various organ systems. These manifestations include acute coronary syndrome, ST- segment elevations, cardiomyopathy, and dysrhythmias. Some of these dysrhythmias can be detrimental to the patient. Therefore, it is important for the emergency physician to be aware of the different arrhythmias associated with COVID-19 and how to manage them. This narrative review discusses the pathophysiology underlying the various arrhythmias associated with COVID-19 and their management considerations.