Medicine and Health Sciences Commons^™

Transfer Of Patients With St Elevation Myocardial Infarction For Primary Percutaneous Coronary Intervention During Ordinary & Pandemic Times Position Statement Of The Saudi Arabian Cardiac Intervention Society, Shukri M. Al Saif, Owayed Al Shammeri, Abdullah Alkhushail, Ramzi Almohammadi, Mohamed Kurdi

Journal of the Saudi Heart Association

Primary percutaneous coronary intervention is the most effective therapy in the management of acute ST Elevation Myocardial Infarction. Evidence recommends keeping the period from symptom onset to reperfusion to a minimum in order to preserve left ventricular function, improve outcome, and reduce mortality. The position statement describes the recommendations of the the Saudi Arabian Cardiac Intervention Society for optimal conditions and timing for the acute management of patients presenting with ST Elevation Myocardial Infarction during ordinary and pandemic times.

Conference Proceedings: Aurora Scientific Day 2020

Journal of Patient-Centered Research and Reviews

Abstracts published in this supplement were among those presented at the 46th annual Aurora Scientific Day research symposium, held virtually on May 20, 2020. The symposium provides a forum for describing research studies conducted by faculty, fellows, residents, and allied health professionals affiliated with Wisconsin-based Aurora Health Care, a part of the Advocate Aurora Health health system, which publishes the Journal of Patient-Centered Research and Reviews.

Optimizing Wellness In Academic Emergency Medicine, Kristen E. Nordenholz, Al'ai Alvarez, Michelle D. Lall, Christine Stehman, Cindy C. Bitter, Emily L. Hirsh, Rita Manfredi, Rosanna D. Sikora, Dave W. Lu, Leon D. Sanchez, Matthew L. Wong, Steven Bird, Andra L. Blomkalns

Journal of Wellness

Introduction

Academic Emergency Physicians (EPs) face additional unique challenges in optimizing wellness compared to community EPs.

Objective

Our objective was to explore specific individual and systems challenges that academic EPs encounter that affect their wellbeing and professional fulfillment in emergency medicine (EM).

Methods

An expert group of academic EPs convened in 2019 at the annual meeting of the Society of Academic Emergency Medicine to investigate the overall causes of burnout in healthcare providers, the effects of burnout on the healthcare system, specific causes of burnout in EM, and the distinct challenges facing academic emergency physicians.

Results

We outline specific causes …

Parent Perspectives Of Perceived Racial Bias In Their Adolescent’S Healthcare Experience In Emergency Rooms, Ashleigh Godby

ELAIA

Background Research reports that health outcomes are not equal among individuals in the United States. For instance, maternal death rates are higher for Black women than for White (Rabin, 2019). Such healthcare disparities are not limited to adult healthcare. Some research indicates evidence of disparity in pediatric prescriptions and diagnoses of certain illnesses in Black children versus non-Black children (Gerber et al., 2013). Additionally, research has been published discussing the prevalence of implicit bias in health care and how such bias impacts implementation of medical care (Gerber et al., 2013; Wisniewski & Walker, 2020; Sabin & Greenwald, 2012). A review …

Promoting Resident Emotional Health Meaningful Connections: An Evaluation Of A Wellness Game, Bruce St. Amour, William B. Dehart

Journal of Wellness

Introduction

Physician wellness is a topic of significant national interest. Physician burnout is at its highest point during residency and is linked to many negative outcomes. The Core Emotional Needs are a useful framework to guide thinking toward wellness in residents: connection and acceptance, healthy autonomy and performance, reasonable limits, and healthy responsibility and standards. We examined the efficacy of a game (“Well, For Me…”) designed to improve social connection and acceptance among residents to reduce social isolation. We hypothesized that this activity would be viewed positively by the residents as an intervention to improve resident wellness.

Methods

Participants …

Early Aggressive Hydration Is Associated With Decreased Opioid Use And Readmission In Mild Acute Pancreatitis, Shreyans Doshi, Hong Liang, Hale Z. Toklu, Selina Fritze, Sue-Wei Luu

HCA Healthcare Journal of Medicine

Background: Acute pancreatitis (AP) is one of the most common causes of hospital admissions due to gastrointestinal disorders. No pharmacologic agents have been proven to impact the prognosis, and the treatment still remains supportive with intravenous fluids for hydration. Although early hydration has been recommended for the management of mild AP, there is no consensus on the type, rate, and amount of the fluid replacement.

Objective: In this study, we aimed to investigate the outcome of aggressive hydration in patients with AP.

Methods: Retrospective data from patients admitted to 12 hospitals (2015–2017) was used for analysis. Five hundred patients who …

Investigation Of A Peculiar Case Of Childhood Lymphadenopathy, Chade Aribo, Alonso Al, Allison Woodall, Tommy Y. Kim

HCA Healthcare Journal of Medicine

Introduction: Lymphadenopathy is a common physical finding often associated with an infectious etiology. We present a case of a patient with generalized cervical and supraclavicular lymphadenopathy diagnosed with a rare malignancy. Health care providers should be aware of some uncommon historical or physical examination findings that warrant further investigation.

Clinical Findings: A 16-year-old female presented to the emergency department with 3 days of a fever, congestion and sore throat with swelling around the jaw. Her physical examination findings included bilateral mandibular swelling and generalized cervical lymphadenopathy with palpable supraclavicular lymph nodes.

Outcomes: Complete blood count showed pancytopenia with a white …

Low Dose Clenbuterol Toxicity: Case Report And Review Of Literature, Kenneth Lan, Adarsh Saheba, Paul Mathew

HCA Healthcare Journal of Medicine

Clenbuterol is a long-acting β-agonist used in oral and inhaled form for asthma treatment outside the U.S. and in veterinary medicine within the U.S. It is also used off-label for anabolic effects worldwide. Toxicity with clenbuterol is increasingly seen in U.S. hospitals, primarily in younger individuals using the drug for competitive athletics or bodybuilding. We present a case of a young patient who presented after an intentional overdose and discuss the relevant literature. Presentations do not correlate with the dosage ingested. Signs and symptoms can range from simple nausea to myocardial ischemia, rhabdomyolysis and cardiogenic shock. Treatment of overdose is …

Factor Structure And Measurement Invariance Of The Maslach Burnout Inventory In Emergency Medicine Residents, Tim P. Moran, Nicole Battaglioli, Simiao Li-Sauerwine

Journal of Wellness

Introduction: Emergency medicine residents suffer from high rates of occupational burnout. Recent research has focused on identifying risk and protective factors for burnout as well as targets for intervention. This research has primarily employed the Maslach Burnout Inventory to evaluate burnout in this population. Factor analytic work has identified three underlying factors measured by the Maslach Burnout Inventory: Emotional Exhaustion, Depersonalization, and Personal Accomplishment. However, this three-factor structure has not been evaluated in emergency medicine residents. Furthermore, its structural equivalence has not been demonstrated across commonly-studied risk factors, such as gender and year of post-graduate training. In the present study, …

Patient Experience In A Pediatric Emergency Department During Covid-19, Beth L. Emerson Md, Erika Setzer

Patient Experience Journal

The COVID-19 pandemic has changed many dynamics in healthcare in the United States. This study explores an increase in patient experience (PE) scores in a pediatric emergency department. Visits were analyzed before and after March 8, 2020, corresponding with the first local case of COVID-19. Changes in the patient population and characteristics of survey responders were analyzed. Overall, the number of daily visits decreased (113 vs 36/day) and survey response rate decreased (3.7 vs 2.8%, p = 0.03), but PE scores increased (87.21 to 93.73, p = 0.002). Comparatively, an increase in patients with higher acuity levels by Emergency Severity …

Defining And Characterizing Frequent Attenders: Systematic Literature Review And Recommendations, Dip Shukla, Erik Faber, Brian Sick

Journal of Patient-Centered Research and Reviews

Purpose: To decrease cost and improve efficiency, health care organizations have focused on frequent attenders — patients with high health care utilization. Prior studies have investigated singular health care settings, used varying definitions of frequent attendance, and inconsistently identified factors correlated with frequent attendance. The purpose of this article is to suggest a uniform definition of frequent attenders for different health care settings and to determine factors correlated with frequent attendance.

Methods: This systematic review of three databases identified 2761 unique articles; 174 met inclusion criteria. Studies were analyzed for their definition of frequent attenders and factors associated with frequent …

Prehospital Antibiotics Improve Morbidity And Mortality Of Emergency Medical Service Patients With Sepsis, Thomas Martel, Monica N. Melmer, Samuel M. Leaman, Nicole Kassen, Seth Kozlowski, Jonathan Pangia, Scott Gutovitz, Dietrich Jehle

HCA Healthcare Journal of Medicine

Background: Severe sepsis is a major cause of mortality in patients evaluated in the Emergency Department (ED). Early initiation of antibiotic therapy and IV fluids in the ED is associated with improved outcomes. We investigated whether early administration of antibiotics in the prehospital setting improves outcomes in these patients with sepsis.

Methods: This is a retrospective study comparing outcomes of patients meeting sepsis criteria in the field by EMS, who were treated with IV fluids and antibiotics. Their outcomes were compared with controls where fluids were administered prehospital and antibiotics were initiated in the ED. We compared morbidity and mortality …

A Fatal Rectus Sheath Hematoma After A Myasthenia Crisis Case Report, Robert G. Michaud, Lesley B. Gordon

Journal of Maine Medical Center

Introduction: Rectus sheath hematomas (RSH) generally occur due to damage to the inferior epigastric artery. They are rare causes of abdominal pain or acute blood loss anemia, but are an important diagnostic consideration because they can be cryptic and are potentially fatal.

Clinical Findings: An 85-year-old female who had been admitted to the hospital for 10 days with a myasthenia crisis was found to be abruptly hypotensive with a tender abdominal mass in the left lower quadrant subtly crossing midline. She was on prophylactic anticoagulation during her hospitalization.

Main diagnosis, therapeutics, interventions, and outcomes: The patient was initially stabilized with …

Emergency Medicine In The Time Of Covid, Martin Huecker, Jacob Shreffler, Adam Ross, Hugh Shoff, Mary Nan S. Mallory, J. Jeremy Thomas

The University of Louisville Journal of Respiratory Infections

The novelty and uncertainty associated with COVID-19 has created challenges for politicians, citizens, and healthcare providers, leaving no one unaffected. As members of the front line of defense, providers in Emergency Departments (EDs) face the momentous challenge of effectively identifying and treating patients with COVID-19, working with experts in Infectious Disease, Internal Medicine, Critical Care, Public Health, and other disciplines. We must coordinate these efforts while also protecting staff, implementing strategies to reduce transmission, and managing ED patients with conditions unrelated to COVID-19. Striving to maintain a grasp of the rapidly accumulating publications in medical journals and the media, we …

Emergency Department Testing And Disposition Of Deaf American Sign Language Users And Spanish-Speaking Patients, Jason Rotoli, Timmy Li, Suejong Kim, Tina Wu, Jennifer Hu, Julie Endrizzi, Nathan Garton, Courtney Jones

Journal of Health Disparities Research and Practice

Objectives: Non-English speaking patients frequently present to the emergency department (ED) for acute care and may present a challenge to efficient clinical ED management and disposition. This study aimed to assess differences in the disposition and clinical management of Spanish-speaking patients and Deaf American Sign Language (ASL) users, who worked with a certified, in-person interpreter, compared with English proficient patients who did not utilize interpreter services.

Methods: A retrospective study querying electronic medical records was performed at an academic medical center ED. Patients with a chief complaint of abdominal pain were chosen for this study, as this is a common …

Understanding Etiologies Of Road Traffic Crashes, Injuries, And Death For Patients At National Hospital Abuja: A Qualitative Content Analysis Using Haddon’S Matrix, Benjamin D. Holmes, Kristin Haglund, Emmanuel A. Ameh, Oluwole O. Olaomi, Uthman Uthman, Laura D. Cassidy

The Qualitative Report

Road traffic crashes and sequelae are reaching pandemic proportions globally and have currently achieved disproportionately high levels in Nigeria. Quantitative studies are accumulating in the peer-reviewed literature, but there is a paucity of qualitative research in Nigeria. Data for this study of structural and behavioral factors of road traffic crashes and injuries in Federal Capital Territory were collected in semi-structured interviews with crash survivors at National Hospital Abuja. Interviews were analyzed via qualitative content analysis, revealing crash location and participant beliefs about crash etiologies. Units of analysis were developed from participant statements and were structured within four a priori etiologic …

Assessing For Gender Disparities In The Selection Of Chief Residents Of Emergency Medicine Residency Programs, Emilio G. Volz, Justin Steinberg, Tony Zitek

HCA Healthcare Journal of Medicine

Introduction: Although the number of women physicians has been increasing, there may be gender disparities in the assessment of female emergency medicine residents. This study sought to determine if female emergency medicine residents are less likely to become chief residents than males.

Methods: In July 2017, an anonymous survey was distributed to the program coordinators of all accredited emergency medicine residency programs in the United States. The survey requested the number of males and females in each graduating class from 2015 to 2017. The percentage of female residents who were chief residents was calculated and compared to that for males. …

The Great Imitator Strikes Again: A Case Of A Lupus Flare-Up Presenting Like An Acute Abdomen, Emmanouil Kiriakopoulos, Vanessa Perez, Robyn Hoelle

HCA Healthcare Journal of Medicine

Systemic lupus erythematosus (SLE) is an autoimmune disease affecting all age groups and can manifest in various forms, often making the initial or successive presentations difficult to diagnose. Peritonitis secondary to lupus is a rare manifestation of this disease and the prevalence is said to be much lower in children. We present a case report of an adolescent male with a known history of lupus who presented to the emergency department with a clinical picture consistent with an acute surgical abdomen and underwent an appendectomy. Subsequent workup identified the culprit as a lupus-related peritonitis requiring corticosteroids for resolution.