Medicine and Health Sciences Commons^™

Challenges In Evaluating Pediatric Fever And Rash In The Era Of Covid-19 And Multisystem Inflammatory Syndrome In Children (Mis-C)., Taylor Jarvill, Priyanka Lauber Do, Samuel Umaru Md, Tibisay Villalobos Md, Susan K. Yaeger Md

Department of Emergency Medicine

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged the medical community to characterize and treat a new illness. Now almost two years after the initial confirmed cases of COVID-19, medical teams are faced with another unique disease process temporally related to the pandemic-multisystem inflammatory syndrome in children (MIS-C). The comparison of these patients’ presentations illustrates the new challenges of evaluating a pediatric rash and fever in the era of MIS-C. Case Reports: This report presents three cases with features of MIS-C, positivity for SARS-CoV-2, rashes, fevers, gastrointestinal involvement, and elevated inflammatory markers. The first case poses a diagnostic …

A Study On The Efficacy Of A Naloxone Training Program, Gillian A. Beauchamp Md, Hoonani M. Cuadrado, Seth A. Campbell Pa-C, Bennie Eliason Chw, Chase Jones Do, Aaron Fedor Do, Lauren Grantz Pharmd, Csp, Paige Roth Lsw, Marna Greenberg

Department of Emergency Medicine

Introduction: The use of naloxone to reverse a potentially fatal opioid overdose is a harm reduction strategy that reduces mortality and increases the potential for referral to substance use treatment for affected individuals. In the setting of outreach performed by a street medicine team, we aimed to determine the effectiveness of an educational intervention involving distribution of naloxone accompanied by a brief instructive session about opioids, opioid overdose, and medication administration. Methods: Our street medicine outreach team distributed 200 naloxone kits to clinicians and volunteers involved in caring for patients on ‘street rounds,’ as well as in shelters, soup kitchens, …

Agents Of Exposure In Transgender Patient Cases Managed By A Toxicologist: An Analysis Of The Toxicology Investigator’S Consortium (Toxic) Registry, Gillian A. Beauchamp Md, Olivia A. Hardy, Alexandra M. Amaducci, Judith N. Sabino, Beth Careyva, Matthew D. Cook Do, Kenneth D. Katz Md, Marna Greenberg Do, Mph, Ryan M Surmaitis Do, Andrew Koons, Joseph B. Zackary Md

Department of Family Medicine

No abstract provided.

Obsolete Or Essential? Gastrointestinal Decontamination In Severe Bupropion Ingestions: A Case Series, Alexandra Amaducci Do, Andrew F. Miller Do, Derek J. Fikse Do, Gillian A. Beauchamp Md

Department of Emergency Medicine

No abstract provided.

Relationship Between Sexual Activity, Contraceptive Utilization And Biopsychosocial Characteristics Among Homeless Shelter Adolescents., Brittney A Gaudet, Nina Liu, Allison N Kayne, Taylor L Jarvill, Cecilia Zemanek, Jeffrey M Downen, Hoonani M Cuadrado, Amy B Smith, Marna R Greenberg, Jessica L Jacoby, Joanne N Quinones

Department of Emergency Medicine

Objective: To determine whether biopsychosocial factors are associated with sexual activity and contraceptive utilization among homeless shelter adolescents. Methods: A retrospective study of 440 adolescents at a shelter in Pennsylvania between February 2015 and September 2019 was conducted. The cohort was evaluated to determine what relationship age, gender identity, substance use, and trauma history have with sexual activity and contraceptive utilization. Results: Sexual activity was significantly related to age (mean 15.8+1.4 years in sexually active vs. 14.7+1.6 years in abstinent youth, p<0.001); remote history of self-harm behavior (relative risk ratio (RR) 1.23 [95% CI 1.03-1.46]; p=0.02), history of aggressive behavior (RR 1.21 [95% CI 1.01-1.46]; p=0.04), history of trauma (RR 1.24 [95% CI 1.04-1.48]; p=0.03), and substance use (RR 2.27 [95%CI 1.86-2.77]; p<0.001). There were 55.7% sexually active females vs. 42.50% males reporting contraception use (p=0.01). After adjustment, older age and substance use remained significantly associated with sexual activity (adjusted odds ratio (AOR) 1.58 [95% CI 1.36-1.83]; p<0.001 and AOR 5.18 [95% CI 3.28-8.18]; p<0.001, respectively). Conclusions: Females self-reported sexual activity using contraception more than males. After adjustment, older age and substance use were associated with sexual activity. By better understanding the impact these factors can have on contraceptive utilization, informed policy and practice interventions can be developed and implemented to help increase safe sex practices in spaces where homeless adolescents access healthcare.

Syndrome Of Inappropriate Antidiuretic Hormone Secretion And Lead Toxicity In A Child With Sickle Cell Disease And Pica., Akshay Gupta Do, Alexandra Amaducci Do, Andrew L. Koons, John D. Lindmark, Gillian A. Beauchamp Md

Department of Emergency Medicine

We describe the presentation and management of a three-year-old child with a history of pica, vitamin D deficiency, and sickle cell disease, who was admitted for pyelonephritis, and found to have elevated blood lead level (BLL) of 103.7 µg/dL, and who subsequently developed altered mental status and syndrome of inappropriate antidiuretic hormone secretion (SIADH). In consultation with Medical Toxicology, the patient was chelated with calcium disodium edetate (EDTA) and British Anti Lewisite (BAL). The patient's hyponatremia was managed with hypertonic saline infusion. The patient's encephalopathy improved throughout her hospital course, and she was discharged on hospital day 8. Following five …

Bridging The Gaps: Individual And Community Level Risk Factors For Non-Lethal Firearm Injuries In The U.S., Alexander Hanisak, Mark Cipolle Md

Research Scholars

No abstract provided.

Assessment Of Emergency Medicine Resident Performance In A Pediatric In Situ Simulation Using Multi-Source Feedback., Michael C Nguyen, Nicole C Elliott, Diane P Begany, Katie M Best, Matthew D Cook, Michael R Jong, Zachary M Matuzsan, Louis A Morolla, Suzanne S Partington, Bryan G Kane

Department of Emergency Medicine

Introduction Multi-source feedback (MSF) is an evaluation method mandated by the Accreditation Council for Graduate Medical Education (ACGME). The Queen's Simulation Assessment Tool (QSAT) has been validated as being able to distinguish between resident performances in a simulation setting. The QSAT has also been demonstrated to have excellent MSF agreement when used in an adult simulation performed in a simulation lab. Using the QSAT, this study sought to determine the degree of agreement of MSF in a single pediatric (Peds) simulation case conducted in situ in a Peds emergency department (ED). Methods This Institutional Review Board-approved study was conducted in …

Concurrent Primary Cardiac Tumors In A High-Risk Patient Presenting With Tamponade., Jay V Gopal, Lauren Crowley, Shawn M Quinn, Timothy S Misselbeck, Joseph B Zackary

Department of Emergency Medicine

Primary cardiac tumors are rare, particularly in the elderly population. The patient described in this report presented with symptoms of dyspnea on exertion, leg swelling, and weight gain and was found to have two histologically distinct cardiac masses: atrial myxoma with concurrent aortic fibroelastoma. Given her history of cirrhosis and end-stage renal disease, the patient was a poor surgical candidate but opted for excision of both masses. The patient eventually succumbed to her cirrhosis six weeks after presentation. In this report, we advocate for further research into medical management for the unique presentation of concurrent primary cardiac tumors in high-operative-risk …

Management Of Peritonsillar Abscess Within A Local Emergency Department: A Quality Analysis Study., Briana K Ortega, Spencer Short, Bryan G. Kane Md, Robert M. Dedio Md

Department of Emergency Medicine

OBJECTIVE: Peritonsillar abscess (PTA) is the most common deep space infection of the head and neck, affecting thousands of people annually with high treatment costs. The purpose of this project was to determine how in-network emergency departments (EDs) adhere to generally accepted guidelines regarding diagnosis and management of potential PTAs.

METHODS: The authors performed a retrospective chart review to identify patients with PTA in five EDs in one year. Information pertaining to diagnostic tests, treatment, and airway status was also collected. Descriptive analysis was used to assess if EDs were consistent with generally accepted guidelines.

RESULTS: Six hundred twenty-one patient …

Detection Of Unknown Pregnancy With Complications Using Point-Of-Care Ultrasound., Allison N Kayne, Julie A Fritzges, Michelle W. Huang Md, Elizabeth M. Evans Do

Department of Emergency Medicine

Eclampsia, a condition diagnosed in pre-eclamptic patients who experience seizures, can lead to maternal and fetal death if not treated early. The present case discusses the clinical management of an 18-year-old female who presented to the emergency department (ED) after a generalized tonic-clonic seizure. A physical examination revealed that she was also hypertensive. Based on these symptoms which required urgency due to the patient's instability, and the suspicion that the patient could be pregnant, point-of-care ultrasound (POCUS) was performed. In this case, a POCUS was a faster more accessible modality than a urine or serum human chorionic gonadotropin test. Although …

Incidence Of Secondary Hemophagocytic Lymphohistiocytosis In Critically-Ill Covid-19 Patients., Jamie Allen, Matthew M Mccambridge, Hope Kincaid, Joshua A Kalter

Department of Emergency Medicine

Objective Coronavirus disease 2019 (COVID-19) is associated with diffuse lung injury that can progress to acute respiratory distress syndrome, multisystem-organ failure, and death. The inflammatory storm seen in many COVID-19 patients closely resembles secondary hemophagocytic lymphohistiocytosis (sHLH) which has been described in other virus-associated severe sepsis. We sought to describe the incidence of sHLH in COVID-19 infected patients. Design In this retrospective study, we reviewed the records of critically ill COVID-19 positive patients to determine the incidence of sHLH. An H-score for sHLH diagnosis was determined for each study participant, with a score greater than 169 points needed for diagnosis. …

Detection Of Central Retinal Artery Occlusion By Point-Of-Care Ultrasound In The Emergency Department: A Case Series., Kevin R Caja, Kaylan M Griffith, Kevin R. Roth Do, Facoep, Charles C. Worrilow Md, Marna R. Greenberg Do, Mph, Facep, Theodore Doherty Do

Department of Emergency Medicine

Central retinal artery occlusion (CRAO) is a rare, but serious, diagnosis that can lead to blindness, most often due to thromboembolic disease. In the emergency department (ED), CRAO can present as acute, painless loss of vision. Physicians need quick ways to rule in this diagnosis due to the time-sensitive nature of the event. We describe two patients in this cases series who present to the same ED with unilateral painless vision loss and histories that include notable risk factors such as thromboembolic and atherosclerotic disease. Upon arrival, point-of-care ultrasound (POCUS) done at the bedside allowed for quick determination of CRAO. …

Resuscitation Of Severe Accidental Hypothermia To Normal Neurologic Outcome With Use Of Extracorporeal Membrane Oxygenation., Jamie Allen, Megan D Wardak, Rovinder S. Sandhu Md, Ahmed Nassar, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

Accidental hypothermia is a condition associated with significant morbidity and mortality. A 48-year-old male with a history of alcohol use disorder and optic neuropathy presented to the emergency department after being found unresponsive with an unknown downtime. One hundred four minutes passed from resuscitation, to pre-hospital discovery, until cannulation with extracorporeal membrane oxygenation. Here, a rare case of successful resuscitation of a profoundly hypothermic patient to normal neurologic outcome is presented.

Point-Of-Care Ultrasound Assists In Rapid Diagnosis Of T-Cell Lymphoblastic Lymphoma In A Young Boy., Ceyda H Sablak, Rebecca M Dudley, Alexander Youngdahl, Kevin R Roth

Department of Emergency Medicine

T-cell lymphoblastic lymphoma (T-cell LBL) is an uncommon diagnosis for acute dyspnea in pediatric emergencies. This case details a 13-year-old boy presenting to the ED with dyspnea, who was diagnosed with T-cell LBL. It was a unique presentation in which there was no obvious mediastinal mass on the examination or primary imaging. As a safe and cost-effective modality for a patient that was too unstable to transfer to the radiology department for computed tomography, point-of-care ultrasound (POCUS) was useful in the patient's rapid assessment for suspected pericardial and pleural effusion. This case highlights the advantage of early utilization of POCUS …

Feasibility Of Implementing A Street Medicine Program To Deliver Naloxone Kits And Associated Education, Gillian A. Beauchamp Md, Lexis Laubach Bs, Hoonani M. Cuadrado Mspas, Pa-C, Seth A. Campbell Pa-C, Lauren Grantz Pharmd, Csp, Paige Roth Lsw, Jennifer E. Macfarlan Mph, Chase Jones Do, Aaron Fedor Do, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

A Pilot Study Comparing Over And Under Triage Systems At A Center Pursuing Trauma Accreditation, Caitlyn N. Balsay Bs, Mr, Bree A. Harrison Bsn, Rn, Tcrn, Joseph J. Stirparo Md, Michael T. Crowley Md, Nicholas P. Johnson Do, Bryan G. Kane Md, Kathleen E. Kane Md

Department of Emergency Medicine

No abstract provided.

Emergency Medicine Resident Identification Of Medication Safety Issues, Natalie E. Ebeling-Koning Do, Charles A. Soares Md, Gillian A. Beauchamp Md, Gavin C. Barr Jr. Md, Terrence E. Goyke Do, Shawn M. Quinn Do, Kevin Weaver D.O.,Facoep, Dawn M. Yenser C-Tagme, Bryan G. Kane Md

Department of Emergency Medicine

No abstract provided.

A Pilot Study Comparing Over And Under Triage Systems At A Center Pursuing Trauma Accreditation, Caitlyn N. Balsay Bs, Mr, Bree A. Harrison Bsn, Rn, Tcrn, Joseph J. Stirparo Md, Michael T. Crowley Md, Nicholas P. Johnson Do, Bryan G. Kane Md, Kathleen E. Kane Md

USF-LVHN SELECT

No abstract provided.

Analysis Of Falls Efficacy Scale And Vulnerable Elders Survey As Predictors Of Falls., Marna R. Greenberg Do, Mph, Facep, Jeanne L. Jacoby Md, Robert D. Barraco Md, Mph, Ali Yazdanyar Do, Phd, Mmm, Ryan M Surmaitis Do, Alexander Youngdahl Do, Richard Chow Do, Sofia Murillo, Allen Zeng, Bryan G. Kane Md

Department of Emergency Medicine

Introduction Falls are the leading cause of injury-related death among older adults according to the Centers for Disease Control and Prevention (CDC). The Falls Efficacy Scale (FES) and Vulnerable Elder Survey (VES-13) are validated screening tools used to assess concern of falling, health deterioration and functional decline. We set out to determine if the FES or VES-13 could serve as a predictor of falls among older adults in the Emergency Department (ED) setting. Methods This prospective pilot cohort study was conducted at a Level 1 Trauma Center. ED patients aged ≥65 were eligible for the study if they had a …

Evali During The Covid-19 Pandemic: A Needle In The Ground Glass, Derek J. Fikse Do, Matthew Nimmo Do, Alexandra Amaducci Do, Kenneth D. Katz Md

Department of Emergency Medicine

No abstract provided.

Escape This Emergency Room: Simulation Education During A Pandemic, Michael C. Nguyen Md, Nicole Elliott Do, Julie A. Fritzges Do, Louis Morolla Do, Steven A Johnson Md

Department of Emergency Medicine

No abstract provided.

Interventions To Reduce Emergency Department Demand During A Pandemic, Cynthia Wang Bs, Bryan G. Kane Md, Jason L. Forgeon Md, Justin Giordano Do, Armando Orta Md, Richard S. Mackenzie Md

Department of Emergency Medicine

No abstract provided.

Spontaneous Tumor Lysis Syndrome In An Adenocarcinoma Of Unknown Origin., Joshua A. Kalter Ms3, Jamie Allen Do, Yuchen Yang Do, Tyler Willing Do, Elizabeth M. Evans Do

Department of Emergency Medicine

Spontaneous tumor lysis syndrome (STLS) is a rare oncologic emergency caused by massive cancer cell lysis or necrosis without a precipitating factor. Although tumor lysis syndrome (TLS) is most commonly associated with hematologic malignancies, a small number of cases in solid tumor malignancies have been reported. We present a case of spontaneous tumor lysis syndrome in a 77-year-old female with a widely metastatic, poorly differentiated adenocarcinoma of unknown origin. She presented in distributive shock, and laboratory testing at admission revealed acute renal failure, high anion gap metabolic acidosis, hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Rasburicase and continuous renal replacement therapy were …

Concurrent Primary Cardiac Tumors In A High Risk Patient Presenting With Tamponade, Joseph B. Zackary Md, Lauren Crowley Ba, Shawn M. Quinn Do, Timothy S. Misselbeck

Department of Emergency Medicine

No abstract provided.

Fat Embolism Syndrome As The Presenting Syndrome Of Undiagnosed Sickle Cell Disease In A Middle-Aged Adult, Jamie Allen Do, Osman Z. Abbasi Do, Louis Morolla Do, Andres Zirlinger Md, Jeffrey M. Gesell Do, Benjamin Lin Ms

Department of Emergency Medicine

No abstract provided.

The Impact Of Appendectomy In Clostridium Difficile Infection And Length Of Hospital Stay., Rajesh Essrani Md, Dany Saturno, Shehriyar Mehershahi, Rajesh Kumar Essrani, Muhammad Rajib Hossain, Shri Jai Kirshan Ravi, Andrea Berger, Asif Mehmood

Department of Emergency Medicine

Introduction We aim to investigate Clostridium difficile infection (CDI) recurrence, severity, complications, and length of hospital stay in patients with and without prior history of appendectomy who were admitted to the hospital with CDI. Method We analyzed retrospective data for 862 patients, 18 years and older, with C. difficile inpatients diagnosed between January 1, 2017 and December 31, 2018 and sorted into two groups, with or without prior appendicectomy, to look for outcomes such as recurrence, hospital stay, complications, and related death in each group and use statistical analysis for comparison. Result There were 862 patients admitted with CDI, of …

Physician Directed Smoking Cessation In The Ed: Do Patients Opt-Out?, Ali S. Aziz Bs, Natalie M. Greco Md, Timothy J. Batchelor Md, Andrew H F Miller Do, Theodore Doherty Do, Robert Kruklitis Md, Phd, Lauren Crowley Ba, Edward W. Casey Rph, Mba, Elizabeth A. Maclean Pharmd, Phd, Joann B. Trainer Pharmd, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Self-Harm Poisonings Among Transgender Patients: Analysis Of Toxicology Investigator’S Consortium Registry, Marna R. Greenberg Do, Mph, Facep, Natalie E. Ebeling-Koning Do, Cody R. Mcwhirter Bs, Mikayla B. Hurwitz Bs, Lexis T. Laubach Bs, Gillian A. Beauchamp Md, Judith Sabino Mph, Cdp, Beth Careyva M.D., Andrew L. Koons, Matthew D. Cook Do, Kenneth D. Katz Md, Robert D. Cannon Do, Ryan M Surmaitis Do

Department of Emergency Medicine

No abstract provided.

Second Degree Av Heart Block After Candlenut Ingestion, Andrew L. Koons Do, Lexis Laubach Bs, Alexandra Amaducci Do, Robert D. Cannon Do, Kenneth D. Katz Md, Ryan M. Surmaitis Do, Matthew D. Cook Do, Gillian A. Beauchamp Md

Department of Emergency Medicine

No abstract provided.