Medicine and Health Sciences Commons^™

Improving Efficiency And Patient Experience In Emergency Medicine With A Virtual Physician In Triage, Christian Voloshen, Eric W. Bean Do

Research Scholars

No abstract provided.

Intentional Self-Harm Overdoses Before And During The Covid-19 Pandemic In Adolescents Managed By A Medical Toxicology Consultation Service, Samantha L. Gaetani Md, Natalie E. Ebeling-Koning Do, Nicholas S. Imperato, Katelyn Mclain, Derek J. Fikse Do, Gillian A. Beauchamp Md, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Exploratory Review Of Medical Student Essays Reveals Learner Discomfort, Lack Of Opportunities But Desire To Gain Competence, Nuha Cebeci Md, Susan E. Hansen Ma, Jessica K. Eygnor Do

Department of Family Medicine

No abstract provided.

Intentional Self-Harm Overdoses Before And During The Covid-19 Pandemic In Adolescents Managed By A Medical Toxicology Consultation Service, Samantha L. Gaetani Md, Natalie E. Ebeling-Koning Do, Nicholas S. Imperato, Katelyn Mclain, Derek J. Fikse Do, Gillian A. Beauchamp Md, Marna R. Greenberg Do, Mph, Facep, Alexandra Amaducci

Toxicology Division

No abstract provided.

The Importance Of Emphasizing Addiction Medicine During Medical Toxicology Fellowship Training: A Case Study Of Tertiary Care Hospital System Toxicology Consultation Service, Nicholas S. Imperato, Chase Jones Do, Derek J. Fikse Do, Gillian A. Beauchamp Md, Marna R. Greenberg Do, Mph, Facep, Alexandra Amaducci, Katelyn Mclain

Toxicology Division

No abstract provided.

On Behalf Of The Toxicology Investigators Consortium (Toxic). A Five-Year Analysis Of The Toxicology Investigator’S Consortium (Toxic) Core Registry: Exposure Differences In Patients That Identified As Transgender Vs. Cisgender, K Magnusson, Derek J. Fikse Do, E Glidden, Gillian A. Beauchamp Md, K Aldy, D Mustaquim, Judith Sabino Mph, Cdp, Marna R. Greenberg Do, Mph, Facep, Alexandra Amaducci

Toxicology Division

No abstract provided.

African Bush Viper Envenomation: A Case Report, Nicholas S. Imperato, Alexandra Amaducci, Benjamin N. Abo, Andrew L. Koons, Derek J. Fikse Do, Kenneth D. Katz Md

Toxicology Division

No abstract provided.

Diagnosis Of Intrauterine Pregnancy Despite The Presence Of Etonogestrel Implant, Ryan J. Sawyers, Pratik M. Parikh Do, Jose Lazaro Md, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Malignant Acute Disseminated Encephalomyelitis (Adem) Presenting As A Stroke Alert: A Case Report., Madeline J Hooper, Joshua A. Kalter Ms3, Nicholas S. Imperato, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

Acute disseminated encephalomyelitis (ADEM) is a rare illness. Generally characterized by encephalopathy and non-specific, heterogeneous neurological deficits depending on the location of the demyelinated lesions, ADEM is considered a clinical diagnosis with radiological findings that may or may not have supportive features based on the temporal relationship of an inciting factor and symptom onset. Even rarer, hyperacute or malignant ADEM can be defined by rapid symptom onset followed by catastrophic brain edema and its sequelae. We present a case of a patient who presented with an acute stroke with activation of a rapid sequence care pathway (stroke alert protocol) to …

Utilization Of The Lempert Maneuver For Benign Paroxysmal Positional Vertigo In The Emergency Department., Vanessa Hwu, Arielle Burris, Jessica R Pavolko, Daniel Sawyer Pt, Dpt, Marna R. Greenberg Do, Mph, Facep, David B. Burmeister Do, Facep, Cpe

Department of Emergency Medicine

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo. Symptoms from BPPV lead to Emergency Department (ED) visits, and persistence of symptoms, particularly in the elderly, may impact patient disposition. We describe the techniques used in the case of a 72-year-old male with dizziness, who had symptom resolution, and was able to be safely discharged after a Lempert maneuver (barbeque (BBQ) roll) was performed in the ED setting. The patient presented to the ED with left gaze nystagmus, and otherwise normal evaluation results. Physical therapy was consulted, and their initial evaluation indicated right horizontal canalithiasis noted by fatiguing …

A Severe Case Of Odontogenic Infection And Necrotizing Fasciitis Of The Anterior Chest Wall And Neck., Mallorie L Huff, Kyle S Wilson Md, Kathleen E. Kane Md, Kathryn L Wheel Md, Joseph J. Stirparo Md

Department of Surgery

Necrotizing fasciitis is a life-threatening infection that can be rapidly fatal. Early identification and emergent surgical management are essential to minimize morbidity and mortality. This case report describes a 25-year-old male who presented to the emergency department with a three-day history of worsening left lower dental infection and new-onset neck pain and swelling. He received broad-spectrum antibiotics and intravenous fluid resuscitation and underwent computed tomography of the neck and chest. Following intensive care unit admission, he underwent tooth extraction where intraoperative evaluation revealed subcutaneous crepitus. Immediate debridement was performed, revealing copious foul-smelling purulent discharge and necrotic tissue extending over the …

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 …

Agents Of Exposure Among Pediatric Transgender Patients: An Analysis Of The Toxicology Investigator’S Consortium (Toxic) Registry, William Nick Doyle Bs, Derek J. Fikse Do, Richard J. Mazzaccaro Md, Gillian A. Beauchamp Md, Marna R. Greenberg Do, Mph, Facep, Tasha Desai Do, Natalie E. Ebeling-Koning Do, Katelyn Mclain, Judith Sabino Mph, Cdp, Beth Careyva M.D., Alexandra Amaducci Do

Toxicology Division

No abstract provided.

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.

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

Toxicological Exposures In Covid-19 Patients, Alexandra M. Amaducci Do, Kim Aldy Do, Sharan L Campleman Phd, Mph, Dabt, Shao Li Mph, Alison Meyn Mph, Stephanie Abston Rn, Bsn, Meghan B Spyres Md, Paul M Wax Md, Facmt, Jeffery Brent Md, Phd

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.

Teaching Wilderness Medicine Virtually During Covid-19, Nicole Elliott Do, Derek J. Fikse Do, Eric Schneider Do, Kevin R. Roth Do, Facoep, Bryan G. Kane Md, Hillary Irons Md, Michael C. Nguyen Md

Department of Emergency Medicine

No abstract provided.

A Standardized Orientation For Newly-Licensed Nurses And Preceptors In The Emergency Department, Judith Baker Bsn, Rn, Michelle Greis Bsn, Rn, Cen, Reza Armaghan Msn, Rn, Cen, Phrn

Department of Emergency Medicine

No abstract provided.

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 …

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 …

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 …

Assessing The Clinical Characteristics And Ventilator Parameters Of Covid-19 Mechanically Ventilated Patients At Lehigh Valley Health Network, Andrew Kelly, Kenneth Miller Med, Rrt-Nps

Research Scholars

No abstract provided.

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 …

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 …

Does Performing Endoscopy Sooner Have An Impact On Outcomes In Patients With Acute Nonvariceal Upper Gastrointestinal Hemorrhage? A Systematic Review., Zahid Ijaz Tarar, Muhammad Usman Zafar, Umer Farooq, Ghulam Ghous, Hafiz Muhammad Hassan Shoukat, Vanessa Kuwajima

Department of Emergency Medicine

Background Endoscopy is the cornerstone for the diagnosis and treatment of nonvariceal upper gastrointestinal bleeding. Regarding the management of nonvariceal bleeding, the administration of crystalloid solution and proton pump inhibitors before endoscopy is well established, but the optimal timing of endoscopy has been a matter of debate and a subject of many investigational studies. The need for urgent endoscopy arises to provide prompt redress to acute bleeding, decrease the length of stay, and lower mortality from ongoing bleeding. Objective This study aimed to determine if endoscopy performed within 24 hours of presentation improves outcomes in terms of mortality, hospital length …

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. …