Emergency Medicine Commons^™

Motivation Rulers For Smoking Cessation: A Prospective Observational Examination Of Construct And Predictive Validity, Edwin D. Boudreaux, Ashley F. Sullivan, Beau W. Abar, Steven L. Bernstein, Adit A. Ginde, Carlos A. Camargo Jr.

Open Access Articles

BACKGROUND: Although popular clinically, the psychometric properties of motivation rulers for tobacco cessation are unknown. This study examined the psychometric properties of rulers assessing importance, readiness, and confidence in tobacco cessation.

METHODS: This observational study of current smokers was conducted at 10 US emergency departments (EDs). Subjects were assessed during their ED visit (baseline) and reassessed two weeks later. We examined intercorrelations between the rulers as well as their construct and predictive validity. Hierarchical multinomial logistic regressions were used to examine the rulers' predictive ability after controlling for covariables.

RESULTS: We enrolled 375 subjects. The correlations between the three rulers ...

Smoking, Cardiac Symptoms, And An Emergency Care Visit: A Mixed Methods Exploration Of Cognitive And Emotional Reactions, Karyn A. Tappe, Edwin D. Boudreaux, Beth Bock, Erin L. O'Hea, Brigitte M. Baumann, Steven Hollenberg, Bruce M. Becker, Gretchen B. Chapman

Open Access Articles

Emergency departments and hospitals are being urged to implement onsite interventions to promote smoking cessation, yet little is known about the theoretical underpinnings of behavior change after a healthcare visit.

This observational pilot study evaluated three factors that may predict smoking cessation after an acute health emergency: perceived illness severity, event-related emotions, and causal attribution. Fifty smokers who presented to a hospital because of suspected cardiac symptoms were interviewed, either in the emergency department (ED) or, for those who were admitted, on the cardiac inpatient units. Their data were analyzed using both qualitative and quantitative methodologies to capture the individual ...

Inferior Vena Cava Displacement During Respirophasic Ultrasound Imaging, David J. Blehar, Dana Resop, Benjamin Chin, Matthew Dayno, Romolo Joseph Gaspari

Open Access Articles

BACKGROUND: Ultrasound measurement of dynamic changes in inferior vena cava (IVC) diameter can be used to assess intravascular volume status in critically ill patients, but published studies vary in accuracy as well as recommended diagnostic cutoffs. Part of this variability may be related to movements of the vessel relative to the transducer during the respiratory cycle which results in unintended comparison of different points of the IVC at end expiration and inspiration, possibly introducing error related to variations in normal anatomy. The objective of this study was to quantify both craniocaudal and mediolateral movements of the IVC as well as ...

Effect Of Iron Chelators On Methemoglobin And Thrombin Preconditioning., Jing Chen-Roetling, Jesse Sinanan, Raymond F. Regan

Department of Emergency Medicine Faculty Papers

Cell loss immediately adjacent to an intracerebral hemorrhage may be mediated in part by the toxicities of extracellular hemoglobin (Hb) and thrombin. However, at low concentrations, these proteins induce tolerance to hemin and iron that may limit further peri-hematomal injury as erythrocyte lysis progresses. The mechanisms mediating these preconditioning effects have not been completely defined, but increased expression of both heme oxygenase (HO)-1 and iron binding proteins likely contributes. In the present study, we hypothesized that iron chelator therapy would attenuate this protective response. Pretreatment of cortical glial cultures (> 90 % GFAP+) with 3 μM methemoglobin (metHb) or 5 units ...

Aortic Dissection Presenting As Gait Disturbance: A Case Report., Michael Estreicher, Joseph Portale, Bernard Lopez

Department of Emergency Medicine Faculty Papers

Emergency medicine dogma traditionally teaches that aortic dissection presents as tearing chest pain, radiating to the back. This case report describes a 55 year old woman presenting with a left homonymous hemianopsia and resultant gait disturbance. Initial head CT demonstrated a right parietal infarct, and chest radiograph demonstrated a markedly widened mediastinum. Acute Stanford Type A aortic dissection was subsequently confirmed. This report provides further evidence for atypical, painless presentations of aortic dissection. Given recent literature on the increasing prevalence of painless dissection, the disease entity should be included in the differential diagnosis for stroke, and a simple portable chest ...

Decrease In Central Venous Catheter Placement And Complications Due To Utilization Of Ultrasound-Guided Peripheral Intravenous Catheters, Arthur K Au, Masashi Rotte, Robert Grzybowski, Bon Ku, Jason M. Fields

Department of Emergency Medicine Faculty Papers

Poster presented at: American College of Emergency Physicians (ACEP) conference.

Introduction: -Up to 40% of ED visits include diagnostic blood tests and 26% result in administration of IV fluids necessitating successful peripheral intravenous (IV) catheter placement.1 -There is a subset of patients with difficult IV access (DIVA) in which traditional cannulation methods are unsuccessful resulting in central venous cannulation (CVC). -CVCs have a 5-15 percent complication rate2 and attributable costs per CVC related infection have been estimated at $34,508-$56,000.3 -Ultrasound-guided peripheral IV catheters (USGPIVs) provide a method of potentially decreasing the need for CVC placement ...

The Effect Of Vessel Depth, Diameter, And Location On Ultrasound-Guided Peripheral Intravenous Catheter Longevity., J Matthew Fields, Anthony J Dean, Raleigh W Todman, Arthur K Au, Kenton L Anderson, Bon S Ku, Jesse M Pines, Nova L Panebianco

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Ultrasound-guided peripheral intravenous catheters (USGPIVs) have been observed to have poor durability. The current study sets out to determine whether vessel characteristics (depth, diameter, and location) predict USGPIV longevity.

METHODS: A secondary analysis was performed on a prospectively gathered database of patients who underwent USGPIV placement in an urban, tertiary care emergency department. All patients in the database had a 20-gauge, 48-mm-long catheter placed under ultrasound guidance. The time and reason for USGPIV removal were extracted by retrospective chart review. A Kaplan-Meier survival analysis was performed.

RESULTS: After 48 hours from USGPIV placement, 32% (48/151) had failed prematurely ...

A Cluster Randomization Trial To Test The Effectiveness Of A Clinical Pathway In Managing Atrial Fibrillation In The Emergency Department, Girish Madhavan Nair

Open Access Dissertations and Theses

BACKGROUND:

Emergency Department (ED) visit rates for patients with symptomatic, recent onset atrial fibrillation or atrial flutter (RAFF) are on the rise, which in turn has resulted in high hospital admission rates (38-45%). Optimal management strategies need to be developed for reducing hospital admission rates.

STUDY QUESTION:

The primary objective of this study is to evaluate the effectiveness of a clinical pathway for the management of low-risk RAFF patients in the ED. The hypothesis is that an evidence-based clinical pathway will help ED physicians better manage AF patients and reduce hospital admissions.

STUDY DESIGN:

A prospective, blinded, stratified, two-arm cluster-randomized ...