Medicine and Health Sciences Commons^™

Management Of Primary Spontaneous Pneumothorax: A Single Institution Protocol Analysis, Shai Stewart Md, James A. Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Tolulope A. Oyetunji, Shawn D. St.Peter

Posters

Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis

Background: The Midwest Pediatric Surgery Consortium (MWPSC) has suggested a management algorithm to include simple aspiration of primary spontaneous pneumothorax (PSP), failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes in patients who have been managed with this suggested protocol.

Methods: An Institutional Review Board (IRB) approved, single institution retrospective analysis was conducted on all patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2022. Initial management consisted of aspiration alone with a 12F Thal-Quick chest tube followed by …

A Multimodal Approach To Reducing Opioid Administration In The Emergency Department, Eddie Ford, Vito Rocco, Shanna Jones, Patrick Karabon

Posters

INTRODUCTION
The United States is battling a deadly epidemic against opioid abuse and misuse, which began as a result of pharmaceutical companies purposely downplaying the addictive potential of their opioid medications. In 2016, a Colorado health care system developed a groundbreaking alternative to opioids (ALTO) protocol for acute pain relief in the Emergency Department (ED). This protocol was adapted and implemented in the Beaumont Troy ED and is the focus of this current study. The primary goal of this study is to characterize the impact of the ALTO protocol on the rate of opioid and non-opioid administration in the ED …

The Current State Of Diagnostic Error Education In U.S. Medical Schools, Dakota Hall, Sandra Lablance, Brett Todd

Posters

Diagnostic error has been identified by the Institute of Medicine as a major cause of patient harm. Despite recent focus on the importance of diagnostic error, little is known about how medical schools are educating future physicians, specifically, the extent to which it is taught. We aimed to investigate the current state of diagnostic error education in U.S. medical schools.

Imaging For Suspected Pediatric Appendicitis: Can Ultrasound Alone Be Trusted?, Ryan Nierstedt, Nafisa Bhuiyan, Michelle Jankowski, Lauren Desantis, Aveh Bastani, Shanna Jones

Posters

INTRODUCTION
Diagnosis of pediatric appendicitis relies on a combination of laboratory results, diagnostic imaging, and clinician judgement. However, the necessity of CT imaging has been questioned given radiation exposure. Therefore, ultrasound imaging has become a useful diagnostic tool, yet its sensitivity in identifying appendicitis is often lower in comparison to CT. This study aims to determine the sensitivity of US imaging for pediatric appendicitis and if differences exist in the diagnosis of appendicitis utilizing both CT and ultrasound or ultrasound alone.

Differences Within A Health System: Imaging Use For Suspected Pediatric Appendicitis, Nafisa Bhuiyan, Ryan Nierstedt, Michelle Jankowski, Shanna Jones, Aveh Bastani

Posters

INTRODUCTION
Ultrasound (US) is the first line imaging used for suspected pediatric appendicitis. However, following equivocal US findings and its lower negative predictive value for ruling out appendicitis, Computed Tomography (CT) imaging is often performed in children. This study investigates the differences in imaging utilization between a community hospital (Beaumont Troy) and a children’s ED hospital (Beaumont Royal Oak), making it the first study to evaluate suspected pediatric appendicitis in Beaumont Health System. It also aims to further characterize differences in patient outcomes such as surgery, length of hospital stay, complications of appendicitis, and highlight the need to reduce unnecessary …

Differences In Small Bowel Obstruction Outcomes In An Academic Vs Community Hospital., Kelly Fahey, Aveh Bastani, Shanna Jones, Philip Kilanowski-Doroh

Posters

Small bowel obstruction: blockage in small intestine. Adhesions are the most common cause. Accounts for 300,000 hospitalizations in the US annually, and 20% of emergency surgical procedures in patients with abdominal pain. High morbidity and mortality. Average hospital stay of 8 days. 30-day readmission rate of 16%. In-hospital mortality rate of 3%. Costly diagnosis: more than $2 billion spent on admissions for adhesion-related disease in the United States. Clinical presentation: variable, includes abdominal pain, vomiting, constipation, nausea, and abdominal distention. Management. Operative: important if signs of ischemia, peritonitis, or strangulation. Conservative: includes bowel rest, nasogastric decompression, serial examinations, and a …

Assessing Geriatric Patients In The Emergency Department Using A New Trauma Protocol, Benjamin Travers, Ali Beydoun, Patrick Karabon, Shanna Jones, Michael Opsommer, Aveh Bastani, David Donaldson

Posters

INTRODUCTION
The Level III trauma protocol was implemented to reduce time to diagnosis and treatment for elderly patients (defined as patients aged > 65 who are taking anticoagulant/antiplatelet agents) presenting in the ED with a potential head injury after a fall. In 2017, approximately 11.4% of the patients triaged by the new Level III trauma protocol had an intracranial bleed, which is a population that had previously been overlooked as they have a low index of suspicion for an intracranial bleed. This study sought to determine if the recent implementation of the Level III trauma protocol in the Troy Beaumont Emergency …

Cardiac Arrest Patient Length Of Stay And Survival In Michigan Hospitals, Jaemin Song, David A. Berger, James H. Paxton, Joseph B. Miller, Joshua Reynolds, Nai-Wei Chen, Robert Swor

Posters

INTRODUCTION
Current guidelines recommend deferring prognostic decisions for at least 72 hours following admission after Out of Hospital cardiac arrest (OHCA). Most non-survivors experience withdrawal of life-sustaining therapy (WLST), and early WLST may adversely impact survival. We sought to characterize the hospital length of stay (LOS) and timing of Do Not Resuscitate (DNR) orders (as surrogates for WLST) to assess their relationship to survival following cardiac arrest.

Outcomes For Patients With Congestive Heart Failure And Chronic Kidney Disease Receiving Fluid Resuscitation For Severe Sepsis Or Septic Shock, Melany Wiczorek, Ronny Otero, Steven Knight, Kaitlin Ziadeh, James Blumline, Zachary Rollins

Posters

INTRODUCTION
Sepsis core measures are an integral part of sepsis treatment. Current fluid administration guidelines consist of administering at least 30cc/kg of intravenous fluids (IVF) per ideal body weight (IBW) within the first three hours of sepsis diagnosis regardless of pre-existing comorbidities at risk for fluid overload. This study aims to evaluate the outcomes of patients with a history of congestive heart failure (CHF) and/or chronic kidney disease (CKD) who receive fluid resuscitation for the management of severe sepsis or septic shock.

Risk Factors Affecting Delayed Diagnosis Of Adult Acute Appendicitis, Nicholas W. Prewitt, Brett R. Todd

Posters

INTRODUCTION
The diagnosis of appendicitis is time-sensitive and delays increase the risk of morbidity and mortality through complications, including perforation, gangrene, and abscess formation. Nearly all cases of appendicitis are diagnosed in and admitted through the emergency department (ED). Therefore, improvements in the time to diagnosis of acute appendicitis in the ED may improve patient outcomes. However, it currently remains unclear what factors contribute to prolonged diagnostic times of appendicitis. This study aimed to determine if demographic, environmental, or provider-related factors result in delays in the diagnosis of adult acute appendicitis in the ED.

The Impact Of Medical Scribes On Emergency Physician Diagnostic Testing And Diagnosis Charting, Lucas Nelson, Brett R. Todd

Posters

INTRODUCTION
Since the widespread adoption of electronic medical records (EMRs), medical scribes have been increasingly utilized in emergency department (ED) settings to offload the documentation burden of emergency physicians (EPs). Scribes have been shown to increase EP productivity and satisfaction; however, little is known about their effects on the EP’s diagnostic process. We aimed to assess what effect, if any, scribes have on EP diagnostic test ordering and their documentation of differential diagnoses.

Journal Club In The Pre-Clinical Years During Medical School, Kristin Cuadra, Steven Joseph

Posters

INTRODUCTION
Traditionally, journal clubs have been conducted within graduate medical programs to help integrate evidence-based learning. This study will be focused on beginning to integrate journal club into the pre-clinical years while implementing successful techniques used in past journal clubs. Our hypothesis is that, with a structured review instrument in place to help students analyze clinical articles, students will be able to benefit from monthly journal clubs and fully grasp concepts taught in these pre-clinical years. Overall, the results will contribute significantly in determining the efficacy of journal club and whether or not it can be a valuable tool in …

A Review Of The Clinical And Cost Effectiveness Of Intravenous And Intramuscular Pharmacological Treatment On Acute Agitation In Patients Admitted To The Emergency Department, Ryan Ferris, Carol Keller

Providence Pharmacy PGY1 Program at Providence Milwaukie and Providence Newberg Medical Centers 2022

No abstract provided.

Us-Guided Regional Anesthesia (Ugra) In The Ed- A Qi Project, Joshua Rehberg

Costas T. Lambrew Research Retreat 2022

Introduction-

Between 01/2021-09/2021 there were 95 people diagnosed with hip fractures in the emergency department. •56% (n= 53) got a fascia iliacacompartment block. •9% of notes had a comment on reevaluation of effectiveness or re-evaluation post-block, only ~50% had a neurovascular exam commenting on both motor function and pulses, and 7% of all blocks (n= 4) had no procedure note. •Goal: The purpose of was to improve the quality of care given to patients receiving US-guided regional anesthesia, provide a way to track the number of ultrasound-guided regional blocks performed in the emergency department, and improve resident education and documentation

Patient Attitudes, Perceptions, Knowledge, And Beliefs Regarding Immigration Status In The Healthcare Setting, Anik Patel

Presentations

No abstract provided.

Parental Teach Back In The Ed Setting For Non-English Speaking Families, Rohan Akhouri

Presentations

90 million Americans have low health literacy1.in Missouri 35% of adults have prose literacy at or below basic skill level2. Literacy, more specifically health literacy, is a modifiable social determinant of health that has a large impact on patient care and outcome. Poor health literacy in adults is associated with a higher number of ED visits and worse health outcomes3,4. Teach back is a method used in multiple pediatric and adult settings, shown to improve patient outcomes and comfort with discharge instructions5. There is limited data regarding teach back in non-English speaking patients and its efficacy with this group of …

Outpatient Emergency Preparedness, Mary Haywood

Presentations

It is commonly believed that medical emergencies do not present to general pediatric offices. However, it has been estimated that 0.9-42 emergencies per office site/year occur. The most common presentations are respiratory in nature. However, children can also present with dehydration, seizure, psychiatric or behavioral complaints. Despite this, most offices are not prepared to handle these presentations for various reasons. Multiple studies have showed that preparedness in inpatient settings is improved with education, implementation, or protocols and deliberate practice with mock codes. However, there have been few studies in the outpatient setting. One study utilized simulation as a tool to …

Ultrasound Guided Peripheral Iv Access Curriculum For The Pediatric Emergency Department: A Pilot Study., Samuel Dillman, Frances Turcotte Benedict, Christopher S. Kennedy

Posters

Ultrasound Guided Peripheral IV Access Curriculum for the Pediatric Emergency Department: a pilot study. Background: Up to 50% of children have difficult venous access. Studies in the Pediatric Emergency department (PED) have shown that ultrasound guided peripheral IV (USGPIV) access has decreased IV access time and ED length of stay.  Barriers for use include lack of training and comfort with the procedure. Objectives/Goal: Our objectives are to pilot and evaluate USGPIV training for Pediatric Emergency Medicine (PEM) physicians and nurses.  Methods/Design: The course included a 4-hour, hands-on session with US IV training using a blue phantom task trainer in conjunction …

Suspected Blow To The Chest? Investigate It!, Parisa Biazar, Catherine Mitchell, David I. Rosenberg

South Atlantic Division Research Day 2022

No abstract provided.

Triceps Tendon Avulsion In Elderly Male, Mary Claire Lark, Garrett Root, Bryan T. Luu

South Atlantic Division Research Day 2022

No abstract provided.

Corneal Ulcer On The Verge Of Rupture: An Ocular Emergency In A Free-Standing Emergency Room, Kevin Thomas, Garrett Root

South Atlantic Division Research Day 2022

No abstract provided.

Prochlorperazine Vs Metoclopramide As First Line Treatment In Intractable Headache In The Pediatric Emergency Department, Courtney Hill, Kaitlynn Small, Urvashi Baruanath, Erica Junqueira, Brandon Carter, Anita Datta, Ameer Hassoun, Zuhair Ali

Gulf Coast Division Research Day 2022

No abstract provided.

Care Alert Program In Chronic Recurrent Ed Utilizing Patients, Kaitlyn Phelps, Erica Gibbons, Jonathan Leggett, Jonathan Bryan

South Atlantic Division Research Day 2022

No abstract provided.

Shark Bite In A Seven Year-Old Female: A Case Report, James Schmid, Jarrett Koper, Jonathan Leggett

South Atlantic Division Research Day 2022

No abstract provided.

Gallstone Ileus: A Case Report, Jarrett Koper, Liz Bowers, Jonathan Leggett

South Atlantic Division Research Day 2022

No abstract provided.

Envenomation By A Gaboon Viper, Mary Claire Lark, Jarratt Lark

South Atlantic Division Research Day 2022

No abstract provided.

Improving Access To Medication Assisted Treatment For Opioid Use Disorder In A Rural Emergency Department, Warren Grunvald

Family Medicine Clerkship Student Projects

Opioid Use Disorder (OUD) is a growing epidemic throughout the United States and Maine has not been sparred by this. As the Emergency Department is a frequent location for people with OUD to interact with physicians it has been targeted as an opportunity to initiate Medication-Assisted Treatment (MAT) with Suboxone. This project details an effort to streamline this process and improve outcomes for patients interested in MAT.

Improving access to medication assisted treatment for opioid use disorder in a rural Emergency Department

Improving Access To Medication Assisted Treatment For Opioid Use Disorder In A Rural Emergency Department, Warren Grunvald

Family Medicine Clerkship Student Projects

Opioid Use Disorder (OUD) is a growing epidemic throughout the United States and Maine has not been sparred by this. As the Emergency Department is a frequent location for people with OUD to interact with physicians it has been targeted as an opportunity to initiate Medication-Assisted Treatment (MAT) with Suboxone. This project details an effort to streamline this process and improve outcomes for patients interested in MAT.