Medicine and Health Sciences Commons^™

Life-Threatening Retropharyngeal Hemorrhage Secondary To Rupture Of The Inferior Thyroid Artery., Cristina G Calogero, Andrew C. Miller Do, Marna R. Greenberg Do, Mph, Facep

Marna R Greenberg DO, MPH, FACEP

Inferior thyroid artery (ITA) rupture is rare and may progress to life-threatening conditions. We present a patient who visited the emergency department after an episode of syncope and dizziness in which he had a mechanical fall that resulted in abrasions and a hematoma to his left forehead. The patient presented with dysphagia and anterior neck swelling that progressed rapidly into airway compromise requiring endotracheal intubation. Emergent computed tomography revealed a large retropharyngeal hematoma, with active arterial extravasation that was thought to be arising from the thyrocervical trunk on the left. The hematoma measured approximately 6.7 cm transversely and 3.2 cm …

Funding Mechanisms For Gender-Specific Research: Proceedings From A Panel Discussion At The 2014 Academic Emergency Medicine Consensus Conference., Basmah Safdar, Marna Greenberg, Ayodola Anise, Jeremy Brown, Robin Conwit, Rosemarie Filart, Jane Scott, Esther K Choo

Marna R Greenberg DO, MPH, FACEP

As part of the 2014 Academic Emergency Medicine (AEM) consensus conference "Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," we assembled a diverse panel of representatives from federal and nonfederal funding agencies to discuss future opportunities for sex- and gender-specific research. The discussion revolved around the mission and priorities of each organization, as well as its interest in promoting sex- and gender-specific research. The panelists were asked to provide specific examples of funding lines generated or planned for as pertinent to emergency care. Training opportunities for future researchers in this area were also discussed.

Emergency Medicine Gender-Specific Education., John Ashurst, Alyson J Mcgregor, Basmah Safdar, Kevin Weaver, Shawn M Quinn, Alexander Rosenau, Terrence Goyke, Kevin Roth, Marna Greenberg

Marna R Greenberg DO, MPH, FACEP

The 2014 Academic Emergency Medicine consensus conference has taken the first step in identifying gender-specific care as an area of importance to both emergency medicine (EM) and research. To improve patient care, we need to address educational gaps in this area concurrent with research gaps. In this article, the authors highlight the need for sex- and gender-specific education in EM and propose guidelines for medical student, resident, and faculty education. Specific examples of incorporating this content into grand rounds, simulation, bedside teaching, and journal club sessions are reviewed. Future challenges and strategies to fill the gaps in the current education …

A Research Agenda For Gender And Substance Use Disorders In The Emergency Department, Esther K Choo, Gillian Beauchamp, Francesca L Beaudoin, Edward Bernstein, Judith Bernstein, Steven L Bernstein, Kerryann B Broderick, Robert Cannon, Gail D'Onofrio, Marna Greenberg, Kathryn Hawk, Rashelle B Hayes, Gabrielle A Jacquet, Melanie J Lippmann, Karin V Rhodes, Susan H Watts, Edwin D Boudreaux

Marna R Greenberg DO, MPH, FACEP

For many years, gender differences have been recognized as important factors in the etiology, pathophysiology, comorbidities, and treatment needs and outcomes associated with the use of alcohol, drugs, and tobacco. However, little is known about how these gender-specific differences affect ED utilization; responses to ED-based interventions; needs for substance use treatment and barriers to accessing care among patients in the ED; or outcomes after an alcohol-, drug-, or tobacco-related visit. As part of the 2014 Academic Emergency Medicine consensus conference on "Gender-Specific Research in Emergency Care: Investigate, Understand and Translate How Gender Affects Patient Outcomes," a breakout group convened to …

Gender Differences In Perceptions And Self-Reported Driving Behaviors Among Teenagers., Gavin Barr, Kathleen Kane, Robert Barraco, Timarie Rayburg, Lauren Demers, Chadd Kraus, Marna Greenberg, Valerie Rupp, Kimberly Hamilton, Bryan Kane

Marna R Greenberg DO, MPH, FACEP

BACKGROUND: The Centers for Disease Control reports that motor vehicle crashes (MVCs) are the leading cause of injury and death among U.S. teenagers, and disproportionately affect males. Among preventable causes of MVCs involving teenage drivers, distracted driving continues to be a serious public health problem. OBJECTIVES: To describe gender differences in teenage drivers' self-perceptions of safe driving behaviors, and self-reported risk behaviors and distractions while driving. METHODS: We prospectively surveyed teenage drivers from four high schools in Pennsylvania and New Jersey. Gender comparisons were made between self-reported perceptions and self-reported driving behaviors. Descriptive statistics and chi-squared testing were used in …

Detecting Foreign Bodies In A Head Laceration, Thomas R Fowler, Steven Crellin, Marna Greenberg

Marna R Greenberg DO, MPH, FACEP

Open wounds represent a potential area of medicolegal risk if foreign bodies are not identified prior to wound closure. The importance of imaging of lacerations was underscored by a recent case where a 20-year-old male collided with a friend's mouth on a trampoline sustaining a simple, superficial scalp laceration. The wound was evaluated in typical fashion including irrigation and local exploration and was prepared for closure. The friend was then evaluated and noted to have multiple extensive dental fractures. An increased index of suspicion generated further evaluation of the first patient's wound. Plain radiography obtained of the first patient's skull …

Implementation Of A Rapid Assessment Unit (Intake Team): Impact On Ed Length Of Stay., Richard Mackenzie, David Burmeister, Jennifer Brown, Melissa Teitsworth, Christopher J Kita, Megan Dambach, Shaheen Shamji, Marna Greenberg

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

Comparison Of Airway Intubation Devices When Using A Biohazard Suit: A Feasibility Study., Kevin Weaver, Gavin Barr, Kayla Long, Leonel Diaz, Aaron Ratner, Jeffery Reboul, Dougals Sturm, Marna Greenberg, Stephen W Dusza, Bernadette Glenn-Porter, Bryan Kane

Marna R Greenberg DO, MPH, FACEP

OBJECTIVES: We set out to compare emergency medicine residents' intubating times and success rates for direct laryngoscopy (DL), GlideScope-assisted intubation (GS), and the Supraglottic Airway Laryngopharyngeal Tube (SALT) airway with and without biohazard gear.

METHODS: Each resident passed through 2 sets of 3 testing stations (DL, GS, SALT) in succession, intubating Laerdal mannequin heads with the 3 modalities after randomization to start with or without biohazard gear.

RESULTS: Thirty-seven residents participated, and 27 were male (73%); 14 (37.8%) had prior experience intubating in biohazard suits. There was a statistically significant difference in those who had prior intubation experience between DL …

Gender-Specific Regulatory Challenges To Product Approval: A Panel Discussion., Alyson J Mcgregor, Helen Barr, Marna Greenberg, Basmah Safdar, Peter Wildgoose, David W Wright, Judd E Hollander

Marna R Greenberg DO, MPH, FACEP

On May 13, 2014, a 1-hour panel discussion session titled "Gender-specific Regulatory Challenges to Product Approval" was held during the Academic Emergency Medicine consensus conference, "Gender-specific Research in Emergency Medicine: Investigate, Understand, and Translate How Gender Affects Patient Outcomes." The session sought to bring together leaders in emergency medicine (EM) research, authors, and reviewers in EM research publications, as well as faculty, fellows, residents, and students engaged in research and clinical practice. A panel was convened involving a representative from the Office of Women's Health of the U.S. Food and Drug Administration, two pharmaceutical executives, and a clinical EM researcher. …

Mechanical Falls: Are Patients Willing To Discuss Their Risk With A Health Care Provider?, Marna Greenberg, Michael Nguyen, Brian Stello, Arnold Goldberg, Robert Barraco, Bernadette Glenn-Porter, Anita Kurt, Stephen Dusza, Bryan Kane

Marna R Greenberg DO, MPH, FACEP

Background: Falls in the elderly cause serious injury. Objective: We aimed to determine subjects’ comfort in discussing fall risk and home safety evaluations. Methods: This prospective study surveyed a convenience sample of subjects ($50 years old) in an emergency department (ED), health fair (HF), and family practice (FP). The survey included the Falls Efficacy Scale and Vulnerable Elders Survey—validated surveys measuring fall concern and functional decline. Other data—environmental living conditions, participant behaviors, fall frequency—were collected. The associations between perceived fall risk and participant characteristics were assessed using descriptive statistics and random-effects logistic regression. Results: Participants (n = 416, 38% males, …

Effect Of Triage-Based Use Of The Ottawa Foot And Ankle Rules On The Number Of Orders For Radiographic Imaging., John Ashurst, Thomas Nappe, Stephanie Digiambattista, Avinash Kambhampati, Sarfraz Alam, Michelle Ortiz, Paul Delpais, Bernadette Glenn-Porter, Anita Kurt, Bryan Kane, Marna Greenberg

Marna R Greenberg DO, MPH, FACEP

CONTEXT: Reducing unnecessary testing lessens the cost burden of medical care, but decreasing use depends on consistently following evidence-based clinical decision rules. The Ottawa foot and ankle rules (OFARs) are validated, longstanding evidence-based guidelines to predict fractures. Frequently, radiography is automatically ordered for acute ankle injuries despite findings from OFARs suggesting no fracture. OBJECTIVES: First, to determine whether implementation of protocol-driven use of the OFARs at triage would decrease the number of radiography orders and length of stay (LOS) in the emergency department. Second, to quantify the incidence of OFARs use at triage and to assess patient expectations of radiography …

In Reply., Marna Greenberg, Deepak Jayant, Gavin Barr

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

Absolute And Relative Changes (Delta) In Troponin I For Early Diagnosis Of Myocardial Infarction: Results Of A Prospective Multicenter Trial., Alan B Storrow, Richard M Nowak, Deborah B Diercks, Adam J Singer, Alan H B Wu, Erik Kulstad, Frank Lovecchio, Christian Fromm, Gary Headden, Tracie Potis, Christopher J Hogan, Jon W Schrock, Daniel P Zelinski, Marna Greenberg, Robert H Christenson, James C Ritchie, Janna S Chamberlin, Kurtis R Bray, Daniel W Rhodes, Deirdre Trainor, Paula C Southwick

Marna R Greenberg DO, MPH, FACEP

OBJECTIVES: We investigated absolute and relative cardiac troponin I (TnI) delta changes, optimal sampling protocols, and decision thresholds for early diagnosis of myocardial infarction (MI). Serial cardiac biomarker values demonstrating a rise and/or fall define MI diagnosis; however the magnitude of change, timing, and diagnostic accuracy of absolute versus relative (percentage) deltas remains unsettled. METHODS: We prospectively measured TnI (AccuTnI+3™, Beckman Coulter) at serial time intervals in 1929 subjects with chest pain or equivalent symptoms of acute coronary syndrome at 14 medical centers. Diagnosis was adjudicated by an independent central committee. RESULTS: Elevated TnI above a threshold of 0.03ng/mL demonstrated …

Future Directions In Sex- And Gender-Specific Emergency Medicine., Marna Greenberg, Basmah Safdar, Esther K Choo, Alyson J Mcgregor, Lance B Becker, David C Cone

Marna R Greenberg DO, MPH, FACEP

The 2014 Academic Emergency Medicine (AEM) consensus conference "Gender-Specific Research in Emergency Medicine: Investigate, Understand, and Translate How Gender Affects Patient Outcomes" convened a diverse group of stakeholders to target gaps in emergency medicine (EM) sex- and gender-specific research and identify research priorities. At the close of the conference, the executive committee sought feedback from group leaders and conference attendees about the next critical steps in EM sex- and gender-specific research, goals for their own future research, and anticipated barriers in pursuing this research. This article summarizes this feedback on the future directions in sex- and gender-specific research in emergency …

Post Transapical Aortic Valve Replacement (Tavr) Pseudoaneurysm., Michael W Manning, Leonel Diaz, Michael Weigner, Colin L Donnelly, Marna Greenberg

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

Injury Due To Mechanical Falls: Future Directions In Gender-Specific Surveillance, Screening, And Interventions In Emergency Department Patients., Marna Greenberg, Bryan Kane, Vicken Y Totten, Neha P Raukar, Elizabeth C Moore, Tracy Sanson, Robert Barraco, Michael Nguyen, Federico E Vaca

Marna R Greenberg DO, MPH, FACEP

The Centers for Disease Control and Prevention report that among older adults (≥65 years), falls are the leading cause of injury-related death. Fall-related fractures among older women are more than twice as frequent as those for men. Gender-specific evidence-based fall prevention strategy and intervention studies show that improved patient-centered outcomes are elusive. There is a paucity of emergency medicine literature on the topic. As part of the 2014 Academic Emergency Medicine (AEM) consensus conference on "Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," a breakout group convened to generate a research agenda on priority …

Sex Differences In Cardiac Arrest Survivors Who Receive Therapeutic Hypothermia, Marna Greenberg, Amy Ahnert, Nainesh Patel, Courtney Bennett, Nicole Elliott, Mark Lundquist, Andrew Miller, Ellina Feiner, Anita Kurt, Bernadette Gl-Porter, Mercedes Rios-Scott, David Burmeister

Marna R Greenberg DO, MPH, FACEP

OBJECTIVE: Sex differences have not been well defined for patients undergoing therapeutic hypothermia (TH). We aimed to determine sex differences in mortality and Cerebral Performance Category (CPC) scores at discharge among those receiving TH. METHODS: This retrospective cohort study used data abstracted from an "ICE alert" database, an institutional protocol expediting mild TH for postarrest patients. Quality assurance variables (such as age, time to TH, CPC scores, and mortality) were reviewed and compared by sex. χ(2) Test and Wilcoxon rank sum test were used. Stepwise logistic regression was used to assess the association between mortality and sex, while controlling for …

Diagnostic Performance Of Cardiac Troponin I For Early Rule-In And Rule-Out Of Acute Myocardial Infarction: Results Of A Prospective Multicenter Trial, Alan Storrow, Robert Christenson, Richard Nowak, Deborah Diercks, Adam Singer, Alan Wu, Erik Kulstad, Frank Lovecchio, Christian Fromm, Gary Headden, Tracie Potis, Christopher Hogan, Jon Schrock, Daniel Zelinski, Marna Greenberg, James Ritchie, Janna Chamberlin, Kurtis Bray, Daniel Rhodes, Deirdre Trainor, Dawn Holmes, Paula Southwick

Marna R Greenberg DO, MPH, FACEP

OBJECTIVES: To compare emergency department TnI serial sampling intervals, determine optimal diagnostic thresholds, and report representative diagnostic performance characteristics for early rule-in and rule-out of MI. METHODS: We prospectively measured TnI (AccuTnI+3™, Beckman Coulter) at serial time intervals in 1929 subjects with chest pain or equivalent ischemic symptoms suggestive of acute coronary syndromes at 14 medical centers. Diagnosis was adjudicated by an independent central committee. RESULTS: TnI ≥0.03ng/mL provided 96.0% sensitivity and 89.4% specificity at 1-3h after admission, and 94.9% sensitivity and 86.7% specificity at 3-6h. NPV (rule-out, non-MI) was 99.5% at 1-3h, and 99.0% at 3-6h when TnI is …

Management Of Benign Paroxysmal Positional Vertigo: A Randomized Controlled Trial, Regina Sacco, David Burmeister, Valerie Rupp, Marna Greenberg

Marna R Greenberg DO, MPH, FACEP

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is a common presenting problem. OBJECTIVE: Our aim was to compare the efficacy of vestibular rehabilitation (maneuver) vs. conventional therapy (medications) in patients presenting to the emergency department (ED) with BPPV. METHODS: This was a prospective, single-blinded physician, randomized pilot study comparing two groups of patients who presented to the ED with a diagnosis of BPPV at a Level 1 trauma center with an annual census of approximately 75,000. The first group received standard medications and the second group received a canalith repositioning maneuver. The Dizziness Handicap Inventory was used to measure symptom resolution. …

Cardiopulmonary Resuscitation Prescription Program: A Pilot Randomized Comparator Trial, Marna Greenberg, Gavin Barr, Valerie Rupp, Nainesh Patel, Kevin Weaver, Kimberly Hamilton, James Reed

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

Tobacco Screening Multicomponent Quality Improvement Network Program: Beyond Education, Sharon Kimmel, Suzanne Smith, Judith Sabino, Eric Gertner, Julie Dostal, Marna Greenberg

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

Emergency Department Tobacco Cessation Program: Staff Participation And Intervention Success Among Patients, Marna Greenberg, Michael Weinstock, Deborah Fenimore, Gina Sierzega

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

Residents As Teachers: Residents' Perceptions Before And After Receiving Instruction In Clinical Teaching, Julie Wachtel, Marna Greenberg, Amy Smith, Kevin Weaver, Bryan Kane

Marna R Greenberg DO, MPH, FACEP

CONTEXT: Residents play an integral role in educating junior residents, medical students, and patients. OBJECTIVE: To determine how residents describe their training, proficiency, and comfort level in teaching before and after receiving instruction in clinical teaching. METHODS: Emergency medicine residents at a 980-bed suburban hospital system filled out a 12-question survey on their training as teachers and their self-perceptions of themselves as teachers. The residents then participated in a 2-hour education session on adult learning principles, methods of clinical teaching, and how to give effective feedback. After the session, participants completed a second, 11-question survey on the effectiveness of the …

Training Mothers In Infant Cardiopulmonary Resuscitation With An Instructional Dvd And Manikin., Gavin Barr, Valerie Rupp, Kimberly Hamilton, Charles Worrilow, James Reed, Kristin Friel, Stephen Dusza, Marna Greenberg

Marna R Greenberg DO, MPH, FACEP

CONTEXT: Classes in infant cardiopulmonary resuscitation (CPR) can be time consuming and costly. OBJECTIVE: To determine whether mothers in an obstetric unit could learn infant CPR by using a 22-minute instructional kit and to assess the value and confidence they gained by learning CPR. DESIGN: Quasi-experimental study with enrollment between January and December 2008. SETTING: Obstetric unit in Lehigh Valley Hospital, a suburban teaching hospital in Allentown, Pennsylvania. PARTICIPANTS: Mothers at least 18 years old who had given birth within the previous 24 hours. INTERVENTION: The experimental group included mothers without prior CPR training who watched a 22-minute instructional DVD …

Gender-Specific Emergency Care: Part Two, Alyson Mcgregor, Esther Choo, Stacey Poznanski, Robert Hendrickson, Marna Greenberg

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

Impact Of Education On Physician Attitudes Toward Computed Tomography Utilization And Consent (Article), Michael Weigner, Kate Dewar, Hilary Basham, Valerie Rupp, Marna Greenberg

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

Gender Disparity In Non St Elevation Myocardial Infarction Cardiac Care: A Unique Illustration, Marna Greenberg, R Llaguri, Monisha Bindra, Valerie Rupp, Sharon Kimmel, William Bond, Richard Mackenzie

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

In Memory Of Amy February 8, 2009, Marna Greenberg

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

Building An Effective Ed Influenza Vaccine Program, Marna Greenberg, Gavin Barr, Jr., Richard Mackenzie, Alexander Rosenau, Kevin Weaver, Michele Ortiz

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

Gender Disparity In Emergency Department Non-St Elevation Myocardial Infarction Management, Marna Greenberg, William Bond, Richard Mackenzie, Rezarta Lloyd, Valerie Rupp, Anna-Marie Crown, James Reed, Monisha Bindra

Marna R Greenberg DO, MPH, FACEP

No abstract provided.