Medicine and Health Sciences Commons^™

Prediction Of Major Adverse Cardiac Events In The Emergency Department Using An Artificial Neural Network With A Systematic Grid Search, Ahmed Raheem Buksh, Nadeem Ullah Khan, Rida Jawed, Shahan Waheed, Musa Karim

Department of Emergency Medicine

Background: The aim of our research was to design and evaluate an Artificial Neural Network (ANN) model using a systemic grid search for the early prediction of major adverse cardiac events (MACE) among patients presenting to the triage of an emergency department.
Methods: This is a single-center, cross-sectional study using electronic health records from January 2017 to December 2020. The research population consists of adults coming to our emergency department triage at Aga Khan University Hospital. The MACE during hospitalization was the main outcome. To enhance the architecture of an ANN using triage data, we used a systematic grid search …

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.

Tip-Over Injuries Among Children: Data From An Urban Emergency Department Of Karachi, Pakistan, Rubaba Naeem, Asrar Ali, Ahmed Raheem Buksh, Ayesha Quddusi, Uzma Rahim Khan

Department of Emergency Medicine

Introduction: Most unintentional injuries among children occur in the home environment. Tip-overs, defined as incidents where heavy objects fall on children due to some type of interaction, are one of the reasons for injuries inside the home. This study aims to determine injury patterns and outcomes for child injuries resulting from tip-overs in the home environment as reported in the emergency department.
Methods: We performed a retrospective chart review of pediatric (under 18 years) tip-overs injuries occurred in years 2010 to 2015 at the Aga Khan University Hospital. Furthermore, parents of injured children participated in phone interviews to provide information …

Monkeypox Outbreak In The Age Of Covid-19: A New Global Health Emergency, Rahim Hirani, Dawood Rashid, Joshua Lewis, Rasheed Hosein-Woodley, Ali Issani

Department of Emergency Medicine

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.

Determinants Of Domestic Violence Among Women Of Reproductive Age (15-49 Years) In Quetta, Balochistan-A Mixed-Method Protocol, Salman Muhammad Soomar, Sarmad Muhammad Soomar

Department of Emergency Medicine

Background: Worldwide, domestic violence (DV) is a cause of death and disability among women aged 15-49 years. In Pakistan, DV appears in different forms, and only 3.2% of women report any DV. There are various factors associated with DV against women. The data are sparse for the Balochistan province due to the under-reporting and scattered population. This research study aims to determine the factors associated with DV and the types of violence among women of reproductive age. Also, to understand the perspective of community leaders and healthcare workers (HCWs) for developing interventions for DV prevention against women of reproductive age …

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 …

Use Of Steroids In Covid-19 Patients: What Is Known?, Syed Muhammad Mustahsan, Marzia Tahir, Emaduddin Siddiqui

Department of Emergency Medicine

COVID-19 pandemic has exaggerated the role of steroids in the standard of care despite minimum direct evidence of their efficacy in COVID-19 patients and their well-known adverse effects. The literature abounds on the side effects of steroids affecting different organ systems of the body. COVID-19 patients, who are on long-term steroids, are more susceptible to their adverse effects. We, herein, briefly review the potential uses and the adverse effects of steroids on different organ systems of the body. Key Words: Steroids, COVID-19, Adverse effects.

The Role Of Emergency Departments For Antimicrobial Stewardship In Covid-19 Pandemic; The Time Is Now, Madiha Ismail, Nazeer Najeeb Kapadia, Sara Usman

Department of Emergency Medicine

No abstract provided.

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 …

Prolonged Ocular Foreign Body Found On Repeat Visit To A Second Emergency Department, Conor Mclaughlin, Sara Safari, Avani Shah, Bryan G. Kane Md

Department of Emergency Medicine

No abstract provided.

Managing Chronic Pain With Medical Cannabis: A Chance To Reduce Opioid-Related Ed Visits, Nicholas S. Imperato, Gretchen Maurer, Hope Kincaid Mph, Cph, Joseph E. Patruno Md, Joshua S. Krassen, Robert Wilson, Autumn Kieber-Emmons Md, Mph, Andrew L. Koons

Department of Emergency Medicine

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, …

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.

Mindfulness In The Emergency Department (Med): An Asynchronous Learning Course To Practise Mindfulness And Resilience In The Emergency Room Of Low Resource Setting, Syed Maaz Salahuddin, Shahan Waheed

Department of Emergency Medicine

Owing to the fast-paced, stressful, and frequent crucial rapid decisions that trigger cognitive exhaustion, emergency physicians are especially vulnerable to burnout. Mindfulness practices have been defined in the literature and it focuses on the well-being and resilience. Mindfulness is characterised as the ability to use tools and expertise to mentally respond to environmental problems to fulfil psychological needs. To overcome burnout, a self-directed learning course was developed for emergency physicians that will include learning goals on mindfulness, peer group discussions and tasks, role playing and practising meditation exercises. It would concentrate on the foundations of mindfulness and resilience, learning and …

Relative Risk Of Anxiety And Depression Among Covid-19 Survivor Healthcare Workers From A Tertiary Care Hospital In Pakistan: A Pilot Cohort Study, Farnaz Zahoor, Zahid Nazar, Sarwat Masud, Rehana Rahim

Department of Emergency Medicine

Longitudinal studies for determining the risk of anxiety and depression among COVID-19 survivor healthcare workers are lacking. This study aimed to determine the risk of anxiety and depression among healthcare workers that survived COVID-19 infection through a six-month post-recovery follow-up. This was a cohort study conducted at the Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar, from 1st March to 30th August 2020. A total of 64 subjects participated. Hospital Anxiety and Depression Scale (HADS) was used for assessing the anxiety and depression symptoms. HADS has three score cutoff as normal, borderline abnormal and, abnormal anxiety/depression. For the purpose …

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.

Bedside Index (Bisap) V/S Ranson Scores In Predicting Mortality And Severity In Patients With Acute Pancreatitis, Nazir Najeeb Kapadia, Emaduddin Siddiqui

Department of Emergency Medicine

Objective: To determine the diagnostic accuracy of the bedside index for severity in acute pancreatitis in comparison with Ranson scores in predicting mortalities and severities in patients with acute pancreatitis.
Methods: The cross-sectional study was conducted at the Department of Emergency Medicine, Aga Khan University Hospital, Karachi, from July 1, 2017, to January 1, 2018, and comprised patients who presented with acute pancreatitis. The bedside index for severity in acute pancreatitis score was applied in the emergency department and the patients were followed up in ward/intensive care unit where Ranson scores were calculated within the following 48 hours. Both the …

Red Blood Cell Transfusion In Critically-Ill Children And Its Association With Outcome, Hafsa Sohail, Shah Ali Ahmed, Parveen Usman, Farah Khalid, Anwar Ul Haque, Qalab Abbas

Department of Emergency Medicine

Objective: To determine the indications and threshold of haemoglobin levels for packed red blood cell transfusion and its association with outcomes in a paediatric intensive care setting.
Methods: The retrospective study was conducted in the paediatric intensive care unit of the Aga Khan University Hospital, Karachi, and comprised medical records of all inpatients with age between 1 month and 16 years who received packed red blood cell transfusions between January and December 2017. Data was retrieved from the hospital database and was analyzed using SPSS 22.
Results: Of the 147 subjects with a mean age of 67.89±65.8 months, 76(51.7%) were …

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 …

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 …

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 …

Acute Urinary Retention: Should We Call It A Manifestation Of Appendicitis?, Sadaf Sheikh, Umair Javed, Muhammad Akbar Baig

Department of Emergency Medicine

Acute urinary retention (AUR) is a fairly common presentation in the elderly; but interesting to be noted in a healthy young individual as a manifestation of acute appendicitis. We present a case of a 32-year gentleman with decreased urine output with mild tenderness at the supra-pubic region; which was later on, shifted to the right iliac fossa. Computed tomography of the abdomen showed acute appendicitis. Emergency physicians are challenged to recognize the uncommon presentation of acute appendicitis and need to be reminded of this common complaint as a rare presentation of it. This case also stresses on the repeated abdominal …

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. …

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 …