Medical Specialties Commons^™

Sex-Based Differences In Depth Of Soft Tissue At The Proximal Tibia Intraosseous Catheter Insertion Site, Tristan Lemon Bs, Revelle Gappy Bs, Ryan Kelly Bs, Kenneth Kutschman Bs, Sarah Meram Ms, James Paxton Md, Mba

Medical Student Research Symposium

Background

Intraosseous (IO) catheters are commonly used to rapidly obtain vascular access for critically-ill patients in the emergency department (ED). Although the proximal tibia (PT) is a standard IO insertion site for adult subjects, little is known about sex-based variation in the proper depth of insertion.

Methods

A retrospective cohort study was performed, utilizing CT scans obtained from DMC over a ten-year period (2009-2018) to estimate soft tissue depth overlying the recommended PT-IO insertion site. Depths of soft tissue from skin surface to bone surface (Measurement A) and from skin surface to the opposite bony cortex (Measurement B) were measured …

Second Degree Av Heart Block After Candlenut Ingestion, Andrew L. Koons Do, Lexis Laubach Bs, Alexandra Amaducci Do, Robert D. Cannon Do, Kenneth D. Katz Md, Ryan M. Surmaitis Do, Matthew D. Cook Do, Gillian A. Beauchamp Md

Department of Emergency Medicine

No abstract provided.

Self-Harm Poisonings Among Transgender Patients: Analysis Of Toxicology Investigator’S Consortium Registry, Marna R. Greenberg Do, Mph, Facep, Natalie E. Ebeling-Koning Do, Cody R. Mcwhirter Bs, Mikayla B. Hurwitz Bs, Lexis T. Laubach Bs, Gillian A. Beauchamp Md, Judith Sabino Mph, Cdp, Beth Careyva M.D., Andrew L. Koons, Matthew D. Cook Do, Kenneth D. Katz Md, Robert D. Cannon Do, Ryan M Surmaitis Do

Department of Emergency Medicine

No abstract provided.

Agents Of Exposure In Transgender Patient Cases Managed By A Toxicologist: An Analysis Of The Toxicology Investigator’S Consortium (Toxic) Registry, Phillip M. Grenz Do, Mikayla B. Hurwitz Bs, Cody R. Mcwhirter Bs, Lexis Laubach Bs, Gillian A. Beauchamp Md, Judith Sabino Mph, Cdp, Beth Careyva M.D., Matthew D. Cook Do, Marna R. Greenberg Do, Mph, Facep, Robert D. Cannon Do, Ryan M Surmaitis Do

Department of Emergency Medicine

No abstract provided.

Two Resident Wellness Exercises And Their Impact, Nick J. Mccauley

Emergency Medicine

How program leaders in the CORD community are implementing innovations to improve residency wellness and resident resilience.

• Define resilience and describe how it can prevent burnout.
• Discuss ways that residency programs can work to promote resilience amongst residents COURSE DESCRIPTIONS #CORDAA20 35
• Introduce ‘Resilience Rounds’ as a didactic intervention, and the literature upon which this innovation is based
• Introduce art as a tool to overcome trauma and prevent burnout
• Demonstrate how conference/didactic time can help residents combat the perceived “culture of perfection” by sharing meaningful or successful moments with each other to improve one’s general outlook on their own practice

Using The Qsat To Generate Multi-Source Feedback On An In-Situ Pediatric Simulation Case, Michael C. Nguyen Md, Nicole Elliott Do, Matthew D. Cook Do, Diane Begany Md, Zachary Matuzsan Do, Louis Morolla Do, Suzanne S. Partington Msn, Rn, Ccrn, Jennifer E. Macfarlan Mph, Michael Jong Md, Bryan G. Kane Md

Department of Emergency Medicine

No abstract provided.

Scheduling Like A Pro, Joseph Gibney

Emergency Medicine

Scheduling is difficult, but believe it or not, it can also be rewarding. This is one chief’s take on three years of scheduling and the highs, lows, do’s, don’ts, and novel ways to help your fellow residents live their best residency life.

• Show that resident wellness is impacted by scheduling
• Demonstrate our scheduling process, some errors we made over time, and how we learned from them
• Discuss some novel scheduling tactics, how other residencies may apply what we’ve learned, and how to adapt it to fit their needs

Qualitative Analysis Of Emergency Medicine Resident Logged Patient Safety Observations, Bryan G. Kane Md, Jon D. Raso Bs, David M. Richardson Md, Kevin Weaver D.O.,Facoep, John W. Daubert Do, Rafay A. Khan Do, Claire L. Paulson Do, Dawn M. Yenser

Department of Emergency Medicine

No abstract provided.

Impact Of Traffic, Poverty And Facility Ownership On Travel Time To Emergency Care In Nairobi, Kenya, Maya S. Fraser, Benjamin Wachira, Abraham D. Flaxman, Aaron Y. Lee, Herbert C. Duber

Emergency Medicine, East Africa

Background: In many low and middle-income countries (LMICs), timely access to emergency healthcare services is limited. In urban settings, traffic can have a significant impact on travel time, leading to life-threatening delays for time-sensitive injuries and medical emergencies. In this study, we examined travel times to hospitals in Nairobi, Kenya, one of the largest and most congested cities in the developing world.

Methods: We used a network approach to estimate average minimum travel times to different types of hospitals (e.g. ownership and level of care) in Nairobi under both congested and uncongested traffic conditions. We also examined the correlation between …

Pediatric Congenital Heart Diseases: Patterns Of Presentation To The Emergency Department Of A Tertiary Care Hospital, Surraiya Bano, Saleem Akhtar, Uzma R. Khan

Department of Emergency Medicine

Objective: To observe presentation of Pediatric congenital cardiac defects to the Emergency Department (ED) of a tertiary care hospital in Pakistan.
Methods: This is a retrospective chart review of patients under the age of 16 years with congenital cardiac defects presenting to the Emergency Department of Aga Khan University Hospital over a period of eighteen months, from January 2012 to June 2013. Study population was divided into two groups; first group constituted children with undiagnosed congenital cardiac defects, whereas second group constituted children with diagnosed congenial cardiac defects presented to ED. In previously diagnose cases each visit was counted as …

Mount Fuji Sign Following Nasal Polypectomy: Conservative Management Of Pneumocephalus, Matthew Szymaszek, Gentian Toshkezi

Department of Emergency Medicine Faculty Papers

Pneumocephalus is seen in conjunction with a variety of conditions, particularly traumatic injury, neurosurgical, and ears, nose, and throat (ENT) procedures. We describe the successful, non-operative management with supplemental oxygen of symptomatic pneumocephalus following polypectomy without further complication. This case adds to other case reports of pneumocephalus but differs in the non-invasive, conservative management with supplemental oxygen obviating the need for more invasive neurosurgical intervention such as decompressive craniectomy, burr holes, or drain placement.

Sex-Specific Outcomes In A Substance Use Intervention Program., Alexandra Amaducci, Marna R. Greenberg Do, Mph, Facep, Andrew W. Sheen Do, Hanna R. Warren Do, Pratik M. Parikh Do, Paige Roth Lsw, Kevin Weaver D.O.,Facoep, David M. Richardson Md, David B. Burmeister Do, Facep, Cpe, Jennifer Stephens Do, Robert D. Cannon Do

Department of Emergency Medicine

PURPOSE: We performed an emergency department (ED)-based substance use screening, motivational interview-based intervention, and treatment referral program with the goal of determining sex-specific outcomes. Specifically, in this quality improvement project, we aimed to determine whether there was a difference among sexes in the type of substances used; the frequency of positive screening results for substance use disorder; agreeing to an intervention; the type of follow-up evaluation, participation, and referral; and attempts to change substance use after intervention.

METHODS: We prospectively studied a convenience sample of patients at 3 hospitals in Northeastern Pennsylvania from May 2017 through February 2018. Inclusion criteria …

Assessing For Gender Disparities In The Selection Of Chief Residents Of Emergency Medicine Residency Programs, Emilio G. Volz, Justin Steinberg, Tony Zitek

HCA Healthcare Journal of Medicine

Introduction: Although the number of women physicians has been increasing, there may be gender disparities in the assessment of female emergency medicine residents. This study sought to determine if female emergency medicine residents are less likely to become chief residents than males.

Methods: In July 2017, an anonymous survey was distributed to the program coordinators of all accredited emergency medicine residency programs in the United States. The survey requested the number of males and females in each graduating class from 2015 to 2017. The percentage of female residents who were chief residents was calculated and compared to that for males. …

The Great Imitator Strikes Again: A Case Of A Lupus Flare-Up Presenting Like An Acute Abdomen, Emmanouil Kiriakopoulos, Vanessa Perez, Robyn Hoelle

HCA Healthcare Journal of Medicine

Systemic lupus erythematosus (SLE) is an autoimmune disease affecting all age groups and can manifest in various forms, often making the initial or successive presentations difficult to diagnose. Peritonitis secondary to lupus is a rare manifestation of this disease and the prevalence is said to be much lower in children. We present a case report of an adolescent male with a known history of lupus who presented to the emergency department with a clinical picture consistent with an acute surgical abdomen and underwent an appendectomy. Subsequent workup identified the culprit as a lupus-related peritonitis requiring corticosteroids for resolution.

The Role Of Mindset, Impostorism, And Irrational Beliefs In Resident Wellness: Results From The Hca Nationwide Longitudinal Resident Wellness Study, Gregory Guldner, Jason Siegel, Brendon Ellis, Anne Brafford

Medical Education

Background The significant proportion of residents reporting poor levels of well-being has appropriately fueled a call for interventions. Yet the specific constructs that impact well-being have not been well researched and validated in the resident population. Mindset (fixed versus growth), impostorism (the belief that one’s success is fraudulent) and irrational beliefs (dysfunctional beliefs that contribute to emotional pain and anguish) are among individual variables postulated to relate to well-being in a high-pressure educational environment. Each of these constructs is amenable to interventions should they have causal relationships to well-being.

Objectives Our prior research resulted in a statistically validated model of …

Simulation-Based Mastery Learning Compared To Standard Education For Discussing Diagnostic Uncertainty With Patients In The Emergency Department: A Randomized Controlled Trial., Danielle M. Mccarthy, Rhea E. Powell, Kenzie A. Cameron, David H. Salzman, Dimitrios Papanagnou, Amanda Doty, Benjamin E. Leiby, Katherine Piserchia, Matthew R. Klein, Xiao C. Zhang, William C. Mcgaghie, Kristin L. Rising

Department of Pharmacology and Experimental Therapeutics Faculty Papers

BACKGROUND: Diagnostic uncertainty occurs frequently in emergency medical care, with more than one-third of patients leaving the emergency department (ED) without a clear diagnosis. Despite this frequency, ED providers are not adequately trained on how to discuss diagnostic uncertainty with these patients, who often leave the ED confused and concerned. To address this training need, we developed the Uncertainty Communication Education Module (UCEM) to teach physicians how to discuss diagnostic uncertainty. The purpose of the study is to evaluate the effectiveness of the UCEM in improving physician communications.

METHODS: The trial is a multicenter, two-arm randomized controlled trial designed to …

Hispanics Have Higher Grade Intracerebral Hemorrhage Compared To Non-Hispanics, Jessica Houck Do, Tej Stead, Paul Banerjee, Latha Ganti Md

Emergency Medicine

No abstract provided.

The Zoom Picture Book Game: A Creative Way To Promote Teamwork In Undergraduate Medical Education., Xiao Chi Zhang, Arjun Balakumar, Carlos Rodriguez, Anthony Sielicki, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Effective team building and leadership are crucial in running an effective and safe healthcare system with improved patient care and clinical outcomes. Currently, there is a great demand for formal leadership training throughout the extensive medical education curriculum. We constructed an interactive team-building activity utilizing gamification-theory with the Zoom game. The Zoom activity requires a team of learners to organize a set of sequential images, each of which contains a "zoomed out" section from the previous image, into the correct order within a set time frame. Given the unique and approachable nature of this team-based activity, we propose the following: …

General Surgery Residency And Emergency General Surgery Service Reduces Readmission Rates And Length Of Stay In Non-Operative Small Bowel Obstruction, Sarah Waterman Manning Md, Katherine S. Mastriani

General Surgery

No abstract provided.

Mandatory And Permissive Reporting Laws: Obligations, Challenges, Moral Dilemmas, And Opportunities, Joel M. Geiderman, Catherine A. Marco

Emergency Medicine Faculty Publications

The duty to report certain conditions to public health or law enforcement authorities is one that falls on all physicians and other health care workers as part of their duty to protect the public from harm. In an open society, others, such as teachers, clergy, police officers, or simply neighbors, share the responsibility of protecting individuals at risk, often by reporting them to authorities. The emergency physician and others in the emergency department are uniquely positioned to identify people at risk or who pose a risk, and to report them as required or allowed under the law. In some circumstances, …

Knowledge Gain Of The Non-Vascular Surgeons After Attending A Course On Traumatic Vascular Emergencies, Zia Ur Rehman, Muhammad Asad Moosa, Qamar Riaz

Department of Surgery Docs

Objective: To measure the effectiveness of the workshop in enhancing the knowledge and skills of the non-vascular surgeons in dealing with traumatic vascular emergencies.
Methodology: It was a Quasi-experimental pre-post design study conducted at Section of Vascular Surgery, Aga Khan University Hospital, Karachi (Pakistan) in February 2019. One-day workshop was conducted to enhance the knowledge and operative skills of the non-vascular surgeons in managing traumatic vascular emergencies. A written test and course evaluation survey were used to evaluate the effectiveness of the course in achieving the desired objectives.
Results: Total of 21 participants attended the workshop with mean age of …

Contemporary Nstemi Management: The Role Of The Hospitalist., Charles V Pollack, Alpesh Amin, Tracy Wang, Steven Deitelzweig, Marc Cohen, David Slattery, John Fanikos, Christopher Dilascia, Regan Tuder, Scott Kaatz

Department of Emergency Medicine Faculty Papers

Non-ST-segment elevation myocardial infarction (NSTEMI) is defined as elevated cardiac biomarkers of necrosis in the absence of persistent ST-segment elevation in the setting of anginal symptoms or other acute event. It carries a poorer prognosis than most ST-segment elevation events, owing to the typical comorbidity burden of the older NSTEMI patients as well as diverse etiologies that add complexity to therapeutic decision-making. It may result from an acute atherothrombotic event ('Type 1') or as the result of other causes of mismatch of myocardial oxygen supply and demand ('Type 2'). Regardless of type and other clinical factors, the hospital medicine specialist …

Aseptic Barriers Allow A Clean Contact For Contaminated Stethoscope Diaphragms, Rajiv Vasudevan, Ji H Shin, Jessica Chopyk, William F Peacock, Francesca J Torriani, Alan S Maisel, David T Pride

Faculty, Staff and Students Publications

OBJECTIVE: To determine whether a single-use stethoscope diaphragm barrier surface remains aseptic when placed on pathogen-contaminated stethoscopes.

METHODS: From May 31 to August 5, 2019, we tested 2 separate barriers using 3 different strains of 7 human pathogens, including extended-spectrum β-lactamase-producing

RESULTS: For all diaphragms with either of the 2 barriers tested, no growth was recorded for any of the pathogens. Stethoscopes with aseptic barriers remained sterile for up to 24 hours. These single-use barriers also provided aseptic surfaces when stethoscope diaphragms were inoculated with human specimens, including saliva, stool, urine, and sputum.

CONCLUSION: Disposable aseptic diaphragm barriers may provide …

Solving The Sepsis Puzzle: Every Minute Counts, Jamie Roney, Amber Cline

Articles, Abstracts, and Reports

SPEMS Pre-Conference Course Sepsis Class

A Case Of Blunt Trauma-Induced St-Elevation Myocardial Infarction Sustained During A Prison Brawl., Zachary T Clark, Natalie Thiel, John Perry, Michael R Minckler

Articles, Abstracts, and Reports

Myocardial infarction (MI) is a serious and time-sensitive condition. MIs are typically seen in patients with coronary artery disease (CAD) and are caused by the rupture of an atherosclerotic plaque due to factors contributing to plaque instability. However, this case illustrates that plaque rupture can also be caused by blunt trauma to the chest. Considering MI as a possible result of chest trauma may decrease time from presentation to diagnosis and treatment and, therefore, improve outcomes in similar cases, particularly when patients presents unusually or with very few risk factors for MI.

Starting Simulation For New Residency Programs, Steve Warrington

Emergency Medicine

Objectives

1. Identify 3 barriers and methods to overcome them when implementing simulation in new graduate medical education programs.
2. Discuss pearls and pitfalls to use when implementing a new simulation program at an institution.

Ultrasound On The Frontlines Of Covid-19: Report From An International Webinar, Rb Liu, Vs Tayal, Nl Panebianco, Y Tung-Chen, A Nagdev, S Shah, E Pivetta, Pc Henwood, Mj Nelson, Cl Moore

Journal Articles

No abstract provided.

Covid-19 And Older Adults: What We Know, Z Shahid, R Kalayanamitra, B Mcclafferty, D Kepko, D Ramgobin, R Patel, Cs Aggarwal, R Vunnam, N Sahu, R Jain, +3 Additional Authors

Journal Articles

No abstract provided.

A Case Report Of Coronavirus Disease 2019 Presenting With Tremors And Gait Disturbance., S. Klein, F. Davis, A. Berman, S. Koti, J. D'Angelo, N. Kwon

Journal Articles

INTRODUCTION:Neurologic symptoms present as significant complications of coronavirus disease 2019 (COVID-19) infection. This report describes a novel manifestation of tremors triggered by severe acute respiratory syndrome coronavirus 2 infection. CASE PRESENTATION:We describe a case of a 46-year-old man with COVID-19 infection complicated by a bilateral intention tremor and wide-based gait. Although neurological manifestations have been reported related to COVID-19, tremulousness has not yet been described. CONCLUSION:Considering the evolving diversity of neurologic manifestations in this infection, emergency physicians should be vigilant of possible COVID-19 infection in patients presenting with unexplained neurologic symptoms.

Interim Guidance For Basic And Advanced Life Support In Adults, Children, And Neonates With Suspected Or Confirmed Covid-19 From The Emergency Cardiovascular Care Committee And Get With The Guidelines-Resuscitation Adult And Pediatric Task Forces Of The American Heart Association, D. P. Edelson, C. Sasson, P. S. Chan, D. L. Atkins, K. Aziz, L. B. Becker, R. A. Berg, S. M. Bradley, S. C. Brooks, A. A. Topjian, +17 Additional Authors

Journal Articles

No abstract provided.