Medical Specialties Commons^™

Outpatient Treatment Of Pulmonary Embolism: A Single-Center Case Series, Annie Huyler, Casey Z. Macvane, Andrew Perron, Tania D Strout

MaineHealth Maine Medical Center

Background: Pulmonary embolus (PE) is associated with significant utilization of health care resources and financial burden Several additions that have allowed us to look at safely treating patients with PEs as outpatients:

• Simplified Pulmonary Embolism Severity Index (sPESI) -Risk stratifies patients based on their age, vital signs, and past medical history

• Novel oral anticoagulants

Primary Objective: To describe the population, treatment strategies, short-term complications and outcomes associated with outpatient management of PE following treatment in the ED.

Seerratus Anterior Plane Block (Sapb) Improves Paine Control In Rib Fractures, Randy Kring, Peter Croft, David Mackenzie, Christina Wilson, Joseph Rappold, Tania D. Strout

MaineHealth Maine Medical Center

Background:

•Trauma is a major cause of morbidity and mortality worldwide. Rib fractures are identified in at least 10% of all injured patients.

•Rib fractures can lead to significant respiratory complications, with pneumonia and respiratory failure occurring in up to 31% of patients with rib fractures. Early initiation of aggressive pain control and pulmonary hygiene with incentive spirometry are standard of care to prevent complications from developing.

•In the Emergency Department, patients with rib fractures typically receive systemic analgesia that is largely narcotic-based. This pain control strategy puts patients at risk for the side effects of narcotics such as constipation, …

Reducing Length Of Stay For Mental Health Patients, Faye Collins, Nancijean Goudey

MaineHealth Maine Medical Center

Background:

Our facility sees an average of over 200 mental health patients every month, with limited community resources. The length of stay (LOS) for these patients had slowly risen to unacceptable levels; the number of patients whose LOS was greater than 24 hours increased in fiscal year (FY) 2017, from 633 patients to 1145. Patients in crisis require expedited transfer to appropriate care locations. Our goal was to decrease the overall length of stay for mental health patients in the Emergency Department.

Utilization Of Acupuncture Services In The Emergency Department Setting: A Quality Improvement Study, John R. Burns, Jessica J. F. Kram, Vashir Xiong, Jeanne M. Stark Casadont, Tiffany A. Mullen, Nancy Conway, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Purpose: Patients often present to the emergency department (ED) for pain. As opioid fatalities rise, alternative treatments are warranted for pain management. Acupuncture, a nonpharmacological treatment involving the insertion of needles into skin or tissue at specific points within the body, may help to decrease acute pain. Our study aimed to assess the utilization and impact of acupuncture in the ED for acute pain management.

Methods: We conducted a retrospective analysis of purposefully collected quality improvement data. Patients who were ≥18 years old and who presented to the ED at an urban medical center in Wisconsin during 2017 were offered …

Improving Bronchiolitis Care Across Multiple Care Settings Using A Deimplementation Bundle, Amanda Nedved, Kathleen Berg, Troy Richardson, Amanda Montalbano, Matthew B. Johnson

Posters

Despite the availability of a bronchiolitis CPG; variation in care practices still existed at our institution. The aim of our quality improvement (QI) project was to increase overall adherence with our institutional CPG in patients 60 days to 24 months of age diagnosed with bronchiolitis in the urgent care centers (UCC), emergency departments (ED), and general inpatient units from a baseline of 40.9% to 60% by the end of two bronchiolitis seasons.

Patients With Refractory Out-Of-Cardiac Arrest And Sustained Ventricular Fibrillation As Candidates For Extracorporeal Cardiopulmonary Resuscitation - Prospective Multi-Center Observational Study., Takahiro Nakashima, Teruo Noguchi, Yoshio Tahara, Kunihiro Nishimura, Soshiro Ogata, Satoshi Yasuda, Daisuke Onozuka, Naoto Morimura, Ken Nagao, David F. Gaieski, Yasufumi Asai, Hiroyuki Yokota, Satoshi Nara, Mamoru Hase, Takahiro Atsumi, Tetsuya Sakamoto

Department of Emergency Medicine Faculty Papers

BACKGROUND: We investigated whether patients with out-of-hospital cardiac arrest (OHCA) and sustained ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) or conversion to pulseless electrical activity/asystole (PEA/asystole) benefit more from extracorporeal cardiopulmonary resuscitation (ECPR). Methods and Results: We analyzed data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan, which was a prospective, multicenter, observational study with 22 institutions in the ECPR group and 17 institutions in the conventional CPR (CCPR) group. Patients were divided into 4 groups by cardiac rhythm and CPR group. The primary endpoint was favorable neurological outcome, defined as Cerebral Performance Category 1 …

Information And Readiness Build Resilience: The Role Of The Disaster Information Management Research Center, Stacey J. Arnesen, Florence Chang

Collaborative Librarianship

The National Library of Medicine (NLM) established the Disaster Information Management Research Center (DIMRC) in 2008 based on its history of providing health information for disaster preparedness, response, and recovery. The NLM long range plan (Charting a Course for the 21st Century: NLM's Long Range Plan 2006-2016) called for creation of a center to show "a strong commitment to disaster remediation and to provide a platform for demonstrating how libraries and librarians can be part of the solution to this national problem". NLM was urged to "ensure continuous access to health information and effective use of libraries and …

An Evaluation Of Risk Attitudes And Risk Tolerance In Emergency Medicine Residents., Carlos Rodriguez, Nishad A Rahman, Kory London, Robin Naples, Simran Buttar, Xiao Chi Zhang, Hyunjoo Lee, Joshua Rudner, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Introduction Previous studies have shown that risk attitudes and tolerance for uncertainty are significant factors in clinical decision-making, particularly in the practice of defensive medicine. These attributes have also been linked with rates of physician burnout. To date, the risk profile of emergency medicine (EM) physicians has not yet been described. Our goal was to examine the risk profile of EM residents using a widely available risk tolerance and attitude assessment tool. Methods First-, second-, and third-year residents of Thomas Jefferson University Hospital's EM residency program completed the commercially available, unmodified Risk Type Compass, a validated instrument offered by Multi-Health …

Acute Fondaparinux (Arixtra) Intentional Overdose Via Self-Injection: A Case Report, Andrew L. Koons Do, Kenneth D. Katz Md, Matthew D. Cook Do, Robert D. Cannon Do, Gillian A. Beauchamp Md, Ryan M. Surmaitis Do

Department of Emergency Medicine

No abstract provided.

Beware Of Barbiturates: Coma And Hypothermia In A 94-Year-Old Woman Due To Combined Secobarbital And Pentobarbital Toxicity, Andrew L. Koons Do, Amy Wier Do, Kenneth D. Katz Md, Matthew D. Cook Do, Robert D. Cannon Do, Gillian A. Beauchamp Md, Ryan M. Surmaitis Do

Department of Emergency Medicine

No abstract provided.

Coronary Angiography After Cardiac Arrest - The Right Timing Or The Right Patients?, Benjamin S. Abella, David F. Gaieski

Department of Emergency Medicine Faculty Papers

No abstract provided.

Defining And Measuring Quality In Acute Paediatric Trauma Stabilisation: A Phenomenographic Study., Ralph James Mackinnon, Karin Pukk-Härenstam, Ulrica Von Thiele Schwarz, Christopher S. Kennedy, Terese Stenfors

Manuscripts, Articles, Book Chapters and Other Papers

Objectives: Trauma is the leading cause of death in children. The lack of an accepted definition of what constitutes a high-quality stabilisation of a traumatically injured child has limited the evaluation of direct interventions in simulation-based education and service-delivery models to improve trauma care. The aim of this study was to create a framework that delineates quality by exploring the perceptions of the multi-disciplinary team providing and improving this initial care.

Methods: Interviews were conducted with 36 experienced UK trauma team members and governance administrators (clinical directors to executive board level), from three standard UK trauma units. This study used …

The Anticipated Negative Impact On Emergency Medicine Faculty Of The New Acgme Common Program Requirements (Poster)., Shawn M. Quinn Do, Bryan G. Kane Md, Terrence E. Goyke, Dawn M. Yenser C-Tagme, Marna R. Greenberg Do, Mph, Facep, Gavin C. Barr Jr. Md

Department of Emergency Medicine

No abstract provided.

Feasibility Of Incorporating Components Of A ‘Sex And Gender’ In Em Toolkit Into Residency Education, Alyson J. Mcgregor Md, Ma, Marna R. Greenberg Do, Mph, Facep, Rebecca Barron Md, Mph, Lauren A. Walter Md, Jeannette Wolfe Md, Ashley L. Deutsch Md, Steven A. Johnson Md, Derek A. Robinett Md, Gillian A. Beauchamp Md

Department of Emergency Medicine

No abstract provided.

Hallway Bed Status Is Associated With Lower Patient Satisfaction, Max Needham Ba, Kathryn B. Bartlett Do, Akshay Gupta Do, John J. Scholz Do, Jennifer Sadowski Do, Bryan G. Kane Md, Jeanne L. Jacoby Md, Marna R. Greenberg Do, Mph, Facep, David M. Richardson Md

Department of Emergency Medicine

No abstract provided.

Status Of Sex And Gender In Emergency Medicine A Five Year Follow Up Report, Basmah Safdar Md, Msc, Kimberly E. Ona Ayala Ba, Syed Shayan Ali Md, Benjamin J. Seifer Bsme, Michelle Hong Bs, Ms, Marna R. Greenberg Do, Mph, Facep, Esther K. Choo Md, Mph, Alyson J. Mcgregor Md, Ma

Department of Emergency Medicine

No abstract provided.

A Case Of Creutzfeldt-Jakob Disease Presenting With Depression And Anxiety, Kathryn B. Bartlett Do, Kathleen E. Kane Md, Bryan G. Kane Md, Kevin Weaver D.O.,Facoep, Gavin C. Barr Jr. Md

Department of Emergency Medicine

No abstract provided.

Search And Rescue: The Importance Of Using Tracking Systems In Rural 135 Operations, April Larsen, Brent D. Bowen

Student Works

In January 2020, under the NextGen initiative put in place by the Federal Aviation Administration (FAA), all aircraft flying in controlled airspace, both general aviation and commercial operations, will be required to have an Automatic Dependent Surveillance – Broadcast (ADS–B) system installed and operational. However, this is not required for Title 14 Code of Federal Regulations (CFR) Part 135 operations taking place outside of controlled airspace. Part 135 of the Federal Aviation Regulations (FAR) refers to aircraft operating as on-demand or air taxi services. A substantial amount of these operator’s bases, as well as flights, are conducted outside of controlled …

The Vitamin C, Thiamine And Steroids In Sepsis (Victas) Protocol: A Prospective, Multi-Center, Double-Blind, Adaptive Sample Size, Randomized, Placebo-Controlled, Clinical Trial., David N. Hager, Michael H. Hooper, Gordon R. Bernard, Laurence W. Busse, E. Wesley Ely, Alpha A. Fowler, David F. Gaieski, Alex Hall, Jeremiah S. Hinson, James C. Jackson, Gabor D. Kelen, Mark Levine, Christopher J. Lindsell, Richard E. Malone, Anna Mcglothlin, Richard E. Rothman, Kert Viele, David W. Wright, Jonathan E. Sevransky, Greg S. Martin

Department of Emergency Medicine Faculty Papers

BACKGROUND: Sepsis accounts for 30% to 50% of all in-hospital deaths in the United States. Other than antibiotics and source control, management strategies are largely supportive with fluid resuscitation and respiratory, renal, and circulatory support. Intravenous vitamin C in conjunction with thiamine and hydrocortisone has recently been suggested to improve outcomes in patients with sepsis in a single-center before-and-after study. However, before this therapeutic strategy is adopted, a rigorous assessment of its efficacy is needed.

METHODS: The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) trial is a prospective, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled trial. It will enroll …

A Curious Critic's Guide On Writing A Five-Star Student Evaluation: Five Lessons Learned From Food Blogging., Xiao Chi Zhang, Meryl Abrams, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Timely feedback is critical in promoting learner self-reflection. When provided effectively, feedback can assist learners with the acquisition of new skills and knowledge in the ever-changing and complex landscape of healthcare. While the literature is replete on methods to provide feedback, faculty and supervisors receive little, if any, training on writing constructive feedback. Abbreviated comments (i.e., 'good job' or 'read more') provide little information on specific behaviors learners can change. As an avid food enthusiast and restaurant reviewer, I, too, am met with the challenge of writing a meaningful, constructive review (or evaluation) of a dining experience. To better assist …

Motorbike-Related Injuries & Safety Practices Among Motorbike Riders In Kisumu, Western Kenya In 2019, Rowan Poehler

Independent Study Project (ISP) Collection

Road traffic injuries are a growing public health problem throughout the world. Kenya has is known for having unsafe roads with an estimated 13,463 road traffic fatalities in 2016 and 24% of road traffic fatalities coming from 2-and 3-wheeled vehicles (WHO, 2018). This study sought to analyze road safety measures and road traffic injuries amongst motorbike taxi drivers in Kisumu, Kenya. A qualitative survey was administered to 152 motorbike taxi drivers in Kisumu over a two-week period in April 2019. The results were then analyzed. Results showed that 70% of drivers owned a helmet for themselves and 48.3% of drivers …

Sex Specific Outcomes Of An Ed Stopping Elderly Accidents, Deaths, And Injuries (Ed-Steadi) Program, Marna R. Greenberg Do, Mph, Facep, Jeanne L. Jacoby Md, Robert D. Barraco Md, Mph, Victoria Goodheart Do, Alexander Youngdahl Do, Ryan Day Md, Danielle Collins Md, Lauren Crowley Ba, Bryan G. Kane Md

Department of Emergency Medicine

No abstract provided.

Emergency Departments And Care For Marginalized Populations, Irvin B. Harrell

Institute for the Humanities Theses

Healthcare providers in emergency departments (EDs) face a daunting daily task: providing health care in a triage setting to a diverse group of patients many with complex medical issues. Many patients rely on ED services out of financial necessity, when their healthcare issues could be better suited for care from a primary care physician. Many of these already vulnerable patients – minorities, those health illiterate, low-income, uninsured and those with language barriers – must also deal with ED overcrowding and staffing conditions. In some cases, patients leave without being seen while others face bed shortages. This study explores healthcare provider …

An Integrated Model Of Palliative Care In The Emergency Department To Improve Referrals, Jennifer L. Schlatter

Doctoral Projects

Introduction: The emergency department plays a critical role in the trajectory of in-hospital patient care. The Center to Advance Palliative Care (CAPC) along with the American College of Emergency Physicians (AECP) recommend early referral to palliative care for patients with life limiting illnesses that present to the emergency department. Research demonstrates that early palliative care consultations result in patient directed goals of care, improved symptom management, decreased length of stay, and reduced direct costs for inpatient hospitalizations.

Objectives: The goal of this project was to implement evidence-based recommendations for early palliative care referrals in an adult emergency department to improve …

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

Department of Emergency Medicine

No abstract provided.

Opinions Of Academic Em Society Members On The New Acgme Common Program Requirements, Shawn M. Quinn Do, Bryan G. Kane Md, Marna R. Greenberg Do, Mph, Facep, Terrence E. Goyke, Steven Bird Md, Megan Schagrin Mba, Gavin C. Barr Jr. Md

Department of Emergency Medicine

No abstract provided.

Emergency Department Skull Trephination For Management Of Acute Epidural Hematoma, Julie A. Fritzges Do

Department of Emergency Medicine

No abstract provided.

The Use Of An ‘Acclimatisation’ Heatwave Measure To Compare Temperature-Related Demand For Emergency Services In Australia, Botswana, Netherlands, Pakistan, And Usa, Naomi Van Der Linden, Thomas Longden, John R. Richards, Munawar Khursheed, Wilhelmina M. T. Goddijn, Michiel J. Van Veelen, Uzma R. Khan, M. Christien Van Der Linden

Department of Emergency Medicine

Background: Heatwaves have been linked to increased risk of mortality and morbidity and are projected to increase in frequency and intensity due to climate change. The current study uses emergency department (ED) data from Australia, Botswana, Netherlands, Pakistan, and the United States of America to evaluate the impact of heatwaves on ED attendances, admissions and mortality.
Methods: Routinely collected time series data were obtained from 18 hospitals. Two separate thresholds (≥4 and ≥7) of the acclimatisation excess heat index (EHIaccl) were used to define "hot days". Analyses included descriptive statistics, independent samples T-tests to determine differences in case mix between …

Acquiring Blood Pressures On High Risk Sepsis Patients In The Ed, Mckenna Scharlau, Jacob Schneider

Nurse Presentations

Describes a project to improve use of the Sepsis Tool in the Emergency Department and to improve documentation of blood pressure measurements in high risk sepsis patients under three years of age.

Safety Oriented, Low-Cost Peritonsillar Abscess Needle Aspiration Model For Emergency Medicine Simulation, Anne Mai Bs, Julie A. Fritzges Do, Gavin C. Barr Jr. Md, Marna R. Greenberg Do, Mph, Facep, Smeet Bhimani Do

Department of Emergency Medicine

No abstract provided.