Medical Specialties Commons^™

Emergency Medical Services And Public Policy In Durban, Kwazulu-Natal, John Buyske

Independent Study Project (ISP) Collection

This project seeks to explore the realities of the emergency medical system in the Durban area, particularly relative to government policy. It contextualizes its findings within the literature on public policy. Data for the project was collected via nine in-depth interviews with various professionals working in the field of emergency medical services, as well as a survey of fourteen citizens conducted in the peri-urban township of Cato Manor. This data was analyzed using qualitative methods. While every participant had different views and a different perspective on emergency services, some recurring themes and trends became evident, allowing for conclusions to be …

Blog And Podcast Watch: Pediatric Emergency Medicine, Fareen Zaver, Michael Hansen, C. Leibner, A. Little, M. Lin

Emergency Medicine Faculty Publications

Introduction: By critically appraising open access, educational blogs and podcasts in emergency medicine (EM) using an objective scoring instrument, this installment of the ALiEM (Academic Life in Emergency Medicine) Blog and Podcast Watch series curated and scored relevant posts in the specific areas of pediatric EM.

Methods: The Approved Instructional Resources - Professional (AIR-Pro) series is a continuously building curriculum covering a new subject area every two months. For each area, six EM chief residents identify 3-5 advanced clinical questions. Using FOAMsearch.net to search blogs and podcasts, relevant posts are scored by eight reviewers from the AIR-Pro Board, which is …

Feasibility Of An Ed-To-Home Intervention To Engage Patients: A Mixed-Methods Investigation, Jessica Schumacher, Barbara J. Lutz, Allyson Hall, Jesse M. Pines, Andrea Jones, Phyllis Hendry, Colleen Kalynych, Donna L. Carden

Emergency Medicine Faculty Publications

Introduction: Older, chronically ill patients with limited health literacy are often under-engagedin managing their health and turn to the emergency department (ED) for healthcare needs. Wetested the impact of an ED-initiated coaching intervention on patient engagement and follow-updoctor visits in this high-risk population. We also explored patients’ care-seeking decisions. Methods: We conducted a mixed-methods study including a randomized controlled trial andindepth interviews in two EDs in northern Florida. Participants were chronically ill older EDpatients with limited health literacy and Medicare as a payer source. Patients were assignedto an evidencebased coaching intervention (n= 35) or usual post-ED care (n= 34). Qualitativeinterviews …

Spontaneous Subarachnoid Hemorrhage: A Systematic Review And Meta-Analysis Describing The Diagnostic Accuracy Of History, Physical Examination, Imaging, And Lumbar Puncture With An Exploration Of Test Thresholds., Christopher R Carpenter, Adnan M Hussain, Michael J Ward, Gregory J Zipfel, Susan Fowler, Jesse M Pines, Marco L A Sivilotti

Emergency Medicine Faculty Publications

BACKGROUND: Spontaneous subarachnoid hemorrhage (SAH) is a rare, but serious etiology of headache. The diagnosis of SAH is especially challenging in alert, neurologically intact patients, as missed or delayed diagnosis can be catastrophic.

OBJECTIVES: The objective was to perform a diagnostic accuracy systematic review and meta-analysis of history, physical examination, cerebrospinal fluid (CSF) tests, computed tomography (CT), and clinical decision rules for spontaneous SAH. A secondary objective was to delineate probability of disease thresholds for imaging and lumbar puncture (LP).

METHODS: PubMed, Embase, Scopus, and research meeting abstracts were searched up to June 2015 for studies of emergency department patients …

Uchunguzi (Journal Watch/Montre De Journal) September 2016, Benjamin Wachira

Emergency Medicine, East Africa

Most states in the USA have ‘Good Samaritan’ laws that oblige doctors to stop and render emergency treatment under certain circumstances, without incurring legal liability even if they are negligent. Whether doctors are legally obliged to stop and render assistance at road accidents in most countries across the world remains controversial. In 1978, the South African Medical and Dental Council ruled that ‘in cases of emergency a practitioner is obliged to render assistance in all circumstances’. It has therefore been said that ‘where persons are in a situation where their life or health will be seriously endangered unless they receive …

Academic Primer Series: Five Key Papers Fostering Educational Scholarship In Junior Academic Faculty., Teresa M. Chan, Michael Gottlieb, Abra L. Fant, Anne Messman, Daniel W. Robinson, Robert R. Cooney, Dimitrios Papanagnou, Lalena M. Yarris

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Scholarship is an essential part of academic success. Junior faculty members are often unfamiliar with the grounding literature that defines educational scholarship. In this article, the authors aim to summarize five key papers which outline education scholarship in the setting of academic contributions for emerging clinician educators.

METHODS: The authors conducted a consensus-building process to generate a list of key papers that describe the importance and significance of academic scholarship, informed by social media sources. They then used a three-round voting methodology, akin to a Delphi study, to determine the most useful papers.

RESULTS: A summary of the five …

Recurrent Violent Injury: Magnitude, Risk Factors, And Opportunities For Intervention From A Statewide Analysis., Elinore Kaufman, Kristin L. Rising, Md, Ms, Douglas J. Wiebe, David J. Ebler, Marie L. Crandall, M. Kit Delgado

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Although preventing recurrent violent injury is an important component of a public health approach to interpersonal violence and a common focus of violence intervention programs, the true incidence of recurrent violent injury is unknown. Prior studies have reported recurrence rates from 0.8% to 44%, and risk factors for recurrence are not well established.

METHODS: We used a statewide, all-payer database to perform a retrospective cohort study of emergency department visits for injury due to interpersonal violence in Florida, following up patients injured in 2010 for recurrence through 2012. We assessed risk factors for recurrence with multivariable logistic regression and …

A Matter Of Degrees? Views Of Ems Online Degrees' Value And Design, Sandy Hunter

EKU Faculty and Staff Scholarship

EMS has continued its move from a product of training to being the result of education. A part of that process has been the proliferation of academic programs that focus upon emergency medical services related topical areas. As this trend continues, it is incumbent upon the educators who teach these curricula to determine the most desired and (therefore) effective designs for EMS degrees. This presentation will discuss the results of statewide online research of Paramedics in Kentucky, asking several questions to determine: - the current level of education among that population, - the types of EMS programs they completed, - …

Webpoisoncontrol: Can Poison Control Be Automated?, Toby Litovitz, Blaine E Benson, Susan Smolinske

Emergency Medicine Faculty Publications

BACKGROUND: A free webPOISONCONTROL app allows the public to determine the appropriate triage of poison ingestions without calling poison control. If accepted and safe, this alternative expands access to reliable poison control services to those who prefer the Internet over the telephone. This study assesses feasibility, safety, and user-acceptance of automated online triage of asymptomatic, nonsuicidal poison ingestion cases.

METHODS: The user provides substance name, amount, age, and weight in an automated online tool or downloadable app, and is given a specific triage recommendation to stay home, go to the emergency department, or call poison control for further guidance. Safety …

Type 1 Diabetes Mellitus Presenting With Diabetic Ketoacidosis (Dka) In A Neonate, Fareed Ahmed, Sayyeda Ghazala Kazi, Waqas Khan

Department of Emergency Medicine

Neonatal diabetes mellitus (NDM) is a rare manifestation with an incidence of one affected individual among 400000 live births. NDM can be divided into Transient (TNDM) and Permanent (PNDM) types. A significant overlap occurs between both groups, to an extent that TNDM cannot be distinguished from PNDM based solely on clinical features. Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (TIDM). DKA at diagnosis is more common in young children near the age of five years. Neonatal DKA is a rare occurrence causing it to be missed in the differential …

Pattern Of Relapse In Paediatric Acute Lymphoblastic Leukaemia In A Tertiary Care Unit, Emaduddin Siddiqui, Sayyeda Ghazala Kazi, Muhammad Irfan Habib, Khalid Mehmood Ahmed Khan, Nukhba Zia

Department of Emergency Medicine

OBJECTIVE:

To determine the frequency, site and time to relapse from diagnosis, and to see the relationship of relapse with important prognostic factors.

METHODS:

The prospective descriptive observational study was conducted at the National Institute of Child Health, Karachi, June 2005 to May 2007, and comprised newly-diagnosed cases of acute lymphoblastic leukaemia. Bone marrow aspiration was done on reappearance of blast cells in peripheral smear and cerebrospinal fluid. Detailed report was done each time when intra-thecal chemotherapy was given or there were signs and symptoms suggestive of central nervous system relapse. SPSS 12 was used for data analysis.

RESULTS:

Of …

Frequency And Outcome Of Meningitis In Pediatric Intensive Care Unit Of Pakistan, Amna Jawaid, Surriya Bano, Anwarul Haque, Khubaib Arif

Department of Emergency Medicine

Meningitis is a leading cause of morbidity and mortality worldwide in intensive care settings. The aim of this study was to assess the frequency and outcome in children with meningitis through a retrospective chart review done in pediatric intensive care unit of a tertiary care hospital from January 2000 to December 2014. During these 14 years, 64 patients were admitted with meningitis in pediatric intensive care unit. Out of 64, 36 were diagnosed with pyogenic meningitis, 18 patients with viral meningitis, and 10 with tuberculous meningitis. Most complications were observed in the initial 48 hours. Most common presentation was altered …

Traumatic Posterior Tibial Pseudoaneursym: A Rare Late Complication Repaired Conventionally, Farzad Amiri, Md, Zachary Sanford, Constantinous Constantinou, Md

Marshall Journal of Medicine

Posterior tibial artery pseudoaneurysms are extremely rare. They commonly present as a late complication of trauma or iatrogenic injury. Diagnosis can be elusive. Treatment has been described in the context of open primary repair, endovascular stenting, and coil embolization. There has been increasing interest in the use of endovascular treatment options for this type of injury. If left untreated, pseudoaneurysms can rupture, partially thrombose, expand and cause adjacent local compression and compartment syndrome. The following case presented is of a young gentleman with a posterior tibial pseudoaneurysm incidentally discovered after stepping on glass and the management of his posterior tibial …

Control Of Poisoning Through Product Labeling Of Hazardous Chemicals, Nadeem Ullah Khan, Arshad Iqbal, Sadaf Sheikh

Department of Emergency Medicine

No abstract provided.

Early Goal-Directed Therapy In Severe Sepsis And Septic Shock: Insights And Comparisons To Process, Promise, And Arise, H. Bryant Nguyen, Anja Kathrin Jaehne, Namita Jayaprakash, Matthew W. Semler, Sara Hegab, Angel Coz-Yataco, Geneva Tatem, Dhafer Salem, Steven Moore, Kamran Boka, Jasreen Kaur Gill, Jayna Gardner-Gray, Jacqueline Pflaum, Juan Pablo Domecq, Gina Hurst, Justin B Belsky, Raymond Fowkes, Ronald B. Elkin, Steven Q. Simpson, Jay L. Falk, Daniel J. Singer, Emanuel P. Rivers

Internal Medicine Faculty Publications

Prior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar outcome benefits have been reported in over 70 observational and randomized controlled studies comprising over 70,000 patients. As a result, early goal-directed therapy was …

Acute Post-Disaster Medical Needs Of Patients With Diabetes: Emergency Department Use In New York City By Diabetic Adults After Hurricane Sandy., David C. Lee, Vibha K. Gupta, Brendan G. Carr, Sidrah Malik, Brandy Ferguson, Stephen P. Wall, Silas W. Smith, Lewis R. Goldfrank

Department of Emergency Medicine Faculty Papers

OBJECTIVE: To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy.

RESEARCH DESIGN AND METHODS: Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012.

RESULTS: In the highest level evacuation zone in New …

Uchunguzi (Journal Watch/Montre De Journal) June 2016, Benjamin Wachira

Emergency Medicine, East Africa

When someone telephones for an ambulance, an interaction ensues which should be efficient and effective to facilitate a speedy dispatch of the appropriate level of vehicle, equipment and personnel to where it is needed. The process in South Africa begins with a three-part opening sequence which typically identifies the organisation, introduces the call-taker (CT) and invites the caller to proceed with the business of the call. In a recent project conducted in a South African emergency service, the researchers aimed to ascertain the impact of the CT’s identification sequence on the progression of the call and to determine whether there …

Biventricular Thrombus In Hypereosinophilic Syndrome Presenting With Shortness Of Breath, Abdul Baqi, Shahan Waheed, Fateh Ali Tipoo Sultan, Aamir Hameed

Section of Cardiology

A 48 years old male presented to clinic with 12 months of low grade fever with shortness of breath which has progressively worsened with no associated weight loss, night sweats or loss of appetite. There was no prior history of chronic illness before the current illness. Laboratory workup revealed a high white blood cell count with predominant eosinophils. Chest X-ray was normal. Transthoracic echocardiography and Cardiac Magnetic Resonance showed biventricular thrombi. On further extensive workup the findings were consistent with hypereosinophilic syndrome. The patient was started on oral steroids, hydroxyurea, imatanib mesylate and oral anticoagulation. The patient responded to the …

The Frequency Of Influenza And Bacterial Co-Infection: A Systematic Review And Meta-Analysis., Eili Y. Klein, Bradley Monteforte, Alisha Gupta, Wendi Jiang, Larissa May, Yu-Hsiang Hsieh, Andrea Freyer Dugas

Emergency Medicine Faculty Publications

AIM: Co-infecting bacterial pathogens are a major cause of morbidity and mortality in influenza. However, there remains a paucity of literature on the magnitude of co-infection in influenza patients.

METHOD: A systematic search of MeSH, Cochrane Library, Web of Science, SCOPUS, EMBASE, and PubMed was performed. Studies of humans in which all individuals had laboratory confirmed influenza, and all individuals were tested for an array of common bacterial species, met inclusion criteria.

RESULTS: Twenty-seven studies including 3,215 participants met all inclusion criteria. Common etiologies were defined from a subset of eight articles. There was high heterogeneity in the results (I(2) …

Adiponectin Ameliorates The Apoptotic Effects Of Paraquat On Alveolar Type Ⅱ Cells Via Improvements In Mitochondrial Function., Yarong He, Liqun Zou, Yaxiong Zhou, Hai Hu, Rong Yao, Yaowen Jiang, Wayne Bond Lau, Tun Yuan, Wen Huang, Zhi Zeng, Yu Cao

Department of Emergency Medicine Faculty Papers

Previous studies have demonstrated that excessive reactive oxygen/nitrogen species (ROS/RNS)‑induced apoptosis is an important feature of the injury to the lung epithelium in paraquat (PQ) poisoning. However the precise mechanisms of PQ‑induced dysfunction of the mitochondria, where ROS/RNS are predominantly produced, remain to be fully elucidated. Whether globular adiponectin (gAd), a potent molecule protective to mitochondria, regulates the mitochondrial function of alveolar type II cells to reduce PQ‑induced ROS/RNS production remains to be investigated. The current study aimed to investigate the precise mechanisms of PQ poisoning in the mitochondria of alveolar type II cells, and to elucidate the role of …

Patient Perception Of Telehealth Primary Care Video Visits, Rhea E. Powell, Md, Mph, Jeffrey Henstenburg, Bs, Grace Cooper, Ba, Judd Hollander, Md, Kristin L. Rising, Md, Ms

Department of Medicine Posters

Introduction

• Telehealth (TH) is an innovative model of care delivery with potential to provide more patient-centered healthcare, allowing patients to receive care when and where is most convenient.
• To date, little is known about patient perceptions of receiving care with the use of TH video visits.

Impact Of Delay In Admission On The Outcome Of Critically Ill Patients Presenting To The Emergency Department Of A Tertiary Care Hospital From Low Income Country, Badar Afzal Khan, Nishi Shakeel, Emad Uddin Siddiqui, Ghazala Kazi, Irum Qamar Khan, Munawer Khursheed, Asher Feroze, Kiran Ejaz, Sumaiya Tauseeq Khan, Hatem Adel

Department of Emergency Medicine

Objective: To assess the impact of admission delay on the outcome of critical patients.Methods: The retrospective chart review was done at Aga Khan University Hospital, Karachi, and comprised adult patients visiting the Emergency Department during 2010. Outcome measures assessed were total hospital length of stay, total cost of the visit and in-hospital mortality. Patients admitted within 6 hours of presentation at Emergency Department were defined as non-delayed. Data was analysed using SPSS 19.Results: Of the 49,532 patients reporting at the Emergency Department during the study period, 17,968 (36.3%) were admitted. Of them 2356(13%) were admitted to special or intensive care …

Exploits Of A Helicopter Tv Journalist, Jerry Foster

ERAU Prescott Aviation History Program

Jerry Foster was the first TV helicopter pilot/reporter in the country; the first to go live over the scene of a breaking story. High speed police chases; devastating floods and daring rescues now splashed all over cable TV, started in the early 1970s in Phoenix. Hear this fascinating story from a remarkable aviator who won the Harmon Trophy for his flying exploits. What he pioneered would later be copied by medical and law enforcement agencies throughout the country leading to the saving of countless lives.

Research Professionals’ Experience And Perspectives On Women’S Participation In Clinical Research, Anita Kurt Phd, Rn, Lauren Semler Ms, Matthew Meyers Bs, Bernadette Gl-Porter Bs, Samantha Myles Bs, Stephen W. Dusza Drph, Jeanne L. Jacoby Md, John C. Smulian Md, Mph

Department of Emergency Medicine

No abstract provided.

Emergency Medicine Resident On Shift Clinical Teaching Efficacy As Measured By Student Evaluation And Self-Reflection Using A Previously Validated Metric, Alan R. Cherney Md, Dawn M. Yenser, Amy B. Smith Phd, Kevin Weaver D.O.,Facoep, Charles C. Worrilow Md, Bryan G. Kane Md

Department of Emergency Medicine

No abstract provided.

Inadequate Sensitivity Of Laboratory Risk Indicator To Rule Out Necrotizing Fasciitis In The Emergency Department, Elizabeth Burner, Sean Henderson, Guenevere Burke, Jeffrey Nakashioya, Jerome R. Hoffman

Emergency Medicine Faculty Publications

Introduction: Necrotizing fasciitis (NF) is a life-threatening illness, particularly when surgical debridement is delayed. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was developed to identify patients at higher risk for NF. Despite limited information in this regard, the LRINEC score is often used to "rule out" NF if negative. We describe the sensitivity of the LRINEC score in emergency department (ED) patients for the diagnosis of NF.

Methods: We conducted a chart review of ED patients in whom coding of hospital discharge diagnoses included NF. We employed standard methods to minimize bias. We used laboratory data to …

Interactive Spaced Online Education In Pediatric Trauma, Rohit Shenoi, Daniel Rubalcava, Bindi Naik-Mathuria, Harold A. Sloas, David Delemos, Linzhi Xu, Donna Mendez

Emergency Medicine Faculty Publications

Pediatric resident trauma education is suboptimal due to lack of a curriculum and limited trauma experience and education resources. The objective of the study was to test knowledge retention and acceptability of interactive spaced education (ISE) in pediatric trauma. Prospective, randomized trial involving 40 physicians in a pediatric emergency department was used. Instrument was comprised of 48 multiple-choice questions (evaluative component) and answer critiques (educational component) on pediatric trauma divided into two modules. The instrument was assessed for test–retest reliability, item difficulty, and construct validity. Intervention consisted of online administration of each module as eight spaced emails (3 questions each) …

Development And Use Of A Tablet-Based Resuscitation Sheet For Improving Outcomes During Intensive Patient Care, Wasif Bokahri, Vimla L. Patel, Ashish Amresh, Ayan Sen

Publications

Data documentation from resuscitation events in hospitals, termed "code blue" events, utilizes a paper form, which is institution-specific. Problems with data capture and transcription exists, due to the challenges of dynamic documentation of patient, event and outcome variables as the code blue event unfolds. We hypothesize that an electronic version of code blue real-time data capture would lead to improved resuscitation data transcription, and enable clinicians to address deficiencies in quality of care. To this effect, we present the design of a tablet-based application and its use by 20 nurses at the Mayo Clinic hospital. The results showed that the …

Telemedicine Resuscitation And Arrest Trial (Treat): A Feasibility Study Of Real-Time Provider-To-Provider Telemedicine For The Care Of Critically Ill Patients, Anish K. Agarwal, David F. Gaieski, Sarah M. Perman, Marion Leary, Gail Delfin, Benjamin S. Abella, Brendan G. Carr

Department of Emergency Medicine Faculty Papers

No abstract provided.

A Model To Predict Pre-Hospital Endotracheal Intubation Success, Leigh Ann Diggs

Health Services Research Dissertations

Background: Pre-hospital endotracheal intubation (ETI) is one of the most critical skills performed by paramedics and is considered the “gold standard” of airway management. Pre-hospital ETI success rates are variable, ranging from 33% to 100% across EMS systems in the U.S. Previous investigative efforts have identified factors associated with pre-hospital ETI success, but the generalizability of findings is limited. Few researchers have controlled for the concurrent effects of multiple factors when examining pre-hospital ETI success. Methods: In this retrospective exploratory study, we used national data from the National Emergency Medical Services Information System (NEMSIS) and data from a four state …