Medical Specialties Commons^™

Brief Review: Iv Fluid Choice In The Emergency Department, Kaywan Saed, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Normal saline and balanced crystalloids, such as lactated Ringer's (LR) and Plasma-Lyte A, are commonly used in the emergency setting for fluid resuscitation. However, there has been growing interest in recent years in whether balanced crystalloids may be superior to normal saline, particularly in critically ill patients.

Normal saline has been the traditional fluid of choice for decades due to its widespread availability, low cost, and presumed safety. However, normal saline has a high chloride concentration (154 mmol/L), which can lead to hyperchloremic metabolic acidosis and other adverse effects, such as renal vasoconstriction and reduced renal blood flow.

In contrast, …

Case Report: Vocal Cord Paralysis In The Ed, Richard Baluyot, Russell Mordecai, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

The incident rate of vocal cord paralysis varies greatly depending on the cause of paralysis as well as if it's unilateral or bilateral, for this poster we will be focusing on unilateral paralysis. From 1985 to 1995 cancer was the primary cause for vocal cord paralysis, however this shifted to primarily iatrogenic surgical injury from 1996 to 2005. In another study it was found that idiopathic paralysis and tumors to both be the primary cause (31.11% respectively), with surgery consisting of 28.89%, and trauma, brain problems, systemic disease and other causes being 2.2%.

Spontaneous Iliac Arteriovenous Fistula, High-Output Heart Failure, And Cardiac Arrest, J. Maxwell Piraneo, Russell Mordecai, James Espinosa, Alan Lucerna

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High-output heart failure is a potentially life-threatening condition that can lead to cardiac arrest. The most common causes of this condition are obesity, liver disease, arteriovenous shunts, lung disease, and myeloproliferative disorders, however the exact prevalence remains uncertain [1]. Here we describe an unusual case of cardiac arrest as a consequence of high-output heart failure, secondary to rupture of an iliac artery aneurysm into the common iliac vein, with arteriovenous (AV) fistula formation.

Case Report: The Challenge Of Balancing Stewardship And Advocacy, Samuel Thalathoti, Kishan Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 62-year-old female who presented with chief complaint of generalized weakness and was ultimately diagnosed with hypereosinophilia. This chief complaint is challenging for many EM physicians, and the differential diagnosis of generalized weakness is vast. Etiologies of generalized weakness in the adult population ranges from infection, dehydration, cardiovascular disease, to neurologic compromise. It is crucial for the Emergency Physician to put emphasis on proper history collection, detailed physical exam, and appropriate ancillary testing. In this case report we showcase the significance of the optimal evaluation of life-threatening disorders that presents as generalized weakness, as well …

Case Report: Cavitary Pneumonia In A 28 Year Old Male, Dan Zaayenga, Katelyn Courtney

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Cavitary pneumonia can be caused by several different mechanisms. Such causes include suppurative necrosis (pyogenic lung abscess), caseous necrosis (tuberculosis), ischemic necrosis (pulmonary infarction) cystic dilatation of lung structures (ball value obstruction and Pneumocystis pneumonia) as well as malignant processes. Causes are subject to both environmental factors and host susceptibility. The most common cause of infectious process is tuberculosis with its propensity to cause extensive caseous necrosis. The potential for secondary infection after an individual develops a cavitary pneumonia is also great as it provides a shelter for various pathogens the flourish in an environment otherwise usually well-guarded by host …

Case Study Of Horner Syndrome Due To Internal Carotid Artery Dissection, Kajel Patel

Rowan-Virtua Research Day

Carotid artery dissection can occur either spontaneously or because of trauma. It is usually the most common cause of stroke in middle-aged patients. The symptoms can be transient or persistent and typically occur a few days after the inciting traumatic event.

A 5-Year Clinical Course Of Phenocopy Syndrome Of Behavioral Variant Frontotemporal Dementia: Case Report And Literature Review, Joseph Melillo, Keyur Patel, Christian White

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Frontotemporal dementia is a neurocognitive disease which affects language, behavior, or executive functioning. This disease includes a spectrum of presentations which includes multiple variants. The phenocopy syndrome of behavioral variant frontotemporal dementia is one which mimics the behavioral variant of frontotemporal dementia. Patients with this condition show a decline in personality, social conduct and cognitive ability but often display no signs of neurological imaging and exhibit slow progression. This case focuses on a now 70-year-old male who has shown signs of behavioral changes with a slowly progressive clinical course and minimal findings on PET scan, but moderate changes seen on …

Case Report: Abrupt Psychosis Or Nmda Receptor Encephalitis?, Alexis Dunn, Neelesh Parikh, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 46-year-old female who was initially committed to a psychiatric facility for new onset schizophrenia symptoms. She later had an extensive workup in the hospital due to leukocytosis and was believed to have NMDA Receptor Encephalitis as the cause for her new behavioral symptoms. This case report aims to educate EM (emergency medicine) physicians to keep a broad differential diagnosis on patients who present with new onset, unprovoked psychosis later in life.

Case Report And Brief Review: A Case Of Erythema Ab Igne Due To A Space Heater, Adam Kandil, James Espinosa, Alan Lucerna, James Lee, Robin Lahr

Rowan-Virtua Research Day

A 35 year old male presented to the Emergency Department (ED) with a rash of his left lateral lower leg of a 2 months duration. The patient had been using an electric space heater and the affected area was the closest part of his body to the heater. A diagnosis of erythema ab igne was made. Here we discuss erythema ab igne in reference to the medical history of the diagnosis, pathophysiology, modern causative heat sources such as laptop computers and treatment.

Sigmoid Perforation Extending Into The Abdominal Wall, Zamran Masih, Wayne Tamaska, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Sigmoid colon perforation and spread into the abdominal wall is a rare condition that can occur due to various causes such as diverticulitis, trauma, malignancy, or iatrogenic injury during surgery. Although rare, sigmoid colon perforation into the abdominal wall can result in significant morbidity and mortality if not promptly diagnosed and treated. Most common cause of diverticular disease leading to perforation is diverticulitis, accounting for 60% of all colonic perforations.

New Onset Lichen Planus And Back Pain Leading To Discovery Of A Peri Aortic Abscess, Monica Diep, Wayne Tamaska, Philip Carhart, James Espinosa, Alan Lucerna

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Back pain is a common chief complaint in the emergency department. With the differential ranging from musculoskeletal pain to cauda equina, there are a plethora of diagnoses. Differentiating between benign back pain and back pain that warrants further evaluation and even possible emergent surgical intervention is often a challenge in the acute setting. In this case report, a strange combination of all new symptoms including lichen planus, fevers, chills and atraumatic back pain lead to the eerie and very unexpected diagnosis of a peri-aortic abscess.

Case Report And Brief Review: A Puzzling Case Of Leg And Ankle Swelling, Michael Morris, James Espinosa, Alan Lucerna, Robin Lahr, James Lee

Rowan-Virtua Research Day

Here we present the case of a medical student in his twenties who had experienced episodes of heat edema that had been previously evaluated at other EDs and thought to be possible DVT. An awareness of heat edema as a minor heat-related illness is important in order to avoid unnecessary testing and in order to help prevent future episodes

Perioperative Ketamine Use For Post Mastectomy Pain, Alessia Cooney, Jaylyn Thompson, Naomi Watkins-Granville

Rowan-Virtua Research Day

PMPS is defined as chronic neuropathic pain following breast cancer procedures in the ipsilateral arm, chest wall, axilla or shoulder.1-3 Approximately 20 to 50% of post mastectomy patients suffer from Post Mastectomy Pain Syndrome (PMPS).1 With more than 3.8 million breast cancer survivors, due to advances in treatment, there is increased importance in findings ways to better manage the quality of life of breast cancer survivors.1,4 Ketamine induces analgesic effects through its non-competitive antagonism of NDMA receptors.5 Low doses of ketamine infusion (20–30 mg x h−1) have been shown to produce analgesia in neuropathic pain states with benefits lasting up …

Migratory Dermatographic Urticaria Following Covid-19 Vaccine Booster In Young Adult Male, Richard A. Maiella, Kelly Staples, Ashok Veldanda

Rowan-Virtua Research Day

With the recent approval of booster vaccinations in the United States for adults who already received their primary vaccinations, millions of adults have been administered the Pfizer-BioNTech or Moderna booster vaccines.

Adverse events related to these vaccines continue to be reported and are majority self-limited. In this case report, we present a young male who acquired chronic, migratory dermatographic urticaria two weeks after administration of the Moderna mRNA-1273 COVID-19 vaccine booster.

Investigation Of Emergency Department Visits And Hospitalization Rates Of Child Physical Abuse At Cooper University Hospital Prior To And During The Covid-19 Pandemic, Afeerah Ahmad, Rachel Silliman Cohen, Laura Brennan

Rowan-Virtua Research Day

The COVID-19 pandemic has been detrimental for children. Many families have experienced stressors, including unemployment, financial hardship, and familial illness. These factors all pose increased risk for child physical abuse. Limitations in child welfare services affected investigations and provision of services to high-risk families. The extent to which the rates of physical abuse in NJ have been affected is unknown. We sought to answer the question of whether the COVID-19 pandemic affected the severity of physical abuse and the incidence of physical abuse presenting to Cooper University Hospital.

We hypothesized that there would be a higher proportion of severe child …

Is Blood Flow Restriction Training Superior For The Limitation Of Hamstring And Quadriceps Atrophy After Anterior Cruciate Ligament Reconstruction? A Review Of Randomized Controlled Trials, Joshua M. Spada, Ryan W. Paul, Bradford S. Tucker

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Post operative recovery from Anterior Cruciate Ligament Reconstruction (ACLR) includes extensive rehabilitation of 6-9 months with return to sport/activity at 12 months

Rehabilitation is initiated shortly following surgery to limit quadriceps and hamstring atrophy, maximizing long term tibiofemoral joint stability and functional outcomes

The best way to achieve improved muscle strength and prevent atrophy is progressive overload training, however, these activities cannot be performed post operatively without risk to the reconstructed knee

Blood Flow Restriction Training (BFR) involves impairing the blood supply for short periods through the application of an air-filled bladder or cuff to restrict the venous drainage of …

Latarjet Surgery Leads To Decreased Rates Of Subjective Instability Compared To Bankart Repair With Concomitant Remplissage, Joshua Spada, Ryan W. Paul, Manoj Reddy, Gabriel Onor, John Hayden Sonnier, Ari Clements, Meghan E. Bishop, Brandon J. Erickson

Rowan-Virtua Research Day

Background: Predictive factors for performing remplissage concomitantly with arthroscopic Bankart repair include the presence of humeral or glenoid defects >11% and/or revision surgery. International and societal consensus statements support these findings, as surgeons recommend the Latarjet procedure for patients with significant glenoid bone loss (>15-20%) while remplissage is recommended for patients with off-track or engaging Hill-Sachs lesions without significant glenoid bone loss. While several studies have compared outcomes between Latarjet surgery and remplissage, these studies have only evaluated patients with engaging Hill-Sachs lesions, not consecutive patient cohorts indicated for each surgery.

Purpose: To compare rates of recurrent instability, re-operation, …

A Puzzling Case Of Normal Pressure Hydrocephalus In The Outpatient Setting, Shadi Shams, Asim Shafique, Marym Khan, James Bailey

Rowan-Virtua Research Day

Normal Pressure Hydrocephalus (NPH) is a disease of adulthood characterized by the triad of gait disturbance, dementia, and urinary incontinence. Since NPH shares a lot of characteristics with other disorders including neurodegenerative disorders and degenerative-dystrophic spine, it is usually underdiagnosed and undertreated. Combination of ventriculomegaly seen on a computerized tomography (CT) scan or magnetic resonance imaging (MRI) with clinical findings could be used in diagnosis of NPH. However, improvement of symptoms post spinal tap procedure would be a better indication of diagnosis. Currently, shunt placement is the best available modality of treatment for NPH. Here we present a case of …

Case Report: A Patient With Gait Dysfunction With Acute Inflammatory Demyelinating Polyneuropathy Masquerading As Diabetic Polyneuropathy, David Parkes, Russell Mordecai

Rowan-Virtua Research Day

New onset gait dysfunction often prompts admission to the hospital for further evaluation. The typical patient is an elderly person who normally is self-sufficient but had recently experienced a decline in their ability to care for themselves. Sometimes, however, those who present with gait dysfunction do not fit the expected demographic. These individuals raise concern for less common “zebra” presentations of neurological dysfunction. We describe one such rare case of a 39-year-old female with a new onset of type 2 diabetes mellitus and recent COVID-19 infection that presented to the emergency department with a sensation of bilateral lower extremity burning …

Case Report And Review: Spontaneous Coronary Artery Dissection (Scad), Michael Morris, Wayne Tamaska, James Espinosa, Alan Lucerna, Trent Malcolm

Rowan-Virtua Research Day

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome or sudden death. SCAD has a high incidence in a younger, female population with an association with peripartum or postpartum status. Connective tissue disorders and vasculitides are also associated with SCAD. The purpose of this poster will be to examine the presentation and risk factors associated with SCAD and to discuss optimal treatment strategies.

Impact Forces And Patterns Of Axonal Injury Differ Between Two Models Of Tbi, Edward Lai, David M Devilbiss

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Traumatic brain injury (TBI) affects approximately 3.8 million Americans a year and results in complex neuropathological and neurocognitive sequelae. Animal models of TBI attempt to replicate the impact forces and pathology of injury in humans. However, in these models, the forces generated at the time of impact are poorly understood. Nonetheless, a variety of shear and strain forces generated at the time of impact can produce diffuse axonal injury. Injury to axons and neurons across a variety of brain regions resulting from axonal injury underlies the cognitive and behavioral impairments observed after TBI. Three critical brain regions, the corpus callosum …

Stroke In Hfref Without Atrial Fibrillation And Concurrent Protein S Deficiency: What Is The Best Treatment?, Rohan Umrani, Trinava Roy, Bhavana Kadiyala, Yvette Wang

Rowan-Virtua Research Day

Hypercoagulable disorders are often the culprit for repeated strokes in young patients, with or without other comorbidities

Medications typically used for stroke prophylaxis:

• Warfarin
• Aspirin
• Direct Oral Anticoagulants (DOACs)

Warfarin is the preferred method of anticoagulation for stroke prophylaxis in patients with hypercoagulable disorders

A deficiency of protein S increases the risk of pro coagulation due to a relative deficiency of anticoagulants.

Patients with protein S deficiency tend to have recurrent venous thromboses and pulmonary emboli

Case Report: How A Vallecular Cyst Could Have Become An Airway Emergency, Adam Kandil, Robin Lahr, Andrew Caravello

Rowan-Virtua Research Day

Vallecular cysts, also known as epiglottic mucous retention cysts are known to be generally self-limiting laryngeal lesion. They can however also be associated with airway obstruction, and dysphagia in infants. In adults, they are usually asymptomatic, and usually incidentally diagnosed. At times they are diagnosed during rapid sequence intubation, as they may contribute to endotracheal intubation difficulty. Moreover, there is question as to the correlation between vallecular cysts and the incidence of acute epiglottitis, as a vallecular cyst may become infected and cause a localized expansion of inflammation and infection. This expansion from the vallecula progresses to epiglottis.

Comparative Assessment Of Grit In The Allopathic Versus Osteopathic Physician, Amber Cheesman, Meagan Vermeulen, Joanna Petrides, Charalampos Papachristou

Rowan-Virtua Research Day

Matriculating into medical school is a strenuous process, including numerous roadblocks unique to both allopathic and osteopathic schools, with osteopathic applicants often jumping more hurdles in the journey.

Grit: passion and perseverance towards long term goals, especially in the setting of failure/adversity

High levels of grit correlate with low levels of burnout

Purpose: examine grit in allopathic versus osteopathic physician to help identify resources to prevent physician burnout

Exploring The Viability Of A Microglia Attenuating Treatment Model For Fibromyalgia Patients, Rohan Yarlagadda

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Fibromyalgia refers to a rheumatic condition experienced as pain all over the body without a specific cause. This is considered a diagnosis of exclusion. This classification seems to suggest that any treatment options for it are purely symptomatic and are not disease targeted. Its complex diagnosis and underlying pathology contribute to the challenge of medically addressing fibromyalgia. Without a strict cause, fibromyalgia is often treated symptomatically with CBT and SNRIs. However, recent research suggests that existing therapeutic approaches are not very effective, especially when considering long term benefits for this chronic condition. This beckons for novel treatment options for these …

Extragonadal Perirectal Mature Cystic Teratoma In The Adult Male, Pranamaya Mahankali, Liam Trimble, Diana Panciera, Hui Li, Thaer Obaid

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A teratoma is a mass that originates from the germ cells of the three primitive embryonic layers and commonly arises from the ovaries or testicles, thereby characterized as gonadal in origin. These masses comprise different types of tissues such as fat, hair, muscle, and bone. Extragonadal teratomas are uncommon and arise from anatomical locations other than the gonads, such as the pineal gland, anterior mediastinum, retroperitoneum, and sacrococcygeal regions. The most common is the presacral region, as it contains tissue derived from all germ layers. Tumors in this specific location are far more common in neonates, infants, and children rather …

Family-Centered Training And Therapy As Substance Abuse Intervention In Adolescents, Ryan St. John, Cam'ron Klotz, Muskaan Bibi, Archana Salek

Rowan-Virtua Research Day

We hypothesized that providing mental health resources for adolescents and educating their parents and families would decrease the prevalence of substance abuse in the Camden, NJ community given that overdose death had risen 138% from 2014-2018. Educating parents and families on the importance of adolescents dealing with mental disorders may help evaluate the mental stability of their child and prevent them from turning to illicit substance to cope. Increasing the communication and the availability of resources for adolescents to turn to before resorting to illicit substances can have beneficial effects.

Factors Associated With Unplanned Conversion To Open In Nephrectomy For Kidney Cancer, Young Son, Benjamin A. Fink, Justine Garfinkel, Lance Earnshaw, Brian Thomas, Thomas Mueller, David Sussman

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Minimally invasive surgery (MIS) has been adopted as an approach in kidney surgery. Laparoscopic kidney surgery has been introduced in the 1990s with robotics emerging a decade after. The minimally invasive approach has been technically feasible and has been shown to be noninferior with preserved oncology standards to open surgery. The ubiquitous use of MIS for kidney cancer has been standard of practice; however, unplanned conversion to open kidney surgery has been characterized at 4.9% for laparoscopic radical nephrectomy compared to 6.0% in robotic radical nephrectomy. Another analysis of 54,246 patients undergoing partial nephrectomy for kidney cancer observed an unplanned …

Neoadjuvant Chemotherapy As A Risk Factor For Urinary Anastomotic Leak In Patients Undergoing Radical Cystectomy, Young Son, Katelyn Klimowich, Joseph Flemming, Lance Earnshaw, Benjamin Fink, Brian Thomas, Thomas Mueller

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Muscle-invasive bladder cancer (MIBC) represents approximately 25% of all bladder cancer and carries a significant risk of mortality. Neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) is the standard of care for MIBC. One complication associated with RC is ureteral anastomotic leak with a predicted rate of 3%. The objective of this National Surgical Quality Improvement Project (NSQIP) database analysis is to determine if correlations exist between radiation (RAD) and/or NAC before RC and anastomotic leak in the treatment of MIBC.

Rate Of Intraoperative Proximal Femoral Fractures With Automated Broaching, Tyler Radack, Hope Skibicki, Julian Zangrilli, Ruchir Nanavati, Cole Kleinman, Michael Harrer

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Intraoperative proximal femur fractures (PFF) occur in 3.7% of total hip arthroplasties (THA) using the standard mallet broaching technique and increase a patient’s risk of revision surgery from 3.4% to 10%. The Depuy KINCISE automatic broaching system is designed to attenuate the risk of these fractures by applying consistent co-linear force to the broach. The aim of this study is to determine if the KINCISE system decreases the rate of intraoperative PFF fracture during THA compared to the standard mallet technique.