Emergency Medicine Commons^™

Illicit Drug Use Patterns In Myrtle Beach, S.C. From 2017-2022, Michelle Fowler, Mark Plexousakis, Meg Riley, Blaine Rourke, Erin Artigiani, Amy Billing, Margaret Hsu, Ebonie Massey, Eric Wish

South Atlantic Division GME Research Day 2023

No abstract provided.

Sonographic Measurements Of Inferior Vena Cava Collapsibility In Recreational Divers, David Pardue, Brandon Bowers, Scott Chewning, Casey Wilson

South Atlantic Division GME Research Day 2023

No abstract provided.

A Comparison Of Chief Complaints, Specific Diagnoses, And Demographics Of Pediatric Urgent Care Visits Before And During The Covid-19 Pandemic: A Retrospective Study, Zaharoula A. Viennas, Julie Martin, Benjamin Klick, Tammy Speerhas, Turaj Vazifedan, Danielle Millspaugh, Jennifer Ferris, Margret Bedle, Lauren Paluch, Theresa Guins

Ellmer School of Nursing Faculty Publications

There was an increased incidence of pediatric patients who presented with injuries caused by falls not related to sports or other recreational activities, as well as for animal bites, during the early pandemic period of April 2020. Education of parents and caregivers of young children is warranted to raise awareness of the even greater potential for falls and animal bites when children are confined at home for longer than typical periods of time, as occurred with the stay-at-home government orders during the initial period of the COVID-19 pandemic.

Raptir: Retroclavicular Approach To The Infraclavicular Region, Casey Wilson, Jacob Pope, David Pardue, Thomas Thornton

South Atlantic Division GME Research Day 2023

No abstract provided.

Injuries In Manual And Mechanical Cpr, Macon Spruill, Malik Bangura

Physician Assistant Capstones, 2020-current

Objective: To compare the rate of injuries during cardiopulmonary resuscitation (CPR) using manual versus mechanical chest compressions with the Lund University Cardiopulmonary Assist System (LUCAS™).

Design: Systematic literature review

Methods: We investigated the use of 2 different CPR methods, manual and mechanical, in order to determine if one was more likely to cause injury in individuals during a cardiac arrest. PubMed searches were conducted using the terms “cardiopulmonary resuscitation,” “adverse effect,” “classification,” “method,” “mortality,” “statistical and numerical data,” “trends,” “complication,” “epidemiology,” and “etiology.” Studies were excluded if they took place before the year 2000, included individuals under 18 …

Heart To Heart, Mom To Mom, Karis L. Tekwani

Journal of Patient-Centered Research and Reviews

This essay describes the human connection forged between two young moms, one the physician and one the patient, when their paths collided one night in the emergency department of a busy hospital. It describes a challenging and most memorable care experience in the career of a young emergency physician, the clinical outcome, and the patient’s appreciative follow-up message years later.

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 …

When Are Inpatient And Emergency Dermatology Consultations Appropriate?, Hershel Dobkin, Timothy Blackwell, Robin Ashinoff

Rowan-Virtua Research Day

Hospitalists and emergency physicians continue to struggle with the assessment of dermatologic conditions, often consulting dermatology whenever a patient has a “rash” or skin concern. Dermatology is still not emphasized in medical education and often is taught to most medical students in an abbreviated fashion, which results in physicians feeling ill-equipped to deal with any dermatologic condition—either mundane or potentially life-threatening.

Better guidelines are needed for physicians in the ED and on inpatient units to guide them on appropriate use of dermatologic consultation outside the ambulatory office and the clinic. We constructed a consultation flowchart to help guide the triage …

An Interesting Case Of Factitious Disorder Superimposed On Self: Factitious Disorder Vs Somatic Symptom Disorder, Michaela Margolis, Logan Noone, Jessica Baaklini

Rowan-Virtua Research Day

Factitious disorder superimposed on self (FDIS) was first described in 1951by Richard Asher, who associated the disorder with Baron Munchhausen, who narrated unrealistic and exaggerated stories about his life.

Suspicion for FDIS should be raised when patients with atypical presentations of medical disorders seek excessive use of healthcare services despite ongoing lack of clinical evidence. Patients with FDIS often demand hospitalization for their symptoms, leading to unnecessary tests and treatments. These patients show signs of pathological lying, deceitfulness, are obstinate with medical staff, and display erratic behavior. When medical investigation does not support their symptoms, patients often develop new “symptoms” …

Complications Of Fitz-Hugh-Curtis Syndrome In A Teenage Female: A Case Presentation, Marina Cugliari, Trupti Pandit

Rowan-Virtua Research Day

Fitz-Hugh-Curtis Syndrome is a manifestation of Pelvic Inflammatory Disease (PID) associated with Chlamydia trachomatis infections and less frequently with Neisseria gonorrhea.

PID affects sexually active women (15-30 years old) and accounts for 750,000 cases each year.

The case presented illustrates a female who presented with a small bowel obstruction and appendicitis, who was incidentally found to have Fitz-Hugh-Curtis Syndrome on laparoscopic exam.

Syncope Masquerading As Pulmonary Embolism, Melissa Itidiare Locke, Andrew Caravello, Melanie Angelo, Andrew Vasta

Rowan-Virtua Research Day

Syncope is a clinical syndrome that occurs due to a period of inadequate cerebral blood flow that cause a transient loss of consciousness that usually resolves within 8-10 seconds) [1] Our case demonstrates a 56-year-old female who experienced syncope for the first time. The patient had an unwitnessed fall and subsequently had imaging studies performed. A discovery of a Sub-Massive Pulmonary embolism was revealed.

Celiac Artery Aneurysm: A Rare Cause Of Abdominal Pain, Duwayne Campbell, Wayne Tamaska, Kevin Dwyer

Rowan-Virtua Research Day

Celiac artery aneurysm is a very rare vascular lesion accounting for only 5.1% of all splanchnic artery aneurysms. Etiology for celiac artery aneurysm includes, but not limited to, infectious diseases, atherosclerosis, trauma, congenital conditions such as median arcuate ligament syndrome and iatrogenic causes.

Etiology for abdominal pain is extensive. Patients should be evaluated for both intra-abdominal and extra-abdominal causes for pain, as presentations of a different pathophysiology vary widely. CT scan has become a mainstay part of the work for abdominal pain in the Emergency department, and often elicit pathologies that would otherwise be missed on blood work and other …

Management Of Late-Stage Ewingoid Dedifferentiated Liposarcoma Of The Spermatic Cord With Emergent Complications: A Case Report, Raeann Dalton, Abdullah Junayed, Brian Thomas, Young Son, Megan Donlick, Kathryn Goettle, Lance Earnshaw, Thomas Mueller

Rowan-Virtua Research Day

Liposarcoma (LS), a malignant tumor of adipose origin, is the most common soft tissue sarcoma (STS), and can develop within any soft tissue. It rarely occurs in the paratesticular region, and accounts for 3-7% of spermatic cord tumors. Dedifferentiated liposarcoma (DDLS) and well-differentiated liposarcoma (WDLS) account for two of the five subtypes of LS, with dedifferentiation occurring in 20% of cases. There have been 66 cases of DDLS of the spermatic cord reported to date, but none present with a 22/22q trisomy without the fusion or rearrangement that commonly produces these aggressive tumors.

Accurate diagnosis of LS of the spermatic …

Stroke Network Of Wisconsin (Snow) Scale Predicts Large Vessel Occlusion Stroke In The Prehospital Setting, Kessarin Panichpisal, Sarah Erpenbeck, Paul Vilar, Reji P. Babygirija, Maharaj Singh, M. Riccardo Colella, Richard A. Rovin

Journal of Patient-Centered Research and Reviews

Purpose: In previous trials, the Stroke Network of Wisconsin (SNOW) scale accurately predicted large vessel occlusion (LVO) stroke in the hospital setting. This study evaluated SNOW scale performance in the prehospital setting and its ability to predict LVO or distal medium vessel occlusion (DMVO) in patients suspected of having acute ischemic stroke (AIS), a scenario in which transport time to an endovascular treatment-capable facility (ECSC) is critical.

Methods: All potential AIS patients with last-known-well time of ≤ 24 hours were assessed by Milwaukee County Emergency Medical Services for LVO using SNOW. Patients with a positive SNOW score were transferred to …

Comparison Of Survival Rates Between Two Cardiopulmonary Resuscitation Protocols And The Association Of Crew Consistency, Stacey L. Parrish, Lori Kupczynski, Pradeep Vanguri

Internet Journal of Allied Health Sciences and Practice

Background: Cardiac arrest is a life-altering event that requires swift, coordinated actions from numerous individuals for patient survival. Although return of spontaneous circulation is the goal of every emergency medical service agency, survival rates continue to be low due to many factors. Many variables are out of direct control of emergency medical service agencies, but some, such as protocol development and personnel training, are well within their power. Purpose: The purpose of this mixed-methods study was to examine the new HP-CPR protocol implemented by a large southeastern urban fire rescue department to see if changes to existing protocol assisted, in …

The Effects Of 465nm Blue Light On Sleepiness & Fatigue, Mark E. Childress

DNP Research Projects

Abstract

Background: Exhaustion is now accepted in nursing culture. Staff suffering from sleepiness and fatigue are more likely to commit medical errors and sentinel events. Emergency department nurses have the greatest risk of committing these errors. Currently, there is no relief provided to shift workers beyond a single 30-minute meal break within a 12-hour period. Other researched mitigation strategies have either failed or are unrealistic in this environment.

Local Problem: Emergency Department nurses at Parkridge Medical Center in Chattanooga, TN suffer from chronic sleepiness and fatigue that is exacerbated by shift duration, excessive workload, a stressful environment, and lack of …

Impact Of Care Handoff Methods On Emergency Department Throughput Times, Shelby Graves

DNP Research Projects

Abstract

Background: Emergency department (ED) overcrowding leads to detrimental results including increased morbidity and mortality, delay in evaluation of treatment, increased cost of care, increased length of stay, diminished staff satisfaction, increased ambulance diversion, and reputation damage for the entire institution (American College of Emergency Physicians, 2019). A study performed at three high volume community hospitals revealed inefficiency of nursing handover as one of the many contributors to prolonged ED length of stay (Salehi, 2019).

Local Problem: According to the 2018 Emergency Department Benchmarking Alliance (EDBA) data survey the average length of time from patient arrival to admission disposition was …

Prochlorperazine Vs Metoclopramide As First Line Treatment In Intractable Headache In The Pediatric Emergency Department, Courtney Hill, Kaitlynn Small, Urvashi Baruanath, Erica Junqueira, Brandon Carter, Anita Datta, Ameer Hassoun, Zuhair Ali

Gulf Coast Division GME Research Day 2022

No abstract provided.

Suspected Blow To The Chest? Investigate It!, Parisa Biazar, Catherine Mitchell, David I. Rosenberg

South Atlantic Division GME Research Day 2022

No abstract provided.

Effectiveness Of Stabilized Hypochlorous Acid In Acute Peritonitis Treatment: A Murine Surgical Study, Benjamin Michael Pomeroy

Graduate Theses/Dissertations

Peritonitis is an inflammatory condition affecting the mesothelial cells that line the peritoneal cavity and is commonly induced by bowel perforations. This medical emergency is treated through antibiotic therapy and surgical intervention followed by tissue irrigation (lavage). Acute treatments aim to remove the bacterial burden, however recurring peritoneal infections occur at high rates and contribute to patient morbidity. These recurring infections are likely due to the inability of lavage solutions to remove the entire massive intra-abdominal bacterial load due to intestinal perforation. Numerous antiseptic solutions and antibiotic additives have been evaluated in their ability to improve source control by abdominal …

Geriatric Emergency Medicine Fellowship Journal Club: Frailty, Sarah Keene, Rebecca Fisher, Lauren Cameron-Comasco

Journal of Geriatric Emergency Medicine

No abstract provided.

Reiki For Recovery: Incorporating Japanese Health Practices To Increase Contemporary Resiliency In American Health, Leif Peterson

Master's Projects and Capstones

The Japanese health practice of Reiki attempts to maximize the latent ability of the human system to heal itself. The Reiki system, established over a century ago, combines multiple Asian health traditions, experimenting with practices that maximize the natural processes of the body to perform its own repairs. Reiki encourages healthy behaviors that balance the mind and body, return the human system to a lowered stress level, and allow for an optimal recovery state for the patient. This paper illustrates how this Japanese health-affirming method can be integrated and utilized within existing health and medical practices. An area that is …

Point-Of-Care Ultrasound Assists In Rapid Diagnosis Of T-Cell Lymphoblastic Lymphoma In A Young Boy., Ceyda H Sablak, Rebecca M Dudley, Alexander Youngdahl, Kevin R Roth

Department of Emergency Medicine

T-cell lymphoblastic lymphoma (T-cell LBL) is an uncommon diagnosis for acute dyspnea in pediatric emergencies. This case details a 13-year-old boy presenting to the ED with dyspnea, who was diagnosed with T-cell LBL. It was a unique presentation in which there was no obvious mediastinal mass on the examination or primary imaging. As a safe and cost-effective modality for a patient that was too unstable to transfer to the radiology department for computed tomography, point-of-care ultrasound (POCUS) was useful in the patient's rapid assessment for suspected pericardial and pleural effusion. This case highlights the advantage of early utilization of POCUS …

Posterior Reversible Encephalopathy Syndrome (Pres), Brittany Fera, Andrew Caravello

Rowan-Virtua Research Day

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiographic syndrome that describes certain neuroimaging findings in association with clinical symptoms such as headache, seizure, encephalopathy and vision changes. Classically, PRES is associated with poorly controlled hypertension, and patients present with elevated blood pressure in addition to their symptoms. Most importantly, imaging findings and symptoms are typically reversible, and are a separate entity from ischemic or hemorrhagic cerebrovascular accidents or autoimmune causes of similar symptoms, such as multiple sclerosis.

Syncope Or Seizure?, Joseph Heron, Kevin Dwyer

Rowan-Virtua Research Day

Syncope is a common complaint in the emergency departments, accounting for 1-2% of visits, and can approach admission rates of a staggering 85%. The causes and conditions can be numerous, ranging from benign to life threatening. A good background history can go a long way in determining the etiology of the patient’s syncope. We describe a case of an elderly male who presented with a reported chief complaint of seizures, another syncope-mimic seen in the emergency department. He had a history of CAD, HTN, AAA, and osteoarthritis but no prior history of cardiac arrhythmia, MI, or structural heart disease. The …

Use Of Point Of Care Ultrasound In The Emergency Department For Diagnosis Of Femoral Pseudoaneurysm, Stephen Janssen, Jeffrey Gardecki, Giovanna Finocchio

Rowan-Virtua Research Day

Iatrogenic pseudoaneurysm after puncture or intervention of the femoral artery is a rare complication of arterial surgical intervention occurring in 0.05-0.50% of diagnostic and therapeutic catheterizations and can present weeks after initial presentation. Today we present a 57-year-old gentleman 3 months status post femoral artery stent who presented with swelling to his right groin. Point of care ultrasound was used to diagnose an actively bleeding pseudoaneurysm with hematoma that ultimately led to repeat stenting. This case shows how point of care ultrasound can expedite diagnosis and intervention and is a useful tool for the emergency physician at initial presentation.

The Application Of Point-Of-Care Ultrasound In Ed Intubations And Airway Access: A Systematic Review, Frank Wheeler, James Espinosa, Alan Lucerna, Jeffrey Gardecki

Rowan-Virtua Research Day

Intubation is an essential procedure performed on a routine basis in the emergency room. Unsuccessful intubations are associated with deleterious outcomes. A systematic review was performed to investigate the accuracy of point of care ultrasound (POCUS) in successful Endotracheal Tube (ET) tube confirmation, utilizing ultrasonography, identification of the cricothyroid membrane utilizing ultrasound, and dynamically during use of ultrasonography in the process of intubation. This review demonstrated high sensitivity and specificity for ultrasound confirmation of ET tube placement, high success rate in ultrasound-guided intubation, and lower than expected accuracy in identifying the cricothyroid membrane. Ultrasonography should be considered for ET tube …

Spontaneous Conus Medullary Infarction In The Absence Of Cardiovascular Risk Factors, Bavica Gummadi, Jaffer Ahmed, Swarna Rajagopalan

Rowan-Virtua Research Day

Spinal cord infarction (SCI) is rare and most often occurs in individuals with predisposing cardiovascular risk factors and traumatic injuries

As there are no distinct diagnostic criteria for SCI, diagnosis is difficult in patients presenting without predisposing factors and is often mistaken for transverse myelitis.

Delay in early diagnosis contributes to the high case fatality rate of SCI.

This case highlights the importance of including SCI in the differential of a patient with acute paraparesis even in the absence of co-existing risk factors.

Triad Of Acute Pancreatitis Coexisting With Diabetic Ketoacidosis And Very Severe Hypertriglyceridemia Successfully Resolved With Insulin Therapy Alone, Akash Patel, Monica Patel, Yvette Wang

Rowan-Virtua Research Day

Diabetic ketoacidosis (DKA) is known to cause mild elevations in triglyceride levels.

Severe hypertriglyceridemia (HTG) is a well-known cause of acute pancreatitis; however, in unique cases, DKA has been shown to cause severe HTG leading to the development of acute pancreatitis (AP).

HTG causing AP only accounts for 1-4% of cases of AP

From the few cases in literature that have reported this triad of DKA, HTG, and AP, even fewer have shown to be successfully treated with insulin therapy alone with the severe degree of HTG that we discuss.

In our case, we have treated a triad of DKA, …

Case Report: The Value Of Vigilance And Iterative Evaluations With An Uncooperative Patient In The Emergency Department, Duwayne Campbell

Rowan-Virtua Research Day

Discussion

A Flexible and Vigilant Approach: The initial presenting information from EMS could have led to anchoring bias. A flexible approach led to new information, which led to interative testing.

Iterative physical examination. There are cases, as seen in this case report, where the physical examination was unreliable or even impossible. Iterative evaluations ultimately led to appropriate imaging and accurate diagnosis.

Iterative testing: In the case presented, the radiologist reported a finding as being present on a prior CXR; however, given the patient’s clinical presentation, further imaging studies were necessary.