Emergency Medicine Commons^™

A Rare Presentation: Intracranial Hemorrhage As A Symptom Of Acute Leukemic Transformation In A 23-Year Old Male, Kelsey M. Murray, Kishan B. Patel

Rowan-Virtua Research Day

This case highlights the urgency of considering acute leukemic transformation in young patients presenting with neurological deficits, emphasizing the importance of prompt evaluation and management to optimize patient outcomes. The case depicted is a tragic complication of Chronic Myeloid Leukemia (CML) and its acute blast crisis. Remarkably, the patient exhibited none of the typical constitutional symptoms associated with CML.

Multimodal Neurologic Monitoring In Patients Undergoing Extracorporeal Membrane Oxygenation, Khwaja Siddiqui, Muhammad U Hafeez, Ali Ahmad, Syed O Kazmi, Subhasis Chatterjee, Eric Bershad, Mohammad Hirzallah, Chethan Rao, Rahul Damani

Faculty, Staff and Students Publications

Introduction Extracorporeal membrane oxygenation (ECMO) is associated with a high rate of neurologic complications. Multimodal neurologic monitoring (MNM) has the potential for early detection and intervention. We examined the safety and feasibility of noninvasive MNM during ECMO. We hypothesized that survivors and non-survivors would have meaningful differences in transcranial Doppler (TCD) sonography and electroencephalographic (EEG) characteristics, which we aimed to identify. We also investigated adverse neurologic events and attempted to identify differences in EEG and TCD characteristics among patients based on the type of ECMO and the occurrence of these events. Material and methods We performed an observational study on …

Uti With A New Renal Mass: Chicken Or The Egg?, Grant Nugent, Adam Sigal, Courtney Cassella

Tower Health Research Day

No abstract provided.

Case Of Human Orthohantavirus Infection, Michigan, Usa, 2021, Samuel M Goodfellow, Robert A Nofchissey, Dustin Arsnoe, Chunyan Ye, Seonghyeon Lee, Jieun Park, Won-Keun Kim, Kartik Chandran, Shannon L M Whitmer, John D Klena, Jonathan W Dyal, Trevor Shoemaker, Diana Riner, Mary Grace Stobierski, Kimberly Signs, Steven B Bradfute

Faculty, Staff and Student Publications

Orthohantaviruses cause hantavirus cardiopulmonary syndrome; most cases occur in the southwest region of the United States. We discuss a clinical case of orthohantavirus infection in a 65-year-old woman in Michigan and the phylogeographic link of partial viral fragments from the patient and rodents captured near the presumed site of infection.

Development Of A Follow-Up Measure To Ensure Complete Screening For Colorectal Cancer, Elizabeth L Ciemins, Jeff T Mohl, Carlos A Moreno, Francis Colangelo, Robert A Smith, Mary Barton

Faculty, Staff and Student Publications

IMPORTANCE: The current quality performance measure for colorectal cancer (CRC) screening is limited to initial screening. Despite low rates, there is no measure for appropriate follow-up with colonoscopy after receipt of an abnormal result of a stool-based screening test (SBT) for CRC. A quality performance measure is needed.

OBJECTIVE: To develop and test a quality performance measure for follow-up colonoscopy within 6 months of an abnormal result of an SBT for CRC.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective quality improvement study examined data from January 1, 2016, to December 31, 2020, with 2018 plus 6 months of follow-up as the …

The Utility Of Non-Specific Ecg Findings In The Setting Of Low High-Sensitivity Cardiac Troponin Levels, Arqam Husain, Nathan Klausner, Emily Schwab, Joseph Miller, Kaab Husain

Medical Student Research Symposium

Objective: Our objective was to assess the relationship between non-specific ischemic electrocardiogram (nsi-ECG) findings and the occurrence of major adverse cardiac events (MACE) within a 30-day timeframe among patients in the Emergency Department (ED) with low high-sensitivity cardiac troponin (hs-cTnI) levels.

Methods: We conducted a secondary analysis of the RACE-IT trial, a randomized trial performed across 9 EDs from July 2020 through March 2021 that looked at the effectiveness of hs-cTnI in evaluating the risk for acute myocardial infarction (AMI). Our study assessed the association between nsi-ECG findings (left bundle branch block, ST-segment changes, or T-wave inversions) and 30-day MACE …

The Utility Of Interventional Anesthesia, Kylie Daguio, Kiley Jackson, Samantha Boever, Andrew Chang, James Keane, Leonard B. Goldstein

SOMA Faculty Publications

no abstract

Spontaneous Coronary Artery Dissection With Cardiogenic Shock In The United States, Chayakrit Krittanawong, Dhrubajyoti Bandyopadhyay, Neelkumar Patel, Yusuf Kamran Qadeer, Neil Sagar Maitra, Zhen Wang, Mahboob Alam, Samin Sharma, Hani Jneid

Faculty, Staff and Students Publications

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is defined as a non-traumatic separation of the epicardial coronary artery walls that creates a false lumen. SCAD poses a difficult challenge in management, as decisions regarding revascularization and medical management seem to be tailored to the individual patient. We evaluated and compared outcomes based on cardiogenic shock in patients with SCAD utilizing Nationwide Readmissions Database (NRD) between January 1, 2016, to December 30, 2020.

METHODS: We utilized the NRD 2016-2019 to carry out this study. We evaluated demographics (e.g., age, gender), conventional risk factors, comorbidities present on the index admission, and in-hospital outcomes …

Anesthetic Management Of Unanticipated Subglottic Stenosis In A Patient Undergoing Coronary Artery Bypass Graft Surgery, Claudia Wei, Dominique Wreh, Jacy Gressen, Anvinh Nguyen

Faculty, Staff and Students Publications

A 62-year-old female presented for a scheduled coronary artery bypass graft (CABG) and was found to have an unexpected subglottic stenosis during routine intubation. The case was aborted and six days later, the patient underwent lasering of the stenotic subglottic region and airway balloon dilation. In this case report, causes of subglottic stenosis and surgical/anesthetic management of the condition are discussed. The management of subglottic stenosis in this patient was complicated by concurrent severe coronary artery disease (CAD) involving the left main coronary artery and timing of airway surgery relative to interventions for her CAD. In situations of undiagnosed subglottic …

Scurvy: A Rare Disease Or A Rare Diagnosis?, David F. Gaieski

Department of Emergency Medicine Faculty Papers

Introduction:

Scurvy, the disease state caused by ascorbic acid deficiency, was once an extremely common disease but is now thought to be a rare disease in postmodern societies. Physicians are not trained to consider scurvy as a possible diagnosis in patients at risk; rather, it is considered a rare diagnosis to add to a differential for completeness’s sake.

Methods:

We sought to describe the scorbutic patients seen by one physician during a busy academic emergency medicine career. Case series of patients seen by one physician between 1993 and 2023 at five academic teaching hospitals with Emergency Departments (EDs) in the …

Differing Radiation Exposure In Scrub Technicians And Rotating Staff In Cardiac Catheterization Laboratory: Occupation Matters, Nasir Rahman, Maleeha Javed, Ghufran Adnan, Maria Khan, Zeenat Nizar, Izat Shah

Section of Cardiology

Background: Radiation exposure is a significant hazard associated with invasive Cardiology, with most studies based on primary operator exposure. This prospective, observational study aimed to find out over lead radiation exposure as effective dose acquired by non-physician staff comprising scrub technicians and rotating staff in the cath laboratory. Effective dose (ED) measured per procedure via Raysafe i2®dosimeter badges worn by both rotating staff and scrub technicians over lead aprons along with dose area product (DAP), fluoroscopy time (FT) and procedure time (PT) in minutes was collected prospectively over forty-six invasive Cardiology procedures.
Results: This study shows that rotating staff acquire …

Advancing Virtual At-Home Care For Community Health Center Patients Using Patient Self-Care Tools, Technology, And Education [Letter], Cheryl Modica, Joy H. Lewis, Curtis Bay

SOMA Faculty Publications

Abstract

Introduction

Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers.

Objective

This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven …

Faster Discharge With Lactated Ringers Than Normal Saline In First 72 H Of Acute Pancreatitis: A Multicenter Randomized Trial, Peter R Farrell, Angelica W Despain, Peter Farmer, Leslie M Farrell, Bryan Greenfield, Michael E Rogers, Lindsey Hornung, Esther Kim, Ryan Pearman, Beemnet Neway, Tyler Thompson, James E Heubi, Sona Sehgal, Rana Amoury, Maisam Abu-El-Haija

Faculty, Staff and Students Publications

OBJECTIVES: Data driven strategies for acute pancreatitis (AP) in pediatrics are limited; adult data suggests lactated ringers (LR) compared to normal saline (NS) resulted in favorable outcomes, but has not been studied in pediatrics. Our objective was to evaluate the efficacy of LR during the first 48 h of an AP episode compared with NS.

STUDY DESIGN: A multi-site randomized controlled clinical trial, from 2015 to 2020 (Clinical Trials.gov NCT03242473). Patients were randomized to exclusively LR or NS for the first 48 hours. Primary outcomes were C-Reactive Protein (CRP) values on admission, 24 and 48 hours. Secondary outcomes …

Advancements In Revascularization Strategies For Acute Mesenteric Ischemia: A Comprehensive Review, Jacob J Gries, Hafeez Ul Hassan Virk, Bing Chen, Takashi Sakamoto, Mahboob Alam, Chayakrit Krittanawong

Faculty, Staff and Students Publications

Even with modern advancements in the management of acute mesenteric ischemia over the past decade, morbidity and mortality remain high, and the best primary treatment modality is still debated amongst interventionalists. Traditionally, interventionalists have favored an open surgical approach but are now trending for endovascular interventions due to apparent reduced mortality and complications. Newer studies suggest hybrid approaches, and intestinal stroke centers may be superior to either strategy alone. This narrative review will explore the natural history of acute mesenteric ischemia with the aim of increasing interventionalist awareness of modern advancements in revascularization strategies for this devastating disease.

An Interesting Case Of Modern Day Scurvy, Petar Jen, Jessica Cook, Elise Clark, Laurence Dubensky

East Florida Division GME Research Day 2024

No abstract provided.

A Unique Case Of Spontaneous Pectoral Abscess, Martin Sentmanat, Zachary Shields, David Ross

North Texas GME Research Forum 2024

Pyomyositis is a rare disease that is often misdiagnosed. Formerly more common in tropic areas, it has been more prevalent in temperate climates in the past couple of decades. Most cases of pyomyositis have a known cause or the patient is immunocompromised, but there are a few documented cases of spontaneous pyomyositis in an otherwise healthy patient. Our case describes a 35-year-old male with no past medical history or history of IV drug use who presented to the emergency department with right sided chest pain. The patient was initially seen and diagnosed with a pectoral muscle strain and fever. He …

Drug Reaction With Eosinophilia And Systemic Symptoms (Dress) Syndrome: Lamotrigine Associated, Kendal Allen, Jordan Steelquist, Renee Delos Angeles, He Wang, Andrew Chen

Far West Division GME Research Day 2024

No abstract provided.

Acute Traumatic Cataract Diagnosed By Point-Of-Care Ultrasound, Adrian Huffard, Shannon Overholt, Taryn Hoffman

South Atlantic Division GME Research Day 2024

No abstract provided.

A Case Of Small Bowel Diverticulitis, Taylor Craig, Mahmood Kashan, Harjeev Lahil, Alexandra Alvarez

East Florida Division GME Research Day 2024

No abstract provided.

Woman With A Lump Under Her Tongue, Rachel Sealby, Steven Goodfriend, Martin Wegman

South Atlantic Division GME Research Day 2024

No abstract provided.

Case Study: Calcific Tendinitis Disguised As Retropharyngeal Abscess In 34-Year-Old Female, Brandon Nielsen, Oluyemi Omotoso

South Atlantic Division GME Research Day 2024

No abstract provided.

Blunt Traumatic Pancreatitis In Pediatric Patient After Wrestling Injury, Connor Talbott, Jason An

Far West Division GME Research Day 2024

No abstract provided.

From Angiogram To Fasciotomy: Rare Occurrence Of Compartment Syndrome In An Elderly Patient With Dvt, Maya Itani, Bita Crystal Behaeddin, Alan Patrus, Rafael Bustamante

East Florida Division GME Research Day 2024

No abstract provided.

Viz Lvo Versus Rapid Lvo In Detection Of Large Vessel Occulusion On Ct Angiography For Acute Stroke, Adam Delora, Ali Kerro, Christopher Hadjialiakbari, Eryn Percenti, Jordan Torres, Yazan J. Alderazi, Rime Ezzeldin, Ameer E. Hassan, Mohamad Ezzeldin

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

A Case Of Sore Throat And Dizziness, Victoria Gordon, Anita Datta

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

A Case To Cause Pause, Kai Tubb, Stevley Koshy

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

Case Of Bilateral Glaucoma, Raj Patel, Hengameh Pajer, Rasheed Lawal

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

Should Targeted Temperature Management Be Used In Cardiogenic Shock Patients? Systematic Review And Meta-Analysis, Adam Nieborek, Jerzy R Ladny, Milosz J Jaguszewski, Andrea Denegri, Aleksandra Sikora, Szymon Pucylo, Aleksandra Gasecka, Michal Pruc, Ivan Savytsky, Lukasz Szarpak

Faculty, Staff and Students Publications

BACKGROUND: Therapeutic hypothermia, or targeted temperature management (TTM), is a strategy of reducing the core body temperature of survivors of sudden cardiac arrest, cardiogenic shock (CS) or stroke. Therefore, a systematic literature review and meta-analysis were performed to tackle the question about whether the implementation of TTM is actually beneficial for patients with CS.

METHODS: Study was designed as a systematic review and meta-analysis. PubMed, Cochrane Library, Web of Science and Scopus were searched from these databases inception to July 17, 2022. Eligible studies were those comparing TTM and non-TTM treatment in CS patients. Data were pooled with the Mantel-Haenszel …

Statins And The Risk Of Pancreatic Cancer: A Systematic Review And Meta-Analysis Of 2,797,186 Patients, Eryka Karbowska, Damian Swieczkowski, Aleksandra Gasecka, Michal Pruc, Kamil Safiejko, Jerzy R Ladny, Tomasz Kopiec, Milosz J Jaguszewski, Krzysztof J Filipiak, Zubaid Rafique, Lukasz Szarpak

Faculty, Staff and Students Publications

BACKGROUND: Statin use in many studies is related to the improvement of a patients' condition including reducing the risk of various malignancies. Herein, is a systematic review and meta-analysis to examine the evidence on the association between statin therapy and the risk of the occurrence of pancreatic cancer, mainly in terms of decreased risk of developing pancreatic cancer among patients using statin therapy in the long-term perspective.

METHODS: PubMed, Web of Science, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from database inception to December 1st, 2021. Random effect models were used to estimate summary odds ratios …

The Great Masquerade: Not All Coronary Artery Stenosis Are Created Equal, Prasanti A Kotta, Ajit K Koduri, Jeffrey Berman, Veronica V Rosen, Waleed T Kayani

Faculty, Staff and Students Publications

We present the case of a 60-year-old male, with active smoking and cocaine use disorder, who reported progressive chest pain. Various anatomical and functional cardiac imaging, performed to further evaluate chest pain etiology, revealed changing severity and distribution of left main artery (LMA) stenosis, raising suspicion for vasospasm. Intracoronary nitroglycerin relieved the vasospasm, with resolution of the LMA pseudostenosis. A diagnosis of vasospastic angina (VA) led to starting appropriate medical therapy with lifestyle modification counselling. This case highlights VA, a frequently underdiagnosed etiology of angina pectoris. We discuss when to suspect VA, its appropriate work-up, and management.