Emergency Medicine Commons^™

The Role Of Resilience Among Emergency Medical Service Personnel And Its Relationship With Their Adaptive Performance In Riyadh-Saudi Arabia., Abdullah Alabdali, Majed Althagafi, Malak Alharbi, Amera Almutere, Alanoud Almawzan, Nourh Aljaber, Reem Muafa

Internet Journal of Allied Health Sciences and Practice

Purpose: Healthcare workers, particularly Emergency Medical Services (EMS) personnel, are frequently exposed to traumatic physical and psychological events. EMS personnel regularly encounter critical incidents that challenge their resilience, adaptive performance, and overall quality of life. Understanding the factors that support resilience is essential to maintaining workforce well-being and performance. Methods: A cross-sectional study was conducted among 348 EMS personnel employed by the Saudi Red Crescent Authority (SRCA) in Riyadh, Saudi Arabia, between September 2020 and October 2021. Data were collected using a structured questionnaire assessing resilience, adaptive performance, coping mechanisms, and demographic variables. Results: EMS personnel demonstrated higher resilience levels …

Nurses’ Knowledge Regarding Ventilator-Associated Pneumonia Prevention Bundle In Adult Cardiac Care Units, Marwa Abdo

Nursing

Ventilator-associated pneumonia (VAP) is among the most common ICU infections for ventilated patients, associated with increased mortality (20-50%), morbidity, and health care costs. Nurses' knowledge of VAP prevention bundles is vital to reducing its incidence in critical care areas. Aim: To assess Nurses’ knowledge regarding the ventilator-associated pneumonia prevention bundle in Adult Cardiac Care Units. Study design: A cross-sectional study design was used. Setting: This study was conducted in both the adult cardiac intensive care unit and the cardiac care unit at Aswan Heart Centre–Magdy Yacoub Foundation, Egypt. Subject: A convenience sample of 67 nurses was selected. Data collection tool: …

The Neurobiology Of Interruptions In Emergency Medicine: The Case For Informed Interruption Management In Support Of Cognitive Stability In High-Reliability Clinical Environments, James Espinosa, Henry Schuitema, Alan Lucerna

Rowan-Virtua Research Day

Background: Interruptions are ubiquitous in Emergency Departments (EDs) and have been associated with task delay, multitasking, and increased error risk. While operational and human-factors impacts are well described, the underlying neurocognitive mechanisms remain underexplored. Not all interruptions are avoidable.  However,  interruptions in emergency medicine represent neurocognitive destabilization events that can degrade task representation and increase vulnerability to error during task resumption. Recognizing the neural mechanisms underlying interruptions reframes their management as a systems-level patient safety priority. The aim is not elimination of clinically necessary communication, but thoughtful reduction, prioritization, and design that protects cognitive stability.

Objective: To synthesize cognitive neuroscience …

The Complex World Of Emergency Department Medication Dosing: Weight Scalars, Dose And Area Under The Curve (Auc) In Medication Dosing--Areas For Future Research, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Weight-based dosing is foundational to emergency medicine practice. With modern ED beds capable of automatic patient weighing, inaccuracies in estimated weight have largely diminished. However, medication misalignment persists, particularly in patients at extremes of body weight and in high-stakes clinical contexts such as rapid sequence intubation (RSI), antimicrobial therapy, and anticoagulation. Emerging pharmacokinetic literature emphasizes total drug exposure—represented by the area under the concentration–time curve (AUC)—as a stronger correlate of efficacy and toxicity than single-point serum levels. This review explores where weight precision most likely matters in the ED, examines weight scalars, and reframes dosing decisions through an exposure-centered paradigm. …

When The Clock Stands Still: Clock Time Vs. Experienced Time In The Emergency Department Brief Review: Neurobiology Of Time Perceptiontemporal Distortion As A Marker Of Cognitive Load And Operational Turbulence, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Emergency clinicians frequently report that time during ED shifts can feel unusually slow or unusually fast. This shared observation has rarely been examined formally in emergency medicine. Altered time perception has also been described in high demand professions such as aviation, sports, military operations, and emergency response. Individuals often report time dilation during critical events and time compression during highly coordinated performance. These findings suggest that temporal perception reflects underlying neurocognitive responses to environmental demands. Emergency departments share many characteristics with these environments, including rapid decision making, task switching, and intermittent high stakes events.

Objective:  Brief narrative review concerning …

Imaging In Acute Neurovascular Emergencies: Optimizing Outcomes In Large Vessel Occlusion Stroke, Chandu Goli, Rohit Patel, Elliott Beard, Anna Liles, Saeed Saleh, Aleeza Namit, Alissa Ongaco, Kevin Steed Ph.D.

Annual Research Symposium

Purpose:

Large vessel occlusion (LVO) stroke is associated with high rates of morbidity and mortality, and patient outcomes are strongly influenced by rapid identification and timely reperfusion. Advances in acute neurovascular imaging have transformed stroke care by enabling precise patient selection, extending treatment windows, and accelerating clinical workflows. The purpose of this project is to evaluate how modern neurovascular imaging strategies influence treatment selection, workflow efficiency, and clinical outcomes in patients with acute LVO stroke.

Methods:

A narrative review of peer-reviewed literature published within the past decade was conducted. The review focused on CT-based imaging (non-contrast CT, CT angiography, CT …

Patients Requiring Mechanical Ventilation Reported To The North American Snakebite Registry, Joshua Unger, Spencer Greene

Gulf Coast Division GME Research Day 2026

No abstract provided.

Isolated Clonidine Ingestions In Pediatric Patients, Spencer Greene, Caleb King, Sharan Campleman

Gulf Coast Division GME Research Day 2026

No abstract provided.

Toxicity Following Antiemetic Ingestions Reported To The Toxicology Investigators Consortium Core Registry, Jacob Fisher, Spencer Greene, Sharan Campleman

Gulf Coast Division GME Research Day 2026

No abstract provided.

Medical Toxicology: A Safety Net For Snakebite Victims, Braden Capt, George Warpinski, Sharan Campleman, Anne-Michelle Ruha, Spencer Greene

Gulf Coast Division GME Research Day 2026

No abstract provided.

Increasing Documentation Of Endotracheal Tube Cuff Pressures: A Quality Improvement Initiative For Flight Crew Providers, Matthew D. Noss

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Background: There was a lack of documentation of endotracheal tube (ETT) cuff pressures (CPs) by flight crew providers at Base 1 of HealthNet Aeromedical Services. A three-month pre-intervention data collection showed 1.8% of patients had initial CPs documented. Inadequate documentation and monitoring of ETT CPs can lead to patient complications such as tracheal injury and aspiration making this an important area for quality improvement.

Purpose: To increase documentation of ETT CPs through education and evidence-based interventions.

Intervention: This project implemented an educational in-service on ETT cuff syringe manometry for flight crew providers. The educational intervention consisted of …

When Clotting And Bleeding Collide: A Case Of Bilateral Pe And Concurrent Upper Gi Hemorrhage, Tabitha D. Baca, David Rayburn, Daniel Castro, Jessica Aird

Florida Journal of Emergency Medicine (FJEM)

Introduction

Concurrent episodes of pulmonary emboli and gastrointestinal bleeding in one patient are not commonly seen. When a patient presents with both, it presents a challenge to manage as they are opposite ends of the same disease spectrum associated with the coagulation system.

Case Report

We present the case of a 65-year-old male who presented to our hospital via EMS with unknown prior history after a witnessed cardiac arrest, who on evaluation also had a concurrent bilateral pulmonary emboli with right heart strain.

Why should an emergency physician be aware of this?

While there is extensive research on the management …

A Model For Developing Subspecialty Clinical Practice Guidelines: The Geriatric Emergency Department Guidelines 20, Satheesh Gunaga, Christopher R Carpenter, Maura Kennedy, Lauren T Southerland, Alexander X Lo, Sangil Lee, Kirby Swan, Fabrice Mowbray, Rachel M Skains, Teresita M Hogan, Martin F Casey, Kei Ouchi, Naomi R George, Kerstin De Wit, Cameron J Gettel, Katherine Selman, Luna C Ragsdale, Anita N Chary, James D Van Oppen, Glenn Arendts, Charles L Maddow, Katherine M Hunold, Katren R Tyler, Danya Khoujah, Ula Hwang, Shan Liu

Faculty, Staff and Students Publications

The original consensus-based Geriatric Emergency Department (GED) Guidelines, published in 2014, established a framework of core principles for delivering high-quality, age-appropriate emergency care for older adults. In response to significant advances in geriatric emergency medicine research and evolving clinical priorities, we developed the GED Guidelines 2.0 to ensure continued relevance, clinical utility, and evidence-based rigor. This concept paper describes the systematic and iterative process undertaken to update the guidelines, including the formation of multidisciplinary working groups and the application of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Unlike the original GED Guidelines, our approach prioritized methodological transparency, …

Development Of A Longitudinal, Small-Group Pocus Curriculum For Internal Medicine Residents, Shah N. Mahmud Do, Ammar W. Bhatti Do, Ariq Rahman Md, Omar Al Qassab Md, Fraser Mackay Md

The Lahey Journal

Development of a Longitudinal, Small-Group POCUS Curriculum for Internal Medicine Residents

Introduction

Point-of-Care Ultrasound (POCUS) is integral for clinicians to enhance their diagnostic and procedural skills. Unlike Emergency Medicine or Anesthesia training programs, Internal Medicine programs often lack a structured and standardized curriculum. We thus developed a longitudinal and multi-pronged POCUS curriculum aimed at building trainee competency when utilizing ultrasound for diagnostic and procedural work-up.

Methods

The curriculum encompasses the following: basics of ultrasound, ultrasound-guided procedures, thoracic ultrasound/Bed Lung Ultrasound in Emergency (BLUE), and cardiac ultrasound/Focus-Assessed Transthoracic Echocardiography (FATE). These modules were integrated into the residents’ clinic blocks. We utilized …

Sglt-2 Inhibitor Use Is Associated With Lower Mortality In Patients With Alcoholic Cirrhosis And Type 2 Diabetes Mellitus: A Multinational Analysis, Do Han Kim Md, Donghyun Ko, Jose A. Porres, Wilhelm S. Basegoda Md, Cristina H. Makarian, Luis M. Nieto Md, Pedro Palacios Argueta Md, Paul T. Kroner Md, Frank J. Lukens Md

Posters

In our study, we aimed to investigate whether SGLT2 inhibitors are associated with a reduced risk of all-cause mortality, liver-related events, and cardiovascular outcomes in patients with alcoholic cirrhosis and T2DM.

Navigating Nonlinear Pathways: Challenges And Opportunities For Diversity, Equity, And Inclusion Leaders In Academic Emergency Medicine, Melanie F Molina, Annika Bhananker, Beatrice Torres, Dalia Owda, Edgardo Ordoñez, Anita N Chary

Faculty, Staff and Students Publications

OBJECTIVES: Diversity, equity, and inclusion (DEI) leadership roles have grown in academic emergency medicine (EM). We sought to elucidate specific pathways to DEI leadership roles among current DEI leaders in academic EM.

METHODS: From March to May 2023, we conducted semistructured, qualitative interviews with DEI leaders in academic EM across 5 US regions to investigate their pathways to leadership. Participants were recruited via email using Accreditation Council for Graduate Medical Education-accredited EM residency websites and the Academy for Diversity and Inclusion in EM. After recording and transcribing the interviews, we used an inductive approach to identify major themes.

RESULTS: Of …

Hospice Patients In The Emergency Department: Challenging High-Risk Encounters With Unanswered Questions And Unquestioned Answers, Jason K Bowman, Joan M Teno, Kei Ouchi

Faculty, Staff and Students Publications

No abstract provided.

Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …

Wrongful Migration: A Hidden Culprit Behind Flank Pain, Ryan Miller, Anjeza Cipi, Emma Pierce

Department of Emergency Medicine Faculty Publications

[Introduction] A 32-year-old woman with no significant past medical history presented to the emergency department with 11 days of fever, fatigue, chills, and new-onset fullness in her left flank. She denied dysuria, abdominal pain, or vaginal bleeding. Vital signs showed fever and mild hypotension, and the physical examination revealed left-sided abdominal distension. Laboratory results demonstrated leukocytosis and a lactate of 3.2 mmol/L. She appeared nontoxic but was persistently febrile despite initial fluids and antibiotics. Computed tomography—shown in Figure 1, and ultrasound—shown in Figure 2, were obtained and revealed the diagnosis.

Leveraging Clinical Standards To Improve The Translational Relevance Of Therapies For Experimental Spinal Cord Injury, Aaron L. Silverstein

Theses and Dissertations--Neuroscience

Efforts to improve treatment of spinal cord injury (SCI) often use animals to develop effective therapeutics, intending to improve the survival and the quality of life of persons with SCI. Over half of all SCIs in the United States occur at the cervical level and often cause locomotor deficits and life-threatening breathing dysfunction. Thus, my dissertation is focused on this important patient population.

After beginning with a description of translational research and surveying SCI from a clinical standpoint, I turned to describe experimental models of cervical SCI and more detailed neuroimmunological findings relevant to my work. Then, I conducted a …

Empathy Unmasked: Patient Perception Of Physician Empathy In An Oncologic Emergency Setting A Randomized Controlled Trial Comparing Personal Protective Equipment Wear Versus Unmasked Video Communication, Kathryn J Burk, John J Stroh, Kelly Larkin, Patrick Chaftari, Denise M Langabeer, Jazmin R Menendez, Jeanie F Woodruff, Jan Hargrave, Hongxu Zhu, James P Long, Sai-Ching J Yeung, Kumar Alagappan, Aiham Qdaisat

Faculty, Staff and Student Publications

Background: Amidst the COVID-19 pandemic, telemedicine emerged as an important option that supports and facilitates clinical practice, however, its usefulness in emergency settings that treat patients with cancer is unclear.

Objective: To evaluate patient perception of physician empathy in an emergency oncology setting, comparing video interaction to an in-person with personal protective equipment (PPE) approach.

Methods: In this single-center, prospective, cross-sectional, survey-based randomized controlled trial, patients were randomized 1:1 for the concluding conversation done in-person which included either interacting with physicians wearing PPE or video interaction with physicians without PPE (virtual). Patients' perceptions of the physicians' relational empathy were assessed …

Dance-Related Fractures Occur In The Upper And Lower Extremities At Similar Rates: An Analysis Of The 2004-2023 National Electronic Injury Surveillance System Database, Senah E. Stephens, Joshua F. Edwards, Lisa K. Cannada

Department of Medicine Faculty Publications

Introduction

In the United States, 21% of adolescents participate in dance. Dancers are susceptible to injuries, particularly of the lower extremity, due to extreme positioning, dynamic overload, and repetitive movements.

Objectives

(1) to report the prevalence and describe demographic characteristics of dance-related fractures and (2) to analyze variables associated with disposition status.

Methods

The National Electronic Injury Surveillance System (NEISS) database, published by the US Consumer Product Safety Commission, was used to investigate dance-related fractures diagnosed in a sample of 100 emergency departments over 20 years. Descriptive statistics and demographic variables were analyzed using chi square tests. Age was analyzed …

Technical Pitfalls For Fenestrated-Branched Endovascular Aortic Repair Following Petticoat, Aidin Baghbani-Oskouei, Emanuel R Tenorio, Marina Dias-Neto, Andrea Vacirca, Aleem K Mirza, Naveed Saqib, Bernardo C Mendes, Laura Ocasio, Thanila A Macedo, Gustavo S Oderich

Faculty, Staff and Student Publications

Purpose: The Provisional Extension to Induce Complete Attachment Technique (PETTICOAT) uses a bare-metal stent to scaffold the true lumen in patients with acute or subacute aortic dissections. While it is designed to facilitate remodeling, some patients with chronic post-dissection thoracoabdominal aortic aneurysms (TAAAs) require repair. This study describes the technical pitfalls of fenestrated-branched endovascular aortic repair (FB-EVAR) in patients who underwent prior PETTICOAT repair.

Technique: We report 3 patients with extent II TAAAs who had prior bare-metal dissection stents treated by FB-EVAR. Two patients required maneuvers to reroute the aortic guidewire, which was initially placed in-between stent struts. This was …

Emergency Physicians Spend More Time Caring For Patients Who Prefer A Language Other Than English Which May Not Be Accounted For In Reimbursement Structures, Martin A Reznek, Jennifer Edwards, Sean S Michael, Jacqueline Furbacher, Alexandra Sanseverino, Payal K Modi, Kevin A Kotkowski, Celine Larkin

Faculty, Staff and Student Publications

Background: Emergency departments increasingly serve patients who prefer a language other than English. Honoring patients' language preferences is crucial for quality and cultural appropriateness of care. We sought to assess whether time spent in caring for patients who preferred a language other than English differed from patients whose language preference was English. Secondarily, we sought to assess professional reimbursement across the two groups.

Methods: We retrospectively analyzed an existing dataset from a time-in-motion study that included direct observation measurements of emergency physicians' time spent during patient encounters. Our primary outcome was physician time spent conducting patient care, comparing patients who …

Transcription And Post-Translational Mechanisms: Dual Regulation Of Adiponectin-Mediated Occludin Expression In Diabetes, Yanru Duan, Demin Liu, Huahui Yu, Shihan Zhang, Yihua Xia, Zhiyong Du, Yanwen Qin, Yajing Wang, Xin-Liang Ma, Huirong Liu, Yunhui Du

Department of Emergency Medicine Faculty Papers

BACKGROUND: Occludin, a crucial component of tight junctions, has emerged as a promising biomarker for the diagnosis of acute ischemic disease, highlighting its significant potential in clinical applications. In the diabetes, Occludin serves as a downstream target gene intricately regulated by the adiponectin (APN) signaling pathway. However, the specific mechanism by which adiponectin regulates Occludin expression remains unclear.

METHODS AND RESULTS: Endothelial-specific Ocln knockdown reduced APN-mediated blood flow recovery after femoral artery ligation and nullified APN's protection against high-fat diet (HFD)-triggered apoptosis and angiogenesis inhibition in vivo. Mechanically, we have meticulously elucidated APN's regulatory role in Occludin expression through a …

Pre-Hospital Stroke Time Intervals In The Rio Grande Valley, Kelsey Baker, Elio E. Garcia Sosa

Research Colloquium

Background and Introduction: Stroke continues to be a significant cause of mortality in the United States. Despite advancements in acute stroke treatments such as thrombolytic therapy and endovascular procedures, many patients remain unable to benefit from these interventions due to delays in receiving treatment. Healthcare professionals have made substantial efforts to improve 'door to needle' times, the interval between a patient's arrival at the hospital and the administration of thrombolytic therapy, yielding promising outcomes. However, a critical gap persists: the time interval from the onset of stroke symptoms to when patients actually present at a healthcare facility. This study aims …

Communities Disproportionately Affected By Carbon Monoxide Exposure After Winter Storm Uri, Elyse N Portillo, Casandra Quiñones, Zachary C Foughty, Ryan Ramphul, Asha T Morrow, Kathryn Fisher, Stephen A Harding, Elizabeth A Camp, Shubhada Hooli, Eric A Russell

Faculty, Staff and Students Publications

Extreme cold in February 2021 precipitated prolonged power failure in Texas. In Houston, many patients presented for carbon monoxide exposure from neighborhoods with lower per capita income, higher rates of limited English proficiency, and greater median Social Vulnerability Indices than Greater Houston. Weather-related disasters disproportionately affect socially vulnerable communities.

Safety Of Treating Acute Pulmonary Embolism At Home: An Individual Patient Data Meta-Analysis, Dieuwke Luijten, Delphine Douillet, Kim Luijken, Cecile Tromeur, Andrea Penaloza, Olivier Hugli, Drahomir Aujesky, Stefano Barco, Joseph R Bledsoe, Kyle E Chang, Francis Couturaud, Paul L Den Exter, Carme Font, Menno V Huisman, David Jimenez, Christopher Kabrhel, Jeffrey A Kline, Stavros Konstantinides, Thijs Van Mens, Remedios Otero, W Frank Peacock, Olivier Sanchez, William B Stubblefield, Luca Valerio, David R Vinson, Philip Wells, Maarten Van Smeden, Pierre-Marie Roy, Frederikus A Klok

Faculty, Staff and Students Publications

BACKGROUND AND AIMS: Home treatment is considered safe in acute pulmonary embolism (PE) patients selected by a validated triage tool (e.g. simplified PE severity index score or Hestia rule), but there is uncertainty regarding the applicability in underrepresented subgroups. The aim was to evaluate the safety of home treatment by performing an individual patient-level data meta-analysis.

METHODS: Ten prospective cohort studies or randomized controlled trials were identified in a systematic search, totalling 2694 PE patients treated at home (discharged within 24 h) and identified by a predefined triage tool. The 14- and 30-day incidences of all-cause mortality and adverse events …

Pragmatism And Feasibility: A Qualitative Study Of Experiences Implementing And Upgrading Care In Geriatric Emergency Departments, Anita Chary, Annika Bhananker, Vivian Ramont, Lauren Southerland, Aanand Naik, Kyler Godwin, Maura Kennedy

Faculty, Staff and Students Publications

OBJECTIVES: Implementation and sustainability of new care processes in emergency departments (EDs) is difficult. We describe experiences of implementing geriatric care processes in EDs that upgraded their accreditation level for the Geriatric Emergency Department Accreditation (GEDA) program. These EDs can provide a model for adopting and sustaining guidelines for evidence-based geriatric care.

METHODS: We performed qualitative interviews with geriatric ED nurse and physician leaders overseeing their ED's geriatric accreditation processes. The interview guide was based on the Consolidated Framework for Implementation Research (CFIR), a framework consisting of a comprehensive set of factors that impact implementation of evidence-based interventions. We used …

Development And Implementation Of A Digital Quality Measure Of Emergency Cancer Diagnosis, Paarth Kapadia, Andrew J Zimolzak, Divvy K Upadhyay, Saritha Korukonda, Riyaa Murugaesh Rekha, Umair Mushtaq, Usman Mir, Daniel R Murphy, Alexis Offner, Gary A Abel, Georgios Lyratzopoulos, Luke T A Mounce, Hardeep Singh

Faculty, Staff and Students Publications

PURPOSE: Missed and delayed cancer diagnoses are common, harmful, and often preventable. Automated measures of quality of cancer diagnosis are lacking but could identify gaps and guide interventions. We developed and implemented a digital quality measure (dQM) of cancer emergency presentation (EP) using electronic health record databases of two health systems and characterized the measure's association with missed opportunities for diagnosis (MODs) and mortality.

METHODS: On the basis of literature and expert input, we defined EP as a new cancer diagnosis within 30 days after emergency department or inpatient visit. We identified EPs for lung cancer and colorectal cancer (CRC) …