Emergency Medicine Commons^™

Lung Cancer In The Emergency Department, Jeremy R Walder, Saadia A Faiz, Marcelo Sandoval

Faculty, Staff and Student Publications

Background: Though decreasing in incidence and mortality in the USA, lung cancer remains the deadliest of all cancers. For a significant number of patients, the emergency department (ED) provides the first pivotal step in lung cancer prevention, diagnosis, and management. As screening recommendations and treatments advance, ED providers must stay up-to-date with the latest lung cancer recommendations. The purpose of this review is to identify the many ways that emergency providers may intersect with the disease spectrum of lung cancer and provide an updated array of knowledge regarding detection, management, complications, and interdisciplinary care.

Findings: Lung cancer, encompassing 10-12% of …

A Longitudinal Seroepidemiology Study To Evaluate Antibody Response To Sars-Cov-2 Virus Infection And Vaccination In Children In Calgary, Canada From July 2020 To April 2022: Alberta Covid-19 Childhood Cohort (Ab3c) Study, Emily J Doucette, Joslyn Gray, Kevin Fonseca, Carmen Charlton, Jamil N Kanji, Graham Tipples, Susan Kuhn, Jessica Dunn, Payton Sayers, Nicola Symonds, Guosong Wu, Stephen B Freedman, James D Kellner

Faculty, Staff and Student Publications

BACKGROUND: Measurement of SARS-CoV-2 antibody seropositivity is important to accurately understand exposure to infection and/or vaccination in specific populations. This study aimed to estimate the serologic response to SARS-CoV-2 virus infection and vaccination in children in Calgary, Alberta over a two-year period.

METHODS: Children with or without prior SARS-CoV-2 infections, were enrolled in Calgary, Canada in 2020. Venous blood was sampled 4 times from July 2020 to April 2022 for SARS-CoV-2 nucleocapsid and spike antibodies. Demographic and clinical information was obtained including SARS-CoV-2 testing results and vaccination records.

RESULTS: 1035 children were enrolled and 88.9% completed all 4 visits; median …

Meta-Analysis Of Chest Compression-Only Versus Conventional Cardiopulmonary Resuscitation By Bystanders For Adult With Out-Of-Hospital Cardiac Arrest, Karol Bielski, Jacek Smereka, Jaroslaw Chmielewski, Michal Pruc, Francesco Chirico, Aleksandra Gasecka, Nataliia Litvinova, Milosz J Jaguszewski, Grazyna Nowak-Starz, Zubaid Rafique, Frank W Peacock, Lukasz Szarpak

Faculty, Staff and Students Publications

BACKGROUND: According to the guidelines of cardiopulmonary resuscitation (CPR) conducted by bystanders, two methods of CPR are feasible: standard CPR (sCPR) with mouth-to-mouth ventilations and continuous chest compression-only CPR (CCC) without rescue breathing. The goal herein, was to evaluate the effect of sCPR (30:2) and CCC on resuscitation outcomes in patients with out-of-hospital cardiac arrest (OHCA) patients.

METHODS: This study was a systematic review and meta-analysis. Using standardized criteria, Pub- Med, Web of Science, Scopus, EMBASE and Cochrane Collaboration were searched for trials assessing the effect of sCPR vs. CCC on resuscitation outcomes after adult OHCA. Random-effects model meta-analysis was …

Ems Administration Of Systemic Corticosteroids To Pediatric Asthma Patients: An Analysis By Severity And Transport Interval, Lauren Riney, Sam Palmer, Erik Finlay, Andrew Bertrand, Shannon Burcham, Phyllis Hendry, Manish Shah, Kathryn Kothari, David Ashby, Daniel Ostermayer, Olga Semenova, Benjamin N Abo, Benjamin Abes, Nichole Shimko, Emily Myers, Marshall Frank, Tim Turner, Mac Kemp, Kim Landry, Greg Roland, Jennifer Fishe

Faculty, Staff and Students Publications

INTRODUCTION: Pediatric asthma exacerbations are a common cause of emergency medical services (EMS) encounters. Bronchodilators and systemic corticosteroids are mainstays of asthma exacerbation therapy, yet data on the efficacy of EMS administration of systemic corticosteroids are mixed. This study's objective was to assess the association between EMS administration of systemic corticosteroids to pediatric asthma patients on hospital admission rates based on asthma exacerbation severity and EMS transport intervals.

METHODS: This is a sub-analysis of the Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial (EASI AS ODT). EASI AS ODT is a non-randomized, stepped wedge, observational study …

Implementation And Outcomes Of A Comprehensive Emergency Care Curriculum At A Low-Resource Referral Hospital In Liberia: A Novel Approach To Application Of The Who Basic Emergency Care Toolkit, Lane Epps, Anu Ramachandran, Sojung Yi, Alexander Mayah, Taylor Burkholder, Michael Jaung, Ahson Haider, Paul Wesseh, John Shakpeh, Corey Bills, Kayla Enriquez

Faculty, Staff and Students Publications

BACKGROUND: Emergency care is vital in low- and middle-income countries (LMICs) but many frontline healthcare workers in low-resource settings have no formal training in emergency care. To address this gap, the World Health Organization (WHO) developed Basic Emergency Care (BEC): Approach to the acutely ill and injured, a multi-day, open-source course for healthcare workers in low-resource settings. Building on the BEC foundation, this study uses an implementation science (IS) lens to develop, implement, and evaluate a comprehensive emergency care curriculum in a single emergency facility in Liberia.

METHODS: A six-month emergency care curriculum consisting of BEC content, standardized WHO clinical …

Enabling Human Space Exploration Missions Through Progressively Earth Independent Medical Operations (Eimo), Dana R Levin, Jon Steller, Arian Anderson, Jay Lemery, Benjamin Easter, David C Hilmers, Kris R Lehnhardt

Faculty, Staff and Students Publications

Goal: Current Space Medicine operations depend on terrestrial support to manage medical events. As astronauts travel to destinations such as the Moon, Mars, and beyond, distance will substantially limit this support and require increasing medical autonomy from the crew. This paper defines Earth Independent Medical Operations (EIMO) and identifies key elements of a conceptual EIMO system. Methods: The NASA Human Research Program Exploration Medical Capability Element held a 2-day conference at Johnson Space Center in Houston, TX with NASA experts representing all aspects of Space Medicine. Results: EIMO will be a process enabling progressively resilient deep space exploration systems and …

Patient-Centered Outcomes Of An Emergency Department Social And Medical Resource Intervention, Rohit Gupta, Anthony Wang, Daniel Wang, Daniela Ortiz, Karen Kurian, Thiago Halmer, Michael S Jaung

Faculty, Staff and Students Publications

INTRODUCTION: Few studies have examined the impact of emergency department (ED) social interventions on patient outcomes and revisits, especially in underserved populations. Our objective in this study was to characterize a volunteer initiative that provided community medical and social resources at ED discharge and its effect on ED revisit rates and adherence to follow-up appointments at a large, county hospital ED.

METHODS: We performed a cross-sectional analysis of ED patients who received medical and social resources and an educational intervention at discharge between September 2017-June 2018. Demographic information, the number of ED return visits, and outpatient follow-up appointment adherence within …

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 …

Hyperkalemia And Electrocardiogram Manifestations In End-Stage Renal Disease, Zubaid Rafique, Bryan Hoang, Heba Mesbah, Ryan Pappal, Frank W Peacock, Raul Juarez-Vela, Lukasz Szarpak, Dick C Kuo

Faculty, Staff and Students Publications

Hyperkalemia is one of the more common acute life-threatening metabolic emergencies. The aim of our study is to determine the correlation and accuracy of abnormal ECG parameters as a function of serum potassium concentration in the end-stage renal disease (ESRD) population. We performed a retrospective chart review of emergency department patients presenting with ESRD and receiving emergent hemodialysis treatment. A total of 96 patients, each with five independent ED visits, provided 480 sets of ECGs and electrolytes. Of these, four ECGs were excluded for inability to interpret, leaving a total of 476 patient encounters that met all inclusion criteria. Linear …

Accidental Organophosphate Poisoning: A Case Series Of 2 Pediatric Coumaphos Exposures, Justin A Seltzer, Sarah Friedland, Nathan A Friedman, Garret A Winkler, Emily Foreman, Yousef Al Mubarak, Brent Buccine, Branden Engorn, Allyson Kreshak, Alicia Minns, Christian A Tomaszewski, Daniel R Lasoff, Richard F Clark

Faculty, Staff and Student Publications

INTRODUCTION: Pediatric organophosphate insecticide poisonings are rare in the United States, and life-threatening toxicity is rarely seen. We report 2 accidental ingestions of the organophosphate insecticide coumaphos that resulted in life-threatening symptoms.

CASE REPORTS: A 7-year-old boy and 10-year-old girl both presented from home after accidental ingestion of 1 "spoonful" of coumaphos 20% liquid (Asuntol; Bayer de Mexico, S.A. de C.V., Mexico D.F., Mexico). There were no other known ingestions. Both became rapidly symptomatic, with the boy developing dyspnea, vomiting, and depressed mental status and the girl developing headache and nausea. Soon afterward, the boy had witnessed cardiopulmonary arrest and …

Outcomes Of Audio-Instructed And Video-Instructed Dispatcher-Assisted Cardiopulmonary Resuscitation: A Systematic Review And Meta-Analysis, Karol Bielski, Bernd W Böttiger, Michal Pruc, Aleksandra Gasecka, Mariusz Sieminski, Milosz J Jaguszewski, Jacek Smereka, Natasza Gilis-Malinowska, Frank W Peacock, Lukasz Szarpak

Faculty, Staff and Students Publications

BACKGROUND: The present meta-analysis of clinical and simulation trials aimed to compare video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation (V-DACPR) with conventional audio-instructed dispatcher-assisted bystander cardiopulmonary resuscitation (C-DACPR).

METHODS: We searched PubMed, Embase, Web of Science, Cochrane Collaboration databases and Scopus from inception until June 10, 2021. The primary outcomes were the prehospital return of spontaneous circulation (ROSC), survival to hospital discharge, and survival to hospital discharge with a good neurological outcome for clinical trials, and chest compression quality for simulation trials. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) indicated the pooled effect. The analyses were performed …

A Consensus List Of Ultrasound Competencies For Graduating Emergency Medicine Residents, David A Haidar, William J Peterson, Patrick G Minges, Jennifer Carnell, Jason T Nomura, John Bailitz, Jeremy S Boyd, Megan M Leo, E Liang Liu, Youyou Duanmu, Josie Acuña, Ross Kessler, Marco F Elegante, Mathew Nelson, Rachel B Liu, Resa E Lewiss, Arun Nagdev, Rob D Huang

Faculty, Staff and Students Publications

OBJECTIVES: Emergency ultrasound (EUS) is a critical component of emergency medicine (EM) resident education. Currently, there is no consensus list of competencies for EUS training, and graduating residents have varying levels of skill and comfort. The objective of this study was to define a widely accepted comprehensive list of EUS competencies for graduating EM residents through a modified Delphi method.

METHODS: We developed a list of EUS applications through a comprehensive literature search, the American College of Emergency Physicians list of core EUS benchmarks, and the Council of Emergency Medicine Residency-Academy of Emergency Ultrasound consensus document. We assembled a multi-institutional …

Clinical And Biological Factors With Prognostic Value In Acute Pancreatitis, Mihai Faur, Dan Dumitrescu, Dan Sabau, Ciprian Tanasescu, Dan Cretu, Denisa Tanasescu, Vlad Denis Constantin, Calin Mohor

Journal of Mind and Medical Sciences

Acute pancreatitis is an acute inflammatory process of the pancreas, which can remain localized at the level of the gland or can extend to the peripancreatic and retroperitoneal tissues. The use and interpretation of paraclinical examinations at the onset can predict the form of evolution of acute pancreatitis (mild or severe). Depending on the evolution, these data are useful in determining the type of surgical intervention that might be necessary based on severity.

We present a retrospective study consisting of 118 patients diagnosed and hospitalized with acute pancreatitis during 2016-2020 in the Surgery I section of the Sibiu County Emergency …

Upper Gastrointestinal Bleeding During The Covid-19 Pandemic; Particularities Of Diagnosis And Therapy, Adrian Silaghi, Bogdan Severus Gaspar, Dragos Epistatu, Daniela Gabriela Bălan, Ioana Păunică, Anca Silvia Dumitriu, Stana Paunica, Bogdan Socea, Vlad Denis Constantin

Journal of Mind and Medical Sciences

SARS-COV 2 recently caused a global pandemic, with the first case being reported in Romania in February 2020. Important restrictive measures were imposed, so that the addressability of patients to medical services decreased. Upper gastrointestinal bleeding had more severe forms of evolution at the time of presentation, which required additional methods of diagnosis and treatment. This is a retrospective study performed on 268 patients, which aims to evaluate the type and effectiveness of different treatment methods for upper gastrointestinal bleeding during the COVID 19 pandemic. Severity assessment was performed by measuring the Rockall score and additional methods of diagnosis. The …

Near-Peers Effectively Teach Clinical Documentation Skills To Early Medical Students, Anita Vijay Kusnoor, Rajeev Balchandani, Malford Tyson Pillow, Stephanie Sherman, Nadia Ismail

Faculty, Staff and Students Publications

BACKGROUND: Composing the History of Present Illness (HPI), a key component of medical communication, requires critical thinking. Small group learning strategies have demonstrated superior effectiveness at developing critical thinking skills. Finding sufficient faculty facilitators for small groups remains a major gap in implementing these sessions. We hypothesized that "near-peer" teachers could effectively teach HPI documentation skills and fill the gap of small group facilitators. Here, we present a head-to-head comparison of near-peer and faculty teaching outcomes.

METHODS: Second-year medical students in a single institution participated in an HPI Workshop as a clinical skills course requirement. Students were randomly assigned a …

The Ubiquitin-Proteasome System Is Necessary For Long-Term Synaptic Depression In Aplysia, Jennifer S Love, Dana L Karshenas, Meghan B Spyres, Lynn A Farrugia, A Min Kang, Hoanvu Nguyen, Sharan L Campleman, Shao Li, Paul M Wax, Jeffery Brent, Kim Aldy, Toxicology Investigators Consortium Study Group

Faculty, Staff and Student Publications

The Toxicology Investigators Consortium (ToxIC) Core Registry was established by the American College of Medical Toxicology in 2010. The Core Registry collects data from participating sites with the agreement that all bedside and telehealth medical toxicology consultations will be entered. This twelfth annual report summarizes the registry's 2021 data and activity with its additional 8552 cases. Cases were identified for inclusion in this report by a query of the ToxIC database for any case entered from January 1 to December 31, 2021. Detailed data was collected from these cases and aggregated to provide information, which included demographics, reason for medical …

A Case Of Malpositioned Endotracheal Tube With Resultant Left Lung Collapse., Anushri Naga, Anushri Naga

Digital Journal of Clinical Medicine

BACKGROUND

ENDOTRACHEAL INTUBATION IS USUALLY DONE AS A PART OF EMERGENCY MANAGEMENT OF PATIENTS WITH A THREATENED AIRWAY AND GENERAL ANAESTHSIA, IN ORDER TO ENSURE PATENCY OF THE AIRWAY AS WELL AS PROPER VENTILATION. POSITIONING AN ET TUBE CORRECTLY IS OF PARAMOUNT IMPORTANCE IN ORDER TO PREVENT HYPOVENTILATION, INAPPROPRIATE VENTILATION AND ALSO COLLAPSE OF LUNG DUE TO MALPOSITIONING OF ET TUBE.

ETT POSITION IS USUALLY ASSESSED USING FRONTAL CHEST RADIOGRAPH. THE POSITION OF THE ETT IS DEPENDENT ON THE POSITION OF THE HEAD & NECK. THE MANDIBLE CAN BE USED FOR ASSESSMENT OF WHETHER THE NECK IS IN A NEUTRAL …

Detecting Cognitive Impairment And Dementia In The Emergency Department: A Scoping Review, Armin Nowroozpoor, Jeff Dussetschleger, William Perry, Mary Sano, Amy Aloysi, Michael Belleville, Alexandria Brackett, Jon Mark Hirshon, William Hung, Joan Michelle Moccia, Ugochi Ohuabunwa, Manish N Shah, Ula Hwang

Faculty, Staff and Student Publications

OBJECTIVES: To identify research and practice gaps to establish future research priorities to advance the detection of cognitive impairment and dementia in the emergency department (ED).

DESIGN: Literature review and consensus-based rankings by a transdisciplinary, stakeholder task force of experts, persons living with dementia, and care partners.

SETTING AND PARTICIPANTS: Scoping reviews focused on adult ED patients.

METHODS: Two systematic scoping reviews of 7 medical research databases focusing on best tools and approaches for detecting cognitive impairment and dementia in the ED in terms of (1) most accurate and (2) most pragmatic to implement. The results were screened, reviewed, and …

Adipose Tissue-Specific Ablation Of Ces1d Causes Metabolic Dysregulation In Mice, Gang Li, Xin Li, Li Yang, Shuyue Wang, Yulin Dai, Baharan Fekry, Lucas Veillon, Lin Tan, Rebecca Berdeaux, Kristin Eckel-Mahan, Philip L Lorenzi, Zhongming Zhao, Richard Lehner, Kai Sun

Faculty, Staff and Student Publications

Carboxylesterase 1d (Ces1d) is a crucial enzyme with a wide range of activities in multiple tissues. It has been reported to localize predominantly in ER. Here, we found that Ces1d levels are significantly increased in obese patients with type 2 diabetes. Intriguingly, a high level of Ces1d translocates onto lipid droplets where it digests the lipids to produce a unique set of fatty acids. We further revealed that adipose tissue-specific Ces1d knock-out (FKO) mice gained more body weight with increased fat mass during a high fat-diet challenge. The FKO mice exhibited impaired glucose and lipid metabolism and developed exacerbated liver …

Factors Associated With Parental Acceptance Of Covid-19 Vaccination: A Multicenter Pediatric Emergency Department Cross-Sectional Analysis, Brigitte M Baumann, Robert M Rodriguez, Amy M Delaroche, David Rayburn, Stephanie A Eucker, Nicole L Nadeau, Lisa A Drago, Danielle Cullen, Sarah Dennis Meskill, Suzanne Bialeck, Michael Gillman

Faculty, Staff and Students Publications

STUDY OBJECTIVE: During the delta surge of the COVID-19 pandemic in 2021, we sought to identify characteristics and beliefs associated with COVID-19 vaccination acceptance in parents of pediatric emergency department (ED) patients.

METHODS: We conducted a cross-sectional survey-based study of the parents of children aged 3 to 16 years presenting to 1 of 9 pediatric EDs from June to August 2021 to assess the parental acceptance of COVID-19 vaccines. Using multiple variable regression, we ascertained which factors were associated with parental and pediatric COVID-19 vaccination acceptance.

RESULTS: Of 1,491 parents approached, 1,298 (87%) participated, of whom 50% of the parents …

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.

Selected Transesophageal Echocardiographic Parameters Of Left Ventricular Diastolic Function Predict Length Of Stay Following Coronary Artery Bypass Graft-A Prospective Observational Study, Samhati Mondal, Nauder Faraday, Wei Dong Gao, Sarabdeep Singh, Sachidanand Hebbar, Kimberly N Hollander, Thomas S Metkus, Lee A Goeddel, Maria Bauer, Brian Bush, Brian Cho, Stephanie Cha, Stephanie O Ibekwe, Domagoj Mladinov, Noah S Rolleri, Laeben Lester, Jochen Steppan, Rosanne Sheinberg, Nadia B Hensley, Anubhav Kapoor, Jeffrey M Dodd-O

Faculty, Staff and Students Publications

(1) Importance: Abnormal left ventricular (LV) diastolic function, with or without a diagnosis of heart failure, is a common finding that can be easily diagnosed by intra-operative transesophageal echocardiography (TEE). The association of diastolic function with duration of hospital stay after coronary artery bypass (CAB) is unknown. (2) Objective: To determine if selected TEE parameters of diastolic dysfunction are associated with length of hospital stay after coronary artery bypass surgery (CAB). (3) Design: Prospective observational study. (4) Setting: A single tertiary academic medical center. (5) Participants: Patients with normal systolic function undergoing isolated CAB from September 2017 through June 2018. …

Macrophage Migration Inhibitory Factor (Mif) Makes Complex Contributions To Pain-Related Hyperactivity Of Nociceptors After Spinal Cord Injury, Alexis Bavencoffe, Emily A Spence, Michael Y Zhu, Anibal Garza-Carbajal, Kerry E Chu, Ona E Bloom, Carmen W Dessauer, Edgar T Walters

Faculty, Staff and Student Publications

Neuropathic pain is a major, inadequately treated challenge for people with spinal cord injury (SCI). While SCI pain mechanisms are often assumed to be in the CNS, rodent studies have revealed mechanistic contributions from primary nociceptors. These neurons become chronically hyperexcitable after SCI, generating ongoing electrical activity that promotes ongoing pain. A major question is whether extrinsic chemical signals help to drive ongoing electrical activity after SCI. People living with SCI exhibit acute and chronic elevation of circulating levels of macrophage migration inhibitory factor (MIF), a cytokine implicated in preclinical pain models. Probable nociceptors isolated from male rats and exposed …

Socio-Demographic And Trauma-Related Predictors Of Depression Within Eight Weeks Of Motor Vehicle Collision In The Aurora Study, Jutta Joormann, Samuel A Mclean, Francesca L Beaudoin, Xinming An, Jennifer S Stevens, Donglin Zeng, Thomas C Neylan, Gari Clifford, Sarah D Linnstaedt, Laura T Germine, Scott L Rauch, Paul I Musey, Phyllis L Hendry, Sophia Sheikh, Christopher W Jones, Brittany E Punches, Gregory Fermann, Lauren A Hudak, Kamran Mohiuddin, Vishnu Murty, Meghan E Mcgrath, John P Haran, Jose Pascual, Mark Seamon, David A Peak, Claire Pearson, Robert M Domeier, Paulina Sergot, Roland Merchant, Leon D Sanchez, Niels K Rathlev, William F Peacock, Steven E Bruce, Deanna Barch, Diego A Pizzagalli, Beatriz Luna, Steven E Harte, Irving Hwang, Sue Lee, Nancy Sampson, Karestan C Koenen, Kerry J Ressler, Ronald C Kessler

Faculty, Staff and Students Publications

BACKGROUND: This is the first report on the association between trauma exposure and depression from the

METHODS: We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression.

RESULTS: Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger

CONCLUSIONS: These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological …

Challenges Created By The Covid-19 Pandemic: Pediatric Emergency Medicine And Disaster Management Perspectives, Thomas E Tanner, Nichole R Davis, Brent D Kaziny, Erin E Endom, Esther M Sampayo

Faculty, Staff and Students Publications

OBJECTIVE: The coronavirus disease (COVID-19) pandemic has presented unique challenges to pediatric emergency medicine (PEM) departments. The purpose of this study was to identify these challenges and ascertain how centers overcame barriers in creating solutions to continue to provide high-quality care and keep their workforce safe during the early pandemic.

METHODS: This is a qualitative study based on semi-structured interviews with physicians in leadership positions who have disaster or emergency management experience. Participants were identified through purposive sampling. Interviews were recorded and transcribed electronically. Themes and codes were extracted from the transcripts by 2 independent coders. Constant comparison analysis was …

Impact Of A Rapid High-Sensitivity Troponin Pathway On Patient Flow In An Urban Emergency Department, Edward Hyun Suh, Aleksandr M Tichter, Lauren S Ranard, Andrew Amaranto, Betty C Chang, Phong Anh Huynh, Alexander Kratz, Rebekah Jihae Lee, Leroy E Rabbani, Dana Sacco, Andrew J Einstein

Faculty, Staff and Students Publications

STUDY OBJECTIVE: To evaluate whether the introduction of a 1-hour high-sensitivity cardiac troponin-T (hs-TnT) pathway for patients who present to the emergency department (ED) with suspected acute coronary syndrome (ACS) improves ED patient flow without changing the rate of "missed" major adverse cardiac events (MACE), compared to use of conventional cardiac troponin with an associated 3-hour pathway.

METHODS: This was a prospective, uncontrolled observational study conducted before and after implementation of a 1-hour hs-TnT pathway at a high-volume urban ED. Patients undergoing evaluation for ACS in the ED were enrolled during their initial visit and clinical outcomes were assessed at …

Decreasing Time To Antibiotic Administration In Febrile Neutropenic Adult Oncology Patients In The Emergency Department: An Evidence-Based Quality Improvement Project, Kristin Murray

DNP Projects

Introduction—Significance and Background: Febrile Neutropenia (FN) is the most common and serious complication of hematopoietic cancers and in patients receiving chemotherapy. Patients in this immunocompromised state have weakened immunity to fight off infection and a mortality rate of almost 10%. Thus, Infectious Diseases Society of America has identified the single most important determining factor of outcomes is the timing of antibiotic (TTA) administration and has identified the gold standard to be 60 minutes. Current practice does not follow guidelines and the current policy does not address the urgency of antibiotic administration.

Purpose: The purpose of this project is to improve …

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 …

Emergency Department Antimicrobial Use In A Low-Resource Setting: Results From A Retrospective Observational Study At A Referral Hospital In Liberia, Sojung Yi, Anu Ramachandran, Lane Epps, Alex Mayah, Taylor W Burkholder, Michael Senyu Jaung, Ahson Haider, Paul Whesseh, John Shakpeh, Kayla Enriquez, Corey Bills

Faculty, Staff and Students Publications

OBJECTIVE: Data on antimicrobial use in low-income and middle-income countries (LMICs) remain limited. In Liberia, the absence of local data impedes surveillance and may lead to suboptimal treatment, injudicious use and resistance against antimicrobials. This study aims to examine antimicrobial prescribing patterns for patients in the emergency department (ED) of a large Liberian public hospital. Secondarily, this prescribing was compared with WHO prescribing indicators.

DESIGN: Retrospective observational study.

SETTING: An adult ED of a large public hospital in Monrovia, Liberia.

PARTICIPANTS: A total of 1082 adult patients (>18 years of age) were recorded in the ED, from 1 January …

Acetaminophen, A Therapeutic Or An Extremely Toxic Remedy – A Review, Genica Caragea, Oana Avram, Andreea Pauna, Andreea Cristina Costea, Miruna Tudosie

Journal of Mind and Medical Sciences

When a new coronavirus appeared in the late 2019, identified as the cause of several cases of pneumonia in Wuhan, Paracetamol was initially reported to be the preferable antipyretic medication, choice which was detrimental to the use of other drugs. People have resorted to buying large stocks of Paracetamol and some have used it in large doses, regardless of the consequences. However, the Paracetamol (Acetaminophen) overdose remains the leading cause of death or transplantation due to acute liver failure in many parts of the world. This review aims at presenting the pharmacokinetics, the clinical signs, and the risk factors for …