Emergency Medicine Commons^™

The Protective Effect Of Traditional Chinese Medicine On Liver Ischemia-Reperfusion Injury., Wen Ma, Songling Tang, Dina Xie, Guoqiang Gu, Lu Gan

Department of Emergency Medicine Faculty Papers

Liver ischemia-reperfusion (I/R) injury occurs during transplantation and major hepatic surgery, which may lead to postoperative liver dysfunction. More and more traditional Chinese medicines (TCMs) have been used to treat liver ischemia-reperfusion injury. The purpose of this review is to evaluate the different protective effects of TCMs in the treatment of liver ischemia-reperfusion injury and to summarize its possible mechanisms. The results indicate that TCMs attenuate liver I/R injury via multiple mechanisms, including antioxidation stress, anti-inflammatory response, antiapoptosis, and inhibiting endoplasmic reticulum stress. However, the in-depth mechanism of the protective effects of these traditional Chinese medicines still remains unknown.

Monitoring Tissue Oxygenation Index Using Near-Infrared Spectroscopy During Pre-Hospital Resuscitation Among Out-Of-Hospital Cardiac Arrest Patients: A Pilot Study, Jumpei Tsukuda, Shigeki Fujitani, Mahbubur Rahman, Kenichiro Morisawa, Takeshi Kawaguchi, Yasuhiko Taira

Department of Emergency Medicine Faculty Papers

BACKGROUND: Tissue oxygenation index (TOI) using the near infrared spectroscopy (NIRS) has been demonstrated as a useful indicator to predict return of spontaneous circulation (ROSC) among out-of-hospital cardiac arrest (OHCA) patients in hospital setting. However, it has not been widely examined based on pre-hospital setting.

METHODS: In this prospective observational study, we measured TOI in pre-hospital setting among OHCA patients receiving cardio-pulmonary resuscitation (CPR) during ambulance transportation between 2017 and 2018. Throughout the pre-hospital CPR procedure, TOI was continuously measured. The study population was divided into two subgroups: ROSC group and non-ROSC group.

RESULTS: Of the 81 patients included in …

Identification Of A Ctrp9 C-Terminal Polypeptide Capable Of Enhancing Bone-Derived Mesenchymal Stem Cell Cardioprotection Through Promoting Angiogenic Exosome Production., Demin Liu, Guoqiang Gu, Lu Gan, Wenjun Yan, Zhen Zhang, Peng Yao, Di Zhu, Wayne Bond Lau, Dina Xie, Sisi Wu, Zhijun Meng, Jumpei Tsukuda, Theodore Christopher, Bernard Lopez, Jianli Zhao, Erhe Gao, Walter Koch, Xin-Liang Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

BACKGROUND: Mesenchymal stem cell therapy improves ischemic heart failure via incompletely understood mechanisms. C1q-TNFα related protein-9 (CTRP9) is a novel anti-oxidative cardiokine capable of improving the local microenvironment and cell survival by its c-terminal active globular domain (gCTRP9). The current study attempted to: 1) identify active gCTRP9 c-terminal polypeptides with stem cell protective function; 2) determine whether a lead polypeptide may enable/enhance cortical bone-derived mesenchymal stem cell (CBSC) cardioprotection against post-myocardial infarction (post-MI) remodeling; and 3) define the responsible underlying cellular/molecular mechanisms.

METHODS AND RESULTS: Utilizing I-TASSER structure prediction and 3-D active site modeling, we cloned and purified 3 gCTRP9 …

C1q Complement/Tumor Necrosis Factor-Associated Proteins In Cardiovascular Disease And Covid-19, Yaoli Xie, Zhijun Meng, Jia Gao, Caihong Liu, Jing Wang, Rui Guo, Jianli Zhao, Bernard Lopez, Theodore Christopher, Daniel Lee, Xin-Liang Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

With continually improving treatment strategies and patient care, the overall mortality of cardiovascular disease (CVD) has been significantly reduced. However, this success is a double-edged sword, as many patients who survive cardiovascular complications will progress towards a chronic disorder over time. A family of adiponectin paralogs designated as C1q complement/tumor necrosis factor (TNF)-associated proteins (CTRPs) has been found to play a role in the development of CVD. CTRPs, which are comprised of 15 members, CTRP1 to CTRP15, are secreted from different organs/tissues and exhibit diverse functions, have attracted increasing attention because of their roles in maintaining inner homeostasis by regulating …

Atg16l1 As A Novel Biomarker And Autophagy Gene For Diabetic Retinopathy., Xinxiao Gao, Yunhui Du, Wayne Bond Lau, Yu Li, Siquan Zhu, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

Objective: Accumulating evidence suggests the critical role of autophagy in the pathogenesis of diabetic retinopathy (DR). In the current study, we aim to identify autophagy genes involved in DR via microarray analyses.

Methods: Gene microarrays were performed to identify differentially expressed lncRNAs/mRNAs between normal and DR retinas. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses of lncRNA-coexpressed mRNAs were used to determine the related pathological pathways and biological modules. Real-time polymerase chain reactions (PCR) were conducted to validate the microarray analyses.

Results: A total of 2474 significantly dysregulated lncRNAs and 959 differentially expressed mRNAs were identified in the …

Global Point-Of-Care Ultrasound Education And Training In The Age Of Covid-19., Onyinyechi F Eke, Patricia C. Henwood, Grace W Wanjiku, Abiola Fasina, Sigmund J Kharasch, Hamid Shokoohi

Department of Emergency Medicine Faculty Papers

The COVID-19 pandemic has disrupted traditional global point-of-care ultrasound (POCUS) education and training, as a result of travel restrictions. It has also provided an opportunity for innovation using a virtual platform. Tele-ultrasound and video-conferencing are alternative and supportive tools to augment global POCUS education and training. There is a need to support learners and experts to ensure that maximum benefit is gained from the use of these innovative modalities.

The Effect Of Medical Nutrition Therapy On Weight Loss, Ayesha Baig, Hannah Kostan, Cynthia Cheng

Phase 1

Introduction: In this retrospective study, we evaluated the effects of Jefferson’s medical nutrition therapy (MNT) program on weight loss. We anticipate that participation in the MNT program will lead to an improvement in weight and metabolic syndrome parameters.

Methods: We selected a convenience sample of 10 participants with BMI > 25 for this pilot retrospective chart review. Subjects were screened for various exclusion criteria such as past bariatric surgery, heart failure, malignancy, renal dialysis, and uncontrolled conditions such as hypothyroidism, anemia, or B12 deficiency. Weight measurements were collected from EPIC records starting from baseline, defined as 3 months prior to initiation …

An Assessment Of Quality Improvement Strategies For The Implementation Of Certified Recovery Specialists In Treating Opioid Use Disorder At The Emergency Department At Jefferson, A. Cosmo Annese, Rickie Brawer, Phd, Mph, Ches

Phase 1

Introduction: Opioid overdose mortality rate in the U.S. has seen a staggering upward trend lately, more than tripling between the years 2000-2017. Although the use of Certified Recovery Specialists (CRSs) has been shown to improve overdose rates, relapse rates, and treatment completion rates for people with opioid use disorder (OUD), the optimal specialization of CRSs in healthcare settings has yet to be clearly defined. This project seeks the perspectives of CRSs and healthcare workers to gain insight into how CRSs can be most effectively implemented in the ED at Jefferson to treat OUD.

Methods: The study population includes CRSs and …

Early Hemodynamic Assessment Using Nicom In Patients At Risk Of Developing Sepsis Immediately After Emergency Department Triage., Steve B Chukwulebe, David F. Gaieski, Abhishek Bhardwaj, Lakeisha Mulugeta-Gordon, Frances S Shofer, Anthony J Dean

Department of Emergency Medicine Faculty Papers

BACKGROUND: One factor leading to the high mortality rate seen in sepsis is the subtle, dynamic nature of the disease, which can lead to delayed detection and under-resuscitation. This study investigated whether serial hemodynamic parameters obtained from a non-invasive cardiac output monitor (NICOM) predicts disease severity in patients at risk for sepsis.

METHODS: Prospective clinical trial of the NICOM device in a convenience sample of adult ED patients at risk for sepsis who did not have obvious organ dysfunction at the time of triage. Hemodynamic data were collected immediately following triage and 2 hours after initial measurement and compared in …

"Trauma To The Eye"-A Low Fidelity Resident Teaching Module For Identifying And Treating A Retrobulbar Hematoma., Jared Raikin, R. Hall, Dimitrios Papanagnou, Md

Department of Emergency Medicine Faculty Papers

Introduction: A retrobulbar hematoma (RH) is a serious time-dependent diagnosis due to its potential for permanent damage of the optic nerve, resulting in blindness. Emergency medicine (EM) physicians face the challenge of recognizing this time-sensitive injury and treating it before irreversible damage occurs. Due to its relative infrequency in the emergency department, residents may not have adequate experience in recognizing and treating RH.

Methods: This educational intervention outlined a simulated scenario that we developed to educate EM residents to diagnose RH and perform an emergent lateral canthotomy and cantholysis (LCC). Participating residents were asked to obtain a history and perform …

A Comparison Of Standardized Letters Of Evaluation For Emergency Medicine Residency Applicants., David Wilson, Chaiya Laoteppitaks, Shruti Chandra

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Medical students pursuing an emergency medicine (EM) residency are advised to obtain at least two Standardized Letters of Evaluation (SLOE). Students often complete one rotation at their home institution and at least one "away" rotation at a program separate from their home institution. The SLOE was introduced as an objective evaluation tool. The aim of this study was to determine whether there was a difference in scores between home rotation and away rotation SLOEs.

METHODS: We retrospectively reviewed the SLOEs of all applicants to an urban, academic EM residency program. For each SLOE, we calculated a composite score from …

Mir15a/Mir16-1 Cluster And Its Novel Targeting Molecules Negatively Regulate Cardiac Hypertrophy., Hongchang Guo, Ke Ma, Wenjing Hao, Yao Jiao, Ping Li, Jing Chen, Chen Xu, Fu-Jian Xu, Wayne Bond Lau, Jie Du, Xin-Liang Ma, Yulin Li

Department of Emergency Medicine Faculty Papers

In response to pathological stimuli, the heart develops ventricular hypertrophy that progressively decompensates and leads to heart failure. miRNAs are increasingly recognized as pathogenic factors, clinically relevant biomarkers, and potential therapeutic targets. We identified that mir15a/mir16-1 cluster was negatively correlated with hypertrophic severity in patients with hypertrophic cardiomyopathy. The mir15a/mir16-1 expression was enriched in cardiomyocytes (CMs), decreased in hypertrophic human hearts, and decreased in mouse hearts after transverse aortic constriction (TAC). CM-specific mir15a/mir16-1 knockout promoted cardiac hypertrophy and dysfunction after TAC. CCAAT/enhancer binding protein (C/EBP)β was responsible for the downregulation of mir15a/mir16-1 cluster transcription. Mechanistically, mir15a/mir16-1 cluster attenuated the insulin/IGF1 …

Advising Special Population Emergency Medicine Residency Applicants: A Survey Of Emergency Medicine Advisors And Residency Program Leadership., Alexis E. Pelletier-Bui, Caitlin Schrepel, Liza Smith, Xiao Chi Zhang, Adam Kellogg, Mary Ann Edens, Christopher W. Jones, Emily Hillman

Department of Emergency Medicine Faculty Papers

BACKGROUND: The objective of this study was to determine the advising and emergency medicine (EM) residency selection practices for special population applicant groups for whom traditional advice may not apply.

METHODS: A survey was distributed on the Council of Residency Directors in EM and Clerkship Directors in EM Academy listservs. Multiple choice, Likert-type scale, and fill-in-the-blank questions addressed the average EM applicant and special population groups (osteopathic; international medical graduate (IMG); couples; at-risk; re-applicant; dual-accreditation applicant; and military). Percentages and 95% confidence intervals [CI] were calculated.

RESULTS: One hundred four surveys were completed. Of respondents involved in the interview process, …

The Sensitivity Of Qsofa Calculated At Triage And During Emergency Department Treatment To Rapidly Identify Sepsis Patients., Sarah M. Perman, Mark E. Mikkelsen, Munish Goyal, Adit Ginde, Abhishek Bhardwaj, Byron Drumheller, S. Cham Sante, Anish K. Agarwal, David F. Gaieski

Department of Emergency Medicine Faculty Papers

The quick sequential organ failure assessment (qSOFA) score has been proposed as a means to rapidly identify adult patients with suspected infection, in pre-hospital, Emergency Department (ED), or general hospital ward locations, who are in a high-risk category with increased likelihood of "poor outcomes:" a greater than 10% chance of dying or an increased likelihood of spending 3 or more days in the ICU. This score is intended to replace the use of systemic inflammatory response syndrome (SIRS) criteria as a screening tool; however, its role in ED screening and identification has yet to be fully elucidated. In this retrospective …

Inpatient Hospital Performance Is Associated With Post-Discharge Sepsis Mortality., Nicholas M. Mohr, Alexis M. Zebrowski, David F. Gaieski, David G. Buckler, Brendan G. Carr

Department of Emergency Medicine Faculty Papers

BACKGROUND: Post-discharge deaths are common in patients hospitalized for sepsis, but the drivers of post-discharge deaths are unclear. The objective of this study was to test the hypothesis that hospitals with high risk-adjusted inpatient sepsis mortality also have high post-discharge mortality, readmissions, and discharge to nursing homes.

METHODS: Retrospective cohort study of age-qualifying Medicare beneficiaries with sepsis hospitalization between January 2013 and December 2014. Hospital survivors were followed for 180-days post-discharge, and mortality, readmissions, and new admission to skilled nursing facility were measured. Inpatient hospital-specific sepsis risk-adjusted mortality ratio (observed: expected) was the primary exposure.

RESULTS: A total of 830,721 …

Solving Community Sars-Cov-2 Testing With Telehealth: Development And Implementation For Screening, Evaluation And Testing., Aditi Joshi, Resa E. Lewiss, Maria Aini, Bracken Babula, Patricia C. Henwood

Department of Emergency Medicine Faculty Papers

BACKGROUND: Telehealth has emerged as a crucial component of the SARS-CoV-2 pandemic emergency response. Simply stated, telehealth is a tool to provide health care from a distance. Jefferson Health has leveraged its acute care telehealth platform to screen, order testing, and manage patients with COVID-19-related concerns.

OBJECTIVE: This study aims to describe the expansion and results of using a telehealth program to increase access to care while minimizing additional potential exposures during the early period of the COVID-19 pandemic.

METHODS: Screening algorithms for patients with SARS-CoV-2-related complaints were created, and 150 new clinicians were trained within 72 hours to address …

Early General Hypothermia Improves Motor Function After Spinal Cord Injury In Rats; A Systematic Review And Meta-Analysis., Mahmoud Yousefifard, Mohammad Hossein Vazirizadeh-Mahabadi, Leila Haghani, Farhad Shokraneh, Alex R. Vaccaro, Vafa Rahimi-Movaghar, Mostafa Hosseini

Rothman Institute Papers

Introduction: There is still controversy about the effect of early hypothermia on the outcome of spinal cord injury (SCI). The aim of this review article is to investigate the effect of local or general hypothermia on improving the locomotion after traumatic SCI.

Methods: Electronic databases (Medline and Embase) were searched from inception until May 7, 2018. Two independent reviewers screened and summarized the relevant experimental studies on hypothermia efficacy in traumatic SCI. The data were analyzed and the findings were presented as pooled standardized mean difference (SMD) and 95% confidence interval (95% CI).

Results: 20 papers contain-ing 30 separate experiments …

Redefining Cardiac Biomarkers In Predicting Mortality Of Inpatients With Covid-19, Juan-Juan Qin, Xu Cheng, Feng Zhou, Fang Lei, Gauri Akolkar, Jingjing Cai, Xiao-Jing Zhang, Alice Blet, Jing Xie, Peng Zhang, Ye-Mao Liu, Zizhen Huang, Ling-Ping Zhao, Lijin Lin, Meng Xia, Ming-Ming Chen, Xiaohui Song, Liangjie Bai, Ze Chen, Xingyuan Zhang, Da Xiang, Jing Chen, Qingbo Xu, Xin-Liang Ma, Rhian M Touyz, Chen Gao, Haitao Wang, Liming Liu, Weiming Mao, Pengcheng Luo, Youqin Yan, Ping Ye, Manhua Chen, Guohua Chen, Lihua Zhu, Zhi-Gang She, Xiaodong Huang, Yufeng Yuan, Bing-Hong Zhang, Yibin Wang, Peter P Liu, Hongliang Li

Department of Emergency Medicine Faculty Papers

The prognostic power of circulating cardiac biomarkers, their utility, and pattern of release in coronavirus disease 2019 (COVID-19) patients have not been clearly defined. In this multicentered retrospective study, we enrolled 3219 patients with diagnosed COVID-19 admitted to 9 hospitals from December 31, 2019 to March 4, 2020, to estimate the associations and prognostic power of circulating cardiac injury markers with the poor outcomes of COVID-19. In the mixed-effects Cox model, after adjusting for age, sex, and comorbidities, the adjusted hazard ratio of 28-day mortality for hs-cTnI (high-sensitivity cardiac troponin I) was 7.12 ([95% CI, 4.60-11.03] P<0.001), (NT-pro)BNP (N-terminal pro-B-type natriuretic peptide or brain natriuretic peptide) was 5.11 ([95% CI, 3.50-7.47] P<0.001), CK (creatine phosphokinase)-MB was 4.86 ([95% CI, 3.33-7.09] P<0.001), MYO (myoglobin) was 4.50 ([95% CI, 3.18-6.36] P<0.001), and CK was 3.56 ([95% CI, 2.53-5.02] P<0.001). The cutoffs of those cardiac biomarkers for effective prognosis of 28-day mortality of COVID-19 were found to be much lower than for regular heart disease at about 19%-50% of the currently recommended thresholds. Patients with elevated cardiac injury markers above the newly established cutoffs were associated with significantly increased risk of COVID-19 death. In conclusion, cardiac biomarker elevations are significantly associated with 28-day death in patients with COVID-19. The prognostic cutoff values of these biomarkers might be much lower than the current reference standards. These findings can assist in better management of COVID-19 patients to improve outcomes. Importantly, the newly established cutoff levels of COVID-19-associated cardiac biomarkers may serve as useful criteria for the future prospective studies and clinical trials.

Sudden Shoulder Swelling In An Elderly Man After The Flu Shot., Joseph Jean, Md, Elizabeth M Lee, Xiao Chi Zhang

Department of Emergency Medicine Faculty Papers

A 99-year-old man presented to the emergency department (ED) with sudden left shoulder pain hours after receiving the influenza vaccine. DIAGNOSIS: Aseptic inflammatory arthritis secondary to influenza vaccination

Pain In The Prehospital Setting In Rwanda: Results Of A Mixed-Methods Quality Improvement Project., A Rosenberg, E Uwitonze, M Dworkin, J P D Guidry, T Cyuzuzo, D Banerjee, K Mcintyre, K Carlyle, J M Uwitonze, I Kabagema, T Dushime, S Jayaraman

Student Papers, Posters & Projects

Introduction: Pain is a universal human experience tied to an individual's health but difficult to understand. It is especially important in health emergencies. We performed a two-step quality improvement project to assess pain management by the SAMU ambulance service in Kigali, Rwanda, examining how pain is assessed and treated by ambulance staff to facilitate development of standardized guidelines of pain management in the prehospital setting, which did not exist at the time of the study.

Materials and Methods: Deidentified ambulance service records from December 2012 to May 2016 were analyzed descriptively for patient demographics, emergency conditions, pain assessment, and medications …

Consensus Guidelines For Digital Scholarship In Academic Promotion., Abbas Husain, Zachary Repanshek, Manpreet Singh, Felix Ankel, Jennifer Beck-Esmay, Daniel Cabrera, Teresa M Chan, Robert Cooney, Michael Gisondi, Michael Gottlieb, Jay Khadpe, Jennifer Repanshek, Jessica Mason, Dimitrios Papanagnou, Jeff Riddell, N Seth Trueger, Fareen Zaver, Emily Brumfield

Department of Emergency Medicine Faculty Papers

INTRODUCTION: As scholarship moves into the digital sphere, applicant and promotion and tenure (P&T) committee members lack formal guidance on evaluating the impact of digital scholarly work. The P&T process requires the appraisal of individual scholarly impact in comparison to scholars across institutions and disciplines. As dissemination methods evolve in the digital era, we must adapt traditional P&T processes to include emerging forms of digital scholarship.

METHODS: We conducted a blended, expert consensus procedure using a nominal group process to create a consensus document at the Council of Emergency Medicine Residency Directors Academic Assembly on April 1, 2019.

RESULTS: We …

C1q/Tnf-Related Protein 5 Contributes To Diabetic Vascular Endothelium Dysfunction Through Promoting Nox-1 Signaling., Jing Liu, Zhijun Meng, Lu Gan, Rui Guo, Jia Gao, Caihong Liu, Di Zhu, Demin Liu, Ling Zhang, Zhen Zhang, Dina Xie, Xiangying Jiao, Wayne Bond Lau, Bernard L. Lopez, Theodore A. Christopher, Xin-Liang Ma, Jimin Cao, Yajing Wang

Department of Emergency Medicine Faculty Papers

OBJECTIVE: Dysregulated adipokine profiles contribute to the pathogenesis of diabetic cardiovascular complications. Endothelial cell (EC) dysfunction, a common pathological alteration in cardiovascular disorders, is exaggerated in diabetes. However, it is unclear whether and how dysregulated adipokines may contribute to diabetic EC dysfunction.

METHODS AND RESULTS: Serum C1q/TNF-Related Protein 5 (CTRP5) were determined in control/diabetes patients, and control/diabetic mice (high-fat diet, HFD). We observed for the first time that serum total CTRP5 was increased, high molecular weight (HMW) form was decreased, but the globular form (gCTRP5) was significantly increased in diabetic patients. These pathological alterations were reproduced in diabetic mice. To …

Development Of The Uncertainty Communication Checklist: A Patient-Centered Approach To Patient Discharge From The Emergency Department, Kristin L. Rising, Rhea E. Powell, Kenzie A Cameron, David H Salzman, Dimitrios Papanagnou, Amanda Doty, Lori Latimer, Katherine Piserchia, William C Mcgaghie, Danielle M Mccarthy

Department of Emergency Medicine Faculty Papers

Clear communication with patients upon emergency department (ED) discharge is important for patient safety during the transition to outpatient care. Over one-third of patients are discharged from the ED with diagnostic uncertainty, yet there is no established approach for effective discharge communication in this scenario. From 2017 to 2019, the authors developed the Uncertainty Communication Checklist for use in simulation-based training and assessment of emergency physician communication skills when discharging patients with diagnostic uncertainty. This development process followed the established 12-step Checklist Development Checklist framework and integrated patient feedback into 6 of the 12 steps. Patient input was included as …

Brugada Syndrome Unmasked By Fever: A Comprehensive Review Of Literature, Sohaib S. Roomi, Waqas Ullah, Hassan Abbas, Hafez Abdullah, Usama Talib, Vincent Figueredod

Department of Emergency Medicine Faculty Papers

Background: The Brugada pattern is identified on the EKG by a coved ST-segment elevation accompanied by a negative T wave in the early precordial leads in the absence of a cardiac structural abnormality. Brugada pattern and Brugada syndrome should be differentiated, as the latter is associated with an increased risk of sudden cardiac death.

Methods: The literature was searched using multiple databases to identify all the articles on Brugada pattern. Data were screened and analyzed by independent authors.

Results: Sixty articles, comprising 71 patients, were included in the study. The mean age of patients was 42.6 years, with a higher …

Pneumocephalus And Facial Droop On An Airplane: A Case Report, Irina Sanjeevan-Cabeza, Morgan Oakland

Department of Emergency Medicine Faculty Papers

Introduction: Pneumocephalus (PNC) is most commonly associated with trauma or intracranial surgery, less commonly secondary to an infectious source, and is rarely caused by barotrauma.

Case report: A 32-year-old woman presented to the emergency department with complaint of resolved left-sided facial droop and a lingering paresthesia of her left upper extremity after a cross-country flight. Computed tomography demonstrated several foci of air in the subdural space consistent with PNC.

Conclusion: For PNC to occur there must be a persistent negative intracranial pressure gradient, with or without an extracranial pressure change. In this case the pressure change occurred due to cabin …

Zooming-Out Covid-19: Virtual Clinical Experiences In An Emergency Medicine Clerkship., Shruti Chandra, Chaiya Laoteppitaks, Nina Mingioni, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

In the setting of the novel 2019 coronavirus (COVID‐19) pandemic, it has been challenging to provide medical students in the Emergency Medicine (EM) clerkship meaningful clinical experiences that would meet clinical course goals and objectives, as well as satisfy Liaison Committee for Medical Education (LCME) requirements. During the EM clerkship, students play an integral role in interviewing patients, formulating treatment plans, facilitating patient discharges, and counseling patients. Immediately available direct and indirect supervision are paramount to ensure student learning and safe patient care. The authors present a novel clinical educational experience for senior medical students in an EM clerkship that …

First Rwanda National Trauma Symposium 2019: Challenges And Priorities., Ashley Rosenberg, Faustin Ntirenganya, Irene Bagahirwa, Gabin Mbanjumucyo, Lambert Rutayisire, Severien Muneza, Innocent Nzeyimana, Eric Benimana, Ernest Nahayo, Busisiwe Bhengu, Assuman Nuhu, Arsene Muhumuza, Costica Uwitonze, Ghislaine Umwali, Menelas Nkeshimana, Jeanne D'Arc Nyinawankusi, Elizabeth Krebs, Jean Marie Uwitonze, Igance Kabagema, Theophile Dushime, Jean Claude Byiringiro, Gilles Ndayisaba, Sudha Jayaraman

Department of Emergency Medicine Faculty Papers

No abstract provided.

E-Cigarette Or Vaping Product Use-Associated Lung Injury (Evali) Characterized By Pulmonary Ultrasound, Peter Sacci, Arthur Au

Department of Emergency Medicine Faculty Papers

Pulmonary ultrasound is a useful tool in the diagnosis and resuscitation of emergency department (ED) patients with dyspnea. We present the case of a patient who was diagnosed with E-cigarette or vaping product use-associated lung injury (EVALI) using pulmonary ultrasound. Many of these cases are diagnosed using x-ray, computerized tomography, or bronchoscopy and to our knowledge this is the first published case that demonstrates utility of ultrasound in diagnosing EVALI. While more investigation is needed on the use of this technique, the patient in this case was diagnosed with EVALI based on positive history, presence of normal cardiac function, non-cardiogenic …

Obstacles To Nurse-Performed Ultrasound Guided Peripheral Iv Placement, Ali Elsaied, Do, Farhan Khan, Do, Rishi Kalwani, Md, Cara Kanter, Md, Kenn Ghafferian, Do

Health Equity and Quality Improvement (HEQI) Summit

With an aging population, the rate of obesity, the regional prevalence of dialysis patients and the increase in IV drug abuse, obtaining routine vascular access in the emergency department (ED) has become more challenging. Ultrasound (US) guided IV placement has been pivotal in identifying deeper veins to access. This is traditionally performed by ED physicians, however given the time constraints, lower acuity patients who require US IV access can experience significant delays to care. We attempted to train ED nurses to perform this skill, however many trained nurses are still not attempting US IVs regularly. This study aimed to identify …

Hepatitis A Vaccination Program In Jefferson Emergency Departments, Katelyn Levy, Md, Belinda Lao, Md, Mitchell Berman, Md, Joseph Jean, Md, Sejal Patel, Pharmd, Benjamin Slovis, Md, Scott Sutherland, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Increase the rate of hepatitis A vaccination in high-risk patients (homeless and drug users) who present to Thomas Jefferson University Hospital and Jefferson Methodist emergency departments over a 5 month period starting on 9/4/2019.