Emergency Medicine Commons^™

Addition Of Levalbuterol To A Pediatric Emergency Department Automated Medication Management System Does Not Increase Its Use., Gregory P. Conners, Daniel P. Hays, Thomas Richardson, Frank L. Zwemer

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Although adding a drug to an emergency department-based automated medication management system is known to increase how frequently it is ordered, little is known about this effect when the added drug does not offer substantial benefit over a substitute drug that was already available.

AIMS: We studied the effect of adding nebulized levalbuterol to a pediatric emergency department-based automated medication management system that already included albuterol.

METHODS: All completed orders for nebulized levalbuterol or nebulized albuterol from our academic pediatric emergency department were retrospectively identified using a computerized pharmacy database. We compared ordering of these drugs for the year …

Trauma Registry Needs And Challenges In Developing Countries., Amber Mehmood, Junaid Abdul Razzak

Department of Emergency Medicine

No abstract provided.

End-Of-Life Issues In The Acute And Critically Ill Patient, Eric A. Savory, Catherine A. Marco

Emergency Medicine Faculty Publications

The challenges of end-of-life care require emergency physicians to utilize a multifaceted and dynamic skill set. Such skills include medical therapies to relieve pain and other symptoms near the end-of-life. Physicians must also demonstrate aptitude in comfort care, communication, cultural competency, and ethical principles. It is imperative that emergency physicians demonstrate a fundamental understanding of end-of-life issues in order to employ the versatile, multidisciplinary approach required to provide the highest quality end-of-life care for patients and their families.

Telemedicine And Advanced Technology Research Center: Quarterly Report, July 18, 2009 To October 17, 2009, Bea Babbitt

Telemedicine & Advanced Technology Research Center

Development of a P.O.I. and a Blended Learning Ecology for use in Combat Lifesaver Skills Training for the Army.

The Correlation Between Adolescent-Reported Parental Driving Behaviors And Observed Adult Driving Behaviors., Bryan G. Kane Md, Gavin C. Barr Md, Shawna Murphy Do, Valerie Rupp Rn, Bsn, Kimberly Hamilton Ba, Robert D. Barraco Md, Traci Anselmo Do, James F. Reed Iii Phd

Department of Emergency Medicine

No abstract provided.

A Prospective, Randomized, Double-Blind, Placebo Controlled Trial To Evaluate 4% Liposomal Lidocaine Cream On Pain And Anxiety During Venipuncture In Pediatric Patients Who Present To The Ed, Jenny Boucher, Valerie Rupp Rn, Bsn, Joanna L. Bokovoy Drph, Rn, Scott Hamilton, Kimberly Hamilton Ba, Scott M. Brenner Md, Kevin Weaver Do

Department of Emergency Medicine

No abstract provided.

A Prospective Study Of Cardiopulmonary Resuscitation Training In 7th Grade Students Using Take Home Self-Instruction Cardiopulmonary Resuscitation Kit, Kathleen Faccio Do, Gavin C. Barr Jr. Md, Marna R. Greenberg Do, Mph, Facep, Kevin Weaver Do, Valerie Rupp Rn, Bsn

Department of Emergency Medicine

No abstract provided.

Materials Management Of A Busy Emergency Department, David Richardson Md, Valerie Rupp Rn, Bsn, Kimberly Hamilton Ba, Christine A. Talmage, James F. Reed Iii Phd

Department of Emergency Medicine

No abstract provided.

How Early Do Antibiotics Have To Be To Impact Mortality In Severe Sepsis? A Prospective, Observational Study From An Emergency Department., Shahla Siddiqui, Nawal Salahuddin, Adeel Raza, Junaid Abdul Razzak

Department of Emergency Medicine

BACKGROUND:

The objective of this study was to assess the promptness of antibiotic administration to patients presenting with sepsis and the effects on survival and length of hospitalization.

METHODS:

Consecutive, adult patients presenting with Systemic Inflammatory Response Syndrome (SIRS) to the emergency department of the Aga Khan University hospital were enrolled in a prospective, observational study over a period of 4 months. Univariate, multivariate regression modeling and one-way ANOVA were used to examine the effects of various variables on survival and for significant differences between timing of antibiotic administration and survival, two-sided p values < 0.05 were considered significant.

RESULTS:

One hundred and eleven patients …

How Early Do Antibiotics Have To Be To Impact Mortality In Severe Sepsis? A Prospective, Observational Study From An Emergency Department, Shahla Siddiqui, Nawal Salahuddin, Adeel Raza, Junaid Razzak

Department of Anaesthesia

BACKGROUND: The objective of this study was to assess the promptness of antibiotic administration to patients presenting with sepsis and the effects on survival and length of hospitalization.

METHODS: Consecutive, adult patients presenting with Systemic Inflammatory Response Syndrome (SIRS) to the emergency department of the Aga Khan University hospital were enrolled in a prospective, observational study over a period of 4 months. Univariate, multivariate regression modeling and one-way ANOVA were used to examine the effects of various variables on survival and for significant differences between timing of antibiotic administration and survival, two-sided p values < 0.05 were considered significant.

RESULTS: One hundred and eleven patients …

Educational Opportunities In Integrative Medicine: The A-To-Z Healing Arts Guide And Professional Resource Directory, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Chinese Coal Mines--The Industrial Death Trap, Amber Mehmood

Department of Emergency Medicine

No abstract provided.

Safe Emergency Management Of Acute Ischemic Stroke: An Academic Community Hospital Decade Experience, John Castaldo, Richard S. Mackenzie Md, Peter J. Barbour Md, Lorraine Spikol, Yevgeniy Isayev, Yuebing Li Phd, Gary Clauser Md, John Margraf Md, Glenn Mackin Md, Faan, Facp, David Richardson, Gavin C. Barr, Jr. Md, Donna Jenny, Susan Nevada, Claranne Mathiesen

Department of Emergency Medicine

No abstract provided.

Cardioprotective Effect Of Adiponectin Is Partially Mediated By Its Ampk-Independent Antinitrative Action., Yajing Wang, Ling Tao, Yuexing Yuan, Wayne Bond Lau, Rong Li, Bernard L. Lopez, Theodore A. Christopher, Rong Tian, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

Adiponectin (APN) exerts its metabolic regulation largely through AMP-dependent protein kinase (AMPK). However, the role of AMPK in APN's antiapoptotic effect in ischemic-reperfused (I/R) adult cardiomyocytes remains incompletely understood. The present study was designed to determine the involvement of AMPK in the antiapoptotic signaling of APN. Cardiomyocytes from adult male mice overexpressing a dominant-negative alpha(2)-subunit of AMPK (AMPK-DN) or wild-type (WT) littermates were subjected to simulated I/R (SI/R) and pretreated with 2 microg/ml globular domain of APN (gAPN) or vehicle. SI/R-induced cardiomyocyte apoptosis was modestly increased in AMPK-DN cardiomyocytes (P < 0.05). Treatment with gAPN significantly reduced SI/R-induced apoptosis in WT cardiomyocytes as well as in AMPK-DN cardiomyocytes, indicating that the antiapoptotic effect of gAPN is partially AMPK independent. Furthermore, gAPN-induced endothelial nitric oxide synthase (eNOS) phosphorylation was significantly reduced in AMPK-DN cardiomyocytes, suggesting that the APN-eNOS signaling axis is impaired in AMPK-DN cardiomyocytes. Additional experiments demonstrated that treatment of AMPK-DN cardiomyocytes with gAPN reduced SI/R-induced NADPH oxidase overexpression, decreased superoxide generation, and blocked peroxynitrite formation to the same extent as that observed in WT cardiomyocytes. Collectively, our present study demonstrated that although the metabolic and eNOS activation effect of APN is largely mediated by AMPK, the superoxide-suppressing effect of APN is not mediated by AMPK, and this AMPK-independent antioxidant property of APN increased nitric oxide bioavailability and exerted significant antiapoptotic effect.

Improving Outcome In Pediatric Intensive Care Unit In Academic Hospital In Pakistan, Anwarul Haque, Surraiya Bano

Department of Emergency Medicine

Objective:

To assess the impact on the clinical outcome of critically ill children before and after introduction of pediatric intensivist in an academic pediatric intensive care unit (PICU) inPakistan.

Methodology: :

This is aretrospective audit of children (age from one month to 14 years) admitted in the PICU during two 12-month periods in PICU of Aga Khan University Hospital (AKUH).Patients in Cohort one were managed by pediatric intensivist while in Cohort two were managed by general pediatricians.Patients were compared during the two 12-month cohort period.

Results:

During the study, in cohort one, 314 patients were admitted, mean age was 24 …

Analysis Of 2006 Maine Emergency Department Use: A Study Conducted On Behalf Of The Emergency Department Use Work Group Of The Maine Advisory Council On Health System Development, Carolyn E. Gray Mph, Catherine Mcguire Bs, Beth Kilbreth, Tamar Chitashvili

Population Health & Health Policy

This study, conducted on behalf of the Emergency Department Use Work Group of the Maine Advisory Council on Health System Development provides an analysis of visits to hospital emergency departments in Maine that took place in 2006. The study relied on two sources of data: a comprehensive file of hospital discharge records provided by the Maine Health Data Organization; and comprehensive claims records for most privately insured residents in Maine and most MaineCare members. The 2006 data used for this analysis pre-dated some of the initiatives undertaken by the Department of Human Services to improve access to primary care and …

Near Fatal Posterior Reversible Encephalopathy Syndrome Complicating Chronic Liver Failure And Treated By Induced Hypothermia And Dialysis: A Case Report., Rashmi Chawla, Daniel Smith, Paul E Marik

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

INTRODUCTION: Posterior reversible encephalopathy syndrome is a clinico-neuroradiological entity characterized by headache, vomiting, altered mental status, blurred vision and seizures with neuroimaging studies demonstrating white-gray matter edema involving predominantly the posterior region of the brain. CASE PRESENTATION: We report a 47-year-old Caucasian man with liver cirrhosis who developed posterior reversible encephalopathy syndrome following an upper gastrointestinal hemorrhage and who was managed with induced hypothermia for control of intracranial hypertension and continuous veno-venous hemodiafiltration for severe hyperammonemia. CONCLUSION: We believe this is the first documented case report of posterior reversible encephalopathy syndrome associated with cirrhosis as well as the first report …

Frequent Users Of The Emergency Department: A Policy Proposal, Tina Ann Olson

All Graduate Theses, Dissertations, and Other Capstone Projects

Research has extensively documented that a small number of Emergency Department (ED) patients make disproportionate use of emergency services (Okin et al., 2000). The term “Frequent Users” is used to describe patients who utilize ED services more than four times per year (Byrne et al., 2003). Frequent Users are often times patients with chronic medical, mental health, alcohol and drug problems, as well as other psychosocial issues (Fulde & Duffy, 2006). Homeless people also appear to have significantly higher ED rates than the general population (Pope et al., 2000). Immanuel St. Joseph’s-Mayo Health System (ISJ) ED appears to have many …

The Effectiveness Of Placing A Mid-Level Provider In Triage As An Intervention To Improve Patient Flow In The Emergency Department, Penney A. Burlingame

MUSC Theses and Dissertations

With increasing scrutiny on the condition of the nation's emergency services and emphasis on patient satisfaction and pay for performance, Emergency Departments (EDs) are examining ways to improve public perceptions of satisfaction and quality. A reduction in ED wait times and left without being seen (LWBS) volumes can have a significant impact on patient satisfaction scores. The purpose of this study is to determine if placement of a mid-level provider in triage to perform medical screening exams (MSEs) will reduce ED wait times, increase efficient patient flow, and increase patient and staff satisfaction. For one hundred sixty nine days, a …

Disease In The Desert: Las Vegas As A Case Study Of How First Responders And Emergency Managers Understand Novel Threats To Human Health And Plan To Respond During Biological Emergencies, Monique Williamson

UNLV Theses, Dissertations, Professional Papers, and Capstones

Over recent years it has become clear that technological advancements, globalization, and ecological change, combined with the onset of increased terrorist incidents, are all currently working to create an extremely hazardous environment in terms of pathogenic invasion. Realizing that infectious diseases are both newly emerging and re-emerging in many parts of the world, the question of how prepared an expansive United States will be in the face of an oncoming global pandemic is easily raised. Using Las Vegas as an example of just how unequipped a largely visited U.S. city may be in the face of such a situation, this …

Examining The Relationship Of Accurate Esi© Triage Scores To Emergency Department Nursing Attitudes And Experience, Andrew Martin Bsn, Rn, Phrn, Cen, Anne Panik Ms, Rn, Nea-Bc, Courtney Vose Rn Msn Cen, Charlotte Buckenmyer Rn, Ms, Paul Delpais Rn Bsn Cen, Keith D. Micucci Rn Bsn Phrn Cen, Bryan G. Kane Md, Kimberly Badillo Rn, Michele Oritz Rn Bsn Cen, Cheryl Celia Rn Crnp, Michael Guelzow Bsn Cen, Eileen Bechtel Rn, Maria Cruz Rn, Nikki Hatmaker-Garris Rn, Bsn, Traci Dickson-Watner Rn. Bsn, Elizabeth Karoly Rrt Mba, Mae Ann Pasquale Phd, Msn, Rn, Carolyn L. Davidson Rn Ccrn Cprn Phd©

Patient Care Services / Nursing

No abstract provided.

Social Work Involvement In Supporting Survivors Of An Unexpected Death In An Emergency Department, Jennifer E. Buchanan

All Graduate Theses, Dissertations, and Other Capstone Projects

People occasionally present to a hospital’s emergency department (ED) after an event such as a heart attack or a motor vehicle accident that results in their sudden and unexpected death. Although members of the ED attempt to support the survivors as much as possible, due to the fast pace of the environment and responsibilities to other patients, the survivors may not always be provided with the necessary resources and support. This can leave survivors feeling isolated and confused about the appropriate course of action after this type of experience. A planned, organized approach delivered by educated and sensitive staff can …

Training New Mothers In Infant Cardiopulmonary Resuscitation (Cpr), Gavin C. Barr Jr. Md, Marna R. Greenberg Do, Mph, Facep, Valerie Rupp Rn, Bsn, Charles C. Worrilow Md, Katie Fredericks, Anne Marie Crown, John Reed Rrt

Department of Emergency Medicine

No abstract provided.