Emergency Medicine Commons^™

Impact Of Improving Throughput In The Emergency Department, Katherine J. Edrington

Doctor of Nursing Practice (DNP) Projects

The purpose of this project was to evaluate the patient experience in the emergency department (ED) and in the inpatient setting while correlating increased throughput and patient outcomes at a suburban Acute Care facility in Ohio. The culture in the organization has lacked accountability and ownership of the patients. The ED admitted length of stay (ALOS) was 358 minutes in the beginning of 2013. For the first time in the organization’s history, the ED ALOS is now typically less than the recommended benchmark of 300 minutes. A report of findings among ED’s surveyed showed the ALOS best practice is 244 …

La Cesárea Y El Parto Natural: Las Opiniones De Profesionales De La Salud En La Provincia De Buenos Aires / Cesarean Section And Natural Birth: The Opinions Of Health Provinces In The Province Of Buenos Aires, Jacqueline Chipkin

Independent Study Project (ISP) Collection

Introduction: The ways in which women of society give birth have the power to influence maternal-infant health and shape the economy of the healthcare system. Today, the rates of cesarean sections are increasing throughout the world. In Argentina, on average, more than 35% of pregnant women received cesarean sections in 2008, with large differences observed in the rates between the public and private health sectors. The World Health Organization (WHO) has established that healthcare systems should only employ a cesarean section if labor cannot progress safely. According to this standard, the organization estimates that cesarean sections should only be utilized …

Pediatric Emergency Medical Care In Yerevan, Armenia: A Knowledge And Attitudes Survey Of Out-Of-Hospital Emergency Physicians., Aline A. Baghdassarian, Ross I. Donaldson, Andrew D Depiero, Nancy L Chernett, Harsh P. Sule Md

Department of Emergency Medicine Faculty Papers

BACKGROUND: Out-of-hospital emergency care is at an early stage of development in Armenia, with the current emergency medical services (EMS) system having emergency physicians (EPs) work on ambulances along with nurses. While efforts are underway by the Ministry of Health and other organizations to reform the EMS system, little data exists on the status of pediatric emergency care (PEC) in the country. We designed this study to evaluate the knowledge and attitudes of out-of-hospital emergency physicians in pediatric rapid assessment and resuscitation, and identify areas for PEC improvement.

METHODS: We distributed an anonymous, self-administered Knowledge and Attitudes survey to a …

A Cross Sectional Study Of Medical Student Knowledge Of Evidence Based Medicine As Measured By The Fresno Test Of Evidence Based Medicine, Lauren Semler Ms, Elizabeth Rehman, Zachary Haddad Bs, Katie Ahmadzadeh Do, Steven J. Crellin Do, Katarzyna Falkowska Do, Kalif Kendig Do, Brent H. Steinweg Do, Amy B. Smith Phd, Bryan G. Kane Md

Department of Emergency Medicine

No abstract provided.

Comparison Of Airway Intubation Devices When Using A Biohazard Suit: A Feasibility Study, Kevin Weaver Do, Kayla R. Long Do, Gavin C. Barr Jr. Md, Jeffery P. Reboul Do, Aaron S. Ratner Do, Leonel Diaz Jr.,Do, Dougals A. Sturm Do, Bernadette Glenn-Porter Bs, Marna R. Greenberg Do, Mph, Facep, Bryan G. Kane Md

Department of Emergency Medicine

No abstract provided.

Wearable Technology In Obstetrical Emergency Simulation: A Pilot Study, Jami Goodwin, Rayan A. Elkattah, Martin Olsen

International Journal of Health Sciences Education

Background: Medical student involvement in clinical care of obstetrical emergencies is limited. Wearable technology, namely Google Glass, has been used to enhance the simulation experience for trainees at our institution. We present a pilot study that examines the utility of this technology in medical students’ education through remotely-conducted exercises in obstetric emergencies.

Materials & Methods: A total of thirteen medical students accepted the opportunity to participate in an obstetric emergencies training exercise with remote monitoring. Students wore the Google Glass device while participating in two simulated obstetrical emergencies: shoulder dystocia and vaginal breech delivery. A remote instructor monitored the students’ …

Curcumin-Induced Heme Oxygenase-1 Expression Prevents H2o2-Induced Cell Death In Wild Type And Heme Oxygenase-2 Knockout Adipose-Derived Mesenchymal Stem Cells., Niels A J Cremers, Ditte M S Lundvig, Stephanie C M Van Dalen, Rik F Schelbergen, Peter L E M Van Lent, Walter A Szarek, Raymond F. Regan, Carine E Carels, Frank A D T G Wagener

Department of Emergency Medicine Faculty Papers

Mesenchymal stem cell (MSC) administration is a promising adjuvant therapy to treat tissue injury. However, MSC survival after administration is often hampered by oxidative stress at the site of injury. Heme oxygenase (HO) generates the cytoprotective effector molecules biliverdin/bilirubin, carbon monoxide (CO) and iron/ferritin by breaking down heme. Since HO-activity mediates anti-apoptotic, anti-inflammatory, and anti-oxidative effects, we hypothesized that modulation of the HO-system affects MSC survival. Adipose-derived MSCs (ASCs) from wild type (WT) and HO-2 knockout (KO) mice were isolated and characterized with respect to ASC marker expression. In order to analyze potential modulatory effects of the HO-system on ASC …

When Exercise Is A Pain In The Head, Rebecca D. Granger

Nursing Student Class Projects (Formerly MSN)

Headache is one of the five most common chief complaints in the US, resulting in nearly 5 million visits to the ED (Lange, 2011). With great variance in quality, etiology, pathophysiology, and as a potential indicator of a serious underlying problem, it is critical that these headaches be accurately diagnosed, primarily for rapid identification of life threatening factors, but also to offer treatment and education specific to the particular type of headache the patient is experiencing. This will result in better outcomes for the patient through better control and will subsequently save health care dollars by reducing ED visits and …

Troponin Leak Associated With Drug-Induced Methemoglobinemia., Robert D. Cannon Do, Michael Wagner, Jeanne L. Jacoby Md

Department of Emergency Medicine

Drug-induced methemoglobinemia is a well-described entity but has not been previously associated with elevated troponins in the absence of cardiac symptoms. We report a case of a patient presenting to the emergency department (ED) with complaints related to an exacerbation of her long-standing cystitis. A low pulse oximetry reading prompted an evaluation, revealing a troponin leak, which peaked at 10 hours. Her methemoglobin level was found to be elevated at 11.4%, but a preexisting anemia apparently prevented the clinical recognition of cyanosis. The methemoglobinemia was determined to be secondary to her ingestion of phenazopyridine and trimethoprim-sulfa methoxizole. Although phenazopyridine and …

Development Of A Fatal Noncompressible Truncal Hemorrhage Model With Combined Hepatic And Portal Venous Injury In Normothermic Normovolemic Swine, Ujwal R. Yanala, Jason M. Johanning, Iraklis I. Pipinos, Gustavo F. Larsen, William H. Velander, Mark A. Carlson

William H. Velander Publications

Noncompressible truncal hemorrhage and brain injury currently account for most early mortality of warfighters on the battlefield. There is no effective treatment for noncompressible truncal hemorrhage, other than rapid evacuation to a surgical facility. The availability of an effective field treatment for noncompressible truncal hemorrhage could increase the number of warfighters salvaged from this frequently-lethal scenario. Our intent was to develop a porcine model of noncompressible truncal hemorrhage with a ,50% one-hour mortality so that we could develop new treatments for this difficult problem. Normovolemic normothermic domestic swine (barrows, 3 months old, 34–36 kg) underwent one of three injury types …

Neuroprotective Effect Of Heme Oxygenase-2 Knockout In The Blood Injection Model Of Intracerebral Hemorrhage., Jing Chen-Roetling, Ying Cai, Raymond F Regan

Department of Emergency Medicine Faculty Papers

BACKGROUND: The toxicity of heme breakdown products may contribute to the pathogenesis of intracerebral hemorrhage (ICH). Heme catabolism is catalyzed by the heme oxygenase enzymes. We have previously reported that heme oxygenase-2 (HO-2), the constitutive isoform, protects neurons from hemin in vitro and reduces oxidative stress after striatal blood injection. In order to further evaluate HO-2 as a therapeutic target, we tested the hypothesis that HO-2 gene deletion protects neurons and attenuates behavioral deficits after ICH.

FINDINGS: Injection of 20 μl blood into the right striatum of HO-2 wild-type mice resulted in loss of approximately one third of striatal neurons …

Hypertensive Crisis, Burden, Management, And Outcome At A Tertiary Care Center In Karachi, Aysha Almas, Ayaz Ghouse, Ahmed Raza Iftikhar, Munawar Khursheed

Department of Medicine

Objectives:. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi.
Methods: This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included.
Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) …

Evaluation Of An Emergency Department Lean Process Improvement Program To Reduce Length Of Stay, Marian J. Vermeulen, Therese A. Stukel, Astrid Guttmann, Brian H. Rowe

Dartmouth Scholarship

In recent years, lean principles have been applied to improve wait times in the emergency department (ED). In 2009, an ED process improvement program based on lean methods was introduced in Ontario as part of a broad strategy to reduce ED length of stay and improve patient flow. This study seeks to determine the effect of this program on ED wait times and quality of care. We conducted a retrospective cohort study of all ED visits at program and control sites during 3 program waves from April 1, 2007, to June 30, 2011, in Ontario, Canada. Time series analyses of …

Death Of A Child In The Emergency Department., American Academy Of Pediatrics Committee On Pediatric Emergency Medicine, American College Of Emergency Physicians Pediatric Emergency Medicine Committee, Emergency Nurses Association Pediatric Committee, Gregory P. Conners

Manuscripts, Articles, Book Chapters and Other Papers

The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association have collaborated to identify practices and principles to guide the care of children, families, and staff in the challenging and uncommon event of the death of a child in the emergency department in this policy statement and in an accompanying technical report.

Death Of A Child In The Emergency Department., Patricia O'Malley, Isabel Barata, Sally Snow, American Academy Of Pediatrics Committee On Pediatric Emergency Medicine, American College Of Emergency Physicians Pediatric Emergency Medicine Committee, Gregory P. Conners

Manuscripts, Articles, Book Chapters and Other Papers

The death of a child in the emergency department (ED) is one of the most challenging problems facing ED clinicians. This revised technical report and accompanying policy statement reaffirm principles of patient- and family-centered care. Recent literature is examined regarding family presence, termination of resuscitation, bereavement responsibilities of ED clinicians, support of child fatality review efforts, and other issues inherent in caring for the patient, family, and staff when a child dies in the ED. Appendices are provided that offer an approach to bereavement activities in the ED, carrying out forensic responsibilities while providing compassionate care, communicating the news of …

Psychiatric Boarding In U.S. Eds: A Multifactorial Problem That Requires Multidisicplinary Solutions, Zaynah Abid, Andrew C. Meltzer, Danielle Lazar, Jesse M. Pines

Center for Health Care Quality

ED visits for psychiatric conditions make up an ever-increasing share of all ED visits. Patients with psychiatric complaints have a significantly greater length-of-stay in the ED than patients with non-psychiatric complaints. Prolonged boarding in the ED for psychiatric patients is associated with lower quality care for psychiatric patients and further contributes to overall ED crowding.

Understanding Non-Emergent Pediatric Ed Visits: Using Hospital And Family Centric Data To Inform System Redesign, Deborah Swavely Dnp, Rn, Kathy Baker Mph, Rn, Krista L. Bilger Bsn, Rn, David Zimmerman Mph, Andrew Martin Msn, Rn

Department of Community Health and Health Studies

No abstract provided.

Clinical Management Of Skin And Soft Tissue Infections In The U.S. Emergency Departments, Rakesh Mistry, Daniel J. Shapiro, Monika Goyal, Theoklis Zaoutis, Jeffrey Gerber, Catherine Liu, Adam L. Hersh

Emergency Medicine Faculty Publications

Community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) has emerged as the most common cause of skin and soft-tissue infections (SSTI) in the United States. A nearly three-fold increase in SSTI visit rates had been documented in the nation's emergency departments (ED). The objective of this study was to determine characteristics associated with ED performance of incision and drainage (I+D) and use of adjuvant antibiotics in the management of skin and soft tissue infections (SSTI).

METHODS:

Cross-sectional study of the National Hospital Ambulatory Medical Care Survey, a nationally representative database of ED visits from 2007-09. Demographics, rates of I+D, and adjuvant antibiotic …

Predictors Of Hospitalization Among Newly Admitted Skilled Nursing Facility Residents: Rethinking The Role Of Functional Decline, Sun J. Kim, Joo H. Lee, Shunichi Nakagawa, Elizabeth Bukowy, Ankoor Biswas, Boram Han, Yeilim Cho, Hyun Phil Shin, Ji Won Yoo

Journal of Patient-Centered Research and Reviews

Purpose: Hospital transfer from a skilled nursing facility (SNF) is costly, and many are potentially preventable. This study examines: 1) whether functional decline is a predictor of hospital transfer, and 2) the magnitude of relationships between predictors (functional impairment and chronic medical illness) and hospital transfer from SNFs.

Methods: We used Minimum Data Set (MDS) Version 2.0 in the state of Michigan between 2007 and 2009. In total, 196,662 new SNF admissions were observed. Multilevel generalized estimating equations and regression models were performed for each functional and clinical domain while adjusting for demographic variables and change in activities of daily …

Pediatric Care Recommendations For Freestanding Urgent Care Facilities., Committee On Pediatric Emergency Medicine, Gregory P. Conners

Manuscripts, Articles, Book Chapters and Other Papers

Treatment of children at freestanding urgent care facilities has become common in pediatric health care. Well-managed freestanding urgent care facilities can improve the health of the children in their communities, integrate into the medical community, and provide a safe, effective adjunct to, but not a replacement for, the medical home or emergency department. Recommendations are provided for optimizing freestanding urgent care facilities' quality, communication, and collaboration in caring for children.

Real-Time Patient Satisfaction Of Emergency Department Services In A Tertiary-Care Hospital In Karachi, Pakistan, Munawar Khursheed, Jabeen Fayyaz, Nukhba Zia, Asher Feroze, Ahsan Jamil, Syed Muhammad Baqir

Department of Emergency Medicine

Background:

In Emergency Department (ED), patient satisfaction is an important quality indicator. The aim of this study was to assess the patient satisfaction with ED services using real- time patient satisfaction survey.

Methods:

The study was conducted for two weeks in the ED of Aga Khan University in December 2011. A structured questionnaire was used to capture patient’s feedback on service quality in the ED. Patient response was recorded using five-level Likert scale; strongly agree, agree, neutral, disagree and strongly disagree. Respondents were either patients or their relatives.

Results:

Total 348 real-time survey forms were completed. Of these 18.6% …

Perceived Mechanical Fall Risk And Openness To Communication With Providers, Marna R. Greenberg Do, Mph, Facep, Michael Nguyen Md, Brian Stello Md, Robert D. Barraco Md, Arnold R. Goldberg Md, Colin L. Donnelly Do, Benjamin R. Preiss Do, Bernadette Gl-Porter Bs, Anita Kurt Phd, Rn, Bryan G. Kane Md

Department of Emergency Medicine

No abstract provided.

Palliative Medicine Competency Education In Emergency Medicine Residency Training: A Preliminary Report, Chadd K. Kraus Do, Mph, Matthew Meyers Bs, Bryan G. Kane Md, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Gender Differences In Cardiac Arrest Survivors Who Receive Therapeutic Hypothermia (Poster), Marna R. Greenberg Do, Mph, Facep, Amy M. Ahnert Md, Nainesh C. Patel Md, Courtney Bennett Do, Nicole Elliott Do, Mark Lundquist, Andrew C. Miller Do, Ellina C. Feiner Md, Anita Kurt Phd, Rn, Bernadette Gl-Porter Bs, Mercedes Rios-Scott Bs, David B. Burmeister Do, Facep

Department of Emergency Medicine

No abstract provided.

The Effect Of Triage-Based Application Of The Ottawa Ankle And Foot Rules (Oar/Ofr) On The Number Of Radiographs Ordered: A Pilot Study, John V. Ashurst Do, Stephanie Digiambattista Md, Thomas M. Nappe Do, Avinash Kambhampati Do, Sarfraz Alam, Michele Ortiz Rn, Paul Delpais Bsn, Rn, Cen, Bernadette Gl-Porter Bs, Anita Kurt Phd, Rn, Bryan G. Kane Md, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Utility Of Pelvic Examination In Lower Abdominal Pain Without Vaginal Complaints, L. Sharan, J. Chien, T. Maiers, Wb Lau

Sigma Xi Student Research Day

Abstract

Abdominal pain is the most common presenting ED complaint. ED texts advocate speculum bimanual pelvic exam to differentiate pathology of abdominal versus pelvic etiology in women of childbearing age. However, the exam is invasive and requires significant ED resources. We hypothesize that routine pelvic exams of females complaining of abdominal pain without vaginal complaints in the ED does not alter clinical management. We performed a retrospective observational study of ED patients in an urban Level 1 trauma center for all non-pregnant women seen from January 2013 to July 2013, aged 18-50, with a chief complaint of isolated lower abdominal …

Redefining Frequent Emergency Department Users, Amy Waldner, Maria Raven, Danielle Lazar, Jesse Pines

Center for Health Care Quality

Frequent ED users are perceived to be a costly population that often abuse or misuse ED services due to a combination of unmet social needs and medical conditions that, in theory, could be treated outside of the ED at a lower cost. The reality is that factors contributing to frequent ED use are more varied and complex than originally believed.

Withholding Or Termination Of Resuscitation In Pediatric Out-Of-Hospital Traumatic Cardiopulmonary Arrest., American College Of Surgeons Committee On Trauma, American College Of Emergency Physicians Pediatric Emergency Medicine Committee, National Association Of Ems Physicians, American Academy Of Pediatrics Committee On Pediatric Emergency Medicine,, Mary E. Fallat, Gregory P. Conners

Manuscripts, Articles, Book Chapters and Other Papers

This multiorganizational literature review was undertaken to provide an evidence base for determining whether recommendations for out-of-hospital termination of resuscitation could be made for children who are victims of traumatic cardiopulmonary arrest. Although there is increasing acceptance of out-of-hospital termination of resuscitation for adult traumatic cardiopulmonary arrest when there is no expectation of a good outcome, children are routinely excluded from state termination-of-resuscitation protocols. The decision to withhold resuscitative efforts in a child under specific circumstances (decapitation or dependent lividity, rigor mortis, etc) is reasonable. If there is any doubt as to the circumstances or timing of the traumatic cardiopulmonary …

Ct Scan In Children With Acute Bacterial Meningitis: Experience From Emergency Department Of A Tertiary-Care Hospital In Karachi, Pakistan, Jabeen Fayyaz, Arshalooz Rehman, Akhter Hamid, Munawar Khursheed, Nukhba Zia, Asher Feroze, Uzma R. Khan

Department of Emergency Medicine

Objective: To determine the role of computed tomography scan in children presenting to emergency department with symptoms and signs of suspected acute bacterial meningitis.

Methods: The retrospective analysis was done on children who were admitted through the Emergency Department at Aga Khan University Hospital, Karachi, from September 2009 to September 2011 with the diagnosis of acute bacterial meningitis. Information related to age, gender, presenting complaints, clinical signs and symptoms, computed tomography scan findings and final outcome of patients was gathered from the medical records. SPSS 19 was used for statistical analysis.

Results: A total of 192 patients were admitted with …

Quality Of Emergency Departments In Amman Evaluated By The Availability Of Essential Emergency Equipment, Seif Laeth Sari Nasir

Independent Study Project (ISP) Collection

The present study aims to determine the quality of emergency health care in Jordan by assessing the availability of essential emergency equipment in emergency departments in Amman. This study uses a cross-­‐sectional questionnaire assessing the accessibility of equipment and medication in emergency departments, as well as eliciting the opinions of the participants regarding the future development of the emergency medical sector in Jordan. The questionnaires were distributed to the physician directors of every participating hospital emergency department in Amman, and completed by the physician director excepting two cases, one of which was completed by the head staff nurse, and the …