Emergency Medicine Commons^™

Aging Aggravates Nitrate-Mediated Ros/Rns Changes., Qian Fan, Lifen Chen, Shujuan Cheng, Fang Li, Wayne Bond Lau, Le Feng Wang, Jing Hua Liu

Department of Emergency Medicine Faculty Papers

Nitrates are the most frequently prescribed and utilized drugs worldwide. The elderly are a major population receiving nitrate therapy. Both nitrates and aging can increase in vivo reactive oxygen species (ROS) and reactive nitrogen species (RNS). To date, the effects of aging upon nitrate-induced ROS/RNS alteration are unknown. The present study tested the effects of aging upon nitrate-induced ROS/RNS alteration in vivo. 32 adults and 43 elderly unstable angina (UA) patients were subjected to 48 hours of isosorbide dinitrate intravenous injection (50  μg/minutes) in this clinical study. Blood samples were obtained at baseline and conclusion. Outcome measures of oxidative stress …

Trends In Antibiotic Resistance In Coagulase-Negative Staphylococci In The United States, 1999 To 2012, Larissa S. May, Eili Y. Klein, Richard E. Rothman, Ramanan Laxminarayan

Emergency Medicine Faculty Publications

Coagulase-negative staphylococci (CoNS) are important bloodstream pathogens that are typically resistant to multiple antibiotics. Despite the concern about increasing resistance, there have been no recent studies describing the national prevalence of CoNS pathogens. We used national resistance data over a period of 13 years (1999 to 2012) from The Surveillance Network (TSN) to determine the prevalence of and assess the trends in resistance for Staphylococcus epidermidis, the most common CoNS pathogen, and all other CoNS pathogens. Over the course of the study period, S. epidermidis resistance to ciprofloxacin and clindamycin increased steadily from 58.3% to 68.4% and from 43.4% to …

Uchunguzi (Journal Watch/Montre De Journal) March 2014, Benjamin Wachira

Family Medicine, East Africa

Uchunguzi means investigation in Swahili and provides a summary of some of the most recent international literature as presented in other leading journals, but with an emphasis on what is relevant to our continent.

Emergency Department Length Of Stay: Accuracy Of Patient Estimates, Brendan T. Parker, Catherine A. Marco

Emergency Medicine Faculty Publications

Introduction

Managing a patient’s expectations in the emergency department (ED) environment is challenging. Previous studies have identified several factors associated with ED patient satisfaction. Lengthy wait times have shown to be associated with dissatisfaction with ED care. Understanding that patients are inaccurate at their estimation of wait time, which could lead to lower satisfaction, provides administrators possible points of intervention to help improve accuracy of estimation and possibly satisfaction with the ED. This study was undertaken to examine the accuracy of patient estimates of time periods in an ED and identify factors associated with accuracy.

Method

In this prospective convenience …

Age Related Clinical Manifestation Of Acute Bacterial Meningitis In Children, Jabeen Fayyaz, Arshalooz Rehman, Akhter Hamid, Munawar Khursheed, Nukhbha Zia, Asher Feroze

Department of Emergency Medicine

Objective: To determine the signs and symptoms of acute bacterial meningitis (ABM) in different age grops of a paediatric population.

Methods: The retrospective study comprised patients who had been admitted through the Emergency Department of Aga Khan University Hospital, Karachi with the relevant diagnosis from September 2009 to September 2011. Case record forms were used to collect data from patient files. Data was collected using variables such as age, gender, presenting complaints, clinical signs and symptoms, computed tomography scan findings and final outcome of patients. There was a minimal risk of breach in patient confidentiality. SPSS 19 was used for …

Gender Differences In Perceptions And Self-Reported Driving Behaviors Among Teenagers. (Poster), Gavin C. Barr Jr. Md, Kathleen E. Kane Md, Robert D. Barraco Md, Timarie Rayburg Do, Lauren Dugan Do, Chadd K. Kraus Do, Mph, Marna R. Greenberg Do, Mph, Facep, Valerie Rupp Rn, Bsn, Kimberly Hamilton, Bryan G. Kane Md

Department of Emergency Medicine

No abstract provided.

A Statewide Survey Of Institutional Trauma Human Resource Allocation And Associated Patient Mortality, Bryan G. Kane Md, Quincy Gerrald Do, Catherine Fischer Do, Kevin Vong Do, Mary Sibley Do, Justin Binstead Do

Department of Emergency Medicine

No abstract provided.

Does Destination Determine Destiny? A Statewide Analysis Of Trauma Center Mortality, Bryan G. Kane Md, Quincy Gerrald Do, Catherine Fischer Do, Kevin Vong Do, Mary Sibley Do, Justin Binstead Do

Department of Emergency Medicine

No abstract provided.

Introduction Of Evidence-Based Diagnostic Order Sets In An Electronic Medical Record Is Associated With An Increase In Laboratory Orders, Bryan G. Kane Md, Justin Arnold Do, Joshua Morrison Do, Ryan Southworth Do, William Greenhut Do, Will Russell Do, Jeremy Selley Do, Michael Stanley Do

Department of Emergency Medicine

No abstract provided.

Irf8 Suppresses Pathological Cardiac Remodelling By Inhibiting Calcineurin Signalling., Ding-Sheng Jiang, Xiang Wei, Xiao-Fei Zhang, Yu Liu, Yan Zhang, Ke Chen, Lu Gao, Heng Zhou, Xue-Hai Zhu, Peter P. Liu, Wayne Bond Lau, Xin-Liang Ma, Yunzeng Zou, Xiao-Dong Zhang, Guo-Chang Fan, Hongliang Li

Department of Emergency Medicine Faculty Papers

Interferon regulatory factor 8 (IRF8) is known to affect the innate immune response, for example, by regulating the differentiation and function of immune cells. However, whether IRF8 can influence cardiac hypertrophy is unknown. Here we show that IRF8 levels are decreased in human dilated/hypertrophic cardiomyopathic hearts and in murine hypertrophic hearts. Mice overexpressing Irf8 specifically in the heart are resistant to aortic banding (AB)-induced cardiac hypertrophy, whereas mice lacking IRF8 either globally or specifically in cardiomyocytes develop an aggravated phenotype induced by pressure overload. Mechanistically, we show that IRF8 directly interacts with NFATc1 to prevent NFATc1 translocation and thus inhibits …

Rota Virus Diarrhea In Hospitalized Children, Muhammad Irfan Habib, Sayyeda Ghazala Kazi, Khalid Mehmood Ahmed Khan, Nukhba Zia

Department of Emergency Medicine

Objective: To determine the frequency and clinical features of Rota virus diarrhea in children presenting in a tertiary care hospital.

Study Design: A cross-sectional, observational study.

Place and Duration of Study: National Institute of Child Health, Karachi, from January to June 2007.

Methodology: A total of three hundred children of either gender aged 1 month to 5 years, who presented with diarrhea of < 7 days as a primary illness were enrolled. Children with bloody diarrhea or nosocomial gastroenteritis acquired duringhospitalization for other disease were not included. Detection of Rota virus in stool was done by enzyme linked immunoassay.

Results: Out of 300 children, 188 (63%) tested positive and 112 (37%) tested negative for Rota virus. Positive Rota virus cases in 7 – 12 months of age was (n = 34, 18.08%). Overall, 151 (80.3%) children …

Social Media Guidelines And Best Practices: Recommendations From The Council Of Residency Directors Social Media Task Force., Malford T Pillow, Laura Hopson, Michael Bond, Daniel Cabrera, Leigh Patterson, David Pearson, Harsh P. Sule Md, Felix Ankel, Madonna Fernández-Frackelton, R. Hall, Jason A Kegg, Donald Norris, Katrin Takenaka

Department of Emergency Medicine Faculty Papers

Social media has become a staple of everyday life among over one billion people worldwide. A social networking presence has become a hallmark of vibrant and transparent communications. It has quickly become the preferred method of communication and information sharing. It offers the ability for various entities, especially residency programs, to create an attractive internet presence and "brand" the program. Social media, while having significant potential for communication and knowledge transfer, carries with it legal, ethical, personal, and professional risks. Implementation of a social networking presence must be deliberate, transparent, and optimize potential benefits while minimizing risks. This is especially …

Management Of Benign Paroxysmal Positional Vertigo: A Randomized Controlled Trial, Regina Sacco Dpt, Ba, Bhsc, David B. Burmeister Do, Facep, Valerie Rupp Rn, Bsn, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is a common presenting problem.

OBJECTIVE: Our aim was to compare the efficacy of vestibular rehabilitation (maneuver) vs. conventional therapy (medications) in patients presenting to the emergency department (ED) with BPPV.

METHODS: This was a prospective, single-blinded physician, randomized pilot study comparing two groups of patients who presented to the ED with a diagnosis of BPPV at a Level 1 trauma center with an annual census of approximately 75,000. The first group received standard medications and the second group received a canalith repositioning maneuver. The Dizziness Handicap Inventory was used to measure symptom resolution. …

Early Quick Acuity Score Provides More Complete Data On Emergency Department Walkouts., Paris B Lovett, Md, J Akiva Kahn, Md, Stuart E Greene, Md, Matthew A Bloch, Md, Daniel R Brandt, Md, Michael R Minckler, Md

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Many prior studies have compared the acuity of Emergency Department (ED) patients who have Left Without Being Seen (LWBS) against non-LWBS patients. A weakness in these studies is that patients may walk out prior to the assignment of a triage score, biasing comparisons. We report an operational change whereby acuity was assessed immediately upon patient arrival. We hypothesized more patients would receive acuity scores with EQAS. We also sought to compare LWBS and non-LWBS patient characteristics with reduced bias.

SETTING: urban, academic medical center. Retrospective cohort study, electronic chart review, collecting data on all ED patients presenting between 4/1/2010 …

Sideline Coverage: When To Get Radiographs? A Review Of Clinical Decision Tools, S. J. Gould, D. A. Cardone, J. Munyak, P. J. Underwood, S. A. Gould

Journal Articles

CONTEXT: Sidelines coverage presents unique challenges in the evaluation of injured athletes. Health care providers may be confronted with the question of when to obtain radiographs following an injury. Given that most sidelines coverage occurs outside the elite level, radiographs are not readily available at the time of injury, and the decision of when to send a player for radiographs must be made based on physical examination. Clinical tools have been developed to aid in identifying injuries that are likely to result in radiographically important fractures or dislocations. EVIDENCE ACQUISITION: A search for the keywords x-ray and decision rule along …

Effect Of Clinical Decision Support On Documented Guideline Adherence For Head Ct In Emergency Department Patients With Mild Traumatic Brain Injury, A. Gupta, I. K. Ip, A. S. Raja, J. E. Andruchow, A. Sodickson, R. Khorasani

Journal Articles

Imaging utilization in emergency departments (EDs) has increased significantly. More than half of the 1.2 million patients with mild traumatic brain injury (MTBI) presenting to US EDs receive head CT. While evidence-based guidelines can help emergency clinicians decide whether to obtain head CT in these patients, adoption of these guidelines has been highly variable. Promulgation of imaging efficiency guidelines by the National Quality Forum has intensified the need for performance reporting, but measuring adherence to these imaging guidelines currently requires labor-intensive and potentially inaccurate manual chart review. We implemented clinical decision support (CDS) based on published evidence to guide emergency …

Examining Clinical Decision Support Integrity: Is Clinician Self-Reported Data Entry Accurate?, A. Gupta, A. S. Raja, R. Khorasani

Journal Articles

The aim of this study was to assess the accuracy of clinician-entered data in imaging clinical decision support (CDS). We used CDS-guided CT angiography (CTA) for pulmonary embolus (PE) in the emergency department as a case example because it required clinician entry of d-dimer results which could be unambiguously compared with actual laboratory values. Of 1296 patients with CTA orders for suspected PE during 2011, 1175 (90.7%) had accurate d-dimer values entered. In 55 orders (4.2%), incorrectly entered data shielded clinicians from intrusive computer alerts, resulting in potential CTA overuse. Remaining data entry errors did not affect user workflow. We …

The Hmgb1/Rage Inflammatory Pathway Promotes Pancreatic Tumor Growth By Regulating Mitochondrial Bioenergetics, R. Kang, D. Tang, N. E. Schapiro, T. Loux, K. M. Livesey, T. R. Billiar, H. Wang, B. Van Houten, M. T. Lotze, H. J. Zeh

Journal Articles

Tumor cells require increased adenosine triphosphate (ATP) to support anabolism and proliferation. The precise mechanisms regulating this process in tumor cells are unknown. Here, we show that the receptor for advanced glycation endproducts (RAGE) and one of its primary ligands, high-mobility group box 1 (HMGB1), are required for optimal mitochondrial function within tumors. We found that RAGE is present in the mitochondria of cultured tumor cells as well as primary tumors. RAGE and HMGB1 coordinately enhanced tumor cell mitochondrial complex I activity, ATP production, tumor cell proliferation and migration. Lack of RAGE or inhibition of HMGB1 release diminished ATP production …

A Consensus Parameter For The Evaluation And Management Of Angioedema In The Emergency Department, J. J. Moellman, J. A. Bernstein, C. Lindsell, A. Banerji, P. J. Busse, C. A., Jr. Camargo, S. P. Collins, R. L. Campbell, S. Schneider, R. Sinert, +10 Additional Authors

Journal Articles

Despite its relatively common occurrence and life-threatening potential, the management of angioedema in the emergency department (ED) is lacking in terms of a structured approach. It is paramount to distinguish the different etiologies of angioedema from one another and more specifically differentiate histaminergic-mediated angioedema from bradykinin-mediated angioedema, especially in lieu of the more novel treatments that have recently become available for bradykinin-mediated angioedema. With this background in mind, this consensus parameter for the evaluation and management of angioedema attempts to provide a working framework for emergency physicians (EPs) in approaching the patient with angioedema in terms of diagnosis and management …

Hmgb1 In Health And Disease, R. Kang, R. C. Chen, Q. H. Zhang, W. Hou, S. Wu, X. G. Fan, Z. W. Yan, X. F. Sun, H. C. Wang, D. L. Tang, +8 Additional Authors

Journal Articles

Complex genetic and physiological variations as well as environmental factors that drive emergence of chromosomal instability, development of unscheduled cell death, skewed differentiation, and altered metabolism are central to the pathogenesis of human diseases and disorders. Understanding the molecular bases for these processes is important for the development of new diagnostic biomarkers, and for identifying new therapeutic targets. In 1973, a group of non-histone nuclear proteins with high electrophoretic mobility was discovered and termed high-mobility group (HMG) proteins. The HMG proteins include three superfamilies termed HMGB, HMGN, and HMGA. High-mobility group box 1 (HMGB1), the most abundant and well-studied HMG …

Gender Differences In Acute And Chronic Pain In The Emergency Department: Results Of The 2014 Academic Emergency Medicine Consensus Conference Pain Section, P. I. Musey, S. D. Linnstaedt, T. F. Platts-Mills, J. R. Miner, A. V. Bortsov, D. C. Lee, C. S. Nam, R. G. Patel, R. B. Fillingim, S. A. Mclean, +12 Additional Authors

Journal Articles

Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas, in May 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine …

The Use Of Decision Support To Measure Documented Adherence To A National Imaging Quality Measure, A. S. Raja, A. Gupta, I. K. Ip, A. M. Mills, R. Khorasani

Journal Articles

RATIONALE AND OBJECTIVES: Present methods for measuring adherence to national imaging quality measures often require a resource-intensive chart review. Computerized decision support systems may allow for automated capture of these data. We sought to determine the feasibility of measuring adherence to a national quality measure (NQM) regarding computed tomography pulmonary angiograms (CTPAs) for pulmonary embolism using measure-targeted clinical decision support and whether the associated increased burden of data captured required by this system would affect the use and yield of CTs. MATERIALS AND METHODS: This institutional review board-approved prospective cohort study enrolled patients from September 1, 2009, through November 30, …

No Man Is An Island: Living In A Disadvantaged Neighborhood Influences Chronic Pain Development After Motor Vehicle Collision, J. C. Ulirsch, M. A. Weaver, A. V. Bortsov, A. C. Soward, R. A. Swor, D. A. Peak, J. S. Jones, N. K. Rathlev, D. C. Lee, S. A. Mclean, +2 Additional Authors

Journal Articles

Living in a lower socioeconomic status neighborhood has been shown to alter stress system function and is associated with a number of adverse health outcomes, but its influence on musculoskeletal pain (MSP) outcomes after traumatic stress exposures such as motor vehicle collision (MVC) has not been assessed. We performed a multicenter, prospective study that enrolled 948 European-American individuals within 24 hours of MVC who were discharged home after emergency department evaluation. Follow-up evaluations were completed via telephone or Internet survey 6 weeks, 6 months, and 1 year after MVC on 91%, 89%, and 91% of participants, respectively. A robust aggregate …

Targeting Hmgb1 In The Treatment Of Sepsis, H. C. Wang, M. F. Ward, A. E. Sama

Journal Articles

Introduction: Sepsis refers to the host's deleterious and non-resolving systemic inflammatory response to microbial infections and represents the leading cause of death in the intensive care unit. The pathogenesis of sepsis is complex, but partly mediated by a newly identified alarmin molecule, the high mobility group box 1 (HMGB1). Areas covered: Here we review the evidence that support extracellular HMGB1 as a late mediator of experimental sepsis with a wider therapeutic window and discuss the therapeutic potential of HMGB1-neutralizing antibodies and small molecule inhibitors (herbal components) in experimental sepsis. Expert opinion: It will be important to evaluate the efficacy of …

Pkm2 Regulates The Warburg Effect And Promotes Hmgb1 Release In Sepsis, L. C. Yang, M. Xie, M. H. Yang, Y. Yu, S. Zhu, M. T. Lotze, T. R. Billiar, H. C. Wang, L. Z. Cao, D. L. Tang, +2 Additional Authors

Journal Articles

Increasing evidence suggests the important role of metabolic reprogramming in the regulation of the innate inflammatory response, but the underlying mechanism remains unclear. Here we provide evidence to support a novel role for the pyruvate kinase M2 (PKM2)-mediated Warburg effect, namely aerobic glycolysis, in the regulation of high-mobility group box 1 (HMGB1) release. PKM2 interacts with hypoxia-inducible factor 1 alpha (HIF1 alpha) and activates the HIF-1 alpha-dependent transcription of enzymes necessary for aerobic glycolysis in macrophages. Knockdown of PKM2, HIF1 alpha and glycolysis-related genes uniformly decreases lactate production and HMGB1 release. Similarly, a potential PKM2 inhibitor, shikonin, reduces serum lactate …

Intraperitoneal Administration Of Fetuin-A Attenuates D-Galactosamine/Lipopolysaccharide-Induced Liver Failure In Mouse, P. Zhang, H. Shen, J. L. Huang, H. C. Wang, B. X. Zhang, R. R. Zhou, B. Y. Zhong, X. G. Fan

Journal Articles

Fulminant hepatic failure (FHF) is a devastating syndrome, which sometimes results in death or liver transplantation, in which inflammation would aggravate the development of fetuin-A which would act as an anti-inflammatory factor and may be an available approach to attenuate FHF. The purpose of this study was to investigate the effects of fetuin-A on d-galactosamine/lipopolysaccharide (d-GalN/LPS)-induced liver failure in mice. A mouse model of FHF induced by d-GalN/LPS was established and fetuin-A was injected intraperitoneally prior to d-GalN/LPS treatment. At different time points after d-GalN/LPS intervention, serum TNF-alpha and IL-6 levels were measured by ELISA. Fetuin-A mRNA and protein expression …

Effect Of Pain Location And Duration On Life Function In The Year After Motor Vehicle Collision, A. V. Bortsov, T. F. Platts-Mills, D. A. Peak, J. S. Jones, R. A. Swor, D. C. Lee, N. K. Rathlev, P. L. Hendry, R. B. Fillingim, S. A. Mclean, +1 Additional Author

Journal Articles

Persistent musculoskeletal pain is common after motor vehicle collision (MVC) and often results in substantial disability. The objective of this study was to identify distributions of post-MVC pain that most interfere with specific life functions and that have the greatest interference with aggregate life function. Study data were obtained from a prospective longitudinal multicenter emergency department-based cohort of 948 European Americans experiencing MVC. Overall pain (0-10 numeric rating scale [NRS]), pain in each of 20 body regions (0-10 NRS), and pain interference (Brief Pain Inventory, 0-10 NRS) were assessed 6 weeks, 6 months, and 1 year after MVC. After adjustment …

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 Sule

Emergency Medicine Publications

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 …

High Dose Insulin Therapy, An Evidence Based Approach To Beta Blocker/Calcium Channel Blocker Toxicity, Christina Woodward, Ali Pourmand, Maryann Mazer-Amirshahi

Emergency Medicine Faculty Publications

Poison-induced cardiogenic shock (PICS) as a result of beta-blocker (?-blocker) or calcium channel blocker (CCB) overdose is a common and potentially life-threatening condition. Conventional therapies, including fluid resuscitation, atropine, cardiac pacing, calcium, glucagon, and vasopressors often fail to improve hemodynamic status. High-dose insulin (HDI) is an emerging therapeutic modality for PICS. In this article, we discuss the existing literature and highlight the therapeutic success and potential of HDI. Based on the current literature, which is limited primarily to case series and animal models, the authors conclude that HDI can be effective in restoring hemodynamic stability, and recommend considering its use …

Do Emergency Department Patients Receive A Pathological Diagnosis? A Nationally Representative Sample., Leana S. Wen, Janice A. Espinola, Joshua M. Kosowsky, Carlos A. Camargo Jr

Emergency Medicine Faculty Publications

No abstract provided.