Emergency Medicine Commons^™

Intracellular Hmgb1 Inhibits Inflammatory Nucleosome Release And Limits Acute Pancreatitis In Mice, R. Kang, Q. Zhang, W. Hou, Z. Yan, R. Chen, J. Bonaroti, P. Bansal, T. R. Billiar, A. Tsung, Q. Wang, D. L. Bartlett, D. C. Whitcomb, E. B. Chang, X. Zhu, H. Wang, B. Lu, K. J. Tracey, L. Cao, X. G. Fan, M. T. Lotze, H. J., 3rd Zeh, D. Tang

Journal Articles

BACKGROUND & AIMS: High mobility group box 1 (HMGB1) is an abundant protein that regulates chromosome architecture and also functions as a damage-associated molecular pattern molecule. Little is known about its intracellular roles in response to tissue injury or during subsequent local and systemic inflammatory responses. We investigated the function of Hmgb1 in mice after induction of acute pancreatitis. METHODS: We utilized a Cre/LoxP system to create mice with pancreas-specific disruption in Hmbg1 (Pdx1-Cre; HMGB1(flox/flox) mice). Acute pancreatitis was induced in these mice (HMGB1(flox/flox) mice served as controls) after injection of l-arginine or cerulein. Pancreatic tissues and acinar cells were …

Hmgb1-Dna Complex-Induced Autophagy Limits Aim2 Inflammasome Activation Through Rage, L. Y. Liu, M. H. Yang, R. Kang, Y. P. Dai, X. J. Sun, X. L. Li, J. H. Li, H. C. Wang, L. Z. Cao, D. L. Tang, +3 Additional Authors

Journal Articles

High mobility group box 1 (HMGB1) is a prototype damage-associated molecular pattern (DAMP) that can induce inflammatory and immune responses alone as well as in combination with other molecules such as DNA. However, the intricate molecular mechanisms underlying HMGB1-DNA complex-mediated innate immune response remains largely elusive. In this study, we demonstrated that HMGB1-DNA complex initially induced absent in melanoma 2 (AIM2)-dependent inflammasome activation, and promoted rapid release of inflammasome-dependent early proinflammatory cytokines such as interleukin 10 (IL-1 beta). Subsequently, HMGB1 - DNA complex stimulated an ATG5-dependent cellular degradation process, autophagy, which was paralleled by a cessation of AIM2 inflammasome activation …

Molecular Mechanism And Therapeutic Modulation Of High Mobility Group Box 1 Release And Action: An Updated Review, B. Lu, C. Wang, M. Wang, W. Li, F. P. Chen, K. J. Tracey, H. C. Wang

Journal Articles

High mobility group box 1 (HMGB1) is an evolutionarily conserved protein, and is constitutively expressed in virtually all types of cells. Infection and injury converge on common inflammatory responses that are mediated by HMGB1 secreted from immunologically activated immune cells or passively released from pathologically damaged cells. Herein we review the emerging molecular mechanisms underlying the regulation of pathogen-associated molecular patterns (PAMPs)-induced HMGB1 secretion, and summarize many HMGB1-targeting therapeutic strategies for the treatment of infection- and injury-elicited inflammatory diseases. It may well be possible to develop strategies that specifically attenuate damage-associated molecular patterns (DAMPs)-mediated inflammatory responses without compromising the PAMPs-mediated …

Mirror Image Artifact Mimicking Heterotopic Pregnancy On Transvaginal Ultrasound: Case Series, R. Malhotra, R. M. Bramante, M. Radomski, M. Nelson

Journal Articles

Vaginal bleeding in early pregnancy is a common emergency department complaint. Point-of-care ultrasound is a useful tool to evaluate for intrauterine ectopic pregnancy. Emergency physicians performing these studies need to be cognizant of artifacts produced by ultrasound technology, as they can lead to misdiagnosis. We present two cases where mirror-image artifacts initially led to a concern for heterotopic pregnancies but were excluded on further imaging.

Patients In A Private Hospital In India Leave The Emergency Department Against Medical Advice For Financial Reasons, S. Naderi, J. R. Acerra, K. Bailey, P. Mukherji, T. Taraphdar, T. Mukherjee, A. Pal, M. F. Ward, K. Miele, M. Mathias, R. Tan, M. Kline, K. Alagappan, R. Silverman

Journal Articles

BACKGROUND: Some reports indicate financial concerns as a factor affecting ED patients leaving the acute care setting against medical advice (AMA). In India, no person is supposed to be denied urgent care because of inability to pay. Since a large proportion of the Indian health care system is financed by out-of-pocket expenses, we investigate the role of financial constraints for ED patients at a private hospital in India in leaving AMA. METHODS: A prospective ED-based cross-sectional survey of patients leaving AMA was conducted at a private hospital in India from 1 October 2010 to 31 December 2010. Descriptive statistics and …

Case Report: Transient Small Bowel Intussusception Presenting As Right Lower Quadrant Pain In A 6-Year-Old Male, M. J. Nelson, T. Paterson, C. Raio

Journal Articles

In children presenting to the emergency room with right lower quadrant pain, ultrasound is the preferred initial modality. In our patient, a 6-year-old male with a sudden onset of severe right lower quadrant pain, the differential is broad, including appendicitis and intussusception. In order to narrow our differential and secure the diagnosis, our first modality was ultrasonography. With the increased use of point-of-care ultrasound in the emergency department, the diagnosis of appendicitis and ileo-colic intussusception has been made more frequently. In addition, other entities such as transient small bowel intussusception may be identified. As in our case, obstruction secondary to …

Arthroscopic Treatment Of Bucket-Handle Labral Tear And Acetabular Fracture, K. J. Stabile, J. A. Neumann, S. Mannava, E. A. Howse, A. J. Stubbs

Journal Articles

Traumatic hip dislocations are associated with chondral and labral pathology as well as loose bodies that can be incarcerated in the joint. These types of injury often lead to traumatic arthritis. In some cases an osseo-labral fragment may become incarcerated in the joint that is not readily visualized preoperatively. In place of open surgery, hip arthroscopy permits a technique to remove loose bodies and repair labral tears to restore joint congruity and achieve fracture reduction and fixation.

Inhibition Of Extracellular Hmgb1 Attenuates Hyperoxia-Induced Inflammatory Acute Lung Injury, M. Entezari, M. Javdan, D. J. Antoine, D. M. Morrow, R. A. Sitapara, V. Patel, M. Wang, L. Sharma, H. Wang, L. L. Mantell, +7 Additional Authors

Journal Articles

Prolonged exposure to hyperoxia results in acute lung injury (ALI), accompanied by a significant elevation in the levels of proinflammatory cytokines and leukocyte infiltration in the lungs. However, the mechanisms underlying hyperoxia-induced proinflammatory ALI remain to be elucidated. In this study, we investigated the role of the proinflammatory cytokine high mobility group box protein 1 (HMGB1) in hyperoxic inflammatory lung injury, using an adult mouse model. The exposure of C57BL/6 mice to >/=99% O2 (hyperoxia) significantly increased the accumulation of HMGB1 in the bronchoalveolar lavage fluids (BALF) prior to the onset of severe inflammatory lung injury. In the airways of …

Comment On "Effectiveness Of Naltrexone In The Prevention Of Delayed Respiratory Arrest In Opioid-Naive Methadone-Intoxicated Patients'', B. D. Kessler, R. S. Hoffman

Journal Articles

No abstract provided.

Arthroscopic Hip Labral Repair: The Iberian Suture Technique, A. J. Stubbs, J. S. Andersen, S. Mannava, B. M. Wooster, E. A. Howse, S. B. Winter

Journal Articles

Arthroscopic hip labral repair has beneficial short-term outcomes; however, debate exists regarding ideal surgical labral repair technique. This technical note presents an arthroscopic repair technique that uses intrasubstance labral suture passage to restore the chondrolabral interface. This "Iberian suture technique" allows for an anatomic repair while posing minimal risk of damage to the labral and chondral tissues.

Should Osteopathic Students Applying To Allopathic Emergency Medicine Programs Take The Usmle Exam?, M. Weizberg, D. Kass, A. Hussains, J. Cohen, B. Hahn

Journal Articles

INTRODUCTION: Board scores are an important aspect of an emergency medicine (EM) residency application. Residency directors use these standardized tests to objectively evaluate an applicant's potential and help decide whether to interview a candidate. While allopathic (MD) students take the United States Medical Licensing Examination (USMLE), osteopathic (DO) students take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX). It is difficult to compare these scores. Previous literature proposed an equation to predict USMLE based on COMLEX. Recent analyses suggested this may no longer be accurate. DO students applying to allopathic programs frequently ask whether they should take USMLE to overcome this …

Bilateral Hydronephrosis And Cystitis Resulting From, V. H. Tran, M. Nelson, J. Nogar, R. M. Bramante

Journal Articles

Ketamine associated urinary dysfunction has become increasingly more common worldwide. Point-of-care ultrasound (POCUS) is an established modality for diagnosing hydronephrosis in the emergency department. We describe a case of a young male ketamine abuser with severe urinary urgency and frequency in which POCUS performed by the emergency physician demonstrated bilateral hydronephrosis and a focally thickened irregular shaped bladder. Emergency physicians should consider using POCUS evaluate for hydronephrosis and bladder changes in ketamine abusers with lower urinary tract symptoms. The mainstay of treatment is discontinuing ketamine abuse.

Ethical Dilemmas Posed In The Care Of Obese Patients In The Emergency Department, Arvind Venkat, Gregory Luke Larkin

Journal of Health Ethics

The rising prevalence of obesity represents a health care crisis. As the gateway to the health care system, the emergency department is the clinical setting where the difficulties posed by the care of obese patients are heightened. These difficulties include the increasing burden of obesity-related illnesses, the challenges posed in diagnostic evaluation and treatment and the known barriers to access to care seen in this patient population. The limitations posed by obesity on care in the emergency department, the one guaranteed access point for medical treatment, creates a series of ethical dilemmas for emergency physicians and the facilities in which …

Assessing 2 D-Dimer Age-Adjustment Strategies To Optimize Computed Tomographic Use In Ed Evaluation Of Pulmonary Embolism, A. Gupta, A. S. Raja, I. K. Ip, R. Khorasani

Journal Articles

STUDY OBJECTIVE: Validate the sensitivity and specificity of 2 age adjustment strategies for d-dimer values in identifying patients at risk for pulmonary embolism (PE) compared with traditional D-dimer cutoff value (500 ng/mL) to decrease inappropriate computed tomography pulmonary angiography (CTPA) use. METHODS: This institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study included all adult emergency department patients evaluated for PE over a 32-month period (1/1/11-8/30/13). Only patients undergoing CTPA and D-dimer testing were included. We used a validated natural language processing algorithm to parse CTPA radiology reports and determine the presence of acute PE. Outcome measures were …

Incidence And Predictors Of Acute Psychological Distress And Dissociation After Motor Vehicle Collision: A Cross-Sectional Study, G. C. Lewis, T. F. Platts-Mills, I. Liberzon, E. Bair, R. Swor, N. Rathlev, D. Lee, R. Domeier, P. Hendry, S. A. Mclean, +2 Additional Authors

Journal Articles

Objective: We examined the incidence and predictors of peritraumatic distress and dissociation after one of the most common forms of civilian trauma exposure: motor vehicle collision (MVC). Method: In this study, patients presenting to the emergency department after MVCs who were without serious injury and discharged to home after evaluation (n = 935) completed an emergency department interview evaluating sociodemographic, collision-related, and psychological characteristics. Results: The incidence and predictors of distress (Peritraumatic Distress Inventory score 23) and dissociation (Michigan Critical Events Perception Scale score >3) were assessed. Distress was present in 355 of 935 patients (38%), and dissociation was present …

Incidence And Predictors Of Neck And Widespread Pain After Motor Vehicle Collision Among Us Litigants And Nonlitigants, S. A. Mclean, J. C. Ulirsch, G. D. Slade, A. C. Soward, R. A. Swor, D. A. Peak, J. S. Jones, N. K. Rathlev, D. C. Lee, E. Bair, +3 Additional Authors

Journal Articles

Debate continues regarding the influence of litigation on pain outcomes after motor vehicle collision (MVC). In this study we enrolled European Americans presenting to the emergency department (ED) in the hours after MVC (n = 948). Six weeks later, participants were interviewed regarding pain symptoms and asked about their participation in MVC-related litigation. The incidence and predictors of neck pain and widespread pain 6 weeks after MVC were compared among those engaged in litigation (litigants) and those not engaged in litigation (nonlitigants). Among the 859 of 948 (91%) participants completing 6-week follow-up, 711 of 849 (83%) were nonlitigants. Compared to …

Middle Cerebral Artery Arrow Sign, Z. D. Levy, R. E. Temes, A. R. Dehdashti

Journal Articles

No abstract provided.

Westgate Shootings: An Emergency Department Approach To A Mass-Casualty Incident, Benjamin Wachira, Ramadhani Abdalla, Lee Wallis

Emergency Medicine, East Africa

At approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital. This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other …

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

Family Medicine, East Africa

Content: If you want to know how we practised medicine 5 years ago, read a textbook. If you want to know how we practised medicine 2 years ago, read a journal. If you want to know how we practise medicine now, go to a (good) conference. If you want to know how we will practise medicine in the future, listen in the hallways and use FOAM (Joe Lex, 2012). FOAM is free, open-access medical education. As stated in the Hippocratic Oath: “…and to teach them this art – if they desire to learn it – without fee and covenant”, the …

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

Family Medicine, East Africa

No abstract provided.

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

Family Medicine, East Africa

No abstract provided.

Pain Scores Among Ed Patients: Correlation With Desire For Pain Medication, Catherine A. Marco, Megan Mcgervey, Joan Gekonde, Caitlin Martin

Emergency Medicine Faculty Publications

Introduction: Pain has been identified as the most common reason for Emergency Department (ED) visits. The verbal numeric rating pain scale (VNRS) is commonly used to assess pain in the ED. This study was undertaken to determine whether VNRS pain scores correlate with desire for pain medication among ED patients.

Methods: In this prospective survey study, eligible patients included Emergency Department patients over 18 with painful conditions. The primary outcome measures included self-reported VNRS, ED diagnosis, number of ED visits and number of ED admissions within the past year, and the self-reported desire for pain medication.

Results: Among 482 participants …

A Retrospective Analysis Of Paramedic Student Performance Under Simulated Stress, Nicholas Franklin Miller

Online Theses and Dissertations

The paramedic profession is an inherently difficult, dangerous and stressful profession. The paramedic is constantly barraged with acute stressors during the performance of his duties. These stressors have predictable, documented, negative effects on performance. The acute and chronic exposure to stress can negatively impact the safety and the well being of the paramedic. These stressors, if not successfully managed, can also result in negative effects to patients. Despite the overwhelming presence of stress in the paramedic environment, most paramedics receive little or no training to successfully perform under stress. One exception was a program called Trauma Lanes that was held …

Acute Management Of St-Elevation Myocardial Infarction In A Tertiary Hospital In Kenya: Are We Complying With Practice Guidelines?, Benjamin Wachira, Andrew Owuor, Harun Otieno

Internal Medicine, East Africa

Introduction: Current practice guidelines emphasize the importance of rapid reperfusion of patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to evaluate the current rate of compliance with evidence-based practice guidelines for the management of STEMI patients at a tertiary hospital in Kenya.

Methods: This was a retrospective chart review. Data on patient characteristics, emergency treatment, and outcomes were collected on adults admitted with a diagnosis of STEMI from January 2012 to February 2013.

Results: Data were collected for 45 patient presentations. There were 37 male patients (82%). The mean age was 59.7 ± 3.8 years. Of …