Emergency Medicine Commons^™

A Systematic Review Of Cases Of Meningitis In The Absence Of Cerebrospinal Fluid Pleocytosis On Lumbar Puncture, Michelle Troendle, Alexis Pettigrew

Emergency Medicine Publications

Background: Definitive diagnosis of meningitis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) obtained from a lumbar puncture (LP), which may take days. A timelier diagnostic clue of meningitis is pleocytosis on CSF analysis. However, meningitis may occur in the absence of pleocytosis on CSF.

Areas of Uncertainty: A diagnosis of meningitis seems less likely without pleocytosis on CSF, leading clinicians to prematurely exclude this. Further, there is little available literature on the subject.

Methods: Ovid/Medline and Google Scholar search was conducted for cases of CSF culture-confirmed meningitis with lack of pleocytosis. …

Opportunities For Research In Mental Health Emergencies: Executive Summary And Methodology, M. P. Wilson, C. Shenvi, L. Rives, K. Nordstrom, S. Schneider, M. Gerardi

Journal Articles

© 2019 Wilson et al. Introduction: Despite the ever-increasing numbers of mental health patients presenting to United States emergency departments, there are large gaps in knowledge about acute care of the behavioral health patient. To address this important problem, the Coalition on Psychiatric Emergencies convened a research consensus conference in December 2016 consisting of clinical researchers, clinicians from emergency medicine, psychiatry and psychology, and representatives from governmental agencies and patient advocacy groups. Methods: Participants used a standardized methodology to select and rank research questions in the order of importance to both researchers and patients. Results: Three working groups (geriatrics, substance …

Integration Of Entrustable Professional Activities With The Milestones For Emergency Medicine Residents, D. Hart, D. Franzen, M. Beeson, R. Bhat, M. Kulkarni, L. Thibodeau, M. Weizberg, S. Promes

Journal Articles

© 2019 Hart et al. Introduction: Medical education is moving toward a competency-based framework with a focus on assessment using the Accreditation Council for Graduate Medical Education Milestones. Assessment of individual competencies through milestones can be challenging. While competencies describe characteristics of the person, the entrustable professional activities (EPAs) concept refers to work-related activities. EPAs would not replace the milestones but would be linked to them, integrating these frameworks. Many core specialties have already defined EPAs for resident trainees, but EPAs have not yet been created for emergency medicine (EM). This paper describes the development of milestone-linked EPAs for EM. …

Simulation-Based Remediation In Emergency Medicine Residency Training: A Consensus Study, N. A. Nadir, D. Hart, M. Cassara, J. Noelker, T. Moadel, M. Kulkarni, C. S. Sampson, S. Bentley, N. K. Naik, C. Strother, +4 Additional Authors

Journal Articles

© 2019 Nadir et al. Introduction: Resident remediation is a pressing topic in emergency medicine (EM) training programs. Simulation has become a prominent educational tool in EM training and been recommended for identification of learning gaps and resident remediation. Despite the ubiquitous need for formalized remediation, there is a dearth of literature regarding best practices for simulation-based remediation (SBR). Methods: We conducted a literature search on SBR practices using the terms "simulation," "remediation," and "simulation based remediation." We identified relevant themes and used them to develop an open-ended questionnaire that was distributed to EM programs with experience in SBR. Thematic …

A Research Agenda For Assessment And Management Of Psychosis In Emergency Department Patients, J. Peltzer-Jones, K. Nordstrom, G. Currier, J. S. Berlin, C. Singh, S. Schneider

Journal Articles

© 2019 Peltzer-Jones et al. Introduction: Emergency departments (ED) manage a wide variety of critical medical presentations. Traumatic, neurologic, and cardiac crises are among the most prevalent types of emergencies treated in an ED setting. The high volume of presentations has led to collaborative partnerships in research and process development between experts in emergency medicine (EM) and other disciplines. While psychosis is a medical emergency frequently treated in the ED, there remains a paucity of evidence-based literature highlighting best practices for management of psychotic presentations in the ED. In the absence of collaborative research, development of best practice guidelines cannot …

Assessment Of Physician Well-Being, Part Two: Beyond Burnout, M. D. Lall, T. J. Gaeta, A. S. Chung, S. A. Chinai, M. Garg, A. Husain, C. Kanter, S. Khandelwal, C. S. Rublee, N. T. Himelfarb, +3 Additional Authors

Journal Articles

© 2019 Lall et al. Part One of this two-article series reviews assessment tools to measure burnout and other negative states. Physician well-being goes beyond merely the absence of burnout. Transient episodes of burnout are to be expected. Measuring burnout alone is shortsighted. Well-being includes being challenged, thriving, and achieving success in various aspects of personal and professional life. In this second part of the series, we identify and describe assessment tools related to wellness, quality of life, resilience, coping skills, and other positive states.

Camp Metabolism Controls Caspase-11 Inflammasome Activation And Pyroptosis In Sepsis, R. Chen, L. Zeng, S. Zhu, J. Liu, H. J. Zeh, G. Kroemer, H. Wang, T. R. Billiar, J. Jiang, R. Kang, +1 Additional Author

Journal Articles

No abstract provided.

A Pilot Study Of Respiratory Rate Derived From A Wearable Biosensor Compared With Capnography In Emergency Department Patients, T. Li, S. Divatia, J. Mckittrick, J. Moss, N. M. Hijnen, L. B. Becker

Journal Articles

© 2019 Li et al. Purpose: Respiratory rate is assessed less frequently than other vital signs, and documented respiratory rates are often erroneous. This pilot study compared respiratory rates derived from a wearable biosensor to those derived from capnography. Methods: Emergency department patients with respiratory complaints were enrolled and had capnography via nasal cannula and a wireless, wearable biosensor from Philips applied for approximately one hour. Respiratory rates were obtained from both of these methods. We determined the difference between median respiratory rates obtained from the biosensor and capnography and the proportion of biosensor-derived respiratory rates that were within three …

Caspase-11 Signaling Enhances Graft-Versus-Host Disease, Y. Lu, R. Meng, X. Wang, Y. Xu, Y. Tang, J. Wu, Q. Xue, S. Yu, H. Wang, B. Lu

Journal Articles

No abstract provided.

Retrospective Review Of The Patient Cases At A Major Trauma Center In Nairobi, Kenya And Implications For Emergency Care Development, Julie Saleeby, Justin G. Myers, Karen Ekernas, Katherine Hunold, Ali Wangara, Alice Maingi, Peyton Wilson, Vincent Mutiso, Sarah Zamamiri, Daniel Bacon, Wes Davis, John Suder, Yash Agrawal, Ogar Ogar, Ian B.K. Martin, Stephen Dunlop

Faculty & Staff Scholarship

Introduction

Low- and middle-income countries (LMICs) are continuing to experience a “triple burden” of disease - traumatic injury, non-communicable diseases (NCDs), and communicable disease with maternal and neonatal conditions (CD&Ms). The epidemiology of this triad is not well characterised and poses significant challenges to resource allocations, administration, and education of emergency care providers. The data collected in this study provide a comprehensive description of the emergency centre at Kenya's largest public tertiary care hospital.

Methods

This study is a retrospective chart review conducted at Kenyatta National Hospital of all patient encounters over a four-month period. Data were collected from financial …

Enhanced Macrophage Pannexin 1 Expression And Hemichannel Activation Exacerbates Lethal Experimental Sepsis, W. Chen, S. Zhu, Y. Wang, J. Li, X. Qiang, X. Zhao, L. Becker, P. Wang, K. J. Tracey, H. Wang, +2 Additional Authors

Journal Articles

No abstract provided.

Standardized Video Interviews Do Not Correlate To United States Medical Licensing Examination Step 1 And Step 2 Scores, D. J. Egan, A. Husain, M. C. Bond, W. Caputo, L. Cygan, J. Van Dermark, J. M. Shoenberger, I. Li, B. Ardolic, M. Weizberg, +7 Additional Authors

Journal Articles

© 2019 Egan et al. Introduction: In 2017, the Standardized Video Interview (SVI) was required for applicants to emergency medicine (EM). The SVI contains six questions highlighting professionalism and interpersonal communication skills. The responses were scored (6-30). As it is a new metric, no information is available on correlation between SVI scores and other application data. This study was to determine if a correlation exists between applicants' United States Medical Licensing Examination (USMLE) and SVI scores. We hypothesized that numeric USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores would not correlate with the SVI score, but that performance …

Does Training Level Affect The Accuracy Of Visual Assessment Of Capillary Refill Time?, K. Shinozaki, L. S. Jacobson, K. Saeki, N. Kobayashi, S. Weisner, J. M. Falotico, T. Li, J. Kim, J. W. Lampe, L. B. Becker

Journal Articles

No abstract provided.

Free Open Access Medical Education Applications: A Critical Appraisal Of Techniques For Quality Assessment And Content Discovery, A. Zhi, A. Husain

Journal Articles

No abstract provided.

How Well Does The Standardized Video Interview Score Correlate With Traditional Interview Performance?, A. S. Chung, K. H. Shah, M. Bond, B. Ardolic, A. Husain, I. Li, L. Cygan, W. Caputo, J. Shoenberger, M. Weizberg, +2 Additional Authors

Journal Articles

© 2019 Chung et al. Introduction: In 2017, all medical students applying for residency in emergency medicine (EM) were required to participate in the Standardized Video Interview (SVI). The SVI is a video-recorded, unidirectional interview consisting of six questions designed to assess interpersonal and communication skills and professionalism. It is unclear whether this simulated interview is an accurate representation of an applicant’s competencies that are often evaluated during the in-person interview. Objective: The goal of this study was to determine whether the SVI score correlates with a traditional in-person interview score. Methods: Six geographically and demographically diverse EM residency programs …

Incoming Interns Perceived Preparedness For Core Entrustable Professional Activities, R. E. Pearlman, M. A. Pawelczak, J. B. Bird, A. C. Yacht, G. A. Farina

Journal Articles

© 2019, International Association of Medical Science Educators. Introduction: The AAMC described 13 core entrustable professional activities (EPAs) for which every graduating medical student should perform proficiently on day 1 of residency. We studied how prepared starting interns felt in the core EPAs. Methods: Interns from a diverse health system were surveyed on how well medical school prepared them in the 13 core EPAs. Data were collected on type of medical school, participation in an acting/sub-internship (AI/SI), knowledge of EPAs, and participation in an EPA experience. Results: We collected 224 surveys out of 384 (58%) interns. 61.2% attended allopathic, 14.6% …

Recent Advances In Personalizing Cardiac Arrest Resuscitation, C. E. Kuschner, L. B. Becker

Journal Articles

© 2019 Kuschner CE and Becker LB. Cardiac arrest remains a significant cause of death and disability throughout the world. However, as our understanding of cardiac arrest and resuscitation physiology has developed, new technologies are fundamentally altering our potential to improve survival and neurologic sequela. Some advances are relatively simple, requiring only alterations in current basic life support measures or integration with pre-hospital organization, whereas others, such as extra-corporeal membrane oxygenation, require significant time and resource investments. When combined with consistent rescuer and patient-physiologic monitoring, these innovations allow an unprecedented capacity to personalize cardiac arrest resuscitation to patient-specific pathophysiology. However, …

Sexual Dimorphism Of Gut Microbiota Dictates Therapeutics Efficacy Of Radiation Injuries, M. Cui, H. Xiao, Y. Li, S. Zhang, J. Dong, B. Wang, C. Zhu, M. Jiang, H. Wang, S. Fan, +2 Additional Authors

Journal Articles

© 2019 The Authors. Published by WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim Accidental or iatrogenic ionizing radiation exposure precipitates acute and chronic radiation injuries. The traditional paradigm of mitigating radiotherapy-associated adverse side effects has ignored the gender-specific dimorphism of patients' divergent responses. Here, the effects of sexual dimorphism on curative efficiencies of therapeutic agents is examined in murine models of irradiation injury. Oral gavage of simvastatin ameliorates radiation-induced hematopoietic injury and gastrointestinal tract dysfunction in male mice, but adversely deteriorates these radiation syndromes in female animals. In a sharp contrast, feeding animals with high-fat diet (HFD) elicites explicitly contrary …

The Relationship Between Generalized Anxiety Disorder And Patient Age Among Emergency Department Patients, Mitchell Mcmurray

Scholarship in Medicine - All Papers

The objective of this study was to determine the relationship between Generalized Anxiety Disorder (GAD) and patient age in emergency department patients. The GAD-7 screening tool was used in an urban ED setting to survey patients about their anxiety, with a score of 8 or higher suggesting a diagnosis of GAD. Eligible participants included ED patients over the age of 18 with a painful condition ranging from 1-10 on the verbal numeric rating pain scale (VNRS). Participants were excluded if they were in distress and/or did not speak English. Of the 320 patients surveyed, the mean patient age was determined …

Automobile Restraint Use Among Patients In Motor Vehicle Crashes: Factors Associated With Noncompliance, Ashley A. Brent

Scholarship in Medicine - All Papers

Despite the 1968 U.S. law requiring that all vehicles have seat belts in every seat, many drivers and passengers choose not to use them. This is an important healthcare issue when the there is an estimated $917 billion spent annually on hospital services due to noncompliance with seat belt use.1 Previous literature has demonstrated that patients who are noncompliant with seatbelts are not only “more likely to use more hospital resources because they are more severely injured”, but also less likely to have health insurance, thus incurring more debt for the hospitals serving them¹. Conversely, restraint compliance has …

Parenteral Ascorbic Acid For Treatment Of Sepsis, Lindsey Hiatt

Physician Assistant Scholarly Project Posters

Sepsis kills nearly 1 million people each year in the United States and sepsis-related hospitalizations cost approximately $24 billion annually (Paoli, Reynolds, Sinha, Gitlin, & Crouser, 2018). Current treatment guidelines are limited to targeted antibiotics and hemodynamic support. While antibiotics are the definitive treatment to eradicate the infectious pathogen, there are currently no standard-of-care treatments that consistently and successfully attenuate the damage sustained to the body by its own inflammatory response to infection. Many different treatments have been trialed and failed to show improved outcomes. Vitamin C, or ascorbic acid, has long been associated with supporting immune function, and has …

What Does Anxiety Look Like? Prevalence Among Ed Patients, Justin B. Anderson

Scholarship in Medicine - All Papers

The prevalence of mental illness in the US population is common, with an estimated value of 8%. The emergency department patient population is especially vulnerable to mental illness. Previous studies from 2012 and 2017 estimated the rate of undiagnosed mental illness in the Emergency Department (ED) at 41-42%.1,2 According to the studies, only a minority of these were identified by the physician.

DSM-5 defines the criteria for generalized anxiety disorder (GAD) as “excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school …

The Relationship Between Generalized Anxiety Disorder And Self-Reported Pain Scores Among Emergency Department Patients, Nicholas Seitz

Scholarship in Medicine - All Papers

Anxiety is common among Emergency Department (ED) patients. Self-reported pain scores have been associated with a variety of physical and psychological factors. However, the relationship between pain and anxiety in ED patients has not been previously reported. This study aims to identify a relationship between self-reported pain scores and the diagnosis of generalized anxiety disorder among ED patients.

This prospective patient survey study was conducted at Miami Valley Hospital, an urban ED in Dayton, Ohio. Eligible participants included ED patients age 18 or over, with a self-reported pain score ranging from 1-10 on the verbal numeric rating pain scale (VNRS). …

Cannabis Use And Association With Pain, Anxiety, And Depression Among Emergency Department Patients, John Detherage

Scholarship in Medicine - All Papers

Introduction:

Cannabis use is increasing nationwide. Many states have legalized medical and recreational use of cannabis. This study was undertaken to identify any association between cannabis use and chronic pain among ED patients.

Methods:

This was a prospective survey study of Emergency Department (ED) patients at Miami Valley Hospital, a level 1 trauma center in Dayton, Ohio conducted during June – August 2018. The survey included data regarding the frequency of cannabis use, chronic pain, and current mental illness.

Results:

Three hundred and sixty patients participated in this study. The majority of respondents were white (55%) or African American (42%). …

Becoming A Washington Firefighter, Connor Ridgeway

Undergraduate Honors Theses

For this project, under direction of Judy Beard and Matthew Martinson, I have created a manual to further assist individuals in the process of fulfilling dreams to become a firefighter. I have researched the vast number steps it takes to become a firefighter and provided helpful suggestions that will aid individuals throughout the process. Becoming a firefighter is a demanding process with physical abilities that need to be taken into consideration when going through the elaborate process. This project includes background information on structure firefighting, volunteer firefighting, wildland firefighting, emergency medical technicians, paramedics, and what the role of each of …

Utility Of Point-Of-Care Beta-Hydroxybutyrate Testing For Predicting Diabetic Ketoacidosis In The Pediatric Emergency Department, Michelle Knoll, Kelsee Halpin, Ryan Mcdonough

Posters

The objective of our investigation was to describe the diagnostic characteristics of point-of-care capillary beta-hydroxybutyrate (BOHB) testing to predict diabetic ketoacidosis among pediatric patients presenting with hyperglycemia in the pediatric emergency department.

Factors Contributing To The Negative And Unhealthy Psychological Conditions In The Ed Rn, Ariana M. Nieves

Honors Undergraduate Theses

The emergency department is a stressful environment. Emergency department registered nurses (ED RNs) are at an increased risk of development of negative and unhealthy psychological conditions due to their frequent exposure to stress and traumatic events. These conditions include post-traumatic stress disorder, compassion fatigue, and burnout syndrome, which are already known to be common in the emergency department registered nurse population. It is important to understand the factors that influence the development of these psychological conditions in order to provide better education to nurses regarding prevention of the development of these psychological conditions. This literature review aimed to identify articles …

Evaluating The Impact Of An Intervention To Promote Empathy For Patients With Substance Use Disorder In A Rural Emergency Department, Theresa Poling

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background

Negative attitudes of health professionals towards patients with SUD are common and contribute to suboptimal health care for this marginalized group of patients (Van-Boekel, Brouwers, Van-Weeghel & Garretson, 2013).

Objectives

Promoting empathy in the Emergency Department (ED) has the potential to increase nursing staff’s awareness of their attitudes and perceptions toward patients with SUD, thereby decreasing the stigma associated with addiction and improving patient care and patient outcomes. The rationale for implementing this project was to evaluate a tool to promote empathy. This tool was developed by the student researcher based on a literature search and analysis.

Design

This …

Consent For Emergency Treatment: Emergency Department Patient Recall And Understanding, Ashley Lafountain

Scholarship in Medicine - All Papers

Informed consent is an important ethical and legal requirement that underlies the concept of patient autonomy. This prospective survey study was conducted to assess patient recall and understanding of consent for treatment in adult emergency department (ED) patients at an urban level 1 trauma center with annual volume of 95,000, Miami Valley Hospital. Out of a total 293 patients, most individuals reported only receiving a verbal explanation of the consent document (45%) or not reading the document at all (36%). About half of the patients recalled consenting to treatment (N=144, 49%) and over one third of patients could not recall …

Risk Factors For Pneumonia Following Rib Fractures, Brittany Bowers

Scholarship in Medicine - All Papers

Objective: Pneumonia is a known complication following rib fractures. The purpose of this study is to identify factors associated with the development of pneumonia following rib fractures. Methods: In this retrospective chart review, eligible participants included trauma patients with one or more rib fractures who were admitted to Miami Valley Hospital during 2012 through 2017. Variables studied included age, gender, injury severity score (ISS), mechanism of injury, smoking status, alcohol use, administration of influenza and pneumococcal vaccine, number and side of rib fracture(s), spirometer use, blood transfusion, and intravenous fluid administration.

Results: Among 78 cases and 74 controls, matched for …