Emergency Medicine Commons^™

Family/Decision Maker Perception Of Patient Care And Withdrawal Of Life Sustaining Treatment, Joshua Paul, Revelle Gappy, Tracy Wunderlich-Barillas, Robert A. Swor

Posters

Withdrawal of life sustaining treatment (WLST) is the process by which a patient has life supporting measures removed when a decision is reached that further care if futile. This process is a complex interplay of medical science, the healthcare teams’ past experiences, and communication with the patient’s family/decision maker Family members are commonly called upon to make critical decisions regarding the provision or withdrawal of patient care. Our objective was to describe the perceptions and experiences of the family members of patients who were admitted to an intensive care unit after resuscitation from an Out of Hospital Cardiac Arrest (OHCA).

Simulation-Based Resuscitative Transesophageal Echocardiography Training For Emergency Medicine Residents, August Felix, Andrew Fried, Jessica Hathaway, Tania D. Strout

Costas T. Lambrew Research Retreat 2023

Introduction: Resuscitative TEE is an emerging tool in the cardiac arrest tool-box, and can improve outcomes in OHCA.

• Identifies reversible causes

• Decreases time off chest

• Evaluates compression efficacy

• Improves assessment during pulse-checks

• Simulation training can prepare EM residents to obtain and interpret TEE views on a live patient.

Befast Assessment In A Rural Community Hospital – The Birch Study, Caroline Knight, Eileen Hawkins, Hilary Merrifield, Laura Stein, Robert Stein

Costas T. Lambrew Research Retreat 2023

Background: There are known regional disparities in treatment rates with thrombolysis and thrombectomy for acute ischemic stroke. BEFAST has been implemented in acute stroke protocols to aid in recognition of signs of stroke, but its utility in a rural ED is not well known.

A Prospective Sonographic Evaluation Of Peripheral Intravenous Catheter Associated Thrombophlebitis, Nicholas Mielke, Steven Johnson, Patrick Karabon, Amit Bahl

Posters

Thrombophlebitis associated with peripheral intravenous catheters (PIVCs) is a poorly described complication in the literature. Given limited accuracy of current assessment tools and poor documentation in the medical record, the true incidence and relevance of this complication is misrepresented. We aimed to identify risk factors in the development of thrombophlebitis using an objective methodology coupling serial diagnostic ultrasound and clinical assessment.

Impact Of Earlier Ophthalmology Clerkships On Medical Student Match Rates In Ophthalmology, Andrew Lee, Steven Joseph

Posters

The purpose of this study is to analyze the association between earlier clerkship exposure and match success, specifically in ophthalmology. Medical schools are constantly changing their clinical curriculums to provide a stronger foundational education to their students. The structure of each medical school’s clerkship curriculum varies in timing, length and availability of certain core and elective rotations. Gaining a better understanding of the factors that affect student match rates in certain specialties can influence changes in clinical curricula to maximize future match success.

Abc's Of Geriatric Trauma, Teresita Hogan

Journal of Geriatric Emergency Medicine

The ABC's approach to geriatric trauma alerts clinicians to specific important factors in emergency evaluation of an injured older adult.

Rapid Response Team Codes Following Transition-Of-Care From The Emergency Department To An Inpatient Medicine Unit, Kerrin Bersani, Brett Todd

Posters

Transitions-of-care from the emergency department (ED) to an inpatient unit have been identified as a high-risk period for medical error due to multiple causes, such as communication mishaps, excessive workload, variability in patient flow, and unclear assignment of responsibility. Patients who experience a diagnostic error are also at increased risk for poor outcomes, including increased length-of-stay and mortality. Rapid Response Teams (RRTs) are frequently utilized by hospitals to address a sudden deterioration in clinical status, often after a transition-of-care. We investigated the occurrence of RRT in patients shortly after a transition-of-care from the ED to a medicine unit. Further, we …

Evaluation Of Online Patient Information Regarding Emergency Center Utilization, Rachel Truland, Steven Joseph

Posters

The decision a patient makes when seeking emergency medical care comes with risks and ambiguity if the right decision is not made. The internet is increasingly accessible to patients, and they often consult an internet search prior to seeking healthcare. The aim of this study is to assess the readability and reliability of online information regarding a patient’s decision to seek emergency care.

Major Differences In Transcriptional Alterations In Dorsal Root Ganglia Between Spinal Cord Injury And Peripheral Neuropathic Pain Models, Raquel Cuevas-Diaz Duran, Yong Li, Anibal Garza Carbajal, Yanan You, Carmen W Dessauer, Jiaqian Wu, Edgar T Walters

Faculty, Staff and Student Publications

Chronic, often intractable, pain is caused by neuropathic conditions such as traumatic peripheral nerve injury (PNI) and spinal cord injury (SCI). These conditions are associated with alterations in gene and protein expression correlated with functional changes in somatosensory neurons having cell bodies in dorsal root ganglia (DRGs). Most studies of DRG transcriptional alterations have utilized PNI models where axotomy-induced changes important for neural regeneration may overshadow changes that drive neuropathic pain. Both PNI and SCI produce DRG neuron hyperexcitability linked to pain, but contusive SCI produces little peripheral axotomy or peripheral nerve inflammation. Thus, comparison of transcriptional signatures of DRGs …

Leveraging The Electronic Health Record To Implement Emergency Department Delirium Screening, Anita N Chary, Elise Brickhouse, Beatrice Torres, Ilianna Santangelo, Christopher R Carpenter, Shan W Liu, Kyler M Godwin, Aanand D Naik, Hardeep Singh, Maura Kennedy

Faculty, Staff and Students Publications

OBJECTIVE: The aim of this study is to understand how emergency departments (EDs) use health information technology (HIT), and specifically the electronic health record (EHR), to support implementation of delirium screening.

METHODS: We conducted semi-structured interviews with 23 ED clinician-administrators, representing 20 EDs, about how they used HIT resources to implement delirium screening. Interviews focused on challenges participants experienced when implementing ED delirium screening and EHR-based strategies they used to overcome them. We coded interview transcripts using dimensions from the Singh and Sittig sociotechnical model, which addresses use of HIT in complex adaptive health care systems. Subsequently, we analyzed data …

Metformin-Associated Lactic Acidosis: A Case Report, Joshua Santoli, Jamie Lee Aldakkour, Hossein Tohidi, Yizhi Lin

HCA Healthcare Journal of Medicine

Introduction

Metformin is considered a first-line therapy for patients with diabetes secondary to its cost efficiency, minimal side effects, and marked improvement in one’s hemoglobin A1c; however, metformin is avoided in patients with renal insufficiency out of concern for drug accumulation and lactic acidosis. In fact, there is a black box warning for metformin, identifying lactic acidosis as the inciting trigger for fatal arrhythmias and death.

Case Presentation

A 62-year-old male presented with multiple episodes of nausea, vomiting, abdominal pain, and decreased urine output for 3 days after working on a roof, all day in the summer heat. He did …

Accidental Extravasation Of Mitomycin C Into The Subcutaneous Tissue, Johnathon Chung, Brooke Walterscheid, Jose Lopez-Vera, Hytham Rashid, Mike K. Liang

HCA Healthcare Journal of Medicine

Introduction

Mitomycin C (MMC) is a common chemotherapeutic agent used to treat a variety of solid tumors. Cutaneous adverse events are rare, but MMC is a known vesicant reported to cause tissue necrosis and sloughing, erythema, and ulceration if incorrectly infused into the subcutaneous tissue. Definitive treatment of extravasation injuries due to MMC depends on the severity of the cutaneous manifestation, which includes stopping the infusion, removing the catheter, or possible debridement.

Case Presentation

We present the case of a 70-year-old female with extensive soft-tissue injury secondary to extravasation of MMC that required hospital admission and surgical intervention to remove …

Everything I Needed To Know To Be A Pediatric Emergency Room Doctor, I Learned As A Waitress, Sarah Gard Lazarus

Patient Experience Journal

When I began my career as a pediatric emergency medicine physician, I believed I was prepared to take on any medical emergency. However, I was not prepared to provide a good patient family experience. Throughout my years of training, I was not taught productive ways of interacting with patients and was unaware of how impactful the patient family experience would be. Negative patient family experience scores affected my interactions with patients, my shared decision making and my ability to provide quality care. After working to improve my scores, I focused on skills I obtained in a non-medical setting, as a …

Great Expectations: A Multi-Site Randomized Controlled Trial Of A Novel Patient Expectations Communication Tool In The Emergency Department, Martin Wegman, Jennifer Chapman, Michael Wakely, Hayley Williams, Kelsey Leonard, Elizabeth Piwowarski, Penelope Cote

South Atlantic Division GME Research Day 2023

No abstract provided.

Glaucoma Associated With Sinusitis: A Case Report, Nawzad Jacksi, Jennifer Chapman, Martin Wegman

South Atlantic Division GME Research Day 2023

No abstract provided.

Limitations Of Telemedicine Vs. Face-To-Face Eye Examination In A Patient With New Headaches, Joseph Hallak, Od, Danielle Kalberer, Od

Optometric Clinical Practice

Background: During the emergence and rise of COVID-19, precaution directives and limitations on in-person eye examinations re-routed a significant portion of care to telemedicine and virtual modalities. While these technologies allowed for healthcare communications that otherwise could not occur during such trying times, there are major limitations to these sanctioned applications. This report will present a seemingly benign case that could have easily been re-routed from an in-person examination to a telemedicine version due to the patient’s seemingly “routine” vision complaints.

Case Report: A 50-year-old male patient contacted the eye clinic with a complaint of a minor, new, unexplained headache …

Diagnosis And Management Of Colon Cancer Patients Presenting In Advanced Stages Of Complications, Vlad Denis Constantin, Adrian Silaghi, Dragos Epistatu, Anca Silvia Dumitriu, Stana Paunica, Daniela Gabriela Bălan, Bogdan Socea

Journal of Mind and Medical Sciences

Colorectal cancer is an important health problem with a significant impact on the individual and society. Malignancy (including colorectal cancer) is usually slightly symptomatic in its initial stages. This causes cancer to be discovered in some patients accidentally (either through screening tests in predisposed individuals or during routine investigations for other diseases), while in other patients the colorectal cancer is discovered in late stages, when the symptoms are much more intense due to complications. Unfortunately, such advanced cases of the disease have high rates of morbidity and mortality even with treatment. Current treatment methods are usually complex, interdisciplinary, causing significant …

That’S Not Your Implant!, Janet Han, Do, Elizabeth Paterek, Md, Faaem

Department of Emergency Medicine Posters

History of Present Illness

CHIEF COMPLAINT: Left breast pain/swelling

53-year-old female with PMHx of bilateral breast implants, IV drug use, and hypertension presents to the emergency department with swelling and pain to the left breast over the last 5 months after an assault with trauma to the area. She was seen at a previous hospital for these symptoms 3 months ago and reports fluid was drained from the left breast at that time. She reports subjective fevers and chills but denies other symptoms at this time including drainage or discharge from the breast/ nipple, chest pain, or shortness of breath. …

An Inflection Point To Improve Emergency Care For Older Adults, Jonny Macias Tejada, Michael Malone, Kevin Biese

Journal of Geriatric Emergency Medicine

Not applicable.

Emergency Medicine In-Training Examination Scores Are Not Associated With Burnout And Not Affected By The Introduction Of A Wellness Curriculum, Kelly Williamson Md, Patrick M. Lank, Nicholas Hartman, Nathan Olson, Elise O. Lovell

Journal of Wellness

Introduction: There is little research examining the relationship between burnout and medical knowledge. Study Objectives: The authors sought to determine if emergency medicine (EM) resident performance on the In-Training Examination (EM-ITE) is associated with burnout and if EM-ITE scores are affected by the implementation of a wellness curriculum.

Methods: As part of a multi-institution prospective education intervention trial, the Maslach Burnout Inventory, a valuable tool in the assessment of physician burnout, was administered at 10 EM residencies in February 2017. Then, five intervention sites introduced a year-long wellness curriculum. The MBI was re-administered at all sites in August 2017 and …

The History Of Geriatric Emergency Medicine, Teresita M. Hogan Md, Lowell Gerson Phd, Aurthur B. Sanders Md

Journal of Geriatric Emergency Medicine

Abstract: Excellent emergency care does not happen by chance. The standard emergency approach that excels in the young, fails in older patients. Older adults experience unnecessary morbidity and excess mortality in our emergency departments. This article describes the pursuit of excellent emergency care in the historically challenging older adult population. A pivotal point occurred once emergency physicians recognized older patients as a distinct population in need of unique evaluation and treatment.

In the early 1990s a group of geriatricians, philanthropists, and emergency physicians joined forces to improve older patient care. Geriatric Emergency Medicine (GEM) emerged as a subspecialty as these …

Exploring Hapi Incidence In Patients Admitted Through The Ed: A Quality Improvement Initiative, Alexa L. Tietgens

DNP Projects

Each year in the U.S., pressure injuries, or PIs, are responsible for more than 60,000 patient deaths and billions of dollars’ worth of treatment costs. Research shows that roughly 95% of all PIs are preventable by following evidence-based practice guidelines which include early identification of patients at risk, frequent skin assessments, and implementation of prevention strategies. However, the ED environment creates unique risks for PI development due to the routine use of hard surfaces (i.e., stretchers, backboards, exam tables) and frequent hospital overcrowding. Although nurses play a pivotal role in PI prevention, frequent staffing shortages, high patient acuity levels, and …

I Finally Understand How Applying The Fagan Nomogram Can Change Medical Decision-Making, David Salvatori, Do

Clinical Research in Practice: The Journal of Team Hippocrates

The author reflects on the case that changed his opinion on the efficacy of the Fagan nomogram.

Geriatric Depression Screening And Chief Complaint: What Is The Risk For 30- And 90-Day Readmission?, Eric James, Joan Michelle Moccia, Victoria Lucia

Journal of Geriatric Emergency Medicine

Abstract

Background:

Readmission to the hospital within 30-days has a high cost and represents a gap in care for older adults. Older adults are at significant risk for depression, particularly given their medical comorbidities and social factors such as isolation due to SARS-CoV-2. Many patients who screen positive for depression may have no known history of depression. This investigation examines the relationship between a positive geriatric depression screen and chief complaint as a function of 30- and 90-day readmission risk.

Methods:

We examined the electronic medical record of 329 older adults aged 65 and older from February 1, 2020, to …

Implementation Of A Code Lobby Surge And The Impact On Left Without Being Seen Rates, Nicole Plouffe

Student Scholarly Projects

Practice Problem: Crowding of emergency departments contribute to higher-than-average left without being seen (LWBS) rates. LWBS patients pose risks to the hospital as well as to one’s own health.

PICOT: The PICOT question that guided this project was in a pediatric emergency department (P), does implementation of a “Code Lobby Surge” (I), compared to standard care (C), decrease left without being seen rates (O) within eight weeks (T)?

Evidence: Surge interventions and decreasing the visual of crowding have shown to decrease LWBS rates.

Intervention: “Code Lobby Surge” was implemented to decrease LWBS rates and improve throughput within the …

Successful Heart-Liver Transplant Using Dual-Organ Normothermic Perfusion In A Patient With Fontan Failure, Anton Kozyryev, Daniel Lemen, Jessica Dunn, Steven E Rokita

Faculty, Staff and Student Publications

Iodotyrosine deiodinase (IYD) is unusual in its reliance on flavin to promote reductive dehalogenation of halotyrosines under aerobic conditions. Applications of this activity can be envisioned for bioremediation, but expansion of its specificity requires an understanding of the mechanistic steps that limit the rate of turnover. Key processes capable of controlling steady-state turnover have now been evaluated and described in this study. While proton transfer is necessary for converting the electron-rich substrate into an electrophilic intermediate suitable for reduction, kinetic solvent deuterium isotope effects suggest that this process does not contribute to the overall efficiency of catalysis under neutral conditions. …

A Matched Cohort Study Of Open Thoracostomies Performed By Ground Medics, Alison Smith, Angelo Ciaraglia, Benjamin Axtman, Cj Winckler, David Wampler, Maxwell Braverman, C. Patrick Shahan, Rachelle Babbitt Jonas, Michael Shiels, Brian Eastridge, Ronald Stewart, Susannah Nicholson, Donald Jenkins

School of Medicine Faculty Publications

Background: Tension pneumothorax resulting from chest trauma is a rapidly fatal condition that requires prompt treatment. Prehospital open thoracostomy (POT) is a potentially lifesaving intervention that can be performed in the field to treat tension pneumothorax. However, the results from POT performed by ground EMS providers have not been well-studied. The objective of this study was to compare outcomes for patients with chest trauma who underwent POT performed by ground EMS providers with a matched cohort who did not undergo this procedure in the field. Methods: A retrospective chart review of consecutive adult patients presenting to a Level I trauma …

Breaking Barriers: Improving Care For Incarcerated Patients While Hospitalized, Spencer Steadman, Jordan Schroeder, Jacob Straus, Colton Berry

View All Graduate Medical Education Content

No abstract provided.

Peripartum Cardiomyopathy, Victoria L Morris, Carolina Mendoza, Gowri S Stevens, Jessica L Wilson, Adeola A Kosoko

Faculty, Staff and Student Publications

AUDIENCE: This simulation is appropriate for emergency medicine (EM) residents of all levels.

INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a rare, idiopathic condition that occurs in the mother around the time of childbirth. Heart failure with reduced ejection fraction and/or reduced systolic function diagnosed in patients during the last month of pregnancy or up to five months following delivery defines PCCM.1 Another broader definition from the European Society of Cardiology defines PPCM as heart failure that occurs "towards the end of pregnancy or in the months following delivery, where no other cause of heart failure is found."2 Though PPCM occurs worldwide, …

Use Of High-Flow Cannula In Pediatric Patients With Respiratory Failure: A Prospective Cohort Study In Three High-Altitude Hospitals, Natalia Ante-Ardila, Camilo Novoa Garnica, Paola Mora Umaña, Olga Lucía Baquero Castañeda, Alexandra Jiménez Cháves, Melisa Sofía Naranjo, Juan G Piñeros, Carolina Bonilla, Luz M Mejía, María L Mesa-Rubio, Sonia Restrepo-Gualteros, Pedro Barrera, Sergio Moreno-Lopez, Paola Rueda-Guevara, Andrea Ramírez Varela

Faculty, Staff and Student Publications

BACKGROUND AND AIMS: Acute respiratory failure (ARF) is a common cause of morbimortality, and a frequent reason for admission to the pediatric intensive care unit (PICU). It requires a high-flow oxygen device as treatment. Our aim is to determine the frequency and main indications for the use of high-flow nasal cannula (HFNC), and the prevalence of HFNC failure and its main causes, in three hospitals.

METHODS: It is a multicenter prospective cohort study, developed in three hospitals in Bogota. Eligible patients were children older than 1 month and younger than 18 years who presented ARF and required management with an …