Emergency Medicine Commons^™

Investigating Markers For Intracranial Hemorrhage Severity: Insights From Cbc Changes And Beyond, Mckenzie Locker, Kasey Chelemedos, Nataly Apollonsky

Tower Health Research Day

No abstract provided.

Opioid Prescribing Habits Of Emergency Department Providers In Response To An Educational Intervention, Tory A. Makela, Benjamin Aaker

Aesculapius Journal (Health Sciences & Medicine)

Opioid prescribing habits of Emergency Department providers in response to an educational intervention

Tory Makela, MS4; Benjamin Aaker, MD

Introduction: Prescription opioid misuse and dependency has been a rising cause for concern in the United States in recent years, and many of these cases began with an initial prescription in the Emergency Department (ED). Prior studies found that patients seen by “high intensity” prescribers, who prescribe greater quantities of opioids than 75% of other ED physicians within the same hospital, are significantly more likely to suffer from long-term opioid use. Other studies have shown that educational interventions on appropriate opioid …

Comparison Of Prehospital Finger Thoracostomy And Needle Thoracostomy Performed By Ground Emergency Medical Services, Angelo Ciaraglia, Alison Smith, Benjamin Axtman, Brian Eastridge, Ronald Stewart, Susannah Nicholson, Donald Jenkins

School of Medicine Faculty Publications

Introduction: Tension pneumothorax related to chest trauma is a rapidly lethal condition that requires immediate treatment, often prior to arrival at definitive ca.re. Recent concerns regarding the safety and efficacy of needle thoracostomy (NT) have led to alternatives. Finger thoracostomy (FT) is a potential life-sav­ing treatment performed by prehospital providers as an alternative to NT. We hypothesize that FT has improved rates of prehospital thoracic decompression and is a safe alternative to NT. Materials and Methods: Retrospective cohort study of consecutive adult trauma patients presenting to a Level 1 trauma center who sustained chest trauma. A matched cohort of patients …

Pods: A Team-Based Approached To Reduce The Left Without Being Seen Rate In An Urban, High-Volume Emergency Department, Charis Keane Md, Daryn Brauner Msn, Amy Bobbit Rn, Nikki Campbell Bsn, April Alfano Ms

Posters

The purpose of this QI project is to evaluate the impact of the Patient-Oriented Discharge System (PODS) model, a registered nurse-provider team-based approach, on reducing the rate of LWBS in a high-volume, urban ED

Preventing And Responding To Workplace Violence In The Emergency Department, Janina La Porte, Stefanie Lai, Alicia Rodriguez

Articles, Abstracts, and Reports

No abstract provided.

Improving Emergency Department Belongings Inventory Electronic Medical Record Documentation, Shanekia Garrett, Stefanie Lai, Jairo Pagan, Wendy Lu, Katie Whitehead

Articles, Abstracts, and Reports

No abstract provided.

Case Of Human Orthohantavirus Infection, Michigan, Usa, 2021, Samuel M Goodfellow, Robert A Nofchissey, Dustin Arsnoe, Chunyan Ye, Seonghyeon Lee, Jieun Park, Won-Keun Kim, Kartik Chandran, Shannon L M Whitmer, John D Klena, Jonathan W Dyal, Trevor Shoemaker, Diana Riner, Mary Grace Stobierski, Kimberly Signs, Steven B Bradfute

Faculty, Staff and Student Publications

Orthohantaviruses cause hantavirus cardiopulmonary syndrome; most cases occur in the southwest region of the United States. We discuss a clinical case of orthohantavirus infection in a 65-year-old woman in Michigan and the phylogeographic link of partial viral fragments from the patient and rodents captured near the presumed site of infection.

S100a8/A9 As A Prognostic Biomarker With Causal Effects For Post-Acute Myocardial Infarction Heart Failure, Jie Ma, Yang Li, Ping Li, Xinying Yang, Shuolin Zhu, Ke Ma, Fei Gao, Hai Gao, Hui Zhang, Xin-Liang Ma, Jie Du, Yulin Li

Department of Emergency Medicine Faculty Papers

Heart failure is the prevalent complication of acute myocardial infarction. We aim to identify a biomarker for heart failure post-acute myocardial infarction. This observational study includes 1062 and 1043 patients with acute myocardial infarction in the discovery and validation cohorts, respectively. The outcomes are in-hospital and long-term heart failure events. S100A8/A9 is screened out through proteomic analysis, and elevated circulating S100A8/A9 is independently associated with heart failure in discovery and validation cohorts. Furthermore, the predictive value of S100A8/A9 is superior to the traditional biomarkers, and the addition of S100A8/A9 improves the risk estimation using traditional risk factors. We finally report …

Development Of A Follow-Up Measure To Ensure Complete Screening For Colorectal Cancer, Elizabeth L Ciemins, Jeff T Mohl, Carlos A Moreno, Francis Colangelo, Robert A Smith, Mary Barton

Faculty, Staff and Student Publications

IMPORTANCE: The current quality performance measure for colorectal cancer (CRC) screening is limited to initial screening. Despite low rates, there is no measure for appropriate follow-up with colonoscopy after receipt of an abnormal result of a stool-based screening test (SBT) for CRC. A quality performance measure is needed.

OBJECTIVE: To develop and test a quality performance measure for follow-up colonoscopy within 6 months of an abnormal result of an SBT for CRC.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective quality improvement study examined data from January 1, 2016, to December 31, 2020, with 2018 plus 6 months of follow-up as the …

Improving Emergency Department Belongings Inventory Electronic Medical Record Documentation Rates, Stefanie Lai

Providence Nursing Research Conference 2023 – Present

Background: Electronic Medical Record (EMR) education and training for RNs should be multifaceted and targeted to the RN clinical workflow. Input from direct care RNs is essential to ensure EMR education is relevant and effective. Shared Governance at a community hospital identified quality and safety concerns among inpatient RNs. RNs reported that belongings inventories were not consistently documented in the EMR for Emergency Department (ED) admissions. Hospital policy requires belongings inventory EMR documentation for all admitted patients. An audit of charts for ED admissions over three months revealed only 5% compliance with this policy.

Purpose: The purpose of this project …

The Utility Of Non-Specific Ecg Findings In The Setting Of Low High-Sensitivity Cardiac Troponin Levels, Arqam Husain, Nathan Klausner, Emily Schwab, Joseph Miller, Kaab Husain

Medical Student Research Symposium

Objective: Our objective was to assess the relationship between non-specific ischemic electrocardiogram (nsi-ECG) findings and the occurrence of major adverse cardiac events (MACE) within a 30-day timeframe among patients in the Emergency Department (ED) with low high-sensitivity cardiac troponin (hs-cTnI) levels.

Methods: We conducted a secondary analysis of the RACE-IT trial, a randomized trial performed across 9 EDs from July 2020 through March 2021 that looked at the effectiveness of hs-cTnI in evaluating the risk for acute myocardial infarction (AMI). Our study assessed the association between nsi-ECG findings (left bundle branch block, ST-segment changes, or T-wave inversions) and 30-day MACE …

Characterizing Cold Water Drownings In The Great Lakes, Elizabeth T. Helfrich, Anthony Lagina

Medical Student Research Symposium

Since the COVID-19 outbreak in 2020, Great Lakes drownings have increased. The Great Lakes are a unique and understudied environment due to being cold, fresh water, and resuscitation protocols and guidelines being derived from warm, primarily salt water environments. We analyzed open sources materials to find records of Great Lakes drownings from 2021-2023 and analyze the data looking for trends in cold and warm water drownings.

We found 80.0-85.0% of the included drowning victims were male and had an average age of 38.0-39.0 years old. 40.0%-57.7% of Great Lakes drowning deaths were in cold water; of those, Lake Michigan had …

Preventing And Responding To Workplace Violence In The Emergency Department, Stefanie Lai, Alicia Rodriguez

Providence Nursing Research Conference 2023 – Present

Background: Workplace violence (WPV) is defined as physical violence or verbal threats of physical violence, regardless of whether an employee sustains an injury. Emergency department (ED) staff are at high risk of exposure to WPV, which can lead to burnout, job dissatisfaction, and secondary stress. Effective preparation for and response to WPV incidents can help mitigate these negative effects. Multicomponent interventions, including education, safety huddles, behavioral health rapid response teams, and environmental modifications, have been shown to reduce WPV incidents and increase staff perceptions of safety.

Purpose: The purpose of this evidence informed-quality improvement project was to increase knowledge of …

An Educational Intervention Differentiating Pressure Injuries From End-Of-Life Wounds, Alicia Perez Varela, Annette Callis

Providence Nursing Research Conference 2023 – Present

Background

End-of-life (EOL) wounds are identified in the literature as Kennedy Terminal Ulcers (KTU), Skin Failure (SF), Trombley-Brennan Terminal Tissue Injury (TB-TTI), and SCALE (Skin Changes at Life’s End). EOL wounds have a similar appearance to pressure injuries (PIs) with a fundamentally different etiology. The misclassification of EOL wounds as PIs results in increased Hospital Acquired Pressure Injuries (HAPI), hospital fines, and less-than-optimal EOL wound management.

Purpose

To examine the effectiveness of an educational intervention on EOL wounds in increasing nurse confidence in providing End-of-Life Care (EOLC) and differentiating PIs from EOL wounds.

Methods

This quasi-experimental study used the 28-item …

A Better Tool For Ed Fall Risk Assessments: The Monego-Barra Ed Fall Risk Assessment Tool (Moba), Roxanne Barra, Mary Waldo, Angela Graves, Jessica Monego

Providence Nursing Research Conference 2023 – Present

Background

The incidence of falls has been increasing in emergency departments (EDs), with some resulting in harm. In a large health care system in the Western United States, the Morse Fall Risk Assessment Tool (Morse) is used across care settings, despite not being validated in the ED. Other ED tools in the literature are the Memorial ED Fall Risk Assessment Tool (Memorial) and Kinder 1 Fall Risk Assessment Tool (Kinder). These three tools contain risk factors that may not be specific to EDs or are missing relevant factors. This led the researchers to create the Monego-Barra ED Fall Risk Assessment …

Adherence To Sb5195 Naloxone Distribution Requirements At Discharge From The Emergency Department, E Stewart, J Delfeld, J Mckay, J Corhei, Kailyn Elliot

Providence Nursing Research Conference 2023 – Present

Background: Washington State, mirroring a national crisis, experienced a surge in opioid-related deaths, with 17,502 fatalities from 2007 to 2021. This trend aligns with the U.S.'s broader opioid epidemic, marked by 70,000 drug overdose deaths in 2017, data show overdose deaths involving opioids increased from an estimated 70,029 in 2020 to 80,816 in 2021. Overdose deaths were from synthetic opioids, primarily fentanyl. In response, empowering registered nurses (RNs) in emergency departments (EDs) to issue Nurse-Initiated Orders (NIO) for patients to discharge from the hospital with physical naloxone pre-pack kits to be used in the community, an opioid antagonist, has …

The Utility Of Interventional Anesthesia, Kylie Daguio, Kiley Jackson, Samantha Boever, Andrew Chang, James Keane, Leonard B. Goldstein

SOMA Faculty Publications

no abstract

Spontaneous Coronary Artery Dissection With Cardiogenic Shock In The United States, Chayakrit Krittanawong, Dhrubajyoti Bandyopadhyay, Neelkumar Patel, Yusuf Kamran Qadeer, Neil Sagar Maitra, Zhen Wang, Mahboob Alam, Samin Sharma, Hani Jneid

Faculty, Staff and Students Publications

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is defined as a non-traumatic separation of the epicardial coronary artery walls that creates a false lumen. SCAD poses a difficult challenge in management, as decisions regarding revascularization and medical management seem to be tailored to the individual patient. We evaluated and compared outcomes based on cardiogenic shock in patients with SCAD utilizing Nationwide Readmissions Database (NRD) between January 1, 2016, to December 30, 2020.

METHODS: We utilized the NRD 2016-2019 to carry out this study. We evaluated demographics (e.g., age, gender), conventional risk factors, comorbidities present on the index admission, and in-hospital outcomes …

Anesthetic Management Of Unanticipated Subglottic Stenosis In A Patient Undergoing Coronary Artery Bypass Graft Surgery, Claudia Wei, Dominique Wreh, Jacy Gressen, Anvinh Nguyen

Faculty, Staff and Students Publications

A 62-year-old female presented for a scheduled coronary artery bypass graft (CABG) and was found to have an unexpected subglottic stenosis during routine intubation. The case was aborted and six days later, the patient underwent lasering of the stenotic subglottic region and airway balloon dilation. In this case report, causes of subglottic stenosis and surgical/anesthetic management of the condition are discussed. The management of subglottic stenosis in this patient was complicated by concurrent severe coronary artery disease (CAD) involving the left main coronary artery and timing of airway surgery relative to interventions for her CAD. In situations of undiagnosed subglottic …

Scurvy: A Rare Disease Or A Rare Diagnosis?, David F. Gaieski

Department of Emergency Medicine Faculty Papers

Introduction:

Scurvy, the disease state caused by ascorbic acid deficiency, was once an extremely common disease but is now thought to be a rare disease in postmodern societies. Physicians are not trained to consider scurvy as a possible diagnosis in patients at risk; rather, it is considered a rare diagnosis to add to a differential for completeness’s sake.

Methods:

We sought to describe the scorbutic patients seen by one physician during a busy academic emergency medicine career. Case series of patients seen by one physician between 1993 and 2023 at five academic teaching hospitals with Emergency Departments (EDs) in the …

Comparison Of In-Person Versus Virtual Ultrasound Instruction For Pediatric Residents, Jason T. Gillon, E. Liang Liu, Valerie Dutreuil, Stephanie G. Cohen, Lekha A. Shah

School of Medicine Faculty Publications

Purpose: Point-of-care ultrasound (POCUS) instruction is prevalent in medical schools but not in pediatric residency programs, even though the majority of pediatric residents desire POCUS instruction. Virtual ultrasound instruction with affordable handheld ultrasound devices may help remedy this deficiency by allowing qualified instructors to circumvent geographic and financial limitations to reach this population. This study sought to determine if virtual ultrasound instruction is an effective alternative to traditional in-person instruction in a cohort of pediatric residents for the extended Focused Assessment with Sonography in Trauma (eFAST) exam. Methods: Pediatric residents were randomized to receive either in-person or virtual instruction to …

Relationship Between On-Demand Telehealth Visits And Emergency Department And Hospital Surge During The Covid-19 Pandemic, B. H. Slovis, Xin Ji, Anna Marie Chang, John C. Kairys, Judd Hollander

Department of Emergency Medicine Faculty Papers

OBJECTIVES: The relationship between COVID-19-related telehealth calls could be used to predict emergency department visits and hospital surges 3 days later potentially facilitating staffing adjustments in advance of patient arrivals. The purpose of this research was to study the temporal association between frequencies of on demand telehealth calls and emergency department surges during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

METHODS: This cohort study examined patients who self-initiated synchronous audio-video on-demand telehealth calls between January 1, 2020 and June 30, 2022, and compared these to emergency department arrivals. The exposure in question was a synchronous audio-video on-demand telehealth …

" Does Educational Level Affect The Outcome Of Myocardial Infarction? ", Ahmed Magdy Ahmed Elsayed

Theses and Dissertations

Background: Heath awareness plays a major role in determining the outcomes of serious medical conditions specially when response time is crucial. STEMI patients are prone to serious compilations if they didn’t receive the appropriate treatment on time. Raising the health awareness of the community would result in seeking medical help at earlier stage of the disease. Earlier presentation to the medical center would result in better health outcomes. Certain factors form the health awareness of the community. This includes educational level, previous exposure to similar situations, and exposure to health awareness materials.

Methods: This is a cohort study in …

Developing And Piloting An Online Course On Osteoporosis Using A Multidisciplinary Multi-Institute Approach- A Cross-Sectional Qualitative Study, Lena Jafri, Hafsa Majid, Arsala Jameel Farooqui, Sibtain Ahmed, Muhammad Umer Naeem Effendi, Maseeh Uz Zaman, Qamar` Riaz, Noreen Nasir, Syeda Sadia Fatima, Sarah Nadeem, Rizwan Haroon Rashid, Aysha Habib

Department of Pathology and Laboratory Medicine

Introduction: Postgraduate medical trainees (PGs) in developing nations face various educational hurdles due to limited access to quality resources and training facilities. This study aimed to assess the effectiveness of e-learning, particularly Massive Open Online Courses (MOOCs), within postgraduate medical education. It involved the development of a customized online course focused on osteoporosis for PGs and an examination of their perspectives and preferences concerning online learning methods like Virtual Learning Environment (VLE) platforms.
Methods: The study was conducted from January 2018 to December 2020. A multi-institutional, multidisciplinary team was assembled to design an osteoporosis course on the VLE platform. PGs …

Medication Errors Among Als Providers In The Prehospital Setting, Cody Vaughn Gibson, Victor Jimenez Jr

Annual Research Symposium

EMS providers administer a variety of medications to patients in the prehospital environment, and while there are numerous published studies on medication errors pertaining to the hospital environment, there are comparatively fewer studies which focus on the prehospital environment. Therefore, the purpose of this survey is to investigate the type and frequency of medication errors occurring in the prehospital environment.

Differing Radiation Exposure In Scrub Technicians And Rotating Staff In Cardiac Catheterization Laboratory: Occupation Matters, Nasir Rahman, Maleeha Javed, Ghufran Adnan, Maria Khan, Zeenat Nizar, Izat Shah

Section of Cardiology

Background: Radiation exposure is a significant hazard associated with invasive Cardiology, with most studies based on primary operator exposure. This prospective, observational study aimed to find out over lead radiation exposure as effective dose acquired by non-physician staff comprising scrub technicians and rotating staff in the cath laboratory. Effective dose (ED) measured per procedure via Raysafe i2®dosimeter badges worn by both rotating staff and scrub technicians over lead aprons along with dose area product (DAP), fluoroscopy time (FT) and procedure time (PT) in minutes was collected prospectively over forty-six invasive Cardiology procedures.
Results: This study shows that rotating staff acquire …

Validation Of A Novel, Rapid Sepsis Diagnostic For Emergency Department Use, Hollis R. O'Neal, Roya Sheybani, David R. Janz, Robert Scoggins, Tonya Jagneaux, James E. Walker, Daniel J. Henning, Elizabeth Rosenman, Simon A. Mahler, Hariharan Regunath, Christopher S. Sampson, D. Clark Files, Richard D. Fremont, Michael J. Noto, Erica E. Schneider, Wesley R. Shealey, Matthew S. Berlinger, Thomas C. Carver, Morgan K. Walker, Nathan A. Ledeboer, Ajay M. Shah, Henry T.K. Tse, Dino Dicarlo, Todd W. Rice, Christopher B. Thomas

School of Medicine Faculty Publications

OBJECTIVES: To assess the in vitro IntelliSep test, a microfluidic assay that quantifies the state of immune activation by evaluating the biophysical properties of leukocytes, as a rapid diagnostic for sepsis. DESIGN: Prospective cohort study. SETTING: Five emergency departments (EDs) in Louisiana, Missouri, North Carolina, and Washington. PATIENTS: Adult patients presenting to the ED with signs (two of four Systemic Inflammatory Response Syndrome criteria, where one must be temperature or WBC count) or suspicion (provider-ordered culture) of infection. INTERVENTIONS: All patients underwent testing with the IntelliSep using ethylene diamine tetraacetic acid-anticoagulated whole blood followed by retrospective adjudication for sepsis by …

Analysis Of Anonymous Student Narratives About Experiences With Emergency Medicine Residency Programs, Molly Estes, Jacob Garcia, Ronnie Ren, Mark Olaf, Shannon Moffett, Michael Galuska, Xiao C. Zhang

Department of Emergency Medicine Faculty Papers

Background: Academic emergency medicine (EM) communities have viewed anonymous online communities (AOC) such as Reddit or specialty-specific “applicant spreadsheets” as poor advising resources. Despite this, robust EM AOCs exist, with large user bases and heavy readership. Insights about applicants’ authentic experiences can be critical for applicants and program leadership decision-making. To date, there are no EM studies to qualitatively assess EM AOC narratives during the application cycle. Our goal was to perform a qualitative analysis of students’ EM program experiences through a publicly available AOC. Methods: This was a qualitative analysis of a publicly available, time-stamped, user-locked AOC dataset: “Official …

Assessing Pattern Of The Pediatric Multisystem Inflammatory Syndrome (Pmis) In Children During The Covid-19 Pandemic: Experience From The Emergency Department Of Tertiary Care Center Of A Low-Middle-Income Country, Saleem Akhtar, Iqra Anis, Kumar Nirdosh, Muhammad Ihsan Tayyab Ihsan, Ahmed Raheem Buksh, Surraiya Bano

Department of Paediatrics and Child Health

Background: Pediatric Multisystem Inflammatory Syndrome (PMIS) is a hyperinflammatory condition affecting multiple organs in children, often resembling incomplete Kawasaki Disease during later phases of COVID-19 infection. Data on PMIS in low-middle-income countries, particularly in emergency department settings, is limited.
Objectives: This prospective observational study at Aga Khan University Hospital, Karachi, aimed to determine the frequency, clinical presentation patterns, and laboratory parameters of children with PMIS visiting the emergency department during the COVID-19 pandemic. Secondary objectives included assessing factors associated with in-hospital mortality.
Methods: From March 2020 to September 2021, patients meeting World Health Organization PMIS criteria were enrolled. COVID-19 testing …

Advancing Virtual At-Home Care For Community Health Center Patients Using Patient Self-Care Tools, Technology, And Education [Letter], Cheryl Modica, Joy H. Lewis, Curtis Bay

SOMA Faculty Publications

Abstract

Introduction

Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers.

Objective

This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven …