Emergency Medicine Commons^™

Cefdinir Use For Adults With Urinary Tract Infections In The Emergency Department, Emily Vo, Brittanii Prahl, William Barany, Barbara Branneman, Jack Huber

2025 Swedish FISH (Fostering Interdisciplinary Solutions in Healthcare) Conference

No abstract provided.

Surgical Management Of An Intracranial Injury Caused By A Handcrafted Arrow In Sub-Saharan Africa: A Global Neurosurgical Relevance., Allie L Heineman, Quinn Jackson, Chris Karas, Robert Galler, Victor Awuor, Hiren Patel

Trauma and Acute Care Articles

This case report and literature review describe an intracranial injury resulting from a handcrafted arrow that required emergent surgical management in a patient treated at a public hospital in Sub-Saharan Africa. The authors are members of the non-profit organizations Chunilal Initiative and Kisumu Intuitive, which deliver charitable neurosurgical care to the region on a quarterly basis. This unique neurotrauma case, involving a penetrating, contaminated, metallic object, highlights the surgical and antibacterial management of intracranial arrow injuries and emphasizes the importance of neurosurgical missions to underserved regions globally. The patient is a 16-year-old male tribal member with no known or reported …

Accidental Ingestion Of Extended-Release Guanfacine In A Toddler., Dina R Assali, Alek Q Adkins, Jonathan Chang

Trauma and Acute Care Articles

This case report describes the clinical presentation and treatment following an exploratory ingestion of extended release (ER) guanfacine in a healthy toddler. Guanfacine, an alpha-2a agonist, can cause transient hypertension as it moves from the serum into the CNS where it causes the more commonly seen central nervous system (CNS) depression, hypotension, and bradycardia. Persistent hypertension requiring intravenous (IV) vasodilatory medication is a rare and life-threatening complication of an alpha-2 agonist with only one other published report. This case report re-emphasizes and further expands available literature on this rarely reported effect.

Silent But Deadly: A Case Of Obtuse Marginal Artery Occlusion., Austin M Miller, Vishal Tharani, Erin Fraser, Howard W Levitin

Heart and Vascular Articles

The obtuse marginal artery (OMA) is a key branch of the left circumflex coronary artery, supplying blood to the lateral wall of the left ventricle. OMA occlusions can result in myocardial ischemia and serious cardiac events, often presenting with subtle or atypical electrocardiogram (EKG) changes, unlike the more pronounced alterations observed with left anterior descending artery occlusions. This case report discusses a 57-year-old female presenting with chest pain and shortness of breath, indicative of acute coronary syndrome. The patient's initial EKG showed occasional premature ventricular contractions (PVCs), T-wave flattening in aVL, and 1 mm ST elevation in V6, but otherwise, …

Implementation Of An Opt-Out And Rapid Point-Of-Care Syphilis Testing Program For Pregnant Patients Presenting To The Emergency Department, Irene Stafford, Carrie Bakunas, Joe Haydamous, Ana Mosqueda, Jeffrey D Klausner, Leandro Mena, Sean C Blackwell

Faculty, Staff and Student Publications

Background: Adult and congenital syphilis rates are rising in the United States. The aim of this pre- and post-implementation study was to determine whether implementation of an opt-out laboratory-based and rapid syphilis point-of-care testing program in the emergency department (ED) improves the detection and treatment of syphilis during pregnancy in a high-prevalence region.

Methods: This pre- and post-implementation study was conducted at the University of Texas Health Science Center, Houston, TX. During the pre-implementation phase (November 1, 2023-February 29, 2024), pregnant patients presenting to the ED underwent laboratory-based syphilis testing using the reverse algorithm only when clinically indicated. In the …

Association Of Sars-Cov-2 With Health-Related Quality Of Life 1 Year After Illness Using Latent Transition Analysis, Lauren Wisk, Michael Gottlieb, Peizheng Chen, Huihui Yu, Kelli O'Laughlin, Kari Stephens, Graham Nichol, Juan Carlos Montoy, Robert Rodriguez, Michelle Santangelo, Kristyn Gatling, Erica Spatz, Arjun Venkatesh, Kristin Rising, Mandy Hill, Ryan Huebinger, Ahamed Idris, Michael Willis, Efrat Kean, Samuel Mcdonald, Joann Elmore, Robert Weinstein

Department of Emergency Medicine Faculty Papers

BACKGROUND: Long-term sequelae after SARS-CoV-2 infection may impact health-related quality-of-life (HRQoL), yet it is unknown how HRQoL changes during recovery. We compared patient-reported HRQoL among adults with COVID-19-like illness who tested SARS-CoV-2 positive (COVID+) with those who tested negative (COVID-).

METHODS: Participants in this prospective, multicenter, longitudinal registry study were enrolled from December 2020 through August 2022 and completed 3-month follow-up assessments until 12 months after enrollment. Participants were adults (≥18 years) with acute symptoms suggestive of COVID-19 who received a Food and Drug Administration-approved SARS-CoV-2 test. Participants received questions from PROMIS-29 (subscales: physical function, anxiety, depression, fatigue, social participation, …

Assessment Of Emergency Medicine Residents' Situational Awareness And Perception Of Patient Safety Culture In The Emergency Department, Adriana Olson, Nathan Olson, Nicholas Hartman, Casey Morrone, Morgan Battaglia, Kamna Balhara

Department of Emergency Medicine Faculty Papers

BACKGROUND: Situational awareness (SA) and positive safety climate are crucial to patient safety. Little is known about emergency medicine (EM) trainees' SA and perception of emergency department (ED) safety climate, and the interactions of those factors with safety-related behaviors.

OBJECTIVES: Our objective was to evaluate EM residents' perceptions of ED safety climate, self-reported SA, and comfort with identifying, rectifying, and reporting safety hazards.

METHODS: In this cross-sectional study at two EM residencies, residents completed the Situational Awareness Rating Technique (SART) after ED-based or simulated resuscitations as well as a survey regarding safety climate and comfort with identifying, rectifying, and reporting …

Navigating Crisis: A Qualitative Exploration Of Parents' Journeys With Suicidal Adolescents In Australian Emergency Departments, Demee Rheinberger, Lauren Mcgillivray, Fiona Shand, Sally Ann Pollard, Susanne Oliver Armstrong, Julia Lessing, Katherine Boydell

The Qualitative Report

Rates of emergency department (ED) presentations for suicide crisis (thoughts, feelings, plans and behaviours) in adolescents are increasing. Parents play a key role in supporting adolescents during and after the ED presentation, however little is known about parental experiences in the ED. Interviews with 20 parents from across Australia were undertaken to help understand this experience. A reflexive thematic analysis was conducted, resulting in three themes which explore the impact of the suicide crisis and ED presentation on the parents’ sense of identity. First, parents’ identity was threatened as they were faced with the juxtaposition between the role of protector …

Critical Care Billing Interventions In A Level 1 Trauma Center Ed, Archit Shukla Md, Michelle Huber Md, Stephen Lim Md, David Rayburn Md

Quality Improvement & Patient Safety Forum

No abstract provided.

Make Them Hear You: Improving Handoffs For Critically Ill Patients In The Emergency Department, Allen J. Turechek Md, Usman S. Chaudhry Md, Jasmine S. Homes Md, Kara C. Plasko Md, David A. Rayburn Md

Quality Improvement & Patient Safety Forum

No abstract provided.

Assessing Ed Provider Response After Prehospital Administration Of Buprenorphine For Patients With Oud, Scott Sabo Md, Sage Teasley Mph, David Rayburn Md, Mph

Quality Improvement & Patient Safety Forum

No abstract provided.

Impact Of A Sepsis Quality Improvement Initiative On Clinical And Operational Outcomes, Christopher B. Thomas, Benjamin Wyler, Claude M. D’Antonio, Mark Laperouse, Shannon Alwood, Kristen Richard, Alyse Grantham, Roya Sheybani, Matt G. Sorrells, Wei Jien Tan, James W. Teague, Hollis O’Neal, Tonya Jagneaux

School of Medicine Faculty Publications

Background/Objectives: Sepsis is a costly and life-threatening condition caused by a dysregulated host response to infection. Lack of a reliable, timely diagnostic for sepsis leads to under- and overdiagnosis, suboptimal outcomes, and strained hospital resources. Our Lady of the Lake Regional Medical Center (OLOLRMC) implemented a sepsis learning health program to evaluate and improve outcomes through standardized ED workflows and the incorporation of a novel sepsis diagnostic test. Methods: We report the results of the first year of experience following the implementation of the learning health initiative and sepsis testing. Data from the Epic EHR were analyzed across two groups: …

Cultivating Workplace Wellness: An Evaluation Of Gratitude Card Interventions Among University Faculty, Jeffrey Druck, Patrick Ockerse, Jamal Jones

Journal of Wellness

Introduction: There has been a growing interest in understanding the role of gratitude in promoting well-being. Gratitude, defined as a feeling of thankfulness and appreciation in response to receiving a benefit from someone else, has been shown to improve mood, increase social support, and decrease symptoms of depression and anxiety. This research paper explores an innovative intervention using gratitude cards for faculty members and measures the emotional impact of this intervention.

Methods: The study involved 32 clinical physicians from the Department of Emergency Medicine at the University of Utah. Participants were invited to write a gratitude card to …

Perianal Infections Update, Boris Garber, Jonathan Glauser

Faculty Scholarship

Purpose of Review We describe the evaluation, treatment, and disposition of patients presenting with perianal and rectal complaints, specifically focusing on identifying and treating various infectious diseases affecting this area. Risk factors and preventative strategies are also discussed where known. Recent Findings Several professional medical associations, namely the World Society of Emergency Surgery and the American Association for the Surgery of Trauma, recently promulgated new guidelines concerning the diagnosis and management of common infectious rectal disorders [1]. The American College of Radiology also published its criteria for choosing appropriate imaging modalities for anorectal disease [2]. Additionally, new meta-analyses have been …

Emergency Medicine Residency Website Wellness Pages: A Content Analysis, Alexandra Sappington, Brian Milman

School of Medicine Faculty Publications

Introduction: The COVID-19 pandemic impacted the way medical students seek residency positions. In 2020, the Accreditation Council for Graduate Medical Education advocated for virtual interviews. Most emergency medicine (EM) interviews in 2023 remained virtual, and this format will persist for the foreseeable future. Since students are not evaluating programs in person in most cases, residency websites are crucial for prospective residents. Resident wellness is critical for resident training and important to prospective residents; it follows that programs must be transparent about resident wellness on websites. In this study we aimed to quantify the number of EM programs with wellness pages …

Checklists To Improve Emergency Medicine Resident Confidence In Airway Management, Tiara Paul, Bs, Elizabeth Glowacki, Md, Sean Mcgann, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• Determine the level of confidence regarding airway management among TJUH emergency medicine residents
• Implement education based on identifiable knowledge gaps
• Assess for improvement in resident confidence and discover avenues to optimize the education program

Burnout And Self-Efficacy: Exploring The Rewards And Challenges Faced By Crisis Counselors Working In Emergency Department Settings, Ellen Dotas

Dissertations, 2020-current

This dissertation explores burnout and self-efficacy in counselors who work with clients in crisis in emergency department settings. Mental health and emergency departments are two areas that tend to report higher levels of burnout than are reported in other occupational fields. While much research has been done on the topics of burnout and self-efficacy, limited information is available about counselors who work in these crisis roles. This dissertation follows a three-manuscript format and includes a conceptual, qualitative, and quantitative manuscript. The conceptual manuscript explores the nature of the crisis assessment itself, focusing on the area of risk assessment. The qualitative …

Normobaric And Hyperbaric Oxygen Therapy In Pediatric Dog Bite Nasal Tip Avulsion/Replantation, Paul G. Harch, Adam Shalek, Jen Karen Erbil, Brett J. King, Abigail E. Chaffin

School of Medicine Faculty Publications

A 4-year-old healthy girl sustained a composite dog bite avulsion of the tip of her nose that was intraoperatively replanted without vascular reanastomosis 2 hours and 45 minutes after the avulsion. The replanted tip initially appeared viable, but became dusky at 16 hours and cyanotic at 32 hours postreplantation. Hyperbaric oxygen therapy commenced at 40 hours postreplantation, and intermittent normobaric oxygen was added at night after the fourth hyperbaric oxygen treatment. Hyperbaric oxygen therapy was dosed according to tissue response/appearance and signs of patient oxidative stress with progressive improvement in viability. The patient received 30 hyperbaric oxygen treatments in 26 …

Reducing Antibiotic Duration For Pneumonia And Sinusitis In The Emergency Department: A Quality Improvement Approach, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Marsha Dannenburg, Patricia Phillips, Jennifer Floyd, Alaina N. Burns, Rana El Feghaly

Research Days

Background: Our aim is to increase the percentage of children discharged home from the ED with a diagnosis of CAP or ABRS treated with an optimal antibiotic duration (3-5 days for CAP, 5-7 days for ABRS) from 13% to 70% by July 25.

Methods: Outcome metric is the percentage of patients receiving recommended antibiotic duration for CAP and ABRS. Process metrics include use of order set, "Quick Discharge” order set, and clinical pathway QR codes. Balancing metric is the number of return visits with the same diagnosis < 14 days. Plan-Do-Study-Act methodology was used. In Aug 23, our ASP disseminated a handbook that emphasized shorter durations. A new multidisciplinary team (infectious diseases, ED, and urgent care physicians, advanced practice providers, nurses, and pharmacy) formed in Dec 23. We utilized cause-and-effect analysis, driver diagram, and prioritization matrix, which helped identify other impactful interventions, including implementation of new internal CAP clinical pathway order set (April 24) and “Quick Discharge” order sets (May 24). Next, we surveyed prescriber comfort (June 24) with shorter duration identifying barriers and providing education, leading to posted evidence for lower duration treatment in practitioner workrooms and developing a new ABRS clinical pathway (Sept 24). Top prescribers providing optimal duration received email acknowledgement (Oct 24) and resident rotators received antibiotic handbook and CAP clinical pathway QR codes (Nov 24). New best treatment practices for ABRS were elucidated and disseminated through clinical pathway and internal article publishing to our hospital and associated clinics (Dec 24).

Results: We saw shifts in the outcome metric’s center line in Sept 23 …

Decreasing Time To Narcotic Pain Medication In Patients With Sickle Cell Disease Presenting With Acute Pain Crises In A Pediatric Emergency Department: A Quality Improvement Initiative., Allison Adam, Leslie Hueschen, Lina Patel, Christopher Kaberline, Ibad Siddiqi

Research Days

Background: Guidelines published by the National Heart, Lung and Blood Institute recommend that patients with sickle cell disease who present in acute pain crisis receive narcotic medication < 60 minutes from arrival. Multi-center studies indicate approximately 50% of institutions are adherent to this level 1a recommendation. From October 2022-October 2023, our institutional median time to narcotic was 61 minutes.

Objective: Our aim was to decrease the time to narcotic administration by 10% (61 min to 55 min) in patients with Sickle Cell Disease presenting to the emergency department for acute pain crisis while simultaneously decreasing disparities in our patient population by Oct 2024. Additionally, we sought to increase the percentage of patients within this population to receive their first narcotic in 60 min from 49% to 70%, by Oct 2024.

Methods: We …

Lightning Assocated With More Visits To The Ed For Chest Pain, Bailee Lichter, Benjamin Aaker

Scholarship Pathways Program

This study investigates the potential association between lightning events,used as a proxy for thunder, and increased emergency department (ED) visits for chest pain and myocardial infarction (MI). Electronic medical records from Avera McKennan Hospital were analyzed for chest pain and MI diagnoses between June 1 and July 31, 2021. Lightning data within a 100-mile radius were obtained from Vaisala and cross-referenced with patient presentation times. Statistical analysis revealed a significant increase in chest pain-related ED visits within 0.5 hours and between 2.5 to 5.5 hours following lightning strikes, with p-values ranging from 0.018 to 0.047. Although a trend toward increased …

Factors Associated With Emergency Difficult Tracheal Intubation And Difficult Airway Management In A Non–Operating Room Setting At A Cancer Treatment Center, Jackson Su, Neil Bailard, Jens Tan, Jeffrey Lim, Catherine Vu, Wenli Dong, Gang Zheng

Advances in Cancer Education and Quality Improvement

Difficult tracheal intubations are reported more often in the emergency non−operating room setting than in the operating setting. To identify the factors associated with emergency difficult intubation (DI) and difficult airway (DA) management in hospitalized patients with cancer, we conducted a single-center retrospective study in hospitalized patients who underwent emergency intubations in a non−operating setting from 2016 to 2019 at a cancer treatment center. Cases of DI (inability to visualize the vocal cords and/or >2 intubation attempts) and DA (DI, advanced airway device use, and/or need for a surgical airway) were included. We reviewed 763 cases; the DI and DA …

Sglt-2 Inhibitor Use Is Associated With Lower Mortality In Patients With Alcoholic Cirrhosis And Type 2 Diabetes Mellitus: A Multinational Analysis, Do Han Kim Md, Donghyun Ko, Jose A. Porres, Wilhelm S. Basegoda Md, Cristina H. Makarian, Luis M. Nieto Md, Pedro Palacios Argueta Md, Paul T. Kroner Md, Frank J. Lukens Md

Posters

In our study, we aimed to investigate whether SGLT2 inhibitors are associated with a reduced risk of all-cause mortality, liver-related events, and cardiovascular outcomes in patients with alcoholic cirrhosis and T2DM.

All Clear For Virtual Simulation In Transition To Practice, Stephanie Barrett Msn, Rn, Onc, Rebecca Riznyk Msn, Rn, Cne, Npd-Bc

Posters

The goal of this innovative project was to increase new graduate nurses’ comfort with emergency management, improve communication with the interdisciplinary team, and provide a valuable and engaging experience in a TTPP at a large health care system

A New Approach: Evaluating The Effectiveness Of Artificial Intelligence Developments For Trauma Triage In The Emergency Department, William C. Anoka

2025 Spring Honors Capstone Projects - Archive

Triage in emergent situations occurs when patients are assigned to areas of the hospital with different levels of care according to the perceived risks determined by their signs and symptoms. The variability of current triage protocols substantially increases the proportion of lower acuity patients who die unexpectedly due to improper risk stratification. However, recent artificial intelligence (AI) developments have been applied to trauma triage situations to improve accuracy and patient outcomes. To further evaluate the effectiveness of this new tool, this study used various AI models to assess the presenting assessments of multiple situations and determine the appropriate level of …

Case Report: A Severe Case Of Post-Operative Ogilvie Syndrome Requiring Surgical Intervention, Aashna A. Chaudhry

Rowan-Virtua Research Day

Ogilvie Syndrome is an acute colonic pseudo-obstruction described as a paralysis of the colon with no real mechanical obstruction. This condition is oftentimes a benign post-surgical complication but can progress in severity if not treated appropriately. This case report presents a unique clinical case in which an adult female patient developed a severe case of Ogilvie syndrome postoperatively requiring surgical intervention.

Identification Of Subarachnoid Hemorrhage: The Impact Of A Nurse Led Screening Tool Utilizing The Ottawa Rule, Chandra Brower, Shannon Krumvieda, Shalana Bolton

Nursing Posters

The ETC lacked a formal tirage process for identification of Subarachnoid Hemorrhage (SAH), which can lead to delayed treatment and suboptimal patient outcomes. Data showed SAH patients who presented to the Emergency Trauma Center (ETC) with headache (HA) and hypertension frequently had long wait times before evaluation by a provider.

Improving Monticello Emergency Department Stroke Door To Drug Time, Andrew Winter Eppa, Alea Stanger, Jessica Miller, Naomi Schneider, Kristi Patterson

Nursing Posters

The aim of this project is to decrease the Monticello ED Stroke Door to Drug measure performance from the baseline of 67 minutes in CY2024 to < 60 minutes by September 30, 2025.

Blood Culture Contamination With Ultrasound Iv, Nick Del Boccio

Articles, Abstracts, and Reports

No abstract provided.

Hydralazine-Induced Vasculitis Resulting In Large Pleural Effusion And Progressive Renal Dysfunction, Michael A. Acevedo, Hammad Choudhry

Rowan-Virtua Research Day

Hydralazine is a vasodilator commonly used to treat high blood pressure. Even with the safety profile of Hydralazine, it is necessary to know that it may lead to Hydralazine-Induced Vasculitis. Here, we discuss how this rare side effect can present in an 80-year-old female with a past medical history of hypertension who presented to the emergency department with complaints of progressive shortness of breath on exertion and while lying supine. Further evaluation revealed a large right-sided pleural effusion with consolidation at the right lower lobe. The patient’s dyspnea worsened, and the surgical team placed a chest tube. The patient also …