Emergency Medicine Commons^™

Ogilvie's Syndrome, Muhammad Waqas Khan, Sanniya Khan Ghauri, Sara Shamim

Department of Emergency Medicine

Ogilvie's syndrome, also known as 'paralytic ileus of the colon', is characterised by pseudo-obstruction of the large intestine in the absence of any mechanical obstructing component; and presents as a massively distended abdomen. If left untreated, it may lead to bowel perforation or ischemia. Ogilvie's syndrome usually presents as a postsurgical complication, mainly due to the lack and/or restriction of movement coupled with a possible electrolyte imbalance. Here, we present a case of a pre-surgical 63-year lady, having a right hip fracture, who came with complaints of severe abdominal pain and distension for 4 days. Abdominal X-rays showed massively dilated …

Uchunguzi (Journal Watch/Montre De Journal) December 2016, Benjamin Wachira

Emergency Medicine, East Africa

Uchunguzi means investigation in Swahili and provides a summary of some of the most recent international literature as presented in other leading journals, but with an emphasis on what is relevant to our continent

The 2016 Academic Emergency Medicine Consensus Conference, "Shared Decision Making In The Emergency Department: Development Of A Policy-Relevant Patient-Centered Research Agenda" Diagnostic Testing Breakout Session Report., Tyler W. Barrett, Kristin L. Rising, M. Fernanda Bellolio, M. Kennedy Hall, Aaron Brody, Kenneth W. Dodd, Mira Grieser, Phillip D. Levy, Ali S. Raja, Wesley H. Self, Gail Weingarten, Erik P. Hess, Judd Hollander

Department of Emergency Medicine Faculty Papers

Diagnostic testing is an integral component of patient evaluation in the emergency department (ED). Emergency clinicians frequently use diagnostic testing to more confidently exclude "worst-case" diagnoses rather than to determine the most likely etiology for a presenting complaint. Increased utilization of diagnostic testing has not been associated with reductions in disease-related mortality but has led to increased overall healthcare costs and other unintended consequences (e.g., incidental findings requiring further workup, unnecessary exposure to ionizing radiation or potentially nephrotoxic contrast). Shared decision making (SDM) presents an opportunity for clinicians to discuss the benefits and harms associated with diagnostic testing with patients …

Inter-Rater Reliability Of Post-Arrest Cerebral Performance Category (Cpc) Scores., Anne V. Grossestreuer, Benjamin S. Abella, Kelsey R. Sheak, Marisa J. Cinousis, Sarah M. Perman, Marion Leary, Douglas J. Wiebe, David F. Gaieski

Department of Emergency Medicine Faculty Papers

PURPOSE: Cerebral Performance Category (CPC) scores are often an outcome measure for post-arrest neurologic function, collected worldwide to compare performance, evaluate therapies, and formulate recommendations. At most institutions, no formal training is offered in their determination, potentially leading to misclassification.

MATERIALS AND METHODS: We identified 171 patients at 2 hospitals between 5/10/2005 and 8/31/2012 with two CPC scores at hospital discharge recorded independently - in an in-house quality improvement database and as part of a national registry. Scores were abstracted retrospectively from the same electronic medical record by two separate non-clinical researchers. These scores were compared to assess inter-rater reliability …

The Association Between Hemoglobin Concentration And Neurologic Outcome After Cardiac Arrest., Nicholas J. Johnson, Babette Rosselot, Sarah M. Perman, Kalani Dodampahala, Munish Goyal, David F. Gaieski, Anne V. Grossestreuer

Department of Emergency Medicine Faculty Papers

PURPOSE: The purpose of the study is to determine the association between hemoglobin concentration (Hgb) and neurologic outcome in postarrest patients.

METHODS: We conducted a retrospective cohort study using the Penn Alliance for Therapeutic Hypothermia (PATH) cardiac arrest registry. Inclusion criteria were resuscitated cardiac arrest (inhospital or out of hospital) and an Hgb value recorded within 24 hours of return of spontaneous circulation. The primary outcome was favorable neurologic status at hospital discharge. Survival to hospital discharge was a secondary outcome.

RESULTS: There were 598 eligible patients from 21 hospitals. Patients with favorable neurologic outcome had significantly higher median Hgb …

Firearm Injury Prevention In Clinical Practice: Staying On Message., M Denise Dowd

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Indoor Tobacco Legislation Is Associated With Fewer Emergency Department Visits For Asthma Exacerbation In Children., Christina E. Ciaccio, Tami Gurley-Calvez, Theresa I. Shireman

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: During the past 3 decades, numerous cities and states have adopted laws that ban smoking in public indoor spaces. The rationale for these policies has been to protect nonsmokers from the adverse health effects of secondhand smoke.

OBJECTIVE: To determine whether the implementation of indoor smoking legislation is associated with a decrease in emergency department visits for asthma in children.

METHODS: This retrospective analysis used a natural experiment to estimate the impact of clean indoor air legislation on the rate of emergency department admissions for asthma exacerbation in children. Data were obtained from the Pediatric Health Information System. A …

Brief Compression-Only Cardiopulmonary Resuscitation Training Video And Simulation With Homemade Mannequin Improves Cpr Skills., Gregory K Wanner, Arayel Osborne, Charlotte H. Greene Phd

PCOM Scholarly Works

BACKGROUND: Cardiopulmonary resuscitation (CPR) training has traditionally involved classroom-based courses or, more recently, home-based video self-instruction. These methods typically require preparation and purchase fee; which can dissuade many potential bystanders from receiving training. This study aimed to evaluate the effectiveness of teaching compression-only CPR to previously untrained individuals using our 6-min online CPR training video and skills practice on a homemade mannequin, reproduced by viewers with commonly available items (towel, toilet paper roll, t-shirt).

METHODS: Participants viewed the training video and practiced with the homemade mannequin. This was a parallel-design study with pre and post training evaluations of CPR skills …

Can Bedside Ultrasound Inferior Vena Cava Measurements Accurately Diagnose Congestive Heart Failure In The Emergency Department? A Clin-Iq, Miranda Gaskamp, Mark Blubaugh, Laine H. Mccarthy, Dewey C. Scheid

Journal of Patient-Centered Research and Reviews

Congestive heart failure (CHF) is a major cause of morbidity and mortality. Early diagnosis of CHF in patients presenting to the emergency department with undifferentiated dyspnea would allow clinicians to begin appropriate treatment more promptly. Current guidelines recommend B-type natriuretic peptide (BNP) levels for more accurate diagnosis of CHF in dyspneic patients. Although BNP levels are relatively inexpensive, the test is not usually performed at bedside and results may take up to an hour or more. BNP also may have a “gray zone” in which the values can neither confirm nor rule out CHF. BNP has a reported sensitivity of …

Lack Of Gender Differences In Prevalence Of Homelessness In The Emergency Department (Poster), Marna R. Greenberg Do, Mph, Facep, Brett Feldman Pa-C, Alexandra M. Craen, Zachary M. Dillon Md, Kenneth Dzike Md, Julie A. Fritzges Do, Jessica L. Glaubman Do, Nathaniel M. Yoder Do, Emily A. Kiernan Do, Shaye M. Glovas, Danielle E. Mustin Bs, Korrinne N. Yurick Bs, Timothy J. Friel Md

Department of Emergency Medicine

No abstract provided.

Prevalence Of Homelessness Or At-Risk For Homelessness In The Ed Setting, Marna R. Greenberg Do, Mph, Facep, Brett Feldman Pa-C, Osman Z. Abbasi Do, Joshua Enyart Do, Yasir Abunamous Ba, Timothy Batchelor, Emily L. Bennett Bs, Cristina G. Calogero Bs, Kareem S. Elsayed, Rachel F. Ledyard Bs, Mikdat Ulas Bs, Alexis M. Begliomini Ba, Zachary J. Ezrow Bs, Timothy J. Friel Md

Department of Emergency Medicine

No abstract provided.

Introduction To Direct Oral Anticoagulants And Rationale For Specific Reversal Agents., Charles V. Pollack

Department of Emergency Medicine Faculty Papers

No abstract provided.

Evidence Supporting Idarucizumab For The Reversal Of Dabigatran., Charles V. Pollack

Department of Emergency Medicine Faculty Papers

Idarucizumab is a monoclonal antibody fragment specifically targeted to dabigatran. It has demonstrated prompt and durable reversal of the anticoagulant effects of dabigatran in animal studies and phase 1 studies of young, elderly, and renally impaired volunteers. Although elective invasive procedures and most bleeding complications in dabigatran-treated patients can be managed by temporarily stopping dabigatran therapy and using supportive measures, there are rare clinical situations that require urgent reversal of the anticoagulant effect of dabigatran. The effectiveness and safety of 5 g of intravenous idarucizumab is being investigated in a prospective, open-label, single-cohort study in patients with serious bleeding or …

The Influence Of Age On The Diagnostic Performance Of White Blood Cell Count And Absolute Neutrophil Count In Suspected Pediatric Appendicitis., Richard G. Bachur, Peter S. Dayan, Nanette C. Dudley, Lalit Bajaj, Michelle D. Stevenson, Charles G. Macias, Manoj K. Mittal, Jonathan Bennett, Kelly A. Sinclair, Michael C. Monuteaux, Anupam B. Kharbanda

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: White blood cell (WBC) count and absolute neutrophil count (ANC) are a standard part of the evaluation of suspected appendicitis. Specific threshold values are utilized in clinical pathways, but the discriminatory value of WBC count and ANC may vary by age. The objective of this study was to investigate whether the diagnostic value of WBC count and ANC varies across age groups and whether diagnostic thresholds should be age-adjusted.

METHODS: This is a multicenter prospective observational study of patients aged 3-18 years who were evaluated for appendicitis. Receiver operator characteristic curves were developed to assess overall discriminative power of …

Academic Medicine Responds To The Opioid Crisis, John Prescott

Marshall Journal of Medicine

Opioid dependence has devastated communities across the nation particularly in rural states and academic medicine has responded in a variety of ways. Through its tripartite mission of education, research, and clinical care, creative solutions are being implanted. Medical schools and teaching hospitals are partnering with public health and law enforcement agencies, as well as local healthcare providers to address the clinical, social, and rehabilitative challenges. Academic medicine continues to adapt to the needs of the nation and teach, train, and prepare the next generation of physicians to be at their best when things are at their worst.

Helping Navigate The Complex Web Of Community Medicine: How Dedicated Social Services Support In The Ed Can Prevent Unnecessary Ed Visits And Hospital Readmissions, Adam Kennah

Learning Showcase 2016: A Celebration of Discovery, Transformation and Success

A hospital's Emergency Department (ED) serves as its front door to the community. The vast majority of admitted patients present initially to the ED, and even more still begin and end their hospital visit in the ED. A hospital's ED will deal with every societal ill facing that community. However, most hospitals reserve dedicated Social Service resources to admitted patients who have had prolonged inpatient hospital stays. EDs around the country are being overburdened with patients who present to the ED for non-emergent conditions. Access to community based healthcare is daunting even for well-connected individuals. It can be downright impenetrable …

Trends Of Acute Poisoning: 22 Years Experience From A Tertiary Care Hospital In Karachi, Pakistan., Nadeem Ullah Khan, Uzma Rahim Khan, Asher Feroze, Sajjad Ali Khan, Najia Ali, Kiran Ejaz, Afshan Rahim Khan, Shahnila Nooruddin, Jabeen Fayyaz

Department of Emergency Medicine

Objective: To determine the trends of acute poisoning in terms of frequency, nature of poisoning agent, clinical presentation and its outcome. Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of patients who presented with poisoning between January 1989 and December 2010.The patients were randomly selected , and demographic, chemical information, clinical feature, treatment and outcome were analysed using SPSS 16. Results: Of the total hospital admissions during the period, 3,189(0.3%) were cases of poisoning. Of them, medical records of 705(22%) cases were reviewed; 462(65.5%) adult and 243(34.5%) paediatric cases below 16 years …

Practice Characteristics Of Emergency Department Extracorporeal Cardiopulmonary Resuscitation (Ecpr) Programs In The United States: The Current State Of The Art Of Emergency Department Extracorporeal Membrane Oxygenation (Ed Ecmo)., Joseph E. Tonna, Nicholas J. Johnson, John Greenwood, David F. Gaieski, Zachary Shinar, Joseph M. Bellezo, Lance Becker, Atman P. Shah, Scott T. Youngquist, Michael P. Mallin, James Franklin Fair, Kyle J. Gunnerson, Cindy Weng, Stephen Mckellar

Department of Emergency Medicine Faculty Papers

PURPOSE: To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department.

METHODS: We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO). Our objective was to characterize the following domains of ED ECMO practice: program characteristics, patient selection, devices and techniques, and personnel.

RESULTS: Among 99 centers queried, 70 responded. Among these, 36 centers performed ED ECMO. …

Emergency Medical Services And Public Policy In Durban, Kwazulu-Natal, John Buyske

Independent Study Project (ISP) Collection

This project seeks to explore the realities of the emergency medical system in the Durban area, particularly relative to government policy. It contextualizes its findings within the literature on public policy. Data for the project was collected via nine in-depth interviews with various professionals working in the field of emergency medical services, as well as a survey of fourteen citizens conducted in the peri-urban township of Cato Manor. This data was analyzed using qualitative methods. While every participant had different views and a different perspective on emergency services, some recurring themes and trends became evident, allowing for conclusions to be …

The Impact Of A Brief Educational Intervention On Provider Practice: Instituting An, Gary Bonfante Do, Alexandra Malenka Rn, Bsn, Robert Zoshak Mba, Bsha

Department of Emergency Medicine

No abstract provided.