Emergency Medicine Commons^™

Handoff Communication In The Emergency Department, Kristen Matichko

DNP Forum

The communication of patient information through use of handoff ensures continuity of care and patient safety. A study of hand-off reports between pre-hospital personnel and staff in the emergency department revealed a lack of complete or formal information dialogue. Nurses play a vital role in the process of communication and information exchange through the use of handoff despite minimal guidelines for that exchange in current nursing practice. The pre-hospital hand-off informational exchange impacts patient safety as well as the planning and implementation of nursing care based upon that information.

The sample used was from a convenience sampling of patients arriving …

Outbreak: Emergency Room Overcrowding, Mary Elizabeth Sum

University Honors Program

A phenomenon referred to as emergency room (ER) overcrowding, which is defined as, “the demand for emergency services exceeds the ability of physicians and nurses to provide quality care within a reasonable time” (Sinclair, 2007), is happening around the world today. This problem causes much grief for the patients trying to receive quality care from the affected hospitals, and therefore hospitals are looking for any solution to solve this problem. The research was conducted by a literary review by utilizing the CINAHL and the Nursing and Allied Health Collection database. It was conducted to discover any evidence of ER overcrowding, …

A Delphi Method Analysis To Create An Emergency Medicine Educational Patient Satisfaction Survey., Kory S London, Bonita Singal, Jennifer Fowler, Rebecca Prepejchal, Stefanie Simmons, Douglas Finefrock

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Feedback on patient satisfaction (PS) as a means to monitor and improve performance in patient communication is lacking in residency training. A physician's promotion, compensation and job satisfaction may be impacted by his individual PS scores, once he is in practice. Many communication and satisfaction surveys exist but none focus on the emergency department setting for educational purposes. The goal of this project was to create an emergency medicine-based educational PS survey with strong evidence for content validity.

METHODS: We used the Delphi Method (DM) to obtain expert opinion via an iterative process of surveying. Questions were mined from …

Low-Dose Versus Standard-Dose Tissue Plasminogen Activator In Acute Ischemic Stroke In Asian Populations: A Meta-Analysis., Meng-Dong Liu, Wei-Dong Ning, Ren-Cong Wang, Wei Chen, Yang Yang, Yan Lin, Da-Hai Hu, Wayne Bond Lau, Yan Qu

Department of Emergency Medicine Faculty Papers

Recent studies have investigated the most efficacious dose of intravenous tissue plasminogen activator (IV-tPA) for acute ischemic stroke (AIS) patients. There remains no definitive consensus concerning the superior efficacious IV-tPA dose (standard- vs. low-dose), prompting us to perform a meta-analysis comparing the efficacy and safety profile of standard- versus low-dose IV-tPA.We identified relevant studies pertaining to the specific aim of our meta-analysis by searching PubMed and EMBASE (January 1990-September 2015) Either a fixed- or random-effects model was employed (dependent upon data heterogeneity) to analyze the efficacy and safety outcome.Ten cohort studies involving 4389 sum patients were included in the meta-analysis. …

Overcrowding In The Emergency Departments: Challenges And Opportunities For Improvement, Muhammad Akbar Baig, Asad Mian, Fatima Najeeb, Hira Shahzad

Department of Emergency Medicine

With the advent of Emergency Medicine, one can observe an increase in the number of Emergency Departments (ED) across the country. However, most EDs struggle due to an overwhelming number of patients. Overcrowding can lead to delays in patient care. For a city like Karachi which is an active disaster zone, preemptive preparedness is required in the face of terror threats and such overcrowding needs to be decreased to a bare minimum. The most frequent causes of prolonged length of stay (LOS) in the ED include non-availability of in-hospital beds, delays in response to subspecialty consultations and escalating medical expenses. …

Bomb Blast Injuries: An Exploration Of Patient Characteristics And Outcome Using Pakistan National Emergency Departments Surveillance (Pak-Neds) Data., Irum Qamar Khan, Nadeem Ullah Khan, Rubaba Naeem, Salima Kerai, Kate Allen, Nukhba Zia, Sana Shahbaz, Shiraz Qayoom Afridi, Emaduddin Siddiqui, Uzma Rahim Khan, Adnan A. Hyder, Junaid Abdul Razzak

Department of Emergency Medicine

BACKGROUND:

Bomb blast injuries result in premature deaths and burdening of healthcare systems. The objective of this study was to explore the characteristics and outcome of patients presenting to the emergency departments in Pakistan with bomb blast injuries.

METHODS:

Active surveillance was conducted in seven major emergency departments of Pakistan from November 2010-March 2011. All the sites are tertiary care urban centers. All the patients who presented to the hospital's emergency department (ED) following a bomb blast injury as per self-report or the ambulance personnel were included in the study. Frequency of demographics, injury pattern, and outcomes were calculated.

RESULTS: …

An Emergency Department's Journey To Decreasing Door-To-Neurology Consult Times In Our Acute Stroke Patient Population, Jessica Sanabria

All Publications

No abstract provided.

Right Ventricular Dysfunction After Resuscitation Predicts Poor Outcomes In Cardiac Arrest Patients Independent Of Left Ventricular Function., Vimal Ramjee, Anne V. Grossestreuer, Yuan Yao, Sarah M. Perman, Marion Leary, James N. Kirkpatrick, Paul R. Forfia, Daniel M. Kolansky, Benjamin S. Abella, David F. Gaieski

Department of Emergency Medicine Faculty Papers

OBJECTIVE: Determination of clinical outcomes following resuscitation from cardiac arrest remains elusive in the immediate post-arrest period. Echocardiographic assessment shortly after resuscitation has largely focused on left ventricular (LV) function. We aimed to determine whether post-arrest right ventricular (RV) dysfunction predicts worse survival and poor neurologic outcome in cardiac arrest patients, independent of LV dysfunction.

METHODS: A single-center, retrospective cohort study at a tertiary care university hospital participating in the Penn Alliance for Therapeutic Hypothermia (PATH) Registry between 2000 and 2012.

PATIENTS: 291 in- and out-of-hospital adult cardiac arrest patients at the University of Pennsylvania who had return of spontaneous …

Cola With A Splash Of Arsenic: Acute Arsenic Poisoning, Ryan Rogers Do, Jennifer Strow Do, Philip Dunn Do, Robert D. Cannon Do, Jeffrey P. Reboul Do

Department of Emergency Medicine

No abstract provided.

Gender Differences In Study Enrollment For A Mechanical Fall Prevention Study, Kaley J. Miller Bs, Pa-S, Bryan G. Kane Md, Jeanne L. Jacoby Md, Robert D. Barraco Md, Mph, Vartika Bhardwaj Ms, Michael Goodwin Ms, Cameron Paterson Ms, Kara Mia V. Villaneuva Msii, Phillip Zegelbone Ms, Bernadette Glenn-Porter Bs, Marna R. Greenberg Do, Mph, Facep, Samantha L. Myles Bs

Department of Emergency Medicine

No abstract provided.

Medical School Partnerships: Addressing Rough Sleeping In Vulnerable Youth., Rachael Snow Ms4, Sen Lu Ms4, Rachel Fieman Ms4, Jameson Dyal Ms4, Phillip Zegelbone Ms4, Brett Feldman Pa-C, Amy E. Smith Phd, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Serotonin Syndrome Associated With Therapeutic Metaxalone Dosing In A Patient With Cirrhosis, Ryan M Surmaitis Do, Thomas M. Nappe Do, Matthew D. Cook Do

Department of Emergency Medicine

No abstract provided.

Pentobarbital Toxicity After Self-Administration Of Euthasoltm Veterinary Euthanasia Medication, Steven J. Crellin Do, Kenneth D. Katz Md

Department of Emergency Medicine

No abstract provided.

A Case Of Three Patients With Severe Hypothermia Rewarmed With Ecmo, Matthew Niehaus Do, Rita Pechulis Md, Fccp, James K. Wu Md

Department of Emergency Medicine

No abstract provided.

Near Misses And Unsafe Conditions Reported In A Pediatric Emergency Research Network, Richard M. Ruddy, James M. Chamberlain, Prashant V. Mahajan, Tomohiko Funai, Karen J. O'Connell, Et Al.

Emergency Medicine Faculty Publications

Objective Patient safety may be enhanced by using reports from front-line staff of near misses and unsafe conditions to identify latent safety events. We describe paediatric emergency department (ED) near-miss events and unsafe conditions from hospital reporting systems in a 1-year observational study from hospitals participating in the Pediatric Emergency Care Applied Research Network (PECARN).

Design This is a secondary analysis of 1 year of incident reports (IRs) from 18 EDs in 2007–2008. Using a prior taxonomy and established method, this analysis is of all reports classified as near-miss (events not reaching the patient) or unsafe condition. Classification included type, …

Differences In Risk-Adjusted Outcome Of Road Traffic Injuries In Urban Tertiary Care Centers Of Pakistan, Amber Mehmood, Junaid Abdul Razzak, Mohammed Umer Mir, Rashid Jooma

Department of Emergency Medicine

Objective: To assess the differences in road injury survival in three tertiary care hospitals in an urban setting.
Methods: The study was conducted in and comprised all road traffic injury victims presenting to the three state-run tertiary care centres in Karachi from September 2006 to October 2009. Patients' age, gender, mode, and delay in arrival, severity of injury were noted. Data was stratified by hospital of presentation. A logistic regression model was developed and probability of survival was assessed after adjusting for various risk factors, including patient characteristics and injury severity.
Results: There were 93,657victims in the study, but complete …

Adiporon, The First Orally Active Adiponectin Receptor Activator, Attenuates Postischemic Myocardial Apoptosis Through Both Ampk-Mediated And Ampk-Independent Signalings., Yanqing Zhang, Jianli Zhao, Rui Li, Wayne Bond Lau, Yue-Xing Yuan, Bin Liang, Rong Li, Er-He Gao, Walter J. Koch, Xin-Liang Ma, Ya-Jing Wang

Department of Emergency Medicine Faculty Papers

Adiponectin (APN) is a cardioprotective molecule. Its reduction in diabetes exacerbates myocardial ischemia/reperfusion (MI/R) injury. Although APN administration in animals attenuates MI/R injury, multiple factors limit its clinical application. The current study investigated whether AdipoRon, the first orally active molecule that binds APN receptors, may protect the heart against MI/R injury, and if so, to delineate the involved mechanisms. Wild-type (WT), APN knockout (APN-KO), and cardiomyocyte specific-AMPK dominant negative (AMPK-DN) mice were treated with vehicle or AdipoRon (50 mg/kg, 10 min prior to MI) and subjected to MI/R (30 min/3-24 h). Compared with vehicle, oral administration of AdipoRon to WT …

Prevalence Of And Risk Factors For Intracranial Abnormalities In Unprovoked Seizures., Peter S. Dayan, Kathleen Lillis, Jonathan Bennett, Gregory P. Conners, Pam Bailey, James Callahan, Cigdem Akman, Neil Feldstein, Joshua Kriger, W Allen Hauser, Nathan Kuppermann

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND AND OBJECTIVES: Prospective data are lacking to determine which children might benefit from prompt neuroimaging after unprovoked seizures. We aimed to determine the prevalence of, and risk factors for, relevant intracranial abnormalities in children with first, unprovoked seizures.

METHODS: We conducted a 6-center prospective study in children aged >28 days to 18 years with seemingly unprovoked seizures. Emergency department (ED) clinicians documented clinical findings on a standardized form. Our main outcome was the presence of a clinically relevant intracranial abnormality on computed tomography (CT) or MRI, defined as those that might change management, either emergently, urgently, or nonurgently.

RESULTS: …

Clinical Placement Before Or After Simulated Learning Environments? A Naturalistic Study Of Clinical Skills Acquisition Amongst Early-Stage Paramedicine Students, Brennen W. Mills Mr, Owen Carter A/Prof, Cobie Rudd Prof, Nathan Ross Mr, Louise Claxton Mrs

eCULTURE

Background

There is conflicting evidence surrounding the merit of clinical placements (CP) for early-stage health-profession students. Some contend early-stage CPs facilitate contextualisation of subsequently learned theory. Others argue attending CP before attaining skills competency is problematic and should only occur after training in simulated-learning environments (SLE). The evidentiary basis surrounding the extent to which either is true remains limited.

Methods

First-year paramedicine students (n=85) undertook three days of CP and SLEs as part of course requirements. Students undertook CP either before or after participation in SLEs creating two groups (Clin→Sim/Sim→Clin). Clinical skills acquisition was measured via objectively-structured clinical examinations (OSCE) …

Using Eye Tracking, Time-To-Action, Heart-Rate And Perceived Task Difficulty To Assess Level Of Distraction And Performance Of Entry-Level Paramedicine Students In Low- Versus High-Fidelity Simulation, Owen Carter, Brennen W. Mills, Cobie Rudd, Natalie Strobel, Louise Claxton, Nathan Ross

eCULTURE

Introduction

There is limited research investigating the usefulness of high-fidelity simulations (HFS) for early-stage students. Some argue the additional expense of HFS over low-fidelity simulation (LFS) is unnecessary as early-stage students are too easily distracted by non-relevant stimuli inhibiting student’s ability to focus on the core task. However, the extent to which this is true is yet to be empirically tested.

Methods

First-year paramedicine students were randomly assigned to complete either a LFS or HFS involving a collapsed patient with an obstructed airway. Level of distraction was measured via eye-tracking, arousal via heart-rate (HR), task difficulty via the NASA TLX, …