Emergency Medicine Commons^™

Setting Up Triage Services In The Emergency Department: Experience From A Tertiary Care Institute Of Pakistan. A Journey Toward Excellence., Munawar Khursheed, Jabeen Fayyaz, Ahsan Jamil

Department of Emergency Medicine

The history of triage started from the French battle field for prioritizing patients. Emergency triage was started in early 1950's in USA in order to treat the sickest first. It has now become an integral component of all emergency departments (ED). The basic aim of triage is not only to sort out patients according to the criticality of their illness, but it also serves to streamline the patient flow. This will ultimately enable the ED physician to provide right management at the right time to the right patient in the available resources. In turn has a positive impact in reducing …

Matters Of Life And Death: The Flight Of Paramedic Mike Choate '97, Stephen Collins

Colby Magazine

Helicopter paramedic Mike Choate ’97 flies to the rescue.

Concomitant Retrograde Coronary Venous Infusion Of Basic Fibroblast Growth Factor Enhances Engraftment And Differentiation Of Bone Marrow Mesenchymal Stem Cells For Cardiac Repair After Myocardial Infarction., Xiao Wang, Lei Zhen, Huangtai Miao, Qiwei Sun, Ya Yang, Bin Que, Edmundo Patricio Lopes Lao, Xingxin Wu, Hongmei Ren, Shutian Shi, Wayne Bond Lau, Xin-Liang Ma, Changsheng Ma, Shaoping Nie

Department of Emergency Medicine Faculty Papers

AIM: Basic fibroblast growth factor (bFGF) increases the migration and viability of bone marrow mesenchymal stem cells (MSCs) in vitro. Retrograde coronary venous infusion can provide both increased regional bFGF concentrations and homogeneous cell dissemination. We determined whether retrograde delivery of bFGF enhances the potency of transplanted MSCs for cardiac repair in a canine infarct model.

METHODS AND RESULTS: Under hypoxic conditions, cellular migration was significantly increased in MSCs co-cultured with bFGF compared to vascular endothelial growth factor or insulin-like growth factor, and bFGF promoted MSCs differentiation into a cardiomyocyte phenotype. A canine infarct model was employed by coronary ligation. …

Characterization Of In-Hospital Cardiac Arrest In Adult Patients At A Tertiary Hospital In Kenya, Benjamin Wachira

Internal Medicine, East Africa

Background:In-hospital cardiac arrest (IHCA) is defined as a cardiac arrest that occurs in a hospital and for which resuscitation is attempted. Despite the increased morbidity and mortality, IHCA incidence and outcomes remain largely unknown especially in sub-Saharan Africa. This study describes the baseline characteristics, prearrest physiological parameters and the rate of survival to hospital discharge of adult patients with an IHCA at a tertiary hospital in Kenya.

Methods:This was a retrospective chart review. Data on patient characteristics, pre-arrest physiological parameters and discharge condition were collected on all patients 18 years of age or older with an IHCA at …

The Relationships Between Patients’ Perceptions Of Nurse Caring Behaviors, Nurses’ Perceptions Of Nurse Caring Behaviors And Patient Satisfaction In The Emergency Department, Theresa Bucco

Seton Hall University Dissertations and Theses (ETDs)

Background: Approximately 100 million people seek care in Emergency Departments yearly, which can be overwhelming for many Emergency Department (ED) nurses. Thus, caring for these patients and meeting their needs is challenging for ED nurses. It is the patients’ perceptions of the first caring encounters in the ED that can have a significant impact on patient satisfaction.

Objective: The purpose of the study was to examine the relationships between patients’ perceptions of nurse caring behaviors, nurses’ perceptions of nurse caring behaviors, and patient satisfaction in the ED.

Methods: This was a descriptive cross-sectional study that examined the …

Prospective Study Of Recovery From Copperhead Snake Envenomation: An Observational Study, Eric J. Lavonas, Charles J. Gerardo, Rebecca C. Bowers, Joann Short, Copperhead Snakebite Recovery Outcome Group

Emergency Medicine Faculty Publications

BACKGROUND: Although much is known about signs, symptoms, and management in the acute phase of crotaline snake envenomation, little is known about signs, symptoms, function, and quality of life during the recovery phase. The purpose of this observational pilot investigation is to evaluate the utility of several clinical outcome instruments in the setting of copperhead snakebite, and to characterize the clinical course of recovery.

METHODS: This is a multi-center prospective, open-label, observational study of patients envenomated by copperhead snakes. We administered the Disabilities of the Arm, Shoulder, and Hand (DASH), Lower Extremity Functional Scale (LEFS), Patient-Specific Functional Scale …

Adiponectin Attenuates Lung Fibroblasts Activation And Pulmonary Fibrosis Induced By Paraquat., Rong Yao, Yu Cao, Ya-Rong He, Wayne Bond Lau, Zhi Zeng, Zong-An Liang

Department of Emergency Medicine Faculty Papers

Pulmonary fibrosis is one of the most common complications of paraquat (PQ) poisoning, which demands for more effective therapies. Accumulating evidence suggests adiponectin (APN) may be a promising therapy against fibrotic diseases. In the current study, we determine whether the exogenous globular APN isoform protects against pulmonary fibrosis in PQ-treated mice and human lung fibroblasts, and dissect the responsible underlying mechanisms. BALB/C mice were divided into control group, PQ group, PQ + low-dose APN group, and PQ + high-dose APN group. Mice were sacrificed 3, 7, 14, and 21 days after PQ treatment. We compared pulmonary histopathological changes among different …

Continued Confusion After Resolution Of Diabetic Ketoacidosis, Ryan Rogers Do, Gretchen A. Perilli Md, Philip Dunn Do

Department of Emergency Medicine

No abstract provided.

The Correlation Between Usmle And Comlex Exam Scores For Applicants To A Dually- Approved Emergency Medicine Residency: An Eight-Year Experience, Kathleen E. Kane Md, Dawn M. Yenser Pgme, Laura Semler Ms, Kevin Weaver Do, Gavin Barr Jr. Md, Terrence E. Goyke Do, Andre Burckhart Do, Adam Leonetti Do, Isamu Yoshioka, Bryan Kane Md

Department of Emergency Medicine

No abstract provided.

Providence Ed Guide Program - Analysis Of Program Impacts; The Center For Outcomes Research & Education (Core); Providence Health & Services, Bill J. Wright

Articles, Abstracts, and Reports

No abstract provided.

Point-Of-Care Ultrasonography By Pediatric Emergency Medicine Physicians., Jennifer R. Marin, Resa E. Lewiss, American Academy Of Pediatrics, Committee On Pediatric Emergency Medicine, Society For Academic Emergency Medicine, Academy Of Emergency Ultrasound, American College Of Emergency Physicians, Pediatric Emergency Medicine Committee, World Interactive Network Focused On Critical Ultrasound, Gregory P. Conners

Manuscripts, Articles, Book Chapters and Other Papers

Emergency physicians have used point-of-care ultrasonography since the 1990 s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing …

Attitudes Of Paramedic Students Towards Specific Medical Conditions: A Four-Year Study, Brett A. Williams, Malcolm J. Boyle, Stuart Howard

Internet Journal of Allied Health Sciences and Practice

Purpose: The purpose of this study was to determine the attitude of first year students entering a paramedic course over 4 consecutive yearly intakes toward patients with intellectual disability, substance abuse, attempted suicide, and acute mental illness. Method: The students’ attitude towards four medical conditions commonly encountered in the out-of-hospital setting was assessed using the Medical Condition Regard Scale (MCRS). The MCRS score ranges from 11 to 66. Results: 230 students in Victoria, Australia, participated in the study; 66% were female, and 76% of all students < 21 years of age. Students showed the most negative attitudes towards substance abuse, mean 35(SD+6.6), and the most positive attitude toward intellectual disability, mean 38.2(SD+6.3). Students in 2008 cohort displayed significantly higher regard for all medical conditions (pConclusions: The study findings suggest that these students in Victoria, Australia, entering an undergraduate paramedic or paramedic/nursing course have a relatively poor attitude towards the four reviewed medical conditions, particularly substance abuse.

Point-Of-Care Ultrasonography By Pediatric Emergency Medicine Physicians, American Academy Of Pediatrics, Committee On Pediatric Emergency Medicine, Society For Academic Emergency Medicine,Academy Of Emergency Ultrasound, American College Of Emergency Physicians, Pediatric Emergency Medicine Committee, World Interactive Network Focused On Critical Ultrasound, Gregory P. Conners

Manuscripts, Articles, Book Chapters and Other Papers

Point-of-care ultrasonography is increasingly being used to facilitate accurate abstract and timely diagnoses and to guide procedures. It is important for pediatric emergency medicine (PEM) physicians caring for patients in the emergency department to receive adequate and continued point-of-care ultrasonography training for those indications used in their practice setting. Emergency departments should have credentialing and quality assurance programs. PEM fellowships should provide appropriate training to physician trainees. Hospitals should provide privileges to physicians who demonstrate competency in point-of-care ultrasonography. Ongoing research will provide the necessary measures to define the optimal training and competency assessment standards. Requirements for credentialing and hospital …

Clinical Profiles And Outcomes Of Children Admitted To The Pediatric Intensive Care Unit From The Emergency Department, Anwarul Haque, Naveed Ur Rehman Siddiqui, Sidra Kaleem Jafri, Mehar Hoda, Surraiya Bano, Asad Mian

Department of Paediatrics and Child Health

The aim of this study was to describe clinical profiles and outcomes of children admitted directly from the Emergency Room (ER) to the Pediatric Intensive Care Unit (PICU) of academic hospital. The medical records of all children (1 month to 16 years) admitted in PICU from ER, from January 2011 to December 2012 were reviewed. Of the 26,774 patients seen in the ER during the study period, 468 (1.7%) were admitted to the PICU which constituted about 41.5% (468/1127) of all the total PICU admissions. Sixty three percent (n=294) were under-five; males were 60.9% (285), 82.3% (385) were in medical …

Uchunguzi (Journal Watchmontre De Journal) March 2015, Benjamin Wachira

Internal 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.

Framework For Classifying Compliance And Medical Immediacy Among Low-Acuity Presentations At An Urban Trauma Center, Joshua G. Behr, Rafael Diaz, Barry Knapp, Cynthia Kratzke

VMASC Publications

Background: This research offers two exploratory frameworks for medical regimen compliance and medical immediacy. The first classifies compliance awareness, compliance mitigation, and financial limitation for those patients that exhibit nonadherence with a medical regimen. The second classifies medical immediacy and characterizes avoidable utilization.

Methods: Representative sampling of adult patients presenting at an emergency department (62,000/ppy) triaged as low acuity; emergency department physician assessment of noncompliance with medical regimen for those patients with a complaint related to a chronic condition; and emergency department physician assessment of medical immediacy and avoidable utilization.

Results: Physicians report 48.3% (95% confidence interval (CI) 43.5% to …

Do Emergency Department Patients Receive A Pathological Diagnosis? A Nationally-Representative Sample, Leana Wen, Janice A. Espinola, Joshua M. Mosowsky, Carlos A. Camargo

Emergency Medicine Faculty Publications

Introduction: Understanding the cause of patients’ symptoms often requires identifying a pathological diagnosis. A single-center study found that many patients discharged from the emergency department (ED) do not receive a pathological diagnosis. We analyzed 17 years of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to identify the proportion of patients who received a pathological diagnosis at ED discharge. We hypothesized that many patients do not receive a pathological diagnosis, and that the proportion of pathological diagnoses increased between 1993 and 2009.

Methods:Using the NHAMCS data from 1993-2009, we analyzed visits of patients age ≥18 years, …

A Massive Overdose Of Dalfampridine, L. J. Fil, P. Sud, S. Sattler

Journal Articles

Multiple sclerosis (MS) is an immune mediated inflammatory disease that attacks myelinated axons in the central nervous system. Dalfampridine (4-aminopyridine) was approved by the Food and Drug Administration in January 2010 for treatment of MS. Our patient was a 34-year-old male with a history of MS, who was brought to the emergency department after being found unresponsive. His current medications were valacyclovir, temazepam, dalfampridine (4-AP) and a tysabri intravenous (IV) infusion. Fifteen minutes after arrival the patient seized. The seizures were refractory to benzodiazepines, barbiturates and phenytoin. The 4-AP level was 530ng/mL (25ng/mL and 49ng/mL). The patient stopped seizing on …

Bleb Point: Mimicker Of Pneumothorax In Bullous Lung Disease, C. Gelabert, M. Nelson

Journal Articles

In patients presenting with severe dyspnea, several diagnostic challenges arise in distinguishing the diagnosis of pneumothorax versus several other pulmonary etiologies like bullous lung disease, pneumonia, interstitial lung disease, and acute respiratory distress syndrome. Distinguishing between large pulmonary bullae and pneumothorax is of the utmost importance, as the acute management is very different. While multiple imaging modalities are available, plain radiographs may be inadequate to make the diagnosis and other advanced imaging may be difficult to obtain. Ultrasound has a very high specificity for pneumothorax. We present a case where a large pulmonary bleb mimics the lung point and therefore …

Not Just Painless Bleeding: Meckel's Diverticulum As A Cause Of Small Bowel Obstruction In Children-Two Cases And A Review Of The Literature, K. Itriyeva, M. Harris, J. Rocker, R. Gochman

Journal Articles

Physicians are educated with the classical teaching that symptomatic patients with Meckel's diverticulum (MD) most often present with painless rectal bleeding. However, a review of the literature reveals that young patients with MD will most commonly present with signs of intestinal obstruction, an etiology not frequency considered in patients presenting to the emergency department with obstruction. We present two cases of intestinal obstruction diagnosed in our emergency department, with Meckel's diverticulum being the etiology.