Emergency Medicine Commons^™

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 …

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., 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 …

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 …

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 …

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.

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.

Managing The Inherent Patient Safety Risks Of Electronic Health Records, G.S. Rudolph

Journal Articles

No abstract provided.

Hspb1 As A Novel Regulator Of Ferroptotic Cancer Cell Death, X. Sun, Z. Ou, M. Xie, R. Kang, Y. Fan, X. Niu, H. Wang, L. Cao, D. Tang

Journal Articles

Ferroptosis is an iron-dependent form of non-apoptotic cell death, but its molecular mechanism remains largely unknown. Here, we demonstrate that heat shock protein beta-1 (HSPB1) is a negative regulator of ferroptotic cancer cell death. Erastin, a specific ferroptosis-inducing compound, stimulates heat shock factor 1 (HSF1)-dependent HSPB1 expression in cancer cells. Knockdown of HSF1 and HSPB1 enhances erastin-induced ferroptosis, whereas heat shock pretreatment and overexpression of HSPB1 inhibits erastin-induced ferroptosis. Protein kinase C-mediated HSPB1 phosphorylation confers protection against ferroptosis by reducing iron-mediated production of lipid reactive oxygen species. Moreover, inhibition of the HSF1-HSPB1 pathway and HSPB1 phosphorylation increases the anticancer activity …

Zipline-Related Injuries Treated In Us Eds, 1997-2012, Rachel M. Billock, Jonathan J. Anderegg, Tracy J. Mehan, Thiphalak Chounthirath, Gary A. Smith

Faculty Publications - Department of Communication and Cinematic Arts

Purpose

To investigate the epidemiology of zipline-related injuries in the United States.

Basic Procedures

The National Electronic Injury Surveillance System database was used to examine non-fatal zipline-related injuries treated in US emergency departments (EDs) from 1997 through 2012. Sample weights were applied to calculate national estimates.

Main Findings

From 1997 through 2012, an estimated 16850 (95% CI, 13188-20512) zipline-related injuries were treated in US EDs. The annual injury rate per 1 million population increased by 52.3% from 7.64 (95% CI, 4.86-10.42) injuries in 2009 (the first year with a stable annual estimate) to 11.64 (95% CI, 7.83-15.45) injuries in 2012. …

Emergency Department Ultrasound Probe Infection Control: Challenges And Solutions, Hamid A. Shokoohi, Paige Armstrong, Ryan Tansek

Emergency Medicine Faculty Publications

Point-of-care ultrasound (US) has become a cornerstone in the diagnosis and treatment of patients in the emergency department (ED). Despite the beneficial impact on patient care, concern exists over repeat use of probes and the role as a vector for pathogen transmission. US probes are used for various applications, with the level of infection risk, based on the Spaulding Classification, ranging from noncritical with common practice to semicritical with endocavitary probes. To date, the most closely studied organisms are Staphylococcus aureus and human papilloma virus. Current evidence does confirm probe colonization but has not established a causative role in human …

Educational Technology Improves Ecg Interpretation Of Acute Myocardial Infarction For Medical Students And Emergency Medicine Residents, Ali Pourmand, Mary Tanski, Steven Davis, Hamid A. Shokoohi, Raymond Lucas, Fareen Zaver

Emergency Medicine Faculty Publications

Introduction: Asynchronous online training has become an increasingly popular educational format in the new era of technology-based professional development. We sought to evaluate the impact of an online asynchronous training module on the ability of medical students and emergency medicine (EM) residents to detect electrocardiogram (ECG) abnormalities of an acute myocardial infarction (AMI).

Methods: We developed an online ECG training and testing module on AMI, with emphasis on recognizing ST elevation myocardial infarction (MI) and early activation of cardiac catheterization resources. Study participants included senior medical students and EM residents at all postgraduate levels rotating in our emergency department (ED). …

Do Emergency Department Patients Receive A Pathological Diagnosis? A Nationally-Representative Sample., Leana S. 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, discharged …

Solving The Worldwide Emergency Department Crowding Problem - What Can We Learn From An Israeli Ed?, Jesse M Pines, Steven L Bernstein

Emergency Medicine Faculty Publications

ED crowding is a prevalent and important issue facing hospitals in Israel and around the world, including North and South America, Europe, Australia, Asia and Africa. ED crowding is associated with poorer quality of care and poorer health outcomes, along with extended waits for care. Crowding is caused by a periodic mismatch between the supply of ED and hospital resources and the demand for patient care. In a recent article in the Israel Journal of Health Policy Research, Bashkin et al. present an Ishikawa diagram describing several factors related to longer length of stay (LOS), and higher levels of ED …

Treatment Failure Outcomes For Emergency Department Patients With Skin And Soft Tissue Infections, Larissa S. May, Mark S. Zocchi, Catherine Zatorski, Jeanne A. Jordan, Richard E. Rothman, Chelsea Ware

Emergency Medicine Faculty Publications

Introduction: Skin and soft tissue infections (SSTIs) are commonly evaluated in the emergency department (ED). Our objectives were to identify predictors of SSTI treatment failure within one week post-discharge in patients with cutaneous abscesses, as well as to identify predictors of recurrence within three months in that proportion of participants. Methods: This was a sub-analysis of a parent study, conducted at two EDs, evaluating a new, nucleic acid amplification test (NAAT) for Staphylococcus aureus in ED patients. Patients≥18 years receiving incision and drainage (I and D) were eligible. Patient-reported outcome data on improvement of fever, swelling, erythema, drainage, and pain …

Mental Health Disorders In Child And Adolescent Survivors Of Post-War Landmine Explosions., Mohammad Ali Hemmati, Hamid Shokoohi, Mehdi Masoumi, Shahriar Khateri, Mohammadreza Soroush, Ehsan Modirian, Mahtab Poor Zamany Nejat Kermany, Maryam Hosseini, Batool Mousavi

Emergency Medicine Faculty Publications

BACKGROUND: To describe the mental health status of 78 child and adolescent survivors of post-war landmine explosions.

METHODS: Child and adolescent survivors of landmine explosions who were younger than 18 years old at the time of the study were identified and enrolled in this study. The mental health status of the participants was assessed by general health assessment and psychiatric examinations. Psychiatric assessment and diagnosis were undertaken using the Diagnostic and Statistical Manual for mental disorders (DSM-IV) criteria. A psychiatrist visited and interviewed each survivor and identified psychiatric disorders.

RESULTS: Seventy-eight child and adolescent survivors with a mean age of …

Telepsychiatric Assessment Of A Mariner Expressing Suicidal Ideation., Alexander Lee, Neal Sikka, Francis O'Connell, Allen Dyer, Keith Boniface, James Betz

Emergency Medicine Faculty Publications

This case report highlights the successful use of telepsychiatric consultation by secure video chat to remotely assess a mariner expressing suicidal ideation. As a result of this intervention, telemedicine providers initiated psychiatric stabilisation while the mariner was still aboard the vessel, determined that he was safe for repatriation under the care of qualified medical escorts, and facilitated admission to a psychiatric facility near his home in the United States. Mental health emergencies are a significant cause of morbidity and mortality among mariners. Telepsychiatry is a validated method of establishing a psychiatric diagnosis and disposition as well as assessing risk of …