Emergency Medicine Commons^™

Single-Portal Arthroscopy Of The Central Compartment Of The Hip, S. Mannava, E. A. Howse, T. J. Kelsey, R. H. Barnes, A. Antunes, A. J. Stubbs

Journal Articles

Since hip arthroscopy has become a standard of orthopaedic practice, the indications have continued to expand as it has proved to be a helpful diagnostic, as well as therapeutic, tool. Access to the hip joint, however, remains challenging for the orthopaedic surgeon who does not routinely perform hip arthroscopy. We present a single-portal arthroscopic technique, showing the feasibility of single-portal arthroscopic access to the hip joint, as well as describing basic indications and instrumentation for single-portal hip arthroscopy. Single-portal hip arthroscopy is ideal for the patient who needs to undergo diagnostic hip arthroscopy or for treatment in patients with simple …

What Is The Prevalence And Success Of Remediation Of Emergency Medicine Residents?, M. Silverberg, M. Weizberg, T. Murano, J. L. Smith, J. C. Burkhardt, S. A. Santen

Journal Articles

INTRODUCTION: The primary objective of this study was to determine the prevalence of remediation, competency domains for remediation, the length, and success rates of remediation in emergency medicine (EM). METHODS: We developed the survey in Surveymonkey with attention to content and response process validity. EM program directors responded how many residents had been placed on remediation in the last three years. Details regarding the remediation were collected including indication, length and success. We reported descriptive data and estimated a multinomial logistic regression model. RESULTS: We obtained 126/158 responses (79.7%). Ninety percent of programs had at least one resident on remediation …

Arthroscopic Excision Of Acetabular Osteoid Osteoma: Computer Tomography-Guided Approach, C. Tamam, E. A. Howse, M. Tamam, R. H. Barnes, T. J. Kelsey, B. Perry, A. J. Stubbs

Journal Articles

Osteoid osteoma is a benign osteoblastic tumor that occurs in the subcortical shaft and metaphysis of the long bones of the lower extremities; however, intra-articular lesions are also possible. Intra-articular osteoid osteomas are rare, and clinical symptoms are often less specific and, thereby, may lead to misdiagnosis. The definitive treatment for osteoid osteoma is the excision of the nidus. We present the case of a 23-year-old man with a 4-year history of right anterior hip pain, subsequently diagnosed with a subarticular osteoid osteoma located in the right anterior acetabulum. Hip arthroscopic excision of the juxta-articular osteoid osteoma is presented as …

An Ongoing Search For Potential Targets And Therapies For Lethal Sepsis, G. Q. Bao, L. He, D. Lee, J. D'Angelo, H. C. Wang

Journal Articles

Sepsis, which refers to a systemic inflammatory response syndrome resulting from a microbial infection, represents the leading cause of death in intensive care units. The pathogenesis of sepsis remains poorly understood although it is attributable to dysregulated immune responses orchestrated by innate immune cells that are sequentially released early (e.g., tumor necrosis factor(TNF), interleukin-1(IL-1), and interferon-gamma(IFN-gamma)) and late (e.g., high mobility group box 1(HMGB1)) pro-inflammatory mediators. As a ubiquitous nuclear protein, HMGB1 can be passively released from pathologically damaged cells, thereby converging infection and injury on commonly dysregulated inflammatory responses. We review evidence that supports extracellular HMGB1 as a late …

Bedside Echocardiography For Undifferentiated Hypotension: Diagnosis Of A Right Heart Thrombus, J. F. Kenny, X. Zhong, C. Brown, D. Das, B. Royall, M. Kapoor

Journal Articles

A free-floating right heart thrombus is often a harbinger of a massive pulmonary embolism and must be diagnosed and treated rapidly in order to avoid significant adverse sequelae. We present the case of an 84-year-old female who presented with two days of dyspnea and was hypotensive on arrival. Bedside ultrasound was performed by the emergency physician and showed a large, mobile right heart thrombus leading to immediate administration of a thrombolytic. In this case, bedside ultrasound was utilized to help further delineate clinical care in a progressively worsening patient, leading to a potentially lifesaving treatment.

Serum Amyloid A Stimulates Pkr Expression And Hmgb1 Release Possibly Through Tlr4/Rage Receptors, W. Li, S. Zhu, J. Li, J. D'Amore, J. D'Angelo, H. Yang, P. Wang, K. J. Tracey, H. Wang

Journal Articles

Serum amyloid A proteins (SAAs) have been suggested as surrogate markers of sepsis, but their pathogenic roles remain poorly elucidated. Here we provide evidence to support a possible role of SAA as a pathogenic mediator of lethal sepsis. In a subset of septic patients whose serum HMGB1 levels paralleled with the clinical scores, some anti-HMGB1 antibodies detected a 12 kDa protein belonging to the SAA family. In contrast to the most abundant SAA1, human SAA induced PKR expression and HMGB1 release in the wild-type, but not TLR4/RAGE-deficient, macrophages. Pharmacological inhibition of PKR phosphorylation blocked SAA-induced HMGB1 release, suggesting an important …

Cannabinoid Cb2 Receptors In A Mouse Model Of A Beta Amyloidosis: Immunohistochemical Analysis And Suitability As A Pet Biomarker Of Neuroinflammation, A. V. Savonenko, T. Melnikova, Y. C. Wang, H. Ravert, Y. J. Gao, J. Koppel, D. Lee, P. Davies, M. G. Pomper, A. G. Horti, +6 Additional Authors

Journal Articles

In Alzheimer's disease (AD), one of the early responses to A beta amyloidosis is recruitment of microglia to areas of new plaque. Microglial receptors such as cannabinoid receptor 2 (CB2) might be a suitable target for development of PET radiotracers that could serve as imaging biomarkers of A beta-induced neuroinflammation. Mouse models of amyloidosis (J20APPswe/ind and APPswe/PS1 Delta E9) were used to investigate the cellular distribution of CB2 receptors. Specificity of CB2 antibody (H60) was confirmed using J20APPswe/ind mice lacking CB2 receptors. APPswe/PS1 Delta E9 mice were used in small animal PET with a CB2-targeting radiotracer, [C-11]A836339. These studies revealed …

Achilles Tendon Rupture, S. P. Stickles, L. Friedman, M. Demarest, C. Raio

Journal Articles

No abstract provided.

Choledochal Cyst Mimicking Gallbladder With Stones In A Six-Year-Old With Right-Sided Abdominal Pain, R. Subramony, N. Kittisarapong, I. Barata, M. Nelson

Journal Articles

Choledochal cysts are rare but serious bile duct abnormalities are found in young children, usually during the first year of life.1 They require urgent surgical intervention due to the risk of developing cholangiocarcinoma.2 Clinicians should consider this diagnosis and perform a point-of-care ultrasound (POCUS) when a child presents to the emergency department (ED) with findings of jaundice, abdominal pain, and the presence of an abdominal mass. We present the case of a six-year-old child presenting only with abdominal pain upon arrival to our ED and was ultimately diagnosed by POCUS to have a choledochal cyst.

Have First-Year Emergency Medicine Residents Achieved Level 1 On Care-Based Milestones?, M. Weizberg, M. C. Bond, M. Cassara, C. Doty, J. Seamon

Journal Articles

BACKGROUND: Residents in Accreditation Council for Graduate Medical Education accredited emergency medicine (EM) residencies were assessed on 23 educational milestones to capture their progression from medical student level (Level 1) to that of an EM attending physician (Level 5). Level 1 was conceptualized to be at the level of an incoming postgraduate year (PGY)-1 resident; however, this has not been confirmed. OBJECTIVES: Our primary objective in this study was to assess incoming PGY-1 residents to determine what percentage achieved Level 1 for the 8 emergency department (ED) patient care-based milestones (PC 1-8), as assessed by faculty. Secondary objectives involved assessing …

Novel Mechanisms Of Herbal Therapies For Inhibiting Hmgb1 Secretion Or Action, A. H. Wu, L. He, W. Long, Q. Zhou, S. Zhu, P. Wang, S. Fan, H. Wang

Journal Articles

High mobility group box 1 (HMGB1) is an evolutionarily conserved protein and is constitutively expressed in virtually all types of cells. In response to microbial infections, HMGB1 is secreted from activated immune cells to orchestrate rigorous inflammatory responses. Here we review the distinct mechanisms by which several herbal components inhibit HMGB1 action or secretion, such as by modulating inflammasome activation, autophagic degradation, or endocytic uptake. In light of the reciprocal interactions between these cellular processes, it is possible to develop more effective combinational herbal therapies for the clinical management of inflammatory diseases.

High Mobility Group Box Protein 1 (Hmgb1): The Prototypical Endogenous Danger Molecule, Huan Yang, H. Wang, Sangeeta S. Chavan, Ulf Andersson

Journal Articles

No abstract provided.

Milk Fat Globule Epidermal Growth Factor-Factor 8-Derived Peptide Attenuates Organ Injury And Improves Survival In Sepsis, W. L. Yang, A. Sharma, F. Zhang, S. Matsuo, Z. Wang, H. Wang, P. Wang

Journal Articles

INTRODUCTION: Sepsis involves overwhelming inflammatory responses with subsequent immune-suppression that can lead to multiple organ dysfunction and ultimately death. Milk fat globule epidermal growth factor-factor 8 (MFG-E8) is a secretory protein found to have multiple biological activities against autoimmune and inflammatory diseases. MFG-E8 contains an Arg-Gly-Asp (RGD) motif involved in cell-cell and cell-matrix interactions. In sepsis, excessive neutrophils migration through endothelial cells and matrix to sites of inflammation results in organ damage. We hypothesized that MFG-E8-derived short peptides (MSP) flanking its RGD motif could provide protection against organ injury in sepsis. METHODS: The differentiated human neutrophil-like HL-60 cells (dHL60) were …

Hmgb1: A Novel Protein That Induced Platelets Active And Aggregation Via Toll-Like Receptor-4, Nf-Kappab And Cgmp Dependent Mechanisms, X. Yang, H. Wang, M. Zhang, J. Liu, B. Lv, F. Chen

Journal Articles

BACKGROUND: Thrombotic diseases are a group of prevalent and life-threatening diseases. Selective inhibition of pathological thrombosis holds the key to treat variety of thrombotic diseases. The pathological thrombosis can be induced by either tissue necrosis and deregulated inflammation. HMGB1, as an important proinflammatory cytokine and a late mediator, also involves on thrombosis disease. However, the underlying mechanisms are not fully understood. METHODS: Immunofluorescence, ELISA assay, Platelet Aggregation, Thromboelastogram (TEG) analyzes. Flow cytometric analysis and Western blot analysis were used to investigated the role of HMGB1 in platelet aggregation and obtained following observations. RESULTS: By doing so, we obtained the following …

Mitochondrial Dysfunction In Peripheral Blood Mononuclear Cells In Pediatric Septic Shock, S. L. Weiss, M. A. Selak, F. Tuluc, J. Perales Villarroel, V. M. Nadkarni, C. S. Deutschman, L. B. Becker

Journal Articles

OBJECTIVES: Mitochondrial dysfunction in peripheral blood mononuclear cells has been linked to immune dysregulation and organ failure in adult sepsis, but pediatric data are limited. We hypothesized that pediatric septic shock patients exhibit mitochondrial dysfunction within peripheral blood mononuclear cells which in turn correlates with global organ injury. DESIGN: Prospective observational study. SETTING: Academic PICU. PATIENTS: Thirteen pediatric patients with septic shock and greater than or equal to two organ failures and 11 PICU controls without sepsis or organ failure. INTERVENTIONS: Ex vivo measurements of mitochondrial oxygen consumption and membrane potential (DeltaPsim) were performed in intact peripheral blood mononuclear cells …

Prescription For Antidepressant In Reducing Future Alcohol-Related Readmission In Patients Suffering From Depression And Alcohol Use Disorder: A Retrospective Medical Record Review, P. Chan, K. Yomen, J. Turcios, M. Richman

Journal Articles

BACKGROUND: Patients suffering from major depressive disorder are more likely to suffer from alcohol use disorder. The data is inconclusive for the effectiveness of antidepressant treatment of patients suffering from both illnesses in regards to improving sobriety and reducing alcohol-related healthcare expenses such as hospitalizations. The objective of this study is to determine if a new prescription of an antidepressant upon inpatient discharge is associated with a reduction in the number of future acute alcohol-related hospital readmissions to the same institution in patients suffering from major depressive disorder and alcohol-use disorder. METHODS: A retrospective, medical record review study was conducted …

Mu-Opioid Receptor Gene A118 G Variants And Persistent Pain Symptoms Among Men And Women Experiencing Motor Vehicle Collision, S. D. Linnstaedt, J. M. Hu, A. V. Bortsov, A. C. Soward, R. Swor, J. Jones, D. Lee, R. Domeier, P. Hendry, S. A. Mclean, +2 Additional Authors

Journal Articles

The mu-opioid receptor 1 (OPRM1) binds endogenous opioids. Increasing evidence suggests that endogenous OPRM1 agonists released at the time of trauma may contribute to the development of posttraumatic musculoskeletal pain (MSP). In this prospective observational study, we evaluated the hypothesis that individuals with an AG or GG genotype at the OPRM1 A118 G allele, which results in a reduced response to opioids, would have less severe MSP 6 weeks after motor vehicle collision (MVC). Based on previous evidence, we hypothesized that this effect would be sex-dependent and most pronounced among women with substantial peritraumatic distress. European American men and women …

Genetic Polymorphisms In The Dopamine Receptor 2 Predict Acute Pain Severity After Motor Vehicle Collision, Y. J. Qadri, A. V. Bortsov, D. C. Orrey, R. A. Swor, D. A. Peak, J. S. Jones, N. K. Rathlev, D. C. Lee, P. L. Hendry, S. A. Mclean, +1 Additional Author

Journal Articles

Objectives:Dopaminergic signaling is implicated in nociceptive pathways. These effects are mediated largely through dopamine receptors and modulated in part by dopamine transporters. This study tested the hypothesis that genetic variants in the genes encoding dopamine receptor 2 (DRD2) and the dopamine active transporter (SLC6A3) influence acute pain severity after motor vehicle collision.Materials and Methods:European Americans presenting to the emergency department after motor vehicle collision were recruited. Overall pain intensity in emergency department was assessed using a 0 to 10 numeric rating scale. DNA was extracted from blood samples and genotyping of single-nucleotide polymorphisms (SNPs) in the DRD2 and SLC6A3 gene …

Er Referral Models: Specialty Clinic — Seattle King County, Swedish Medical Center, American Dental Association

Action for Dental Health

No abstract provided.

Pre-Hospital Tranexamic Acid Use For Trauma, Troy Thompson

Physician Assistant Scholarly Project Posters

• Nearly 40% of deaths after trauma can be attributed to blood loss. It is well known that early surgical interventions, combined with other treatment modalities found in the hospital setting, lead to the decreased morbidity and mortality of trauma patients. However, in an outpatient setting, treatments for hemorrhage control are extremely limited.

• The purpose of this literature review was to explore tranexamic acid (TXA) use as an option for hemorrhage control and to determine its effect on morbidity and mortality in both prehospital and outpatient settings. TXA is an FDA approved antifibrinolytic that has proven efficacy for hemorrhage …