Emergency Medicine Commons^™

Lymphotoxin-Α Is A Novel Adiponectin Expression Suppressor Following Myocardial Ischemia/Reperfusion., Wayne Bond Lau, Yanqing Zhang, Jianli Zhao, Baojiang Liu, Xiaoliang Wang, Yuexing Yuan, Theodore A. Christopher, Bernard Lopez, Erhe Gao, Walter J. Koch, Xin L. Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

Recent clinical observations demonstrate adiponectin (APN), an adipocytokine with potent cardioprotective actions, is significantly reduced following myocardial ischemia/reperfusion (MI/R). However, mechanisms responsible for MI/R-induced hypoadiponectinemia remain incompletely understood. Adult male mice were subjected to 30-min MI followed by varying reperfusion periods. Adipocyte APN mRNA and protein expression and plasma APN and TNFα concentrations were determined. APN expression/production began to decline 3 h after reperfusion (reaching nadir 12 h after reperfusion), returning to control levels 7 days after reperfusion. Plasma TNFα levels began to increase 1 h after reperfusion, peaking at 3 h and returning to control levels 24 h after …

Pathogen-Specific Risk Of Chronic Gastrointestinal Disorders Following Bacterial Causes Of Foodborne Illness, Chad K. Porter, Daniel Choi, Brooks Cash, Mark Pimentel, Joseph Murray, Larissa May, Mark S. Riddle

Emergency Medicine Faculty Publications

Background

The US CDC estimates over 2 million foodborne illnesses are annually caused by 4 major enteropathogens: non-typhoid Salmonella spp., Campylobacter spp., Shigella spp. and Yersinia enterocoltica. While data suggest a number of costly and morbid chronic sequelae associated with these infections, pathogen-specific risk estimates are lacking. We utilized a US Department of Defense medical encounter database to evaluate the risk of several gastrointestinal disorders following select foodborne infections.

Methods

We identified subjects with acute gastroenteritis between 1998 to 2009 attributed to Salmonella(nontyphoidal) spp., Shigella spp., Campylobacter spp. or Yersinia enterocolitica and matched each with up to 4 …

School-Based Injury Outcomes In Children From A Low-Income Setting: Results From The Pilot Injury Surveillance In Rawalpindi City, Pakistan, Uzma Rahim Khan, Junaid A. Bhatti, Nukhba Zia, Umar Farooq

Department of Emergency Medicine

Background

School-based injuries account for one in five unintentional childhood injuries. Little is known about the epidemiology of school-based injuries in low-income settings. The objective of our study was to compare emergency department (ED) outcomes of the school-based injuries with respect to age, sex, and injury mechanisms in a Pakistani urban setting.

Findings

A pilot injury surveillance study was conducted at the EDs of three major tertiary-care hospitals of Rawalpindi city from July 2007 to June 2008 and included children of less than 15 years injured at school. The World Health Organization’s questionnaire for injury surveillance was used. There were …

Broadening Access To Medical Care During A Severe Influenza Pandemic: The Cdc Nurse Triage Line Project., Lisa M. Koonin, Dan Hanfling

Emergency Medicine Faculty Publications

The impact of a severe influenza pandemic could be overwhelming to hospital emergency departments, clinics, and medical offices if large numbers of ill people were to simultaneously seek care. While current planning guidance to reduce surge on hospitals and other medical facilities during a pandemic largely focuses on improving the “supply” of medical care services, attention on reducing “demand” for such services is needed by better matching patient needs with alternative types and sites of care. Based on lessons learned during the 2009 H1N1 pandemic, the Centers for Disease Control and Prevention and its partners are currently exploring the acceptability …

Asynchronous Web-Based Learning, A Practical Method To Enhance Teaching In Emergency Medicine, Ali Pourmand, Raymond Lucas, Mehdi Nouraie

Emergency Medicine Faculty Publications

Objective: To compare medical knowledge acquisition among emergency medicine (EM) residents who attend weekly core content lectures with those absent but asynchronously viewing the same lectures in a Web-based electronic platform.

Subjects and Methods: During the study period all EM residents attending or absent from weekly educational conferences were given a quiz on the covered material. During Phase 1, absentees were not given supplemental educational content for missed lectures. During Phase 2, absentees were sent a link to an online multimedia module containing an audiovisual recording of the actual missed lecture with presentation slides. Scores between attendees and absentees during …

Bedside Teaching On Time To Disposition Improves Length Of Stay For Critically-Ill Emergency Departments Patients, Ali Pourmand, Raymond Lucas, Jesse M. Pines, Hamid Shokoohi, Kabir Yadav

Emergency Medicine Faculty Publications

Introduction: We tested the effect of a brief disposition process intervention on residents’ time to disposition and emergency department (ED) length of stay (LOS) in high acuity ED patients.

Methods: This was a quasi-experimental study design in a single teaching hospital where ED residents are responsible for administrative bed requests for patients. Enrollment was performed for intervention and control groups on an even-odd day schedule. Inclusion criteria were ED patients triaged as Emergency Severity Index (ESI) 1 and 2. In the intervention group, the attending physician prompted the resident to make the disposition immediately after the evaluation of resuscitation patients. …

Reducing Ambulance Diversion At Hospital And Regional Levels: Systematic Review Of Insights From Simulation Models, M. Kit Delgado, Lesley J. Meng, Mary P. Mercer, Jesse M. Pines, Douglas K. Owens, Gregory S. Zaric

Emergency Medicine Faculty Publications

Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear. We performed a systematic review of published simulation studies to identify: 1) the tradeoff between ambulance diversion and ED wait times; 2) the predicted impact of patient flow interventions on reducing diversion; and 3) the optimal regional strategy for reducing diversion.

Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent …

Intubation In Emergency Department Of A Tertiary Care Hospital In A Low-Income, Nadeem Ullah Khan, Uzma R. Khan, Kiran Ejaz, Humaid Ahmad, Nukhba Zia, Junaid Abdul Razzak

Department of Emergency Medicine

Objective: To study the indications, method, success rate and complications of intubation at the Emergency Department of a private, tertiary care hospital in Karachi, Pakistan.
Methods: The case series involved 278 patients above 14 years of age who underwent emergency intubation at the Emergency Department of Aga Khan University Hospital, Karachi between 1998 and 2003. Descriptive statistics were used to compare rapid sequence intubation with crash intubation. The level of significance was p<0.05.
Results: Of the total 278 intubations performed, 37 (13.3%) had to be left out for incomplete information. The study population remaining for inferential analysis comprised of 241 …

Nitric Oxide And Its Metabolites In The Critical Phase Of Illness: Rapid Biomarkers In The Making, Asad Mian, Mayank Aranke, Nathan S. Bryan

Department of Emergency Medicine

The potential of nitric oxide (NO) as a rapid assay biomarker, one that could provide a quantum leap in acute care, remains largely untapped. NO plays a crucial role as bronchodilator, vasodilator and inflammatory mediator. The main objective of this review is to demonstrate how NO is a molecule of heavy interest in various acute disease states along the emergency department and critical care spectrum: respiratory infections, central nervous system infections, asthma, acute kidney injury, sepsis, septic shock, and myocardial ischemia, to name just a few. We discuss how NO and its oxidative metabolites, nitrite and nitrate, are readily detectable …

Clinician-Performed Beside Ultrasound For The Diagnosis Of Traumatic Pneumothorax., Bon S. Ku, Jason M. Fields, Brendan Carr, Worth W Everett, Vincent H Gracias, Anthony J Dean

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Prior studies have reported conflicting results regarding the utility of ultrasound in the diagnosis of traumatic pneumothorax (PTX) because they have used sonologists with extensive experience. This study evaluates the characteristics of ultrasound for PTX for a large cohort of trauma and emergency physicians.

METHODS: This was a prospective, observational study on a convenience sample of patients presenting to a trauma center who had a thoracic ultrasound (TUS) evaluation for PTX performed after the Focused Assessment with Sonography for Trauma exam. Sonologists recorded their findings prior to any other diagnostic studies. The results of TUS were compared to one …

Uchunguzi (Journal Watch/Montre De Journal) March 2013, Benjamin Wachira

Family Medicine, East Africa

No abstract provided.

The Treatment Of Cutaneous Abscesses: Comparison Of Emergency Medicine Providers' Practice Patterns, Gillian Schmitz, Tress Goodwin, Adam Singer, Chad S. Kessler, David Bruner, Hollyn Larabee, Larissa S. May, Samuel D. Luber, Justin Williams, Rahul Bhat

Emergency Medicine Faculty Publications

INTRODUCTION:

Cutaneous abscesses are commonly treated in the emergency department (ED). Although incision and drainage (I&D) remains the standard treatment, there is little high-quality evidence to support additional interventions such as pain control, type of incision, and use of irrigation, wound cultures, and packing. Although guidelines exist to support clinician management of abscesses, they do not clearly specify these additional interventions. This study sought to describe the ED treatments administered to adults with uncomplicated superficial cutaneous abscesses, defined as purulent lesions requiring incision and drainage that could be managed in an ED or outpatient setting.

METHODS:

Four hundred and seventy-four …

Perceptions Of Emergency Department Crowding In The Commonwealth Of Pennsylvania, Jesse M. Pines, Joshua A. Isserman, John J. Kelly

Emergency Medicine Faculty Publications

Introduction: The state of emergency department (ED) crowding in Pennsylvania has not previously been reported.

Methods: We assessed perceptions of ED crowding by surveying medical directors/chairs from Pennsylvania EDs in the spring of 2008.

Results: A total of 106 completed the questionnaire (68% response rate). A total of 83% (86/104) agreed that ED crowding was a problem; 26% (27/105) reported that at least half of admitted patients boarded for more than 4 hours. Ninety-eight percent (102/104) agreed that patient satisfaction suffers during crowding and 79% (84/106) stated that quality suffers. Sixty-five percent (68/105) reported that crowding had worsened during the …

False Passage To The Trachea After Emergency Intubation In A Victim Of Near Hanging, Ali Pourmand, Hamid A. Shokoohi

Emergency Medicine Faculty Publications

Emergency medicine physicians should have enough knowledge and experience to deal with emergent and traumatic difficult airway. In this paper, we present a case of near hanging with neck soft tissue injury, tracheal and esophageal rupture that is complicated by a displaced intubation and false passage to the trachea.

Tension Pneumothorax, Pneumoperitoneum, And Cervical Emphysema Following A Diagnostic Colonoscopy, Ali Pourmand, Hamid A. Shokoohi

Emergency Medicine Faculty Publications

Colonoscopy is currently a widespread procedure used in screening for colorectal cancer. Iatrogenic colonic perforation during colonoscopy is a serious and potentially life-threatening complication that can cause significant morbidity and mortality. “Triple pneumo” (a combination of pneumothorax, pneumomediastinum, and pneumoperitoneum) following colonoscopy is a rare but a serious condition requiring immediate diagnosis and emergent intervention. In majority of these cases a colonic perforation is the initial injury that is followed by pneumothorax and pneumomediastinum through the potential anatomical connection with retroperitoneal and mediastinal spaces. In this rare case report we are presenting a case of “triple pneumo” with no evidence …

Impacts Of Social Networking Sites On Patient Care In The Emergency Department, Anne Bennett, Ali Pourmand, Robert Shesser, Jesus Sanchez, Joseph Joyce

Emergency Medicine Faculty Publications

The use of Facebook is ubiquitous among both patients and physicians. Often Facebook intrudes into medical practice, thereby highlighting its potential to be either a positive or negative factor in a patient's medical care. Despite being a “hot topic” in the medical literature, very few real world examples exist of physicians actually using information obtained from Facebook to reach a diagnosis or otherwise affect patient care. We present a case involving a 13-year-old girl who posted photographs and captions on Facebook demonstrating suicidal ideation. The patient's parents were alerted to the girl's statements in her Facebook profile and brought her …

A Syndromic Approach To Emergency Department Surveillance For Skin And Soft Tissue Infections, Larissa S. May, Marcus Rennick, Leah Gustafson, Julia Gunn

Emergency Medicine Faculty Publications

Objective

We sought to describe the epidemiology of emergency department (ED) visits for skin and soft tissue infections (SSTI) in an urban area with diverse neighborhood populations using syndromic surveillance system data for the time period from 2007–2011. Our aims were threefold: to demonstrate a proof of concept using syndromic surveillance for SSTI surveillance in the absence of laboratory data, to estimate the burden of ED visits associated with SSTI, and to determine potential geographic “hotspots” for these infections.

Introduction

The incidence of and hospitalizations for SSTI have steadily increased over the last decade in the United States, primarily due …

Household Catastrophic Medical Expenses In Eastern China: Determinants And Policy Implications, Xiaohong Li, Jay J. Shen, Jun Lu, Mei Sun, Chengyue Li, Fengshui Chang, Mo Hao

School of Public Health Faculty Research

Background: Much of research on household catastrophic medical expenses in China has focused on less developed areas and little is known about this problem in more developed areas. This study aimed to analyse the incidence and determinants of catastrophic medical expenses in eastern China.

Methods: Data were obtained from a health care utilization and expense survey of 11,577 households conducted in eastern China in 2008. The incidence of household catastrophic medical expenses was calculated using the method introduced by the World Health Organization. A multi-level logistic regression model was used to identify the determinants.

Results: The incidence of household catastrophic …

Patient-Family Centered Advisory Council For The Emergency Department, Kelly Sanocki

Theses and Graduate Projects

Issues such as overcrowding and long wait times in the ED cause an increase in patient frustration and dissatisfaction, which may lower hospital satisfaction scores,, and reimbursement. This project proposes the implementation of a Patient-Family Advisory Council (PFAC) in the Emergency Department (ED) setting in a large urban hospital. The addition of a PFAC will offer patients and family members a voice in their care, as they work collaboratively with various healthcare providers to improve patient care, patient safety, and overall satisfaction. The addition of Watson's Caring theory will serve as the theoretical framework for the PFAC since it is …

Missing The Boat: Odds For The Patients Who Leave Ed Without Being Seen, Jabeen Fayyaz, Munawar Khursheed, Mohammed Umer Mir, Amber Mehmood

Department of Emergency Medicine

BACKGROUND:

A patient left without being seen is a well-recognized indicator of Emergency Department overcrowding. The aim of this study was to define the characteristics of LWBS patients, their rates and associated factors from a tertiary care hospital of Pakistan.

METHODS:

A retrospective patient record review was undertaken. All patients presenting to the Aga Khan University Hospital, Karachi, between April and December of the year 2010, were included in the study. Information was collected on age, sex, presenting complaints, ED capacity, month, time, shift, day of the week, and waiting times in the ED. A basic descriptive analysis was made …