Emergency Medicine Commons^™

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 …

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

Family Medicine, East Africa

No abstract provided.

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

Family Medicine, East Africa

No abstract provided.

Development Of A Standard And Functional Tactical Emergency Medical Curriculum -- Tems Medic, Benjamin Hannon

Honors Theses

Violent crime causes death and injury regularly in the United States. Some events such as the Newtown shootings, the Oklahoma City bombings, or the Washington, DC sniper case acutely focus the entire nation’s attention while other, less contemporary events fade away. The public safety apparatus – police, fire, and emergency medical services – always respond to save lives. On December 11, 2012 a man opened fire at a mall in Clackamas County, Oregon. The 9-1-1 dispatchers sent units to a shooting at the mall and then quickly reported that the shooter was still firing in the mall. One of the …

Optimizing Atraumatic Emergency Care In Child Sexual Abuse, Kristen A. Morris

Evidence-Based Practice Project Reports

Child sexual abuse has been identified as a common problem. According to the United States Department of Health and Human Services, in 2010 it was estimated that child victims of sexual abuse accounted for 9.2% (69,368) of the 573,794 children under the age of 12 years who were the victims of maltreatment. The emergency department (ED) is often the point of entry into the healthcare system for child sexual abuse victims, which adds to the resource burden of this department nationwide. The purpose of this evidence-based project was to develop a best-practice screening tool for medical providers to guide the …

Aortic Dissection Presenting As Gait Disturbance: A Case Report., Michael Estreicher, Joseph Portale, Bernard Lopez

Department of Emergency Medicine Faculty Papers

Emergency medicine dogma traditionally teaches that aortic dissection presents as tearing chest pain, radiating to the back. This case report describes a 55 year old woman presenting with a left homonymous hemianopsia and resultant gait disturbance. Initial head CT demonstrated a right parietal infarct, and chest radiograph demonstrated a markedly widened mediastinum. Acute Stanford Type A aortic dissection was subsequently confirmed. This report provides further evidence for atypical, painless presentations of aortic dissection. Given recent literature on the increasing prevalence of painless dissection, the disease entity should be included in the differential diagnosis for stroke, and a simple portable chest …

Tumor Necrosis Factor-Α And Lymphotoxin-Α Mediate Myocardial Ischemic Injury Via Tnf Receptor 1, But Are Cardioprotective When Activating Tnf Receptor 2., Yanqing Zhang, Jianli Zhao, Wayne Bond Lau, Li-Yuan Jiao, Baojiang Liu, Yuexing Yuan, Xiaoliang Wang, Erhe Gao, Walter J Koch, Xin-Liang Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

OBJECTIVE: This study determines the roles of tumor necrosis factor-α (TNFα) and lymphotoxin-α (LTα) in post-myocardial infarction (post-MI) cardiac injury, and identifies the TNF receptor type responsible for TNFα- and LTα-mediated cardiac injury.

METHODS AND RESULTS: Adult male wild type (WT), TNFα(-/-), LTα(-/-), TNFR1(-/-), and TNFR2(-/-) mice were subjected to MI via coronary artery occlusion. Functional, histological, and biochemical analyses were performed 1 to 7 days post-MI. In WT mice, MI significantly increased both TNFα and LTα levels in plasma, but in distinct temporal manner. Plasma TNFα peaked 1 day after MI, and decreased toward baseline 3 days after MI. …

Rewarming For Accidental Hypothermia In An Urban Medical Center Using Extracorporeal Membrane Oxygenation., David Morley, Kentaro Yamane, Rika O'Malley, Nicholas Cavarocchi, Hitoshi Hirose

Department of Emergency Medicine Faculty Papers

BACKGROUND: Accidental hypothermia complicated by cardiac arrest carries a high mortality rate in urban areas. For moderate hypothermia cases conventional rewarming methods are usually adequate, however in severe cases extracorporeal membrane oxygenation (ECMO) is known to provide the most efficient rewarming with complete cardiopulmonary support. We report a case of severe hypothermia complicated by prolonged cardiac arrest successfully resuscitated using ECMO.

CASE REPORT: A 45 year old female was brought to our emergency department with a core body temperature

CONCLUSIONS: This case demonstrates the advantages of advanced internal rewarming techniques, such as ECMO, for quick and efficient rewarming of severely …

Ginsenoside Rd Attenuates Myocardial Ischemia/Reperfusion Injury Via Akt/Gsk-3Β Signaling And Inhibition Of The Mitochondria-Dependent Apoptotic Pathway., Yang Wang, Xu Li, Xiaoliang Wang, Wayne Bond Lau, Yajing Wang, Yuan Xing, Xing Zhang, Xinliang Ma, Feng Gao

Department of Emergency Medicine Faculty Papers

Evidence suggests Ginsenoside Rd (GSRd), a biologically active extract from the medical plant Panax Ginseng, exerts antioxidant effect, decreasing reactive oxygen species (ROS) formation. Current study determined the effect of GSRd on myocardial ischemia/reperfusion (MI/R) injury (a pathological condition where ROS production is significantly increased) and investigated the underlying mechanisms. The current study utilized an in vivo rat model of MI/R injury and an in vitro neonatal rat cardiomyocyte (NRC) model of simulated ischemia/reperfusion (SI/R) injury. Infarct size was measured by Evans blue/TTC double staining. NRC injury was determined by MTT and lactate dehydrogenase (LDH) leakage assay. ROS accumulation and …

Screening For Elder Mistreatment Among Older Adults Seeking Legal Assistance Services, Sheryl M. Strasser, Megan Smith, Scott Weaver, Shimin Zheng, Yan Cao

ETSU Faculty Works

Introduction: The aging population is a rapidly growing demographic in the United States. Isolation, limited autonomy, and declining physical and mental health render many older adults vulnerable to elder mistreatment (EM). The purpose of this study was to assess the prevalence and correlates of EM among a sample of older adults using legal assistance services in Atlanta, Georgia.

Methods: Researchers administered surveys to consenting older adults (aged 60þ) in 5 metro Atlanta community centers that hosted legal assistance information sessions as part of the Elderly Legal Assistance Program. The surveys screened for risk factors and prevalence of EM risk using …

Evidence-Based Protocols For Assessment And Treatment Of Adolescent Suicide Risk In An Emergency Department, Rebecca Bentele

All Graduate Theses, Dissertations, and Other Capstone Projects

Suicide and suicide attempts are a frequently encountered clinical crisis and the assessment, management and treatment of suicidal patients is one of the most stressful tasks for clinicians (Fowler, 2012). The purpose of this project was to examine whether current assessment and treatment protocols followed in the ED, Mankato, adhere to best-­‐practices as identified through research, as well as to make recommendations to MCHS-­‐Mankato for future considerations and potential modifications to existing protocols.

The Tip Of The Tail Needle Affects The Rate Of Dna Delivery By Bacteriophage P22., Justin C Leavitt, Lasha Gogokhia, Eddie B Gilcrease, Anshul Bhardwaj, Gino Cingolani, Sherwood R Casjens

Department of Biochemistry and Molecular Biology Faculty Papers

The P22-like bacteriophages have short tails. Their virions bind to their polysaccharide receptors through six trimeric tailspike proteins that surround the tail tip. These short tails also have a trimeric needle protein that extends beyond the tailspikes from the center of the tail tip, in a position that suggests that it should make first contact with the host's outer membrane during the infection process. The base of the needle serves as a plug that keeps the DNA in the virion, but role of the needle during adsorption and DNA injection is not well understood. Among the P22-like phages are needle …

Effect Of Blood Collection Practices On Emergency Department Blood Specimen Rejection Rates, Barbara K. Vernoski

UNF Graduate Theses and Dissertations

The practice of obtaining blood as part of the placement of a new peripheral venous access device (p-VAD) is a frequent practice in the emergency department (ED). Of the concerns related to this practice is the possibility of laboratory specimen rejection due to p-VAD catheter size, use of the wrong collection device, and the absence of a standardized collection process. The objective of this study, therefore, was to examine the effect of the use of evidence-based venipuncture and p-VAD blood collection protocols on the rejection rate of blood specimens drawn by staff in the adult areas of an urban academic …