Emergency Medicine Commons^™

Pre-Hospital Stroke Time Intervals In The Rio Grande Valley, Kelsey Baker, Elio E. Garcia Sosa

Research Colloquium

Background and Introduction: Stroke continues to be a significant cause of mortality in the United States. Despite advancements in acute stroke treatments such as thrombolytic therapy and endovascular procedures, many patients remain unable to benefit from these interventions due to delays in receiving treatment. Healthcare professionals have made substantial efforts to improve 'door to needle' times, the interval between a patient's arrival at the hospital and the administration of thrombolytic therapy, yielding promising outcomes. However, a critical gap persists: the time interval from the onset of stroke symptoms to when patients actually present at a healthcare facility. This study aims …

The Discover In-Hospital Cardiac Arrest (Discover Ihca) Study: An Investigation Of Hospital Practices After In-Hospital Cardiac Arrest, Luke Andrea, Nathaniel S. Herman, Jacob Vine, Katherine M. Berg, Saiara Choudhury, Mariana Vaena, Jordan E. Nogle, Saleem M. Halablab, Aarthi Kaviyarasu, Jonathan Elmer, Gabriel Wardi, Alex K. Pearce, Conor Crowley, Micah T. Long, J. Taylor Herbert, Kipp Shipley, Brittany D. Bissell Turpin, Michael J. Lanspa, Adam Green, Shekhar A. Ghamande, Akram Khan, Siddharth Dugar, Aaron M. Joffe, Michael Baram, Cooper March, Nicholas J. Johnson, Alexander Reyes, Krassimir Denchev, Michael Loewe, Et Al

School of Medicine Faculty Publications

IMPORTANCE: In-hospital cardiac arrest (IHCA) is a significant public health burden. Rates of return of spontaneous circulation (ROSC) have been improving, but the best way to care for patients after the initial resuscitation remains poorly understood, and improvements in survival to discharge are stagnant. Existing North American cardiac arrest databases lack comprehensive data on the post-resuscitation period, and we do not know current post-IHCA practice patterns. To address this gap, we developed the Discover In-Hospital Cardiac Arrest (Discover IHCA) study, which will thoroughly evaluate current post-IHCA care practices across a diverse cohort. OBJECTIVES: Our study collects granular data on post-IHCA …

Cardiomyocyte-Derived Small Extracellular Vesicle: A New Mechanism Driving Diabetic Cardiac Fibrosis And Cardiomyopathy, Yu Li, Yunhui Du, Yang Liu, Xiuhuan Chen, Xinxin Li, Yanru Duan, Yanwen Qin, Huirong Liu, Xinliang Ma, Shaoping Nie, Huina Zhang

Department of Emergency Medicine Faculty Papers

Rationale: Diabetic cardiomyopathy is one of the major diabetic cardiovascular complications in which fibrosis plays a critical pathogenetic role. However, the precise mechanisms by which diabetes triggers cardiac fibrosis in the heart remain elusive. Small extracellular vesicles (sEVs) play an important role in the cellular communication. Nevertheless, whether and how diabetes may adversely alter sEVs-mediated cardiomyocyte-fibroblast communication, promoting diabetic cardiac fibrosis and contributing to diabetic cardiomyopathy, has not been previously investigated. Methods and results: High-fat diet (HFD)-induced and genetic (db/db) type 2 diabetic models were utilized. Cardiomyocyte sEVs (Myo-sEVs) were isolated by ultracentrifugation. Normal cardiomyocyte-derived Myo-sEVs attenuated diabetic cardiac fibrosis …

Tranq Dope: Characterization Of An Ed Cohort Treated With A Novel Opioid Withdrawal Protocol In The Era Of Fentanyl/Xylazine, Kory London, Yutong Li, Jennifer Kahoud, Davis Cho, Jamus Mulholland, Sebastian Roque, Logan Stugart, Jeffrey Gillingham, Elias Borne, Benjamin Slovis

Department of Emergency Medicine Faculty Papers

BACKGROUND: Treating opioid use disorder has reached a new level of challenge. Synthetic opioids and xylazine have joined the non-medical opioid supply, multiplying the complexities of caring for individuals in emergency departments (ED). This combination, known as 'tranq dope,' is poorly described in literature. Inadequate withdrawal treatment results in a disproportionately high rate of patient-directed discharges (also known as against medical advice dispositions, or AMA). This study aimed to describe a cohort of individuals who received a novel order set for suspected fentanyl and xylazine withdrawal in the ED.

METHODS: This is a descriptive study evaluating a cohort of ED …

Emergency Department Slit Lamp Interdisciplinary Training Via Longitudinal Assessment In Medical Practice, Samara Hamou, Shayan Ghiaee, Christine Chung, Maureen Lloyd, Kelly Khem, Xiao Zhang

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Eye emergencies make up nearly 3% of US emergency department (ED) visits. While emergency physicians (EP) should diagnose and treat these ophthalmologic emergencies, many trainees report limited ocular exposure and insufficient training throughout their residency to confidently conduct a thorough slit-lamp exam.

METHODS: We created an interdisciplinary, simulation-based mastery learning (SBML) curriculum to teach emergency attending physicians how to operate the slit lamp with multimodal learning methodology at a tertiary academic center. The EPs first demonstrate their initial slit-lamp competency with a 20-item checklist, and they then review the necessary curricular content to pass their independent readiness test before …

Digital Health Research Symposium: Closing Panel Commentary, Judd E. Hollander, Kristin L. Rising, Brian M. Dougan

Department of Emergency Medicine Faculty Papers

No abstract provided.

Hereditary Spherocytosis Due To A Novel Variant, P.Q1034x, In The Beta Subunit Of The Spectrin Gene: A Case Report, Emmalee M. Kugler, Akash Patel, Faraz Afridi, Maria I. Scarano, Rafat Ahmed

Department of Emergency Medicine Faculty Papers

Background: Heterozygous pathogenic variants of SPTB cause hereditary spherocytosis (HS) in a quarter of cases. Case report: A 14-day-old male presenting with persistent anemia and hyperbilirubinemia was diagnosed with HS by increased red blood cell osmotic fragility and decreased fluorescence on the eosin-5′-maleimide binding test. For his failure to thrive and hypotonia, genetic sequencing revealed a de novo variant of the SPTB gene (p.Q1034X) on exon 15. This variant is predicted to cause loss of normal protein function either through protein truncation or nonsense-mediated mRNA decay. A variant of uncertain significance (p.R438W) in the chondroitin sulfate synthase 1 (CHSY1) gene …

Exploring Medical Student Experiences Of Trauma In The Emergency Department: Opportunities For Trauma-Informed Medical Education, Giselle Appel, Ahmed Shahzad, Kestrel Reopelle, Stephen Didonato, Frances Rusnack, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

PURPOSE: During the third-year emergency medicine (EM) clerkship, medical students are immersed in traumatic incidents with their patients and clinical teams. Trauma-informed medical education (TIME) applies trauma-informed care (TIC) principles to help students manage trauma. We aimed to qualitatively describe the extent to which students perceived the six TIME domains as they navigated critical incidents during their EM clerkship.

METHODS: We employed a constructivist, modified grounded theory approach to explore medical students' experiences. We used the critical incident technique to elicit narratives to better understand the six TIME domains as they naturally appear in the clerkship. Participants were asked to …

The Discover In-Hospital Cardiac Arrest (Discover Ihca) Study: An Investigation Of Hospital Practices After In-Hospital Cardiac Arrest, Luke Andrea, Nathaniel S Herman, Jacob Vine, Katherine M Berg, Saiara Choudhury, Mariana Vaena, Jordan E Nogle, Saleem M Halablab, Aarthi Kaviyarasu, Jonathan Elmer, Gabriel Wardi, Alex K Pearce, Conor Crowley, Micah T Long, J Taylor Herbert, Kipp Shipley, Brittany D Bissell Turpin, Michael J Lanspa, Adam Green, Shekhar A Ghamande, Akram Khan, Siddharth Dugar, Aaron M Joffe, Michael Baram, Cooper March, Nicholas J Johnson, Alexander Reyes, Krassimir Denchev, Michael Loewe, Ari Moskowitz

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

IMPORTANCE: In-hospital cardiac arrest (IHCA) is a significant public health burden. Rates of return of spontaneous circulation (ROSC) have been improving, but the best way to care for patients after the initial resuscitation remains poorly understood, and improvements in survival to discharge are stagnant. Existing North American cardiac arrest databases lack comprehensive data on the post-resuscitation period, and we do not know current post-IHCA practice patterns. To address this gap, we developed the Discover In-Hospital Cardiac Arrest (Discover IHCA) study, which will thoroughly evaluate current post-IHCA care practices across a diverse cohort.

OBJECTIVES: Our study collects granular data on post-IHCA …

Communities Disproportionately Affected By Carbon Monoxide Exposure After Winter Storm Uri, Elyse N Portillo, Casandra Quiñones, Zachary C Foughty, Ryan Ramphul, Asha T Morrow, Kathryn Fisher, Stephen A Harding, Elizabeth A Camp, Shubhada Hooli, Eric A Russell

Faculty, Staff and Students Publications

Extreme cold in February 2021 precipitated prolonged power failure in Texas. In Houston, many patients presented for carbon monoxide exposure from neighborhoods with lower per capita income, higher rates of limited English proficiency, and greater median Social Vulnerability Indices than Greater Houston. Weather-related disasters disproportionately affect socially vulnerable communities.

Clinical And Radiological Identification And Management Of Sapho Syndrome, Obyda Al-Housni, Jessica M. Alonso, Matthew Thornburg, Enny Cancio

HCA Healthcare Journal of Medicine

Introduction

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is an autoinflammatory disease whose acronymic name stands for the symptoms commonly seen in the disease. These symptoms typically occur simultaneously, in different combinations, in patients during exacerbations of the disease. SAPHO syndrome is a rare disease, most frequently seen in patients aged 30 to 50. It is estimated to be found in 1 in 10 000 persons in White populations, with an even lower incidence seen in non-White populations.

Case Presentation

A post-menopausal woman with a medical history of SAPHO presented to the emergency department with left foot pain and …

Man On The Mound: Pictures Of A Pitcher In Pain, Jean Medina, Matthew Campanella, Elliot Mendelsohn, Carl Mitchell, Murtaza Akhter

HCA Healthcare Journal of Medicine

Atraumatic ball thrower's humerus fracture is an uncommon, and poorly understood injury pattern. The majority of these cases are seen in untrained and younger individuals. A missed diagnosis could severely impact a patient's quality of life, as management is operative in most cases. Here, we present the case of a young patient, suffering an atraumatic "ball thrower's" fracture. We present images of this exceedingly rare injury pattern and showcase original artwork with a proposed mechanism of injury.

A Clinical Review On Spinal Epidural Abscess: Epidemiology, Pathophysiology, Diagnosis, And Management For Emergency Medicine And Hospitalist Physicians, Madeline A. Guy, Jeffrey S. Guy

HCA Healthcare Journal of Medicine

Spinal epidural abscess (SEA), a critical surgical emergency, demands prompt recognition and intervention to prevent severe complications and fatalities. The incidence of SEA is notably increasing, particularly among individuals with diabetes, intravenous drug use, or a history of invasive spinal procedures. Although SEA can manifest through various clinical symptoms, the presence of its classic triad—back pain, fever, and neurological deficits—is noteworthy despite its occurrence in only 10% to 13% of cases. Identifying this triad is vital due to its high specificity for SEA, which is essential to guiding swift diagnostic and therapeutic actions in a condition where early intervention is …

“Dead Or Alive?” Regression Imputation Of The Binary End-Of-Event Outcome Indicator For The Nemsis Public Research Dataset, Mary E. Helander

Social Science - All Scholarship

Objectives: Recent studies address missing survival outcomes in the National Emergency Medical Services Information System (NEMSIS), a system that stores and shares standardized EMS data from U.S. States and Territories. This study aspired to improve imputed EMS outcome accuracy and establish benchmarks for common medical emergencies treated in prehospital care. Methods: This retrospective cohort study of ground-transported EMS patients with definitive end-of-EMS-event outcomes, based on dataset years 2017 to 2023, predicted the probability of “dead” or “alive” status using logistic regression. K-fold cross-validation assessed over-fitting and internal generalization. Threshold optimization and machine learning classification metrics enabled comparison with a …

“Dead Or Alive?” Assessment Of The Binary End-Of-Event Outcome Indicator For The Nemsis Public Research Dataset, Mary E. Helander

Social Science - All Scholarship

OBJECTIVE: The broad absence of definitive patient outcomes in the NEMSIS public release data hinders research that seeks to understand the impact of pre-hospital care, operations, and overall patterns of population health – including geospatial and demographic differences. This study evaluated the recently proposed binary end-of-event outcome indicator to provide additional validity of the method, to evangelize its employment for more studies to analyze survival impact following an emergency medical event, and to identify appropriate use and interpretation given imperfection in predicted outcomes. METHODS: A recently published binary end-of-event outcome indicator was applied to datasets for each year from 2017 …

Safety Of Treating Acute Pulmonary Embolism At Home: An Individual Patient Data Meta-Analysis, Dieuwke Luijten, Delphine Douillet, Kim Luijken, Cecile Tromeur, Andrea Penaloza, Olivier Hugli, Drahomir Aujesky, Stefano Barco, Joseph R Bledsoe, Kyle E Chang, Francis Couturaud, Paul L Den Exter, Carme Font, Menno V Huisman, David Jimenez, Christopher Kabrhel, Jeffrey A Kline, Stavros Konstantinides, Thijs Van Mens, Remedios Otero, W Frank Peacock, Olivier Sanchez, William B Stubblefield, Luca Valerio, David R Vinson, Philip Wells, Maarten Van Smeden, Pierre-Marie Roy, Frederikus A Klok

Faculty, Staff and Students Publications

BACKGROUND AND AIMS: Home treatment is considered safe in acute pulmonary embolism (PE) patients selected by a validated triage tool (e.g. simplified PE severity index score or Hestia rule), but there is uncertainty regarding the applicability in underrepresented subgroups. The aim was to evaluate the safety of home treatment by performing an individual patient-level data meta-analysis.

METHODS: Ten prospective cohort studies or randomized controlled trials were identified in a systematic search, totalling 2694 PE patients treated at home (discharged within 24 h) and identified by a predefined triage tool. The 14- and 30-day incidences of all-cause mortality and adverse events …

Team-Centered Care After Trauma Patient Death: Promoting Healers’ Healing By Humanizing Our Roles, Sydni Au Hoy, Carlie J. Arbaugh, Caitlin P. Bungo, Amanda J. Deutsch, Bonnie E. Chow, Kristen Gallegos, Nerissa Alansalon, Emmanuel Jisrawi, Al’Ai Alvarez, Brooke Gurland, Joseph Forrester

Journal of Wellness

Introduction: Recurrent exposures to adverse patient events, including death, affect all members of the care team and can have long-term effects on clinician performance, personal well-being, and patient safety. Recognizing the impact of patient deaths on care teams is essential to mitigating potential risks of increased clinician burnout. We share the outcomes of a three-month pilot wellness intervention implemented at a busy academic hospital, directed explicitly toward resuscitation care teams managing patients who die from traumatic injuries.

Approach: A collaborative group from Stanford’s Trauma Surgery, Emergency Department (ED), and well-being leadership developed an integrated workflow to connect with …

A Systematic Review Of Racial Disparities In Emergency Department Pain Evaluation And Treatment In The United States, Cyrus Wolff

Theses and Graduate Projects

Background: Providers working in emergency departments (ED) must balance the need to relieve patients’ pain with the dangers of overprescribing opioids. Lack of standardization of pain evaluation and treatment may contribute to inequities in the management of pain in emergency departments. Evaluating differences in how different populations receive care in emergency departments can help to identify problems and areas where improvements need to occur.

Purpose: The purpose of this literature review is to evaluate what current research states about the prevalence and causes of racial disparities in pain evaluation and treatment in United States emergency departments and determine what gaps …

Unilateral Facial Swelling In A Sickle Cell Patient., Rohan Akhouri, Alison L. Fowler, Colton Schwarz, Lina Patel

Manuscripts, Articles, Book Chapters and Other Papers

Acute soft head syndrome (ASHS) is a rare complication of sickle cell disease that often requires a high index of suspicion and is often a diagnosis of exclusion. We present the case of an 18-year-old male with sickle cell disease in the United States who developed acute soft head syndrome without known traumatic injury. The goal of this case presentation is to provide awareness and education regarding a rare complication of sickle cell disease and recommended management for the associated symptoms.

Examining The Impact Of Telehealth Visits On Patient And Family Experience In A Pediatric Emergency And Urgent Care Center, Abigail Gauthier Md, Callie Krentz Md, Shiran Chan Ms, Michelle Widecan Dnp, Aprn, Cpnp, Ac/Pc, Adam A. Vukovic Md, Med

Patient Experience Journal

Providers and healthcare organizations have created novel ways of evaluating patients using telehealth. Patient volumes in urgent cares (UCs) and emergency departments (EDs) continue to climb, contributing to longer wait times and suboptimal patient and family experiences (PFEs). Optimizing use of telehealth may not only impact PFE of those evaluated virtually, but also reduce crowding in EDs and UCs, indirectly impacting PFE in those spaces as well. The purpose of this study is to identify any association between telehealth encounters and PFE scores. This is a retrospective review of patients seen via telehealth in virtual urgent care, UC, or the …