Emergency Medicine Commons^™

Breaking Barriers: Improving Care For Incarcerated Patients While Hospitalized, Spencer Steadman, Jordan Schroeder, Jacob Straus, Colton Berry

View All Graduate Medical Education Content

No abstract provided.

Peripartum Cardiomyopathy, Victoria L Morris, Carolina Mendoza, Gowri S Stevens, Jessica L Wilson, Adeola A Kosoko

Faculty, Staff and Student Publications

AUDIENCE: This simulation is appropriate for emergency medicine (EM) residents of all levels.

INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a rare, idiopathic condition that occurs in the mother around the time of childbirth. Heart failure with reduced ejection fraction and/or reduced systolic function diagnosed in patients during the last month of pregnancy or up to five months following delivery defines PCCM.1 Another broader definition from the European Society of Cardiology defines PPCM as heart failure that occurs "towards the end of pregnancy or in the months following delivery, where no other cause of heart failure is found."2 Though PPCM occurs worldwide, …

Effect Of Thromboprophylaxis On Clinical Outcomes After Covid-19 Hospitalization, Tracy Y Wang, Abdus S Wahed, Alison Morris, Lisa Baumann Kreuziger, John G Quigley, Gervasio A Lamas, Alexandra J Weissman, Jose Lopez-Sendon, M Margaret Knudson, Deborah M Siegal, Raj S Kasthuri, Andrew J Alexander, Lana Wahid, Bassel Atassi, Peter J Miller, Janice W Lawson, Bela Patel, Jerry A Krishnan, Nancy L Shapiro, Deborah E Martin, Andrei L Kindzelski, Eric S Leifer, Jungnam Joo, Lingyun Lyu, Annie Pennella, Brendan M Everett, Mark W Geraci, Kevin J Anstrom, Thomas L Ortel, Activ-4c Study Group

Faculty, Staff and Student Publications

BACKGROUND: Patients hospitalized with COVID-19 have an increased incidence of thromboembolism. The role of extended thromboprophylaxis after hospital discharge is unclear.

OBJECTIVE: To determine whether anticoagulation is superior to placebo in reducing death and thromboembolic complications among patients discharged after COVID-19 hospitalization.

DESIGN: Prospective, randomized, double-blind, placebo-controlled clinical trial. (ClinicalTrials.gov: NCT04650087).

SETTING: Done during 2021 to 2022 among 127 U.S. hospitals.

PARTICIPANTS: Adults aged 18 years or older hospitalized with COVID-19 for 48 hours or more and ready for discharge, excluding those with a requirement for, or contraindication to, anticoagulation.

INTERVENTION: 2.5 mg of apixaban versus placebo twice daily for …

Use Of High-Flow Cannula In Pediatric Patients With Respiratory Failure: A Prospective Cohort Study In Three High-Altitude Hospitals, Natalia Ante-Ardila, Camilo Novoa Garnica, Paola Mora Umaña, Olga Lucía Baquero Castañeda, Alexandra Jiménez Cháves, Melisa Sofía Naranjo, Juan G Piñeros, Carolina Bonilla, Luz M Mejía, María L Mesa-Rubio, Sonia Restrepo-Gualteros, Pedro Barrera, Sergio Moreno-Lopez, Paola Rueda-Guevara, Andrea Ramírez Varela

Faculty, Staff and Student Publications

BACKGROUND AND AIMS: Acute respiratory failure (ARF) is a common cause of morbimortality, and a frequent reason for admission to the pediatric intensive care unit (PICU). It requires a high-flow oxygen device as treatment. Our aim is to determine the frequency and main indications for the use of high-flow nasal cannula (HFNC), and the prevalence of HFNC failure and its main causes, in three hospitals.

METHODS: It is a multicenter prospective cohort study, developed in three hospitals in Bogota. Eligible patients were children older than 1 month and younger than 18 years who presented ARF and required management with an …

Utilizing The System Engineering Trade Study Analysis Method To Analyze Patient Aeromedical Evacuation, Sara Shaghaghi, Jeremy M. Slagley, Michael E. Miller, Gaiven Varshney

Faculty Publications

The US Air Force has gone through many aeromedical patient isolation transport system designs. The first designs were developed in response to the Ebola outbreak in 2014 and, more recently, the COVID-19 pandemic. The trade study analysis part of the system engineering design method was used to analyze the historic and current aeromedical patient contamination control transport systems. A trade study is a process that evaluates alternatives based upon various “-ilities”, such as reconfigurability, flexibility, durability, cost, and more, and performs a systematic analysis to aid designers in producing a ‘good’ design alternative given the large set of possible solutions. …

Intolerance Of Uncertainty And Attitudes Towards Persons Living With Disabilities In Medical Students: Is There A Correlation?, Martinique Ogle, Dimitrios Papanagnou, Md, Kestrel Reopelle, Frances Rusnack, Jordan Feingold-Link, Maria Poluch, Nethra S. Ankam

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Patients living with a disability experience an illness trajectory that may be uncertain. While navigating clinical uncertainty has been well-researched, health professionals' intolerance of uncertainty for patients living with disabilities has yet to be explored. We examined the relationship between medical students' intolerance of uncertainty with their attitudes towards people living with disabilities to better inform curricular efforts.

METHODS: We employed a survey-based design consisting of the Intolerance of Uncertainty Scale (IUS) and Disability Attitudes in Healthcare (DAHC) Scale to medical students upon completion of core clerkships (end of third-year of training). Data were de-identified. Mean DAHC and IUS …

Cardiopulmonary Outcomes In Covid-19 Patients Discharged From A Tertiary Care Center: A Prospective Study, Lakshmi Prasanna Vaishnavi Kattamuri, Vibhav Sharma, Radhika Sarda, Kunal Sharma, Anuj Ajayababu, Gaurav Gupta, Surabhi Vyas, Shivam Pandey, Arvind Kumar, Naveet Wig, Rajiv Narang, Sanjeev Sinha

Faculty, Staff and Student Publications

To determine the cardiopulmonary changes in the survivors of acute COVID-19 infection at 3-6 month and 6-12 month. We followed up 53 patients out of which 28 (52%) had mild COVID-19 and 25 (48%) had severe COVID-19. The first follow-up was between 3 month after diagnosis up to 6 month and second follow-up between 6 and 12 month from the date of diagnosis of acute COVID-19. They were monitored using vital parameters, pulmonary function tests, echocardiography and a chest computed tomography (CT) scan. We found improvement in diffusing capacity for carbon monoxide (DLCO) with a median of 52% of predicted …

Comparing The Safety And Efficacy Of A Rapid High-Sensitivity Cardiac Troponin I Protocol Between Hospital-Based And Free-Standing Emergency Departments, Arqam Husain, Joseph B. Miller, Satheesh Gunaga, Seth Krupp, Howard Klausner, Elizabeth Plemmons, Hashem Nasseredine, Jacob Tuttle, Bernard Cook, James K. Mccord

Medical Student Research Symposium

Study Objectives: Current high sensitivity cardiac troponin I (hs-cTnI) research has been conducted almost exclusively in hospital-based emergency department (HBED) settings and the translation of these protocols into free-standing emergency departments (FSED) has yet to be explored. This study compared the safety and efficacy of applying a rapid-rule out protocol using hs-cTnI for exclusion of acute myocardial infarction (AMI) in HBEDs and FSEDs.

Methods: This was a secondary analysis of a randomized trial of patients evaluated for possible AMI in 9 emergency departments (ED) from July 2020 through March 2021. The trial arms included a new 0/1-hour rapid protocol using …

Nonurgent Use Of The Emergency Department For Medication Refills, Bobak M. Ossareh, James Paxton

Medical Student Research Symposium

No abstract provided.

Differences In Depth Of Soft Tissue At The Proximal Tibia Intraosseous Catheter Insertion Site Based On Sex And Bmi, Thomas Sprys-Tellner, John Kulka

Medical Student Research Symposium

Introduction

Intraosseous (IO) cannulation is commonly used for emergent vascular access in unstable patients treated in the emergency department (ED). However, inappropriate depth of IO insertion may be associated with increased risk of complications associated with IO catheter use, including extravasation and subsequent compartment syndrome. Our objective was to characterize the thickness of soft tissue overlying the proximal tibial IO insertion site according to patient sex, body mass index (BMI), and common medical comorbidities.

Methods

Retrospective chart review was performed for patients who received x-ray imaging of the proximal tibia at the study site. Patients were excluded if they had …

Atomic Habits In Meded: Tiny Changes, Remarkable Results, Eric Shappell, Sreeja Natesan, Brett Todd

Website/Multimedia Contributions

No abstract provided.

Adiponectin-Mediated Promotion Of Cd44 Suppresses Diabetic Vascular Inflammatory Effects, Yanru Duan, Shihan Zhang, Yuanyuan Xing, Ye Wu, Wen Zhao, Pinxue Xie, Huina Zhang, Xinxiao Gao, Yanwen Qin, Yajing Wang, Xin-Liang Ma, Yunhui Du, Huirong Liu

Department of Emergency Medicine Faculty Papers

While adiponectin (APN) was known to significantly abolish the diabetic endothelial inflammatory response, the specific mechanisms have yet to be elucidated. Aortic vascular tissues from mice fed normal and high-fat diets (HFD) were analyzed by transcriptome analysis. GO functional annotation showed that APN inhibited vascular endothelial inflammation in an APPL1-dependent manner. We confirmed that activation of the Wnt/β-catenin signaling plays a key role in APN-mediated anti-inflammation. Mechanistically, APN promoted APPL1/reptin complex formation and β-catenin nuclear translocation. Simultaneously, we identified APN promoted the expression of CD44 by activating TCF/LEF in an APPL1-mediated manner. Clinically, the serum levels of APN and CD44 …

Performance Of Six Clinical Physiological Scoring Systems In Predicting In-Hospital Mortality In Elderly And Very Elderly Patients With Acute Upper Gastrointestinal Bleeding In Emergency Department, Po-Han Wu, Shang-Kai Hung, Chien-An Ko, Chia-Peng Chang, Cheng-Ting Hsiao, Jui-Yuan Chung, Hao-Wei Kou, Wan-Hsuan Chen, Chiao-Hsuan Hsieh, Kai-Hsiang Ku, Kai-Hsiang Wu

Faculty, Staff and Student Publications

Background and Objectives: The aim of this study is to compare the performance of six clinical physiological-based scores, including the pre-endoscopy Rockall score, shock index (SI), age shock index (age SI), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), and Modified Early Warning Score (MEWS), in predicting in-hospital mortality in elderly and very elderly patients in the emergency department (ED) with acute upper gastrointestinal bleeding (AUGIB). Materials and Methods: Patients older than 65 years who visited the ED with a clinical diagnosis of AUGIB were enrolled prospectively from July 2016 to July 2021. The six scores were calculated …

Evaluating The Usability Of An Emergency Department After Visit Summary: Staged Heuristic Evaluation, Hanna J Barton, Megan E Salwei, Rachel A Rutkowski, Kathryn Wust, Sheryl Krause, Peter Lt Hoonakker, Paula Vw Dail, Denise M Buckley, Alexis Eastman, Brad Ehlenfeldt, Brian W Patterson, Manish N Shah, Barbara J King, Nicole E Werner, Pascale Carayon

Faculty, Staff and Student Publications

BACKGROUND: Heuristic evaluations, while commonly used, may inadequately capture the severity of identified usability issues. In the domain of health care, usability issues can pose different levels of risk to patients. Incorporating diverse expertise (eg, clinical and patient) in the heuristic evaluation process can help assess and address potential negative impacts on patient safety that may otherwise go unnoticed. One document that should be highly usable for patients-with the potential to prevent adverse outcomes-is the after visit summary (AVS). The AVS is the document given to a patient upon discharge from the emergency department (ED), which contains instructions on how …

Variable Shift Lengths Negatively Affect Emergency Medicine Resident Wellness, Marcus Fazzari, Joseph Longobardi, Joseph Mccarthy, Matthew Hysell, Sidney Hann

Journal of Wellness

Introduction: Burnout is very common in emergency medicine and there has been extensive research evaluating factors that contribute to burnout. We sought to examine the contributions of post-graduate year (PGY), shifts worked per month, patients seen per shift, and length of shifts to emergency medicine resident burnout.

Methods: All emergency medicine residents were surveyed with regards to their PGY, shifts worked per month, patients seen per shift, and length of shifts. They were administered the Stanford Wellness Survey and asked to globally rate their degree of burnout. We then modeled whether consideration of the surveyed factors increased the …

Indication Of Mobility Aids And Training Of Older Patients In A Geriatric Emergency Department: Abiding By International Guidelines, Mario C. De Andrade Junior, Christian V. Morinaga, Christina M M Brito, Igor G. Moraes, Wellington P. Yamaguti, Pedro K. Curiati

Journal of Geriatric Emergency Medicine

Falls are the main cause of injuries, hospitalization, and loss of functionality among adults over 65 years of age. Thus, proper indication of assistive gait devices should be part of multidimensional fall prevention. However, many patients receive little or no professional assistance when selecting a mobility aid, and inadequate selection and use can result in a poor gait pattern.

All patients admitted to our emergency department (ED) undergo a medical evaluation, in which, based on their clinical condition, the protocol for indication and training in the use of walking aids can be triggered. Patients need to be clinically stable and …

Pilot Study Of The Association Between Microbiome And The Development Of Adverse Posttraumatic Neuropsychiatric Sequelae After Traumatic Stress Exposure, Abigail L. Zeamer, Marie-Claire Salive, Xinming An, Stacey L. House, Francesca L. Beaudoin, Jennifer S. Stevens, Donglin Zeng, Thomas C. Neylan, Gari D. Clifford, Robert A. Swor

Articles

Background Patients exposed to trauma often experience high rates of adverse post-traumatic neuropsychiatric sequelae (APNS). The biologic mechanisms promoting APNS are currently unknown, but the microbiota-gut-brain axis offers an avenue to understanding mechanisms as well as possibilities for intervention. Microbiome composition at the time of trauma exposure has been poorly examined regarding neuropsychiatric outcomes. We aimed to determine whether baseline the gut microbiomes of trauma-exposed emergency department patients who later develop APNS have dysfunctional gut microbiome profiles and discover potential associated mechanisms.

Methods We performed metagenomic analysis on stool samples (n=51) from a subset of adults enrolled in the Advancing …

Patterns Of Care Partner Communication For Persons Living With Dementia In The Emergency Department, Adrian D. Haimovich, Aidan Gilson, Evangeline Gao, Ling Chi, Cameron J. Gettel, Mara Schonberg, Ula Hwang, Richard A. Taylor

Journal of Geriatric Emergency Medicine

Abstract

Background:

Nearly half of all persons living with dementia (PLwD) will visit the emergency department (ED) in any given year and ED visits by PLwD are associated with short-term adverse outcomes. Care partner engagement is critical in the care of PLwD, but little is known about their patterns of communication with ED clinicians.

Methods:

We performed a retrospective electronic health record (EHR) review of a random sampling of patients ≥ 65 years with a historical diagnosis code of dementia who visited an ED within a large

regional health network between 1/2014 and 1/2022. ED notes within the EHRs were …

Geriatric Emergency Departments As Laboratories For Innovation, Brian W. Patterson, Manish N. Shah

Journal of Geriatric Emergency Medicine

n/a for editorial

Association Of Symptoms And Mode Of Transportation To Emergency Department In Patients With Acute Coronary Syndrome, Leslie L. Davis, Thomas P. Mccoy, Barbara Riegel, Sharon Mckinley, Lynn V. Doering, Debra K. Moser

UK CARES Faculty Publications

Background: Patients with acute coronary syndrome (ACS) with symptoms matching their expectations of a heart attack are more likely to use emergency medical services (EMS) than not.

Objective: To determine whether presenting symptom clusters are associated with EMS use in ACS patients and if EMS use or symptom clusters are associated with prehospital delay.

Methods: This secondary analysis used data from the PROMOTION trial, a randomized clinical trial that enrolled 3522 subjects with a history of or at risk for ACS from 5 sites in the United States, Australia, and New Zealand. Subjects were randomized to usual care or an …