Emergency Medicine Commons^™

Spontaneous Large Volume Hemothorax Managed With A Small-Bore Chest Tube, Moiz Salahuddin, Samia Ayub

Department of Medicine

A 67-year-old male with metastatic lung cancer presented with acute shortness of breath and increasing oxygen requirements. He had a decreasing hemoglobin for which he required red blood cell transfusions. His chest x-ray showed near complete white-out of the left lung. Bedside ultrasound (Handheld Sonostar C4PL) showed a large pleural effusion with swirling echogenic material suggestive of plankton sign. The pleural effusion was aspirated and showed frank blood, after which a small-bore chest tube (SBCT) was inserted. A total of 3200ml of blood was drained with the SBCT. There was complete clearance of the pleural space, and no further blood …

Presence Of Symptoms 6 Weeks After Covid-19 Among Vaccinated And Unvaccinated Us Healthcare Personnel: A Prospective Cohort Study, Nicholas M. Mohr, Ian D. Plumb, Kari K. Harland, Tamara Pilishvili, Katherine E. Fleming-Dutra, Anusha Krishnadasan, Karin F. Hoth, Sharon H. Saydah, Zachary Mankoff, John P. Haran, Melissa Briggs-Hagen, Eliezer Santos León, David A. Talan

Department of Emergency Medicine Faculty Papers

OBJECTIVES: Although COVID-19 vaccines offer protection against infection and severe disease, there is limited information on the effect of vaccination on prolonged symptoms following COVID-19. Our objective was to determine differences in prevalence of prolonged symptoms 6 weeks after onset of COVID-19 among healthcare personnel (HCP) by vaccination status, and to assess differences in timing of return to work.

DESIGN: Cohort analysis of HCP with COVID-19 enrolled in a multicentre vaccine effectiveness study. HCP with COVID-19 between December 2020 and August 2021 were followed up 6 weeks after illness onset.

SETTING: Health systems in 12 US states.

PARTICIPANTS: HCP participating …

Prediction Of Suicide Attempts And Suicide-Related Events Among Adolescents Seen In Emergency Departments, David A Brent, Lisa M Horowitz, Jacqueline Grupp-Phelan, Jeffrey A Bridge, Robert Gibbons, Lauren S Chernick, Margaret Rea, Mary F Cwik, Rohit P Shenoi, Joel A Fein, E Melinda Mahabee-Gittens, Shilpa J Patel, Rakesh D Mistry, Susan Duffy, Marlene D Melzer-Lange, Alexander Rogers, Daniel M Cohen, Allison Keller, Robert W Hickey, Kent Page, T Charles Casper, Cheryl A King, Pediatric Emergency Care Applied Research Network (Pecarn)

Faculty, Staff and Students Publications

IMPORTANCE: Screening adolescents in emergency departments (EDs) for suicidal risk is a recommended strategy for suicide prevention. Comparing screening measures on predictive validity could guide ED clinicians in choosing a screening tool.

OBJECTIVE: To compare the Ask Suicide-Screening Questions (ASQ) instrument with the Computerized Adaptive Screen for Suicidal Youth (CASSY) instrument for the prediction of suicidal behavior among adolescents seen in EDs, across demographic and clinical strata.

DESIGN, SETTING, AND PARTICIPANTS: The Emergency Department Study for Teens at Risk for Suicide is a prospective, random-series, multicenter cohort study that recruited adolescents, oversampled for those with psychiatric symptoms, who presented to …

Caesarean Section For Placenta Previa: A Retrospective Cohort Study Of Anaesthesia Techniques, Samina Ismail, Saima Rashid

Department of Anaesthesia

Objective: Placenta previa is associated with maternal and neonatal morbidity and mortality. This study aims to add to the limited literature from the developing world on the association of different anaesthetic techniques with blood loss, the need for blood transfusion, and maternal/ neonatal outcomes among women undergoing caesarean section with placenta previa.
Methods: This retrospective study was conducted at Aga University Hospital, Karachi, Pakistan. The patient population included parturients undergoing caesarean section for placenta previa from January 1, 2006, through December 31, 2019.
Results: Out of 276 consecutive cases of placenta previa progressing to caesarean section during the study period, …

Clinical Characteristics, Microbiology And Outcomes Of A Cohort Of Patients Treated With Ceftolozane/Tazobactam In Acute Care Inpatient Facilities, Houston, Texas, Usa, Truc T Tran, Nicolo L Cabrera, Anne J Gonzales-Luna, Travis J Carlson, Faris Alnezary, William R Miller, Aki Sakurai, An Q Dinh, Kirsten Rydell, Rafael Rios, Lorena Diaz, Blake M Hanson, Jose M Munita, Claudia Pedroza, Samuel A Shelburne, Samuel L Aitken, Kevin W Garey, Ryan Dillon, Laura Puzniak, Cesar A Arias

Faculty, Staff and Student Publications

BACKGROUND: Ceftolozane/tazobactam is a β-lactam/β-lactamase inhibitor combination with activity against a variety of Gram-negative bacteria, including MDR

METHODS: We conducted a multicentre retrospective study of patients receiving at least 48 h of ceftolozane/tazobactam therapy from January 2016 through to September 2019 at two hospital systems in Houston. Demographic, clinical and microbiological data were collected, including the infecting bacterial isolate, when available. The primary outcome was composite clinical success at hospital discharge. Secondary outcomes included in-hospital mortality and clinical disposition at 14 and 30 days post ceftolozane/tazobactam initiation. Multivariable logistic regression analysis was used to identify predictors of the primary outcome …

Identification Of Bradycardia Following Remdesivir Administration Through The Us Food And Drug Administration American College Of Medical Toxicology Covid-19 Toxic Pharmacovigilance Project, Jason M Devgun, Rongmei Zhang, Jeffrey Brent, Paul Wax, Keith Burkhart, Alison Meyn, Sharan Campleman, Stephanie Abston, Kim Aldy

Faculty, Staff and Student Publications

IMPORTANCE: The rapid spread and mortality associated with COVID-19 emphasized a need for surveillance system development to identify adverse events (AEs) to emerging therapeutics. Bradycardia is a remdesivir infusion-associated AE listed in the US Food and Drug Administration-approved prescribing information.

OBJECTIVE: To evaluate the magnitude and duration of bradycardic events following remdesivir administration.

DESIGN, SETTING, AND PARTICIPANTS: A multicenter cohort study of patients with recorded heart rate less than 60 beats per minute within 24 hours after administration of a remdesivir dose was conducted between November 23, 2020, and October 31, 2021. Participants included patients hospitalized with COVID-19 at 15 …

Emergency Department Virtual Happy Hour: A Novel Approach To Peer Group Support During A Pandemic, Adeola A Kosoko, Shabana Walia, Ryan Huebinger

Faculty, Staff and Student Publications

Introduction Communities responded to the coronavirus disease 2019 (COVID-19) pandemic with mandatory social-distancing regulations. Pandemic and disaster research shows that social isolation can often cause negative emotions and medical provider burnout. The primary objective of this study was to create and evaluate a novel wellness program, the Happy Hour Wellness Initiative (HHWI), based on peer support group concepts to foster resilience for emergency healthcare providers in response to a novel disaster. Methods The study was performed at a large emergency department with physicians, advanced practice providers, and staff invited to attend weekly "virtual happy hour" sessions. Participants individually opted into …

Design And Characterization Of An Aerosol Test Chamber For Emergency Response Patient Contamination Control Simulation And Research, Megan L. Steele, Emily M. Spatz, George P. Lemmer, Jacob M. Denney, Casey Cooper, Jeremy M. Slagley, Robert M. Eninger

Faculty Publications

Contaminated or infected patients present a risk of cross-contamination for emergency responders, attending medical personnel and medical facilities as they enter a treatment facility. The controlled conditions of an aerosol test chamber are required to examine factors of contamination, decontamination, and cross-contamination. This study presents the design, construction, and a method for characterizing an aerosol test chamber for a full-sized manikin on a standard North Atlantic Treaty Organization litter. The methodology combined air velocity measurements, aerosol particle counts and size distributions, and computational fluid dynamics modeling to describe the chamber’s performance in three dimensions. This detailed characterization facilitates future experimental …

Paxlovid-Induced Tacrolimus Toxicity In The Treatment Of Covid-19: A Case Report., Stephanie Michael, Rachel Heilbronner, Christopher M Lloyd, Howard W Levitin

Pharmacy Articles

Paxlovid^TM (nirmaltrelvir/ritonavir) received emergency use authorization from the Food and Drug Administration (FDA) in December 2021 to treat coronavirus disease 2019 (COVID-19). Given the actions of Paxlovid on cytochrome P450-3A4 (CYP3A4) enzymes, it is imperative to check for potential drug-drug interactions before prescribing. We describe a case in which the common emergency department presentation of generalized weakness was found to be caused by interactions between Paxlovid and a patient's home medications resulting in tacrolimus toxicity.

Geriatric Emergency Medicine Fellowship Journal Club: Syncope Risk Stratification & Geriatric-Specific Clinical Decision Rules, Kyle R. Burton Md Mpp, Phillip Magidson

Journal of Geriatric Emergency Medicine

No abstract provided.

Frequency Of Von Willebrand Disease And Its Types: Data From A Tertiary Care Hospital Of Karachi, Pakistan, Jyoti Mohan Lal, Anila Rashid, Natasha Ali

Department of Pathology and Laboratory Medicine

Introduction: von Willebrand disease is the most common inherited bleeding disorder. It is classified into 3 main types, type I and III are quantitative defects whereas type II is qualitative defect which is further sub-classified in to II-A, II-B, II-M, II-N. The aim of the present study is to see frequency and types of von Willebrand disease in a tertiary care hospital of Karachi, Pakistan.
Materials and methods: This retrospective cross-sectional study was conducted in the section of Hematology and Transfusion Medicine, Department of Pathology and Laboratory Medicine, the Aga Khan University hospital, Karachi, from May 2020 to April 2021 …

Recurrent Cyanotic Spells In An Octogenarian, Chin Tong Kwok, Chun Kit Wong

Journal of the Hong Kong College of Cardiology

We report rare case of an octogenarian who, after years of diagnostic delay, was found to have a patent foramen ovale, and due to an ascending aortic aneurysm that anatomically facilitated right-to-left shunt, presenting with life-threatening cyanotic attacks. The characteristic orthodeoxia-platypnea syndrome and high alveolar arterial gradient hint to the diagnosis. She was eventually treated successfully with urgent percutaneous PFO closure. Routine ordering of a transthoracic echocardiogram, without agitated saline injection under provocation maneuvers, may not be sufficient to rule out shunts.

Updated Documentation Requirements, Michael Gratson

Website/Multimedia Contributions

No abstract provided.

A Survey With Interventional Components Delivered On Tablet Devices Versus Usual Care To Increase Pre-Exposure Prophylaxis Uptake Among Cisgender Black Women: A Pilot Randomized Controlled Trial, Mandy J Hill, Angela M Heads, Robert Suchting, Angela L Stotts

Faculty, Staff and Student Publications

BACKGROUND: Cisgender (cis) Black women in the USA are more likely to become HIV positive during their lifetime than other women. We developed and implemented a behavioral intervention, Increasing PrEP (iPrEP), the first pilot randomized controlled trial (RCT) aimed at motivating cis Black women to be willing to use PrEP for HIV prevention and attend an initial PrEP clinic visit following an emergency department visit.

METHODS: Eligible participants were Black cisgender women ages 18-55 years who acknowledged recent condomless sex and substance use. Participants were randomized to iPrEP or usual care (UC). iPrEP is a survey-based intervention designed to raise …

Is It Time To Re-Think Fast? A Systematic Review And Meta-Analysis Of Contrast-Enhanced Ultrasound (Ceus) And Conventional Ultrasound For Initial Assessment Of Abdominal Trauma, Bayu Sutarjono, Matthew Kessel, Dorian Alexander, Ekjot Grewal

Faculty, Staff and Student Publications

BACKGROUND: The Focused Assessment with Sonography for Trauma (FAST) examination using conventional ultrasound has limited utility for detecting solid organ injury. Therefore, this systematic review and meta-analysis compares the performance of contrast-enhanced ultrasound (CEUS) to conventional ultrasound when used as the initial assessment for abdominal trauma prior to computed tomography (CT) imaging.

METHODS: A systematic literature search of major databases was conducted of human studies investigating the diagnostic accuracy of conventional ultrasound and CEUS occurring prior to CT imaging for abdominal trauma. The study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The quality of studies …

A Qualitative Description Of Barriers To Visual Rehabilitation Experienced By Stroke Survivors With Visual Impairment In Alberta, Canada, Kiran Pohar Manhas, Katelyn Brehon, Jennis Jiang, Karim F. Damji, Fiona Costello

Department of Ophthalmology & Visual Sciences

Background: Post-stroke visual impairment (VI) is a common but under-recognized care challenge. Common manifestations of post-stroke VI include: diplopia, homonymous hemianopia, oscillopsia secondary to nystagmus, and visual inattention or neglect. In acute care settings, post-stroke VI recognition and treatment are often sub-optimal as emphasis is placed on survival. Stroke survivors with VI often face inconsistencies when accessing care out of hospital because variable availability and subsidization of visual rehabilitation. We sought to identify gaps in care experienced by stroke survivors with VI from stroke survivors' and care providers' perspectives.
Methods: We conducted a qualitative description study across 12 care sites …

Multisite Evaluation Of Prediction Models For Emergency Department Crowding Before And During The Covid-19 Pandemic, Ari J Smith, Brian W Patterson, Michael S Pulia, John Mayer, Rebecca J Schwei, Radha Nagarajan, Frank Liao, Manish N Shah, Justin J Boutilier

Faculty, Staff and Student Publications

OBJECTIVE: To develop a machine learning framework to forecast emergency department (ED) crowding and to evaluate model performance under spatial and temporal data drift.

MATERIALS AND METHODS: We obtained 4 datasets, identified by the location: 1-large academic hospital and 2-rural hospital, and time period: pre-coronavirus disease (COVID) (January 1, 2019-February 1, 2020) and COVID-era (May 15, 2020-February 1, 2021). Our primary target was a binary outcome that is equal to 1 if the number of patients with acute respiratory illness that were ED boarding for more than 4 h was above a prescribed historical percentile. We trained a random forest …

Biorisk Management, Laboratory Acquired Infections And Clinical Containment, Kashif Ali, Furqan Kabir, Esmeralda Meyer

Department of Paediatrics and Child Health

No abstract provided.

Sorting Through Life: Evaluating Patient-Important Measures Of Success In A Medication For Opioid Use Disorder (Moud) Treatment Program, Megan K Reed, Kelsey R Smith, Francesca Ciocco, Richard W. Hass, Avery Lin Cox, Erin L Kelly, Lara Weinstein

Department of Emergency Medicine Faculty Papers

Background: Medication for opioid use disorder (MOUD) is the gold standard treatment for opioid use disorder. Traditionally, "success" in MOUD treatment is measured in terms of program retention, adherence to MOUD, and abstinence from opioid and other drug use. While clinically meaningful, these metrics may overlook other aspects of the lives of people with opioid use disorder (OUD) and surprisingly do not reflect the diagnostic criteria for OUD.

Methods: Authors identified items for a pilesorting task to identify participant-driven measures of MOUD treatment success through semi-structured interviews. Interviews were transcribed verbatim and coded in Nvivo using directed and conventional content …

Relationship Of Abdominal Circumference And Trunk Length With Spinal Anesthesia Block Height In Geriatric Patients Undergoing Transurethral Resection Of Prostate, Muhammad Yahya, Aliya Ahmed, Iayla Fatima, Muhammad Nasir

Department of Anaesthesia

Introduction: Spinal anesthesia is commonly used for various surgical procedures. Prediction of spinal anesthesia block height is always a challenging task for anesthetists. Higher than desired levels of spinal anesthesia blocks are associated with serious side effects, while inadequate block height does not provide satisfactory surgical anesthesia. In this study, we observed the relationship between the ratio of trunk length (TL) and square of the abdominal circumference (AC²) and spinal anesthesia sensory block height in geriatric patients undergoing transurethral resection of the prostate (TURP).
Material & Methods: This is a cross-sectional study conducted at the Aga Khan University …