Emergency Medicine Commons^™

Statins: Masked Anti-Epileptic Warriors, Govinda Khatri, Priya Kotak, Ayush Kumar, Mohammad Mehedi Hasan

Medical College Documents

No abstract provided.

Case Report: Axilla Fibroadenoma - An Atypical Presentation, Safna Naozer Virji, Lubna Mushtaque Vohra, Syeda Sakina Abidi, Romana Idress

Department of Surgery Docs

No abstract provided.

Emergency Department Policies To Improve Care Experiences For Older Adults During The Covid-19 Pandemic, Anita Chary, Shan Lliu, Lauren Southerland, Lauren Cameron Comasco, Kei Ouchi, Christopher R. Carpenter Md, Msc, Edward W Boyer, Aanand D. Naik, Maura Kennedy

Journal of Geriatric Emergency Medicine

n/a

A Retrospective Analysis Of Endocrine Disease In Sphingosine-1-Phosphate Lyase Insufficiency: Case Series And Literature Review, Avinaash Maharaj, Ruth Kwong, Jack Williams, Christopher Smith, Helen Storr, Ruth Krone, Debora Braslavsky, Maria Clemente, Nanik Ram, Indraneel Banerjee

Section of Diabetes, Endocrinology and Metabolism

Sphingosine-1-phosphate lyase (SGPL1) insufficiency syndrome (SPLIS) is an autosomal recessive multi-system disorder, which mainly incorporates steroid-resistant nephrotic syndrome and primary adrenal insufficiency. Other variable endocrine manifestations are described. In this study, we aimed to comprehensively annotate the endocrinopathies associated with pathogenic SGPL1 variants and assess for genotype-phenotype correlations by retrospectively reviewing the reports of endocrine disease within our patient cohort and all published cases in the wider literature up to February 2022. Glucocorticoid insufficiency in early childhood is the most common endocrine manifestation affecting 64% of the 50 patients reported with SPLIS, and a third of these individuals have additional …

The Rsph4a Gene In Primary Ciliary Dyskinesia, Ron Nates, Mattan Arazi, Liza Grosman-Rimon, Roy Israel, Jacob Gohari, Leonid Sternik, Erez Kachel

Faculty, Staff and Student Publications

INTRODUCTION: There is no consensus as to which patients should undergo Non-Contrast Chest Computerized Tomography (NCCCT) and carotid arteries Doppler (CD) prior to cardiac surgery. The objective of this study was to examine whether preoperative imaging modalities provide clinical benefits and a change in surgical strategy.

METHODS: We routinely performed NCCCT and CD in all non-urgent cardiac surgery patients. Major NCCCT/CD findings related to cardiovascular findings (aortic calcification/atherosclerosis, carotid artery plaque/stenosis), or other incidental findings (lung kidney, thyroid, adrenal, gastrointestinal sites etc.) were documented. The results were divided into 3 categories: (A) findings requiring both changes in surgical strategy and …

Diagnostic Accuracy Of Various Immunochromatographic Tests For Ns1 Antigen And Igm Antibodies Detection In Acute Dengue Virus Infection, Mughees Haider, Saira Yousaf, Asifa Zaib, Azza Sarfraz, Zouina Sarfraz, Ivan Cherrez-Ojeda

Department of Paediatrics and Child Health

Introduction: Rapid diagnostic tests (RDTs) were evaluated, in this paper, for their utility as a reliable test, using resource-constrained studies. In most studies, NS1 antigen and immunoglobulin M (IgM)-based immunochromatographic tests (ICTs) were considered for acute phase detection. We aimed to evaluate the diagnostic accuracy of NS1, IgM, and NS1/IgM-based ICTs to detect acute dengue virus (DENV) infection in dengue-endemic regions.
Methods: Studies were electronically identified using the following databases: MEDLINE, Embase, Cochrane Library, Web of Science, and CINAHL Plus. Keywords including dengue, rapid diagnostic test, immunochromatography, sensitivity, specificity, and diagnosis were applied across databases. In total, 15 studies were …

A Resident Retreat With Emergency Medicine Specific Mindfulness Training Significantly Reduces Burnout And Perceived Stress, James O'Shea, Mark Dannenfelser, Melissa White, Anwar Osborne, Timothy P. Moran, Michelle D. Lall

Journal of Wellness

Introduction: We hypothesize that a resident retreat with mindfulness training tailored for Emergency Medicine (EM) physicians can significantly reduce levels of burnout and perceived stress in EM residents.

Methods: We conducted an intervention study of 60 EM residents undergoing an annual resident retreat with a 2.5-hour mindfulness training. The retreat was a department-funded 2-day off-site experience with a wellness theme. The training was developed and delivered by an EM physician (JO'S) who is a Mindfulness-Based Stress Reduction (MBSR) teacher trainee, and a certified MBSR teacher (MD). The training focused on techniques that can be used on shift, such as mindful …

Heart To Heart, Mom To Mom, Karis L. Tekwani

Journal of Patient-Centered Research and Reviews

This essay describes the human connection forged between two young moms, one the physician and one the patient, when their paths collided one night in the emergency department of a busy hospital. It describes a challenging and most memorable care experience in the career of a young emergency physician, the clinical outcome, and the patient’s appreciative follow-up message years later.

Treatment Disparities In Emergency Medical Services: The Influence Of Race/Ethnicity, Obesity, And English Proficiency, Jamie Kennel

Dissertations and Theses

Different treatment in healthcare settings provided to different social groups of people may lead to disparities in health, quality of life, and life span. Despite the critical role among healthcare services that Emergency Medical Services (EMS) provides disproportionately for marginalized communities, it remains unclear if and to what extent treatment disparities take place in the pre-hospital setting. Guided by the theoretical frameworks of social worth, aversive racism, and stigma, this study utilizes medical chart data from three different public and private datasets to investigate treatment disparities by Emergency Medical Service providers for racial minority, obese, and limited English proficiency patients. …

Macrophage Migration Inhibitory Factor (Mif) Makes Complex Contributions To Pain-Related Hyperactivity Of Nociceptors After Spinal Cord Injury, Alexis Bavencoffe, Emily A Spence, Michael Y Zhu, Anibal Garza-Carbajal, Kerry E Chu, Ona E Bloom, Carmen W Dessauer, Edgar T Walters

Faculty, Staff and Student Publications

Neuropathic pain is a major, inadequately treated challenge for people with spinal cord injury (SCI). While SCI pain mechanisms are often assumed to be in the CNS, rodent studies have revealed mechanistic contributions from primary nociceptors. These neurons become chronically hyperexcitable after SCI, generating ongoing electrical activity that promotes ongoing pain. A major question is whether extrinsic chemical signals help to drive ongoing electrical activity after SCI. People living with SCI exhibit acute and chronic elevation of circulating levels of macrophage migration inhibitory factor (MIF), a cytokine implicated in preclinical pain models. Probable nociceptors isolated from male rats and exposed …

Modified Jaw Thrust I-Gel Insertion Technique In Adults: A Case Series, Dileep Kumar

Department of Anaesthesia

Background: The I-gel is a second-generation supraglottic airway device that is built with a noninflatable elliptical gel material cuff and has a wide semirigid stem. The I-gel supralaryngeal seal has shown promising efficacy for both spontaneous and controlled ventilation under general anesthesia. The recommended, standard I-gel insertion technique is relatively challenging due to its shape and cuff size. Usually, the I-gel becomes entrapped at the oral cavity and requires excessive force to negotiate across the oropharynx, resulting in insertion resistance, tongue obstruction, insertion failure, and intraoral trauma. This case series evaluated a modified jaw thrust I-gel insertion technique because it …

Bone Mineral Density, Serum Calcium, And Vitamin D Levels In Adult Thalassemia Major Patients: Experience From A Single Center In Eastern India, Soumya Santra, Kunal Sharma, Ipsita Dash, Shaikat Mondal, Himel Mondal

Faculty, Staff and Student Publications

Background and objective Patients suffering from thalassemia major are at higher risk of osteoporosis. Due to their decreased life expectancy, the number of adult patients is low. However, their bone health is rarely checked in developing countries like India. There is no data available in the literature on the bone mineral density (BMD) of adult (aged ≥18 years) thalassemia major patients in eastern India. In this study, we aimed to measure the BMD and serum calcium and vitamin D levels in adult thalassemia major patients and to compare them with healthy controls. Materials and methods We conducted this cross-sectional observational …

Novel Scoring Systems To Predict The Need For Oxygenation And Icu Care, And Mortality In Hospitalized Covid-19 Patients: A Risk Stratification Tool, Vishakh C Keri, Pankaj Jorwal, Rohit Verma, Piyush Ranjan, Ashish D Upadhyay, Anivita Aggarwal, Radhika Sarda, Kunal Sharma, Shubham Sahni, Chaithra Rajanna

Faculty, Staff and Student Publications

INTRODUCTION: A rapid surge in cases during the COVID-19 pandemic can overwhelm any healthcare system. It is imperative to triage patients who would require oxygen and ICU care, and predict mortality. Specific parameters at admission may help in identifying them.

METHODOLOGY: A prospective observational study was undertaken in a COVID-19 ward of a tertiary care center. All baseline clinical and laboratory data were captured. Patients were followed till death or discharge. Univariable and multivariable logistic regression was used to find predictors of the need for oxygen, need for ICU care, and mortality. Objective scoring systems were developed for the same …

Impact Of Risk-Based Sexually Transmitted Infection Screening In The Emergency Department, Fahd A Ahmad, Kayleigh Fischer, Hongjie Gu, Thomas C Bailey, Donna B Jeffe, Christopher R Carpenter, Philip R O Payne

Faculty, Staff and Student Publications

OBJECTIVES: Sexually transmitted infections (STIs), including chlamydia, gonorrhea, and human immunodeficiency virus (HIV) pose a significant health burden in adolescents. Many adolescents receiving care in the emergency department (ED) are in need of testing, regardless of their chief complaint. Our objective was to determine whether an electronic, risk-based STI screening program in our ED was associated with an increase in STI testing among at-risk adolescents.

METHODS: We conducted a retrospective cohort analysis of patient outcomes in our pediatric ED after integrating an Audio-enhanced Computer-Assisted Self-Interview (ACASI) as standard of care. It obtained a focused sexual history and generated STI testing …

Care Alert Program In Chronic Recurrent Ed Utilizing Patients, Kaitlyn Phelps, Jonathan Bryan, Jonathan Leggett, Erica Gibbons, Brian Griggs

HCA Healthcare Journal of Medicine

The Care Alert program is designed to help navigate encounters with patient populations that are high utilizers of emergency department (ED) resources. These populations often have chronic medical conditions, have a poor understanding of their conditions, are unfamiliar with the EDs’ role in the management of these conditions, and commonly lack outpatient resources. The Care Alert program intends to address the needs of this challenging patient population by designing individualized care plans that are approved through a multidisciplinary committee. Data from this study showed a 37% decrease in ED visits and a 47% decrease in hospitalizations during the initial 8 …

Examining Racial, Ethnic, And Gender Disparities In The Treatment Of Pain And Injury Emergencies, Laurel A. Wimbish, Janelle R. Simpson, Lauren R. Gilbert, Andria Blackwood, Emily A. Grant

HCA Healthcare Journal of Medicine

Background

Racial, ethnic, and gender disparities in effective pain management have been well-documented across healthcare settings. However, discrepancies in the treatment of patients in prehospital pain management settings have not been well researched. The objective of this study was to determine whether Wyoming emergency medical service (EMS) providers’ use of opioids to treat prehospital pain or injury varies by patient race/ethnicity or gender.

Methods

This cross-sectional study of EMS records examined 27 448 patient care reports (PCRs) generated during emergency medical responses to pain/injury emergencies in the state of Wyoming between January 2016 and March 2019. We included PCRs in …

Endothelial Autophagy In Coronary Microvascular Dysfunction And Cardiovascular Disease, Fujie Zhao, Ganesh Satyanarayana, Zheng Zhang, Jianli Zhao, Xin-Liang Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

Coronary microvascular dysfunction (CMD) refers to a subset of structural and/or functional disorders of coronary microcirculation that lead to impaired coronary blood flow and eventually myocardial ischemia. Amid the growing knowledge of the pathophysiological mechanisms and the development of advanced tools for assessment, CMD has emerged as a prevalent cause of a broad spectrum of cardiovascular diseases (CVDs), including obstructive and nonobstructive coronary artery disease, diabetic cardiomyopathy, and heart failure with preserved ejection fraction. Of note, the endothelium exerts vital functions in regulating coronary microvascular and cardiac function. Importantly, insufficient or uncontrolled activation of endothelial autophagy facilitates the pathogenesis of …

Paramedics’ Confidence And Perceived Competence When Attending To Varied Patient Presentations: A Mixed-Method Study, Nicholas J. Waltrich, Jade Sheen, Mathew Ling

Internet Journal of Allied Health Sciences and Practice

Purpose: Paramedics are routinely called to patients presenting with mental health concerns. Previous literature suggests paramedics find this patient group challenging. However, no study has investigated whether paramedics find mental health presentations (MHP) more challenging relative to other patient presentations, or whether certain paramedic variables relate to their perceived ability to manage MHP. This study investigates differences in paramedics’ perceived ability to attend to MHP compared to other patient presentations, and whether their perceived ability is related to their level of experience or location of work (metropolitan or rural). The study also explores paramedic’s experiences and perspectives of MHP. Method: …

The Modified Rankin Scale Can Accurately Be Derived From The Electronic Medical Record, Derek Isenberg, Nelson Prus, Frederick Ramsey, Nina T. Gentile

Transformative Medicine

Abstract

Introduction

The modified Rankin Scale (mRS) is used to assess functional outcomes after a stroke and is the primary outcome in many stroke trials. For retrospective stroke research or stroke research in which patients are lost to study follow up, review of the electronic medical record (EMR) may be the sole way to estimate a patient’s functional outcome. The purpose of this study is to determine if a mRS can be accurately derived from the electronic medical record EMR.

Methods

This study used data from completed stroke studies in which in-person 90-day mRS were collected as part of the …

Ems To Trauma Care Transitions: An Investigation Of Patient And Handoff Outcomes, Richard Simonson

Doctoral Dissertations and Master's Theses

The helicopter as a method of emergency medical service transportation of trauma patients has a long history of effective use-cases dating back to its inception during the Vietnam war. Compared to ground-based emergency medical transit, helicopters have been able to reach severely injured patients in environments with challenging terrain features that ground-based medical services cannot traverse. Additionally, the helicopter offers quicker and more direct-route transit options that result in both quicker response and shorter transportation times compared to their ground-based alternative. Further, research has indicated that helicopter ambulance teams utilize paramedics with more experience than ground ambulance paramedics. Prior research …