Emergency Medicine Commons^™

Airway Obstacle Course For Teaching Prehospital Providers Airway Techniques., Robert Young, John O Elliott, Brad D Gable

OhioHealth Research Institute Articles

BACKGROUND:  Early airway intervention is a vital step in the management of critically ill patients. Emergency medical service (EMS) providers are often first in the chain of survival with equipment to manage airway problems that arise. Therefore, it is paramount that they receive thorough training in aspects of airway management. Often, the training providers currently undergo does not reflect the environmental challenges inherent in EMS. Our obstacle course not only offers trainees a situational environment that simulates common challenges associated with the prehospital environment, but also provides a break from traditional tabletop and lecture-based training methods.

METHODS:  An airway obstacle …

Residency Training On The Frontlines Of The Covid-19 Pandemic - A Qualitative Study From Tanzania, Mariam Noorani, Hussein Manji, Elizabeth Mmari, Samina Somji, Nahida Z. Walli, Sherin Kassamali, Shabbir Adamjee, Nancy Matillya, Hanifa Mbithe, Aliasger Nagri, Neelam Ismail

Paediatrics and Child Health, East Africa

Introduction: the Coronavirus Disease 2019 pandemic has affected residency training globally. The aim of this study was to understand how the pandemic affected teaching and learning in residency programs in low resource settings where residents and faculty were working on the front line treating patients with the disease.

Methods: this qualitative study enrolled residents and faculty from the Aga Khan University in Tanzania who were providing front line care during the pandemic. Purposeful sampling was used and data was collected using focus group discussions and in-depth interviews between August and September 2020. Analysis was done using qualitative content analysis.

Results: …

Going Off The Deep End - The Life And Controversies Of Henry Heimlich, Md, Bradford L. Walters, Matthew Drogowski

Articles

No abstract provided.

Can An Emergency Department Adequately Address An Older Adult Who Has Complex Needs?, Rami Tarabay, Adam Perry, Riwa Al Aridi, Michael Malone

Journal of Geriatric Emergency Medicine

Older adults account for a considerable percentage of all emergency departments (ED) patient encounters. Those with very complex needs or multiple co-morbid conditions often have lengthy ED evaluations culminating in admission, many of which are considered potentially avoidable. Provider and process elements can evolve to create efficient and more comprehensive geriatric assessments in ED. This paper describes an older adult with acute on chronic symptoms admitted through the ED to the Acute Care for Elders (ACE) inpatient unit. We illustrate how elements of the ACE model, when applied in the ED, may avoid hospitalization. We review the Domain Management Model …

A Simplified Approach To Identification Of Risk Status In Patients With Atherosclerotic Cardiovascular Disease, Aparna Sajja, Hsin-Fang Li, Kateri J Spinelli, Amir Ali, Salim S Virani, Seth S Martin, Ty J Gluckman

Faculty, Staff and Students Publications

OBJECTIVE: The 2018 American Heart Association/American College of Cardiology (AHA/ACC) Blood Cholesterol Guideline recommendation to classify patients with atherosclerotic cardiovascular disease (ASCVD) as very high-risk (VHR) vs not-VHR (NVHR) has important implications for escalation of medical therapy. We aimed to define the prevalence and clinical characteristics of these two groups within a large multi-state healthcare system and develop a simpler means to assist clinicians in identifying VHR patients using classification and regression tree (CART) analysis.

METHODS: We performed a retrospective analysis of all patients in a 28-hospital US healthcare system in 2018. ICD-10 codes were used to define the ASCVD …

Utilization Of Patient-Controlled Analgesia Reduces Length Of Stay Of Sickle Cell Crisis Hospitalizations, Brett M. Prestia, Talha Ramzan, Catherine Waldron, Ameer Malik, Robert M. Pallay, Candace R. Murbach, Mike Flynn, Eric Shaw Phd, Abdullah Kutlar, Daniel Lowe

HCA Healthcare Journal of Medicine

Background

Sickle cell crisis hospitalizations are emotionally and financially burdensome to patients and healthcare systems, and processes to decrease the frequency or length of stay of these crises should be examined.

Methods

This is a multicenter retrospective hospital record review of sickle cell crisis hospitalizations as defined by ICD-10 codes (D57.1-4), from January 2016 through December 2019, examining inpatient medication administration records and length of stay among admitted adults aged 18–65 years. Patient controlled analgesia orders using morphine, hydromorphone, fentanyl and/or merperidine at any point of an admission (n=188) were compared to admissions without any patient-controlled analgesia orders (n=2,159). The …

Medical Imaging Stewardship And Healthcare Savings: Utilization Of Age Adjusted D-Dimer To Rule Out Acute Pulmonary Embolism, Phillip Bloodworth, Casey Morris, Kenneth Cail, Brian L. Pando, Brian Helmly

HCA Healthcare Journal of Medicine

Introduction

Acute pulmonary embolism (PE) is a common diagnosis that can lead to death if left untreated. Computerized tomography pulmonary angiogram scan (CTPA) is the gold standard for diagnosis of PE. Utilization of CTPA is increasing in the emergency setting even when suspicion for PE is very low. While CTPA is helpful, radiation exposure, contrast reactions, and cost must be considered. D-dimer is a well-established, high sensitivity and low specificity laboratory test that can effectively rule out PE in low-risk patients when negative. The ADJUST-PE trial showed that there is a natural rise of D-dimer levels with age. This age …

Car Ratings Take A Back Seat To Vehicle Type: Outcomes Of Suv Versus Passenger Car Crashes, Dietrich Jehle, Albert Arslan, Chirag Doshi, Clay O'Brien

HCA Healthcare Journal of Medicine

Background

Car safety ratings are routinely utilized in making automobile purchase decisions. These 1- to 5-star ratings are based on crash test data comparing vehicles of similar type, size and weight.

Objectives

We hypothesized that car safety ratings are less important than vehicle factors such as vehicle type and weight in predicting outcomes of head-on crashes.

Methods

A retrospective study was conducted on severe head-on motor vehicle crashes entered into the FARS (Fatality Analysis Reporting System) database between 1995 and 2010. This database includes all US motor vehicle crashes that resulted in a death within 30 days of the accident. …

Critical Care Service Delivery Across Healthcare Systems In Low-Income And Low-Middle-Income Countries: Protocol For A Systematic Review, Andrew George Lim, Sean Kivlehan, Lia Ilona Losonczy, Srinivas Murthy, Enrico Dippenaar, Richard Lowsby, Marc Li Chuan L C Yang, Michael S Jaung, P Andrew Stephens, Nicole Benzoni, Nana Sefa, Emily Suzanne Bartlett, Brandon Alexander Chaffay, Naeha Haridasa, Bernadett Pua Velasco, Sojung Yi, Caitlin A Contag, Amir Lotfy Rashed, Patrick Mccarville, Paul D Sonenthal, Nebiyu Shukur, Abdelouahab Bellou, Carl Mickman, Adhiti Ghatak-Roy, Allison Ferreira, Neill Kj Adhikari, Teri Reynolds

Faculty, Staff and Students Publications

INTRODUCTION: Critical care in low-income and low-middle income countries (LLMICs) is an underdeveloped component of the healthcare system. Given the increasing growth in demand for critical care services in LLMICs, understanding the current capacity to provide critical care is imperative to inform policy on service expansion. Thus, our aim is to describe the provision of critical care in LLMICs with respect to patients, providers, location of care and services and interventions delivered.

METHODS AND ANALYSIS: We will search PubMed/MEDLINE, Web of Science and EMBASE for full-text original research articles available in English describing critical care services that specify the location …

Towards A Medical School Curriculum For Uncertainty In Clinical Practice, Dimitrios Papanagnou, Nethra S. Ankam, David Ebbott, Deborah Ziring

Department of Emergency Medicine Faculty Papers

Uncertainty abounds in the clinical environment. Medical students, however, are not explicitly prepared for situations of uncertainty in clinical practice, which can cause anxiety and impact well-being. To address this gap, we sought to capture how students felt in various clinical scenarios and identify programs they found helpful as they worked through uncertainty in their clerkships to better inform curriculum that prepares them to acknowledge and navigate this uncertainty. This is an observational cross-sectional study of third-year medical students surveyed at the end of core clerkships. The survey consisted of the General Self-Efficacy (GSE) Scale and Intolerance of Uncertainty Scale …

Caregiver Support In The Emergency Department, Candace Kim, Dawn Butler, Todd C. James

Journal of Geriatric Emergency Medicine

Caregiver support in the emergency department can lead to improved patient care, decreased suffering and lower costs. Identifying caregivers and inviting them onto the healthcare team enhances care. It is useful to document risk factors for caregiver stress and provide resources. The Kingston Caregiver Stress Scale is a tool suitable for assessing needs of caregivers. Multiple health professionals in the emergency department can be utilized to support caregivers.

Unmet Needs And Social Challenges For Older Adults During And After The Covid-19 Pandemic: An Opportunity To Improve Care, Alyssa Elman, Daniel Baek, Elaine Gottesman, Michael E. Stern, Mary R. Mulcare, Amy Shaw, Morgan Pearman, Michelle Sullivan, Sunday Clark, Timothy F. Platts-Mills, Rahul Sharma, Tony Rosen

Journal of Geriatric Emergency Medicine

Many older adults have unmet needs and social challenges that can negatively impact their health and well-being, particularly during and after the COVID pandemic. These include social isolation, inadequate care or assistance with their daily activities, food insecurity, housing insecurity, poverty, and abuse/neglect/exploitation. An ED visit provides a unique and critical opportunity to identify these issues and initiate intervention for these vulnerable older adults. By assessing for unmet needs and social challenges, considering a team-based approach as to how they may be ameliorated, using online tools, and integrating telehealth and EMS, ED providers have the potential to dramatically improve …

Factors Associated With Voluntary Refusal Of Emergency Medical System Transport For Emergency Care In Detroit During The Early Phase Of The Covid-19 Pandemic, Nicholas E. Harrison, Robert R. Ehrman, Andrea Curtin, Damon Gorelick, Alex B. Hill, Erin Brennan, Robert Dunne

Urban Studies and Planning Faculty Research Publications

Importance
Emergency department (ED) and emergency medical services (EMS) volumes decreased during the COVID-19 pandemic, but the amount attributable to voluntary refusal vs effects of the pandemic and public health restrictions is unknown.

Objective
To examine the factors associated with EMS refusal in relation to COVID-19 cases, public health interventions, EMS responses, and prehospital deaths.

Design, Setting, and Participants
A retrospective cohort study was conducted in Detroit, Michigan, from March 1 to June 30, 2020. Emergency medical services responses geocoded to Census tracts were analyzed by individuals’ age, sex, date, and community resilience using the Centers for Disease Control and …

Management Of Fall Patients – What Should Be Done For Emergency Department Fall Patients?, Katherine Selman, Christine Binkley, Katherine Davenport, Shan W. Lliu, Maura Kennedy

Journal of Geriatric Emergency Medicine

Falls are the leading cause of injury-related emergency visits in older adults, translating into an estimated 3 million ED visits and 32,000 deaths from fall-related injuries annually in the United States. Falls subsequently result in diminished functional ability and higher risk for future falls and mortality. Despite this, ED clinicians focus primarily on injuries that result from a fall and often defer the modifiable causes of the fall and future fall prevention to outpatient providers. We review two articles that address the feasibility of performing interventions from the ED and the efficacy of a multifactorial fall intervention program.

Does Transitioning To An Omi/Nomi Model For The Evaluation Of Acute Coronary Syndrome In Adult Emergency Department Patients Improve Outcomes Compared To Contemporary Stemi/Nstemi Model?, Ismar Terzic

Theses and Graduate Projects

Acute coronary syndrome (ACS) continues to be the most common cause of death in the United States, and nearly every 34 seconds one American has a coronary event. Based on 12- lead electrocardiogram (ECG) findings myocardial infarction (MI) patients are treated, according to guidelines, emergently with reperfusion therapy if presenting with ST elevation myocardial infarction (STEMI), versus delayed revascularization if presenting with non-ST elevation myocardial infarction (NSTEMI). However, the evidence shows there is a lack of recognition of which patients require immediate catherization utilizing the current guidelines. In recent years, approximately 70% of acute MI (AMI) patients are classified as …

Community-Dwelling Older Adult Fall Prevention Improvement Project, Evan Edminster Bsn, Rn, Cfrn, Tcrn, Cen, Nhdp-Bc

Master's Projects and Capstones

Abstract

Problem: Ground-level falls among community-dwelling adults 60 years and older are significant and contribute to adverse health outcomes such as fractures, functional decline, disability, and death. Additionally, falls among community-dwelling older adults are the number one mechanism of injury seen at a Northern California Level II trauma center. Falls often lead to post-fall fear, activity restriction, and physical deconditioning, further compounding fall risk.

Context: When trauma centers provide targeted outreach and screening for unmanaged health risks such as falls, they reduce unnecessary disability and premature death in the local population. Reducing total fall victim numbers and fall recidivism also …

Using The 4m Model To Screen Geriatric Patients In The Emergency Department, Martinus Megalla, Roopa Avula, Christopher Manners, Portia Chinnery, Lindsey Perrella, Douglas Finefrock

Journal of Geriatric Emergency Medicine

Several models of specialized geriatric care in the Emergency Department (ED) have been developed since the American College of Emergency Physicians (ACEP) began accrediting geriatric EDs in 2018. There is considerable variability in terms of both design and efficacy in regard to screening older patients in the ED and determining proper interventions The John A. Hartford Foundation and Institute for Healthcare Improvement (IHI) have developed the 4M Model for Creating Age-Friendly Health Systems which aims to provide high quality care to older patients by addressing four critical elements: Mentation, Mobility, Medication, What Matters. This article describes a screening tool for …

“I’M Not Staying In The Hospital Tonight”: How Emergency Departments Can Leverage Health And Social Services At Home To Support Care Transitions For Older Patients, Emily Franzosa, Ula Hwang, Maya Genovesi, Orna Intrator, Thomas Edes, Michael Malone

Journal of Geriatric Emergency Medicine

When hospital admission is less than desirable and sending a patient home alone feels unsafe, connecting patients to health and social services at home are a valuable third option for emergency providers. Coordinating home support services from the ED is effective care delivery and aligns with health systems’ goals of decreasing avoidable admissions, and developing capacity to assess and refer patients to home support from the ED is part of good emergency care. Change also doesn’t have to happen overnight. Taking small steps now to improve older patients' transitions to home can help EDs build toward high-quality, patient-centered care for …

Bedside Index (Bisap) V/S Ranson Scores In Predicting Mortality And Severity In Patients With Acute Pancreatitis, Nazir Najeeb Kapadia, Emaduddin Siddiqui

Department of Emergency Medicine

Objective: To determine the diagnostic accuracy of the bedside index for severity in acute pancreatitis in comparison with Ranson scores in predicting mortalities and severities in patients with acute pancreatitis.
Methods: The cross-sectional study was conducted at the Department of Emergency Medicine, Aga Khan University Hospital, Karachi, from July 1, 2017, to January 1, 2018, and comprised patients who presented with acute pancreatitis. The bedside index for severity in acute pancreatitis score was applied in the emergency department and the patients were followed up in ward/intensive care unit where Ranson scores were calculated within the following 48 hours. Both the …

Syndrome Of Inappropriate Antidiuretic Hormone Secretion And Lead Toxicity In A Child With Sickle Cell Disease And Pica., Akshay Gupta Do, Alexandra Amaducci Do, Andrew L. Koons, John D. Lindmark, Gillian A. Beauchamp Md

Department of Emergency Medicine

We describe the presentation and management of a three-year-old child with a history of pica, vitamin D deficiency, and sickle cell disease, who was admitted for pyelonephritis, and found to have elevated blood lead level (BLL) of 103.7 µg/dL, and who subsequently developed altered mental status and syndrome of inappropriate antidiuretic hormone secretion (SIADH). In consultation with Medical Toxicology, the patient was chelated with calcium disodium edetate (EDTA) and British Anti Lewisite (BAL). The patient's hyponatremia was managed with hypertonic saline infusion. The patient's encephalopathy improved throughout her hospital course, and she was discharged on hospital day 8. Following five …