Emergency Medicine Commons^™

Omental Infarction: A Rare Cause Of Abdominal Pain, Eric Doane, Emily Nguyen

Rowan-Virtua Research Day

Omental infarction is a rare cause of acute abdomen pain first described by Eitel in 1899 and has been described in the literature with total numbers ranging from 250-400 worldwide with many coming from individual case reports. Risk factors for developing omental infarction are thought to be obesity, trauma, intense exercise or secondary to torsion from adhesions. Historically, the diagnosis of omental infarction was made incidentally in the operating room for patients with an acute abdomen with a different suspected diagnosis. Most often being appendicitis with associated right lower quadrant abdominal pain and smaller subset from suspected diverticulitis and cholecystitis …

An Evaluation Of The Use Of Tranexamic Acid In The Treatment Of Bradykinin-Mediated Angioedema In The Emergency Department, Sarah Yb Kim, Carol Keller

Providence Pharmacy PGY1 Program at Providence Milwaukie and Providence Newberg Medical Centers 2021

Background

Bradykinin mediated angioedema is an overarching term that includes idiopathic angioedema, angiotensin converting enzyme inhibitor (ACEi) induced angioedema and hereditary angioedema (HAE). •This is an emergent condition that must be treated with the utmost urgency due to the fatal outcomes associated with the rapid constriction of the throat. •Bradykinin mediated angioedema is treated differently from histamine associated angioedema due to its resistance to corticosteroids and antihistamines. •HAE and ACEi induced angioedema are treated similarly but there is a lack of unanimity in the first line pharmacologic treatment. •Current treatment options include fresh frozen plasma, bradykinin-2 receptor antagonists, plasma-kallikrein inhibitors …

Medication And Pharmacy-Related Outcomes As Part Of The Seniors At Risk For Falls After Emergency Room Visit (Safer) Project, Hyesoo Chae, Sharon Leigh, Colleen M Casey

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

The United States is comprised of an aging population; adults over the age of 85 are the fastest-growing age group in the United States and will reach approximately 9 million in 2030.1 25% of patients ≥ 65 years old in the United States report falling each year.1 There are over 3 million emergency department visits related to falls in the United States, totaling approximately 50 billion dollars in total medical expenditures.2 Falls are a major threat for older adults as they can lead to increased risk of further injury, loss of independence, decreased mobility, and premature death.1,2 Despite numerous …

Antibiotic Durations For Skin And Soft Tissue Infections In Pediatric Urgent Care Clinics, Megan Hamner, Amanda Nedved, Holly Austin, Donna Wyly, Alaina N. Burns, Diana King, Brian R. Lee, Rana El Feghaly

Posters

Background: Skin and soft tissue infections (SSTIs) are the second most common diagnosis leading to pediatric antibiotic prescriptions in the outpatient setting after respiratory diagnoses. However, most antibiotic stewardship programs have mainly focused on the latter. Children seen in the ambulatory setting for SSTIs often receive >7 days of antibiotics, although current society guidelines recommend 5-7 days for most diagnoses.


Objective: To determine the baseline percentage of patients receiving antibiotic prescriptions for >7 days for SSTIs in urgent care clinics (UCC)s of a pediatric health system and to evaluate factors that influence providers towards longer durations.


Design/Methods: We built a …

Evaluation Of The Hypothesis That Viral Meningitis Is A Mimic Of Abusive Head Trauma, Danielle Horton, Tanya Burrell, James Anderst, Lyndsey Hultman, Mary Moffatt, Henry T. Puls, Rangaraj Selvarangan

Posters

Background: Viral meningitis (VM) has been proposed as an alternative cause of subdural hemorrhage (SDH) in young children diagnosed with abusive head trauma (AHT). It has been proposed that VM may mimic symptoms and clinical features of AHT, resulting in an incorrect diagnosis of abuse.


Objective: We aim to evaluate the hypothesis that VM is a mimic of AHT by comparing the history of present illness (HPI) and initial clinical presentation of young children with proven VM to those with subdural hemorrhage and concomitant suspicious injuries (SDH + CSIs) and to those with SDH and no CSIs (SDH only). We …

Simulation Based Clinical Systems Testing Of A Pediatric Ed To Improve Staff And Process Readiness For Pediatric Hypoglycemia, Kevin Meilak Md, Christopher S. Kennedy

Posters

Background: Hypoglycemia is the most common metabolic disorder in children in pediatric emergency department (ED) settings 1. Children may present with nonspecific symptoms, or asymptomatically2. So identification/treatment is very challenging. Delayed recognition and under treatment can lead to poor patient outcomes including seizure, coma, and death. Simulation-based clinical systems tests (SbCSTs) are useful to detect gaps/latent safety threats (LSTs) in system design.3-5


Objective: Our aim was to use SbCSTs combined with rapid cycle training to test system function for ED treatment of hypoglycemia.3-5. The research questions were in 2 frames: 1. Can SbCSTs identify gaps/LSTs and recommendations for improvement and …

A Pilot Study Comparing Over And Under Triage Systems At A Center Pursuing Trauma Accreditation, Caitlyn N. Balsay Bs, Mr, Bree A. Harrison Bsn, Rn, Tcrn, Joseph J. Stirparo Md, Michael T. Crowley Md, Nicholas P. Johnson Do, Bryan G. Kane Md, Kathleen E. Kane Md

Department of Emergency Medicine

No abstract provided.

Health Disparities In Black, Latinx, And Native Populations Compared To Caucasians: A Retrospective Descriptive-Analysis Of Care Focused On Hypertensive Emergency, Non-St Segment Elevation Myocardial Infarction (Nstemi), And Cerebrovascular Accident (Cva)., Jonathan Aguilar Roa, Evon Anukam

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Health disparity is a sum of differences in healthcare seen in underserved populations of the United States. 1 • Differences include incidence, prevalence, mortality, burden of disease, and other adverse health conditions • According to ASHP, health disparities continue to be a major public health problem confronting the U.S. health care systems. 2 • Evidence suggests that health disparities can be in part due to differences in the quality of care for different racial and ethnic groups. 2 • All the different disparity factors have been shown to lead to different health outcomes that do not favor Black, …

Evaluation And Implementation Of A New Phenobarbital Protocol For Alcohol Withdrawal Management In The Emergency Department, Sarah J. Kim, Sara Clark, Joshua L. Floyd

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Alcohol withdrawal syndrome can lead to substantial health care costs and mortality. • Although historically benzodiazepines (BZDs) are considered the mainstay treatment for alcohol withdrawal, some studies have shown that phenobarbital may be the safer and preferred alternative option. • Advantages of phenobarbital are its mechanism of action, more predictable pharmacokinetics, and greater therapeutic index. • A prospective study by Rosenson et al. 2012 found that a single 10 mg/kg IV dose of phenobarbital versus standardized lorazepam protocol resulted in decreased ICU admissions (8% vs. 25%). • A retrospective study by Tidewell et al. 2018 demonstrated shorter hospital …

Improving The Rate Of Emergency Department Physician Pre-Procedure Time-Out Documentation For Deep Sedation And Cutaneous Abscess Incision And Drainage, Arjun Sarin, Nikita Sharma, Shobhit Jain

Posters

Background: The pre-procedure time-out, an important safety measure to verify patient identity and accuracy of a planned procedure, and Joint Commission requirement, is not documented consistently by physicians in our emergency department (ED). Deep sedation and cutaneous abscess incision and drainage (I&D) are two high-risk procedures performed in the ED, supporting the use of a time-out in this setting. Between June 2018 and May 2019, a pre-procedure time-out was documented in the physician procedure note of the electronic medical record (EMR) for 75% of deep sedations, and 94% of I&Ds.


Objective: We aimed to improve ED physician pre-procedure time-out documentation …

Teaching Pediatric Procedural Pain And Anxiety Management To Residents: Early Outcomes Of A Newly Developed Curriculum, Jennifer J. Dilts, Brian R. Lee, Shobhit Jain, Ross Newman, Sarah Fouquet, Michael Brancato, Kadriye O. Lewis

Posters

Background: Poorly managed pediatric pain has negative long-term outcomes, including needle phobia, increased pain and anxiety with subsequent procedures, and healthcare avoidance in adulthood. Evidence-based interventions to reduce procedural pain and anxiety are vastly underutilized, and a literature search revealed no specific curriculum to teach residents optimal skills for pain and anxiety management in minor procedures (e.g. venipuncture, laceration repair). Thus, we developed a multimedia-based lecture with PowerPoint, utilizing results from a focus group interview (conducted with 7 pediatric residents, to determine educational content and identify residents’ needs and learning preferences).


Objective: To measure residents’ learning outcomes (knowledge, attitudes, perceived …

Goals-Of-Care Course For Emergency Physicians During The Covid-19 Pandemic., Mari Siegel, Erica Westlake

Department of Emergency Medicine Faculty Papers

BACKGROUND

COVID-19 increased the need for goals of care (GOC) discussions in the Emergency Department (ED). Many Emergency Physicians (EPs) report no formal training in holding GOC discussions. COVID-19 created unique teaching challenges given social distancing requirements.

METHODS

Eight teaching sessions were held using Zoom in March and April at an urban institution in the United States. Sessions were limited to 4-8 participants. They were comprised of a 30-minute lecture and 15 minutes of role-playing, in which providers read scripts to practice communication skills. The lecture introduced vocabulary and models to shape GOC discussions. Participants were invited to complete an …

Geriatric Emergency Medicine Assessment In The Emergency Department Results In Yearly Savings Of $3 Million, Sarah Keene, Lauren Cameron-Comasco

Conference Presentation Abstracts

Background and Objectives: Older adult patients admitted to the hospital from the Emergency Department (ED) have a longer length of stay in the hospital on average compared to younger patients. Geriatric patients make up an increasing percentage of the patient population, and almost all health care for geriatric patients in the United States is paid for by Medicare. The cost of the inpatient care of geriatric patients is a significant contributor to the total cost of health care in the United States. Methods: We conducted a case-control study looking at the impact of a Geriatric Emergency Medicine Assessment (GEMA) team …

Prevalence Of Mycoplasma Genitalium And Macrolide Resistance In Adolescent Females Receiving Care At A Pediatric Hospital, Kayla Barnes, Bishnu Adhikari, Rangaraj Selvarangan, Christopher J. Harrison, Melissa K. Miller

Posters

Background: Mycoplasma genitalium is an established sexually transmitted cause of nongonococcal urethritis in males and macrolide resistance is increasing. The pathogenic role is less well-defined in adolescent females and guidelines recommend M. genitalium testing only be considered in cases of persistent or recurrent cervicitis and pelvic inflammatory disease (PID). We lack understanding of the prevalence and macrolide resistance of M. genitalium in adolescent females.


Objective: To determine the prevalence of M. genitalium and rate of detected macrolide resistance among adolescent females seeking care at a pediatric children’s hospital.


Design/Methods: We collected 200 salvaged urogenital samples (56 urine and 144 vaginal) …

Contraception Counseling Of Adolescents Seeking Care In Pediatric Emergency Departments, Cynthia Mollen, Romina Barral, Tara Ketterer, Jungwon Min, Laurel Gabler, Lauren Poole, Amber Adams, Elizabeth Miller, Aletha Akers, Melissa K. Miller

Presentations

Background: Efforts to increase contraceptive use among adolescents are urgently needed. One approach is to use clinical settings that do not routinely provide contraception services, such as the emergency department (ED). Though many are amenable to ED-based contraceptive care, best practices for providing this care are largely unexplored.

Objective: To assess intention to initiate contraception among adolescent females immediately after receiving ED-based contraceptive counseling, and to assess counseling feasibility, contraception initiation and completion of a follow-up visit for contraceptive care.

Design/Methods: Prospective cohort study in two urban pediatric EDs. Using webinar modules and in-person sessions, advanced practice providers (APPs) were …

Lessons From The Pandemic: How A Children’S Hospital Responded To The Challenges Of Covid-19, John Lantos, Paul Kempinski, Laurie Ellison, Jennifer Watts, Angela Myers

Presentations

The COVID-19 pandemic challenged doctors and hospital administrators as did no other event in our lifetimes. Leaders needed to develop a pandemic command structure with the agility to respond to rapidly evolving situations. They had to deal with drastic financial implications, develop new methods of delivering health care, and collaborate regionally. They learned the importance of communication with staff, policy makers, the local medical community, and the public. They had to allocate of scarce resources internally and externally, and balancing rational policy making against irrational fears. For children’s hospitals, some specific challenges included determining our role in a pandemic that …

Using Standardized Scripting To Improve Antibiotic Stewardship In A National Pediatric Urgent Care Collaborative, Amanda Nedved, Melody Fung, Cindy Liu, Rana Hamdy, Amanda Montalbano

Posters

Background: A study using administrative data reported urgent care providers as having the highest rates of inappropriate antibiotic use for upper respiratory illnesses. In a national survey, pediatric urgent care providers reported family expectations as a primary driver for prescribing inappropriate antibiotics. Standardized scripting has been effective at reducing unnecessary antibiotics while increasing family satisfaction.


Objective: To reduce inappropriate prescribing for upper respiratory infections (acute otitis media (AOM), otitis media with effusion (OME), and pharyngitis) in pediatric urgent cares by 20% by December 1, 2020 through use of standardized scripting in Year 2 of a national pediatric urgent care quality …

Simulation Based Clinical Systems Testing In The Pediatric Emergency Department To Prepare For Covid-19 Pandemic, Christopher S. Kennedy, Marc Sycip, Lisa Ell, Shautonja Woods

Posters

Background: The COVID-19 prompted pediatric emergency departments (PED) to prepare for a surge in patients. In response, guidelines developed represent “work as imagined” and may not reflect work as done. In situ simulations could identify gaps and help to mitigate errors. Simulation-based clinical systems tests (SbCSTs) can detect latent safety threats (LSTs) in systems design.


Objective: Our aim was to use SbCSTs combined with rapid cycle training to test hospital system modifications for ED preparation. This method represenst a new application of SbCSTs. The research questions were in 2 frames: 1. Can rapidly deployed SbCSTs identify LSTs and recommendations for …

Treatment Access For Dual Diagnosis Substance Use And Mental Health Disorders, Pedro Banuelos

Electronic Theses, Projects, and Dissertations

In 2018, of 1.3 million Latinx adults in the United States facing concurrent issues with substance use disorders (SUD) and mental health disorders (MHD) 93% remained untreated for either diagnosis. This is concerning since Substance Abuse and Mental Health Services Administration (SAMHSA) data reveals that this population is at greater risk for suicidal thoughts, plans, and attempts. They also face structural barriers such as employment, housing, legal involvement, and insurability that further impede access to treatment.

This study’s purpose was to examine barriers to accessing treatment for Latinx populations confronting co-occurring SUDs and MHDs. This study used a qualitative design …

Emergency Medicine Resident Identification Of Medication Safety Issues, Natalie E. Ebeling-Koning Do, Charles A. Soares Md, Gillian A. Beauchamp Md, Gavin C. Barr Jr. Md, Terrence E. Goyke Do, Shawn M. Quinn Do, Kevin Weaver D.O.,Facoep, Dawn M. Yenser C-Tagme, Bryan G. Kane Md

Department of Emergency Medicine

No abstract provided.