Emergency Medicine Commons^™

Effect Of Emergency Severity Index (Esi) Annual Competency Assessment On Mistriage Rates, Stefanie Hoffman

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Introduction: In order to accurately assign an Emergency Severity Index (ESI) acuity level to patients who present to the emergency department (ED) triage area, it is essential triage nurses remain competent in the ESI triage tool. In addition, effective use of the ESI triage tool is critical in preventing patients from being mistriaged.
Objective: The purpose of this quality improvement project was to determine the effect of an ESI annual competency assessment in an ED for triage trained registered nurses (RNs).
Methods: Triage trained RNs completed an ESI competency assessment composed of 25 patient scenarios in competency assessment A, and …

Transfer Of Patients With St Elevation Myocardial Infarction For Primary Percutaneous Coronary Intervention During Ordinary & Pandemic Times Position Statement Of The Saudi Arabian Cardiac Intervention Society, Shukri M. Al Saif, Owayed Al Shammeri, Abdullah Alkhushail, Ramzi Almohammadi, Mohamed Kurdi

Journal of the Saudi Heart Association

Primary percutaneous coronary intervention is the most effective therapy in the management of acute ST Elevation Myocardial Infarction. Evidence recommends keeping the period from symptom onset to reperfusion to a minimum in order to preserve left ventricular function, improve outcome, and reduce mortality. The position statement describes the recommendations of the the Saudi Arabian Cardiac Intervention Society for optimal conditions and timing for the acute management of patients presenting with ST Elevation Myocardial Infarction during ordinary and pandemic times.

A Comparison Of Standardized Letters Of Evaluation For Emergency Medicine Residency Applicants., David Wilson, Chaiya Laoteppitaks, Shruti Chandra

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Medical students pursuing an emergency medicine (EM) residency are advised to obtain at least two Standardized Letters of Evaluation (SLOE). Students often complete one rotation at their home institution and at least one "away" rotation at a program separate from their home institution. The SLOE was introduced as an objective evaluation tool. The aim of this study was to determine whether there was a difference in scores between home rotation and away rotation SLOEs.

METHODS: We retrospectively reviewed the SLOEs of all applicants to an urban, academic EM residency program. For each SLOE, we calculated a composite score from …

Spontaneous Tumor Lysis Syndrome In An Adenocarcinoma Of Unknown Origin., Joshua A. Kalter Ms3, Jamie Allen Do, Yuchen Yang Do, Tyler Willing Do, Elizabeth M. Evans Do

Department of Emergency Medicine

Spontaneous tumor lysis syndrome (STLS) is a rare oncologic emergency caused by massive cancer cell lysis or necrosis without a precipitating factor. Although tumor lysis syndrome (TLS) is most commonly associated with hematologic malignancies, a small number of cases in solid tumor malignancies have been reported. We present a case of spontaneous tumor lysis syndrome in a 77-year-old female with a widely metastatic, poorly differentiated adenocarcinoma of unknown origin. She presented in distributive shock, and laboratory testing at admission revealed acute renal failure, high anion gap metabolic acidosis, hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Rasburicase and continuous renal replacement therapy were …

Induction Of Hypothermia In Patients With Traumatic Brain Injury, Frank Hadden, Courtney Lennix

Physician Assistant Capstones, 2020-current

Common Abbreviations:

TBI = Traumatic Brain Injury

Glasgow Outcome Scale = GOS

Glasgow Outcome Scale Extended = GOSE

Objective: To determine whether hypothermia induction improves long-term morbidity and mortality in patients with severe traumatic brain injury

Methods: A search was conducted using PubMed database and the search terms “induced hypothermia” and “traumatic brain injury”. Studies were excluded if the publication dates were over 10 years old, children were the population being studied, and the researchers were looking at other independent variables.

Results: The results from all three randomized control trials showed that the induction of hypothermia did not show effectiveness …

Mir15a/Mir16-1 Cluster And Its Novel Targeting Molecules Negatively Regulate Cardiac Hypertrophy., Hongchang Guo, Ke Ma, Wenjing Hao, Yao Jiao, Ping Li, Jing Chen, Chen Xu, Fu-Jian Xu, Wayne Bond Lau, Jie Du, Xin-Liang Ma, Yulin Li

Department of Emergency Medicine Faculty Papers

In response to pathological stimuli, the heart develops ventricular hypertrophy that progressively decompensates and leads to heart failure. miRNAs are increasingly recognized as pathogenic factors, clinically relevant biomarkers, and potential therapeutic targets. We identified that mir15a/mir16-1 cluster was negatively correlated with hypertrophic severity in patients with hypertrophic cardiomyopathy. The mir15a/mir16-1 expression was enriched in cardiomyocytes (CMs), decreased in hypertrophic human hearts, and decreased in mouse hearts after transverse aortic constriction (TAC). CM-specific mir15a/mir16-1 knockout promoted cardiac hypertrophy and dysfunction after TAC. CCAAT/enhancer binding protein (C/EBP)β was responsible for the downregulation of mir15a/mir16-1 cluster transcription. Mechanistically, mir15a/mir16-1 cluster attenuated the insulin/IGF1 …

Advising Special Population Emergency Medicine Residency Applicants: A Survey Of Emergency Medicine Advisors And Residency Program Leadership., Alexis E. Pelletier-Bui, Caitlin Schrepel, Liza Smith, Xiao Chi Zhang, Adam Kellogg, Mary Ann Edens, Christopher W. Jones, Emily Hillman

Department of Emergency Medicine Faculty Papers

BACKGROUND: The objective of this study was to determine the advising and emergency medicine (EM) residency selection practices for special population applicant groups for whom traditional advice may not apply.

METHODS: A survey was distributed on the Council of Residency Directors in EM and Clerkship Directors in EM Academy listservs. Multiple choice, Likert-type scale, and fill-in-the-blank questions addressed the average EM applicant and special population groups (osteopathic; international medical graduate (IMG); couples; at-risk; re-applicant; dual-accreditation applicant; and military). Percentages and 95% confidence intervals [CI] were calculated.

RESULTS: One hundred four surveys were completed. Of respondents involved in the interview process, …

Burden Of Care As Perceived By Informal Caregivers Of The Patients Receiving Chemotherapy In Tertiary Care Hospital Of Karachi, Pakistan, Asher Ghori, Rubina Barolia, Naghma Rizvi, Ghulam Qadir

School of Nursing & Midwifery

Background: Almost 32.5 million people are diagnosed with cancer annually. The huge number of cancer patients with deteriorating health renders a far greater number of informal caregivers bearing the burden of care in different forms and magnitude. The main purpose of the study was to explore the types of burden perceived by the informal caregivers and the factors associated with the caregiving burden.
Methods: A quantitative descriptive cross-sectional study design was adopted to answer the research questions from April to May 2016. Around 200 informal caregivers were recruited from one of the tertiary hospitals of Karachi, Pakistan. The modified ZBIS …

The Sensitivity Of Qsofa Calculated At Triage And During Emergency Department Treatment To Rapidly Identify Sepsis Patients., Sarah M. Perman, Mark E. Mikkelsen, Munish Goyal, Adit Ginde, Abhishek Bhardwaj, Byron Drumheller, S. Cham Sante, Anish K. Agarwal, David F. Gaieski

Department of Emergency Medicine Faculty Papers

The quick sequential organ failure assessment (qSOFA) score has been proposed as a means to rapidly identify adult patients with suspected infection, in pre-hospital, Emergency Department (ED), or general hospital ward locations, who are in a high-risk category with increased likelihood of "poor outcomes:" a greater than 10% chance of dying or an increased likelihood of spending 3 or more days in the ICU. This score is intended to replace the use of systemic inflammatory response syndrome (SIRS) criteria as a screening tool; however, its role in ED screening and identification has yet to be fully elucidated. In this retrospective …

Nurse-Initiated Protocols For Chest Pain In The Emergency Department, Matthew Hodges

Student Scholarly Projects

Practice Problem: Emergency department crowding inhibits the ability to provide safe patient care to chest pain patients and negatively impact patient outcomes. A Veteran Affairs emergency department has identified a similar concern and implemented a nurse-initiated protocol to decrease the length of stay and improve patient outcomes.

PICOT: This evidence-based practice (EBP) project was guided by the following PICOT question: In the emergency department (ED), how does a nurse-initiated protocol (NIP) for chest pain (CP) patients compared to no protocol use influence length of stay (LOS) in the ED over 8 weeks?

Evidence: The reviewed literature supported the evidence of …

Randomised Controlled Trial To Assess The Effectiveness Of Apnoeic Oxygenation In Adults Using Low-Flow Or High-Flow Nasal Cannula With Head Side Elevation Versus Usual Care To Prevent Desaturation During Endotracheal Intubation In The Emergency Department (Apoxed): Study Protocol, Shahan Waheed, Nazir Najeeb Kapadia, Muhammad Faisal Khan, Salima Mansoor Kerai, Ahmed Raheem, Rubaba Naeem

Department of Emergency Medicine

Introduction: Apnoeic oxygenation is a process of delivering continuous oxygen through nasal cannula during direct laryngoscopy. The oxygen that is delivered through these nasal cannulas is either low flow or high flow. Although the effectiveness of apnoeic oxygenation has been shown through systematic reviews and randomised controlled trials, a comparison of high-flow versus low-flow oxygen delivery has not been tested through a superiority study design. In this study we propose to assess the effectiveness of giving low-flow oxygen with head side elevation versus high-flow oxygen with head side elevation against the usual practice of care in which no oxygen is …

Reorganizing Emergency Department Information Systems To Reduce Physician Cognitive Load, James C. Mcclay, Jeffery Nielson, Benjamin Slovis

Posters and Presentations: Emergency Medicine

No abstract provided.

Family Presence During Resuscitation, Brittany Whistle

Scholars Week

Background:

Families want more involvement in their loved one’s care than they did just twenty years ago. Especially, in the matter of resuscitation efforts, this involvement remains controversial.

Evidence and Findings:

Based on research, theories, and multiple educated opinions, family presence during resuscitation (FPDR) needs to be implemented in hospitals. Theories by Kolcaba and Helvie demonstrate a need for comfort and positive energy around patients to enhance the healing process. Evidence has shown multiple benefits of FPDR. The patient receives a holistic approach of care, the family gains closure and feeling of participation of care, and provides a plan for …

Breakout Of Vaping-Associated Lung Injuries (Vali) 2019: A Public Health Threat, Sadaf Sheikh, Muhammad Akbar Baig

Department of Emergency Medicine

No abstract provided.

Gender And Racial Disparity For Hospital Emergency Service Usage In Usa: A Quantitative Analysis For Various Age Groups During 2010–2017., Subhendra N. Sarkar, Anthony F. Devito, Evans Lespinasse, Faisal Khosa

Publications and Research

Background: Annually emergency department (ED) services are utilized by more than 100 million Americans making ED usage trends important determinants of healthcare quality, outcomes and cost. Previous workers have demonstrated the existence of disparity in various healthcare services in USA although a comprehensive analysis has not been undertaken. Dahlgren and Whitehead rainbow model has offered insights for multiple factors of influence on an individual’s health and focuses on the relationships among these factors. The Commission on Social Determinants of Health (CSDH; WHO initiatives) suggests that the social and environmental factors are at the root of most of the inequalities responsible …

Perception Of The Healthcare Professionals Towards The Current Trauma And Emergency Care System In Kabul, Afghanistan: A Mixed Method Study, Umerdad Khudadad, Wafa Aftab, Asrar Ali, Nadeem Ullah Khan, Junaid Razzak, Sameen Siddiqi

Department of Emergency Medicine

Background: Trauma and injury contribute to 11% of the all-cause mortality in Afghanistan. The study aimed to explore the perceptions of the healthcare providers (pre and in-hospital), hospital managers and policy makers of the public and private health sectors to identify the challenges in the provision of an effective trauma care in Kabul, Afghanistan.
Methods: A concurrent mixed method design was used, including key-informant interviews (healthcare providers, hospital managers and policy makers) of the trauma care system (N = 18) and simultaneous structured emergency care system assessment questionnaire (N = 35) from July 15 to September 25, 2019. Interviews were …

Inpatient Hospital Performance Is Associated With Post-Discharge Sepsis Mortality., Nicholas M. Mohr, Alexis M. Zebrowski, David F. Gaieski, David G. Buckler, Brendan G. Carr

Department of Emergency Medicine Faculty Papers

BACKGROUND: Post-discharge deaths are common in patients hospitalized for sepsis, but the drivers of post-discharge deaths are unclear. The objective of this study was to test the hypothesis that hospitals with high risk-adjusted inpatient sepsis mortality also have high post-discharge mortality, readmissions, and discharge to nursing homes.

METHODS: Retrospective cohort study of age-qualifying Medicare beneficiaries with sepsis hospitalization between January 2013 and December 2014. Hospital survivors were followed for 180-days post-discharge, and mortality, readmissions, and new admission to skilled nursing facility were measured. Inpatient hospital-specific sepsis risk-adjusted mortality ratio (observed: expected) was the primary exposure.

RESULTS: A total of 830,721 …

Conference Proceedings: Aurora Scientific Day 2020

Journal of Patient-Centered Research and Reviews

Abstracts published in this supplement were among those presented at the 46th annual Aurora Scientific Day research symposium, held virtually on May 20, 2020. The symposium provides a forum for describing research studies conducted by faculty, fellows, residents, and allied health professionals affiliated with Wisconsin-based Aurora Health Care, a part of the Advocate Aurora Health health system, which publishes the Journal of Patient-Centered Research and Reviews.

Optimizing Wellness In Academic Emergency Medicine, Kristen E. Nordenholz, Al'ai Alvarez, Michelle D. Lall, Christine Stehman, Cindy C. Bitter, Emily L. Hirsh, Rita Manfredi, Rosanna D. Sikora, Dave W. Lu, Leon D. Sanchez, Matthew L. Wong, Steven Bird, Andra L. Blomkalns

Journal of Wellness

Introduction

Academic Emergency Physicians (EPs) face additional unique challenges in optimizing wellness compared to community EPs.

Objective

Our objective was to explore specific individual and systems challenges that academic EPs encounter that affect their wellbeing and professional fulfillment in emergency medicine (EM).

Methods

An expert group of academic EPs convened in 2019 at the annual meeting of the Society of Academic Emergency Medicine to investigate the overall causes of burnout in healthcare providers, the effects of burnout on the healthcare system, specific causes of burnout in EM, and the distinct challenges facing academic emergency physicians.

Results

We outline specific causes …

Concurrent Primary Cardiac Tumors In A High Risk Patient Presenting With Tamponade, Joseph B. Zackary Md, Lauren Crowley Ba, Shawn M. Quinn Do, Timothy S. Misselbeck

Department of Emergency Medicine

No abstract provided.