Emergency Medicine Commons^™

Access To Point-Of-Care Ultrasound In Maine Emergency Departments, Christina N. Wilson, Campbell Belisle Haley

Journal of Maine Medical Center

Introduction: Point-of-care ultrasound (POCUS) is an essential tool in emergency medicine. We evaluated access to bedside ultrasound machines and characterized POCUS use in Maine emergency departments (EDs).

Methods: We conducted a cross-sectional electronic survey of all ED medical directors in Maine. The survey included questions on ED characteristics, access to ultrasound machines, POCUS use patterns, POCUS administration, and barriers to use.

Results: Thirty-four EDs were identified, and 24 medical directors completed the survey, yielding a response rate of 71%. EDs were predominantly small and rural. Only 21% identified as urban, and 54% reported less than 20 000 annual visits. Surveys …

The Utility Of Hyperbaric Oxygen Therapy In Post-Transplant Cyclophosphamide-Induced Hemorrhagic Cystitis: A Case Report And Review Of The Literature., Moayed Ibrahim, Kshama Bhyravabhotla, Basil Khalaf, Keith Van Meter, Nakhle S Saba, Hana Safah, Francisco Socola

School of Medicine Faculty Publications

Background: To date, there are only a few case reports of cyclophosphamide (Cy)-induced hemorrhagic cystitis (HC) in adult or pediatric allogeneic stem cell transplant (SCT) patients treated successfully with hyperbaric oxygen (HBO). In all the reported cases, Cy was used as a part of the conditioning regimen, rather than post-transplant for graft-versus-host-disease (GVHD) prophylaxis. More recently, the risk of HC in allogeneic SCT is further increased by the widespread use of post-transplantation cyclophosphamide (PTCy) as a highly effective strategy for GVHD prophylaxis. This is the first case reported of PTCy-induced HC successfully treated with HBO to the best of our …

Drowning Rule Out With Novices (Drown) In Ultrasound, Justin Schevers, Stewart R. Richardson, Jacob Pope, Dylan Arnold, Casey Wilson

South Atlantic Division GME Research Day 2021

No abstract provided.

Statins And Women, Debra Schulte

Rural Health Professions Projects

Low-density lipoprotein (LDL) elevation is a primary risk factor for atherosclerotic cardiovascular problems such as heart disease and stroke. Heart disease is the leading cause of death in the United States and stroke is the fifth leading. Earlier LDL reduction improves morbidity and mortality. Literature indicates fewer women start statin medications compared to men.

Signing Your Life Away? Emergency Department Patient Recall And Understanding Of Ed Consent For Treatment Based On Triage Level, Daniel Ross

Scholarship in Medicine - All Papers

Objective: The determine the correlation between patient recall and understanding of Emergency Department (ED) consent for treatment and patient triage level. Methods: This was a prospective study based on demographical and triage data collected from patient charts, in combination with patient responses to the consent for treatment survey. Results: Of the 293 that participated in the study, the mean age was 52, with 122 (41.6%) males and 171 (58.4%) females. 179 (61.5%) identified as white/Caucasian and 100 (34.4%) identified as African-American. Most patients, 210 (72.4%), arrived by walk-in and the rest, 80 (27.6%), were by ambulance. Participants with lower triage …

Consent For Emergency Treatment: Demographic Variables And Relationship To Patient Comprehension, Ashwatha Thenappan

Scholarship in Medicine - All Papers

Objective: One of the most important pillars of patient autonomy is informed consent for medical treatment. This study was undertaken to measure patient recall and understanding of consent for treatment among ED patients. Methods: This prospective survey study was conducted at Miami Valley Hospital, an Urban Level 1 Trauma Center. Trained research assistants obtained verbal consent in private patient treatment rooms. Data were collected from the electronic medical record and from a survey questionnaire. Results: A total of 293 patients consented to participate (95% participation rate). The majority of participants stated that they had signed a consent document (N …

Improving Safety Using Hfmea And Insitu Simulation Prior To Initiating Contrast Mri Studies In An Ambulatory Setting, Micheline Chipman, Todd Dadaleares, Heather Beaulieu, Leah Mallory

Costas T. Lambrew Research Retreat 2021

The objective of this event was to test a new system for emergency response to MRI contrast reactions by ensuring staff familiarity with emergency equipment and a newly drafted emergency response protocols, and to mitigate any LST identified.

Examining The Relationship Between Markers Of Emergency Department Crowding And Physician Wellbeing, Jessica Dibiase, Tania D. Strout, Samir Haydar, Karla Hyde, Elizabeth Hamilton, Christine Hein

Costas T. Lambrew Research Retreat 2021

Objectives-

Explore changes to EP wellbeing over time.

Evaluate the relationships between markers of ED crowding and boarding and EP wellbeing

Resident Instruction In Social Emergency Medicine, Heidi Roche, Christine Knettel, Brandon Knettel, Justin Myers, Jessica Dunn, Timothy S. Fallon

Costas T. Lambrew Research Retreat 2021

Understanding social determinants of health (SDH) and their intersection with emergency medicine, also known as social emergency medicine (SEM), is an important area of EM training.

A Baseline Review Of The Ability Of Hospitals In Kenya To Provide Emergency And Critical Care Services For Covid-19 Patients, Benjamin Wachira, Margarita Mwai

Emergency Medicine, East Africa

Introduction: As the Coronavirus Disease 2019 (COVID-19) cases in Kenya begin to rise, the number of severe and critical COVID-19 patients has the potential to quickly overload the local healthcare system beyond its capacity to treat people.

Objective: The purpose of this study was to gather information about the ability of hospitals in Kenya to provide emergency and critical care services and to identify priority actions for use by policymakers and other stakeholders as a roadmap toward strengthening the COVID-19 response in the country.

Methods: This was a comprehensive review of the published and grey literature on emergency and critical …

Pneumomediastinum Following Endotracheal Intubation, Aroh Ribadiya

Scholarship in Medicine - All Papers

EP, an 81-year-old female with a history of multiple metastases presented to the Emergency Department (ED) for shortness of breath. She developed respiratory failure requiring endotracheal intubation. She was successfully intubated, treated with etomidate, succinylcholine, propofol, fentanyl, and admitted to the Intensive Care Unit (ICU). A follow up chest CT at 2 hours demonstrated an incidental finding of pneumomediastinum.

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 …

Improving Emergency Department Quality Of Care, Carmen Smith

Doctor of Nursing Practice Projects

Emergency department (ED) crowding can cause an extended length of stay (LOS) and high rates of patients who leave without being seen (LWBS). This quality improvement ED project sought to reduce LOS and LWBS by implementing a triage (PIT) team. The design included an outcomes evaluation with available data and a staff pre and posttest. Length of stay and LWBS rates were compared before and after implementation. Results indicated a reduction in the average LOS and LWBS rates for the 30 days of project implementation compared to the 30 days before the project initiation. The overall goal of the PIT …

Developing An End-Of-Life Discussion Protocol In Primary Care Clinics, James L. Hawley

Doctor of Nursing Practice Projects

End-of-life (EOL) issues are far too often addressed reactively in Emergency Departments when patients can no longer express their wishes. This scenario can result in unwanted futile care, increased healthcare costs, and emotional hardships for family and healthcare workers. The purpose of this quality improvement project was to implement a protocol that would shift advanced directive conversations proactively back into primary health care settings. This action would allow patients to make and document informed decisions with their Primary Care Providers (PCPs). A pilot study conducted in November 2020 at a rural clinic provided feedback from PCPs on perceived barriers to …

A Structured Approach To Skin And Soft Tissue Infections (Sstis) In An Ambulatory Setting, Benjamin Silverberg

Faculty & Staff Scholarship

The skin is the largest, and arguably, the most vulnerable organ in the human body. Scratches and scrapes, bites and puncture wounds, impetigo and erysipelas—all these disruptions can lead to pain, swelling, and/or systemic symptoms. In this article, which is based on the Infectious Diseases Society of America’s 2014 guidelines and the World Society of Emergency Surgery and Surgical Infection Society of Europe’s 2018 consensus statement, a structured approach to skin and soft tissue infections (SSTIs) is reviewed, comparing treatment for suppurative and non-suppurative infections, and then discussing specific conditions commonly seen in Primary Care and Urgent Care facilities.

Management Of Refractory Ventricular Fibrillation With Double Sequential Defibrillation, Kaitlyn A. Brown

Capstone Showcase

Patients experiencing cardiac arrest are treated according to ACLS protocols, however current protocols lack recommendations for the treatment of refractory Ventricular Fibrillation which persists after more than 3 cycles of CPR and defibrillation. One potential intervention for these cases that is being researched is the use of simultaneous or sequential activation of two defibrillators. This literature review analyzed the results of several studies to determine if double sequential defibrillation (DSD) is a viable treatment to achieve return of spontaneous circulation (ROSC) and improved patient survival. The results of the studies were mixed with some showing positive outcomes, and others showing …

Coping Skills, Emotional Intelligence, Attachment, And Resilience On Post-Traumatic Stress Disorder In Private Sector Emergency Medical Technicians, Brenda-Joyce Gonzales Orozco Markert-Green

Dissertations

Problem

Private sector Emergency Medical Technicians (EMTs) are first responders who respond to traumatic incident scenes along with firefighters and police officers. However, news agencies and the public do not acknowledge private sector EMTs with the same vigor or accolade as public sector EMTs, nor are the risks to life, health, and mental well-being recognized among this population. Thus, the research literature has been sparse regarding how private sector EMTs experience PTSD, and what unique risk factors and needs may be present.

Purpose Statement

The purpose of this study was to examine the relationship between PTSD symptoms and coping skills, …

Opioid Use Disorder: The Timeline For Medication Assisted Therapy, Alexander Cristofori

Capstone Showcase

Opioid Use Disorder is patterns of opioid use leading to withdrawal, giving up important life events in order to use opioids, and excessive time spent using opioids, to name a few diagnostic criteria. The clinical progression of the disorder involves periods of acute exacerbation and remission that are cyclic in nature. Treatment is most effective when it includes both pharmacological and psychosocial modalities, referred to as medication assisted therapy (MAT). Three drugs used commonly in MAT-based treatment for OUD from oldest to newest include Methadone, Buprenorphine-naloxone, and Naltrexone. Treatment program models that prioritize total abstinence from the addictive substance attached …

Characteristics And Outcomes Of In-Hospital Cardiac Arrest In Covid-19 A Systematic Review And Meta-Analysis, Lukasz Szarpak, Magdalena Borkowska, Frank W Peacock, Zubaid Rafique, Aleksandra Gasecka, Jacek Smereka, Katarzyna Pytkowska, Marta Jachowicz, Lukasz Iskrzycki, Natasza Gilis-Malinowska, Milosz J Jaguszewski

Faculty, Staff and Students Publications

BACKGROUND: The purpose herein, was to perform a systematic review of interventional outcome studies in patients with in-hospital cardiac arrest before and during the coronavirus disease 2019 (COVID-19) pandemic period.

METHODS: A meta-analysis was performed of publications meeting the following PICOS criteria: (1) participants, patients > 18 years of age with cardiac arrest due to any causes; (2) intervention, cardiac arrest in COVID-19 period; (3) comparison, cardiac arrest in pre-COVID-19 period; (4) outcomes, detailed information for survival; (5) study design, randomized controlled trials, quasi-randomized or observational studies comparing cardiac arrest in COVID-19 and pre-COVID-19 period for their effects in patients with …

Laypeople Perception And Interpretation Of Simulated Life-Threatening Bleeding: A Controlled Experimental Study, Erik Prytz, Rachel Phillips, Susanna Lönnqvist, Marc Friberg, Carl-Oscar Jonson

Psychology Faculty Publications

Introduction

First aid performed by immediate responders can be the difference between life and death in the case of trauma with massive bleeding. To develop effective training programs to teach bleeding control to laypersons, it is important to be aware of beliefs and misconceptions people hold on bleeding and severity of bleeding situations.

Method

A controlled study was conducted in which 175 American college students viewed 78 video clips of simulated bleeding injuries. The volume of blood present (between 0 and 1900 ml), rate of blood flow, and victim gender were systematically varied within participants. Participants were asked to rate …