Emergency Medicine Commons^™

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 …

Fat Embolism Syndrome As The Presenting Syndrome Of Undiagnosed Sickle Cell Disease In A Middle-Aged Adult, Jamie Allen Do, Osman Z. Abbasi Do, Louis Morolla Do, Andres Zirlinger Md, Jeffrey M. Gesell Do, Benjamin Lin Ms

Department of Emergency Medicine

No abstract provided.

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.

Solving Community Sars-Cov-2 Testing With Telehealth: Development And Implementation For Screening, Evaluation And Testing., Aditi Joshi, Resa E. Lewiss, Maria Aini, Bracken Babula, Patricia C. Henwood

Department of Emergency Medicine Faculty Papers

BACKGROUND: Telehealth has emerged as a crucial component of the SARS-CoV-2 pandemic emergency response. Simply stated, telehealth is a tool to provide health care from a distance. Jefferson Health has leveraged its acute care telehealth platform to screen, order testing, and manage patients with COVID-19-related concerns.

OBJECTIVE: This study aims to describe the expansion and results of using a telehealth program to increase access to care while minimizing additional potential exposures during the early period of the COVID-19 pandemic.

METHODS: Screening algorithms for patients with SARS-CoV-2-related complaints were created, and 150 new clinicians were trained within 72 hours to address …

Early General Hypothermia Improves Motor Function After Spinal Cord Injury In Rats; A Systematic Review And Meta-Analysis., Mahmoud Yousefifard, Mohammad Hossein Vazirizadeh-Mahabadi, Leila Haghani, Farhad Shokraneh, Alex R. Vaccaro, Vafa Rahimi-Movaghar, Mostafa Hosseini

Rothman Institute Papers

Introduction: There is still controversy about the effect of early hypothermia on the outcome of spinal cord injury (SCI). The aim of this review article is to investigate the effect of local or general hypothermia on improving the locomotion after traumatic SCI.

Methods: Electronic databases (Medline and Embase) were searched from inception until May 7, 2018. Two independent reviewers screened and summarized the relevant experimental studies on hypothermia efficacy in traumatic SCI. The data were analyzed and the findings were presented as pooled standardized mean difference (SMD) and 95% confidence interval (95% CI).

Results: 20 papers contain-ing 30 separate experiments …

Acute Hyperkalemia In The Emergency Department: A Summary From A Kidney Disease: Improving Global Outcomes Conference, Gregor Lindner, Emmanuel A Burdmann, Catherine M Clase, Brenda R Hemmelgarn, Charles A Herzog, Jolanta Małyszko, Masahiko Nagahama, Roberto Pecoits-Filho, Zubaid Rafique, Patrick Rossignol, Adam J Singer

Faculty, Staff and Students Publications

Hyperkalemia is a common electrolyte disorder observed in the emergency department. It is often associated with underlying predisposing conditions, such as moderate or severe kidney disease, heart failure, diabetes mellitus, or significant tissue trauma. Additionally, medications, such as inhibitors of the renin-angiotensin-aldosterone system, potassium-sparing diuretics, nonsteroidal anti-inflammatory drugs, succinylcholine, and digitalis, are associated with hyperkalemia. To this end, Kidney Disease: Improving Global Outcomes (KDIGO) convened a conference in 2018 to identify evidence and address controversies on potassium management in kidney disease. This review summarizes the deliberations and clinical guidance for the evaluation and management of acute hyperkalemia in this setting. …

Redefining Cardiac Biomarkers In Predicting Mortality Of Inpatients With Covid-19, Juan-Juan Qin, Xu Cheng, Feng Zhou, Fang Lei, Gauri Akolkar, Jingjing Cai, Xiao-Jing Zhang, Alice Blet, Jing Xie, Peng Zhang, Ye-Mao Liu, Zizhen Huang, Ling-Ping Zhao, Lijin Lin, Meng Xia, Ming-Ming Chen, Xiaohui Song, Liangjie Bai, Ze Chen, Xingyuan Zhang, Da Xiang, Jing Chen, Qingbo Xu, Xin-Liang Ma, Rhian M Touyz, Chen Gao, Haitao Wang, Liming Liu, Weiming Mao, Pengcheng Luo, Youqin Yan, Ping Ye, Manhua Chen, Guohua Chen, Lihua Zhu, Zhi-Gang She, Xiaodong Huang, Yufeng Yuan, Bing-Hong Zhang, Yibin Wang, Peter P Liu, Hongliang Li

Department of Emergency Medicine Faculty Papers

The prognostic power of circulating cardiac biomarkers, their utility, and pattern of release in coronavirus disease 2019 (COVID-19) patients have not been clearly defined. In this multicentered retrospective study, we enrolled 3219 patients with diagnosed COVID-19 admitted to 9 hospitals from December 31, 2019 to March 4, 2020, to estimate the associations and prognostic power of circulating cardiac injury markers with the poor outcomes of COVID-19. In the mixed-effects Cox model, after adjusting for age, sex, and comorbidities, the adjusted hazard ratio of 28-day mortality for hs-cTnI (high-sensitivity cardiac troponin I) was 7.12 ([95% CI, 4.60-11.03] P<0.001), (NT-pro)BNP (N-terminal pro-B-type natriuretic peptide or brain natriuretic peptide) was 5.11 ([95% CI, 3.50-7.47] P<0.001), CK (creatine phosphokinase)-MB was 4.86 ([95% CI, 3.33-7.09] P<0.001), MYO (myoglobin) was 4.50 ([95% CI, 3.18-6.36] P<0.001), and CK was 3.56 ([95% CI, 2.53-5.02] P<0.001). The cutoffs of those cardiac biomarkers for effective prognosis of 28-day mortality of COVID-19 were found to be much lower than for regular heart disease at about 19%-50% of the currently recommended thresholds. Patients with elevated cardiac injury markers above the newly established cutoffs were associated with significantly increased risk of COVID-19 death. In conclusion, cardiac biomarker elevations are significantly associated with 28-day death in patients with COVID-19. The prognostic cutoff values of these biomarkers might be much lower than the current reference standards. These findings can assist in better management of COVID-19 patients to improve outcomes. Importantly, the newly established cutoff levels of COVID-19-associated cardiac biomarkers may serve as useful criteria for the future prospective studies and clinical trials.

Sudden Shoulder Swelling In An Elderly Man After The Flu Shot., Joseph Jean, Md, Elizabeth M Lee, Xiao Chi Zhang

Department of Emergency Medicine Faculty Papers

A 99-year-old man presented to the emergency department (ED) with sudden left shoulder pain hours after receiving the influenza vaccine. DIAGNOSIS: Aseptic inflammatory arthritis secondary to influenza vaccination

Assessing Time From Door-To-Antibiotic Administration For Adult Cancer Patients With Neutropenic Fever In The Emergency Department, Sarah Roy, Tina Magsarili

All Nursing Boot Camp Posters

Background:

Infection, related to febrile neutropenia, in patients receiving chemotherapy for cancer remains a common complication and is a medical emergency. Fever is often the only sign of severe underlying infection in neutropenic patients due to the patient’s immunosuppressed state (Butts, et.al, 2017). Vigilant nursing assessment and immediate medical attention for neutropenic fever (NF) is imperative because the rate of major organ complication and mortality is as high as 30% and 11% respectively (Freifield et.al, 2011 & Taplitz et.al, 2018). In the setting of severe sepsis or septic shock the mortality rate may be as high as 50% (Taplitz et.al, …

Assessing Time From Door-To-Antibiotic Administration For Adult Cancer Patients With Neutropenic Fever In The Emergency Department, Sarah Roy, Tina Magsarili

Books, Presentations, Posters, Etc.

No abstract provided.

Pain In The Prehospital Setting In Rwanda: Results Of A Mixed-Methods Quality Improvement Project., A Rosenberg, E Uwitonze, M Dworkin, J P D Guidry, T Cyuzuzo, D Banerjee, K Mcintyre, K Carlyle, J M Uwitonze, I Kabagema, T Dushime, S Jayaraman

Student Papers, Posters & Projects

Introduction: Pain is a universal human experience tied to an individual's health but difficult to understand. It is especially important in health emergencies. We performed a two-step quality improvement project to assess pain management by the SAMU ambulance service in Kigali, Rwanda, examining how pain is assessed and treated by ambulance staff to facilitate development of standardized guidelines of pain management in the prehospital setting, which did not exist at the time of the study.

Materials and Methods: Deidentified ambulance service records from December 2012 to May 2016 were analyzed descriptively for patient demographics, emergency conditions, pain assessment, and medications …

C. Blind Taste Testing: A Case Study Of An Emergency Room Rn With Covid-19 Anosmia & Hypogeusia (Loss Of Smell & Taste), Marietta Sperry, Kimberly Kohlieber

Year of the Nurse: Clinical Scholarship Presentations

No abstract provided.

The Impact Of Appendectomy In Clostridium Difficile Infection And Length Of Hospital Stay., Rajesh Essrani Md, Dany Saturno, Shehriyar Mehershahi, Rajesh Kumar Essrani, Muhammad Rajib Hossain, Shri Jai Kirshan Ravi, Andrea Berger, Asif Mehmood

Department of Emergency Medicine

Introduction We aim to investigate Clostridium difficile infection (CDI) recurrence, severity, complications, and length of hospital stay in patients with and without prior history of appendectomy who were admitted to the hospital with CDI. Method We analyzed retrospective data for 862 patients, 18 years and older, with C. difficile inpatients diagnosed between January 1, 2017 and December 31, 2018 and sorted into two groups, with or without prior appendicectomy, to look for outcomes such as recurrence, hospital stay, complications, and related death in each group and use statistical analysis for comparison. Result There were 862 patients admitted with CDI, of …

Acute Exacerbations Of Chronic Obstructive Pulmonary Disease: A Primer For Emergency Physicians, Randy Sorge, Peter Deblieux

School of Medicine Faculty Publications

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) impose a significant burden on patients and the emergency health care system. Patients with COPD who present to the emergency department (ED) often have comorbidities that can complicate their management. Objective: To discuss strategies for the management of acute exacerbations in the ED, from initial assessment through disposition, to enable effective patient care and minimize the risk of treatment failure and prevent hospital readmissions. Discussion: Establishing a correct diagnosis early on is critical; therefore, initial evaluations should be aimed at differentiating COPD exacerbations from other life-threatening conditions. Disposition decisions are based …

Decreasing Inappropriate Usage Of The Emergency Department (Creating Alliances To Deliver Population Health To Seasonal Workforce), Olivia Foster, Lynley Steele-Miller

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No abstract provided.

Moral Distress To Moral Courage, A Pathway To Success For Resident Nurses, Melinda Furrer

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No abstract provided.

Creating An Effective Poster: Research Versus Evidenced-Based Practice Projects, The Ena Institute For Emergency Nursing Research Advisory Council

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Purpose Provide information regarding the: Advantages/disadvantages of a poster presentation, Differences between a research and evidence-based poster, and Key elements of a research and evidenced-based poster. Advantages of a Poster Presentation Allows the emergency nurse to communicate innovative and useful information to peers on a one-to-one basis. ENA conference poster sessions are scheduled over several days so that posters are available for previewing and then interested persons can prepare questions and meet the presenter later Allows the audience to view the poster at their own pace. Presented as “stand alone” or with narrative from presenter who remains with the poster. …

Trauma Pause, Melissa Leighty, Carol Reed, Lance Somerfield, Dawn Rohrbach

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No abstract provided.

Improving Ed Sepsis Bundle Compliance, Jen Selby

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No abstract provided.

Etiology Of Acute Undifferentiated Fever In Patients Presenting To The Emergency Department Of A Tertiary Care Center In Karachi, Pakistan, Noman Ali, Nadeem Ullah Khan, Shahid Shahid, Syed Mustahsan

Department of Emergency Medicine

Objective: Our study aimed at identifying the characteristics and etiology of various causes of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care hospital.
Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever.
Results: A …