Emergency Medicine Commons^™

Optimising Ventilator Use During The Covid-19 Pandemic, Sadaf Sheikh, Muhammad Akbar Baig

Department of Emergency Medicine

Hypoxemia is the most common cause for hospitalization in COVID-19 patients. Acute hypoxemic respiratory failure or acute respiratory distress syndrome (ARDS) is the most common complication in COVID-19 patients. Close monitoring of respiratory decompensation is essential. Supplemental oxygen, high flow nasal canula, non-invasive ventilation and endotracheal intubation are the most commonly suggested methods to improve oxygenation. Early intubation with pre-oxygenation, modified rapid sequence intubation and intubation using a video laryngoscope has been advised as a strategy including lung protective ventilation, prone position ventilation, adequate sedation and extracorporeal membrane oxygenation. Strict personal precautions and challenges related to airway management has been …

Obstacles To Nurse-Performed Ultrasound Guided Peripheral Iv Placement, Ali Elsaied, Do, Farhan Khan, Do, Rishi Kalwani, Md, Cara Kanter, Md, Kenn Ghafferian, Do

Health Equity and Quality Improvement (HEQI) Summit

With an aging population, the rate of obesity, the regional prevalence of dialysis patients and the increase in IV drug abuse, obtaining routine vascular access in the emergency department (ED) has become more challenging. Ultrasound (US) guided IV placement has been pivotal in identifying deeper veins to access. This is traditionally performed by ED physicians, however given the time constraints, lower acuity patients who require US IV access can experience significant delays to care. We attempted to train ED nurses to perform this skill, however many trained nurses are still not attempting US IVs regularly. This study aimed to identify …

Hepatitis A Vaccination Program In Jefferson Emergency Departments, Katelyn Levy, Md, Belinda Lao, Md, Mitchell Berman, Md, Joseph Jean, Md, Sejal Patel, Pharmd, Benjamin Slovis, Md, Scott Sutherland, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Increase the rate of hepatitis A vaccination in high-risk patients (homeless and drug users) who present to Thomas Jefferson University Hospital and Jefferson Methodist emergency departments over a 5 month period starting on 9/4/2019.

Small Bowel Obstruction: Facilitating Diagnosis And Optimizing Resuscitation And Management, Quinton Campbell, Md, Ryan Bateman, Md, Alex Mercado, Do, James Cirone, Do, Robin Naples, Md

Health Equity and Quality Improvement (HEQI) Summit

Objective

• Standardize practice patterns and improve consistency in procedure documentation in ED management of Small Bowel Obstruction (SBO)
• Significant practice variability exists among ED providers for SBO management, specifically in regard to utilization of diagnostic imaging as well as rates of NG tube (NGT) placement and subsequent documentation
• Data review performed by our group demonstrated that of all NG tubes placed, only 61% were documented
• Wide range of practice patterns for diagnostic imaging (see graphics in Results)

Telemedicine Certified Recovery Specialists For Patients With Opioid Use Disorders In The Emergency Department In Covid-19, Kory S. London, Md

Health Equity and Quality Improvement (HEQI) Summit

COVID-19 is a staggering tragedy in a number of manners, but the lack of available access points to healthcare services due to federal, state, local and institutional regulations and decisions creates higher levels of patient vulnerability.

Patients with opioid use disorders (OUD) are especially vulnerable given high levels of coexistent housing insecurity, food insecurity and lack of primary care at baseline. These patients frequently utilize the emergency department for both medical and non-medical concerns.

Existing pathways to assist these patients utilize in person certified (peer) recovery specialists (CRS) who are not employed by the enterprise. Given the need to limit …

Progression Of Patient Cohorting In Response To Covid-19 At The Jefferson Methodist Emergency Department, Kory S. London, Md, Efrat Kean, Md

Health Equity and Quality Improvement (HEQI) Summit

While COVID-19 and it’s various complications are a source of a substantial number of Emergency Department (ED) visits, many patients still arrive to the ED for non-COVID-19 indications.

Due to pre-existing construction which was halted by the pandemic, external space for a tent configuration was unavailable.

In effort to decrease patient, staff and nurse exposure to COVID, a system of cohorting was created to assure uninterrupted service in a manner as safe as possible for all involved.

Given the uncertainty of patient volumes and the potential for a high burden of disease similar to our colleagues in New York and …

Progression Of Patient Cohorting In Response To Covid-19 At The Jefferson Methodist Emergency Department, Kory S. London, Md, Efrat Kean, Md

Health Equity and Quality Improvement (HEQI) Summit

COVID-19 is a predominantly respiratory disease and Philadelphia is a city with a myriad of pulmonary comorbidities such as asthma and COPD.

Use of bronchodilator medications through a nebulizer machine is considered an 'Aerosol Generating Procedure' (AGP), and increases risks to staff who and complicates the cleaning and processing of rooms and equipment where AGPs are performed. Additionally, there is a severe limitation in availability of negative pressure rooms, which mitigate these AGPs.

With the COVID pandemic causing supply chain problems across the country, a multidisciplinary approach was required to appropriately ration available inhalers (MDI), the alternatives to nebulized treatments, …

Patient Notification Of Incidental Findings On Emergency Department Imaging, Tareva Warrick-Stone, Do, Kim Groen, Do, Mph, Jake Finkle, Do, Sarah Lurvey, Do, Fred Gmora, Do

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Ultimately, the goal of properly handling incidental findings in the ED is to preserve the long-term health of the patient and reduce malpractice risk. The objective of this project is to improve the quality of attending, resident, and APP practice in communicating incidental findings noted on radiology-reviewed imaging (X-ray, US, CT, MRI) in the ED. This will be achieved by establishing a methodological approach to informing patients, accurately documenting, and providing clear discharge instructions for follow-up. This project will not include bedside imaging or wet-read discrepancies and will not include other incidental findings such as lab or …

Mitigation Of Ed Patient Boarding: Transferring Admissions From The Center City Ed To Methodist, Quinton Campbell, Md, Lauren Selame, Md, James Cirone, Do, Elizabeth Teixeira, Md, Jennifer White, Md, Frederick Randolph, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives:

• Objectively analyze transferred patient transfers cases as far as LOS (length of stay), final diagnosis, and transfer failure.
• Assess patient satisfaction with the transfer process as means to identify areas for improvement as well as potential patient safety issues.

Prevalence Of Gastrointestinal Symptoms In Patients With Cannabis Abuse Presenting To The Emergency Room, Hadiatou Barry, Md, Mph, Botros Shenoda, Md, Phd, Msc, Purujit Thaker, Md, Mary Naglak, Phd

Health Equity and Quality Improvement (HEQI) Summit

Introduction: Cannabis is a common recreational drug among young adults that is used to induce euphoria, promote relaxation and enhance appetite. There is a recognized correlation between cannabis abuse and cyclic episodes of nausea, vomiting, and abdominal pain (cannabinoid hyperemesis syndrome). However, the contribution of such symptoms to emergency room visits and hospital admissions is not known.

Methods: A one-year, retrospective study was conducted on patients who presented to the emergency department and were later admitted at Abington Hospital-Jefferson Health with confirmed cannabis use (positive urine drug screen).

Aim/Goal: Our primary outcome was to understand the prevalence of gastrointestinal symptoms …

Optimizing Evaluation And Treatment Of Patients With Nausea And Vomiting Of Pregnancy In The Emergency Department, Danielle N. Carr, Md, Angela Carracino, Do, Alisha Sangal, Md, Madeline Smith, Md

Health Equity and Quality Improvement (HEQI) Summit

Problem Definition

• Nausea and vomiting of pregnancy (NVP). Approximately 50% prevalence rate
• Pregnant patients with NVP require special considerations for treatment
• Long ER wait times
• Possibly avoidable hospital admissions

Managing Acute Pain In Hiv+/Aids Patients: Knowledge And Practice Trends Among Emergency Physicians Of Major Tertiary Care Centers Of A Developing Country, Aliya Ahmed, Gauhar Afshan, Robyna Irshad Khan, Badar Afzal Khan, Seemin Jamali, Nighat Farooq, Sarosh Saleem, Rubaba Naeem, Uzma R. Khan

Department of Anaesthesia

Objective: To assess knowledge and practice trends in managing acute pain in patients infected with human immunodeficiency virus (HIV+) or having acquired immunodeficiency syndrome (AIDS) among emergency physicians of four tertiary care hospitals. Acute pain management in such patients is complex because of multiple concomitant painful conditions related to their disease. After obtaining ethical approval and written informed consent, emergency physicians were requested to fill out a questionnaire.
Results: Out of 84 physicians who participated, 49 had managed HIV+/AIDS patients during the preceding year. Out of the 49, 30 (61.2%) physicians stated that they used a combination of analgesics for …

Skin And Soft Tissue Infections In The Emergency Department, Nicole Martinez

Dissertations

Background/Purpose: Skin and soft tissue infections (SSTI) represent a diverse group of infections varying in clinical presentation and degree of severity. The International Classification of Diseases codes for patients presenting with cellulitis or abscess account for $5.5 billion in annual health care costs and 1.4% of all hospital admissions nationally. Data are needed to inform admission and management decisions. The purpose of this study is to examine relationships among sociodemographic, physical examination findings, and treatment modality and management in patients with SSTIs.

Theoretical/Conceptual Framework: Web of Causation Theoretical Framework explores multiple causative factors treated with equal prominence, thus …

Adiponectin Inhibits Cardiac Arrest/Cardiopulmonary Resuscitation‑Induced Apoptosis In Brain By Increasing Autophagy Involved In Adipor1‑Ampk Signaling., Yarong He, Bofu Liu, Peng Yao, Yuming Shao, Yanwei Cheng, Jie Zhao, Jiang Wu, Zhi Wei Zhao, Wen Huang, Theodore A. Christopher, Bernard Lopez, Xin-Liang Ma, Yu Cao

Department of Emergency Medicine Faculty Papers

Emerging evidence suggests that both apoptosis and autophagy contribute to global cerebral ischemia-reperfusion (GCIR)-induced neuronal death, which results from cardiac arrest (CA). However, the mechanism of how GCIR may affect the balance between apoptosis and autophagy resulting from CA remains to be elucidated. Additionally, the role of adiponectin (APN) in reversing the apoptosis and autophagy induced by GCIR following cardiac arrest-cardiopulmonary resuscitation (CA-C PR) is unclear. Thus, the aim of the present study was to investigate how GCIR affect the apoptosis and autophagy in response to CA and to clarify whether APN may alter the apoptosis and autophagy of neuronal …

The 2019-2020 Novel Coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2) Pandemic: A Joint American College Of Academic International Medicine-World Academic Council Of Emergency Medicine Multidisciplinary Covid-19 Working Group Consensus Paper., Stanislaw P. Stawicki, Rebecca Jeanmonod, Andrew C. Miller, Lorenzo Paladino, David F. Gaieski, Anna Q. Yaffee, Annelies De Wulf, Joydeep Grover, Thomas J. Papadimos, Christina Bloem, Sagar C. Galwankar, Vivek Chauhan, Michael S. Firstenberg, Salvatore Di Somma, Donald Jeanmonod, Sona M. Garg, Veronica Tucci, Harry L. Anderson, Lateef Fatimah, Tamara J. Worlton, Siddharth P Dubhashi, Krystal S. Glaze, Sagar Sinha, Ijeoma Nnodim Opara, Vikas Yellapu, Dhanashree Kelkar, Ayman El-Menyar, Vimal Krishnan, S. Venkataramanaiah, Yan Leyfman, Hassan Ali Saoud Al Thani, Prabath Wb Nanayakkara, Sudip Nanda, Eric Cioè-Peña, Indrani Sardesai, Shruti Chandra, Aruna Munasinghe, Vibha Dutta, Silvana Teixeira Dal Ponte, Ricardo Izurieta, Juan A. Asensio, Manish Garg

Department of Emergency Medicine Faculty Papers

What started as a cluster of patients with a mysterious respiratory illness in Wuhan, China, in December 2019, was later determined to be coronavirus disease 2019 (COVID-19). The pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel Betacoronavirus, was subsequently isolated as the causative agent. SARS-CoV-2 is transmitted by respiratory droplets and fomites and presents clinically with fever, fatigue, myalgias, conjunctivitis, anosmia, dysgeusia, sore throat, nasal congestion, cough, dyspnea, nausea, vomiting, and/or diarrhea. In most critical cases, symptoms can escalate into acute respiratory distress syndrome accompanied by a runaway inflammatory cytokine response and multiorgan failure. As of this …

Parental Views On Parent-Generated Asthma History In A Pediatric Ed: A Randomized Control Trial, Marc Sycip

Research Days

No abstract provided.

The Evil Twin: The Case Of Heterotopic Pregnancy, Rashmi Jadhav, Vegas Brown, Gabriel Cabrera

West Florida Division GME Research Day 2020

• Heterotopic pregnancy occurs in about 1 in 30,000 naturally conceived pregnancies (5). The risk rises 1-3% for pregnancies occurring through assisted reproductive technologies (ART) (1).
• Isolated ectopic pregnancy affects an average of 1 in every 150 live births (1).
• A known pre-existing intrauterine pregnancy (IUP) can be falsely reassuring and delay the diagnosis of a potentially life-threatening concurrent ectopic pregnancy.
• Presentation is vague and 45% of patients have no symptoms (5).
• Differential Diagnoses: endometritis, incomplete miscarriage, ruptured ovarian cyst, non-GYN cause (ie: appendicitis or UTI).
• Risk Factors: Infertility treatment, in vitro fertilization (IVF), prior ectopic, prior tubal surgery, use of …

Evolving De Winter Presentation Of Acute Myocardial Infarction, Caroline Shepherd, Anthony Furiato

West Florida Division GME Research Day 2020

de Winter ECG pattern first detailed in 2008 in a case series Diagnostic criteria

• Tall, prominent, symmetric T waves in the precordial leads
• Upsloping ST segment depression >1mm at the J-point in the precordial leads
• Absence of ST elevation in the precordial leads
• ST segment elevation (0.5mm-1mm) in aVR

Strongly correlated with acute LAD occlusion

Social Media And The Modern Scientist: A Research Primer For Low- And Middle-Income Countries, Junghwan Kevin Dong, Colleen Saunders, Benjamin Wachira, Brent Thoma, Teresa M. Chan

Emergency Medicine, East Africa

Social media has changed the way we communicate. Wherever you are in the world, various forms of social media are being used by individuals to share information and connect without borders. Due to its ubiquity, social media holds great promise in linking clinicians, scientists, investigators, and the public to change the way we conduct scientific discourse. In this paper, we present a step-by-step guide on optimizing your social media strategy with regards to: research/scholarly practice (discourse, collaboration, recruitment), knowledge translation, dissemination, and education. This guide also highlights key readings that provide guidance to those interested in incorporating social media into …

A Rare Cause Of Pneumoperitoneum, Robert Zusman, George Michael, Anna E. Augustin, My Myers, Dudith Pierre-Victor

West Florida Division GME Research Day 2020

Pneumoperitoneum is most commonly associated with a perforated viscus. When free air is seen on imaging, the most common course of action is an emergent exploratory laparotomy. However, pneumoperitoneum may not always be indicative of a perforated bowel. In the case described below, we will discuss a patient who developed acute peritonitis and pneumoperitoneum after undergoing chest compressions during cardiopulmonary resuscitation (CPR) and positive pressure mechanical ventilation.