Emergency Medicine Commons^™

A Protocol Driven Stroke Code's Impact On Door-To-Needle Times, Jesse Osborne

Electronic Theses and Dissertations

Tissue plasminogen activator (tPA) is most effective the faster it is able to be administered to a patient that has been affected by stroke. A Stroke Code is a strategy that acute care facilities implement to reduce the time from diagnosing a stroke to administering tPA. The purpose of this study was to determine if the initiation of a Stroke Code in an acute care hospital reduces the door-to-needle time for patients affected by a stroke. In particular, does a Stroke Code reduce door-to-needle times. The research was conducted using data from April 1, 2014 to December 31, 2014 (pre-Stroke …

Factors Associated With Urgent Care Reliance And Outpatient Health Care Use Among Children Enrolled In Medicaid., Rebecca R. Burns, Elizabeth R. Alpern, Jonathan Rodean, Therese Canares, Brian R. Lee, Matt Hall, Amanda Montalbano

Manuscripts, Articles, Book Chapters and Other Papers

Importance: Urgent care (UC) centers are a growing option to address children's acute care needs, which may cause unanticipated changes in health care use.

Objectives: To identify factors associated with high UC reliance among children enrolled in Medicaid and examine the association between UC reliance and outpatient health care use.

Design, Setting, and Participants: A retrospective cohort study used deidentified data on 4 133 238 children from the Marketscan Medicaid multistate claims database to calculate UC reliance and outpatient health care use. Children were younger than 19 years, with 11 months or more of continuous Medicaid enrollment and 1 or …

It's In The Bag: Tidal Volumes In Adult And Pediatric Bag Valve Masks, Benjamin Dafilou, Daniel Schwester, Nathan Ruhl, Andreia Marques-Baptista

College of Science & Mathematics Departmental Research

Introduction: A bag valve mask (BVM) is a life saving device used by all levels of health care professionals during resuscitative care. We focus most of our time optimizing the patient's position, firmly securing the mask, and frequency of ventilations. However, despite our best efforts to control these factors, we may still be precipitating harm to the patient. Multiple studies have shown the tidal volumes typically delivered by the adult BVM are often higher than recommended for lung-protective ventilation protocols. In this study we measure and compare the ventilation parameters delivered by the adult and pediatric BVM ventilators. Methods: A …

Emergency Department Testing And Disposition Of Deaf American Sign Language Users And Spanish-Speaking Patients, Jason Rotoli, Timmy Li, Suejong Kim, Tina Wu, Jennifer Hu, Julie Endrizzi, Nathan Garton, Courtney Jones

Journal of Health Disparities Research and Practice

Objectives: Non-English speaking patients frequently present to the emergency department (ED) for acute care and may present a challenge to efficient clinical ED management and disposition. This study aimed to assess differences in the disposition and clinical management of Spanish-speaking patients and Deaf American Sign Language (ASL) users, who worked with a certified, in-person interpreter, compared with English proficient patients who did not utilize interpreter services.

Methods: A retrospective study querying electronic medical records was performed at an academic medical center ED. Patients with a chief complaint of abdominal pain were chosen for this study, as this is a common …

Meeting Radiation Dosimetry Capacity Requirements Of Population-Scale Exposures By Geostatistical Sampling., Peter K Rogan, Eliseos J Mucaki, Ruipeng Lu, Ben C Shirley, Edward Waller, Joan H M Knoll

Biochemistry Publications

BACKGROUND: Accurate radiation dose estimates are critical for determining eligibility for therapies by timely triaging of exposed individuals after large-scale radiation events. However, the universal assessment of a large population subjected to a nuclear spill incident or detonation is not feasible. Even with high-throughput dosimetry analysis, test volumes far exceed the capacities of first responders to measure radiation exposures directly, or to acquire and process samples for follow-on biodosimetry testing.

AIM: To significantly reduce data acquisition and processing requirements for triaging of treatment-eligible exposures in population-scale radiation incidents.

METHODS: Physical radiation plumes modelled nuclear detonation scenarios of simulated exposures at …

Understanding Etiologies Of Road Traffic Crashes, Injuries, And Death For Patients At National Hospital Abuja: A Qualitative Content Analysis Using Haddon’S Matrix, Benjamin D. Holmes, Kristin Haglund, Emmanuel A. Ameh, Oluwole O. Olaomi, Uthman Uthman, Laura D. Cassidy

The Qualitative Report

Road traffic crashes and sequelae are reaching pandemic proportions globally and have currently achieved disproportionately high levels in Nigeria. Quantitative studies are accumulating in the peer-reviewed literature, but there is a paucity of qualitative research in Nigeria. Data for this study of structural and behavioral factors of road traffic crashes and injuries in Federal Capital Territory were collected in semi-structured interviews with crash survivors at National Hospital Abuja. Interviews were analyzed via qualitative content analysis, revealing crash location and participant beliefs about crash etiologies. Units of analysis were developed from participant statements and were structured within four a priori etiologic …

Physician Directed Smoking Cessation In The Ed: Do Patients Opt-Out?, Ali S. Aziz Bs, Natalie M. Greco Md, Timothy J. Batchelor Md, Andrew H F Miller Do, Theodore Doherty Do, Robert Kruklitis Md, Phd, Lauren Crowley Ba, Edward W. Casey Rph, Mba, Elizabeth A. Maclean Pharmd, Phd, Joann B. Trainer Pharmd, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Predictors Of New-Onset Atrial Fibrillation In Geriatric Trauma Patients, Catherine A. Marco, Jennifer Lynde, Blake Nelson, Joshua Madden, Adam Schaefer, Claire Hardman, Mary Mccarthy

Emergency Medicine Faculty Publications

Geriatric patients (age >65) comprise a growing segment of the trauma population. New-onset atrial fibrillation may occur after injury, complicating clinical management and resulting in significant morbidity and mortality. This study was undertaken to identify clinical and demographic factors associated with new-onset atrial fibrillation among geriatric trauma patients . Methods: In this case control study, eligible participants included admitted trauma patients age 65 and older who developed new-onset atrial fibrillation during the hospitalization. Controls were admitted trauma patients who were matched for age and injury severity score, who did not develop atrial fibrillation. We evaluated the associations between new-onset atrial …

An Overview Of Supply-Chain Logistics In International Humanitarian Aid: Finding Challenges And Solutions, Arjun Ganga

Independent Study Project (ISP) Collection

Humanitarian supply chain logistics concern the flow of goods and services in public health delivery. Such supply chains operate in both general development contexts and in acute crisis situations. In this paper, I give an overview of supply chains and then explore some of the challenges and potential solutions in delivering goods and services effectively and efficiently. Specifically, I analyze procurement, maintaining quality goods, incentivizing countries to act, collaboration, verification, possible losses in the supply chain, and ensuring appropriate use of product. I conclude that although humanitarian supply chains pose unique challenges, there is surprising efficiency in the system. This …

Ensuring Accountability To Affected Populations In Humanitarian Settings: "Holding Humanitarian Organizations Accountable To People.", Jazmin Williamson

Independent Study Project (ISP) Collection

Aim: This research aims to examine what guidelines and regulations help ensure that humanitarian organizations are held accountable to their beneficiary populations.

Background: Although people have always been the focus of humanitarian aid, their voice and participation didn't become a centralized part of the conversation until the 1990s and later gained real traction in the early 2000s. During these times, many new foundational documents were created to highlight the "centrality of local participation in aid." Among the documents that enshrined this new principle of population participation included the 1992 Code of Conduct for the International Red Cross and Red Crescent …

Covid-19 Newsletter (Vol. 2), Center For Disaster Medicine, New York Medical College

COVID-19 Newsletter

No abstract provided.

The Covid-19 Intubation And Ventilation Pathway (Civp); A Commentary, Muhammad Akbar Baig

Department of Emergency Medicine

No abstract provided.

Modified Glucose-Insulin-Potassium Regimen Provides Cardioprotection With Improved Tissue Perfusion In Patients Undergoing Cardiopulmonary Bypass Surgery, Kun Zhao, Yue Zhang, Jia Li, Qin Cui, Rong Zhao, Wensheng Chen, Jincheng Liu, Bijun Zhao, Yi Wan, Xin-Liang Ma, Shiqiang Yu, Dinghua Yi, Feng Gao

Department of Emergency Medicine Faculty Papers

Background Laboratory studies demonstrate glucose-insulin-potassium (GIK) as a potent cardioprotective intervention, but clinical trials have yielded mixed results, likely because of varying formulas and timing of GIK treatment and different clinical settings. This study sought to evaluate the effects of modified GIK regimen given perioperatively with an insulin-glucose ratio of 1:3 in patients undergoing cardiopulmonary bypass surgery. Methods and Results In this prospective, randomized, double-blinded trial with 930 patients referred for cardiac surgery with cardiopulmonary bypass, GIK (200 g/L glucose, 66.7 U/L insulin, and 80 mmol/L KCl) or placebo treatment was administered intravenously at 1 mL/kg per hour 10 minutes …

Intraosseous (Io) Vs Intravenous (Iv) Vascular Access For Out Of Hospital Cardiac Arrest., Syed Tariq Nabi, Megan Mackenzie, Monica Prasad, Mustapha Choucair, Peyton Johnston, Reba John, Sarah Meram, James Paxton

Medical Student Research Symposium

Over 300,000 Americans every year experience an out-of-hospital cardiac arrest (OHCA) (Benjamin EJ 2019). Of these 300,000+ patients only 10.6% of them survive to hospital discharge. Advanced Cardiac Life Support (ACLS) has been suggested to improve survival following an OHCA (Neumar, Otto et al. 2010). Current ACLS guidelines recommend obtaining vascular access, however, offer little suggestion as to which type of access device should be used. It is our belief that using an Intraosseous vascular access device will lead to shorter time to medication delivery and increased rates of return of spontaneous circulation (ROSC) compared to Intravenous vascular access. We …

Sex-Based Differences In Depth Of Soft Tissue At The Proximal Tibia Intraosseous Catheter Insertion Site, Tristan Lemon Bs, Revelle Gappy Bs, Ryan Kelly Bs, Kenneth Kutschman Bs, Sarah Meram Ms, James Paxton Md, Mba

Medical Student Research Symposium

Background

Intraosseous (IO) catheters are commonly used to rapidly obtain vascular access for critically-ill patients in the emergency department (ED). Although the proximal tibia (PT) is a standard IO insertion site for adult subjects, little is known about sex-based variation in the proper depth of insertion.

Methods

A retrospective cohort study was performed, utilizing CT scans obtained from DMC over a ten-year period (2009-2018) to estimate soft tissue depth overlying the recommended PT-IO insertion site. Depths of soft tissue from skin surface to bone surface (Measurement A) and from skin surface to the opposite bony cortex (Measurement B) were measured …

Self-Harm Poisonings Among Transgender Patients: Analysis Of Toxicology Investigator’S Consortium Registry, Marna R. Greenberg Do, Mph, Facep, Natalie E. Ebeling-Koning Do, Cody R. Mcwhirter Bs, Mikayla B. Hurwitz Bs, Lexis T. Laubach Bs, Gillian A. Beauchamp Md, Judith Sabino Mph, Cdp, Beth Careyva M.D., Andrew L. Koons, Matthew D. Cook Do, Kenneth D. Katz Md, Robert D. Cannon Do, Ryan M Surmaitis Do

Department of Emergency Medicine

No abstract provided.

Agents Of Exposure In Transgender Patient Cases Managed By A Toxicologist: An Analysis Of The Toxicology Investigator’S Consortium (Toxic) Registry, Phillip M. Grenz Do, Mikayla B. Hurwitz Bs, Cody R. Mcwhirter Bs, Lexis Laubach Bs, Gillian A. Beauchamp Md, Judith Sabino Mph, Cdp, Beth Careyva M.D., Matthew D. Cook Do, Marna R. Greenberg Do, Mph, Facep, Robert D. Cannon Do, Ryan M Surmaitis Do

Department of Emergency Medicine

No abstract provided.

Second Degree Av Heart Block After Candlenut Ingestion, Andrew L. Koons Do, Lexis Laubach Bs, Alexandra Amaducci Do, Robert D. Cannon Do, Kenneth D. Katz Md, Ryan M. Surmaitis Do, Matthew D. Cook Do, Gillian A. Beauchamp Md

Department of Emergency Medicine

No abstract provided.

Two Resident Wellness Exercises And Their Impact, Nick J. Mccauley

Emergency Medicine

How program leaders in the CORD community are implementing innovations to improve residency wellness and resident resilience.

• Define resilience and describe how it can prevent burnout.
• Discuss ways that residency programs can work to promote resilience amongst residents COURSE DESCRIPTIONS #CORDAA20 35
• Introduce ‘Resilience Rounds’ as a didactic intervention, and the literature upon which this innovation is based
• Introduce art as a tool to overcome trauma and prevent burnout
• Demonstrate how conference/didactic time can help residents combat the perceived “culture of perfection” by sharing meaningful or successful moments with each other to improve one’s general outlook on their own practice

Scheduling Like A Pro, Joseph Gibney

Emergency Medicine

Scheduling is difficult, but believe it or not, it can also be rewarding. This is one chief’s take on three years of scheduling and the highs, lows, do’s, don’ts, and novel ways to help your fellow residents live their best residency life.

• Show that resident wellness is impacted by scheduling
• Demonstrate our scheduling process, some errors we made over time, and how we learned from them
• Discuss some novel scheduling tactics, how other residencies may apply what we’ve learned, and how to adapt it to fit their needs