Emergency Medicine Commons^™

Survey Of Airflow Around A Heated Manikin As A Simulated Aeromedical Evacuation Patient On A Litter With Computational Fluid Dynamics Models, George P. Lemmer

Theses and Dissertations

Aeromedical Evacuations remain the predominant method used to transport patients from forward deployed areas of operations to secure locations with more robust medical infrastructure. Transportation of chemical warfare casualties and infectious patients require additional attention to prevent cross contamination. Specific airflow characteristics paired with environmental control system settings are a gap in scholarly literature. Based on the available literature computational fluid dynamics models were created to simulate the airflow around a patient represented by human geometry using commercially available software. In order to compare simulated and experimental results a heated manikin was placed in the MURPHEE aerosol exposure chamber and …

Building Focused Cardiac Ultrasound Capacity In A Lower Middle-Income Country: A Single Centre Study To Assess Training Impact, Wangari Siika, Anders Barasa, Benjamin Wachira, David Nekyon, Barbara Karau, Fatimah Juma, Grace Wanjiku, Harun Otieno, Gerald S. Bloomfield, Erik Sloth

Anaesthesiology, East Africa

Background: In low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agreement between expert and novice FoCUS and identify barriers to the establishment …

Promoting Resident Emotional Health Meaningful Connections: An Evaluation Of A Wellness Game, Bruce St. Amour, William B. Dehart

Journal of Wellness

Introduction

Physician wellness is a topic of significant national interest. Physician burnout is at its highest point during residency and is linked to many negative outcomes. The Core Emotional Needs are a useful framework to guide thinking toward wellness in residents: connection and acceptance, healthy autonomy and performance, reasonable limits, and healthy responsibility and standards. We examined the efficacy of a game (“Well, For Me…”) designed to improve social connection and acceptance among residents to reduce social isolation. We hypothesized that this activity would be viewed positively by the residents as an intervention to improve resident wellness.

Methods

Participants …

Early Aggressive Hydration Is Associated With Decreased Opioid Use And Readmission In Mild Acute Pancreatitis, Shreyans Doshi, Hong Liang, Hale Z. Toklu, Selina Fritze, Sue-Wei Luu

HCA Healthcare Journal of Medicine

Background: Acute pancreatitis (AP) is one of the most common causes of hospital admissions due to gastrointestinal disorders. No pharmacologic agents have been proven to impact the prognosis, and the treatment still remains supportive with intravenous fluids for hydration. Although early hydration has been recommended for the management of mild AP, there is no consensus on the type, rate, and amount of the fluid replacement.

Objective: In this study, we aimed to investigate the outcome of aggressive hydration in patients with AP.

Methods: Retrospective data from patients admitted to 12 hospitals (2015–2017) was used for analysis. Five hundred patients who …

Investigation Of A Peculiar Case Of Childhood Lymphadenopathy, Chade Aribo, Alonso Al, Allison Woodall, Tommy Y. Kim

HCA Healthcare Journal of Medicine

Introduction: Lymphadenopathy is a common physical finding often associated with an infectious etiology. We present a case of a patient with generalized cervical and supraclavicular lymphadenopathy diagnosed with a rare malignancy. Health care providers should be aware of some uncommon historical or physical examination findings that warrant further investigation.

Clinical Findings: A 16-year-old female presented to the emergency department with 3 days of a fever, congestion and sore throat with swelling around the jaw. Her physical examination findings included bilateral mandibular swelling and generalized cervical lymphadenopathy with palpable supraclavicular lymph nodes.

Outcomes: Complete blood count showed pancytopenia with a white …

Low Dose Clenbuterol Toxicity: Case Report And Review Of Literature, Kenneth Lan, Adarsh Saheba, Paul Mathew

HCA Healthcare Journal of Medicine

Clenbuterol is a long-acting β-agonist used in oral and inhaled form for asthma treatment outside the U.S. and in veterinary medicine within the U.S. It is also used off-label for anabolic effects worldwide. Toxicity with clenbuterol is increasingly seen in U.S. hospitals, primarily in younger individuals using the drug for competitive athletics or bodybuilding. We present a case of a young patient who presented after an intentional overdose and discuss the relevant literature. Presentations do not correlate with the dosage ingested. Signs and symptoms can range from simple nausea to myocardial ischemia, rhabdomyolysis and cardiogenic shock. Treatment of overdose is …

Factor Structure And Measurement Invariance Of The Maslach Burnout Inventory In Emergency Medicine Residents, Tim P. Moran, Nicole Battaglioli, Simiao Li-Sauerwine

Journal of Wellness

Introduction: Emergency medicine residents suffer from high rates of occupational burnout. Recent research has focused on identifying risk and protective factors for burnout as well as targets for intervention. This research has primarily employed the Maslach Burnout Inventory to evaluate burnout in this population. Factor analytic work has identified three underlying factors measured by the Maslach Burnout Inventory: Emotional Exhaustion, Depersonalization, and Personal Accomplishment. However, this three-factor structure has not been evaluated in emergency medicine residents. Furthermore, its structural equivalence has not been demonstrated across commonly-studied risk factors, such as gender and year of post-graduate training. In the present study, …

A Multicenter Mixed-Effects Model For Inference And Prediction Of 72-H Return Visits To The Emergency Department For Adult Patients With Trauma-Related Diagnoses, Ehsan Yaghmaei, Louis Ehwerhemuepha, William Feaster, David Gibbs, Cyril Rakovski

Mathematics, Physics, and Computer Science Faculty Articles and Research

Objective

Emergency department (ED) return visits within 72 h may be a sign of poor quality of care and entail unnecessary use of healthcare resources. In this study, we compare the performance of two leading statistical and machine learning classification algorithms, and we use the best performing approach to identify novel risk factors of ED return visits.

Methods

We analyzed 3.2 million ED encounters with at least one diagnosis under “injury, poisoning and certain other consequences of external causes” and “external causes of morbidity.” These encounters included patients 18 years or older from across 128 emergency room facilities in the …

Novel Use Of Fresh Frozen Plasma In Treating Hereditary Angioedema: A Success Story From Pakistan, Amber Sabeen Ahmed, Sidra Fayyaz

Section of Internal Medicine

Hereditary angioedema (HAE) due to a C1-esterase inhibitor(C1-INH) deficiency is a rare and potentially life-threatening disorder. It is characterized by an episodic and self-limiting increase in vascular permeability. The condition manifests itself as recurrent attacks of swelling in any part of the body. The angioedema can cause the involvement of the respiratory tract, skin, and gastrointestinal tract. Laryngeal involvement can make the condition life-threatening. It does not respond well to conventional angioedema therapy of steroids, adrenaline, and antihistamines. The targeted therapy for HAE consists of plasma-derived or recombinant C1-INH, ecallantide, and icatibant or bradykinin receptor antagonist. In the absence of …

Does The Use Of Extracorporeal Cardiopulmonary Resuscitation Improve Neurologically Favorable Survival In Patients With Refractory Out-Of-Hospital Cardiac Arrest?, Timothy Lund

Theses and Graduate Projects

In this retrospective review, the use of extracorporeal cardiopulmonary resuscitation (ECPR) using extracorporeal membrane oxygenation (ECMO) was assessed in the management of refractory ventricular fibrillation (VF) and ventricular tachycardia (VT) out-of-hospital cardiac arrest (OHCA). Multiple factors were evaluated such as the duration of manual or mechanical cardiopulmonary resuscitation (CPR), ECPR protocols and the rate of favorable neurologic outcomes for these OHCA patients. Survival with a favorable neurologic outcome is defined as cerebral performance categories (CPC) 1 or 2. Although CPR remains and will continue to be a critical component in the management of cardiac arrest, the persistently high mortality rate …

Patient Experience In A Pediatric Emergency Department During Covid-19, Beth L. Emerson Md, Erika Setzer

Patient Experience Journal

The COVID-19 pandemic has changed many dynamics in healthcare in the United States. This study explores an increase in patient experience (PE) scores in a pediatric emergency department. Visits were analyzed before and after March 8, 2020, corresponding with the first local case of COVID-19. Changes in the patient population and characteristics of survey responders were analyzed. Overall, the number of daily visits decreased (113 vs 36/day) and survey response rate decreased (3.7 vs 2.8%, p = 0.03), but PE scores increased (87.21 to 93.73, p = 0.002). Comparatively, an increase in patients with higher acuity levels by Emergency Severity …

Colloids Compared To Crystalloids In Emergent Stabilization Of Critically Ill Adults, Jerry Johnson

Theses and Graduate Projects

Background: With the advent of newer and 􏰖safer􏰗 fluids there have been numerous trials and studies conducted to test the safety and validity of colloids. Are colloids more effective then crystalloid for emergent resuscitation? The purpose of this systematic literature review is to assess the claims on treatment success and explore safety to gain clarity on which fluid is the best treatment for the patient.

Methods: A systematic database search was conducted from 2006 to the present. The search utilized such sources as PubMed, UpToDate and ScienceDirect. This search included more than 70 journal articles, where 24 articles were selected …

Respiratory Failure Due To A Large Mediastinal Mass In A 4-Year-Old Female With Blast Cell Crisis: A Case Report., Christian I Wade, Cody J Couperus-Mashewske, Mia E Geurts, Nicholas Derfler, John Ngo, Kyle S Couperus

Articles, Abstracts, and Reports

INTRODUCTION: Symptomatic leukostasis is an exceptionally atypical presentation of blast crisis; and when coupled with an enlarged neoplastic mediastinal mass in a four-year-old female, an extremely rare and challenging pediatric emergency arises.

CASE REPORT: We present a unique case of a four-year-old female who arrived via emergency medical services in cardiopulmonary arrest with clinical and radiographic evidence suggestive of bilateral pneumothoraces, prompting bilateral chest tube placement. Further evaluation revealed a large mediastinal mass and a concurrent white blood cell count of 428,400 per milliliter (/mL) (4,400-12,900/mL), with a 96% blast differential, consistent with complications of T-cell acute lymphoblastic leukemia.

CONCLUSION: …

Telemedicine In The Emergency Department In The Era Of Covid-19: Front-Line Experiences From 2 Institutions, Joel M. Hamm, Chris Greene, Michael T. Sweeney, Setareh Mohammadie, Linda B. Thompson, Eric Wallace, Walter Schrading

Emergency Medicine Faculty Publications

During the COVID-19 pandemic, one of the major changes that has occurred in emergency medicine is the evolution of telemedicine. With relaxation of regulatory and administrative barriers, the use of this already available technology has rapidly expanded. Telemedicine provides opportunity to markedly decrease personal protective equipment (PPE) and reduce healthcare worker exposures. Moreover, with the convenience and availability of access to medical care via telemedicine, a more fundamental change in healthcare delivery in the United States is likely. The implementation of telemedicine in the emergency department (ED) in particular has great potential to prevent the iatrogenic spread of COVID-19 and …

Defining And Characterizing Frequent Attenders: Systematic Literature Review And Recommendations, Dip Shukla, Erik Faber, Brian Sick

Journal of Patient-Centered Research and Reviews

Purpose: To decrease cost and improve efficiency, health care organizations have focused on frequent attenders — patients with high health care utilization. Prior studies have investigated singular health care settings, used varying definitions of frequent attendance, and inconsistently identified factors correlated with frequent attendance. The purpose of this article is to suggest a uniform definition of frequent attenders for different health care settings and to determine factors correlated with frequent attendance.

Methods: This systematic review of three databases identified 2761 unique articles; 174 met inclusion criteria. Studies were analyzed for their definition of frequent attenders and factors associated with frequent …

Physical And Mental Health Impacts Of Covid-19 On Healthcare Workers: A Scoping Review, Natasha Shaukat, Daniyal Mansoor Ali, Junaid Razzak

Community Health Sciences

Background: Coronavirus disease (COVID-19) pandemic has spread to 198 countries, with approximately 2.4 million confirmed cases and 150,000 deaths globally as of April 18. Frontline healthcare workers (HCWs) face a substantially higher risk of infection and death due to excessive COVID-19 exposure. This review aimed at summarizing the evidence of the physical and mental health impacts of COVID-19 pandemic on health-care workers (HCWs).
Methods: We used the Arksey O'Malley framework to conduct a scoping review. A systematic literature search was conducted using two databases: PubMed and Google Scholar. We found 154 studies, and out of which 10 met our criteria. …

Pathophysiology Of Hyperkalemia Presenting As Brugada Pattern On Electrocardiogram (Ecg), Benjamin Doty, Elaine Kim, Jeremiah T. Phelps, Peter Akpunonu

Emergency Medicine Faculty Publications

BACKGROUND Brugada phenocopies (BrP) are clinical and electrocardiographic (ECG) entities elicited by reversible medical conditions speculated to have pathogenesis rooted in ion current imbalances or conduction delays within the myocardial wall. During an inciting pathologic condition, it produces ECG patterns identical to those of congenitally-acquired Brugada syndrome and subsequently returns to normal ECG patterns upon resolution of the medical condition. This case report describes a 26-year-old man presenting to the Emergency Department (ED) for suspected heroin overdose with a rare ECG consistent with BrP secondary to acute hyperkalemia.

CASE REPORT A 26-year-old man with a history of substance abuse and …

Consensus Guidelines For Digital Scholarship In Academic Promotion., Abbas Husain, Zachary Repanshek, Manpreet Singh, Felix Ankel, Jennifer Beck-Esmay, Daniel Cabrera, Teresa M Chan, Robert Cooney, Michael Gisondi, Michael Gottlieb, Jay Khadpe, Jennifer Repanshek, Jessica Mason, Dimitrios Papanagnou, Jeff Riddell, N Seth Trueger, Fareen Zaver, Emily Brumfield

Department of Emergency Medicine Faculty Papers

INTRODUCTION: As scholarship moves into the digital sphere, applicant and promotion and tenure (P&T) committee members lack formal guidance on evaluating the impact of digital scholarly work. The P&T process requires the appraisal of individual scholarly impact in comparison to scholars across institutions and disciplines. As dissemination methods evolve in the digital era, we must adapt traditional P&T processes to include emerging forms of digital scholarship.

METHODS: We conducted a blended, expert consensus procedure using a nominal group process to create a consensus document at the Council of Emergency Medicine Residency Directors Academic Assembly on April 1, 2019.

RESULTS: We …

Prehospital Antibiotics Improve Morbidity And Mortality Of Emergency Medical Service Patients With Sepsis, Thomas Martel, Monica N. Melmer, Samuel M. Leaman, Nicole Kassen, Seth Kozlowski, Jonathan Pangia, Scott Gutovitz, Dietrich Jehle

HCA Healthcare Journal of Medicine

Background: Severe sepsis is a major cause of mortality in patients evaluated in the Emergency Department (ED). Early initiation of antibiotic therapy and IV fluids in the ED is associated with improved outcomes. We investigated whether early administration of antibiotics in the prehospital setting improves outcomes in these patients with sepsis.

Methods: This is a retrospective study comparing outcomes of patients meeting sepsis criteria in the field by EMS, who were treated with IV fluids and antibiotics. Their outcomes were compared with controls where fluids were administered prehospital and antibiotics were initiated in the ED. We compared morbidity and mortality …

A Fatal Rectus Sheath Hematoma After A Myasthenia Crisis Case Report, Robert G. Michaud, Lesley B. Gordon

Journal of Maine Medical Center

Introduction: Rectus sheath hematomas (RSH) generally occur due to damage to the inferior epigastric artery. They are rare causes of abdominal pain or acute blood loss anemia, but are an important diagnostic consideration because they can be cryptic and are potentially fatal.

Clinical Findings: An 85-year-old female who had been admitted to the hospital for 10 days with a myasthenia crisis was found to be abruptly hypotensive with a tender abdominal mass in the left lower quadrant subtly crossing midline. She was on prophylactic anticoagulation during her hospitalization.

Main diagnosis, therapeutics, interventions, and outcomes: The patient was initially stabilized with …