Emergency Medicine Commons^™

International Scope Of Emergency Ultrasound: Barriers In Applying Ultrasound To Guide Central Line Placement By Providers In Nairobi, Kenya, Fareen Zaver, Keith Boniface, Benjamin Wachira, Grace Wanjiku, Hamid Shokoohi

Emergency Medicine, East Africa

Background: While ultrasound (US) use for internal jugular central venous catheter (CVC) placement is standard of care in North America, most developing countries have not adopted this practice. Previous surveys of North American physicians have identified lack of training and equipment availability as the most important barriers to the use of US.

Objective: We sought to identify perceived barriers to the use of US to guide CVC insertion in a resource-constrained environment.

Methods: Prior to an US-guided CVC placement training course conducted at the Aga Khan University Hospital in Nairobi, Kenya, physicians were asked to complete a survey to determine …

When Disaster Strikes: A Training Intervention To Improve Nurses' Confidence And Preparedness For The Surge, Nichole M. Weber

Evidence-Based Practice Project Reports

There has been an exponential rise in mass casualty incidents (MCI) internationally. These human induced and naturally occurring events have affected over 4.6 billion people, and are not discriminatory to region or community (World Health Organization, 2011). Governing bodies require training and education, but nurses continue to report suboptimal competence and self-reported readiness, and a need for standardized, evidence-based training remains. The purpose if this evidence-based practice project is to authenticate current research supporting implementation of competency-based education, to improve nurses’ self- perceived preparedness and confidence in their ability to respond to MCI. The project results can be utilized for …

Rapid Assessment Of Adults With Traumatic Brain Injuries, Pedro Colio

Doctor of Nursing Practice Final Manuscripts

The aim of this evidence-based project was to improve the medical screening process, enhance medical decision-making, and standardized the utilization of an adult traumatic brain injury neuroimaging guideline among advanced practice providers in a rural emergency department. Neuroimaging, specifically computed tomography (CT) scans, help to identify life-threatening intracranial injuries when clinically appropriate. The literature supports the utilization of neuroimaging guidelines, clinical exam, and provider expertise when identifying the need for a head CT scan. Although head CT scans are clinically useful, they increase healthcare costs and pose potential cancer risks from radiation exposure. Eight advanced practice providers (i.e., nurse practitioners, …

Fifteen Years Experience Of Managing Penetrating Extra-Peritoneal Rectal Injuries, Tanzeela Gala, Noman Shahzad, Ahmed Ibrahim Edhi, Fareed Ahmed Shaikh, Hasnain Zafar

Section of General Surgery

Background: Although civilian injuries are generally less severe, they nevertheless remain a challenging problem for the surgeons. In isolated rectal injury patients, though proximal diversion, pre-sacral drainage, distal rectal wash-out and wound debridement are the various surgical options employed in various combinations, the optimum strategy especially for civilian injuries remains unknown. We reviewed our experience of managing penetrating extra peritoneal rectal injuries.
Methods: We conducted a Retrospective review of Adult patients with penetrating extra-peritoneal rectal injuries. Follow-up information of at least one month was needed for early post-operative complications.
Results: A total number of fifteen patients met …

Spinal Cord Trauma: An Overview Of Normal Structure And Function, Primary And Secondary Mechanisms Of Injury, And Emerging Treatment Modalities, Daniel Morin

Senior Honors Theses

The structures of the spinal cord and vertebral column are designed to provide flexibility, while still providing ample protection for the spinal cord deep within. While it does offer remarkable protection against most routine trauma, the spinal cord is still vulnerable to high-force etiologies of trauma and may become damaged as a result. These events are referred to as primary injury. Following the initial injury, the body’s own physiological responses cause a cascade of deleterious effects, known as secondary injury. Secondary injury is a major therapeutic target in mitigating the effects of spinal cord injury (SCI), and much research is …

The Affective Domain And The Intersection Of Learning In Emergency Medical Technician Paramedic Education, Meghan Williams

Dissertations, Theses, and Capstone Projects

Bloom identified three separate domains for learning: the psychomotor, cognitive, and affective domains. In this thesis, I propose that for paramedic education, the affective domain is not a domain to master equal to the psychomotor and cognitive domains, but must be mastered prior to the other domains in order to fully optimize learning. I propose that students must have a basic ability to apply the skills of the affective domain, and unlike the other domains, mastery of the almost the entire domain must be achieved before a student can complete the two other domains to be successful in a Paramedic …

A Novel Approach To Debriefing Medical Simulations: The Six Thinking Hats., Xiao Chi Zhang, Hyunjoo Lee, Carlos Rodriguez, Joshua Rudner, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Simulation has become a standard training method in emergency medicine (EM). Specifically, post-simulation debriefings offer participants the opportunity for reflection while exposing their knowledge and practice gaps. The educational yield of these debriefings, however, is contingent on the debriefer's skills. Without professional development, faculty and educators may not be equipped with supportive debriefing strategies. We propose the Six Thinking Hats (6TH), originally developed by Edward de Bono (1970) as a debriefing framework to support effective, high-yield debriefing conversations. The six colored hats represent six unique approaches to critical thinking. The white hat represents the facts; the green hat, creativity and …

A Global Health Research Checklist For Clinicians., Rasha D Sawaya, Kristen A Breslin, Eiman Abdulrahman, Jennifer I Chapman, Dafina M Good, Lili Moran, Paul C Mullan, Oluwakemi Badaki-Makun

Pediatrics Faculty Publications

Global health research has become a priority in most international medical projects. However, it is a difficult endeavor, especially for a busy clinician. Navigating the ethics, methods, and local partnerships is essential yet daunting.To date, there are no guidelines published to help clinicians initiate and complete successful global health research projects. This Global Health Research Checklist was developed to be used by clinicians or other health professionals for developing, implementing, and completing a successful research project in an international and often low-resource setting. It consists of five sections: Objective, Methodology, Institutional Review Board and Ethics, Culture and partnerships, and Logistics. …

Reversible Cerebral Vasoconstriction Disorder In A Patient With A Chief Complaint Of Headache., Simran Buttar, Anuja Trivedi, Dimitrios Papanagnou, Md

Department of Emergency Medicine Faculty Papers

As emergency medicine physicians, we have formulated an approach to managing patients with a chief complaint of headache that starts with considering the story the patient relays in the context of a wide differential. Here we will describe a case that presented to our emergency department in hopes to broaden your differential. Reversible cerebral vasoconstriction syndrome (RCVS), well described in the neurology literature, is characterized by severe headaches that may or may not be accompanied by neurological symptoms and is definitively diagnosed by diffuse constriction of cerebral arteries on cerebral angiogram. Here we present a case of a patient who …

Understanding Patient Uncertainty As A Driver Of Emergency Department Utilization: A Concept Mapping Approach, Angela Gerolamo, Phd, Rn, Shannon Doyle, Mph, Rhea E. Powell, Md, Mph, Amanda M.B. Doty, Ms, Marianna Lanoue, Phd, Kristin L. Rising, Md, Mshp

Department of Emergency Medicine Posters

Background and Purpose

• Most previous research regarding factors associated with increased risk of emergency department (ED) use has been done via retrospective review of medical records rather than obtaining patients’ perspectives.
• Recent research identified patient uncertainty related to symptoms as a primary motivator for seeking ED care, and ongoing uncertainty at the time of ED discharge as an unmet need (Rising et al. 2015; Rising, Hudgins, Reigle, Hollander, & Carr 2016).
• While providers have limited ability to influence many factors identified by retrospective medical record review (e.g. financial concerns), patient uncertainty can be addressed by providers directly. To do so …

Integrating Telehealth Emergency Department Follow-Up Visits Into Residency Training., Dimitrios Papanagnou, Danica Stone, Shruti Chandra, Phillip Watts, Anna Marie Chang, Judd E. Hollander

Department of Emergency Medicine Faculty Papers

Introduction: Given the rapid expansion of telehealth (TH), there is an emerging need for trained professionals who can effectively deliver TH services. As there is no formal TH training program for residents, the Department of Emergency Medicine (DEM) at Thomas Jefferson University (TJU) developed a pilot training program for senior post-graduate-year three (PGY-3) residents that exposed them to TH practices. The objective of the study was to determine the feasibility of developing a resident-led, post-Emergency-Department (ED) visit TH follow-up program as an educational opportunity to 1) address patient satisfaction; and 2) expose senior residents to TH delivery.

Methods: During …

Recurrent Episodes Of Acute Pancreatitis Present To The Ed With More Severe Disease By Ct Than First-Time Acute Pancreatitis, Maryam Boumezrag, Hamza Ijaz, Lorna Richards, Sormeh Harounzadeh, Angeline Johny, Paige Kulie, Caitlin Davis, Yan Ma, Maxine Le Saux, Andrew C. Meltzer

GW Research Days 2016 - 2020

Study Objective: Approximately 30% of patients with one episode of acute pancreatitis experience a recurrent episode. The objective of this study is to compare the severity of the first-time episode versus recurrent episodes of acute pancreatitis based on CT scan.

Methods: This study was conducted as part of a retrospective chart review at a single academic urban emergency department from 2012-2016. Criteria for inclusion included clinical symptoms of pancreatitis, age greater than or equal to 18 years, ED diagnosis of acute pancreatitis, and, an abdominal CT scan within 24 hours of triage. Exclusion criteria were traumatic cause of acute pancreatitis …

A Survey Of Language Diversity And Communication In Indian Academic Emergency Departments, Rebecca S. Allen, Lalit Narayan, Jay Pandya, Zohray Talib, Katherine A. Douglass

GW Research Days 2016 - 2020

Background

Communication in the Emergency Department (ED) is particularly important given the acuity of patients and lack of prior medical history. In India, patient care is further complicated by the many spoken languages, the regional differentiation in language and the fact that medical training is primarily delivered in English. Our objective was to document language diversity among clinicians in Indian EDs linked to an international training program and explore issues related to clinician-clinician and clinician-patient communication.

Methodology

A cross-sectional survey of ED clinicians was conducted from May to July 2017. Survey participants were recruited via convenience sampling by a researcher …

Preparing Nursing Students To Respond To Disasters: Faculty Perspectives, Melissa Jayne Freshwater

Dissertations

This mixed methods study explored emergency preparedness and disaster response in the concept-based learning curriculum adopted by the Alabama Community College System (ACCS) in 2016. The concept-based curriculum employs active learning in lieu of the traditional lecture-style teaching methods.

This study addressed the problem that educators may be unfamiliar with this content and are unsure how to present this material to students. The purpose of this study was to gain insight on teaching methodologies, to better prepare nursing students on this content.

Kolb’s 1984 Experiential Learning Theory was the framework that parallels closely with this curriculum. Kolb emphasizes four stages …

Validation Of An Icd Code For Accurately Identifying Emergency Department Patients Who Suffer An Out-Of-Hospital Cardiac Arrest., Shelby K. Shelton, Steve B. Chukwulebe, David F. Gaieski, Benjamin S. Abella, Brendan G. Carr, Sarah M. Perman

Department of Emergency Medicine Faculty Papers

AIM: International classification of disease (ICD-9) code 427.5 (cardiac arrest) is utilized to identify cohorts of patients who suffer out-of-hospital cardiac arrest (OHCA), though the use of ICD codes for this purpose has never been formally validated. We sought to validate the utility of ICD-9 code 427.5 by identifying patients admitted from the emergency department (ED) after OHCA.

METHODS: Adult visits to a single ED between January 2007 and July 2012 were retrospectively examined and a keyword search of the electronic medical record (EMR) was used to identify patients. Cardiac arrest was confirmed; and ICD-9 information and location of return …

Triple Valve Infective Endocarditis - A Late Diagnosis, Edme R. Mustafa, Sineta C. Firulescu, Cristina D. Parvanescu, Beatrice A. Chisalau, Georgica C. Tartea, Ion C. Efrem, Andreea L. Barbulescu, Stefan C. Dinescu, Paulina L. Ciurea, Lucretiu Radu, Ananu F. Vreju

Journal of Mind and Medical Sciences

Behcet's disease is a systemic vasculitis of unknown aetiology with cardiac involvement as well as damage to other organs. Whether the sterile valvular inflammation which occurs in this autoimmune disease predisposes to bacterial adhesion and infective endocarditis is not yet established.

We present the case of a patient with Behcet disease in which transthoracic echocardiography showed mobile masses on the aortic, tricuspid, and mitral valves, leading to multivalvular infective endocarditis diagnosis, possibly in the context of valvular inflammation.

The case presented in this article confirms observation of other studies, namely that ultrasonography plays an important role in the diagnosis and …

Transabdominal Versus Transvaginal, Kyla Camille Gray

Grace Peterson Nursing Research Colloquium

Background: In the United States, there has been a 21% increase in the occurrence of premature births within the last two decades. These children are also more likely to require lifelong therapies, assistive technologies, mobility devices, and more supportive services throughout their time in school. Globally, preterm births, and their preventions, have become a topic of interest. One method that has had significant success rates is placing a cerclage to prevent cervical dilation; while simultaneously treating prophylactically for early delivery.

Objectives: The purpose of this integrative literature review was to focus on which placement of cerclages, transabdominal or transvaginal, …

Trapped As A Group, Escape As A Team: Applying Gamification To Incorporate Team-Building Skills Through An 'Escape Room' Experience, Xiao Chi Zhang, Hyunjoo Lee, Carlos Rodriguez, Joshua Rudner, Teresa M Chan, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Teamwork, a skill critical for quality patient care, is recognized as a core competency by the Accreditation Council for Graduate Medical Education (ACGME). To date, there is no consensus on how to effectively teach these skills in a forum that engages learners, immerses members in life-like activities, and builds both trust and rapport. Recreational 'Escape Rooms' have gained popularity in creating a life-like environment that rewards players for working together, solving puzzles, and completing successions of mind-bending tasks in order to effectively 'escape the room' in the time allotted. In this regard, escape rooms share many parallels with the multitasking …

Identifying Gaps And Launching Resident Wellness Initiatives: The 2017 Resident Wellness Consensus Summit., Fareen Zaver, Nicole Battaglioli, William Denq, Anne Messman, Arlene Chung, Michelle Lin, Emberlynn L Liu

Emergency Medicine Faculty Publications

Introduction: Burnout, depression, and suicidality among residents of all specialties have become a critical focus for the medical education community, especially among learners in graduate medical education. In 2017 the Accreditation Council for Graduate Medical Education (ACGME) updated the Common Program Requirements to focus more on resident wellbeing. To address this issue, one working group from the 2017 Resident Wellness Consensus Summit (RWCS) focused on wellness program innovations and initiatives in emergency medicine (EM) residency programs.

Methods: Over a seven-month period leading up to the RWCS event, the Programmatic Initiatives workgroup convened virtually in the Wellness Think Tank, an online, …

Tobacco Dependence Treatment In The Emergency Department: A Randomized Trial Using The Multiphase Optimization Strategy., Steven L Bernstein, James Dziura, June Weiss, Ted Miller, Katrina A Vickerman, Lauretta E Grau, Michael V Pantalon, Lorien Abroms, Linda M Collins, Benjamin Toll

Prevention and Community Health Faculty Publications

Background

Tobacco dependence remains the leading preventable cause of death in the developed world. Smokers are disproportionately from lower socioeconomic groups, and may use the hospital emergency department (ED) as an important source of care. A recent clinical trial demonstrated the efficacy of a multicomponent intervention to help smokers quit, but the independent contributions of those components is unknown.

Methods

This is a full-factorial (16-arm) randomized trial in a busy hospital ED of 4 tobacco dependence interventions: brief motivational interviewing, nicotine replacement therapy, referral to a telephone quitline, and a texting program. The trial utilizes the Multiphase Optimization …