Emergency Medicine Commons^™

Impact Of Inpatient Care In Emergency Department On Outcomes: A Quasi-Experimental Cohort Study, Aisha Lateef, Soo-Hoon Lee, Dale Andrew Fisher, Wei-Ping Goh, Hui Fen Han, Uma Chandra Segara, Tiong Beng Sim, Malcolm Mahadehvan, Khean Teik Goh, Noel Cheah, Aymeric Yt Lim, Phillip H. Phan, Reshma A. Merchant

Management Faculty Publications

BACKGROUND: Hospitals around the world are faced with the issue of boarders in emergency department (ED), patients marked for admission but with no available inpatient bed. Boarder status is known to be associated with delayed inpatient care and suboptimal outcomes. A new care delivery system was developed in our institution where boarders received full inpatient care from a designated medical team, acute medical team (AMT), while still residing at ED. The current study examines the impact of this AMT intervention on patient outcomes.

METHODS: We conducted a retrospective quasi-experimental cohort study to analyze outcomes between the AMT intervention and conventional …

Cardiac Arrest Risk Standardization Using Administrative Data Compared To Registry Data., Anne V. Grossestreuer, David F. Gaieski, Michael W. Donnino, Joshua I.M. Nelson, Eric L. Mutter, Brendan G. Carr, Benjamin S. Abella, Douglas J. Wiebe

Department of Emergency Medicine Faculty Papers

BACKGROUND: Methods for comparing hospitals regarding cardiac arrest (CA) outcomes, vital for improving resuscitation performance, rely on data collected by cardiac arrest registries. However, most CA patients are treated at hospitals that do not participate in such registries. This study aimed to determine whether CA risk standardization modeling based on administrative data could perform as well as that based on registry data.

METHODS AND RESULTS: Two risk standardization logistic regression models were developed using 2453 patients treated from 2000-2015 at three hospitals in an academic health system. Registry and administrative data were accessed for all patients. The outcome was death …

Danshen-Chuanxiong-Honghua Ameliorates Cerebral Impairment And Improves Spatial Cognitive Deficits After Transient Focal Ischemia And Identification Of Active Compounds., Xianhua Zhang, Wan Zheng, Tingrui Wang, Ping Ren, Fushun Wang, Xin-Liang Ma, Jian Wang, Xi Huang

Department of Emergency Medicine Faculty Papers

Previously, we only apply a traditional Chinese medicine (TCM) Danshen-Chuanxiong-Honghua (DCH) for cardioprotection via anti-inflammation in rats of acute myocardial infarction by occluding coronary artery. Presently, we select not only DCH but also its main absorbed compound ferulic acid (FA) for cerebra protection via similar action of mechanism above in animals of the transient middle cerebral artery occlusion (tMCAO). We investigated whether oral administration of DCH and FA could ameliorate MCAO-induced brain lesions in animals. By using liquid chromatography-tandem mass spectrometry (LC-MS/MS), we analyzed four compounds, including tanshinol, salvianolic acid B, hydroxysafflor yellow A and especially FA as the putative …

Hydrogen Sulfide Gas Poisoning In Fish Garbage Room: A Report Of A Fisherman, Sadaf Sheikh, Muhammad Akbar Baig, Noman Ali, Nadeemullah Khan

Department of Emergency Medicine

We report the case of a fisherman who was exposed to high concentrations of hydrogen sulfide (H2S) gas from the fish garbage room. The patient survived and was discharged with full recovery from the hospital. H2S is a colourless, foul smelling and highly toxic gas next to carbon monoxide, which causes inhalation death. It is a by-product of various industrial processes particularly involves exposure from agriculture, petrochemical industry and organic matter decomposition from sewage processing. It is a by-product of H2S has been referred as the "knock down gas" because inhalation of high concentrations can cause immediate loss of consciousness …

Ctrp3 Is A Novel Biomarker For Diabetic Retinopathy And Inhibits Hghl-Induced Vcam-1 Expression In An Ampk-Dependent Manner., Zheyi Yan, Jianli Zhao, Lu Gan, Yanqing Zhang, Rui Guo, Xiaoming Cao, Wayne Bond Lau, Xin Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

OBJECTIVES: Diabetic retinopathy (DR) is a severe complication of chronic diabetes. The C1q/TNF-related protein family (CTRPs) has been demonstrated to exert protective effects against obesity and atherosclerosis in animal studies. Heretofore, the association between circulating CTRPs and DR patients has been unexplored. In the current study, we attempt to define this association, as well as the effect of CTRPs upon DR pathophysiology.

DESIGN: The present investigation is a case control study that enrolled control subjects and type 2 diabetes mellitus (T2DM) patients diagnosed with DR. Serum CTRPs and sVACM-1 were determined by ELISA.

RESULTS: Serum CTRP3 and CTRP5 levels were …

The Role Of The Heart Score And Clinical Decision Units In Ed Patients With Chest Pain, Gregory Jasani, Jesse M. Pines, Caitlin Carter

Center for Health Care Quality

Every year, millions of patients present to Emergency Departments across the country complaining of chest pain. Even after traditional ED testing which includes electrocardiograms, laboratory testing, and chest radiography, chest pain patients still have a small but real risk of serious illness. The HEART score is a new tool that has been validated to help risk-stratify patients. Clinical Decision Units decrease cost and length of stay without compromising patient safety, allowing for complete evaluations of these patients.

The 2016 Model Of The Clinical Practice Of Emergency Medicine, Francis L. Counselman, Kavita Babu, Mary Ann Edens, Diane L. Gorgas, Cherri Hobgood, Catherine A. Marco, Eric Katz, Kevin Rodgers, Leonard A. Stallings, Michael C. Wadman

Emergency Medicine Faculty Publications

Emergency medicine (EM) has a scientifically derived and commonly accepted description of the domain of its clinical practice. That document, “The Model of the Clinical Practice of Emergency Medicine” (EM Model), was developed through the collaboration of six organizations: the American Board of Emergency Medicine (ABEM), the administrative organization for the project, the American College of Emergency Physicians (ACEP), the Council of Emergency Medicine Residency Directors (CORD), the Emergency Medicine Residents' Association (EMRA), the Residency Review Committee for Emergency Medicine (RRC-EM), and the Society for Academic Emergency Medicine (SAEM). Development of the EM Model was based on an extensive practice …

Pain Perception In Latino Vs. Caucasian And Male Vs. Female Patients: Is There Really A Difference?, Molly Aufiero, Holly Stankewicz, Shaila Quazi, Jeanne Jacoby, Jill Stoltzfus

Jefferson Health - Northeast Papers (formerly Aria Health Papers)

INTRODUCTION: Pain is a common emergency department (ED) complaint. It is important to understand the differences in pain perception among different ethnic and demographic populations.

METHODS: We applied a standardized painful stimulus to Caucasian and Latino adult patients to determine whether the level of pain reported differed depending on ethnicity (N=100; 50 Caucasian [C], 50 Latino [L] patients) and gender (N=100; 59 female, 41 male). Patients had an initial pain score of 0 or 1. A blood pressure cuff was inflated 20 mm HG above the patient's systolic blood pressure and held for three minutes. Pain scores, using both a …

Findings Of Cognitive Impairment At High Altitude: Relationships To Acetazolamide Use And Acute Mountain Sickness., Lara Phillips, Buddha Basnyat, Yuchiao Chang, Erik R. Swenson, N. Stuart Harris

Department of Emergency Medicine Faculty Papers

Phillips, Lara, Buddha Basnyat, Yuchiao Chang, Erik R. Swenson, and N. Stuart Harris. Findings of cognitive impairment at high altitude: relationships to acetazolamide use and acute mountain sickness. High Alt Med Biol. 18:121-127, 2017.

OBJECTIVE: Acute mountain sickness (AMS) is defined by patient-reported symptoms using the Lake Louise Score (LLS), which provides limited insight into any possible underlying central nervous system (CNS) dysfunction. Some evidence suggests AMS might coexist with altered neural functioning. Cognitive impairment (CI) may go undetected unless a sensitive test is applied. Our hypothesis was that a standardized test for mild CI would provide an objective measure …

Diagnostic Effectiveness Of High-Sensitivity Troponins, Sean R. Bodin, Jacqueline Ramirez

Physician Assistant Capstones, 2016 to 2019

Background: Acute myocardial infarctions (AMI) are a leading cause of death in the United States. The key to increasing survivability is early recognition to expedite the proper treatment modalities. In conjunction with the clinical presentation and electrocardiograms, the use of cardiac biomarkers is exponentially important in not only recognizing a cardiac event but also determining the extent of injury. Advancement in laboratory technology has led to the development of high-sensitive troponin (hs-troponin) assays which can detect smaller cardiac troponin serum levels compared to conventional troponin assays. This implies that the use of hs-troponin assays is more effective in the …

Application Of D-Dimer To Aid In Diagnosis Of Acute Aortic Dissection, Hannah Scarboro, Julia Starkey

Physician Assistant Capstones, 2016 to 2019

Introduction: Acute aortic dissection (AAD) is an emergent, relatively uncommon condition that typically presents with sudden onset severe chest or back pain.1 Advanced imaging, such as computerized tomography, is currently the gold standard to diagnose AAD; this can be expensive and unavailable at all health care centers. D-dimer is a blood test that has been shown in recent studies to be elevated in acute aortic dissection. This may be a more cost-effective way to help the clinician “rule-out” an acute aortic dissection.1

Objective: The purpose of this research was to determine if there is significant data regarding the sensitivity and …

Implementation Of A Standardized Handoff During Transition Of Care From The Emergency Department To The Intensive Care Unit, Melinda Abbring

Evidence-Based Practice Project Reports

Patient safety and nursing communication are crucial to the nursing handoff during transition of care from the emergency department (ED) to the intensive care unit (ICU). The Institute of Medicine published To Err is Human: Building a Safer Health System (1999) and Crossing the Quality Chasm (2001) highlighting ED handoffs as a safety measure. In 2006, the Joint Commission recognized handoffs with the National Patient Safety Goal 2E. The purpose of this evidence-based practice project was to determine if implementation of a standardized handoff would improve nursing communication and patient safety during transition of care from the ED to the …

Quality Improvement In Pediatric Head Trauma With Pecarn Rules Implementation As Computerized Decision Support, Shireen M. Atabaki, Brian Jacobs, Kathleen Jacobs, Samira Shahzeidi, Nia Heard-Garris, Meghan Chamberlain, Robert Grell, James M. Chamberlain

Pediatrics Faculty Publications

Background: For the 1.4 million emergency department (ED) visits for traumatic brain injury (TBI) annually in the United States, computed tomography (CT) may be over utilized. The Pediatric Emergency Care Applied Research Network developed 2 prediction rules to identify children at very low risk of clinically important TBI. We implemented these prediction rules as decision support within our electronic health record (EHR) to reduce CT.

Objective: To test EHR decision support implementation in reducing CT rates for head trauma at 2 pediatric EDs.

Methods: We compared monthly CT rates 1 year before [preimplementation (PRE)] and 1 year after [postimplementation (POST)] …

Emergency Preparedness Competencies Among Nurses In Northwest Arkansas, Taylor A. Matlock

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Despite years of training and experience, evidence suggests nurses report wide gaps in emergency competencies and disaster preparedness. Further, nurses report low levels of familiarity in competencies related to planning for disasters, implementing disaster guidelines, and assessing patients exposed to biological and chemical agents. This research sought to establish the self-reported level of emergency preparedness competencies of nurses in Northwest Arkansas, an area that faces a diverse set of potential disasters ranging from nuclear accidents to pandemic disease. Additionally, differences between of the level of preparedness by education level or work specialty were studied. The results are alarming in that …

Treatment Of Hypertensive Emergencies, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

A Unique Cause Of Anion Gap Metabolic Acidosis: Euglycemia Dka., Ross Cohen Do, Pgy-4, Kevin Weaver D.O.,Facoep

Department of Emergency Medicine

No abstract provided.

Mental Illness And Injuries: Emerging Health Challenges Of Urbanisation In South Asia, Devaki Nambiar, Junaid Razzak, Kaosar Afsana, Alayne M. Adams, Arif Hasan, Dinesh Mohan, Vikram Patel

Department of Emergency Medicine

No abstract provided.

Emergency Department Approach To Electrical Toothbrush Associated Hand Injury, A Unique Case Of Non-Oropharyngeal Injury., Hannah Robinson, Neal Sikka, Chimere Little, Ali Pourmand

GW Research Days 2016 - 2020

Puncture wounds are common injuries treated in the emergency department (ED). Prior studies have shown that toothbrushes are common reservoirs for oral flora, especially in regions near the head of the toothbrush near the bristles. ED providers must be aware of the danger associated with bacterial contamination of the associated wound and should be familiar with different pathogens and options for treatment. We present a unique case of a 30-year-old male with non-intraoral injury who presented to the ED after puncturing his left palm with the metal post of an electric toothbrush.

Stakeholders' Perceptions Of A Hospital Based Emergency Medicine Education & Training Program: A System Change, Kate Douglass, Jay Pandya, Michael Brennan, Kyle Yoder, Janice Blanchard, Natasha Powell, Zohray Talib

GW Research Days 2016 - 2020

Background: Emergency Medicine (EM) is a new and developing specialty around the world. In India, one model for capacity building has been the development of partnerships between US academic institutions and private healthcare institutions for implementing post-graduate education and training in EM. Initiated in 2007, programs have grown both in number and scope and have continued to attract new students and partner institutions. This study was undertaken to better understand the impact of EM training programs on hospital systems.

Methods: A mixed-methods evaluation was undertaken at 5 program sites across India in the summer of 2016. Two researchers conducted onsite …

Concussion Screening Evaluation: Bess Vs Sway, Zachariah Hatoum, Aidan Neustadtl, Jeremy Altman, Aurash Zarrinbakhsh, David Milzman

GW Research Days 2016 - 2020

Introduction: Rapid evaluation of concussion is important in the pre-hospital setting as an easy test. It is also useful in the ED, as too often little is done for concussed patients. The Balance Error Scoring System (BESS) is the current gold standard for evaluating balance, one of the best predictors of concussion. SWAY, a new gyroscope based iPhone application, is being proposed as a more sensitive and more objective test than BESS. This study will compare Sway to BESS to determine if there is equal efficacy.
Method: 74 scholastic and collegiate athletes were administered baseline balance evaluations using Sway. …