Current Issue: Volume 17 Issue 5

Mumps Virus: Modification of the Identify-Isolate-Inform Tool for Frontline Healthcare Providers

Author Affiliation Kristi L. Koenig, MD University of California Irvine, Medical Center, Department of Emergency Medicine, Center for Disaster Medical Sciences, Orange, California Siri Shastry, MD University of California Irvine Medical Center, Department of Emergency Medicine, Orange California Bandr Mzahim, MD University of California Irvine, Medical Center, Department of Emergency Medicine, Center for Disaster Medical […]

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Population Health Research Design

Getting Found: Indexing and the Independent Open Access Journal

Getting Found: Indexing and the Independent Open Access Journal
Katie Fourtney, JD, MLIS, et al.

Running an independent journal takes much effort, even if only focusing on managing the process of moving articles through the process of submission, review, and publication. Yet publishing an article is not the only goal. Even a great article has little impact unless it can easily be discovered for people to read and cite. Without visibility, even a journal with a terrific editorial board will not get the high quality submissions its editors seek.

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Academic Primer Series: Five Key Papers Fostering Educational Scholarship in Junior Academic Faculty

Academic Primer Series: Five Key Papers Fostering Educational Scholarship in Junior Academic Faculty
Teresa M. Chan, MD, MHPE, et al.

Scholarship is an essential part of academic success. Junior faculty members are often unfamiliar with the grounding literature that defines educational scholarship. In this article, the authors aim to summarize five key papers which outline education scholarship in the setting of academic contributions for emerging clinician educators.

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Emergency Department Operations

Mobile COWs (Computer on Wheels): Hamburger or VEAL?

Mobile COWs (Computer on Wheels): Hamburger or VEAL?
Maxwell Jen, MD, et al.

The HITECH (Health Information Technology for Economic and Clinical Health) Act of 2009 galvanized the universal adoption of electronic health record (EHR) systems to improve the quality, delivery, and coordination of patient care.1 Initial results demonstrated improvement in population health outcomes and increased transparency.2-3 Through the HITECH Act’s Meaningful Use (MU) incentives, EHR adoption also promised shorter hospital stays, reduced costs and improved access to healthcare data.4 These promises, however, never materialized; studies have demonstrated that EHR adoption causes decreased rates of patients seen per hour, highly variable documentation times, and increased order entry times.

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Optic Nerve Sheath Diameter Measurement During Diabetic Ketoacidosis: A Pilot Study

Optic Nerve Sheath Diameter Measurement During Diabetic Ketoacidosis: A Pilot Study
Bergmann, DO, MS, et al.

Diabetic ketoacidosis-related cerebral edema (DKA-CE) occurs in up to 1% of children with type 1 diabetes (T1D),1 with approximately 20% displaying neurologic symptoms at presentation.2,3 Similarly, up to 54% have a mild form of subclinical DKA-CE identified by extracellular fluid measurements on magnetic resonance imaging (MRI), which is associated with alterations in neuronal function and cerebral injury on MR spectroscopy.2-6 This suggests that DKA-CE occurs along a continuum, ranging from asymptomatic imaging changes, mild neurologic injury, to cerebral herniation and death.

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Critical Care

Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey

Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey
Robert S. Green, MD, et al.

Respiratory failure is a common problem in emergency medicine (EM) and critical care medicine (CCM). However, little is known about the resuscitation of critically ill patients prior to emergency endotracheal intubation (EETI). Our aim was to describe the resuscitation practices of EM and CCM physicians prior to EETI.

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Emergency Department Operations

Does Pneumatic Tube System Transport Contribute to Hemolysis in ED Blood Samples?

Does Pneumatic Tube System Transport Contribute to Hemolysis in ED Blood Samples?
Michael P. Phelan, MD, et al.

Our goal was to determine if the hemolysis among blood samples obtained in an emergency department and then sent to the laboratory in a pneumatic tube system was different from those in samples that were hand-carried.

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Emergency Department Operations

Wide Variability in Emergency Physician Admission Rates: A Target to Reduce Costs Without Compromising Quality

Wide Variability in Emergency Physician Admission Rates: A Target to Reduce Costs Without Compromising Quality
Guberman, MD, MS, et al.

Attending physician judgment is the traditional standard of care for emergency department (ED) admission decisions. The extent to which variability in admission decisions affect cost and quality is not well understood. We sought to determine the impact of variability in admission decisions on cost and quality.

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Education

Derivation of Two Critical Appraisal Scores for Trainees to Evaluate Online Educational Resources: A METRIQ Study

Derivation of Two Critical Appraisal Scores for Trainees to Evaluate Online Educational Resources: A METRIQ Study
Teresa M. Chan, MD, MHPE, et al.

Online education resources (OERs), like blogs and podcasts, increasingly augment or replace traditional medical education resources such as textbooks and lectures. Trainees’ ability to evaluate these resources is poor, and few quality assessment aids have been developed to assist them. This study aimed to derive a quality evaluation instrument for this purpose.

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Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits
Brian Sharp, MD, et al.

Nausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP.

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Association of Age, Systolic Blood Pressure, and Heart Rate with Adult Morbidity and Mortality after Urgent Care Visits

Association of Age, Systolic Blood Pressure, and Heart Rate with Adult Morbidity and Mortality after Urgent Care Visits
James Hart, MD et al.

Little data exists to help urgent care (UC) clinicians predict morbidity and mortality risk. Age, systolic blood pressure (SBP), and heart rate (HR) are easily obtainable and have been used in other settings to predict short-term risk of deterioration. We hypothesized that there is a relationship between advancing age, SBP, HR, and short-term health outcomes in the UC setting.

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The Peregrinating Psychiatric Patient in the Emergency Department

The Peregrinating Psychiatric Patient in the Emergency Department
Scott Simpson, MD, MPH et al.

Many emergency department (ED) psychiatric patients present after traveling. Although such travel, or peregrination, has long been associated with factitious disorder, other diagnoses are more common among travelers, including psychotic disorders, personality disorders, and substance abuse. Travelers’ intense psychopathology, disrupted social networks, lack of collateral informants, and unawareness of local resources complicate treatment. These patients can consume disproportionate time and resources from emergency providers. We review the literature on the emergency psychiatric treatment of peregrinating patients and use case examples to illustrate common presentations and treatment strategies. Difficulties in studying this population and suggestions for future research are discussed.

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Increased 30-Day Emergency Department Revisits Among Homeless Patients with Mental Health Conditions

Increased 30-Day Emergency Department Revisits Among Homeless Patients with Mental Health Conditions
Chun Nuk Lam, MPH, et al.

Patients with mental health conditions frequently use emergency medical services. Many suffer from substance use and homelessness. If they use the emergency department (ED) as their primary source of care, potentially preventable frequent ED revisits and hospital readmissions can worsen an already crowded healthcare system. However, the magnitude to which homelessness affects health service utilization among patients with mental health conditions remains unclear in the medical community. This study assessed the impact of homelessness on 30-day ED revisits and hospital readmissions among patients presenting with mental health conditions in an urban, safety-net hospital.

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ED Patients with Prolonged Complaints and Repeat ED Visits Have an Increased Risk of Depression

ED Patients with Prolonged Complaints and Repeat ED Visits Have an Increased Risk of Depression
Kristopher R. Brickman, MD et al.

The objective of this study was to explore associations between presenting chief complaints of prolonged symptomatology, patient usage of the emergency department (ED), and underlying depression so that emergency physicians may better target patients for depression screening.

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Diagnostic Acumen

Two Cases of Anti-NMDA Receptor Encephalitis

Two Cases of Anti-NMDA Receptor Encephalitis
Jesse Baker, BA, et al.

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a form of autoimmune encephalitis with prominent neuropsychiatric features. Patients present with acute psychosis, memory impairment, dyskinesias, seizures, and/or speech disorders. The clinical course is often complicated by respiratory failure, requiring intubation. Approximately half of patients are found to have an associated ovarian tumor, which expresses NMDAR. Recognition of anti-NMDAR encephalitis by emergency physicians is essential in order to initiate early treatment and avoid psychiatric misdiagnosis. The disease is highly treatable with tumor removal and immunosuppression, and most patients demonstrate a full recovery. In this case series, we report two cases of anti-NMDAR encephalitis in adult women in the United States and provide a review of the literature.

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Diagnostic Acumen

A Rare but Important Clinical Presentation of Induced Methemoglobinemia

A Rare but Important Clinical Presentation of Induced Methemoglobinemia
Faried Banimahd, MD et al.

Phenazopyridine is considered one of the classic causes of drug-induced methemoglobinemia. It is often taught as such and seen in board review courses. Nevertheless, the epidemiology is unknown, presentation quite rare, and less than five cases have been reported in PubMed in over 35 years.1-4 We present a case with a different set of patient characteristics than seen in the few recent case reports, and an approach to treatment that validates further uniqueness, justifying reporting the case in the literature. In particular, the patient was a young otherwise-healthy adult, with the initial diagnosis and decision to treat based on clinical grounds versus laboratory values.

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Diagnostic Acumen

A Curious Case of Right Upper Quadrant Abdominal Pain

A Curious Case of Right Upper Quadrant Abdominal Pain
Andrew Grock, MD et al.

An otherwise healthy 36-year-old man presented with sudden-onset right upper quadrant abdominal pain and vomiting. A bedside ultrasound, performed to evaluate hepatobiliary pathology, revealed a normal gallbladder but free intraperitoneal fluid. After an expedited CT and emergent explorative laparotomy, the patient was diagnosed with a small bowel obstruction with ischemia secondary to midgut volvulus. Though midgut volvulus is rare in adults, delays in definitive diagnosis and management can result in bowel necrosis. Importantly, an emergency physician must be able to recognize bedside ultrasound findings associated with acutely dangerous intrabdominal pathology.

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Prehospital Care

A Comparison of Chest Compression Quality Delivered During On-Scene and Ground Transport Cardiopulmonary Resuscitation

A Comparison of Chest Compression Quality Delivered During On-Scene and Ground Transport Cardiopulmonary Resuscitation
Christopher S. Russi, DO et al.

The 2010 American Heart Association (AHA)/International Liaison Committee on Resuscitation (ILCOR) Cardiopulmonary Resuscitation (CPR) Guidelines call for a minimum chest compression rate of 100 to 120 compressions per minute and a minimum chest compression depth of 1.5 to 2 inches (3.75–5 cm).1 Two clinical studies have reported the quality of chest compressions delivered before emergency medical services (EMS) transport and the quality of those delivered during transport.2,3 Further evidence has suggested that visual, automated CPR feedback improves CPR quality.

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Prehospital Care

Determinants of Success and Failure in Prehospital Endotracheal Intubation

Determinants of Success and Failure in Prehospital Endotracheal Intubation
Lucas A. Myers, BAH et al.

Endotracheal intubation (ETI) performance by emergency medical services (EMS) personnel remains a heavily examined and debated issue for medical directors and prehospital care providers. Research on success rates in adults has demonstrated ranges from 77.2% to 98.5%.1-4 Unfortunately, opportunities for clinical intubation are infrequent.5 EMS educational programs have highlighted the need for greater frequency of ETI performance through clinical opportunities such as the operating suite.6 Given the relatively few opportunities for practicing the procedure in some EMS systems, detailed patient selection and guideline criteria aimed at limiting difficult intubation attempts may increase the relative proportion of success.

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Prehospital Care

Prehospital Lactate Measurement by Emergency Medical Services in Patients Meeting Sepsis Criteria

Prehospital Lactate Measurement by Emergency Medical Services in Patients Meeting Sepsis Criteria
Lori L. Boland, MPH et al.

We aimed to pilot test the delivery of sepsis education to emergency medical services (EMS) providers and the feasibility of equipping them with temporal artery thermometers (TATs) and handheld lactate meters to aid in the prehospital recognition of sepsis.

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Prehospital Care

Geospatial Analysis of Pediatric EMS Run Density and Endotracheal Intubation

Geospatial Analysis of Pediatric EMS Run Density and Endotracheal Intubation
Matthew Hansen, MD, MCR et al.

The association between geographic factors, including transport distance, and pediatric emergency medical services (EMS) run clustering on out-of-hospital pediatric endotracheal intubation is unclear. The objective of this study was to determine if endotracheal intubation procedures are more likely to occur at greater distances from the hospital and near clusters of pediatric calls.

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Prehospital Care

The Medical Duty Officer: An Attempt to Mitigate the Ambulance At-Hospital Interval

The Medical Duty Officer: An Attempt to Mitigate the Ambulance At-Hospital Interval
Megan H. Halliday, MSIII, BS et al.

A lack of coordination between emergency medical services (EMS), emergency departments (ED) and systemwide management has contributed to extended ambulance at-hospital times at local EDs. In an effort to improve communication within the local EMS system, the Baltimore City Fire Department (BCFD) placed a medical duty officer (MDO) in the fire communications bureau. It was hypothesized that any real-time intervention suggested by the MDO would be manifested in a decrease in the EMS at-hospital time.

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

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Suite 640
Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: editor@westjem.org

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.