emergency department Archives - The Western Journal of Emergency Medicine

Predictive Value of Initial Triage Vital Signs for Critically Ill Older Adults

Author Affiliation Michael A. LaMantia, MD, MPH Indiana University Center for Aging Research and Regenstrief Institute, Indianapolis, Indiana Paul W. Stewart, PhD University of North Carolina, Department of Biostatistics, Chapel Hill, North Carolina Timothy F. Platts-Mills, MD University of North Carolina, Department of Emergency Medicine, Chapel Hill, North Carolina Kevin J. Biese, MD, MAT University […]

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Hunger and Food Insecurity among Patients in an Urban Emergency Department

Introduction: To determine the prevalence of hunger and food insecurity among patients presenting to the emergency department (ED) over 3 consecutive years.
Conclusion: A significant proportion of our ED patients experience food insecurity and hunger. Hunger and food insecurity have become more prevalent among patients seen in this urban county ED over the past 3 years. Emergency physicians should be aware of the increasing number of patients who must choose between obtaining food and their prescribed medications, and should consider the contribution of hunger and food insecurity to the development of health conditions for which ED treatment is sought.

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Endemic Infections

Emergency Physicians’ Adherence to Center for Disease Control and Prevention Guidance During the 2009 Influenza A H1N1 Pandemic

Intro: Little is known regarding compliance with management guidelines for epidemic influenza in adult emergency department (ED) settings during the 2009 novel influenza A (H1N1) epidemic, especially in relation to the Centers for Disease Control and Prevention (CDC) guidance.
Conclusion: During the recent H1N1 pandemic, most admitted patients received ED diagnostic testing corresponding to the current recommended guidance. Antibiotic treatment for ED patients admitted with suspected influenza is not uncommon…

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A 37-year-old Woman with Altered Mental Status and Urinary Frequency

We present a case report of a patient who initially presented with altered mental status and significant urinary frequency. Over the course of her emergency department stay, she then developed tachycardia out of proportion to a new fever along with a respiratory alkalosis. Although each objective finding has a broad differential diagnosis, thyroid storm was the only unifying diagnosis when all findings were present.

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Hepatic Abscess: Case Report And Review

Hepatic abscess is an uncommon occurrence in North America, but can be a diagnostic challenge for emergency department physicians. The clinical signs and symptoms may vary, leading to delays in diagnosis and higher morbidity. We present a case of a 35-year old male with a hepatic abscess initially misdiagnosed as pneumonia. On subsequent return to the ED for back pain complaints, a bedside ultrasound led to the appropriate diagnosis. This case report and discussion will attempt to review the literature on the etiology, diagnosis and treatment of hepatic abscess for the emergency physician.

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Emergency Department Access

Comparison Between Emergency Department and Inpatient Nurses’ Perceptions of Boarding of Admitted Patients

Introduction: The boarding of admitted patients in the emergency department (ED) is a major cause of crowding and access block. One solution is boarding admitted patients in inpatient ward (W) hallways.
Conclusion: Inpatient nurses and those who have never worked in the ED are more opposed to inpatient boarding than ED nurses and nurses who have worked previously in the ED. Primary nursing concerns about boarding are lack of monitoring and privacy in hallway beds. Nurses admitted as patients seemed to prefer not being boarded where they work.

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Emergency Department Access

How Long Are Patients Willing to Wait in the Emergency Department Before Leaving Without Being Seen?

Introduction: Our goal was to evaluate patients’ threshold for waiting in an emergency department (ED) waiting room before leaving without being seen (LWBS). We analyzed whether willingness to wait was influenced by perceived illness severity, age, race, triage acuity level, or insurance status.

Conclusion: Many patients have a defined, limited period that they are willing to wait for emergency care. In our study, 50% of patients were willing to wait up to 2 hours before leaving the ED without being seen. This result suggests that efforts to reduce the percentage of patients who LWBS must factor in time limits.

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Emergency Department Management of Delirium in the Elderly

An increasing number of elderly patients are presenting to the emergency department. Numerous studies have observed that emergency physicians often fail to identify and diagnose delirium in the elderly. These studies also suggest that even when emergency physicians recognized delirium, they still may not have fully appreciated the import of the diagnosis. Delirium is not a normal manifestation of aging and, often, is the only sign of a serious underlying medical condition. This article will review the significance, definition, and principal features of delirium so that emergency physicians may better appreciate, recognize, evaluate, and manage delirium in the elderly.

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Blunt Abdominal Trauma Patients Are at Very Low Risk for Intra-Abdominal Injury after Emergency Department Observation

The objective of this study was to determine the prevalence of intra-abdominal injury (IAI) and death in hemodynamically normal and stable BAT patients with initially negative ED evaluations admitted to an ED observation unit and to define a low-risk subgroup of patients and assess whether they may be discharged without abdominal/pelvic CT or observation.

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Cutaneous Conditions Leading to Dermatology Consultations in the Emergency Department

We established the most common cutaneous diseases that received dermatology consultation in the adult emergency department (ED) and identified differentiating clinical characteristics of dermatoses that required hospital admission.

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Ultrasound-Guided Peripheral Intravenous Access in the Emergency Department: Patient-Centered Survey

To assess characteristics, satisfaction, and disposition of emergency department (ED) patients who successfully received ultrasound (US)-guided peripheral intravenous (IV) access.

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Vertebrobasilar Artery Occlusion

The presentation of vertebrobasilar artery occlusion varies with the cause of occlusion and location of ischemia. This often results in delay in diagnosis. Areas of the brain supplied by the posterior circulation are difficult to visualize and usually require angiography or magnetic resonance imaging. Intravenous thrombolysis and local-intra arterial thrombolysis are the most common treatment approaches used. Recanalization of the occluded vessel significantly improves morbidity and mortality. Here we present a review of the literature and a case of a patient with altered mental status caused by vertebrobasilar artery occlusion.

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Randomized Controlled Trial of Ondansetron vs. Prochlorperazine in Adults in the Emergency Department

To compare the effectiveness of ondansetron and prochlorperazine to treat vomiting. Secondary objectives were the effectiveness of ondansetron and prochlorperazine to treat nausea and their tolerability.

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Cognitive Impairment among Older Adults in the Emergency Department

Within the next 30 years, the number of visits older adults will make to emergency departments (EDs) is expected to double from 16 million, or 14% of all visits, to 34 million and comprise nearly a quarter of all visits.

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Analgesia for Older Adults with Abdominal or Back Pain in Emergency Department

To determine the association between age and analgesia for emergency department (ED) patients with abdominal or back pain.

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Chronic or Recurrent Pain in the Emergency Department: National Telephone Survey of Patient Experience

Persons with chronic or recurrent pain frequently visit the emergency department (ED), yet little research examines this experience. We conducted this national survey to assess patients’ ED experiences.

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Intestinal Angioedema Misdiagnosed as Recurrent Episodes of Gastroenteritis

Emergency physicians (EP) frequently encounter angioedema involving the lips and tongue. However, angioedema from Angiotensin Converting Enzyme inhibitors or hereditary angioedema (HAE) can present with gastrointestinal symptoms due to bowel wall involvement. EPs should begin to consider this clinical entity as a potential cause for abdominal pain and associated gastrointestinal symptoms given the common use of medications that can precipitate angioedema. We report a case of a 34-year-old woman who presented with abdominal cramping, vomiting and diarrhea due to an acute exacerbation of HAE.

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Emergency Department Activation of Interventional Cardiology to Reduce Door-to-Balloon Time

To determine if ED activation of interventional cardiology could significantly improve reperfusion times and reach the ACC/AHA target of 90 minutes or less in a safety net hospital, a Level I trauma center and teaching hospital serving primarily uninsured and underinsured patient population with door-to-balloon times ranking in the lowest quartile of United States hospitals.

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Ed Administration

Impact of Resident Physicians on Emergency Department Throughput

Evaluate the impact of adding emergency medicine residents to a medium-size urban hospital by comparing emergency department (ED) admission rate, total census, length of stay (LOS), and proportion of patients who left without being seen (LWBS).

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Feasibility of Identifying Eligible Trauma Patients for Posttraumatic Stress Disorder Intervention

This research report examines the feasibility of identifying eligible trauma patients for a study providing an early therapeutic intervention for the prevention of posttraumatic stress disorder (PTSD), and identifies reasons around participation.

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Identification and Risk-Stratification of Problem Alcohol Drinkers with Minor Trauma in the Emergency Department

Brief alcohol intervention may improve outcomes for injury patients with hazardous drinking but is less effective with increased severity of alcohol involvement. This study evaluated a brief method for detecting problem drinking in minor trauma patients and differentiating hazardous drinkers from those with more severe alcohol problems.

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Molar Pregnancy in the Emergency Department

A 15-year-old female presented to the emergency department with complaints of vaginal bleeding. She was pale, anxious, cool and clammy with tachycardic, thready peripheral pulses and hemoglobin of 2.4g/dL. Her abdomen was gravid appearing, approximately early to mid-second trimester in size. Pelvic examination revealed 2 cm open cervical os with spontaneous discharge of blood, clots and a copious amount of champagne-colored grapelike spongy material. After 2L boluses of normal saline and two units of crossmatched blood, patient was transported to the operating room. Surgical pathology confirmed a complete hydatidiform mole.

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Crowding and Delivery of Healthcare in Emergency Departments: The European Perspective

Emergency department (ED) crowding is a multifactorial problem, resulting in increased ED waiting times, decreased patient satisfaction and deleterious domino effects on the entire hospital. Although difficult to define and once limited to anecdotal evidence, crowding is receiving more attention as attempts are made to quantify the problem objectively.

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Boarder Patrol: A Reform Policy for America’s Paralyzed Emergency Departments

Author Affiliation Peter J. Bloomfied, MD, MPH Olive View-UCLA Medical Center, Department of Emergency Medicine, Sylmar, CA; Brotman Medical Center, Department of Emergency Medicine, Culver City, CA Adam B. Landman, MD, MS, MIS Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, Department of Emergency Medicine, New Haven, CT; US Department […]

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Emergency Department Patients with Psychiatric Complaints Return at Higher Rates than Controls

Author Affiliation Troy E. Madsen, MD University of Utah, Division of Emergency Medicine, Salt Lake City, UT Anne Bennett, MD University of Utah, Division of Emergency Medicine, Salt Lake City, UT Steven Groke, BSN University of Utah, Division of Emergency Medicine, Salt Lake City, UT Anne Zink, MD University of Utah, Division of Emergency […]

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Overcoming Barriers to the Use of Osteopathic Manipulation Techniques in the Emergency Department

To examine barriers to the use of OMT in the ED and provide suggestions to ameliorate these barriers.

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