Volume 13 Issue 5 Archives - The Western Journal of Emergency Medicine

Hospital-Based Coalition to Improve Regional Surge Capacity

Introduction: Surge capacity for optimization of access to hospital beds is a limiting factor in response to catastrophic events. However, these factors may not be optimally functioning to generate an effective and efficient surge response. The objective was to improve the function of these factors.

Conclusion: The HCFP-SCPA successfully increased preparedness and surge capacity through a partnership of regional healthcare facilities and emergency response agencies.

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Injury Outcomes

Pneumothorax in a Single Lung Patient

An 80-year old man referred to the emergency department for chest pain and dyspnea on exertion reported a medical history of left pulmonary tuberculosis in babyhood, treated by therapeutic pneumothorax.This was commonly used to treat tuberculosis prior to the development of antimycobacterial agents. Successful therapeutic…

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Injury Outcomes

Occult Pneumothoraces in Acute Trauma Patients

Introduction: Many traumatic pneumothoraces (PTX) are not seen on initial chest radiograph (CR) (occult PTX) but are detected only on computed tomography (CT). The primary objective of this study was to retrospectively determine the effectiveness of CR for detecting PTX in trauma patients.

Conclusion: Factors associated with PTX on CR included air in the soft tissue on CR and size of the PTX. Even when PTX is not apparent on CR, 44% of these PTXs received placement of a chest tube.

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Intramedullary Spinal Neurocysticercosis Presenting as Brown-Sequard Syndrome

Cysticercosis is an emerging disease in the United States. Neurocysticercosis may rarely cause disease within the spinal cord, but the occurrence of such pathology can produce debilitating symptoms for patients. We present the second report in the literature of intramedullary spinal neurocysticercosis presenting with a Brown-Sequard syndrome.

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Injury Prevention

Development of a Data Collection Instrument for Violent Patient Encounters against Healthcare Workers

Introduction: Healthcare and social workers have the highest incidence of workplace violence of any industry. Our goal was to develop and evaluate an instrument for prospective collection of data relevant to emergency department (ED) violence against healthcare workers.

Conclusion: This survey instrument is the first tool shown to be accurate and reliable in characterizing acts of violence in the ED across all demographic and employment groups using filmed vignettes of violent acts. Gender and occupation of ED workers does not appear to play a significant role in perception of severity workplace violence.

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In the Soup: Caustic Ingestion from the Improper Consumption of a Self-Heating Soup

We report a case of a caustic exposure presenting to the emergency department (ED) from the improper use of a food product. The ingested substance in our case was an alkali solution used to heat the product. OnTech® Hillside made several self-heating food product canisters, such as coffee and soup containers.

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Prescription Drug Monitoring Programs and Other Interventions to Combat Prescription Opioid Abuse

The Center for Disease Control and Prevention (CDC) has published significant data and trends related to opioid prescription pain relievers (OPR). In 2008, 20,044 deaths were attributed to prescription drug overdose of which 14,800 (73.8%) were due to OPR, an amount greater than the number of overdose deaths from heroin and cocaine combined.

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How Frequently are “Classic” Drug-Seeking Behaviors Used by Drug-Seeking Patients in the Emergency Department?

Introduction: Drug-seeking behavior (DSB) in the emergency department (ED) is a very common problem, yet there has been little quantitative study to date of such behavior. The goal of this study was to assess the frequency with which drug seeking patients in the ED use classic drug seeking behaviors to obtain prescription medication.

Conclusion: Drug-seeking patients appear to exhibit “classically” described drug-seeking behaviors with only low to moderate frequency. Reliance on historical features may be inadequate when trying to assess whether or not a patient is drug-seeking.

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Factors Influencing Emergency Department Preference for Access to Healthcare

Introduction: African-Americans are more likely than Caucasians to access healthcare through the emergency department (ED); however, the reasons behind this pattern are unclear. The objective is to investigate the effect of race, insurance, socioeconomic status, and perceived health on the preference for ED use.

Conclusion: African-Americans, independent of health insurance, are more likely than Caucasians to designate the ED as their routine place of healthcare.

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Prehospital Care

Comparison of Prehospital Glucose with or without IV Thiamine

Introduction: Loading of thiamine prior to glucose administration during hypoglycemia to prevent Wernicke’s encephalopathy is routine in the prehospital setting. To date no study has looked at the validity of this therapy.

Conclusion: To our knowledge this is the first study in the literature which evaluated the use of thiamine with glucose to prevent Wernicke’s encephalopathy in the prehospital setting. We found that routine administration of thiamine with glucose did not result in differences in respiratory rate, systolic blood pressure, GCS or ED hospital discharge rates. Until further research is done to validate our results emergency medical services leadership should consider whether the routine use of thiamine in the prehospital setting is appropriate for their system.

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Patient Communication

Urine Collection in the Emergency Department: What Really Happens in There?

Introduction: In women with suspected urinary tract infection (UTI), a non-contaminated voided specimen is considered important for valid urinalysis and culture results. We assess whether midstream parted-labia catch (MSPC) instructions were provided by nurses, understood, and performed correctly, according to the patient.

Conclusion: In this ED, instructions for MSPC urine collection frequently were not given, despite a nursing protocol, and patients rarely performed the essential steps. An evidence-based approach to urine testing in the ED that considers urine collection technique, is needed.

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Quantitative Brain Electrical Activity in the Initial Screening of Mild Traumatic Brain Injuries

Introduction: The incidence of emergency department (ED) visits for Traumatic Brain Injury (TBI) in the United States exceeds 1,000,000 cases/year with the vast majority classified as mild (mTBI). Using existing computed tomography (CT) decision rules for selecting patients to be referred for CT, such as the New Orleans Criteria (NOC), approximately 70% of those scanned are found to have a negative CT. This study investigates the use of quantified brain electrical activity to assess its possible role in the initial screening of ED mTBI patients as compared to NOC.

Conclusion: The hand-held EEG device with a limited frontal montage is applicable to the ED environment and its performance was superior to that obtained using the New Orleans criteria. This study suggests a possible role for an index of brain function based on EEG to aid in the acute assessment of mTBI patients.

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Healthcare Utilization

Value of Mandatory Screening Studies in Emergency Department Patients Cleared for Psychiatric Admission

Introduction: Laboratory and radiographic studies are often required by psychiatric services prior to admitting emergency patients who are otherwise deemed medically stable. Such testing may represent an unnecessary expense that prolongs emergency department stays without significantly improving care. This study determines the prevalence of such testing and how often it leads to changes in care.

Conclusion: Ancillary testing beyond what is required for medical clearance of psychiatric emergency patients rarely alters care. Policies that require panels of testing prior to psychiatric admission are costly and appear to be unnecessary.

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Healthcare Utilization

Does Limiting Oral Contrast Decrease Emergency Department Length of Stay?

Introduction: The purpose of this study was to examine the impact on emergency department (ED) length of stay (LOS) of a new protocol for intravenous (IV)-contrast only abdominal/pelvic computed tomography (ABCT) compared to historical controls.

Conclusion: Implementation of an IV-contrast only ABCT prep for select ED patients presenting for evaluation of acute abdominal pain significantly decreased ED LOS.

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