Archives

Critical Care

Posterior Reversible Encephalopathy Syndrome in the Emergency Department: Case Series and Literature Review

Volume 16, Issue 1, January 2015
Ryan J. Thompson, MD et al.

Posterior Reversible Encephalopathy Syndrome (PRES) often has variable presentations and causes, with common radiographic features—namely posterior white matter changes on magnetic resonance (MRI). As MRI becomes a more frequently utilized imaging modality in the Emergency Department, PRES will become an entity that the Emergency Physician must be aware of and be able to diagnose.

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Anticoagulation Drug Therapy: A Review

Volume 16, Issue 1, January 2015
Katherine Harter, MD et al.

Historically, most patients who required parenteral anticoagulation received heparin, whereas those patients requiring oral anticoagulation received warfarin. Due to the narrow therapeutic index and need for frequent laboratory monitoring associated with warfarin, there has been a desire to develop newer, more effective anticoagulants.

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Population Health Research Design

Feasibility of Tablet Computer Screening for Opioid Abuse in the Emergency Department

Volume 16 Issue 1, January 2015
Scott G. Weiner, MD, MPH et al.

Tablet computer-based screening may have the potential for detecting patients at risk for opioid abuse in the emergency department (ED). Study objectives were a) to determine if the revised Screener and Opioid Assessment for Patients with Pain (SOAPP®-R), a 24-question previously paper-based screening tool for opioid abuse potential, could be administered on a tablet computer to an ED patient population; b) to demonstrate that >90% of patients can complete the electronic screener without assistance in <5 minutes and; c) to determine patient ease of use with screening on a tablet computer.

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Discrepancy Between Clinician and Research Assistant in TIMI Score Calculation (TRIAGED CPU)

Volume 16 , Issue 1, January 2015
Brian T. Taylor, DO et al.

Several studies have attempted to demonstrate that the Thrombolysis in Myocardial Infarction (TIMI) risk score has the ability to risk stratify emergency department (ED) patients with potential acute coronary syndromes (ACS). Most of the studies we reviewed relied on trained research investigators to determine TIMI risk scores rather than ED providers functioning in their normal work capacity.

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Emergency Department Operations

Waiting for Triage: Unmeasured Time in Patient Flow

Volume 16, Issue 1, January 2015
Christopher Houston, MD et al.

The Centers for Medicare and Medicaid Services (CMS) requires reporting of multiple time-sensitive metrics. Most facilities use triage time as the time of arrival. Little is known about how long patients wait prior to triage. As reimbursement to the hospital may be tied to these metrics, it is essential to accurately record the time of arrival.

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Routine Repeat Head CT may not be Indicated in Patients on Anticoagulant/Antiplatelet Therapy Following Mild Traumatic Brain Injury

Volume 16, Issue 1, January 2015
Kevin C. McCammack, MD

Evaluation recommendations for patients on anticoagulant and antiplatelet (ACAP) therapy that present after mild traumatic brain injury (TBI) are controversial. At our institution, an initial noncontrast head computed tomography (HCT) is performed, with a subsequent HCT performed six hours later to exclude delayed intracranial hemorrhage (ICH).

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Prescription Drug Monitoring Programs: Examining Limitations and Future Approaches

Volume 16, Issue 1, January 2015
Christopher A. Griggs, MD, MPH et al.

Prescription drug abuse is a leading cause of accidental death in the United States. Prescription drug monitoring programs (PDMPs) are a popular initiative among policy makers and a key tool to combat the prescription drug epidemic. This editorial discusses the limitations of PDMPs, future approaches needed to improve the effectiveness of PDMPs, and other approaches essential to curbing the rise of drug abuse and overdose.

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Predictors of Psychiatric Boarding in the Emergency Department

Volume 16, Issue 1, January 2015
Ryan K. Misek, DO et al.

The emergency psychiatric care is system is overburdened in the United States. Patients experiencing psychiatric emergencies often require resources not available at the initial treating facility and frequently require transfer to an appropriate psychiatric facility.

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Polysubstance Abuse: Alcohol, Opioids and Benzodiazepines Require Coordinated Engagement by Society, Patients, and Physicians

Volume 16, Issue 1, January 2015
Uzor C. Ogbu, MD, PhD et al.

The Centers for Disease Control and Prevention (CDC) has published significant data trends related to substance abuse involving opioid pain relievers (OPR), benzodiazepines and alcohol in the United States. The CDC describes opioid misuse and abuse as an epidemic, with the use of OPR surpassing that of illicit drugs.

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Healthcare Utilization

Factors Associated with Decision to Hospitalize Emergency Department Patients with Skin and Soft Tissue Infection

Volume 16, Issue 1, January 2015
David A. Talan, MD et al.

Emergency department (ED) hospitalizations for skin and soft tissue infection (SSTI) have increased, while concern for costs has grown and outpatient parenteral antibiotic options have expanded. To identify opportunities to reduce admissions, we explored factors that influence the decision to hospitalize an ED patient with a SSTI.

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Healthcare Utilization

Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need

Volume 16, Issue 1, January 2015
Mark Faul, PhD, MA et al.

The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care.

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Healthcare Utilization

American Academy of Pediatrics 2014 Bronchiolitis Guidelines: Bonfire of the Evidence

Volume 16, Issue 1, January 2015
Paul Walsh, MD, MSc et al.

The American Academy of Pediatrics (AAP) 2014 Bronchiolitis guidelines (the guidelines) were recently published in the official journal of the AAP, Pediatrics. The committee that wrote the guidelines anticipates that these will form the basis of bronchiolitis treatment throughout the house of medicine, not just in pediatricians’ offices.

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Education

Objective Structured Clinical Examinations Provide Valid Clinical Skills Assessment in Emergency Medicine Education

Volume 16, Issue 1, January 2015
Joshua Wallenstein, MD et al.

Evaluation of emergency medicine (EM) learners based on observed performance in the emergency department (ED) is limited by factors such as reproducibility and patient safety. EM educators depend on standardized and reproducible assessments such as the objective structured clinical examination (OSCE).

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Education

Educational Technology Improves ECG Interpretation of Acute Myocardial Infarction among Medical Students and Emergency Medicine Residents

Volume 16, Issue 1, January 2015
Ali Pourmand, MD et al.

Asynchronous online training has become an increasingly popular educational format in the new era of technology-based professional development. We sought to evaluate the impact of an online asynchronous training module on the ability of medical students and emergency medicine (EM) residents to detect electrocardiogram (ECG) abnormalities of an acute myocardial infarction (AMI).

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Education

Ultrafest: A Novel Approach to Ultrasound in Medical Education Leads to Improvement in Written and Clinical Examinations

Volume 16, Issue 1, January 2015
Kiah Connolly, MD et al.

Our objective was to evaluate the effectiveness of hands-on training at a bedside ultrasound (US) symposium (“Ultrafest”) to improve both clinical knowledge and image acquisition skills of medical students. Primary outcome measure was improvement in multiple choice questions on pulmonary or Focused Assessment with Sonography in Trauma (FAST) US knowledge. Secondary outcome was improvement in image acquisition for either pulmonary or FAST.

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Diagnostic Acumen

13-Year-Old with Cryptic Abdominal Pain

Volume 16, Issue 1, January 2015
Stephanie Spring, DO et al.

A 13-year old female patient presented to the emergency department (ED) with four days of intermittent non-radiating, left upper quadrant pain, associated with non-bloody, non-bilious emesis and decreased appetite. The patient had been evaluated by a gastroenterologist three months prior for abdominal pain.

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Diagnostic Acumen

Complications of New Medications

Volume 16, Issue 1, January 2015
Carlos J. Roldan, MD et al.

Numerous mandibular pathologies are diagnosed in the emergency department (ED). We present the case of a woman with severe right-sided mandibular pain who was found to have a pathological fracture and osteonecrosis of the jaw (ONJ).

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

333 The City Blvd. West, Rt 128-01
Suite 640
Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: westjem@gmail.com

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WestJEM
ISSN: 1936-900X
e-ISSN: 1936-9018

CPC-EM
ISSN: 2474-252X

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.