Archives

Emergency Department Access

Rural Ambulatory Access for Semi-Urgent Care and the Relationship of Distance to an Emergency Department

Volume 16, Issue 4, July 2015.
Ashley Parks, MD, et al.

Availability of timely access to ambulatory care for semi-urgent medical concerns in
rural and suburban locales is unknown. Further distance to an emergency department (ED) may
require rural clinics to serve as surrogate EDs in their region, and make it more likely for these clinics
to offer timely appointments. We determined the availability of urgent (within 48 hours) access to
ambulatory care for non-established visiting patients, and assessed the effect of insurance and
ability to pay cash on a patient’s success in scheduling an appointment in rural and suburban
Eastern United States.

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Diagnostic Acumen

Norwegian Scabies

Volume 16, Issue 4, July 2015.
Patrick Burns, MD, et al.

A 48-year-old male presented with body aches and a chronic rash. He had no medical history aside from two unsuccessful treatments for presumed scabies and a recent diagnosis of psoriasis. Physical exam revealed hypotension, tachycardia, and profound, diffuse yellow crusting of the skin with erythematous erosions covering non-crusted areas. The patient was resuscitated and treated for septic shock while microscopic evaluation of scrapings of the crusted skin was performed.

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Diagnostic Acumen

Leriche Syndrome Presenting with Multisystem Vaso-Occlusive Catastrophe

Volume 16, Issue 4, July 2015.
C. Eric McCoy, MD, MPH, et al.

Leriche syndrome, also referred to as aortoiliac
occlusive disease, has been described as a triad of
claudication, impotence and decreased femoral pulses.
The syndrome results from thrombotic aortoiliac occlusion and
was first described by a French surgeon, Rene Leriche, in
1940. The disease most commonly occurs in men, and risk
factors include hypertension, diabetes, hyperlipidemia, and
smoking.

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Diagnostic Acumen

Adult Intussusception Secondary to Inflammatory Fibroid Polyp

Volume 16, Issue 4, July 2015.
Nobuhiko Kimura, MD, et al.

A 30-year-old man presented to the emergency department
for two weeks of diffuse abdominal pain and an episode of
emesis. He denied fever, prior surgery, or any other illnesses.
The patient reported going on a “crash diet regimen” one
month prior, resulting in an intentional weight loss of 25lbs in
30 days.

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Diagnostic Acumen

Open Ring Sign Diagnostic of Multiple Sclerosis in the Emergency Department

Volume 16, Issue 4, July 2015.
Nappe, DO, et al.

A 26-year-old female presented to the emergency department with a chief complaint of dizziness. Further history revealed that she was experiencing generalized weakness and intractable vomiting for three days, without complaint of abdominal pain or lower gastrointestinal symptoms. Physical examination uncovered mild dehydration with stable vital signs and non-fatigable, horizontal nystagmus consistent with internuclear opthalmoplegia.

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Diagnostic Acumen

Massive Hematochezia from Ascending Colonic Varices

Volume 16, Issue 4, July 2015.
Christian, MD, et al.

A 54-year-old man with a history of alcohol use presented with hematochezia and syncope. Upon arrival to the hospital, his bleeding had stopped. He was hemodynamically stable with hemoglobin of 11g/dL, international normalized ratio of 1.8 and platelets of 37K/mcL. Nasogastric aspirate found bilious gastric contents without blood.

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Diagnostic Acumen

Esophageal Intubation of an Infant

Volume 16, Issue 4, July 2015.
Anderson, MD, et al.

A 68-day-old former 30-week infant presented with listlessness, apnea and bradycardia. The patient was intubated for airway protection. After intubation, breath sounds were auscultated bilaterally and a Pedi-Cap carbon dioxide detector had color change from purple to yellow. A nasogastric tube (NGT) was placed and a post-procedural chest radiograph was obtained.

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Diagnostic Acumen

Prochlorperazine-Induced Hemidystonia Mimicking Acute Stroke

Volume 16, Issue 4, July 2015.
Coralic, PharmD, et al.

Prochlorperazine is frequently used in the treatment of refractory nausea and migraines. Known side effects include extrapyramidal symptoms such as akathisia and dystonia. We report a pregnant patient taking prochlorperazine for hyperemesis gravidarum who developed hemidystonia, which
triggered an acute code stroke response from prehospital, emergency medicine and neurology providers. We suspect this report to be the first case of prochlorperazine-induced hemidystonia as a stroke mimic.

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Choledochal Cyst Mimicking Gallbladder with Stones in a Six-Year-Old with Right-sided Abdominal Pain

Volume 16, Issue 4, July 2015.
Subramony, MD, et al.

Choledochal cysts are rare but serious bile duct abnormalities are found in young children, usually during the first year of life. They require urgent surgical intervention due to the risk of developing cholangiocarcinoma. Clinicians should consider this diagnosis and perform a point-of-care ultrasound (POCUS) when a child presents to the emergency department (ED) with findings of jaundice, abdominal pain, and the presence of an abdominal mass. We present the case of a six-year-old child presenting only with abdominal pain upon arrival to our ED and was ultimately diagnosed by POCUS to have a choledochal cyst.

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Point-of-care Ultrasound to Identify Distal Ulnar Artery Thrombosis: Case of Hypothenar Hammer Syndrome

Volume 16, Issue 4, July 2015
Jonathan Ken, MD, et al.

Hypothenar hammer syndrome (HHS) is a rare condition of distal ulnar artery injury and thrombosis secondary to repetitive blunt trauma to the hypothenar area. We present a case of HHS for which point-of-care ultrasound (POCUS) was used as the initial means of imaging, prompting management and disposition without further imaging studies ordered in the emergency department (ED). This case demonstrates the utility of POCUS to aid the Emergency Physician in the diagnosis and management of patients with extremity vascular issues in the ED, and details a rarely seen clinical entity in the ED.

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Importance of Decision Support Implementation in Emergency Department Vancomycin Dosing

Volume 16, Issue 4, July 2015
Brett Faine, PharmD, et al.

The emergency department (ED) plays a critical role in the management of lifethreatening infection. Prior data suggest that ED vancomycin dosing is frequently inappropriate. The objective is to assess the impact of an electronic medical record (EMR) intervention designed to improve vancomycin dosing accuracy, on vancomycin dosing and clinical outcomes in critically ill ED patients.

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Population Health Research Design

Validation of ICD-9 Codes for Stable Miscarriage in the Emergency Department

Volume 16, Issue 4, July 2015
Kelly E. Quinley, MD, et al.

International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes have not been validated for identifying cases of missed abortion where a pregnancy is no longer viable but the cervical os remains closed. Our goal was to assess whether ICD-9 code “632” for missed abortion has high sensitivity and positive predictive value (PPV) in identifying patients in the emergency department (ED) with cases of stable early pregnancy failure (EPF).

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Population Health Research Design

How do Medical Societies Select Science for Conference Presentation? How Should They?

Volume 16, Issue 4, July 2015
Thomas M. Kuczmarski, BA, et al.

Nothing has been published to describe the practices of medical societies in choosing abstracts for presentations at their annual meetings. We surveyed medical societies to determine their practices, and also present a theoretical analysis of the topic. We contacted a convenience sample of large U.S. medical conferences, and determined their approach to choosing abstracts. We obtained information from web sites, telephone, and email. Our theoretical analysis compares values-based and empirical approaches for scoring system development.

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Predictors of Linkage to Care for Newly Diagnosed HIV-Positive Adults

Volume 16, Issue 4, July 2015
Erika Aaron, MSN, et al.

Linkage to care following a human immunodeficiency virus (HIV) diagnosis is critical. In the U.S. only 69% of patients are successfully linked to care, which results in delayed receipt of
antiretroviral therapy leading to immune system dysfunction and risk of transmission to others. We evaluated predictors of failure to link to care at a large urban healthcare center in
Philadelphia in order to identify potential intervention targets.

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Differences in Presentation and Management of Pediatric Facial Lacerations by Type of Health Insurance

Volume 16, Issue 4, July 2015
Siraj Amanullah, MD, MPH, et al.

Limited data are available regarding differences in presentation and management
of pediatric emergency department (PED) patients based on insurance status. The objective of the
study was to assess the difference in management of pediatric facial lacerations based on medical
insurance status.

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Emergency Department Operations

Demographic, Operational, and Healthcare Utilization Factors Associated with Emergency Department Patient Satisfaction

Volume 16, Issue 4, July 2015.
Matthew W. Morgan, MD, et al.

The primary aim of this study was to determine which objectively-measured patient
demographics, emergency department (ED) operational characteristics, and healthcare utilization
frequencies (care factors) were associated with patient satisfaction ratings obtained from phone
surveys conducted by a third-party vendor for patients discharged from our ED.

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Education

Recommendations from the Council of Residency Directors (CORD) Social Media Committee on the Role of Social Media in Residency Education and Strategies on Implementation

Volume 16, Issue 4, July 2015
David Pearson, MD, MS, et al.

Social media (SM) is a form of electronic communication through which users create online
communities and interactive platforms to exchange information, ideas, messages, podcasts,
videos, and other user-generated content. Emergency medicine (EM) has embraced the healthcare
applications of SM at a rapid pace and continues to explore the potential benefit for education. Free
Open Access Meducation has emerged from the ever-expanding collection of SM interactions and
now represents a virtual platform for sharing educational media. This guidance document constitutes
an expert consensus opinion for best practices in the use of SM in EM residency education

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Prehospital Care

Prehospital Evaluation of Effusion, Pneumothorax, and Standstill (PEEPS): Point-of-care Ultrasound in Emergency Medical Services

Volume 16, Issue 4, July 2015
Sundeep R. Bhat, MD, et al.

In the United States, there are limited studies regarding use of prehospital ultrasound
(US) by emergency medical service (EMS) providers. Field diagnosis of life-threatening conditions
using US could be of great utility. This study assesses the ability of EMS providers and students to
accurately interpret heart and lung US images.

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Poisonings with Suicidal Intent Aged 0–21 Years Reported to Poison Centers 2003–12

Volume 16, Issue 4, July 2015
Sophia Sheikh, MD, et al.

Few studies explore the clinical features of youth suicide by poisoning. The use of both social
and clinical features of self-poisoning with suicidal intent could be helpful in enhancing existing and creating
new prevention strategies. We sought to characterize self-poisonings with suicide intent in ages 0 to 21
years reported to three regional poison control centers from 2003-2012.

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Critical Care

Approach to Management of Intravascular Missile Emboli: Review of the Literature and Case Report

Volume 16, Issue 4, July 2015
Kevin Lu, BS, et al.

Missile embolization is regarded as a rare phenomenon in the world of penetrating trauma. While figures in the world of civilian trauma do not exist, there is reason to believe that missile emboli are frequent enough to warrant the attention of any medical decision maker who cares for trauma patients.

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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: 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.