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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Patient satisfaction is an important measure of emergency department (ED) quality of care. Little is known about providers’ ability to estimate patient satisfaction. We aimed to measure providers’ ability to assess patient satisfaction and hypothesized that providers could accurately estimate overall patient satisfaction.
Sports medicine (SM) is a clinical subspecialty concerned with the diagnosis and treatment of injuries and illnesses sustained both in and out of the athletic arena. Historically, orthopedic surgeons provided the bulk of care for the athlete. Since the majority of issues with athletes are nonoperative musculoskeletal injuries, traumatic brain injuries, or general medical conditions, primary care providers have developed…
In the last several decades, South Korea has rapidly adopted Western customs and practices. Yet, cultural differences between South Korea and the United States exist. The purpose of this study was to identify and characterize potential cultural differences in the Korean and US institutional review board (IRB) approach to certain topics.
To survey emergency physicians (EP) regarding the frequency of use of ultrasound guidance for placement of central venous catheters (UGCVC) and to assess their perceptions regarding the technique and barriers to its implementation.
Children presenting to the emergency department with hip pain and fever are at risk for significant morbidity due to septic arthritis. Distinguishing between septic arthritis and other causes of hip pain may be challenging. Sonographic visualization of the hip with real-time ultrasound-guided arthrocentesis may allow faster differentiation between etiologies, hastening definitive therapy and improving analgesia. This report describes the use of hip sonography in a case of Lyme arthritis. The authors review the medical literature in support of bedside hip sonography and discuss how to perform ultrasound-guided hip arthrocentesis. Clinical findings in septic and Lyme arthritis are also described.
Typically, clinicians think of ectopic pregnancies as occurring outside of the uterus. This case is important in underscoring the fact that there are variants of ectopic pregnancies that exist within the uterus. One classic type is the cornual ectopic pregnancy, which occurs in a congenital bicornate uterus. The shape of this uterus may allow for implantation to occur high in one of the cornual limbs.
Pleural effusions are a common finding in emergency departments, with cytologic analysis traditionally required for definitive diagnosis. This article describes a classic sonographic appearance of tuberculous pleural effusion.
Thoracostomy tubes (TT) are commonly placed in the management of surgical, emergency, and trauma patients and chest radiographs (CXR) and computed tomography (CT) are performed to confirm placement. Ultrasound (US) has not previously been used as a means to confirm intrathoracic placement of chest tubes. This study involves a novel application of US to demonstrate chest tubes passing through the pleural line, thus confirming intrathoracic placement.
Emergency physicians (EP) frequently estimate blood loss, which can have implications for clinical care. The objectives of this study were to examine EP accuracy in estimating blood loss on different surfaces and compare attending physician and resident performance.
This case demonstrates that the potential use of bedside ultrasound by emergency physicians can be a rapid and helpful diagnostic tool in differentiating an uncomplicated infectious condition, mastitis, from more complex pathology, such as breast cancer, that was ultimately diagnosed in this patient.
This report presents data and summarizes the evidence on poisoning mortality by demographic and geographic characteristics to describe the burden of poisoning mortality and the differences among sub-populations in the U.S. for a 5-year period.
The purpose of this study was to examine racial/ethnic disparities in being forced to havesexual intercourse against one’s will, and the effect of substance use on these disparities.
ntimate Partner Violence (IPV) is a major public health issue occurring in the United States and globally. While little is known in general about IPV, understanding about the prevalence of physical IPV among gay men is even more obscure. There is a clear disparity in violence research attention focused on this vulnerable segment of society.