Needle Decompression in Appalachia Do Obese Patients Need Longer Needles?

Needle decompression of a tension pneumothorax can be a lifesaving procedure. It requires an adequate needle length to reach the chest wall to rapidly remove air. With adult obesity exceeding one third of the United States population in 2010, we sought to evaluate the proper catheter length that may result in a successful needle decompression procedure. Advance Trauma Life Support (ATLS) currently recommends a 51 millimeter (mm) needle, while the needles stocked in our emergency department are 46 mm. Given the obesity rates of our patient population, we hypothesize these needles would not have a tolerable success rate of 90%.

WestJEM Read More

Emergency Department Operations

Perception of Noise by Emergency Department Nurses

Volume 14, Issue 5, September 2013
John Graneto, DO, MEd, et al.

Noise in the emergency department (ED) may be perceived to be high by both patients and nurses alike. This increased noise level is hypothesized to be responsible for communication interference and subsequent disruption of complex procedures and decision-making. The objective of this study is to quantify ambient noise level in an ED while obtaining coincident subjective surveys from nurses in the assessment of actual versus perceived noise.

WestJEM Read More

Practice Variability

Warming Intravenous Fluids for Improved Patient Comfort in the Emergency Department: A Pilot Crossover Randomized Controlled Trial

Author Affiliation Wesley H. Self, MD, MPH  Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, Tennessee Steven J. White, MD  Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, Tennessee Candace D. McNaughton, MD, MPH  Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, Tennessee Alan B. Storrow, MD  Vanderbilt University […]

WestJEM Read More

Emergency Department Access

Need for Intervention in Families Presenting to the Emergency Department with Multiple Children as Patients

Author Affiliation Jesus Lemus, MD  Keck School of Medicine, University of Southern California, Department of Emergency Medicine, Los Angeles, California Melissa Chacko, MD  Keck School of Medicine, University of Southern California, Department of Emergency Medicine, Los Angeles, California Ilene Claudius, MD  Keck School of Medicine, University of Southern California, Pediatric Emergency Medicine Division, Los Angeles, […]

WestJEM Read More

Emergency Physicians’ Knowledge of Cannabinoid Designer Drugs

Author Affiliation Patrick M. Lank, MD  Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois Elizabeth Pines, MD  Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois Mark B. Mycyk, MD  Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois Introduction Methods Results Discussion Limitations Conclusion […]

WestJEM Read More

Sexual Assault Training in Emergency Medicine Residencies: A Survey of Program Directors

Author Affiliation Margaret K. Sande, MD, MS  Denver Health & Hospital Authority, Denver, Colorado University of Colorado, Aurora, Colorado Kerry B. Broderick, MD  Denver Health & Hospital Authority, Denver, Colorado University of Colorado, Aurora, Colorado Maria E. Moreira, MD  Denver Health & Hospital Authority, Denver, Colorado University of Colorado, Aurora, Colorado Brooke Bender, MPH  Denver […]

WestJEM Read More

An Examination of Bullying in Georgia Schools: Demographic and School Climate Factors Associated with Willingness to Intervene in Bullying Situations

Introduction: The purpose of this study is to examine the associations between demographic characteristics, school climate and psychosocial factors, and willingness to intervene in a bullying situation among middle and high school students in Georgia.

Conclusion: These findings, while preliminary, indicate that girls, students who are white, and students who experience a relatively positive school climate and adaptive psychosocial factors are more likely to report that they would intervene in bullying situations. These findings may guide how bullying is addressed in schools and underscore the importance of safe school climates.

WestJEM Read More

Rapid 13C Urea Breath Test to Identify Helicobacter pylori Infection in Emergency Department Patients with Upper Abdominal Pain

Introduction: We sought to estimate the prevalence of H. pylori infection in symptomatic patients using a convenience sample at a single urban academic ED and demonstrate the feasibility of ED-based testing.
Conclusion: In our ED, H. pylori infection was present in 1 in 4 patients with epigastric pain, and testing with a UBT was feasible. Further study is needed to determine the risk factors associated with infection, the prevalence of H. pylori in other EDs, the effect of the test on ED length of stay and the costeffectiveness of an ED-based test-and-treat strategy.

WestJEM Read More

Multimedia Education Increases Elder Knowledge of Emergency Department Care

Introduction: The purpose of this study was to evaluate a multi-media education intervention as a method for informing independently living elders about ED care. The program delivered messages categorically as, the number of tests, providers, decisions and disposition decision making.
Conclusion: A short video with graphic side-bar information is an effective educational strategy to improve elder understanding of expectations during a hypothetical ED encounter following calling 911.

WestJEM Read More

Increase in Non-Contrast Computerized Tomography Scans of the Head Following Popular Media Stories About Head Injury

Introduction: On March 18, 2009, actress Natasha Richardson died after a head injury. It is possible that the rate of patients presenting with mild head injury and receiving computed tomographies (CTs) may have been influenced by the Richardson event. We hypothesized that there was a statistically significant increase in the rate of census-adjusted head CTs performed for mild trauma after March 16, 2009, compared to prior to this date.

Conclusion: The percentage of all ED patients seen with mild trauma tested with head CT almost doubled when comparing the pre-Richardson accident vs. post time periods. There was an increase in media reports of the accident that occurred rapidly after the event and peaked on day 3.

WestJEM Read More

Grade III or Grade IV Hypertensive Retinopathy with Severely Elevated Blood Pressure

Introduction: Hypertensive retinopathy describes a spectrum of retinal changes in patients with elevated blood pressure (BP).We examined risk factors for grade III/IV hypertensive retinopathy among patients with hypertensive urgency in the emergency department (ED) and compared healthcare utilization and mortality between patients with and without grade III/IV hypertensive retinopathy.

Conclusion:Younger patients may be at higher risk for grade III/IV hypertensive retinopathy among patients with hypertensive urgency. Chronic compensatory mechanisms may have not yet developed in these younger patients. Alternatively, older patients with retinopathy may be underrepresented secondary to increased mortality among these patients at a younger age (survivorship bias).

WestJEM Read More

Emergency Physician Estimation of Blood Loss

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.

WestJEM Read More

Ed Administration

Physician Assistants Contribution to Emergency Department Productivity

The objective of this report is to determine physician assistant (PA) productivity in an academic emergency department (ED) and to determine whether shift length or department census impact productivity.

WestJEM Read More

Ed Administration

Patient and Physician Willingness to Use Personal Health Records in the Emergency Department

Patient care in the emergency department (ED) is often complicated by the inability to obtain an accurate prior history even when the patient is able to communicate with the ED staff. Personal health records (PHR) can mitigate the impact of such information gaps. This study assesses ED patients’ willingness to adopt a PHR and the treating physicians’ willingness to use that information.

WestJEM Read More

Ileus and Small Bowel Obstruction in an Emergency Department Observation Unit: Are There Outcome Predictors?

The purpose of our study was to describe the evaluation and outcome of patients with ileus and bowel obstruction admitted to an emergency department (ED) observation unit (OU) and to identify predictors of successful management for such patients.

WestJEM Read More

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.

WestJEM Read More

Implication and Approach to Incidental Findings in Live Ultrasound Models

Incidental findings during ultrasound examinations occur frequently with live models in training sessions. Because of the broad scope of training sessions available, the ethics and guidelines of dealing with incidental findings in live models need to be discussed.

WestJEM Read More

Simulation in Medical Student Education: Survey of Clerkship Directors in Emergency Medicine

The objective of this study is to identify (1) the current role of simulation in medical student emergency medicine (EM) education; (2) the challenges to initiating and sustaining simulation-based programs; and (3) educational advances to meet these challenges.

WestJEM Read More

Rapid Sequence Intubation from the Patient’s Perspective

This study assesses the efficacy of the rapid sequence intubation (RSI) protocol in preventing patient recollection of resuscitative events and patient discomfort during intubation, as subjectively determined by the patient.

WestJEM Read More

Intimate Partner Violence and Sexual Risk-taking among Men Who Have Sex with Men in South Africa

A growing body of literature suggests that men who have sex with men (MSM) represent a high risk group for human immunodeficiency virus (HIV) infection in Africa, but are often overlooked in the development of HIV interventions and programming. Little attention has been paid to the presence of intimate partner violence (IPV) among MSM in African settings. This paper examines reporting of IPV among a sample of predominantly white, gay internet-recruited MSM in South Africa and examines associations between IPV and sexual risk-taking.

WestJEM Read More

Associations between Electronic Media Use and Involvement in Violence, Alcohol and Drug Use among United States High School Students

We identified associations between time spent watching television and time spent playing video or computer games or using computers and involvement in interpersonal violence, alcohol and drug use in a nationally representative sample of United States high school students.

WestJEM Read More

Pre-Teen Alcohol Use as a Risk Factor for Victimization and Perpetration of Bullying among Middle and High School Students in Georgia

We examined the association between pre-teen alcohol use initiation and the victimization and perpetration of bullying among middle and high school students in Georgia.

WestJEM Read More

Suicide Fads: Frequency and Characteristics of Hydrogen Sulfide Suicides in the United States

To assess the frequency of hydrogen sulfide (H2S) suicides and describe the characteristics of victims in the United States (U.S.) since the technique became common in Japan in 2007.

WestJEM Read More

Intentional Ethylene Glycol Poisoning Increase after Media Coverage of Antifreeze Murders

The media can have a profound impact on human behavior. A sensational murder by ethylene glycol (EG) poisoning occurred in our state. The regional media provided extensive coverage of the murder. We undertook this investigation to evaluate our incidence of EG poisoning during the timeframe of before the first report linking a death to ethylene glycol to shortly after the first murder trial.

WestJEM Read More

Injury Secondary to Antiretroviral Agents: Retrospective Analysis of a Regional Poison Center Database

Poisoning is an increasingly important cause of injury in the United States. In 2009 poison centers received 2,479,355 exposure reports, underscoring the role of poison centers in intentional and unintentional injury prevention. Antiretroviral (ARV) agents are commonly prescribed drugs known to cause toxicity, yet the frequency of these incidents is unknown. The objectives of this study were to quantify the number of reported cases of toxicity secondary to ARV agents at a regional poison center, and to describe the circumstances and clinical manifestations of these poisonings.

WestJEM Read More

Targeted Needs Assessment of Off-service Residents in Emergency Medicine

The purpose of this study is to evaluate the needs of internal medicine residents rotating through the emergency department (ED).

WestJEM Read More