Current Issue: Volume 22 Issue 4 Archives - The Western Journal of Emergency Medicine

Risk Factors of Fall-Related Emergency Department Visits by Fall Location of Older Adults in the US

Kelekar, U.

Prior evidence indicates that predictors of older adult falls vary by indoor-outdoor location of the falls. While a subset of United States’ studies reports this finding using primary data from a single geographic area, other secondary analyses of falls across the country do not distinguish between the two fall locations. Consequently, evidence at the national level on risk factors specific to indoor vs outdoor falls is lacking.

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Endemic Infections

Emergency Department-initiated High-flow Nasal Cannula for COVID-19 Respiratory Distress

Jarou, ZJ.

Patients with coronavirus disease 2019 (COVID-19) can develop rapidly progressive respiratory failure. Ventilation strategies during the COVID-19 pandemic seek to minimize patient mortality. In this study we examine associations between the availability of emergency department (ED)-initiated high-flow nasal cannula (HFNC) for patients presenting with COVID-19 respiratory distress and outcomes, including rates of endotracheal intubation (ETT), mortality, and hospital length of stay.

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Clinical, Operational, and Socioeconomic Analysis of EMS Bypass of the Closest Facility for Pediatric Asthma Patients

Finlay, E.

Pediatric hospital care is becoming increasingly regionalized, with fewer facilities providing inpatient care for common conditions such as asthma. That trend has major implications for emergency medical services (EMS) medical care and operations because EMS historically transports patients to the closest facility. This study describes EMS transport patterns of pediatric asthma patients in greater depth, including an analysis of facility bypass rates and the association of bypass with demographics and clinical outcomes.

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Evaluating Reproducibility and Transparency in Emergency Medicine Publications

Johnson, BS.

We aimed to assess the reproducibility of empirical research by determining the availability of components required for replication of a study, including materials, raw data, analysis scripts, protocols, and preregistration.

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A Review of COVID-19-Related Publications and Lag Times During the First Six Months of the Year 2020

Carvalho, CJ.

Considering the need for information regarding approaches to prevention and treatment of coronavirus disease 2019 (COVID-19), we sought to determine publication lag times of COVID-19-related original research articles published in top general medicine and emergency medicine (EM) journals. We further sought to characterize the types of COVID-19 publications within these journals.

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The FAST VIP (First Aid for Severe Trauma “Virtual” in-Person) Educational Study

Goolsby, CA.

Trauma is the leading cause of death for young Americans. Increased school violence, combined with an emphasis on early hemorrhage control, has boosted demand to treat injuries in schools. Meanwhile, coronavirus disease 2019 (COVID-19) has made educating the public about trauma more difficult. A federally funded high school education program in development, called First Aid for Severe Trauma™ (FAST™), will teach students to aid the severely injured. The program will be offered in instructor-led, web-based, and blended formats. We created a program to prepare high school teachers to become FAST instructors via “virtual” in-person (VIP) instruction. We used a webinar followed by VIP skills practice, using supplies shipped to participants’ homes. To our knowledge, no prior studies have evaluated this type of mass, widely distributed, VIP education.

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Management of Minor Traumatic Brain Injury in an ED Observation Unit

Wheatley, MA.

Traumatic intracranial hemorrhages (TIH) have traditionally been managed in the intensive care unit (ICU) setting with neurosurgery consultation and repeat head CT (HCT) for each patient. Recent publications indicate patients with small TIH and normal neurological examinations who are not on anticoagulation do not require ICU-level care, repeat HCT, or neurosurgical consultation. It has been suggested that these patients can be safely discharged home after a short period of observation in emergency department observation units (EDOU) provided their symptoms do not progress.

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Descriptive Analysis of Components of Emergency Medicine Residency Program Websites

Pollock, JR.

Most emergency medicine (EM) applicants use the internet as a source of information when evaluating residency programs. Previous studies have analyzed the components of residency program websites; however, there is a paucity of information regarding EM program websites. The purpose of our study was to analyze information on EM residency program websites.

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A Novel, Low-cost, Low-fidelity Pericardiocentesis Teaching Model

Lord, S.

Pericardiocentesis is a high-risk/low-frequency procedure important to emergency medicine (EM). However, due to case rarity it is not often performed on a patient during residency training. Because the coronavirus disease 2019 pandemic limited cadaver-based practice, we developed a novel, low-cost, low-fidelity pericardiocentesis model using three dimensional-printing technology to provide advances on prior home-made models.

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The Role of Gender in Nurse-Resident Interactions: A Mixed-methods Study

Manchanda, ECC.

The role of gender in interprofessional interactions is poorly understood. This mixed-methods study explored perceptions of gender bias in interactions between emergency medicine (EM) residents and nurses.

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Cross-sectional Analysis of Food Insecurity and Frequent Emergency Department Use

Estrella, A.

Emergency department (ED) patients have higher than average levels of food insecurity. We examined the association between multiple measures of food insecurity and frequent ED use in a random sample of ED patients.

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Perceptions of Emergency Care by Sexual and Gender Minorities in Colorado: Barriers, Quality, and Factors Affecting Identity Disclosure

LaPlant, WG.

Expanding on data concerning emergency department (ED) use and avoidance by the sexual minority (those who identify as lesbian, gay, bisexual, queer, other [LGTBQ+]) and gender minority (those who identify as transgender, gender nonconforming, other) community may inform future ED LGTBQ+ training and clinical practice. Investigation objectives included characterizing rates of emergency care avoidance, identifying barriers to emergency care, and assessing emergency care quality and cultural competency for sexual and gender minorities.

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Racial Discrimination from Patients: Institutional Strategies to Establish Respectful Emergency Department Environments

Chary, AN.

Social identity-based discrimination from patients against healthcare providers is a prevalent and well- documented phenomenon. Numerous studies and essays detail clinicians’ experiences of slurs, harassment, and violence from patients based on racial identity. In this essay, we advance arguments about how emergency departments (ED) should respond to interpersonal racism from patients. We use an anthropological definition of race as a socially constructed way of categorizing humans based on perceived physical traits, such as skin and hair color.9 However, race does not have an inherent biological or genetic basis: there is greater physical and genetic variation within racial groups than between them, and racial categories vary across societies. Rather, race is assigned in ways that afford privilege, wealth, and power to some, while disadvantaging others.

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An Assessment of the Social Determinants of Health in an Urban Emergency Department

Ordonez, E.

Social determinants of health (SDOH) have significant impacts on patients who seek care in the emergency department (ED). We administered a social needs screening tool and needs assessment survey to assess SDOH and evaluate for trends in the population of patients visiting our ED.

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Emergency Department Operations

The Effects of Implementing a “Waterfall” Emergency Physician Attending Schedule

Spiegelman, L.

Increases in emergency department (ED) crowding and boarding are a nationwide issue resulting in worsening patient care and throughput. To compensate, ED administrators often look to modifying staffing models to improve efficiencies.

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Emergency Department Operations

Are Smaller Emergency Departments More Prone to Volume Variability?

Nourazari, S.

Daily patient volume in emergency departments (ED) varies considerably between days and sites. Although studies have attempted to define “high-volume” days, no standard definition exists. Furthermore, it is not clear whether the frequency of high-volume days, by any definition, is related to the size of an ED. We aimed to determine the correlation between ED size and the frequency of high-volume days for various volume thresholds, and to develop a measure to identify high-volume days.

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Critical Care

Comparing Drugs for Out-of-hospital, Shock-refractory Cardiac Arrest: Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Srisurapanont, K.

The benefit of medications used in out-of-hospital, shock-refractory cardiac arrest remains controversial. This study aims to compare the treatment outcomes of medications for out-of-hospital, shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT).

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Critical Care

Utilization of Point-of-care Echocardiography in Cardiac Arrest: A Cross-sectional Pilot Study

Wolfe, Y.

Point-of-care (POC) echocardiography (echo) is a useful adjunct in the management of cardiac arrest. However, the practice pattern of POC echo utilization during management of cardiac arrest cases among emergency physicians (EP) is unclear. In this pilot study we aimed to characterize the utilization of POC echo and the potential barriers to its use in the management of cardiac arrest among EPs.

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Emergency Department Operations

Impact of a Novel Emergency Department Forward Treatment Area During the New York City COVID-19 Surge

Moskovitz, JB.

Coronavirus disease 2019 (COVID-19) caused a disproportionate number of patients to seek emergency care at hospitals in New York City (NYC) during the initial crisis. Our urban emergency department (ED), a member of the NYC public hospital system had to process the increased volume while also differentiating our patients’ critical needs. We established a forward treatment area (FTA) directly in front of the ED to accomplish these goals from March 23–April 16, 2020.

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Emergency Department Operations

Impact of Coronavirus Disease 2019 Pandemic on Crowding: A Call to Action for Effective Solutions to “Access Block”

Savioli, G.

Healthcare patterns change during disease outbreaks and pandemics. Identification of modified patterns is important for future preparedness and response. Emergency department (ED) crowding can occur because of the volume of patients waiting to be seen, which results in delays in patient assessment or treatment and impediments to leaving the ED once treatment is complete. Therefore, ED crowding has become a growing problem worldwide and represents a serious barrier to healthcare operations.

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Emergency Department Operations

The Impact of COVID-19 Pandemic on Emergency Department Visits at a Canadian Academic Tertiary Care Center

Kwok, ESH.

Public health response to the coronavirus 2019 (COVID-19) pandemic has emphasized social distancing and stay-at-home policies. Reports of decreased emergency department (ED) visits in non-epicenters of the outbreak have raised concerns that patients with non-COVID-19 emergencies are delaying or avoiding seeking care. We evaluated the impact of the pandemic on ED visits at an academic tertiary care center.

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Emergency Department Operations

Reduction in Emergency Department Presentations in a Regional Health System during the Covid-19 Pandemic

Mann, E.

Nationally, there has been more than a 40% decrease in Emergency Department (ED) patient volume during the coronavirus disease 2019 (Covid-19) crisis, with reports of decreases in presentations of time-sensitive acute illnesses. We analyzed ED clinical presentations in a Maryland/District of Columbia regional hospital system while health mitigation measures were instituted.

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Critical Care

Quality Improvement Initiative to Increase Rate of and Time to Post-intubation Analgesia in the Emergency Department

Imhoff, B.

Intubation and mechanical ventilation are common interventions performed in the emergency department (ED). These interventions cause pain and discomfort to patients and necessitate analgesia and sedation. Recent trends in the ED and intensive care unit focus on an analgesia-first model to improve patient outcomes. Initial data from our institution demonstrated an over-emphasis on sedation and an opportunity to improve analgesic administration. As a result of these findings, the ED undertook a quality improvement (QI) project aimed at improving analgesia administration and time to analgesia post-intubation.

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Critical Care

Randomised Controlled Trial Assessing Head Down Deep Breathing Method Versus Modified Valsalva Manoeuvre for Treatment of Supraventricular Tachycardia in the Emergency Department

Lim, HC.

Supraventricular tachycardia (SVT) is commonly encountered in the emergency department (ED). Vagal manoeuvres are internationally recommended therapy in stable patients. The head down deep breathing (HDDB) technique was previously described as an acceptable vagal manoeuvre, but there are no studies comparing its efficacy to other vagal manoeuvres. Our objective in this study was to compare the rates of successful cardioversion with HDDB and the commonly practiced, modified Valsalva manoeuvre (VM).

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Critical Care

Effectiveness of Mechanical Chest Compression Devices over Manual Cardiopulmonary Resuscitation: A Systematic Review with Meta-analysis and Trial Sequential Analysis

Sheraton, M.

Our goal was to systematically review contemporary literature comparing the relative effectiveness of two mechanical compression devices (LUCAS and AutoPulse) to manual compression for achieving return of spontaneous circulation (ROSC) in patients undergoing cardiopulmonary resuscitation (CPR) after an out-of-hospital cardiac arrest (OHCA).

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Response to “Misunderstanding the Match: Do Students Create Rank Lists Based on True Preferences?”

Schnapp, BH.

We agree fully that “reciprocal liking” may be an important causal factor behind some of the mismatch between student behavior and theoretically ideal Match behavior. Indeed, it likely explains why programs and applicants go out of their way to communicate liking for one another despite official National Resident Matching Program (NRMP) policy discouraging communications…

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