Original Research Archives - Page 16 of 40 - The Western Journal of Emergency Medicine

3 for the Price of 1: Teaching Chest Pain Risk Stratification in a Multidisciplinary, Problem-based Learning Workshop

Alley, MD, et al.

Our objective was to evaluate the effectiveness of a multidisciplinary, problem-based learning workshop to teach third-year medical students about risk assessment for patients presenting with chest pain, specifically focusing on acute coronary syndromes.

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The Uphill Battle of Performing Education Scholarship: Barriers Educators and Education Researchers Face

Jordan, MD, et al.

Educators and education researchers report that their scholarship is limited by lack of time, funding, mentorship, expertise, and reward. This study aims to evaluate these groups’ perceptions regarding barriers to scholarship and potential strategies for success.

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Implementation of a Rapid, Protocol-based TIA Management Pathway

Jarhult, MD, et al.

Our goal was to assess whether use of a standardized clinical protocol improves efficiency for patients who present to the emergency department (ED) with symptoms of transient ischemic attack (TIA).

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Prehospital Lactate Predicts Need for Resuscitative Care in Non-hypotensive Trauma Patients

St. John, MD, et al.

This was a secondary analysis from a prospective cohort study of all trauma patients transported by ALS units over a 14-month period. We included patients who received intravenous access and were transported to a Level I trauma center.

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Societal Impact on Emergency Care

Emergency Department Experience with Novel Electronic Medical Record Order for Referral to Food Resources

Martel, MD, et al.

Food insecurity is a significant issue in the United States and is prevalent in emergency department (ED) patients. The purpose of this study was to report the novel use of an integrated electronic medical record (EMR) order for food resources, and to describe our initial institutional referral patterns after focused education and implementation of the order.

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Case Management Reduces Length of Stay, Charges, and Testing in Emergency Department Frequent Users

Grover, MD, et al.

Case management is an effective, short-term means to reduce emergency department (ED) visits in frequent users of the ED. This study sought to determine the effectiveness of case management on frequent ED users, in terms of reducing ED and hospital length of stay (LOS), accrued costs, and utilization of diagnostic tests.

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Emergency Department Operations

Transition of Care from the Emergency Department to the Outpatient Setting: A Mixed-Methods Analysis

Rider, MD, et al.

The goal of this study was to characterize current practices in the transition of care between the emergency department and primary care setting, with an emphasis on the use of the electronic medical record (EMR).

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Emergency Department Operations

A Novel Approach to Addressing an Unintended Consequence of Direct to Room: The Delay of Initial Vital Signs

Basile, MD, et al.

The concept of “direct to room” (DTR) and “immediate bedding” has been described in the literature as a mechanism to improve front-end, emergency department (ED) processing. The process allows for an expedited clinician-patient encounter. An unintended consequence of DTR was a time delay in obtaining the initial set of vital signs upon patient arrival.

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Variations in Cardiac Arrest Regionalization in California

Chang, MD, et al.

This survey of the local EMS agencies (LEMSA) in California was intended to determine current practices regarding the treatment and routing of OHCA patients and the extent to which EMS systems have regionalized OHCA care across California.

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Outcomes of Emergency Medical Service Usage in Severe Road Traffic Injury during Thai Holidays

Riyapan, MD, et al.

There are usually higher incident rates of RTI in Thailand over long holidays such as New Year and Songkran. To our knowledge, there have been no studies that describe the impact of emergency medical service (EMS) utilization by RTI patients in Thailand. We sought to determine the outcomes of EMS utilization in severe RTIs during the holidays.

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Endemic Infections

High Prevalence of Sterile Pyuria in the Setting of Sexually Transmitted Infection in Women Presenting to an Emergency Department

Shipman, DO, et al.

The objective of this study was to determine the frequency of sterile pyuria in women with confirmed STIs, as well as whether the absolute number of leukocytes on microscopy or nitrite on urine dipstick correlated with positive urine cultures in patients with confirmed STIs. We also sought to determine how many patients with STIs were inappropriately prescribed a UTI antibiotic.

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Baby Shampoo to Relieve the Discomfort of Tear Gas and Pepper Spray Exposure: A Randomized Controlled Trial

Stopyra, MD, et al.

Oleoresin capsicum (OC) or pepper spray, and tear gas (CS) are used by police and the military and produce severe discomfort. Some have proposed that washing with baby shampoo helps reduce this discomfort.

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Inpatient Trauma Mortality after Implementation of the Affordable Care Act in Illinois

Weygandt, MD, et al.

Illinois hospitals have experienced a marked decrease in the number of uninsured patients after implementation of the Affordable Care Act (ACA). However, the full impact of health insurance expansion on trauma mortality is still unknown. The objective of this study was to determine the impact of ACA insurance expansion on trauma patients hospitalized in Illinois.

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Emergency Department (ED), ED Observation, Day Hospital, and Hospital Admissions for Adults with Sickle Cell Disease

Cline, MD, et al.

Use of alternative venues to manage uncomplicated vaso-occlusive crisis (VOC), such as a day hospital (DH) or ED observation unit, for patients with sickle cell anemia, may significantly reduce admission rates, which may subsequently reduce 30-day readmission rates.

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Reduced Computed Tomography Use in the Emergency Department Evaluation of Headache Was Not Followed by Increased Death or Missed Diagnosis

Miller, MD, et al.

This study investigated whether a 9.6% decrease in the use of head computed tomography (HCT) for patients presenting to the emergency department (ED) with a chief complaint of headache was followed by an increase in proportions of death or missed intracranial diagnosis during the 22.5-month period following each index ED visit.

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Thromboprophylaxis for Patients with High-risk Atrial Fibrillation and Flutter Discharged from the Emergency Department

Vinson, MD, et al.

Many patients with atrial fibrillation or atrial flutter (AF/FL) who are high risk for ischemic stroke are not receiving evidence-based thromboprophylaxis. We examined anticoagulant prescribing within 30 days of receiving dysrhythmia care for non-valvular AF/FL in the emergency department (ED).

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Radial Arterial Lines Have a Higher Failure Rate than Femoral

Greer, MD, et al.

This is an ambispective, observational, cohort study to determine variance in failure rates between femoral and radial arterial lines. This study took place from 2012 to 2016 and included all arterial lines placed in adult patients at a single institution.

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Evaluation of a Novel Handoff Communication Strategy for Patients Admitted from the Emergency Department

Smith, MD, et al.

Miscommunication during inter-unit handoffs between emergency and internal medicine physicians may jeopardize patient safety. Our goal was to evaluate the impact of a structured communication strategy on the quality of admission handoffs.

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Cannabinoid Hyperemesis Syndrome: Public Health Implications and a Novel Model Treatment Guideline

Lapoint, DO, et al.

They are exposed to an array of pharmacologic interventions including opioids that not only lack evidence, but may also be harmful. This paper presents a novel treatment guideline that highlights the identification and diagnosis of CHS and summarizes treatment strategies aimed at resolution of symptoms, avoidance of unnecessary opioids, and ensuring patient safety.

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Critical Care

Comparison of Static versus Dynamic Ultrasound for the Detection of Endotracheal Intubation

Gottlieb, MD, et al.

Ultrasound is an increasingly studied modality for identifying ETT location. However, there has been significant variation in techniques between studies, with some using the dynamic technique, while others use a static approach. This study compared the static and dynamic techniques to determine which was more accurate for ETT identification.

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Critical Care

Intravenous Continuous Infusion vs. Oral Immediate-release Diltiazem for Acute Heart Rate Control

Means, PharmD, et al.

Atrial fibrillation (AF) is a common diagnosis of patients presenting to the emergency department (ED). Intravenous (IV) diltiazem bolus is often the initial drug of choice for acute management of AF with rapid ventricular response (RVR).

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Critical Care

Pay It Forward: High School Video-based Instruction Can Disseminate CPR Knowledge in Priority Neighborhoods

Rios, MD, et al.

We investigated the feasibility, knowledge acquisition, and dissemination of a high school-centered, CPR video self-instruction program with a “pay-it-forward” component in a low-income, urban, predominantly Black neighborhood in Chicago, Illinois with historically low bystander-CPR rates.

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Critical Care

Higher Mallampati Scores Are Not Associated with More Adverse Events During Pediatric Procedural Sedation and Analgesia

Iyer, MD, et al.

Medical governing bodies have proposed guidelines for PSA performed by NAs, but these recommendations rarely suggest using Mallampati scores in pre-PSA evaluations. Our objective was to compare rates of adverse events during pediatric PSA in children with Mallampati scores of III/IV vs. scores of Mallampati I/II.

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Flipping the Classroom in Medical Student Education: Does Priming Work?

Rose, MD, et al.

The emergency medicine (EM) clerkship curriculum at Los Angeles County + University of Southern California Medical Center includes monthly lectures on pediatric fever and shortness of breath (SOB). This educational innovation evaluated if learning could be enhanced by “priming” the students with educational online videos prior to an in-class session.

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Does the Podcast Video Playback Speed Affect Comprehension for Novel Curriculum Delivery? A Randomized Trial

Song, MD, et al.

The purpose of this study was to compare mean test scores on written assessments to objectively determine if watching a video of a recorded lecture at 1.5× speed was significantly different than 1.0× speed for the immediate retention of novel material.

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Emergency Medicine Residency Applicant Characteristics Associated with Measured Adverse Outcomes During Residency

Bohrer-Clancy, MD, et al.

Negative outcomes in emergency medicine (EM) programs use a disproportionate amount of educational resources to the detriment of other residents. We sought to determine if any applicant characteristics identifiable during the selection process are associated with negative outcomes during residency. Primary analysis consisted of looking at the association of each of the descriptors including resident characteristics and events during residency with a composite measure of negative outcomes. Components of the negative outcome composite were any formal remediation, failure to complete residency, or extension of residency.

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