Original Research Archives - Page 29 of 40 - The Western Journal of Emergency Medicine

Improving Community Understanding of Medical Research: Audience Response Technology for Community Consultation for Exception to Informed Consent

Volume 15, Issue 4, July 2014
Taher Vohra, MD et al.

The Department of Health and Human Services and Food and Drug Administration described guidelines for exception from informed consent (EFIC) research. These guidelines require community consultation (CC) events, which allow members of the community to understand the study, provide feedback and give advice. A real-time gauge of audience understanding would allow the speaker to modify the discussion. The objective of the study is to describe the use of audience response survey (ARS) technology in EFIC CCs.

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Effect of Prior Cardiopulmonary Resuscitation Knowledge on Compression Performance by Hospital Providers

Volume 15, Issue 4, July 2014
Joshua N. Burkhardt, BS et al.

The purpose of this study was to determine cardiopulmonary resuscitation (CPR) knowledge of hospital providers and whether knowledge affects performance of effective compressions during a simulated cardiac arrest.

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Emergency Medicine Clerkship Directors: Current Workforce

Volume 15, Issue 4, July 2014
David A. Wald, DO et al.

The emergency medicine clerkship director serves an important role in the education of medical students. The authors sought to update the demographic and academic profile of the emergency medicine clerkship director.

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Critical Care

Continuous Hemodynamic Monitoring in Acute Stroke: An Exploratory Analysis

Volume 15, Issue 4, July 2014
Ayan Sen, MD, MSc et al.

Non-invasive, continuous hemodynamic monitoring is entering the clinical arena. The primary objective of this study was to test the feasibility of such monitoring in a pilot sample of Emergency Department (ED) stroke patients. Secondary objectives included analysis of hemodynamic variability and correlation of continuous blood pressure measurements with standard measurements.

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USEFUL: Ultrasound Exam for Underlying Lesions Incorporated into Physical Exam

Volume 15, Issue 3, Jon Steller, MD et al.

The Ultrasound Screening Exam for Underlying Lesions (USEFUL) was developed in an attempt to establish a role for bedside ultrasound in the primary and preventive care setting. It is the purpose of our pilot study to determine if students were first capable of performing all of the various scans required of our USEFUL while defining such an ultrasound-assisted physical exam that would supplement the standard hands-on physical exam in the same head-to-toe structure. We also aimed to assess the time needed for an adequate exam and analyze if times improved with repetition and previous ultrasound training.

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Emergency Department Operations

Does Prolonged Length of Stay in the Emergency Department Affect Outcome for Stroke Patients?

Volume 15, Issue 3, May 2014
Minal Jain, MBBS, MPH et al.

Conflicting data exist regarding the association between the length of stay (LOS) of critically ill patients in the emergency department (ED) and their subsequent outcome. However, such patients are an overall heterogeneous group, and we therefore sought to study the association between EDLOS and outcomes in a specific subgroup of critically ill patients, namely those with acute ischemic stroke/transient ischemic attack (AIS/TIA).

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Emergency Department Operations

Follow Up for Emergency Department Patients After Intravenous Contrast and Risk of Nephropathy

Volume 15, Issue 3, May 2014
Getaw Worku Hassen, MD, PhD et al.

Contrast-induced nephropathy (CIN), defined as an increase in serum creatinine (SCr) greater than 25% or ≥0.5 mg/dL within 3 days of intravenous (IV) contrast administration in the absence of an alternative cause, is the third most common cause of new acute renal failure in hospitalized patients. It is known to increase in-hospital mortality up to 27%. The purpose of this study was to investigate the rate of outpatient follow up and the occurrence of CIN in patients who presented to the emergency department (ED) and were discharged home after computed tomography (CT) of the abdomen and pelvis (AP) with IV contrast.

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Emergency Department Operations

Skin Infections and Antibiotic Stewardship: Analysis of Emergency Department Prescribing Practices, 2007–2010

Volume 15, Issue 3, May 2014
Daniel J. Pallin, MD, MPH et al.

National guidelines suggest that most skin abscesses do not require antibiotics, and that cellulitis antibiotics should target streptococci, not community-associated MRSA (CA-MRSA). The objective of this study is to describe antimicrobial treatment of skin infections in U.S. emergency departments (EDs) and analyze potential quality measures.

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Study of Medical Students’ Malpractice Fear and Defensive Medicine: A “Hidden Curriculum?”

Volume 15, Issue 3, May 2014
William F. Johnston, MD et al.

Defensive medicine is a medical practice in which health care providers’ primary intent is to avoid criticism and lawsuits, rather than providing for patients’ medical needs. The purpose of this study was to characterize medical students’ exposure to defensive medicine during medical school rotations.

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Scholar Quest: A Residency Research Program Aligned with Faculty Goals

Volume 15, Issue 3, May 2014
Ashish R. Panchal, MD, PhD et al.

The ACGME requires that residents perform scholarly activities prior to graduation, but this is difficult to complete and challenging to support. We describe a residency research program, taking advantage of environmental change aligning resident and faculty goals, to become a contributor to departmental cultural change and research development.

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Experience with Emergency Ultrasound Training by Canadian Emergency Medicine Residents

Volume 15, Issue 3, May 2014
Daniel J. Kim, MD et al.

Starting in 2008, emergency ultrasound (EUS) was introduced as a core competency to the Royal College of Physicians and Surgeons of Canada (Royal College) emergency medicine (EM) training standards. The Royal College accredits postgraduate EM specialty training in Canada through 5-year residency programs. The objective of this study is to describe both the current experience with and the perceptions of EUS by Canadian Royal College EM senior residents.

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Ethical and Legal Issues

Informed Consent Documentation for Lumbar Puncture in the Emergency Department

Volume 15, Issue 3, May 2014
Pankaj B. Patel, MD et al.

Informed consent is a required process for procedures performed in the emergency department (ED), though it is not clear how often or adequately it is obtained by emergency physicians. Incomplete performance and documentation of informed consent can lead to patient complaints, medico-legal risk, and inadequate education for the patient/guardian about the procedure. We undertook this study to quantify the incidence of informed consent documentation in the ED setting for lumbar puncture (LP) and to compare rates between pediatric (<18 years) and adult patients.

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Critical Care

Epidemiology of the Systemic Inflammatory Response Syndrome (SIRS) in the Emergency Department

Volume 15, Issue 3, May 2014
Timothy Horeczko, MD, MSCR et al.

Consensus guidelines recommend sepsis screening for adults with systemic inflammatory response syndrome (SIRS), but the epidemiology of SIRS among adult emergency department (ED) patients is poorly understood. Recent emphasis on cost-effective, outcomes-based healthcare prompts the evaluation of the performance of large-scale efforts such as sepsis screening. We studied a nationally representative sample to clarify the epidemiology of SIRS in the ED and subsequent category of illness.

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Readiness to Change and Reasons for Intended Reduction of Alcohol Consumption in Emergency Department versus Trauma Population

Volume 15, Issue 3, May 2014
Craig Harrison, MD, MPH et al.

The primary objective was to identify the most common reasons for intending to cut back on alcohol use, in emergency department (ED) and trauma patient populations. The secondary objective was to determine the association between reason to cut back on alcohol and education level.

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Urinary Metabolomic Analysis to Detect Changes After Intravenous, Non-ionic, Low Osmolar Iodinated Radiocontrast for Computerized Tomographic Imaging

Volume 15, Issue 2, March 2014
Deborah B. Diercks, MD, MSc et al.

Contrast-induced nephropathy is a result of injury to the proximal tubules caused by oxidative stress and ischemia. Metabolomics is a novel technique that has been used to identify renal damage from drug toxicities. The objective of this study is to analyze the metabolic changes in the urine after dosing with intravenous (IV) contrast for computed tomograph (CT) of the chest.

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Emergency Department Operations

Hospital Factors Impact Variation in Emergency Department Length of Stay more than Physician Factors

Volume 15, Issue 2, March 2014
Scott P. Krall, MD et al.

To analyze the correlation between the many different emergency department (ED) treatment metric intervals and determine if the metrics directly impacted by the physician correlate to the “door to room” interval in an ED (interval determined by ED bed availability). Our null hypothesis was that the cause of the variation in delay to receiving a room was multifactorial and does not correlate to any one metric interval.

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Emergency Department Operations

Impact of a Teaching Service on Emergency Department Throughput

Volume 15, Issue 2, March 2014
Courtney M. Smalley, MD et al.

There are 161 emergency medicine residency programs in the United States, many of which have medical students rotating through the emergency department (ED). Medical students are typically supervised by senior residents or attendings while working a regular shift. Many believe that having students see and present patients prolongs length of stay (LOS), as care can be delayed.

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Emergency Department Operations

Emergency Department Length of Stay: Accuracy of Patient Estimates

Volume 15, Issue 2, March 2014
Brendan T. Parker, MS et al.

Managing a patient’s expectations in the emergency department (ED) environment is challenging. Previous studies have identified several factors associated with ED patient satisfaction. Lengthy wait times have shown to be associated with dissatisfaction with ED care. Understanding that patients are inaccurate at their estimation of wait time, which could lead to lower satisfaction, provides administrators possible points of intervention to help improve accuracy of estimation and possibly satisfaction with the ED. This study was undertaken to examine the accuracy of patient estimates of time periods in an ED and identify factors associated with accuracy.

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Emergency Department Operations

Impact of Decontamination Therapy on Ultrasound Visualization of Ingested Pills

Volume 15, Issue 2, March 2014
Jason Bothwell, MD, et al.

Acute toxic ingestion is a common cause of morbidity and mortality. Emergency physicians (EP) caring for overdose (OD) patients are often required to make critical decisions with incomplete information. Point of care ultrasound (POCUS) may have a role in assisting EPs manage OD patients. We evaluated the impact of different liquid adjuncts used for gastric decontamination on examiners’ ability to identify the presence of tablets using POCUS, and assessed examiners’ ability to quantify the numbers of tablets in a simulated massive OD.

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Emergency Department Operations

Impact of an Abbreviated Cardiac Enzyme Protocol to Aid Rapid Discharge of Patients with Cocaine-associated Chest Pain in the Clinical Decision Unit

Volume 15, Issue 2, March 2014
Faheem W. Guirgis, MD et al.

In 2007 there were 64,000 visits to the emergency department (ED) for possible myocardial infarction (MI) related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9–12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain.

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Factors Important to Applicants to Osteopathic Versus Allopathic Emergency Medicine Residency Programs

Volume 15, Issue 2, March 2014
Bruce Alfred St. Amour, DO

Our objective is to evaluate the factors important to osteopathic applicants when selecting an American College of Osteopathic Emergency Physicians accredited emergency medicine (EM) residency and to compare these results with previous allopathic EM studies.

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Prehospital Care

4,871 Emergency Airway Encounters by Air Medical Providers: A Report of the Air Transport Emergency Airway Management (NEAR VI: “A-TEAM”) Project

Volume 15, Issue 2, March 2015
Calvin A. Brown, MD et al.

Pre-hospital airway management is a key component of resuscitation although the benefit of pre-hospital intubation has been widely debated. We report a large series of pre-hospital emergency airway encounters performed by air-transport providers in a large, multi-state system.

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Prehospital Care

Ambulatory Cardiac Monitoring for Discharged Emergency Department Patients with Possible Cardiac Arrhythmias

Volume 15, Issue 2, March 2014
Donald Schreiber, MDCM et al.

Many emergency department (ED) patients have symptoms that may be attributed to arrhythmias, necessitating outpatient ambulatory cardiac monitoring. Consensus is lacking on the optimal duration of monitoring. We describe the use of a novel device applied at ED discharge that provides continuous prolonged cardiac monitoring.

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Prehospital Care

Improving Bariatric Patient Transport and Care with Simulation

Volume 15, Issue 2, March 2014
Brad D. Gable, MD, MS et al.

Obesity is prevalent in the United States. Obese patients have physiologic differences from non-obese individuals. Not only does transport and maintenance of these patients require use of specialized equipment, but it also requires a distinct skill set and knowledge base. To date, there is no literature investigating simulation as a model for educating pre-hospital providers in the care of bariatric patients. The purpose of this study was to determine if a 3-hour educational course with simulation could improve paramedics’ knowledge and confidence of bariatric procedures and transport. This study also examined if prior experience with bariatric transport affected training outcomes.

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Provider Workforce

Staff Perceptions of an On-site Clinical Pharmacist Program in an Academic Emergency Department after One Year

Volume 15, Issue 2, March 2014
Zlatan Coralic, PharmD, BCPS et al.

Emergency department clinical pharmacists (EPh) serve a relatively new clinical role in emergency medicine. New EPh may still face barriers prior to working in the emergency department (ED), including staff acceptance. We aimed to assess staff perceptions of a university hospital EPh program 1 year after implementation.

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Societal Impact on Emergency Care

Depression, Suicidal Ideation, and Suicidal Attempt Presenting to the Emergency Department: Differences Between These Cohorts

Volume 15, Issue 2, March 2014
Bharath Chakravarthy, MD, MPH et al.

The World Health Organization estimates that one million people die by suicide every year. Few studies have looked at factors associated with disposition in patients with chief complaints of depression, suicidal ideation (SI) and suicidal attempts (SA) who present to the emergency department (ED). Our objective was to assess individual determinants associated with ED disposition of patients in depressed patients presenting to the ED.

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