Original Research Archives - Page 30 of 40 - The Western Journal of Emergency Medicine

Visual Estimation of Bedside Echocardiographic Ejection Fraction by Emergency Physicians

Volume 15, Issue 2, March 2014
Erden E. Ünlüer, MD et al.

The objective of this study was to determine whether bedside visual estimates of left ventricular systolic function (LVSF) by emergency physicians (EP) would agree with quantitative measurement of LVSF by the modified Simpson’s method (MSM), as recommended by the American Society of Echocardiography.

WestJEM Read More

Injury Outcomes

Dysuria in the Emergency Department: Missed Diagnosis of Chlamydia trachomatis

Volume 15, Issue 2, March 2014
Morgan D Wilbanks, MD et al.

The clinical presentation of genital Chlamydia trachomatis infection (chlamydia) in women is often indistinguishable from a urinary tract infection. While merited in the setting of dysuria, emergency department (ED) clinicians do not routinely test for chlamydia in women. The primary aim of our study was to evaluate the frequency of chlamydia testing among women presenting to the ED with dysuria.

WestJEM Read More

Injury Outcomes

Onset and Duration of Intravenous and Intraosseous Rocuronium in Swine

Volume 15, Issue 2, March 2014
Michael Loughren, CRNA, PhD et al.

The intraosseous (IO) route has become a popular method to gain access to the peripheral circulation in emergency situations. Despite little supporting data, it is generally believed that IO absorption is immediate and equivalent to the intravenous (IV) route. It is important to determine if rocuronium can effectively be administered by the IO route. The aim of the study was to determine and compare the onset and duration of rocuronium when administered via the IO and IV routes in a normovolemic pig model.

WestJEM Read More

Injury Outcomes

The Effect of Compressor-administered Defibrillation on Peri-shock Pauses in a Simulated Cardiac Arrest Scenario

Volume 15, Issue 2, March 2014
Joshua Glick, BS et al.

Coordination of the tasks of performing chest compressions and defibrillation can lead to communication challenges that may prolong time spent off the chest. The purpose of this study was to determine whether defibrillation provided by the provider performing chest compressions led to a decrease in peri-shock pauses as compared to defibrillation administered by a second provider, in a simulated cardiac arrest scenario.

WestJEM Read More

Ethical and Legal Issues

Patient Attitudes Regarding Consent for Emergency Department Computed Tomographies

Volume XV, Issue 1, February 2015
Michael B. Weigner, MD et al.

Little is known about patient attitudes towards informed consent for computed tomography (CT) in the emergency department (ED). We set out to determine ED patient attitudes about providing informed consent for CTs.

WestJEM Read More

Treatment Protocol Assessment

Predictors of Unattempted Central Venous Catheterization in Septic Patients Eligible for Early Goal-directed Therapy

Volume XV, Issue 1, February 2014
David R. Vinson, MD et al.

We sought to determine the association of relative normotension (sustained systolic blood pressure >90 mmHg independent of or in response to an initial crystalloid resuscitation of 20 mL/kg), obesity (body mass index [BMI] ≥30), moderate thrombocytopenia (platelet count <50,000 per μL), and coagulopathy (international normalized ratio ≥2.0) with unattempted CVC in EGDT-eligible patients.

WestJEM Read More

Emergency Department Operations

Importance of Hospital Entry: Walk-in STEMI and Primary Percutaneous Coronary Intervention

Volume XV, Issue 1, February 2014
Eric Bansal, MD et al.

The purpose of this study was to evaluate baseline demographic and clinical differences between walk-in and EMS-transported STEMI patients and identify factors associated with prolonged door to balloon (D2B) time in walk-in STEMI patients.

WestJEM Read More

Emergency Department Operations

The July Effect: Is Emergency Department Length of Stay Greater at the Beginning of the Hospital Academic Year?

Volume XV, Issue 1, February 2014
Christine Riguzzi, MD et al.

The objective of this study is to determine if the average ED LOS at the beginning of the hospital academic year differs for teaching hospitals with residents in the ED, when compared to other months of the year, and as compared to non-teaching hospitals without residents.

WestJEM Read More

Sensitivity of Emergency Bedside Ultrasound to Detect Hydronephrosis in Patients with Computed Tomography-proven Stones

Volume XV, Issue 1, February 2014
Jeff RIddell, MD et al.

Non-contrast computed tomography (CT) is widely regarded as the gold standard for diagnosis of urolithiasis in emergency department (ED) patients. However, it is costly, time-consuming and exposes patients to significant doses of ionizing radiation. Hydronephrosis on bedside ultrasound is a sign of a ureteral stone, and has a reported sensitivity of 72–83% for identification of unilateral hydronephrosis when compared to CT. The purpose of this study was to evaluate trends in sensitivity related to stone size and number.

WestJEM Read More

Should Osteopathic Students Applying to Allopathic Emergency Medicine Programs Take the USMLE Exam?

Volume XV, Issue 1, February 2014
Moshe Weizberg, MD et al.

The objective of the study is to compare the likelihood to match of DO applicants who reported USMLE to those who did not, and to clarify how important program directors consider it is whether or not an osteopathic applicant reported a USMLE score.

WestJEM Read More

Injury Outcomes

Does Young Age Merit Increased Emergency Department Trauma Team Response?

Volume 14, Issue 6, 2014
James F. Holmes, MD, MPH, et al.

To determine if increased trauma team response results in alterations in resource use in a population of children <6 years, especially in those least injured.

WestJEM Read More

Injury Outcomes

Emergency Department Visits by Older Adults for Motor Vehicle Collisions

Volume 14, Issue 6, November 2013
Jody A. Vogel, MD, et al.

To describe the epidemiology and characteristics of emergency department (ED) visits by older adults for motor vehicle collisions (MVC) in the United States (U.S.).

WestJEM Read More

Injury Outcomes Injury Prevention

Emergency Departments and Older Adult Motor Vehicle Collisions

In 2009 the Centers for Disease Control and Prevention reported that there were 33 million licensed drivers 65 years and older in the U.S. This represents a 23 percent increase from 1999, a number that is predicted to double by 2030. Although motor vehicle collisions related to emergency department visits for older adults are lower per capita than for younger adults, the older-adults MVCs require more resources, such as additional diagnostic imaging and increased odds of admission.

WestJEM Read More

Emergency Department Operations

The Impact of Working with Medical Students on Resident Productivity in the Emergency Department

Volume 14, Issue 6, November 2013
Travis Cobb, MD, et al.

Academic emergency departments (ED) strive to balance educational needs of residents and medical students with service requirements that optimize patient care. No study to date has evaluated whether resident precepting of medical students affects residents’ clinical productivity. Understanding the interplay of these variables may allow for ED staffing that maximizes productivity. We sought to determine whether the precepting of medical students impacts resident productivity.

WestJEM Read More

Emergency Department Operations

Predictive Value of Capnography for Suspected Diabetic Ketoacidosis in the Emergency Department

Volume 14, Issue 6, November 2013
Hassan Soleimanpour, MD, et al.

Metabolic acidosis confirmed by arterial blood gas (ABG) analysis is one of the diagnostic criteria for diabetic ketoacidosis (DKA). Given the direct relationship between end-tidal carbon dioxide (ETCO2), arterial carbon dioxide (PaCO2), and metabolic acidosis, measuring ETCO2 may serve as a surrogate for ABG in the assessment of possible DKA. The current study focuses on the predictive value of capnography in diagnosing DKA in patients referring to the emergency department (ED) with increased blood sugar levels and probable diagnosis of DKA.

WestJEM Read More

Provider Workforce

Mid-level Providers Working in a Low-acuity Area are More Productive than in a High-acuity Area

Mid-level providers (MLP) are extensively used in staffing emergency departments (ED). We sought to compare the productivity of MLPs staffing a low-acuity and high-acuity area of a community ED.

WestJEM Read More

Emergency Department Access

National Study of Non-urgent Emergency Department Visits and Associated Resource Utilization

Reducing non-urgent emergency department (ED) visits has been targeted as a method to produce cost savings. To better describe these visits, we sought to compare resource utilization of ED visits characterized as non-urgent at triage to immediate, emergent, or urgent (IEU) visits.

WestJEM Read More

Provider Workforce

Implementation of a Successful Incentive-Based Ultrasound Credentialing Program for Emergency Physicians

With the rapid expansion of emergency ultrasound, resident education in ultrasound has become more clearly developed and broadly integrated. However, there still exists a lack of guidance in the training of physicians already in practice to become competent in this valuable skill. We sought to employ a step-wise, goal-directed, incentive-based credentialing program to educate emergency physicians in the use of emergency ultrasound. Successful completion of this program was the primary outcome.

WestJEM Read More

Provider Workforce

A Survey of Graduating Emergency Medicine Residents’ Experience with Cricothyrotomy

The Emergency Medicine (EM) Residency Review Committee stipulates that residents perform 3 cricothyrotomies in training but does not distinguish between those done on patients or via other training methods. This study was designed to determine how many cricothyrotomies residents have performed on living patients, the breadth and prevalence of alternative methods of instruction, and residents’ degree of comfort with performing the procedure unassisted.

WestJEM Read More

Societal Impact on Emergency Care

Racial Disparity in Duration of Patient Visits to the Emergency Department: Teaching Versus Non-teaching Hospitals

Author Affiliation Zeynal Karaca, PhD Social and Scientific Systems, Inc., Silver Spring, MarylandAgency for Healthcare Research and Quality, Rockville, Maryland George Washington University, Health Policy Department, Washington, DC Herbert S. Wong, PhD Agency for Healthcare Research and Quality, Rockville, Maryland Introduction Methods Results Discussion Limitations Conclusion Abstract Introduction: The sources of racial disparity in duration […]

WestJEM Read More

Emergency Department Access

Emergency Department Crowding and Time to Antibiotic Administration in Febrile Infants

Author Affiliation Jennifer K. Light, MD University of Florida, College of Medicine, Department of Emergency Medicine Gainesville, Florida Robyn M. Hoelle, MD University of Florida, College of Medicine, Department of Emergency Medicine Gainesville, Florida Jill Boylston Herndon, PhD University of Florida, College of Medicine, Institute for Child Health Policy, Department of Health Outcomes and Policy, […]

WestJEM Read More

Prognostic Value of Emergency Physician Performed Echocardiography in Patients with Acute Pulmonary Thromboembolism

Author Affiliation Maurizio Zanobetti, MD Department of Critical Care Medicine and Surgery, University of Florence, Florence, Italy Cristiano Converti, MD Department of Critical Care Medicine and Surgery, University of Florence, Florence, Italy Alberto Conti, MD Department of Critical Care Medicine and Surgery, University of Florence, Florence, Italy Gabriele Viviani, MD Department of Critical Care Medicine […]

WestJEM Read More

Prehospital Care

Electronic Prehospital Records are Often Unavailable for Emergency Department Medical Decision Making

Author Affiliation Bryan E. Bledsoe, DO University of Nevada School of Medicine, Department of Emergency Medicine, Las Vegas, Nevada MedicWest Ambulance/American Medical Response, Las Vegas, Nevada Chad Wasden, MD University of Nevada School of Medicine, Department of Emergency Medicine, Las Vegas, Nevada Larry Johnson, NREMTP University of Nevada School of Medicine, Department of Emergency Medicine, […]

WestJEM Read More

Emergency Medicine in Guyana: Lessons from Developing the Country’s First Degree-conferring Residency Program

Author Affiliation Nicolas P. Forget, MD, MPH Vanderbilt University, Department of Emergency Medicine, Nashville, Tennessee John Paul Rohde, MD Vanderbilt University, Department of Emergency Medicine, Nashville, Tennessee Navindranauth Rambaran, MBBS Georgetown Public Hospital Corporation, Institute of Health Sciences Education, Guyana Madan Rambaran, MBBS Georgetown Public Hospital Corporation, Institute of Health Sciences Education, Guyana Seth W. […]

WestJEM Read More

English-based Pediatric Emergency Medicine Software Improves Physician Test Performance on Common Pediatric Emergencies: A Multicenter Study in Vietnam

Author Affiliation Michelle Lin, MD University of California, San Francisco, Department of Emergency Medicine, San Francisco, California KidsCareEverywhere – Vietnam, Berkeley, California Trevor N. Brooks, BS University of California, San Francisco, Department of Emergency Medicine, San Francisco, California Alex C. Miller, BA KidsCareEverywhere – Vietnam, Berkeley, California Jamie L. Sharp, BA KidsCareEverywhere – Vietnam, Berkeley, […]

WestJEM Read More

Predictive Value of Initial Triage Vital Signs for Critically Ill Older Adults

Author Affiliation Michael A. LaMantia, MD, MPH Indiana University Center for Aging Research and Regenstrief Institute, Indianapolis, Indiana Paul W. Stewart, PhD University of North Carolina, Department of Biostatistics, Chapel Hill, North Carolina Timothy F. Platts-Mills, MD University of North Carolina, Department of Emergency Medicine, Chapel Hill, North Carolina Kevin J. Biese, MD, MAT University […]

WestJEM Read More