Articles Archives - Page 17 of 40 - The Western Journal of Emergency Medicine

Ketamine Safety and Use in the Emergency Department for Pain and Agitation/Delirium: A Health System Experience

Mo, PharmD, et al.

Two protocols were developed to guide the use of subdissociative dose ketamine (SDDK) for analgesia and dissociative sedation ketamine for severe agitation/excited delirium in the emergency department (ED). We sought to evaluate the safety of these protocols implemented in 18 EDs within a large health system.

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Co-Occurrence of Multiple Risk Factors and Intimate Partner Violence in an Urban Emergency Department

Caetano, MD, PhD, et al.

Urban emergency departments (ED) provide care to populations with multiple health-related and overlapping risk factors, many of which are associated with intimate partner violence (IPV). We examine the 12-month rate of physical IPV and its association with multiple joint risk factors in an urban ED.

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Location of Violent Crime Relative to Trauma Resources in Detroit: Implications for Community Interventions

Clery, MD, et al.

Detroit, Michigan, is among the leading United States cities for per-capita homicide and violent crime. Hospital- and community-based intervention programs could decrease the rate of violent-crime related injury but require a detailed understanding of the locations of violence in the community to be most effective.

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Population Health Research Design

Quality and Publication of Emergency Medicine Trials Registered in ClinicalTrials.gov

Calvocoressi, PhD, et al.

Promoting emergency medicine (EM) clinical trials research remains a priority. To characterize the status of clinical EM research, this study assessed trial quality, funding source, and publication of EM clinical trials and compared EM and non-EM trials on these key metrics. We also examined the volume of EM trials and their subspecialty areas.

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Population Health Research Design

Federal Funding in Emergency Medicine: Demographics and Perspectives of Awardees

Chai, MD, et al.

Emergency physicians face multiple challenges to obtaining federal funding. The objective of this investigation was to describe the demographics of federally-funded emergency physicians and identify key challenges in obtaining funding.

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Emergency Department Operations

“Breaking” the Emergency Department: Does the Culture of Emergency Medicine Present a Barrier to Self-Care?

O’Shea, MBBS, MA, et al.

Our goal was to critically examine emergency physician’s (EP) beliefs about taking breaks for self-care on shift. Our operational definition of a break for self-care included time not engaging in direct patient care, eating, drinking, using the bathroom, or leaving a clinical area for a mental break

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Emergency Department Operations

A Playroom Internal Waiting Area Improves Productivity in the Pediatric Emergency Department

Walsh, MB, et al.

Pediatric emergency department (PED) volume is often constrained by the number of available treatment rooms. In many PEDs patients occupy treatment rooms while awaiting test results or imaging, thereby delaying care for patients who arrive after them.

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Triage and Ongoing Care for Critically Ill Patients in the Emergency Department: Results from a National Survey of Emergency Physicians

Mathews, MD, MPH, et al.

We conducted a cross-sectional study at the Icahn School of Medicine at Mount Sinai to elicit emergency physician (EP) perceptions regarding intensive care unit (ICU) triage decisions and ongoing management for boarding of ICU patients in the emergency department (ED). We assessed factors influencing the disposition decision for critically ill patients in the ED to characterize EPs’ perceptions about ongoing critical care delivery in the ED while awaiting ICU admission.

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Abscess Size and Depth on Ultrasound and Association with Treatment Failure without Drainage

Russell, MD, et al.

Smaller and more superficial abscesses may not require a drainage procedure for cure. The goal of this study was to evaluate the optimal abscess size and depth cut-off for determining when a drainage procedure is necessary.

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Prediction Model for 30-day Outcomes Among Emergency Department Patients with Lower Gastrointestinal Bleeding

Ramaekers, MD, MSc, et al.

There are currently no robust tools available for risk stratification of emergency department (ED) patients with lower gastrointestinal bleed (LGIB). Our aim was to identify risk factors and develop a preliminary model to predict 30-day serious adverse events among ED LGIB patients.

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Tricuspid Annular Plane of Systolic Excursion (TAPSE) for the Evaluation of Patients with Severe Sepsis and Septic Shock

Lahham, MD, et al.

Sepsis is a systemic infection that can rapidly progress into multi organ failure and shock if left untreated. Previous studies have demonstrated the utility of point of care ultrasound (POCUS) in the evaluation of patients with sepsis. However, limited data exists on the evaluation of the tricuspid annular plane of systolic excursion (TAPSE) in patients with sepsis.

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Comparison of Ultrasound-Guided Vs Traditional Arterial Cannulation by Emergency Medicine Residents

Wilson, MD, et al.

We sought to determine whether ultrasound-guided arterial cannulation (USGAC) is more successful than traditional radial artery cannulation (AC) as performed by emergency medicine (EM) residents with standard ultrasound training.

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Does Orally-Administered Radiocontrast Impair Ultrasound Image Quality in Pediatric Patients?

Patel, MD, et al.

The objective of this study was to evaluate whether early administration of ORC in children with abdominal pain receiving abdominal CT for possible appendicitis obscures subsequent abdominal US image quality.

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How to Stop the Bleed: First Care Provider Model for Developing Public Trauma Response Beyond Basic Hemorrhage Control

Bobko, MD, et al.

Recent programs, such as the federal “Stop The Bleed” campaign, have placed the emphasis of public training on hemorrhage control. However, recent attacks demonstrate that access to wounded, recognition of injury, and rapid evacuation are equally as important as hemorrhage control in minimizing mortality.

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Tree of Life Synagogue Shooting in Pittsburgh: Preparedness, Prehospital Care, and Lessons Learned

Tobias, MD, MPH, et al.

On Saturday, October 27, 2018, a man with anti-Semitic motivations entered Tree of Life synagogue in the Squirrel Hill section of Pittsburgh, Pennsylvania; he had an AR-15 semi-automatic rifle and three handguns, opening fire upon worshippers.

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UNIFIED: Understanding New Information from Emergency Departments Involved in the San Bernardino Terrorist Attack

Smith, MD, et al.

The primary objective of this study was to gather and detail the common experiences from those hospital-based health professionals directly involved in the response to the San Bernardino terrorism attack on December 2, 2015. Secondary objectives included gathering information on experiences participants found were best practices.

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Predictors of Patient Satisfaction and the Perceived Quality of Healthcare in an Emergency Department in Portugal

Abidova, M. Phil, et al.

The goal of this study was to identify the key predictors of patient satisfaction and perceived quality of healthcare in the framework of an emergency department (ED).

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Role of Point-of-Care Testing in Reducing Time to Treatment Decision-Making in Urgency Patients: A Randomized Controlled Trial

Chaisirin, MD, et al.

Shortening emergency department (ED) visit time can reduce ED crowding, morbidity and mortality, and improve patient satisfaction. Point-of-care testing (POCT) has the potential to decrease laboratory turnaround time, possibly leading to shorter time to decision-making and ED length of stay (LOS). We aimed to determine whether the implementation of POCT could reduce time to decision-making and ED LOS.

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New Clarification About Observation Billing May Improve Care for Behavioral Health Patients

Osborne, MD, et al.

Emergency Physicians provide ongoing care to psychiatric patients beyond the confines of a standard emergency room visit. Often, when we identify patients who need specialty psychiatric care, patients board in the emergency department awaiting acceptance and transfer to an outside facility. Even in cases where it has taken multiple days to complete the transfer, it has been unclear how to properly obtain reimbursement for this care. We discuss a new coding clarification that may provide a pathway to improve part of this situation.

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Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors

Parsons, MD, et al.

Initiatives for addressing resident wellness are a recent requirement of the Accreditation Council for Graduate Medical Education in response to high rates of resident burnout nationally. We review the literature on wellness and burnout in residency education with a focus on assessment, individual-level interventions, and systemic or organizational interventions.

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The Impact of Due Process and Disruptions on Emergency Medicine Education in the United States

Alvarez, MD, et al.

We reviewed the available literature regarding due process in emergency medicine. We also reviewed recent examples of training programs that underwent disruptions. We used this data to create a set of best practices regarding the handling of disruptions and due process in academic EM.

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Innovative Approaches to Emergency Medical Services Fellowship Challenges

Weston, MD, MPH, et al.

Since the development of an Accreditation Council of Graduate Medical Education (ACGME)-accredited emergency medical services (EMS) fellowship, there has been little published literature on effective methods of content delivery or training modalities. Here we explore a variety of innovative approaches to the development and revision of the EMS fellowship curriculum.

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Does the Removal of Textbook Reading from Emergency Medicine Resident Education Negatively Affect In-Service Scores?

Ju, MD, et al.

At our institution, due to resident feedback a change in curriculum was initiated. Our objective was to determine whether assigned Evidence-Based Medicine (EBM) articles and Rosh Review questions were non-inferior to Tintinalli textbook readings. We further hypothesized that the non-textbook assigned curriculum would lead to higher resident satisfaction, greater utilization, and a preference over the old curriculum.

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Challenges Related to the Implementation of an EMS-Administered, Large Vessel Occlusion Stroke Score

Lawner, DO, MS, EMT-P, et al.

Timely access to interventional therapy has been linked to improved stroke outcomes. Accurate triage depends upon the use of a validated screening tool in addition to several emergency medical system (EMS)-specific factors. This study examines the integration of a modified Rapid Arterial oCcclusion Evaluation (mRACE) score into an existing stroke treatment protocol.

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Mistriaged Advanced Life Support Patients in a Two-Tiered, Suburban Emergency Medical Services System

Bucher, MD, et al.

Our study examines patients who were triaged and admitted to a critical care location, including an intensive care unit (ICU), cardiac catheterization laboratory, or operating room (OR).

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Prehospital Trauma Scene and Transport Times for Pediatric and Adult Patients

Ashburn, MD, et al.

Increased out-of-hospital time is associated with worse outcomes in trauma. Sparse literature exists comparing prehospital scene and transport time management intervals between adult and pediatric trauma patients. National Emergency Medical Services guidelines recommend that trauma scene time be less than 10 minutes. The objective of this study was to examine prehospital time intervals in adult and pediatric trauma patients.

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