Current Issue: Volume 19 Issue 2 Archives - The Western Journal of Emergency Medicine

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

A Predictive Model Facilitates Early Recognition of Spinal Epidural Abscess in Adults

Artenstein, MD, et al.

Spinal epidural abscess (SEA), a highly morbid and potentially lethal deep tissue infection of the central nervous system has more than tripled in incidence over the past decade. Early recognition at the point of initial clinical presentation may prevent irreversible neurologic injury or other serious, adverse outcomes. To facilitate early recognition of SEA, we developed a predictive scoring model.

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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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A Tactical Medicine After-action Report of the San Bernardino Terrorist Incident

Bobko, MD, et al.

On December 2, 2015, terrorism landed in Southern California when two perpetrators aligned with the Islamic State (IS), murdered and wounded 38 civilians at the Inland Regional Center of San Bernardino, California.

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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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Educator Toolkits on Second Victim Syndrome, Mindfulness and Meditation, and Positive Psychology: The 2017 Resident Wellness Consensus Summit

Chung, MD, et al.

Burnout, depression, and suicidality among residents across all specialties have become a critical focus of attention for the medical education community. Prevalence studies have revealed rates of burnout among residents to be as high as 76%, as measured by the Maslach Burnout Inventory (MBI).

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Executive Summary from the 2017 Emergency Medicine Resident Wellness Consensus Summit

Battaglioli, MD, et al.

Through a joint collaboration involving Academic Life in Emergency Medicine’s (ALiEM) Wellness Think Tank, Essentials of Emergency Medicine (EEM), and the Emergency Medicine Residents’ Association (EMRA), a one-day Resident Wellness Consensus Summit (RWCS) was organized.

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An Evidence-based, Longitudinal Curriculum for Resident Physician Wellness: The 2017 Resident Wellness Consensus Summit

Arnold, MD, et al.

Physicians are at much higher risk for burnout, depression, and suicide than their non-medical peers. One of the working groups from the May 2017 Resident Wellness Consensus Summit (RWCS) addressed this issue through the development of a longitudinal residency curriculum to address resident wellness and burnout.

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Identifying Gaps and Launching Resident Wellness Initiatives: The 2017 Resident Wellness Consensus Summit

Zaver, MD, et al.

In 2017 the Accreditation Council for Graduate Medical Education (ACGME) updated the Common Program Requirements to focus more on resident wellbeing. To address this issue, one working group from the 2017 Resident Wellness Consensus Summit (RWCS) focused on wellness program innovations and initiatives in emergency medicine (EM) residency programs.

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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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Just Missing the Mark: Discharging High-risk Atrial Fibrillation / Flutter without Thromboprophylaxis

Thompson, MD, et al.

In this issue of WestJEM, Smith and colleagues present a prospective observational evaluation of anticoagulation prescribing practices in non-valvular AF. Patients presenting to one of seven Northern California EDs with AF at high risk for stroke were eligible unless admitted, not part of Kaiser Permanente of Northern California (KPNC), or already prescribed anticoagulation

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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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Optimal Implementation of Prescription Drug Monitoring Programs in the Emergency Department

Elder, MD, et al.

This article describes one method, prescription drug monitoring programs (PDMP), through the lens of how to optimize use for emergency departments (ED). EDs have rapidly become a central location to combat opioid abuse and drug diversion. PDMPs can provide emergency physicians with comprehensive prescribing information to improve clinical decisions around opioids.

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By Default: The Effect of Prepopulated Prescription Quantities on Opioid Prescribing in the Emergency Department

Santistevan, MD, et al.

To date, there have been limited studies on the effect of default tablet quantities as part of emergency department (ED) electronic order entry. Our goal was to evaluate opioid prescribing patterns before and after the removal of a default quantity of 20 tablets from ED electronic order entry.

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