Current Issue: Volume 21 Issue 2 Archives - The Western Journal of Emergency Medicine

Endemic Infections

Scabies: Application of the Novel Identify-Isolate-Inform Tool for Detection and Management

Cheng, MD, et al.

Scabies is a highly contagious, globally prevalent, parasitic skin infestation caused by Sarcoptes scabiei var. hominis, also known as the itch mite. There have been outbreaks not only in the developing world, but also in the developed world among refugees and asylum seekers.

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Endemic Infections

2019-nCoV: The Identify-Isolate-Inform (3I) Tool Applied to a Novel Emerging Coronavirus

Koenig, MD, et al.

This paper reports a modification of the 3I Tool for use in the initial detection and management of patients under investigation for 2019-nCoV. After initial assessment for symptoms and epidemiological risk factors, including travel to affected areas and exposure to confirmed 2019-nCoV patients within 14 days, patients are classified in a risk-stratified system.

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Using Tenecteplase for Acute Ischemic Stroke: What Is the Hold Up?

Zitek, MD, et al.

This narrative review evaluates the literature and addresses the practical issues with regards to the use of tenecteplase versus alteplase for acute ischemic stroke, and it recommends that physicians consider tenecteplase rather than alteplase for thrombolysis of acute ischemic stroke.

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Human Papillomavirus Awareness, Vaccine Status, and Risk Factors in Female Emergency Patients

Walter, MD, et al.

This study sought to gather information pertaining to HPV and cervical cancer risk factors, awareness of HPV and the vaccine, as well as HPV vaccine uptake in female patients presenting to an ED.

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Healthcare Utilization

Changes in Emergency Department Care Intensity from 2007–16: Analysis of the National Hospital Ambulatory Medical Care Survey

Chou, MD, MPH, et al.

The goal of this analysis was to examine the changes in ED care intensity in this context through the changes in ED patient population and ED care provided.

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Safety and Efficacy of Hospital Utilization of Tranexamic Acid in Civilian Adult Trauma Resuscitation

Neeki, DO, et al.

Patients with trauma-induced coagulopathies may benefit from the use of antifibrinolytic agents, such as tranexamic acid (TXA). This study evaluated the safety and efficacy of TXA in civilian adults hospitalized with traumatic hemorrhagic shock.

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Critical Care

Screening for QT Prolongation in the Emergency Department: Is There a Better “Rule of Thumb?”

Rischall, MD, et al.

Many emergency clinicians rely on the “rule of thumb” or “Half the RR” rule (Half-RR) as an initial screening method, but prior studies have shown that the Half-RR rule performs poorly as compared to other QT assessment methods. We sought to characterize the problems associated with the Half-RR rule and find a modified screening tool to more safely assess the QT interval of ED patients for prolonged QT.

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Bridging the Gap in Emergency Medicine in Pakistan

Saleem, MBBS, et al.

Pakistan has an increasing need for a strong emergency care system as emergency conditions – acute cardiovascular disease, road injuries, and stroke – form the top 10 leading causes of death.

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Penalties for Emergency Medical Treatment and Labor Act Violations Involving Obstetrical Emergencies

Terp, MD, MPH, et al.

The Emergency Medical Treatment and Labor Act (EMTALA) was intended to prevent inadequate, delayed, or denied treatment of emergent conditions by emergency departments (ED). While controversies exist regarding the scope of the law, there is no question that EMTALA applies to active labor, a key tenet of the statute and the only medical condition – labor – specifically included in the title of the law.

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The EMTALA Loophole in Psychiatric Care

Schmalz, MD, MPH, et al.

Overhead page: “Code Gray in bed 32.” You find an agitated, combative, and clearly frightened woman in her thirties.

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Provider Workforce

Public Performance Metrics: Driving Physician Motivation and Performance

Jen, MD, et al.

Our objective was to determine whether displaying public performance metrics of physician triage data could drive intangible motivators and improve triage performance in the ED.

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Provider Workforce

#MeToo in EM: A Multicenter Survey of Academic Emergency Medicine Faculty on Their Experiences with Gender Discrimination and Sexual Harassment

Lu, MD, et al.

Gender-based discrimination and sexual harassment of female physicians are well documented. The #MeToo movement has brought renewed attention to these problems. This study examined academic emergency physicians’ experiences with workplace gender discrimination and sexual harassment.

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Emergency Department Clinicians’ Attitudes Toward Opioid Use Disorder and Emergency Department-initiated Buprenorphine Treatment: A Mixed-Methods Study

Im, MD, et al.

Emergency department (ED) visits related to opioid use disorder (OUD) have increased nearly twofold over the last decade. Treatment with buprenorphine has been demonstrated to decrease opioid-related overdose deaths. In this study, we aimed to better understand ED clinicians’ attitudes toward the initiation of buprenorphine treatment in the ED.

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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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