Response to: Emergency Medicine Residents Experience Acute Stress While Working in the Emergency Department

Janicki, AJ.

We first want to thank Peters and colleagues for their interest in our work. They bring up two notable points in discussing our study.

We utilized three-lead Nasiff CardioHolter monitors to assess physiologic parameters. The raw data was downloaded directly from Holter monitors using Nasiff software and then reviewed by study authors to ensure quality data was obtained. While there was some motion artifact throughout the shift, the majority of the data was reliable with discernible QRS complexes in one of the three leads. We did not quantify the amount of artifact in each reading. This data was then analyzed using the provided software. When designing the study, we felt that a three-lead Holter, although less convenient and comfortable, would afford us additional data over pulse rate sensors. We do acknowledge as a limitation that we cannot account for all data obscured by artifact as we cannot control how the software decides to analyze and provide specific summary measures.

Read More

Presentation of Neuro-COVID is Broad and Pathogenesis Diverse

Finsterer, J.

With interest we read the review article by Valiuddin et al. about the neurological implications of coronavirus disease 2019 (COVID-19) (neuro-COVID).1 The authors listed ischemic stroke, transverse myelitis, seizures, acute hemorrhaghic necrotising encephalopathy (AHNE), acute disseminated encephalo-myelitis (ADEM), posterior reversible encephalopathy syndrome (PRES), myasthenia, and sinus venous thrombosis as central nervous system (CNS) manifestations, and hyposmia/hypogeusia, Guillain-Barré syndrome, facial palsy, ophthalmoparesis, and neuropathy, as peripheral nervous system (PNS) manifestations of COVID-19.1 We have the following comments and concerns.

Read More

Ultrasound Hypotension Protocol Time-motion Study Using the Multifrequency Single Transducer Versus a Multiple Transducer Ultrasound Device

Sabbadini, L.

Ultrasound hypotension protocols (UHP) involve imaging multiple body areas, each with different transducers and imaging presets. The time for task switching between presets and transducers to perform an UHP has not been previously studied. A novel hand-carried ultrasound (HCU) has been developed that uses a multifrequency single transducer to image areas of the body (lung, heart, abdomen, superficial) that would typically require three transducers using a traditional cart-based ultrasound (CBU) system. Our primary aim was to compare the time to complete UHPs with a single transducer HCU to a multiple transducer CBU.

Read More

Acceptability of Contraceptive Services in the Emergency Department: A Cross-sectional Survey

Alexander, AB.

Unintended pregnancy disproportionately affects marginalized populations and has significant negative health and financial impacts on women, their families, and society. The emergency department (ED) is a promising alternative setting to increase access to sexual and reproductive health (SRH) services including contraception, especially among marginalized populations. The primary objective of this study was to determine the extent to which adult women of childbearing age who present to the ED would be receptive to receiving contraception and/or information about contraception in the ED. As a secondary objective, we sought to identify the barriers faced in attempting to obtain SRH care in the past.

Read More

Pediatric Emergency Departments and Urgent Care Visits in Houston after Hurricane Harvey

Fanny, SA.

Natural disasters are increasingly common and devastating. It is essential to understand children’s health needs during disasters as they are a particularly vulnerable population. The objective of this study was to evaluate pediatric disease burden after Hurricane Harvey compared to the preceding month and the same period in the previous year to inform pediatric disaster preparedness.

Read More

Paramedic-performed Prehospital Point-of-care Ultrasound for Patients with Undifferentiated Dyspnea: A Pilot Study

Schoeneck, JH.

Thoracic ultrasound is frequently used in the emergency department (ED) to determine the etiology of dyspnea, yet its use is not widespread in the prehospital setting. We sought to investigate the feasibility and diagnostic performance of paramedic acquisition and assessment of thoracic ultrasound images in the prehospital environment, specifically for the detection of B-lines in congestive heart failure (CHF).

Read More

Climate Change Adaptation: Prehospital Data Facilitate the Detection of Acute Heat Illness in India

Ranadive, N.

Extreme heat is a significant cause of morbidity and mortality, and the incidence of acute heat illness (AHI) will likely increase secondary to anthropogenic climate change. Prompt diagnosis and treatment of AHI are critical; however, relevant diagnostic and surveillance tools have received little attention. In this exploratory cross-sectional and diagnostic accuracy study, we evaluated three tools for use in the prehospital setting: 1) case definitions; 2) portable loggers to measure on-scene heat exposure; and 3) prevalence data for potential AHI risk factors.

Read More
Emergency Department Operations

Financial Implications of Boarding: A Call for Research

Canellas, MM.

Boarding, the practice of holding patients in emergency departments (ED) after a decision has been made to admit them to the hospital,1 is well known to adversely affect patient care. Multiple investigations have shown that boarding negatively impacts quality and patient safety outcomes including mortality,2-7 readmission rate,8 hospital length of stay,2,5,8,9 and patient satisfaction.10-12 In addition, boarding is known to be a major contributor to overall ED crowding,13 which also has been demonstrated to have significant negative impact on quality and safety.13,14 Multiple operational tactics are known to reduce boarding but, concerningly, adoption of them has been inconsistent.13,15 Also concerning, ED boarding appears to be worsening over time, based upon our unpublished year-over-year review of two large national ED operations benchmarking databases, the Emergency Department Benchmarking Alliance and the Academy of Administrators in Academic Emergency Medicine/Association of Academic Chairs of Emergency Medicine.16,17

Read More
Population Health Research Design

Universal Screening for Hepatitis C Virus in the ED Using a Best Practice Advisory

Ford, JS.

In 2019 the United States Preventive Services Task Force (USPSTF) released draft guidelines recommending universal hepatitis C virus (HCV) screening for individuals aged 18–79. We aimed to assess the efficacy of an emergency department-based HCV screening program, by comparing screening practices before and after its implementation.

Read More
Population Health Research Design

Emergency Medicine Influencers’ Twitter Use During the COVID-19 Pandemic: A Mixed-methods Analysis

Leibowitz, MK.

The objective of this study was to analyze the messages of influential emergency medicine (EM) Twitter users in the United States (US) during the early stages of the coronavirus disease 2019 (COVID-19) global pandemic by characterizing the themes, emotional tones, temporal viewpoints, and depth of engagement with the tweets.

Read More
Critical Care

Sternal Intraosseous Devices: Review of the Literature

Laney, JA.

The intraosseous (IO) route is one of the primary means of vascular access in critically ill and injured patients. The most common sites used are the proximal humerus, proximal tibia, and sternum. Sternal IO placement remains an often-overlooked option in emergency and prehospital medicine. Due to the conflicts in Afghanistan and Iraq the use of sternal IOs have increased.

Read More
Critical Care

Alteplase for Acute Ischemic Stroke Beyond 3 hours: Enthusiasm Outpaces Evidence

Garg, R.

In a 2014 editorial, Shy pointed out a statistical error in ECASS III.3 The trial’s reported adjusted primary analysis did not account for the baseline imbalance in prior stroke status. The ECASS III authors have not addressed this statistical error in the literature. In a recent publication, Alper et al used the raw data to reanalyze the ECASS III data with appropriate adjustments. In a multivariate model adjusted for both baseline National Institutes of Health Stroke Scale (NIHSS) scores (P = .03 between groups) and prior stroke status (P = .003 between groups) there was a non-significant difference between alteplase and placebo for all efficacy outcomes.4

Read More

Impact of Social Determinants of Health, Health Literacy, Self-perceived Risk, and Trust in the Emergency Physician on Compliance with Follow-up

Sutton, J.

Patients presenting to the emergency department (ED) with “low-risk” acute coronary syndrome (ACS) symptoms can be discharged with outpatient follow-up. However, follow-up compliance is low for unknown nonclinical reasons. We hypothesized that a patient’s social factors, health literacy, self-perceived risk, and trust in the emergency physician may impact follow-up compliance.

Read More

Anti-immigrant Rhetoric and the Experiences of Latino Immigrants in the Emergency Department

Ornelas, C.

Anti-immigrant rhetoric and increased enforcement of immigration laws have induced worry and safety concerns among undocumented Latino immigrants (UDLI) and legal Latino residents/citizens (LLRC), with some delaying the time to care.1 In this study, we conducted a qualitative analysis of statements made by emergency department (ED) patients – a majority of whom were UDLI and LLRC – participating in a study to better understand their experiences and fears with regard to anti-immigrant rhetoric, immigration enforcement, and ED utilization.

Read More

Importance of Mentoring on Workplace Engagement of Emergency Medicine Faculty: A Multi-institutional Study

Lucas, RH.

Mentoring in emergency medicine (EM) has not been well studied despite a larger body of literature that has described the value of mentoring in academic medicine on career satisfaction and scholarly output. Over half of all EM faculty nationally are of junior faculty ranks. The aim of this study was to identify the frequency and types of mentoring in EM, how types of mentoring in EM differ by gender, and how mentoring correlates with workplace satisfaction for EM faculty.

Read More

Nicotine Patch Prescription Fulfillment Rates for Emergency Department Patients

Emerman, CL.

Smoking cessation has significant health benefits, and the emergency department (ED) can be an important venue for smoking cessation counseling. Nicotine replacement therapy with transdermal patches has been shown to be associated with smoking cessation in a variety of studies. This study evaluated fulfillment rates for prescriptions for nicotine replacement transdermal patches (NRT-P) from the ED.

Read More

Utilization of Educational Videos to Improve Communication and Discharge Instructions

Wray, A.

When discharging a patient from the emergency department (ED), it is crucial to make sure that they understand their disposition and aftercare instructions. However, numerous factors make it difficult to ensure that patients understand their next steps. Our objective was to determine whether patient understanding of ED discharge and aftercare instructions could be improved through instructional videos in addition to standard written discharge instructions.

Read More

Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

3800 W Chapman Ave Ste 3200
Orange, CA 92868, USA
Phone: 1-714-456-6389


ISSN: 1936-900X
e-ISSN: 1936-9018

ISSN: 2474-252X

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.