emergency medicine Archives - The Western Journal of Emergency Medicine

Ethical and Legal Issues

Effects of a Dedicated Regional Psychiatric Emergency Service on Boarding of Psychiatric Patients in Area Emergency Departments

Volume XV, Issue 1, February 2014
Scott Zeller, MD et al.

This study sought to assess the effects of a regional dedicated emergency psychiatric facility design known at the “Alameda Model” on boarding times and hospitalization rates for psychiatric patients in area EDs.

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Ethical and Legal Issues

The Alameda Model: An Effort Worth Emulating

Volume XV, Issue 1, February 2014
Aimee Moulin, MD, et al.

In 2009 Alameda placed 11.0 involuntary holds per 1,000 population, while the next highest county in California only placed 6.4 per 1,000 population.5 This may suggest instead that some of Alameda’s mental health patients would not have been placed on an involuntary hold in other California counties in the first place, increasing the proportion of lower acuity psychiatric emergencies and thus accounting for the high discharge rate.

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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.

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Prehospital Care

Reducing Ambulance Diversion at Hospital and Regional Levels: Systemic Review of Insights from Simulation Models

Author Affiliation M. Kit Delgado, MD, MS Stanford University, Division of Emergency Medicine, Stanford, California Lesley J. Meng, HBA, BMSc Columbia University, Mailman School of Public Health, New York City, New York Mary P. Mercer, MD, MPH University of California San Francisco, San Francisco General Hospital, San Francisco, California Jesse M. Pines, MD, MBA, MSCE […]

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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, […]

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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. […]

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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, […]

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Emergency Physicians’ Knowledge of Cannabinoid Designer Drugs

Author Affiliation Patrick M. Lank, MD Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois Elizabeth Pines, MD Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois Mark B. Mycyk, MD Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois Introduction Methods Results Discussion Limitations Conclusion […]

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Levamisole Contaminated Cocaine Induced Cutaneous Vasculitis Syndrome

Author Affiliation Kellee T. James, PharmD University of California San Francisco, Department of Clinical Pharmacy, San Francisco, California Alissa Detz, MD Robert Wood Johnson Foundation Clinical Scholar, University of California Los Angeles, Department of Medicine, Los Angeles, California Zlatan Coralic, PharmD University of California San Francisco, Department of Clinical Pharmacy, San Francisco, CaliforniaUniversity of California […]

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Uterine Rupture Due to Invasive Metastatic Gestational Trophoblastic Neoplasm

Author Affiliation David I. Bruner, MD Naval Medical Center Portsmouth, Emergency Medicine Program, Portsmouth, Virginia Amy M. Pritchard, DO Naval Medical Hospital Camp Pendleton, Oceanside, California Jonathan Clarke, MD Naval Medical Center Jacksonville, Jacksonville, Florida Introduction Case report Discussion Conclusion ABSTRACT While complete molar pregnancies are rare, they are wrought with a host of potential […]

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Vaginal Foreign Bodies and Child Sexual Abuse: An Important Consideration

Author Affiliation Forrest T. Closson, MD University of Maryland School of Medicine, Department of Pediatrics, Division of Pediatric Emergency Medicine, Baltimore, Maryland Richard Lichenstein, MD University of Maryland School of Medicine, Department of Pediatrics, Division of Pediatric Emergency Medicine, Baltimore, Maryland Introduction Case reports Discussion Recommendations ABSTRACT Vaginal foreign bodies are a complaint occasionally encountered […]

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Diaphragmatic Rupture Secondary to Blunt Thoracic Trauma

Author Affiliation Alexander J. Scumpia, DO, MSc Mount Sinai Medical Center, Department of Emergency Medicine, Miami, Florida Daniel A. Aronovich, DO Mount Sinai Medical Center, Department of Emergency Medicine, Miami, Florida Loredana Roman, BS Victor Babes University of Medicine and Pharmacy, Department of Medicine, Timisoara, Romania Vanitha Vasudevan, MD Ryder Trauma Center, Department of Surgery, […]

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Parenteral Hydrocarbon Injection and Associated Toxicities: Two Case Reports

Author Affiliation Michael E. Nelson, MD, MS John H. Stroger Hospital of Cook County, Chicago, Illinois Toxikon Consortium, Illinois Poison Control Center, Chicago, Illinois Isam Nasr, MD John H. Stroger Hospital of Cook County, Chicago, Illinois Westlake Hospital, Melrose Park, Illinois Introduction Case reports Discussion Conclusion INTRODUCTION Many cases of hydrocarbon toxicity occur annually due […]

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Pylephlebitis in a Previously Healthy Emergency Department Patient with Appendicitis

Author Affiliation Christopher J. Coyne, MD Los Angeles County + University of Southern California Health Network, Department of Emergency Medicine, Los Angeles, California Ashokokkumar Jain, MD, MPH Los Angeles County + University of Southern California Health Network, Department of Emergency Medicine, Los Angeles, California Case report Discussion ABSTRACT Pylephlebitis is a septic thrombophlebitis of the […]

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“I Can’t Walk!” Acute Thrombosis of Descending Aorta Causing Paraplegia

Author Affiliation Matthew L. Mitchell, MD Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan Elif Yucebey, MD Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan Mitchell R. Weaver, MD Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan A. Kathrin Jaehne, MD Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan Emanuel P. […]

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Early Presentation of Buried Bumper Syndrome

Author Affiliation Walter Geer, DO St. Luke’s University Hospital, Bethlehem, Pennsylvania Rebecca Jeanmonod, MD St. Luke’s University Hospital, Bethlehem, Pennsylvania Case Discussion Conclusion ABSTRACT Percutaneous endoscopic gastrostomy (PEG) is a relatively safe and effective method of providing nutrition to patients with neurologic deficits or proximal gastrointestinal pathology. Complications that follow this common procedure include dislodgement, […]

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Cephalohematoma in a Patient with Ehlers-Danlos Syndrome

Author Affiliation Brent M. Felton, DO McLaren Greater Lansing Hospital, Department of Emergency Medicine, Lansing, Michigan Michigan State University, Department of Emergency Medicine, East Lansing, Michigan Josh M. White, MD McLaren Greater Lansing Hospital, Department of Emergency Medicine, Lansing, Michigan Michigan State University, Department of Emergency Medicine, East Lansing, Michigan Ryan A. Jones, MD McLaren […]

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Appendicitis Diagnosed by Emergency Physician Performed Point-of-Care Transvaginal Ultrasound: Case Series

Author Affiliation Robert Bramante, MD North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York Marek Radomski, DO North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York Mathew Nelson, DO North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York Christopher Raio, MD North Shore University Hospital, Department of Emergency Medicine, […]

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Uterine Arteriovenous Malformation with Sudden Heavy Vaginal Hemmorhage

Dysfunctional uterine bleeding (DUB) is a common presentation in the emergency department and has a wide differential.

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Bronchopleural Fistula

A 58-year-old man presented to the emergency department with diffuse swelling and crepitus of his face, chest, and extremities due to subcutaneous air

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Injury Prevention

Prevalence of Exposure to Risk Factors for Violence among Young Adults Seen in an Inner-City Emergency Department

Introduction: To assess the prevalence of risk factors for violent injury among young adults treated at an urban emergency department (ED).

Conclusion: Over 30% of young adults presenting to an urban ED reported high exposure to risk factors for violent injury. The high prevalence of these risk factors among ED patients highlights the potential benefit of a survey instrument to identify youth who might benefit from a targeted, ED-based violence prevention program.

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Hunger and Food Insecurity among Patients in an Urban Emergency Department

Introduction: To determine the prevalence of hunger and food insecurity among patients presenting to the emergency department (ED) over 3 consecutive years.
Conclusion: A significant proportion of our ED patients experience food insecurity and hunger. Hunger and food insecurity have become more prevalent among patients seen in this urban county ED over the past 3 years. Emergency physicians should be aware of the increasing number of patients who must choose between obtaining food and their prescribed medications, and should consider the contribution of hunger and food insecurity to the development of health conditions for which ED treatment is sought.

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Endemic Infections

Pneumothorax in Liberia: Complications of Tuberculosis

Tuberculosis (TB) is a known cause of secondary pneumothorax. In areas with endemic TB, complications from the disease, including pneumothorax, are increasing in prevalence. We present the cases of 3 patients (ages 32 years, 17 years, and 3 months) seen in the emergency department at John F. Kennedy Medical Center in Monrovia, Liberia, West Africa. Each presented with shortness of breath and cough, and with some degree of respiratory distress. Airway compromise was present with tracheal or mediastinal deviation. Each patient underwent tube thoracostomy with improvement in pneumothorax and respiratory status.

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Hickam’s Dictum

A 15-year-old female presented to the emergency department (ED) with a 1-week history of fevers, vomiting, back pain and dysuria. Her primary care physician started her on cefdinir for a urinary tract infection. On initial evaluation she was febrile, tachycardic, and had an exam notable for tenderness of both the left costovertebral angle and suprapubic region.

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Injury Outcomes

Riding the Escalator: How Dangerous is it Really?

Intro: About 10,000 escalator-related injuries per year result in emergency department treatment in the United States. Since the 1990s, a steady increase has been reported, but few statistics on escalator-related injuries have been published worldwide.
Conclusion: Escalator accidents can result in severe trauma. Significant gender differences in escalator accidents have been observed. Alcohol intoxication and age are significant risk factors in escalator-related accidents and might be possible targets for preventive measures.

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Emergency Department Access

Established and Novel Initiatives to Reduce Crowding in Emergency Departments

Introduction: We sought to determine the degree that ACEP-identified high-impact initiatives for ED crowding and vertical patient flow have been implemented in academic EDs in the United States (U.S.).
Conclusion: We found great variability in the extent academic EDs have implemented ACEP’s established high-impact ED crowding initiatives, yet most (70%) have adopted to some extent the novel initiative vertical patient flow.

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