Archives

Initial Standardized Framework for Reporting Social Media Analytics in Emergency Care Research

Roland, PhD, et al.

While tools exist to standardize the reporting of clinical studies and systematic reviews, there is no agreed framework for examining social media–based research. This article presents a publication and appraisal checklist for such work and invites further collaboration in the form of a Delphi technique to clarify, expand, improve, and validate the proposal.

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Emergency Department Utilization by Children in the USA, 2010–2011

Goto, MD, et al.

Epidemiological surveillance data for emergency department (ED) visits by children are imperative to guide resource allocation and to develop health policies that advance pediatric emergency care. However, there are sparse population-based data on patient-level information (e.g., the number of children who present to the emergency department [ED]). In this context, we aimed to investigate both the patient- and visit-level rates of ED utilization by children.

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Characterizing New England Emergency Departments by Telemedicine Use

Zachrison, MD, et al.

Telemedicine connects emergency departments (ED) with resources necessary for patient care; its use has not been characterized nationally, or even regionally. Our primary objective was to describe the prevalence of telemedicine use in New England EDs and the clinical applications of use. Secondarily, we aimed to determine if telemedicine use was associated with consultant availability and to identify ED characteristics associated with telemedicine use.

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Ultrasound-Guided Peripheral Intravenous Line Placement: A Narrative Review of Evidence-based Best Practices

Gottlieb, MD, et al.

Peripheral intravenous line placement is a common procedure in emergency medicine. Ultrasound guidance has been demonstrated to improve success rates, as well as decrease complications and pain. This paper provides a narrative review of the literature focusing on best practices and techniques to improve performance with this procedure. We provide an evidence-based discussion of preparation for the procedure, vein and catheter selection, multiple techniques for placement, and line confirmation.

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Diagnostic Accuracy of Ultrasound for Identifying Shoulder Dislocations and Reductions: A Systematic Review of the Literature

Gottlieb, MD, et al.

Patients with shoulder dislocations commonly present to the emergency department. Ultrasound has the potential to save time, radiation exposure, healthcare costs, and possible need for re-sedation. We conducted this systematic review to compare the diagnostic accuracy of ultrasound compared with plain radiography in the assessment of shoulder dislocations.

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Impact of Internally Developed Electronic Prescription on Prescribing Errors at Discharge from the Emergency Department

Hitti, MD, et al.

Medication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%–38%. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions.

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Caudal Edge of the Liver in the Right Upper Quadrant (RUQ) View Is the Most Sensitive Area for Free Fluid on the FAST Exam

Viveta Lobo, MD

The focused assessment with sonography in trauma (FAST) exam is a critical diagnostic test for intraperitoneal free fluid (FF). Current teaching is that fluid accumulates first in Morison’s pouch. The goal of this study was to evaluate the “sub-quadrants” of traditional FAST views to determine the most sensitive areas for FF accumulation.

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Ultrasound Detection of Patellar Fracture and Evaluation of the Knee Extensor Mechanism in the Emergency Department

Kiersten Carter, MD et al.

Traumatic injuries to the knee are common in emergency medicine. Bedside ultrasound (US) has benefits in the rapid initial detection of injuries to the patella. In addition, US can also quickly detect injuries to the entire knee extensor mechanism, including the quadriceps tendon and inferior patellar ligament, which may be difficult to diagnose with plain radiographs.

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Role of Ultrasound in the Identification of Longitudinal Axis in Soft-Tissue Foreign Body Extraction

Al Lulla, MD et al.

Identification and retrieval of soft-tissue foreign bodies (STFB) poses significant challenges in the emergency department. Prior studies have demonstrated the utility of ultrasound (US) in identification and retrieval of STFBs, including radiolucent objects such as wood. We present a case of STFB extraction that uses US to identify the longitudinal axis of the object. With the longitudinal axis identified, the foreign body can be excised by making an incision where the foreign body is closest to the skin. The importance of this technique as it pertains to minimizing surrounding tissue destruction and discomfort for patients has not been previously reported.

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Point-of-Care Sonographic Findings in Acute Upper Airway Edema

Michael Schick, DO, MA et al.

We describe a case where a patient presented with acute angiotensin-converting enzyme inhibitor (ACE-I) induced angioedema without signs or symptoms of upper airway edema beyond lip swelling. Point-of-care ultrasound (POCUS) was used as an initial diagnostic test and identified left-sided subglottic upper airway edema that was immediately confirmed with indirect fiberoptic laryngoscopy. ACE-I induced angioedema and the historical use of ultrasound in evaluation of the upper airway is briefly discussed. To our knowledge, POCUS has not been used to identify acute upper airway edema in the emergency setting. Further investigation is needed to determine if POCUS is a sensitive and specific-enough tool for the identification and evaluation of acute upper airway edema.

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Point-of-Care Ultrasound to Diagnose a Simple Ranula

Ili Margalit, MD et al.

An 11-year-old previously healthy girl presented to the emergency department (ED) with three weeks of a rapidly progressive swelling underneath her tongue, causing difficulty in talking and eating. Physical examination revealed a 4.5 × 3 cm sublingual mass arising from the base of the tongue, around the midline (Figure 1). The mass was soft, movable and non-tender. The contents had a bluish hue, which was covered with normal appearing mucosa. A point-of-care ultrasound (POCUS) revealed a well-circumscribed homogenous cystic mass, separated from the muscular fibers of the tongue, without extravasation towards the neck (Figure 2) and without intra-cystic flow. A diagnosis of simple ranula was made.

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Emergency Department Operations

Mobile COWs (Computer on Wheels): Hamburger or VEAL?

Mobile COWs (Computer on Wheels): Hamburger or VEAL?
Maxwell Jen, MD, et al.

The HITECH (Health Information Technology for Economic and Clinical Health) Act of 2009 galvanized the universal adoption of electronic health record (EHR) systems to improve the quality, delivery, and coordination of patient care.1 Initial results demonstrated improvement in population health outcomes and increased transparency.2-3 Through the HITECH Act’s Meaningful Use (MU) incentives, EHR adoption also promised shorter hospital stays, reduced costs and improved access to healthcare data.4 These promises, however, never materialized; studies have demonstrated that EHR adoption causes decreased rates of patients seen per hour, highly variable documentation times, and increased order entry times.

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Optic Nerve Sheath Diameter Measurement During Diabetic Ketoacidosis: A Pilot Study

Optic Nerve Sheath Diameter Measurement During Diabetic Ketoacidosis: A Pilot Study
Bergmann, DO, MS, et al.

Diabetic ketoacidosis-related cerebral edema (DKA-CE) occurs in up to 1% of children with type 1 diabetes (T1D),1 with approximately 20% displaying neurologic symptoms at presentation.2,3 Similarly, up to 54% have a mild form of subclinical DKA-CE identified by extracellular fluid measurements on magnetic resonance imaging (MRI), which is associated with alterations in neuronal function and cerebral injury on MR spectroscopy.2-6 This suggests that DKA-CE occurs along a continuum, ranging from asymptomatic imaging changes, mild neurologic injury, to cerebral herniation and death.

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There’s an App for That? Highlighting the Difficulty in Finding Clinically Relevant Smartphone Applications

Volume 17, Issue 2, March 2016.
Warren Wiechmann, MD, MBA, et al.

Introduction: The use of personal mobile devices in the medical field has grown quickly, and a large
proportion of physicians use their mobile devices as an immediate resource for clinical decisionmaking,
prescription information and other medical information. The iTunes App Store (Apple,
Inc.) contains approximately 20,000 apps in its “Medical” category, providing a robust repository
of resources for clinicians; however, this represents only 2% of the entire App Store. The App
Store does not have strict criteria for identifying content specific to practicing physicians, making
the identification of clinically relevant content difficult. The objective of this study is to quantify
the characteristics of existing medical applications in the iTunes App Store that could be used by
emergency physicians, residents, or medical students.
Methods: We found applications related to emergency medicine (EM) by searching the iTunes App
Store for 21 terms representing core content areas of EM, such as “emergency medicine,” “critical
care,” “orthopedics,” and “procedures.” Two physicians independently reviewed descriptions of
these applications in the App Store and categorized each as the following: Clinically Relevant, Book/
Published Source, Non-English, Study Tools, or Not Relevant. A third physician reviewer resolved
disagreements about categorization. Descriptive statistics were calculated.
Results: We found a total of 7,699 apps from the 21 search terms, of which 17.8% were clinical,
9.6% were based on a book or published source, 1.6% were non-English, 0.7% were clinically
relevant patient education resources, and 4.8% were study tools. Most significantly, 64.9% were
considered not relevant to medical professionals. Clinically relevant apps make up approximately
6.9% of the App Store’s “Medical” Category and 0.1% of the overall App Store.
Conclusion: Clinically relevant apps represent only a small percentage (6.9%) of the total App
volume within the Medical section of the App Store. Without a structured search-and-evaluation
strategy, it may be difficult for the casual user to identify this potentially useful content. Given the
increasing adoption of devices in healthcare, national EM associations should consider curating
these resources for their members.

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Point-of-Care Ultrasound to Evaluate a Teenager with Presyncope

Volume 17, Issue 2, March 2016.
Michael T. Long, MD

A 16-year-old male presented with three months of
palpitations at rest, fatigue, and episodic pre-syncope; his
paternal grandfather died following presumed premature
myocardial infarction at age 30. He was seen and discharged
one week previously at an outside emergency department
(ED). He followed up with his pediatrician and was promptly
referred to our pediatric ED for evaluation given his risk factors.
Pertinent vitals on arrival were pulse 110, blood pressure
129/66, and oxygen saturation 97% on room air. His exam
was remarkable for a left upper sternal border 2/6 holosystolic
murmur with radiation to apex. In addition, the patient had a
chest radiograph (Figure), a nonspecific but abnormal EKG, and
a point-of-care ultrasound (POCUS) of the heart performed.

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Retrospective Review of Ocular Point-of-Care Ultrasound for Detection of Retinal Detachment

Volume 17, Issue 2, March 2016.
Bradley Jacobsen, BS, et al.

Introduction: Retinal detachment is an ocular emergency that commonly presents to the
emergency department (ED). Ophthalmologists are able to accurately make this diagnosis with a
dilated fundoscopic exam, scleral depression or ophthalmic ultrasound when a view to the retina is
obstructed. Emergency physicians (EPs) are not trained to examine the peripheral retina, and thus
ophthalmic ultrasound can be used to aid in diagnosis. We assessed the accuracy of ocular point-ofcare
ultrasound (POCUS) in diagnosing retinal detachment.
Methods: We retrospectively reviewed charts of ED patients with suspected retinal detachment
who underwent ocular POCUS between July 2012 and May 2015. Charts were reviewed for
patients presenting to the ED with ocular complaints and clinical concern for retinal detachment.
We compared ocular POCUS performed by EPs against the criterion reference of the consulting
ophthalmologist’s diagnosis.
Results: We enrolled a total of 109 patients. Of the 34 patients diagnosed with retinal detachment
by the ophthalmologists, 31 were correctly identified as having retinal detachment by the EP using
ocular POCUS. Of the 75 patients who did not have retinal detachment, 72 were ruled out by ocular
POCUS by the EP. This resulted in a POCUS sensitivity of 91% (95% CI [76-98]) and specificity of
96% (95% CI [89-99]).
Conclusion: This retrospective study suggests that ocular POCUS performed by EPs can aid in the
diagnosis of retinal detachment in ED.

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

333 The City Blvd. West, Rt 128-01
Suite 640
Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: westjem@gmail.com

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

CPC-EM
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.