Volume 15 Issue 3 Archives - The Western Journal of Emergency Medicine

Critical Care

Epidemiología del Síndrome de Respuesta Inflamatoria Sistémica en el Departamento de Emergencia

Volume 15, Issue 3, May 2014
Horeczko T, MD, MSCR, et al.

Guías de consenso recomiendan cernimiento de sepsis para adultos con síndrome de respuesta inflamatoria sistémica (SIRS), pero la epidemiología de SIRS en pacientes adultos de sala de emergencia (ED) es poco entendida. Énfasis reciente en cuidado de salud costo efectivo y basado en resultados, motiva la evaluación del desempeño de esfuerzos de gran escala tales como cernimiento de sepsis. Estudiamos una muestra representativa nacional para clarificar la epidemiología de SIRS en la sala de emergencia y su categoría subsecuente de enfermedad.

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Injury Prevention

Disposición para Cambiar y Razones para Reducir Intencionalmente el Consumo de Alcohol en el Departamento de Medicina de Emergencia versus la Población de Trauma

Volume 15, Issue 3, May 2014
Harrison C, MD, MPH et al.

El objetivo primario era identificar las razones más comunes para la intención de disminuir el uso de alcohol en la sala de emergencia (ED) y en la población de pacientes de trauma. El objetivo secundario era determinar la asociación entre la razón de disminuir el consumo de alcohol y el nivel de educación.

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Sondeo de Publicaciones y el índice-H en Profesores Académicos de Medicina de Emergencia

Volume 15, Issue 3, May 2014
Babineau MR, MD et al.

El número de publicaciones y la frecuencia en que éstas son citadas juegan un rol en las promociones académicas. Se han propuesto bibliométricas que intentan cuantificar el impacto relativo del trabajo académico. El índice-H se define como el número (h) de publicaciones para un individuo que ha sido citado como mínimo en h cantidad de veces. Nosotros calculamos el índice-H y el número de publicaciones para académicos de medicina de emergencia con el rango de profesor.

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Estudio del Temor a la Impericia Médica de los Estudiantes de Medicina y la Medicina Defensiva: ¿Un “Currículo Oculto”?

Volume 15, Issue 3, May 2014
Johnston W, MD et al.

La medicina defensiva es una práctica médica en la cual la intención primordial de los proveedores de la salud es evitar críticas y demandas en lugar de proveer las necesidades médicas de sus pacientes. El propósito de este estudio es caracterizar la exposición de los estudiantes de medicina a la medicina defensiva durante sus rotaciones de escuela de medicina.

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USEFUL: Examen Sonográfico para Lesiones Subyacentes Incorporado al Examen Físico

Volume 15, Issue 3, May 2014
Steller J, MD et al.

El Examen de Cernimiento con Sonograma para la evaluación de Lesiones Subyacentes (USEFUL) fue desarrollado en un intento por establecer un rol para sonografía “bedside” en el marco de cuidado preventivo y primario. El propósito de nuestro estudio piloto era determinar si los estudiantes eran capaces de llevar a cabo todos los “scans” requeridos para USEFUL de manera que este examen físico asistido por sonografía complemente el examen físico estándar en la misma estructura de pies a cabeza. Nosotros también nos propusimos evaluar el tiempo necesario para un examen adecuado y analizar si los tiempos mejoraban con repetición y entrenamiento previo en sonografía.

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USEFUL: Ultrasound Exam for Underlying Lesions Incorporated into Physical Exam

Volume 15, Issue 3, Jon Steller, MD et al.

The Ultrasound Screening Exam for Underlying Lesions (USEFUL) was developed in an attempt to establish a role for bedside ultrasound in the primary and preventive care setting. It is the purpose of our pilot study to determine if students were first capable of performing all of the various scans required of our USEFUL while defining such an ultrasound-assisted physical exam that would supplement the standard hands-on physical exam in the same head-to-toe structure. We also aimed to assess the time needed for an adequate exam and analyze if times improved with repetition and previous ultrasound training.

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Emergency Department Operations

Does Prolonged Length of Stay in the Emergency Department Affect Outcome for Stroke Patients?

Volume 15, Issue 3, May 2014
Minal Jain, MBBS, MPH et al.

Conflicting data exist regarding the association between the length of stay (LOS) of critically ill patients in the emergency department (ED) and their subsequent outcome. However, such patients are an overall heterogeneous group, and we therefore sought to study the association between EDLOS and outcomes in a specific subgroup of critically ill patients, namely those with acute ischemic stroke/transient ischemic attack (AIS/TIA).

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Emergency Department Operations

Follow Up for Emergency Department Patients After Intravenous Contrast and Risk of Nephropathy

Volume 15, Issue 3, May 2014
Getaw Worku Hassen, MD, PhD et al.

Contrast-induced nephropathy (CIN), defined as an increase in serum creatinine (SCr) greater than 25% or ≥0.5 mg/dL within 3 days of intravenous (IV) contrast administration in the absence of an alternative cause, is the third most common cause of new acute renal failure in hospitalized patients. It is known to increase in-hospital mortality up to 27%. The purpose of this study was to investigate the rate of outpatient follow up and the occurrence of CIN in patients who presented to the emergency department (ED) and were discharged home after computed tomography (CT) of the abdomen and pelvis (AP) with IV contrast.

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Emergency Department Operations

Skin Infections and Antibiotic Stewardship: Analysis of Emergency Department Prescribing Practices, 2007–2010

Volume 15, Issue 3, May 2014
Daniel J. Pallin, MD, MPH et al.

National guidelines suggest that most skin abscesses do not require antibiotics, and that cellulitis antibiotics should target streptococci, not community-associated MRSA (CA-MRSA). The objective of this study is to describe antimicrobial treatment of skin infections in U.S. emergency departments (EDs) and analyze potential quality measures.

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Survey of Publications and the H-index of Academic Emergency Medicine Professors

Volume 15, Issue 3, May 2014
Matthew Babineau, MD et al.

The number of publications and how often these have been cited play a role in academic promotion. Bibliometrics that attempt to quantify the relative impact of scholarly work have been proposed. The h-index is defined as the number (h) of publications for an individual that have been cited at least h times. We calculated the h-index and number of publications for academic emergency physicians at the rank of professor.

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Study of Medical Students’ Malpractice Fear and Defensive Medicine: A “Hidden Curriculum?”

Volume 15, Issue 3, May 2014
William F. Johnston, MD et al.

Defensive medicine is a medical practice in which health care providers’ primary intent is to avoid criticism and lawsuits, rather than providing for patients’ medical needs. The purpose of this study was to characterize medical students’ exposure to defensive medicine during medical school rotations.

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Scholar Quest: A Residency Research Program Aligned with Faculty Goals

Volume 15, Issue 3, May 2014
Ashish R. Panchal, MD, PhD et al.

The ACGME requires that residents perform scholarly activities prior to graduation, but this is difficult to complete and challenging to support. We describe a residency research program, taking advantage of environmental change aligning resident and faculty goals, to become a contributor to departmental cultural change and research development.

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Experience with Emergency Ultrasound Training by Canadian Emergency Medicine Residents

Volume 15, Issue 3, May 2014
Daniel J. Kim, MD et al.

Starting in 2008, emergency ultrasound (EUS) was introduced as a core competency to the Royal College of Physicians and Surgeons of Canada (Royal College) emergency medicine (EM) training standards. The Royal College accredits postgraduate EM specialty training in Canada through 5-year residency programs. The objective of this study is to describe both the current experience with and the perceptions of EUS by Canadian Royal College EM senior residents.

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Ethical and Legal Issues

Assessment of the Acute Psychiatric Patient in the Emergency Department: Legal Cases and Caveats

Volume 15, Issue 3, May 2014
Benjamin Good, MD et al.

Assessment of the acute psychiatric emergency is challenging and fraught with error. This paper, using legal cases, will discuss the assessment of new onset psychiatric illness, exacerbation of chronic psychiatric disease, and the suicidal patient. We will share diagnostic caveats, medical clearance, and suicide assessment tools.

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Ethical and Legal Issues

Informed Consent Documentation for Lumbar Puncture in the Emergency Department

Volume 15, Issue 3, May 2014
Pankaj B. Patel, MD et al.

Informed consent is a required process for procedures performed in the emergency department (ED), though it is not clear how often or adequately it is obtained by emergency physicians. Incomplete performance and documentation of informed consent can lead to patient complaints, medico-legal risk, and inadequate education for the patient/guardian about the procedure. We undertook this study to quantify the incidence of informed consent documentation in the ED setting for lumbar puncture (LP) and to compare rates between pediatric (<18 years) and adult patients.

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Healthcare Utilization

Depression is Associated with Repeat Emergency Department Visits in Patients with Non-specific Abdominal Pain

Volume 15, Issue 3, May 2014
Andrew Charles Meltzer, MD et al.

Patients with abdominal pain often return multiple times despite no definitive diagnosis. Our objective was to determine if repeat emergency department (ED) use among patients with non-specific abdominal pain might be associated with a diagnosis of moderate to severe depressive disorder.

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Critical Care

Epidemiology of the Systemic Inflammatory Response Syndrome (SIRS) in the Emergency Department

Volume 15, Issue 3, May 2014
Timothy Horeczko, MD, MSCR et al.

Consensus guidelines recommend sepsis screening for adults with systemic inflammatory response syndrome (SIRS), but the epidemiology of SIRS among adult emergency department (ED) patients is poorly understood. Recent emphasis on cost-effective, outcomes-based healthcare prompts the evaluation of the performance of large-scale efforts such as sepsis screening. We studied a nationally representative sample to clarify the epidemiology of SIRS in the ED and subsequent category of illness.

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Readiness to Change and Reasons for Intended Reduction of Alcohol Consumption in Emergency Department versus Trauma Population

Volume 15, Issue 3, May 2014
Craig Harrison, MD, MPH et al.

The primary objective was to identify the most common reasons for intending to cut back on alcohol use, in emergency department (ED) and trauma patient populations. The secondary objective was to determine the association between reason to cut back on alcohol and education level.

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