Volume 15 Issue 4 Archives - The Western Journal of Emergency Medicine

Discourse in Emergency Medicine and Population Health

Simulation for Professionals Who Care for Bariatric Patients: Some Unanswered Questions

Volume 15, Issue 4, July 2014
Kieran Walsh, FRCPI

Gable et al have presented an interesting study into the effectiveness of an educational intervention involving simulation and didactic teaching.(1) Certainly the problems with caring for obese patients are not going to go away quickly – so it is vital that we have adequate numbers of fully-trained staff that can care for them.

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The Law of Unintended Consequences: Illicit for Licit Narcotic Substitution

Volume 15, Issue 4, July 2014
Martin R. Huecker, MD et al.

The dealers will not use it. Heroin dealers have explicit knowledge of the addictive properties of their product.

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Wordsmithing in Medical Toxicology: A Primer on Portmanteaus

Volume 15, Issue 4, July 2014
Timothy J. Meehan, MD, MPH

The history of language is littered with neologisms. When different cultures met, some words were subsumed – “hamburgesa,” the Spanish word for hamburger is an example. Sometimes spelling is changed in order to denote a cultural difference. There are a number of words that end in ‘er’ in American English, but finish with a ‘re’ in the British usage. Finally, some words are simply combined, deriving their meaning from their individual components, but in their artistry and simplicity are able to exceed the sum of their parts. Words such as these, a particular form of neologism called a portmanteau, can denote an entire idea in a single instant and provide the wordsmith with a particular type of joy.

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Treatment Protocol Assessment

Epidemiology of Nursemaid’s Elbow

Volume 15, Issue 4, July 2014
Sarah Vitello, DO et al.

To provide an epidemiological description of radial head subluxation, also known as nursemaid’s elbow, from a database of emergency department visits.

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Evaluation of Karl Storz CMAC Tip™ Device Versus Traditional Airway Suction in a Cadaver Model

Volume 15, Issue 4, July 2014
Demis N. Lipe, MD et al.

We compared the efficacy of Karl Storz CMAC Tip™ with inline suction to CMAC with traditional suction device in cadaveric models simulating difficult airways, using media mimicking pulmonary edema and vomit.

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Typed Versus Voice Recognition for Data Entry in Electronic Health Records: Emergency Physician Time Use and Interruptions

Volume 15, Issue 4, July 2014
Jonathan E. dela Cruz, MD et al.

Use of electronic health record (EHR) systems can place a considerable data entry burden upon the emergency department (ED) physician. Voice recognition data entry has been proposed as one mechanism to mitigate some of this burden; however, no reports are available specifically comparing emergency physician (EP) time use or number of interruptions between typed and voice recognition data entry-based EHRs. We designed this study to compare physician time use and interruptions between an EHR system using typed data entry versus an EHR with voice recognition.

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Novel Ultrasound Guidance System for Real-time Central Venous Cannulation: Safety and Efficacy

Volume 15, Issue 4, July 2014
Robinson M. Ferre, MD et al.

Real-time ultrasound guidance is considered to be the standard of care for central venous access for non-emergent central lines. However, adoption has been slow, in part because of the technical challenges and time required to become proficient. The AxoTrack® system (Soma Access Systems, Greenville, SC) is a novel ultrasound guidance system recently cleared for human use by the United States Food and Drug Administration (FDA).

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Availability of Insurance Linkage Programs in U.S. Emergency Departments

Volume 15, Issue 4, July 2014
Mia Kanak, MPH et al.

As millions of uninsured citizens who use emergency department (ED) services are now eligible for health insurance under the Affordable Care Act, the ED is ideally situated to facilitate linkage to insurance. Forty percent of U.S. EDs report having an insurance linkage program. This is the first national study to examine the characteristics of EDs that offer or do not offer these programs.

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Outlaw Motorcycle Gangs: Aspects of the One-Percenter Culture for Emergency Department Personnel to Consider

Volume 15, Issue 4, July 2014
Anand N. Bosmia, BA et al.

Outlaw motorcycle gangs (OMGs) are an iconic element of the criminal landscape in the United States, the country of their origin. Members of OMGs may present to the emergency department (ED) as a result of motor vehicle accidents or interpersonal violence. When one member of an OMG is injured, other members and associates are likely to arrive in the ED to support the injured member.

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Impact of the Balance Billing Ban on California Emergency Providers

Volume 15, Issue 4, July 2014
Bing Pao, MD et al.

The objective of this study was to examine reimbursement trends for emergency provider professional services following the balance billing ban in California.

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Provider Workforce

Multidimensional Attitudes of Emergency Medicine Residents Toward Older Adults

Volume 15, Issue 4, July 2014
Teresita M. Hogan, MD et al.

The demands of our rapidly expanding older population strain many emergency departments (EDs), and older patients experience disproportionately high adverse health outcomes. Trainee attitude is key in improving care for older adults. There is negligible knowledge of baseline emergency medicine (EM) resident attitudes regarding elder patients

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Prehospital Care

Emergency Physician Awareness of Prehospital Procedures and Medications

Volume 15, Issue 4, July 2014
Rachel Waldron, MD et al.

Maintaining patient safety during transition from prehospital to emergency department (ED) care depends on effective handoff communication between providers. We sought to determine emergency physicians’ (EP) knowledge of the care provided by paramedics in terms of both procedures and medications, and whether the use of a verbal report improved physician accuracy.

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Prehospital Care

Expansion of U.S. Emergency Medical Service Routing for Stroke Care: 2000–2010

Volume 15, Issue 4, July 2014
Natalie Hanks, MS et al.

Organized stroke systems of care include preferential emergency medical services (EMS) routing to deliver suspected stroke patients to designated hospitals. To characterize the growth and implementation of EMS routing of stroke nationwide, we describe the proportion of stroke hospitalizations in the United States (U.S.) occurring within regions having adopted these protocols.

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Practice Variability

Clinical Management of Skin and Soft Tissue Infections in the U.S. Emergency Departments

Volume 15, Issue 4, July 2014
Rakesh D. Mistry, MD, MS et al.

Community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) has emerged as the most common cause of skin and soft-tissue infections (SSTI) in the United States. A nearly three-fold increase in SSTI visit rates had been documented in the nation’s emergency departments (ED). The objective of this study was to determine characteristics associated with ED performance of incision and drainage (I+D) and use of adjuvant antibiotics in the management of skin and soft tissue infections (SSTI).

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Analysis of Medication Errors in Simulated Pediatric Resuscitation by Residents

Volume 15, Issue 4, July 2014
Evelyn Porter, MD et al.

The objective of our study was to estimate the incidence of prescribing medication errors specifically made by a trainee and identify factors associated with these errors during the simulated resuscitation of a critically ill child.

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Injury Prevention

Successful Conviction of Intoxicated Drivers at a Level I Trauma Center

Volume 15, Issue 4, July 2014
James F. Holmes, MD, MPH et al.

Conviction rates for drivers driving under the influence (DUI) and in motor vehicle collisions (MVC) presenting to trauma centers are based primarily on data from the 1990s.

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Injury Outcomes

Comparison of Three Prehospital Cervical Spine Protocols for Missed Injuries

Volume 15, Issue 4, July 2014
Rick Hong, MD et al.

We wanted to compare 3 existing emergency medical services (EMS) immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based); the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria); and the Hankins’ criteria (immobilization for patients <12 or >65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness).To determine the proportion of patients who would require cervical immobilization per protocol and the number of missed cervical spine injuries, had each protocol been followed with 100% compliance.

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Injury Outcomes

Yield and Clinical Predictors of Thoracic Spine Injury from Chest Computed Tomography for Blunt Trauma

Volume 15, Issue 4, July 2014
Mark I. Langdorf, MD, MHPE et al.

Cost and radiation risk have prompted intense examination of trauma patient imaging. A proposed decision instrument (DI) for the use of chest computed tomography (CT), (CCT) in blunt trauma patients includes thoracic spine (TS) tenderness, altered mental status (AMS) and distracting painful injury (DPI) as potential predictor variables. TS CT is a separate, costly study whose value is currently ill-defined. The objective of this study is to determine test characteristics of these predictor variables alone, and in combination, to derive a TS injury DI.

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Emergency Department Operations

Adherence to Head Computed Tomography Guidelines for Mild Traumatic Brain Injury

Volume 15, Issue 4, July 2014
Landon A. Jones, MD et al.

Traumatic brain injury (TBI) is a significant health concern. While 70–90% of TBI cases are considered mild, decision-making regarding imaging can be difficult. This survey aimed to assess whether clinicians’ decision-making was consistent with the most recent American College of Emergency Physicians (ACEP) clinical recommendations regarding indications for a non-contrast head computed tomography (CT) in patients with mild TBI.

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Emergency Department Operations

Application of a Proactive Risk Analysis to Emergency Department Sickle Cell Care

Volume 15, Issue 4, July 2014
Victoria L. Thornton, MD, MBA et al.

Patients with sickle cell disease (SCD) often seek care in emergency departments (EDs) for severe pain. However, there is evidence that they experience inaccurate assessment, suboptimal care, and inadequate follow-up referrals. The aim of this project was to 1) explore the feasibility of applying a failure modes, effects and criticality analysis (FMECA) in two EDs examining four processes of care (triage, analgesic management, high risk/high users, and referrals made) for patients with SCD, and 2) report the failures of these care processes in each ED.

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Emergency Department Operations

Characteristics of United States Emergency Departments that Routinely Perform Alcohol Risk Screening and Counseling for Patients Presenting with Drinking–related Complaints

Volume 15, Issue 4, July 2014
Michael A. Yokell, ScB et al.

Emergency department (ED) screening and counseling for alcohol misuse have been shown to reduce at-risk drinking. However, barriers to more widespread adoption of this service remain unclear.

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Emergency Department Operations

Unrecognized Hypoxia and Respiratory Depression in Emergency Department Patients Sedated For Psychomotor Agitation: Pilot Study

Volume 15, Issue 4, July 2014
Kenneth Deitch, DO et al.

The incidence of respiratory depression in patients who are chemically sedated in the emergency department (ED) is not well understood. As the drugs used for chemical restraint are respiratory depressants, improving respiratory monitoring practice in the ED may be warranted. The objective of this study is to describe the incidence of respiratory depression in patients chemically sedated for violent behavior and psychomotor agitation in the ED.

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Deliberate Apprenticeship in the Pediatric Emergency Department Improves Experience for Third-year Students

Volume 15, Issue 4, July 2014
Maya Subbarao Iyer, MD et al.

The Pediatric Emergency Department (PED) provides medical students with learning in a high-volume, fast-paced environment; characteristics that can be stressful for new students. Shadowing can improve transitioning, yet this alone does not facilitate students’ development of independent medical care competencies. This study evaluates if third-year medical students’ deliberate apprenticeship with senior residents increases students’ comfort and patient exposure in the PED.

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Analysis of the Evaluative Components on the Standard Letter of Recommendation (SLOR) in Emergency Medicine

Volume 15, Issue 4, July 2014
Kristi H. Grall, MD, MHPE et al.

The standard letter of recommendation in emergency medicine (SLOR) was developed to standardize the evaluation of applicants, improve inter-rater reliability, and discourage grade inflation. The primary objective of this study was to describe the distribution of categorical variables on the SLOR in order to characterize scoring tendencies of writers.

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Assessing Knowledge Base on Geriatric Competencies for Emergency Medicine Residents

Volume 15, Issue 4, July 2014
Teresita M. Hogan, MD et al.

Emergency care of older adults requires specialized knowledge of their unique physiology, atypical presentations, and care transitions. Older adults often require distinctive assessment, treatment and disposition. Emergency medicine (EM) residents should develop expertise and efficiency in geriatric care. Older adults represent over 25% of most emergency department (ED) volumes.

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Improving Community Understanding of Medical Research: Audience Response Technology for Community Consultation for Exception to Informed Consent

Volume 15, Issue 4, July 2014
Taher Vohra, MD et al.

The Department of Health and Human Services and Food and Drug Administration described guidelines for exception from informed consent (EFIC) research. These guidelines require community consultation (CC) events, which allow members of the community to understand the study, provide feedback and give advice. A real-time gauge of audience understanding would allow the speaker to modify the discussion. The objective of the study is to describe the use of audience response survey (ARS) technology in EFIC CCs.

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