Academic Emergency Medicine

Estabraq Al-Najar, Fahd Alrumaih, Danah Arab, Anne Sophie Drouin, Sophie Gosselin, Jake Sawa
We read with interest, "D-dimer triage for COVID-19" by Chenghong et al. This observational cohort study from Wuhan, China concludes that a D-dimer done at admission could be an effective and easily available diagnostic surrogate marker for coronavirus disease-19 (COVID-19). We are concerned that several limitations in the study's methodology affect the authors' conclusions.
July 11, 2020: Academic Emergency Medicine
Alain Braillon
Goldberg and colleagues must be commended for a very simple study providing a major and devastating finding: only one in five older adults reported all of their medications accurately in the Emergency Department (ED) when compared to pharmacy-dispensing records.(1) This deserved comment. Firstly, Goldberg and colleagues rightly recalled that ED visits may be related to drug adverse events which are more frequent in older adults. Could Goldberg and colleagues provide estimations of the mean time spent by research staff for obtaining from pharmacy the list of medications documented in patients' HER? Further, Goldberg and colleagues stressed HER medications lists are frequently inaccurate and obviously their research medications staff called during office hours…...
July 11, 2020: Academic Emergency Medicine
Ian B K Martin, Stephen Hargarten
Recognized as a specialty by the American Board of Medical Specialties over 40 years ago, emergency medicine is unique since its inception-providing care to all patients in all times of unscheduled, time-sensitive need. Members of our specialty-whether working in an academic or private practice setting-provide this care without regard to a patient's sex, sexual orientation, gender, creed, physical ability, ability to pay, or race/ethnicity. The last human determinant of health bears emphasis in our current climate of a race-based inequity crisis...
July 11, 2020: Academic Emergency Medicine
Bernard P Chang, George Bonanno
The COVID-19 pandemic has created an historic global crisis, resulting in unprecedented stressors on frontline healthcare systems. The population remains on edge, and hospitals are stretched to capacity. This is not our first pandemic. We have learned from prior outbreaks that, in addition to the sheer physical burden, there are also likely to be important but often unacknowledged behavioral and psychosocial costs.1 Frontline healthcare workers, may be particularly vulnerable to harmful psychological consequences...
July 10, 2020: Academic Emergency Medicine
Paul L Aronson, Mary C Politi, Paula Schaeffer, Eduardo Fleischer, Eugene D Shapiro, Linda M Niccolai, Elizabeth R Alpern, Steven L Bernstein, Liana Fraenkel
OBJECTIVES: We aimed to develop and test a tool to engage parents of febrile infants ≤60 days of age evaluated in the emergency department (ED). The tool was designed to improve communication for all parents and to support shared decision-making (SDM) about whether to perform a lumbar puncture (LP) for infants 29 to 60 days of age. METHODS: We conducted a multi-phase development and testing process: 1) individual, semi-structured interviews with parents and clinicians (pediatric and general emergency medicine (EM) physicians, and pediatric EM nurses) to learn their preferences for a communication and SDM tool; 2) design of a "storyboard" of the tool with design impression testing; 3) development of a software application (i...
July 9, 2020: Academic Emergency Medicine
Jesse M Pines, Mark S Zocchi, Tamara Ritsema, Maura Polansky, John Bedolla, Arvind Venkat
OBJECTIVE: We examined emergency department (ED) advanced practice provider (APP) productivity and how APP staffing impacted ED productivity, safety, flow, and experience. METHODS: We used 2014-18 data from a national emergency medicine group. The exposure was APP coverage: APP hours as a percentage of total clinician hours at the ED-day level. Multivariable regression was used to assess the relationship between APP coverage and productivity outcomes (patients/clinician hour, relative value units [RVU]/clinician hour, RVUs/visit, and RVUs/salary-adjusted hour), flow outcomes (length of stay & left without treatment), safety (72-hour returns, incident reports), and experience (Press-Ganey scores), adjusting for patient and facility characteristics...
July 7, 2020: Academic Emergency Medicine
Jenny Chang, Joshua Moskovitz, Michael P Jones
"Don't leave me alone," she said. "I'm scared," he said. "Please help me," they said. Their voices echo in my mind against the backdrop of chaos of the Emergency Department. I cuff their forearms with my hands, wondering if they can feel my warmth through my double gloves. I smile to comfort them, forgetting they cannot see my expressions through my N95 mask, goggles, and bouffant. Instead, we lock eyes as I try to soothe them. I let them know I am here for them as I try to remove the weight off their chest...
July 6, 2020: Academic Emergency Medicine
Jameson Mannix
Being the child of an emergency medicine (EM) doctor means a lot of unappetizing dinner conversations. The nauseating remarks are usually casually weaved into common discourse, with a disturbing disregard for the family's digestion. Perhaps a family member mentions an upcoming dental appointment - an innocent remark - which somehow elicits from my mother the gruesome suctioning noise that occurred when she replaced her patient's displaced tooth in its socket. The conversations are a great way to make sure no one overeats...
July 4, 2020: Academic Emergency Medicine
P Hausfater, D Hajage, Julie Bulsei, P Canavaggio, A Lafourcade, A L Paquet, M Arock, I Durand-Zaleski, B Riou, N Oueidat
BACKGROUND AND OBJECTIVES: Crowding is a frequent concern in the emergency department (ED). Laboratory point of care testing (POCT) has been proposed to decrease patients' length of stay (LOS). Our objective was to determine whether an extended panel of POCT solutions could reduce LOS. METHODS: This was a single-center, prospective, open-label, controlled cluster-randomized study. Blood test processing was randomized into one-week inclusion periods: interventional arm (laboratory analyses performed on POCT analyzers implemented in the ED) or control arm (central laboratory)...
July 3, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Liza Hartofilis
"Will buddies." That was an unfortunate phrase a friend of mine and I coined together during a shift early in the pandemic. He was a resident in our program just a couple of years ago and is now one of my attendings. While we were working a shift in the ED swarming with critically ill COVID patients, it came up in the "doc box" that we were both drafting our wills.
July 3, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Kennon Heard, Caroline Ledbetter, Jason Hoppe
Opioids are commonly administered in the emergency department (ED) and prescribed for the treatment of back pain. It is important to understand the unintended consequences of this approach to inform treatment decisions and the consideration of alternative treatments. Recent evidence has shown that ED opioid prescriptions are associated with future opioid use. The objective of this study was to measure the association of opioid administration in the ED to patients treated for back pain with future opioid use...
July 1, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Nicholas M Mohr, Stephen G Pape, Dan Runde, Amy H Kaji, Ron M Walls, Calvin A Brown
OBJECTIVE: The objectives of this study were (1) to describe the current use of etomidate and other induction agents in patients with sepsis and (2) to compare adverse events between etomidate and ketamine in sepsis. METHODS: Observational cohort study of the prospective National Emergency Airway Registry (NEAR) data set. Descriptive statistics were used to report the distribution of induction agents used in patients with sepsis. Adverse events were compared using bivariate analysis, and a sensitivity analysis was conducted using a propensity score-adjusted analysis of etomidate vs...
June 30, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Jaimee Warren, Blake Cooper, Anton Jermakoff, Jonathan C Knott
This was a double-blind, randomized clinical trial comparing three different solutions for the treatment of adults with epigastric pain or dyspepsia presenting to the emergency department (ED). It was conducted in the Royal Melbourne Hospital, a tertiary, adult-only, inner-city center in Melbourne with 75,000 annual ED visits. Data were collected over three months, from June to August 2019, between 0800 and 2300, seven days a week.
June 29, 2020: Academic Emergency Medicine
Suzanne K Bentley, Laura Iavicoli, David Cherkas, Rikki Lane, Ellen Wang, Maria Atienza, Phillip Fairweather, Stuart Kessler
Prior studies on proning awake, non-intubated patients with hypoxemic acute respiratory failure, as well as evolving study of similar COVID-19 patients, coupled with experience and dramatic anecdotal evidence from the COVID-19 pandemic, suggest the importance of proning all such patients with COVID-19 to improve oxygenation and reduce respiratory effort. Literature and experience from healthcare teams in the midst of the pandemic suggest that any COVID-19 patients with respiratory compromise severe enough to warrant admission should be considered for proning...
June 29, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Dustin G Mark, Jie Huang, Mamata V Kene, Dana R Sax, Dale M Cotton, James S Lin, Sean C Bouvet, Uli K Chettipally, Megan L Anderson, Ian I McLachlan, Laura E Simon, Judy Shan, Adina S Rauchwerger, David R Vinson, Dustin W Ballard, Mary E Reed
BACKGROUND: Coronary risk scores are commonly applied to emergency department (ED) patients with undifferentiated chest pain. Two prominent risk score-based protocols are the Emergency Department Assessment of Chest pain Score Accelerated Diagnostic Protocol (EDACS-ADP) and the History, ECG, Age, Risk factors and Troponin (HEART) pathway. Since prospective documentation of these risk determinations can be challenging to obtain, quality improvement projects could benefit from automated retrospective risk score classification methodologies...
June 28, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Michael D April, Allyson Arana, Steven G Schauer, William T Davis, Joshua J Oliver, Andrea Fantegrossi, Shane M Summers, Joseph K Maddry, Ron M Walls, Calvin A Brown
BACKGROUND: The hemodynamic impact of induction agents is a critically important consideration in emergency intubations. We assessed the relationship between peri-intubation hypotension and the use of ketamine versus etomidate as an induction agent for emergency department (ED) intubation. METHODS: We analyzed ED intubation data for patients aged >14 years from the National Emergency Airway Registry performed in 25 EDs during 2016-2018. We excluded patients with pre-intubation hypotension (systolic blood pressure <100 mm Hg) or cardiac arrest prior to intubation...
June 26, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Dana M King, J Priyanka Vakkalanka ScM, Christian Junker Pa-C, Karisa K Harland, Andrew S Nugent
Crowding in emergency departments (EDs) is a concern for hospital administrators, emergency providers, and patients. Many factors contribute to crowding, including variable patient volume and acuity along with contributing hospital factors such as inadequate nursing support and insufficient inpatient beds resulting in prolonged ED boarding times.1 In order to better study and define characteristics indicative of crowding, the National Emergency Department Overcrowding Study (NEDOCS) established a standardized and validated scoring system to quantify crowding in an academic setting...
June 24, 2020: Academic Emergency Medicine
John Conway, Benjamin Friedman
Asthma is a common chronic respiratory disease with acute exacerbations recognized clinically by the signs and symptoms of dyspnea, cough, chest tightness, and wheezing. In the United States approximately 25 million individuals currently have asthma and in 2017, asthma exacerbations accounted for approximately 1.8 million emergency department (ED) visits and 3,500 deaths.
June 23, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Cindy Y Chang, Christopher W Baugh, Calvin A Brown, Scott G Weiner
OBJECTIVE: Emergency physicians are commonly compared by their patients' length of stay (LOS). We test the hypothesis that LOS is associated with patient characteristics, and that accounting for these features impacts physician LOS rankings. METHODS: Retrospective observational study of all encounters at an emergency department in 2010-2015. We compared the characteristics of patients seen by physicians in different quartiles of LOS. Primary outcome was variation in patient characteristics at time of physician assignment (age, gender, comorbidities, Emergency Severity Index [ESI], and chief complaint) across LOS quartiles...
June 22, 2020: Academic Emergency Medicine
Diana J Dean, Noor Sabagha, Kaitlin Rose, Alexander Weiss, John France, Timothy Asmar, Jo-Ann Rammal, Margaret Beyer, Rebecca Bussa, Jacob Ross, Kaleem Chaudhry, Thomas Smoot, Kathleen Wilson, Joseph Miller
BACKGROUND: Patients with cannabinoid hyperemesis syndrome (CHS) present frequently to the emergency department. Previous case studies suggest dramatic symptomatic improvement with topical capsaicin treatment. This exploratory study examined the potential effectiveness of topical capsaicin in patients with nausea and vomiting due to a suspected CHS exacerbation. METHODS: This was a double-blind, randomized placebo-controlled pilot trial. Adults who presented with vomiting suspected to be from CHS were eligible for enrollment...
June 22, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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