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Western Journal of Emergency Medicine

Jonathan Walker, Michael Galuska, David Vega
[This corrects the article on p. 384 in vol. 11, PMID: 21079714.].
November 2018: Western Journal of Emergency Medicine
Carmen N Burrell, Melinda J Sharon, Stephen M Davis, Elena M Wojcik, Ian B K Martin
Introduction: With the current hepatitis C (HCV) epidemic in the Appalachian region and the risk of human immunodeficiency virus (HIV) co-infection, there is a need for increased secondary prevention efforts. The purpose of this study was to implement routine HIV and HCV screenings in the urgent care setting through the use of an electronic medical record (EMR) to increase a provider's likelihood of testing eligible patients. Methods: From June 2017 through May 2018, EMR-based HIV and HCV screenings were implemented in three emergency department-affiliated urgent care settings: a local urgent care walk-in clinic; a university-based student health services center; and an urgent care setting located within a multi-specialty clinic...
November 2018: Western Journal of Emergency Medicine
Ethan Cowan, Heather Herman, Sara Rahman, Jennifer Zahn, Jason Leider, Yvette Calderon
Introduction: An estimated 25% of the 1.2 million individuals living with human immunodeficiency virus (HIV) in the U.S. are co-infected with hepatitis C (HCV). The Centers for Disease Control and Prevention recommends HCV testing for high-risk groups. Our goal was to measure the impact of bundled HIV and HCV testing vs. HIV testing alone on test acceptance and identification of HCV and HIV. Methods: We conducted a two-armed, randomized controlled trial on a convenience sample of 478 adult patients in the Jacobi Medical Center emergency department from December 2012 to May 2013...
November 2018: Western Journal of Emergency Medicine
Katherine M Joyce, Ryan C Burke, Thomas J Veldman, Michelle M Beeson, Erin L Simon
Introduction: Time to facility is a crucial element in emergency medicine (EM). Fine-scale geospatial units such as census block groups (CBG) and publicly available population datasets offer a low-cost and accurate approach to modeling geographic access to and utilization of emergency departments (ED). These methods are relevant to the emergency physician in evaluating patient utilization patterns, emergency medical services protocols, and opportunities for improved patient outcomes and cost utilization...
November 2018: Western Journal of Emergency Medicine
Alexander H Gunn, Zachary P W Smothers, Nicole Schramm-Sapyta, Caroline E Freiermuth, Mark MacEachern, Andrew J Muzyk
Introduction: Substance use disorders, including opioid use disorders, are a major public health concern in the United States. Between 2005 and 2014, the rate of opioid-related emergency department (ED) visits nearly doubled, from 89.1 per 100,000 persons in 2005 to 177.7 per 100,000 persons in 2014. Thus, the ED presents a distinctive opportunity for harm-reduction strategies such as distribution of naloxone to patients who are at risk for an opioid overdose. Methods: We conducted a systematic review of all existing literature related to naloxone distribution from the ED...
November 2018: Western Journal of Emergency Medicine
Sergey Motov, Jefferson Drapkin, Mahlaqa Butt, Andrew Thorson, Antonios Likourezos, Peter Flom, John Marshall
Introduction: We aimed to evaluate the patterns of analgesic prescribing for emergency department (ED) patients suffering from pain of renal colic before, during, and after implementation of an opioid reduction initiative. We hypothesized that this initiative based on the concept of channels/enzymes/receptors-targeted analgesia would result in overall decrease in opioid utilization in the ED and at discharge. Methods: We performed a retrospective analysis of ED electronic medical record of patients presenting with renal colic who received analgesics in the ED and at discharge over a five-year period...
November 2018: Western Journal of Emergency Medicine
Stephen W Hargarten, E Brooke Lerner, Marc Gorelick, Karen Brasel, Terri deRoon-Cassini, Sara Kohlbeck
Gun violence is a complex biopsychosocial disease and as such, requires a multidisciplinary approach to understanding and treatment. Framing gun violence as a disease places it firmly within medical and public health practice. By applying the disease model to gun violence, it is possible to explore the host, agent, and environment in which gun violence occurs, and to identify risk factors to target for prevention. This approach also provides an opportunity to address scientifically inaccurate assumptions about gun violence...
November 2018: Western Journal of Emergency Medicine
Samreen Vora, Matt Lineberry, Valerie Ann Dobiesz
It has been a challenge to assess communication and professional values Milestones in emergency medicine (EM) residents using standardized methods, as mandated by the Accreditation Council for Graduate Medical Education (ACGME). This paper outlines an innovative method of assessing these Milestones using an established instructional method. EM faculty mapped the communication and professional values Milestones to an existing communication and interpersonal skills scale. We identified six communication-focused scenarios: death notification; informed consent; medical non-compliance; medical error; treatment refusal; and advanced directives...
November 2018: Western Journal of Emergency Medicine
Lisa M Meeks, Alina Engelman, Alicia Booth, Michael Argenyi
Approximately 23% of Americans over age 12 have some level of hearing loss.1 Emergency departments can reduce healthcare barriers for deaf and hard-of-hearing (DHoH) patients through improved patient-physician communication. DHoH students, once they become physicians, may provide one mechanism for reducing existing healthcare disparities and communication barriers for DHoH patients, and may be more adept with patients facing other communication barriers. A renewed interest in disability access and a commitment to social justice has increased efforts toward the inclusion of individuals with disabilities in medical education and training...
November 2018: Western Journal of Emergency Medicine
Charlotte Burford, Alexandra von Guionneau
No abstract text is available yet for this article.
November 2018: Western Journal of Emergency Medicine
Linda S Murphy, Chadd K Kraus, Shahram Lotfipour, Michael Gottlieb, James R Langabeer, Mark I Langdorf
There are approximately 78 indexed journals in the specialty of emergency medicine (EM), making it challenging to determine which is the best option for junior faculty. This paper is the final component of a three-part series focused on guiding junior faculty to enhance their scholarly productivity. As an EM junior faculty's research career advances, the bibliometric tools and resources detailed in this paper should be considered when developing a publication submission strategy. The tenure and promotion decision process in many universities relies at least in part on these types of bibliometrics...
November 2018: Western Journal of Emergency Medicine
Michael Gottlieb, Shahram Lotfipour, Linda Murphy, Chadd K Kraus, James R Langabeer, Mark I Langdorf
The landscape of scholarly writing, publishing, and university promotion can be complex and challenging. Mentorship may be limited. To be successful it is important to understand the key components of writing and publishing. In this article, we provide expert consensus recommendations on four key challenges faced by junior faculty: writing the paper; selecting contributors and the importance of authorship order; journal selection and indexing; and responding to critiques. After reviewing this paper, the reader should have an enhanced understanding of these challenges and strategies to successfully address them...
November 2018: Western Journal of Emergency Medicine
Lori L Boland, Tyler G Kinzy, Russell N Myers, Karl M Fernstrom, Jonathan W Kamrud, Pamela J Mink, Andrew C Stevens
Introduction: Very little quantitative data on occupational burnout and exposure to critical incidents are available from contemporary United States emergency medical services (EMS) cohorts. Given that burnout has been associated positively with turnover intentions and absenteeism in EMS workers, studies that uncover correlates of burnout may be integral to combating growing concerns around retention in the profession. Methods: We administered a 167-item electronic survey that included the Maslach Burnout Inventory (MBI) and a modified version of the Critical Incident History Questionnaire (n=29 incident types) to paramedics, emergency medical technicians (EMTs), and dispatchers of a single ambulance service...
November 2018: Western Journal of Emergency Medicine
Michael M Neeki, Fanglong Dong, Jake Toy, Reza Vaezazizi, Joe Powell, David Wong, Michael Mousselli, Massoud Rabiei, Alex Jabourian, Nichole Niknafs, Michelle Burgett-Moreno, Richard Vara, Shanna Kissel, Xian Luo-Owen, Karen R O'Bosky, Daniel Ludi, Karl Sporer, Troy Pennington, Tommy Lee, Rodney Borger, Eugene Kwong
Introduction: Hemorrhage is one of the leading causes of death in trauma victims. Historically, paramedics have not had access to medications that specifically target the reversal of trauma-induced coagulopathies. The California Prehospital Antifibrinolytic Therapy (Cal-PAT) study seeks to evaluate the safety and efficacy of tranexamic acid (TXA) use in the civilian prehospital setting in cases of traumatic hemorrhagic shock. Methods: The Cal-PAT study is a multi-centered, prospective, observational cohort study with a retrospective comparison...
November 2018: Western Journal of Emergency Medicine
Albert Zhang, Regina M Yocum, Michael D Repplinger, Aimee T Broman, Michael K Kim
Introduction: Asking family members to leave during invasive procedures has historically been common practice; however, evidence-based recommendations have altered the trend of family presence during pediatric procedures. The aim of this study was to determine factors related to family members' choice to be present or absent during fracture reductions in a pediatric emergency department (ED), and their satisfaction with that choice. Methods: We administered role-specific, anonymous surveys to a convenience sample of patients' family members in the ED of a Level I pediatric trauma center...
November 2018: Western Journal of Emergency Medicine
Irma T Ugalde, Mary K Claiborne, Marylou Cardenas-Turanzas, Manish N Shah, James R Langabeer, Rajan Patel
Introduction: Computed tomography angiography (CTA) is used to screen patients for cerebrovascular injury after blunt trauma, but risk factors are not clearly defined in children. This modality has inherent radiation exposure. We set out to better delineate the risk factors associated with blunt cervical vascular injury (BCVI) in children with attention to the predictive value of seatbelt sign of the neck. Methods: We collected demographic, clinical and radiographic data from the electronic medical record and a trauma registry for patients less than age 18 years who underwent CTA of the neck in their evaluation at a Level I trauma center from November 2002 to December 2014 (12 years)...
November 2018: Western Journal of Emergency Medicine
Ashley R Etchison, Lia Bos, Meredith Ray, Kelly B McAllister, Moiz Mohammed, Barrett Park, Allen Vu Phan, Corey Heitz
Introduction: Patients frequently present to the emergency department (ED) with migraine headaches. Although low-dose ketamine demonstrates analgesic efficacy for acute pain complaints in the ED, headaches have historically been excluded from these trials. This study evaluates the efficacy and safety of low-dose ketamine for treatment of acute migraine in the ED. Methods: This randomized, double-blinded, placebo-controlled trial evaluated adults 18 to 65 years of age with acute migraine at a single academic ED...
November 2018: Western Journal of Emergency Medicine
C Eric McCoy, Mark I Langdorf, Shahram Lotfipour
The updated American Heart Association (AHA)/American Stroke Association (ASA) Guidelines for the Early Management of Patients with Acute Ischemic Stroke were published in January 2018.1 The purpose of the guidelines is to provide an up-to-date, comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The guidelines detail new and updated recommendations that reflect and incorporate the most recent literature in the evaluation and management of acute ischemic stroke...
November 2018: Western Journal of Emergency Medicine
Laura E Simon, Hilary R Iskin, Ridhima Vemula, Jie Huang, Adina S Rauchwerger, Mary E Reed, Dustin W Ballard, David R Vinson
Introduction: Many emergency department (ED) patients with acute pulmonary embolism (PE) who meet low-risk criteria may be eligible for a short length of stay (LOS) (<24 hours), with expedited discharge home either directly from the ED or after a brief observation or hospitalization. We describe the association between expedited discharge and site of discharge on care satisfaction and quality of life (QOL) among patients with low-risk PE (PE Severity Index [PESI] Classes I-III). Methods: This phone survey was conducted from September 2014 through April 2015 as part of a retrospective cohort study across 21 community EDs in Northern California...
November 2018: Western Journal of Emergency Medicine
Megan Litzau, Joseph Turner, Katie Pettit, Zachary Morgan, Dylan Cooper
Introduction: Patients with limited English proficiency may be at risk for incomplete history collection, potentially a patient safety issue. While federal law requires qualified medical interpreters be provided for these patients, little is known about the quality of information obtained in these encounters. Our study compared the medical histories obtained by physicians in the emergency department (ED) based on whether the patients primarily spoke English or Spanish. Methods: This was a prospective, observational study conducted at a single, urban, academic ED during a six-month time period...
November 2018: Western Journal of Emergency Medicine
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