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Western Journal of Emergency Medicine

Robert Strony, Jennifer R Marin, John Bailitz, Anthony J Dean, Mike Blaivas, Vivek Tayal, Chris Raio, Rachel Liu, Aimee Woods, Michael Zwank, Matthew Fields, Alyssa Abo, Stan Wu, Tarina Kang, Teresa Liu, Megan Leo, Courtney Smalley, Jerry Chiricolo, Mikaela Chilstrom, Resa E Lewiss
[This corrects the article on p. 649 in vol. 19, PMID: 30013699.].
September 2018: Western Journal of Emergency Medicine
Martin Eckhardt, Dimitri Santillán, Tomas Faresjö, Birger C Forsberg, Magnus Falk
Introduction: In many low- and middle-income countries emergency care is provided anywhere in the health system; however, no studies to date have looked at which providers are chosen by patients with perceived emergencies. Ecuador has universal health coverage that includes emergency care. However, earlier research indicates that patients with emergencies tend to seek private care. Our primary research questions were these: What is the scope of perceived emergencies?; What is their nature?; and What is the related healthcare-seeking behavior? Secondary objectives were to study determinants of healthcare-seeking behavior, compare health expenditure with expenditure from the past ordinary illness, and measure the prevalence of catastrophic health expenditure related to perceived emergencies...
September 2018: Western Journal of Emergency Medicine
Jameel Abualenain, Ahd Almarzouki, Rawan Saimaldaher, Mark S Zocchi, Jesse M Pines
Introduction: Prolonged waiting times during episodes of emergency department (ED) crowding are associated with poor outcomes. Point-of-care testing (POCT) at ED triage prior to physician evaluation may help identify critically ill patients. We studied the impact of ED POCT in a single ED with a high degree of crowding for patients with high-risk complaints who were triaged as non-critically ill. Methods: We conducted the study from April-July 2017 at King Abdulaziz University (KAU) Hospital in Jeddah, Saudi Arabia...
September 2018: Western Journal of Emergency Medicine
Quincy K Tran, Tina Nguyen, Gurshawn Tuteja, Laura Tiffany, Ashley Aitken, Kevin Jones, Rebecca Duncan, Jeffrey Rea, Lewis Rubinson, Daniel Haase
Introduction: Pain is the most common complaint for an emergency department (ED) visit, but ED pain management is poor. Reasons for poor pain management include providers' concerns for drug-seeking behaviors and perceptions of patients' complaints. Patients who had objective findings of long bone fractures were more likely to receive pain medication than those who did not, despite pain complaints. We hypothesized that patients who were interhospital-transferred from an ED to an intensive care unit (ICU) for urgent surgical interventions would display objective pathology for pain and thus receive adequate pain management at ED departure...
September 2018: Western Journal of Emergency Medicine
Casey A Grover, Mia Potter McKernan, Reb J H Close
Introduction: Given the high rates of opioid addiction and overdose in the United States, non-opioid means of treating pain are increasingly needed. Transcutaneous electrical nerve stimulation (TENS) therapy is an effective non-opioid modality for treating pain, but has not yet been routinely used in emergency department (ED) settings. In this study we asked the following questions: Are TENS units a feasible treatment for pain in the ED? How effective are TENS units for the management of pain in a general ED population? Methods: At our institution, we performed a pilot study using TENS units for pain...
September 2018: Western Journal of Emergency Medicine
Michael F Harrison
The international normalized ratio (INR) represents a clinical tool to assess the effectiveness of vitamin-K antagonist therapy. However, it is often used in the acute setting to assess the degree of coagulopathy in patients with hepatic cirrhosis or acute liver failure. This often influences therapeutic decisions about invasive procedures or the need for potentially harmful and unnecessary transfusions of blood product. This may not represent a best-practice or evidence-based approach to patient care. The author performed a review of the literature related to the utility of INR in cirrhotic patients using several scientific search engines...
September 2018: Western Journal of Emergency Medicine
Michael B Hocker, Charles J Gerardo, B Jason Theiling, John Villani, Rebecca Donohoe, Hirsh Sandesara, Alexander T Limkakeng
Introduction: Triage systems play a vital role in emergency department (ED) operations and can determine how well a given ED serves its local population. We sought to describe ED utilization patterns for different triage levels using the National Hospital Ambulatory Medical Care Survey (NHAMCS) database. Methods: We conducted a multi-year secondary analysis of the NHAMCS database from 2009-2011. National visit estimates were made using standard methods in Analytics Software and Solutions (SAS, Cary, NC)...
September 2018: Western Journal of Emergency Medicine
Jessica L Corio, Jonathan H Sin, Bryan D Hayes, Joshua N Goldstein, Lanting Fuh
Introduction: Advancements in the treatment of warfarin-associated intracranial hemorrhage (ICH) include the use of four-factor prothrombin complex concentrate (4F-PCC), which has demonstrated more rapid reversal of the international normalized ratio (INR) when compared with fresh frozen plasma. A pharmacist-driven protocol for 4F-PCC was implemented within our institution, which allows for pharmacist approval of 4F-PCC in patients diagnosed with warfarin-associated ICH and an INR ≥2...
September 2018: Western Journal of Emergency Medicine
Gelareh Z Gabayan, Michael K Gould, Robert E Weiss, Vicki Y Chiu, Catherine A Sarkisian
Introduction: The emergency department (ED) is an inherently high-risk setting. Risk scores can help practitioners understand the risk of ED patients for developing poor outcomes after discharge. Our objective was to develop two risk scores that predict either general inpatient admission or death/intensive care unit (ICU) admission within seven days of ED discharge. Methods: We conducted a retrospective cohort study of patients age > 65 years using clinical data from a regional, integrated health system for years 2009-2010 to create risk scores to predict two outcomes, a general inpatient admission or death/ICU admission...
September 2018: Western Journal of Emergency Medicine
Paul Trinquero, Andrew Pirotte, Lauren P Gallagher, Kimberly M Iwaki, Christopher Beach, Jane E Wilcox
The prevalence of patients living with a left ventricular assist device (LVAD) is rapidly increasing due to improvements in pump technology, limiting the adverse event profile, and to expanding device indications. To date, over 22,000 patients have been implanted with LVADs either as destination therapy or as a bridge to transplant. It is critical for emergency physicians to be knowledgeable of current ventricular assist devices (VAD), and to be able to troubleshoot associated complications and optimally treat patients with emergent pathology...
September 2018: Western Journal of Emergency Medicine
Steven A Maher, M'hamed Temkit, Matthew R Buras, Ryan Y McLemore, Rebecca K Butler, Yasmynn Chowdhury, Christopher A Lipinski, Stephen J Traub
Introduction: Patients with malignancy represent a particular challenge for the emergency department (ED) given their higher acuity, longer ED length of stay, and higher admission rate. It is unknown if patients with malignancies and hyperlactatemia are at increased risk of mortality. If serum lactic acid could improve detection of at-risk patients with cancer, it would be useful in risk stratification. There is also little evidence that "alarm" values of serum lactate (such as >/=4 mmol/L) are appropriate for the population of patients with cancer...
September 2018: Western Journal of Emergency Medicine
Daved van Stralen, Sean D McKay, Kenji Inaba, Mark Hartwig, Thomas A Mercer
No abstract text is available yet for this article.
September 2018: Western Journal of Emergency Medicine
Megan Stobart-Gallagher, Alanna O'Connell
Introduction: With the development of and progression toward a single graduate medical education accreditation system combining the current Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA) residency programs, the total number of students competing for the same postgraduate training spots will continue to rise. Given this increasing competition for emergency medicine (EM) residency positions, understanding factors that contribute to match success is important to ensure a successful match for osteopathic medical students...
September 2018: Western Journal of Emergency Medicine
Sara Carey, Michaeleena Carr, Komaira Ferdous, Gina Marie Moffa, Jennifer Axelband, Shaila Quazi
Introduction: High-risk mechanisms in trauma usually dictate certain treatment and evaluation in protocolized care. A 10-15 feet (ft) fall is traditionally cited as an example of a high-risk mechanism, triggering trauma team activations and costly work-ups. The height and other details of mechanism are usually reported by lay bystanders or prehospital personnel. This small observational study was designed to evaluate how accurate or inaccurate height estimation may be among typical bystanders...
September 2018: Western Journal of Emergency Medicine
Tony Zitek, Elizabeth Busby, Heather Hudson, John D McCourt, Jamie Baydoun, David E Slattery
Introduction: The peripheral internal jugular (IJ), also called the "easy IJ," is an alternative to peripheral venous access reserved for patients with difficult intravenous (IV) access. The procedure involves placing a single-lumen catheter in the IJ vein under ultrasound (US) guidance. As this technique is relatively new, the details regarding the ease of the procedure, how exactly it should be performed, and the safety of the procedure are uncertain. Our primary objective was to determine the success rate for peripheral IJ placement...
September 2018: Western Journal of Emergency Medicine
Chadd K Kraus, Terry E Carlisle, Devin M Carney
Introduction: A growing number of formal postgraduate training programs have been established to provide emergency medicine physician assistants (EMPA) with the unique skills and knowledge to work in the emergency department (ED). The objective of this study was to provide an overview of the current state of EMPA postgraduate training and to describe program characteristics and curriculum components. Methods: We conducted a cross-sectional study of EMPA postgraduate training programs using data from websites and contacting individual programs to provide program characteristics and curriculum components...
September 2018: Western Journal of Emergency Medicine
Allison Tadros, Melinda J Sharon, Shelley M Hoffman, Danielle M Davidov
Introduction: Emerging adults (18-25 years of age) are at increased risk for sexual assault. There is little Emergency Department (ED) data on sexual assaults that involve alcohol among this population. The purpose of this study was to analyze ED visits for sexual assault and determine if alcohol consumption by the patient was noted. Methods: This study was a retrospective chart review of patients aged 18-25 presenting to an ED in a college town over a four-year period...
September 2018: Western Journal of Emergency Medicine
Roderick Cross, Rahul Bhat, Ying Li, Michael Plankey, Kevin Maloy
Introduction: Variability in the use of computed tomography (CT) between providers in the emergency department (ED) suggests that CT is ordered on a provider rather than a patient level. We aimed to evaluate the variability of CT ordering practices for non-traumatic abdominal pain (NTAP) across physicians in the ED using patient-visit and physician-level factors. Methods: We conducted a retrospective study among 6,409 ED visits for NTAP from January 1 to December 31, 2012, at a large, urban, academic, tertiary-care hospital...
September 2018: Western Journal of Emergency Medicine
Peter K Milano, Shoma A Desai, Erick A Eiting, Erik F Hofmann, Chun N Lam, Michael Menchine
Introduction: There have been conflicting data regarding the relationship between sepsis-bundle adherence and mortality. Moreover, little is known about how this relationship may be moderated by the anatomic source of infection or the location of sepsis declaration. Methods: This was a multi-center, retrospective, observational study of adult patients with a hospital discharge diagnosis of severe sepsis or septic shock. The study included patients who presented to one of three Los Angeles County Department of Health Services (DHS) full-service hospitals January 2012 to December 2014...
September 2018: Western Journal of Emergency Medicine
Robert M Rodriguez, Noah Hawthorne, Shelby P Murphy, Marcus Theus, David Haase, Chika Chuku, Jason Wen
Introduction: Most trauma centers order abdominal and pelvic computed tomography (CT) as an automatically paired CT for adult blunt trauma evaluation. However, excessive CT utilization adds risks of excessive exposure to ionizing radiation, the need to work up incidental findings (leading to unnecessary and invasive tests), and greater costs. Examining a cohort of adult blunt trauma patients that received paired abdominal and pelvic (A/P) CT, we sought to determine the diagnostic yield of clinically significant injuries (CSI) in the following: 1) the abdomen alone; 2) the pelvis alone; 3) the lumbosacral spine alone; and 4) more than one of these anatomic regions concomitantly...
September 2018: Western Journal of Emergency Medicine
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