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Western Journal of Emergency Medicine

Genevieve Santillanes, Yvette L Kearl, Chun N Lam, Ilene A Claudius
INTRODUCTION: Little is known about the use of involuntary psychiatric holds in preadolescent children. The primary objective was to characterize patients under the age of 10 years on involuntary psychiatric holds. METHODS: This was a two-year retrospective study from April 2013 - April 2015 in one urban pediatric emergency department (ED). Subjects were all children under the age of 10 years who were on an involuntary psychiatric hold at any point during their ED visit...
October 2017: Western Journal of Emergency Medicine
Ilene A Claudius, Shoma Desai, Ebony Davis, Sean Henderson
INTRODUCTION: Violence against healthcare workers in the medical setting is common and associated with both physical and psychological adversity. The objective of this study was to identify features associated with assailants to allow early identification of patients at risk for committing an assault in the healthcare setting. METHODS: We used the hospital database for reporting assaults to identify cases from July 2011 through June 2013. Medical records were reviewed for the assailant's (patient's) past medical and social history, primary medical complaints, ED diagnoses, medications prescribed, presence of an involuntary psychiatric hold, prior assaultive behavior, history of reported illicit drug use, and frequency of visits to same hospital requesting prescription for pain medications...
October 2017: Western Journal of Emergency Medicine
Isabel A Barata, Jamie R Shandro, Margaret Montgomery, Robin Polansky, Carolyn J Sachs, Herbert C Duber, Lindsay M Weaver, Alan Heins, Heather S Owen, Elaine B Josephson, Wendy Macias-Konstantopoulos
INTRODUCTION: Alcohol use disorders (AUD) place a significant burden on individuals and society. The emergency department (ED) offers a unique opportunity to address AUD with brief screening tools and early intervention. We undertook a systematic review of the effectiveness of ED brief interventions for patients identified through screening who are at risk for AUD, and the effectiveness of these interventions at reducing alcohol intake and preventing alcohol-related injuries. METHODS: We conducted systematic electronic database searches to include randomized controlled trials of AUD screening, brief intervention, referral, and treatment (SBIRT), from January 1966 to April 2016...
October 2017: Western Journal of Emergency Medicine
Jason A Hoppe, Christopher McStay, Benjamin C Sun, Roberta Capp
INTRODUCTION: Despite treatment guidelines suggesting alternatives, as well as evidence of a lack of benefit and evidence of poor long-term outcomes, opioid analgesics are commonly prescribed for back pain from the emergency department (ED). Variability in opioid prescribing suggests a lack of consensus and an opportunity to standardize and improve care. We evaluated the variation in attending emergency physician (EP) opioid prescribing for patients with uncomplicated, low acuity back pain (LABP)...
October 2017: Western Journal of Emergency Medicine
Nikita Joshi, Eric J Morley, Taku Taira, Jeremy Branzetti, Andrew Grock
INTRODUCTION: The WestJEM Blog and Podcast Watch presents high-quality, open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing Academic Life in EM (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of procedure emergencies from the AIR Series. METHODS: The AIR Series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors' (CORD) annual testing schedule...
October 2017: Western Journal of Emergency Medicine
Andrés Patiño, Victor Alcalde, Camilo Gutierrez, Mauricio Garcia Romero, Atilio Moreno Carrillo, Luis E Vargas, Carlos E Vallejo, Virginia Zarama, José L Mora Rodriguez, Yury Bustos, Juliana Granada, Leonar G Aguiar, Salvador Menéndez, Jorge I Cohen, Miguel A Saavedra, Juan M Rodriguez, Tatiana Roldan, Christian Arbelaez
INTRODUCTION: Emergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogotá, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in different stages of maturity, with the oldest founded 20 years ago and two founded in the last two years...
October 2017: Western Journal of Emergency Medicine
Fareen Zaver, Michael Craddick, Audrey Sanford, Nana Sefa, George Hughes, Michelle Lin
INTRODUCTION: The WestJEM Blog and Podcast Watch presents high-quality open-access educational blogs and podcasts in emergency medicine based on the ongoing Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional (Pro) series. Both series critically appraise open-access educational blogs and podcasts in EM using an objective scoring instrument. This installment of the blog and podcast watch series curated and scored relevant posts in the specific topic of toxicology emergencies from the AIR-Pro Series...
October 2017: Western Journal of Emergency Medicine
Seth Althoff, Ryan Overberger, Mark Sochor, Dipan Bose, Joshua Werner
INTRODUCTION: There are established and validated clinical decision tools for cervical spine clearance. Almost all the rules include spinal tenderness on exam as an indication for imaging. Our goal was to apply GLASS, a previously derived clinical decision tool for cervical spine clearance, to thoracolumbar injuries. GLass intact Assures Safe Spine (GLASS) is a simple, objective method to evaluate those patients involved in motor vehicle collisions and determine which are at low risk for thoracolumbar injuries...
October 2017: Western Journal of Emergency Medicine
Mitchell Kim, Taketo Watase, Karl D Jablonowski, Medley O Gatewood, Daniel J Henning
INTRODUCTION: Many patients meeting criteria for severe sepsis are not given a sepsis-related diagnosis by emergency physicians (EP). This study 1) compares emergency department (ED) interventions and in-hospital outcomes among patients with severe sepsis, based on the presence or absence of sepsis-related diagnosis, and 2) assesses how adverse outcomes relate to three-hour sepsis bundle completion among patients fulfilling severe sepsis criteria but not given a sepsis-related diagnosis...
October 2017: Western Journal of Emergency Medicine
Michael J Drescher, Jeremy Fried, Ryan Brass, Amanda Medoro, Timothy Murphy, João Delgado
INTRODUCTION: Computerized decision support decreases the number of computed tomography pulmonary angiograms (CTPA) for pulmonary embolism (PE) ordered in emergency departments, but it is not always well accepted by emergency physicians. We studied a department-endorsed, evidence-based clinical protocol that included the PE rule-out criteria (PERC) rule, multi-modal education using principles of knowledge translation (KT), and clinical decision support embedded in our order entry system, to decrease the number of unnecessary CTPA ordered...
October 2017: Western Journal of Emergency Medicine
Alyson J McGregor, Gillian A Beauchamp, Charles R Wira, Sarah M Perman, Basmah Safdar
The National Institutes of Health recently highlighted the significant role of sex as a biological variable (SABV) in research design, outcome and reproducibility, mandating that this variable be accounted for in all its funded research studies. This move has resulted in a rapidly increasing body of literature on SABV with important implications for changing the clinical practice of emergency medicine (EM). Translation of this new knowledge to the bedside requires an understanding of how sex-based research will ultimately impact patient care...
October 2017: Western Journal of Emergency Medicine
C Eric McCoy
Clinicians, institutions, and policy makers use results from randomized controlled trials to make decisions regarding therapeutic interventions for their patients and populations. Knowing the effect the intervention has on patients in clinical trials is critical for making both individual patient as well as population-based decisions. However, patients in clinical trials do not always adhere to the protocol. Excluding patients from the analysis who violated the research protocol (did not get their intended treatment) can have significant implications that impact the results and analysis of a study...
October 2017: Western Journal of Emergency Medicine
Michael D Repplinger, Shashank Ravi, Andrew W Lee, James E Svenson, Brian Sharp, Matt Bauer, Azita G Hamedani
INTRODUCTION: For emergency department (ED) patients, delays in care are associated with decreased satisfaction. Our department focused on implementing a front-end vertical patient flow model aimed to decrease delays in care, especially care initiation. The physical space for this new model was termed the Flexible Care Area (FCA). The purpose of this study was to quantify the impact of this intervention on patient satisfaction. METHODS: We conducted a retrospective study of patients discharged from our academic ED over a one-year period (7/1/2013-6/30/2014)...
October 2017: Western Journal of Emergency Medicine
Benjamin M Krainin, Lane C Thaut, Michael D April, Ryan A Curtis, Andrea L Kaelin, Garrett B Hardy, Wells L Weymouth, Jonathan Srichandra, Eric J Chin, Shane M Summers
INTRODUCTION: Our goal was to determine if heated gel for emergency department (ED) bedside ultrasonography improves patient satisfaction compared to room-temperature gel. METHODS: We randomized a convenience sample of ED patients determined by their treating physician to require a bedside ultrasound (US) study to either heated gel (102.0° F) or room-temperature gel (82.3° F). Investigators performed all US examinations. We informed all subjects that the study entailed investigation into various measures to improve patient satisfaction with ED US examinations but did not inform them of our specific focus on gel temperature...
October 2017: Western Journal of Emergency Medicine
Kori S Zachrison, Emily M Hayden, Lee H Schwamm, Janice A Espinola, Ashley F Sullivan, Krislyn M Boggs, Ali S Raja, Carlos A Camargo
INTRODUCTION: Telemedicine connects emergency departments (ED) with resources necessary for patient care; its use has not been characterized nationally, or even regionally. Our primary objective was to describe the prevalence of telemedicine use in New England EDs and the clinical applications of use. Secondarily, we aimed to determine if telemedicine use was associated with consultant availability and to identify ED characteristics associated with telemedicine use. METHODS: We analyzed data from the National Emergency Department Inventory-New England survey, which assessed basic ED characteristics in 2014...
October 2017: Western Journal of Emergency Medicine
Michael Gottlieb, Tina Sundaram, Dallas Holladay, Damali Nakitende
Peripheral intravenous line placement is a common procedure in emergency medicine. Ultrasound guidance has been demonstrated to improve success rates, as well as decrease complications and pain. This paper provides a narrative review of the literature focusing on best practices and techniques to improve performance with this procedure. We provide an evidence-based discussion of preparation for the procedure, vein and catheter selection, multiple techniques for placement, and line confirmation.
October 2017: Western Journal of Emergency Medicine
Tadahiro Goto, Kohei Hasegawa, Mohammad Kamal Faridi, Ashley F Sullivan, Carlos A Camargo
INTRODUCTION: Epidemiological surveillance data for emergency department (ED) visits by children are imperative to guide resource allocation and to develop health policies that advance pediatric emergency care. However, there are sparse population-based data on patient-level information (e.g., the number of children who present to the emergency department [ED]). In this context, we aimed to investigate both the patient- and visit-level rates of ED utilization by children. METHODS: This was a retrospective cohort study using population-based multipayer data - state ED databases (SEDD) and state inpatient databases (SID) - from six geographically-dispersed U...
October 2017: Western Journal of Emergency Medicine
Benoit Stryckman, Lauren Walsh, Brendan G Carr, Nathaniel Hupert, Nicole Lurie
INTRODUCTION: National health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event. We sought to quantify changes in healthcare utilization patterns for an at-risk Medicare population before, during, and after Superstorm Sandy's 2012 landfall in New Jersey (NJ). METHODS: This study is a retrospective cohort study of Medicare beneficiaries impacted by Superstorm Sandy...
October 2017: Western Journal of Emergency Medicine
Jessica C Schoen, Jason T Machan, Max Dannecker, Leo Kobayashi
INTRODUCTION: Investigators conducted a prospective experimental study to evaluate the effect of team size and recovery exercises on individual providers' compression quality and exertion. Investigators hypothesized that 1) larger teams would perform higher quality compressions with less exertion per provider when compared to smaller teams; and 2) brief stretching and breathing exercises during rest periods would sustain compressor performance and mitigate fatigue. METHODS: In Phase I, a volunteer cohort of pre-clinical medical students performed four minutes of continuous compressions on a Resusci-Anne manikin to gauge the spectrum of compressor performance in the subject population...
October 2017: Western Journal of Emergency Medicine
Stevan R Bruijns, Mmapeladi Maesela, Suniti Sinha, Megan Banner
INTRODUCTION: Based on relative population size and burden of disease, emergency care publication outputs from low- and middle-income regions are disproportionately lower than those of high-income regions. Ironically, outputs from regions with higher publication rates are often less relevant in the African context. As a result, the dissemination of and access to local research is essential to local researchers, but the cost of this access (actual and cost-wise) remains unknown. The aim of this study was to describe access to African emergency care publications in terms of publisher-based access (open access or subscription) and alternate access (self-archived or author provided), as well as the cost of access...
October 2017: Western Journal of Emergency Medicine
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