Performance of Emergency Heart Failure Mortality Risk Grade in the Emergency Department
Introduction:The purpose of this study was to validate and assess the performance of the Emergency Heart Failure Mortality Risk Grade (EHMRG) to predict seven-day mortality in US patients presenting to the emergency department (ED) with acute congestive heart failure (CHF) exacerbation.Methods: We performed a retrospective chart review on patients presenting to the ED with acute CHF exacerbation between January 2014 –January 2016 across eight EDs in New York. We identified patients using codes from the International Classification of Diseases, 9th and 10 Revisions, or who were diagnosed with CHF in the ED. Inclusion ...
Source: Western Journal of Emergency Medicine - April 9, 2021 Category: Emergency Medicine Source Type: research

Presentation of Neuro-COVID is Broad and Pathogenesis Diverse
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - April 8, 2021 Category: Emergency Medicine Source Type: research

Ultrasound Hypotension Protocol Time-motion Study Using the Multifrequency Single Transducer Versus a Multiple Transducer Ultrasound Device
Introduction: Ultrasound hypotension protocols (UHP) involve imaging multiple body areas, each with different transducers and imaging presets. The time for task switching between presets and transducers to perform an UHP has not been previously studied. A novel hand-carried ultrasound (HCU) has been developed that uses a multifrequency single transducer to image areas of the body (lung, heart, abdomen, superficial) that would typically require three transducers using a traditional cart-based ultrasound (CBU) system. Our primary aim was to compare the time to complete UHPs with a single transducer HCU to a multiple transduc...
Source: Western Journal of Emergency Medicine - April 8, 2021 Category: Emergency Medicine Source Type: research

Help Us Help You: Engaging Emergency Physicians to Identify Organizational Strategies to Reduce Burnout
Introduction: Burnout is a major threat to patient care quality and physician career longevity in emergency medicine. We sought to develop and implement a quality improvement process to engage emergency department (ED) faculty in identifying sources of burnout and generating interventions targeted at improving the work environment.Methods: In this prospective interventional study conducted at a large, urban, academic medical center, we surveyed a 60-person faculty group using the Professional Fulfilment Index (PFI), as well as burnout-relevant questions from the American Medical Association ’s Mini-Z survey and the M...
Source: Western Journal of Emergency Medicine - April 8, 2021 Category: Emergency Medicine Source Type: research

Utility Of An Emergency Department Clinical Protocol For Early Identification of Coronavirus Infection
Introduction: We assessed the utility of an emergency department (ED) protocol using clinical parameters to rapidly distinguish likelihood of novel coronavirus 2019 (COVID-19) infection; the applicability aimed to stratify infectious-risk pre-polymerase chain reaction (PCR) test results and accurately guide early patient cohorting decisions.Methods: We performed this prospective study over a two-month period during the initial surge of the 2020 COVID-19 pandemic in a busy urban ED of patients presenting with respiratory symptoms who were admitted for in-patient care. Per protocol, each patient received assessment consistin...
Source: Western Journal of Emergency Medicine - April 6, 2021 Category: Emergency Medicine Source Type: research

Alteplase for Acute Ischemic Stroke Beyond 3 hours: Enthusiasm Outpaces Evidence
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - April 3, 2021 Category: Emergency Medicine Source Type: research

Diabetes Patient Surveillance in the Emergency Department: Proof of Concept and Opportunities
Introduction:The purpose of this study was to characterize the at-risk diabetes and prediabetes patient population visiting emergency department (ED) and urgent care (UC) centers in upstate South Carolina.Methods: We conducted this retrospective study at the largest non-profit healthcare system in South Carolina, using electronic health record (EHR) data of patients who had an ED or UC visit between February 2, 2016 –July 31, 2018. Key variables including International Classification of Diseases, 10th Revision codes, laboratory test results, family history, medication, and demographic characteristics were used to cla...
Source: Western Journal of Emergency Medicine - April 2, 2021 Category: Emergency Medicine Source Type: research

Acute Kidney Injury After CT in Emergency Patients with Chronic Kidney Disease: A Propensity Score-matched Analysis
This study evaluated AKI incidence among emergency department (ED) patients with pre-existing chronic kidney disease (CKD) undergoing CT exams.Methods: This retrospective cohort study in an integrated healthcare system included ED patients previously diagnosed with CKD stages 3-5 (estimated glomerular filtration rate
Source: Western Journal of Emergency Medicine - April 2, 2021 Category: Emergency Medicine Source Type: research

Rate of Decompensation of Normoxic Emergency Department Patients with SARS-CoV-2
We describe the rate of decompensation among patients admitted with suspected SARS-CoV-2 infection but who were not hypoxemic in the ED.Methods: This is a retrospective observational study of patients admitted to our health system between March 1 –May 5, 2020 with suspected SARS-CoV-2 infection.... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - April 2, 2021 Category: Emergency Medicine Source Type: research

Importance of Mentoring on Workplace Engagement of Emergency Medicine Faculty: A Multi-institutional Study
Introduction: Mentoring in emergency medicine (EM) has not been well studied despite a larger body of literature that has described the value of mentoring in academic medicine on career satisfaction and scholarly output. Over half of all EM faculty nationally are of junior faculty ranks. The aim of this study was to identify the frequency and types of mentoring in EM, how types of mentoring in EM differ by gender, and how mentoring correlates with workplace satisfaction for EM faculty.Methods: Using descriptive statistics and chi-squared analysis, we analyzed data from a cohort of medical schools participating in the Assoc...
Source: Western Journal of Emergency Medicine - April 1, 2021 Category: Emergency Medicine Source Type: research

Establishment of an Alternate Care Site (ACS) in Imperial County During COVID-19
Imperial County is in southern California, one of the state ’s two counties at the international United States-Mexico border. The county is one of the most resource-limited in the state, with only two hospitals serving its 180,000 citizens, and no tertiary care centers. A significant portion of the population cared for at the local hospitals commutes from Mexicali, a large city of 1.2 million persons, just south of Imperial County’s ports of entry. Since May 2020, following an outbreak in Mexicali, Imperial County has seen a significant increase in the number of COVID-19 patients, quickly outpacing its local re...
Source: Western Journal of Emergency Medicine - March 25, 2021 Category: Emergency Medicine Source Type: research

Sternal Intraosseous Devices: Review of the Literature
Introduction: The intraosseous (IO) route is one of the primary means of vascular access in critically ill and injured patients. The most common sites used are the proximal humerus, proximal tibia, and sternum. Sternal IO placement remains an often-overlooked option in emergency and prehospital medicine. Due to the conflicts in Afghanistan and Iraq the use of sternal IOs have increased.Methods:The authors conducted a limited review, searching PubMed and Google Scholar databases for “sternal IO,” “sternal intraosseous,” and “intraosseous” without specific date limitations. A total of 47 a...
Source: Western Journal of Emergency Medicine - March 25, 2021 Category: Emergency Medicine Source Type: research

Intracranial Traumatic Hematoma Detection in Children Using a Portable Near-infrared Spectroscopy Device
Introduction: We sought to validate a handheld, near-infrared spectroscopy (NIRS) device for detecting intracranial hematomas in children with head injury.Methods: Eligible patients were those3.5 milliliters in volume and0.2 on three successive scans. We calculated diagnostic performance measures with corresponding exact two-sided 95% Clopper-Pearson confidence intervals (CI). Hypothesis... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - March 24, 2021 Category: Emergency Medicine Source Type: research

Climate Change Adaptation: Prehospital Data Facilitate the Detection of Acute Heat Illness in India
Introduction: Extreme heat is a significant cause of morbidity and mortality, and the incidence of acute heat illness (AHI) will likely increase secondary to anthropogenic climate change. Prompt diagnosis and treatment of AHI are critical; however, relevant diagnostic and surveillance tools have received little attention. In this exploratory cross-sectional and diagnostic accuracy study, we evaluated three tools for use in the prehospital setting: 1) case definitions; 2) portable loggers to measure on-scene heat exposure; and 3) prevalence data for potential AHI risk factors.Methods: We enrolled 480 patients who presented ...
Source: Western Journal of Emergency Medicine - March 24, 2021 Category: Emergency Medicine Source Type: research

Paramedic-performed Prehospital Point-of-care Ultrasound for Patients with Undifferentiated Dyspnea: A Pilot Study
Introduction: Thoracic ultrasound is frequently used in the emergency department (ED) to determine the etiology of dyspnea, yet its use is not widespread in the prehospital setting. We sought to investigate the feasibility and diagnostic performance of paramedic acquisition and assessment of thoracic ultrasound images in the prehospital environment, specifically for the detection of B-lines in congestive heart failure (CHF).Methods: This was a prospective observational study of a convenience sample of adult patients with a chief complaint of dyspnea. Paramedics participated in a didactic and hands-on session instructing th...
Source: Western Journal of Emergency Medicine - March 24, 2021 Category: Emergency Medicine Source Type: research

Clinical Prediction Tool to Assess the Likelihood of a Positive SARS-Cov-2 (COVID-19) Polymerase Chain Reaction Test in Patients with Flu-like Symptoms
Introduction:The clinical presentation of coronavirus disease 2019 (COVID-19) overlaps with many other common cold and influenza viruses. Identifying patients with a higher probability of infection becomes crucial in settings with limited access to testing. We developed a prediction instrument to assess the likelihood of a positive polymerase chain reaction (PCR) test, based solely on clinical variables that can be determined within the time frame of an emergency department (ED) patient encounter.Methods: We derived and prospectively validated a model to predict SARS-CoV-2 PCR positivity in patients visiting the ED with sy...
Source: Western Journal of Emergency Medicine - March 24, 2021 Category: Emergency Medicine Source Type: research

Emergency Medicine Influencers ’ Twitter Use During the COVID-19 Pandemic: A Mixed-methods Analysis
The objective of this study was to analyze the messages of influential emergency medicine (EM) Twitter users in the United States (US) during the early stages of the coronavirus disease 2019 (COVID-19) global pandemic by characterizing the themes, emotional tones, temporal viewpoints, and depth of engagement with the tweets.Methods:We performed a retrospective mixed-methods analysis of publicly available Twitter data derived from the publicly available “Coronavirus Tweet IDs” dataset, March 3, 2020–May 1, 2020. Original tweets and modified retweets in the dataset by 50 influential EM Twitter users in the ...
Source: Western Journal of Emergency Medicine - March 23, 2021 Category: Emergency Medicine Source Type: research

WestJEM Volume 22 Issue 2 - March
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - March 13, 2021 Category: Emergency Medicine Source Type: research

Geographically Indexed Referral Databases to Address Social Needs in the Emergency Department
Introduction: Unmet health-related social needs (HRSN) are among the drivers of disparities in morbidity and mortality during public health emergencies such as the novel coronavirus 2019 (Covid-19) pandemic. Although emergency departments (ED) see a high volume of patients with HRSN, ED providers have limited time to complete detailed assessments of patients ’ HRSN and are not always able to provide up-to-date and comprehensive information to patients on available community resources. Electronic, geographically indexed resource database systems have the potential to provide an efficient way for emergency physicians t...
Source: Western Journal of Emergency Medicine - March 5, 2021 Category: Emergency Medicine Source Type: research

Coding of Sexual Assault by Emergency Physicians: A Nationally Representative Study
Conclusion:Implications of this... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - March 4, 2021 Category: Emergency Medicine Source Type: research

Clinical Features of Emergency Department Patients from Early COVID-19 Pandemic that Predict SARS-CoV-2 Infection: Machine-learning Approach
In this study we aimed to construct machine-learning (ML) models to predict severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection based on the clinical features of patients visiting an ED during the early COVID-19 pandemic.Methods: We retrospectively collected the data of all patients who received reverse transcriptase polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 at the ED of Baylor Scott& White All Saints Medical Center, Fort Worth, from February 23 –May 12, 2020. The variables collected included patient demographics, ED triage data, clinical symptoms, and past medical history. The ...
Source: Western Journal of Emergency Medicine - March 4, 2021 Category: Emergency Medicine Source Type: research

Emergency Medicine Journal Editorial Boards: Analysis of Gender, H-Index, Publications, Academic Rank, and Leadership Roles
Introduction:Our goal in this study was to determine female representation on editorial boards of high-ranking emergency medicine (EM) journals. In addition, we examined factors associated with gender disparity, including board members ’ academic rank, departmental leadership position, h-index, total publications, total citations, and total publishing years.Methods:In this retrospective study, we examined EM editorial boards with an impact factor of 1 or greater according to the Clarivate Journal Citations Report for a total of 16 journals. All board members with a doctor of medicine or doctor of osteopathic medicine...
Source: Western Journal of Emergency Medicine - March 3, 2021 Category: Emergency Medicine Source Type: research

Homeless Shelter Characteristics and Prevalence of SARS-CoV-2
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - March 2, 2021 Category: Emergency Medicine Source Type: research

Four-factor Prothrombin Complex Concentrate for Reversal of Factor Xa Inhibitors versus Warfarin in Life-threatening Bleeding
Introduction: Factor Xa (fXa) inhibitor reversal for life-threatening bleeding is controversial due to a lack of high-quality evidence. The purpose of this study was to determine the hemostatic efficacy of four-factor prothrombin complex concentrate (4F-PCC) for the reversal of fXa inhibitors compared to warfarin for life-threatening bleeding.Methods: This was a multicenter, retrospective cohort study at two academic medical centers between January 1, 2014 –December 31, 2019, which included patients who presented to the emergency department with a life-threatening bleed necessitating anticoagulation reversal with 4F-...
Source: Western Journal of Emergency Medicine - February 27, 2021 Category: Emergency Medicine Source Type: research

Emergency Department Patients Who Leave Before Treatment Is Complete
Introduction: Emergency department (ED) patients who leave before treatment is complete (LBTC) represent medicolegal risk and lost revenue. We sought to examine LBTC return visits character-istics and potential revenue effects for a large healthcare system.Methods: This retrospective, multicenter study examined all encounters from January 1 –December 31, 2019 at 18 EDs. The LBTC patients were divided into left without being seen (LWBS), defined as leaving prior to completed medical screening exam (MSE), and left subsequent to being seen (LSBS), defined as leaving after MSE was complete but before disposition. We reco...
Source: Western Journal of Emergency Medicine - February 26, 2021 Category: Emergency Medicine Source Type: research

Evidence-Based Heatstroke Management in the Emergency Department
The objective of this study was to evaluate current standards of care for the emergent management of heatstroke and propose an evidence-based algorithm to expedite care.Methods: We systematically searched PubMed, Embase, and key journals, and reviewed bibliographies. Original research articles, including case studies, were selected if they specifically addressed the recognition and management of heatstroke in any prehospital, emergency department (ED), or intensive care unit population. Reviewers evaluated study quality and abstracted... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - February 26, 2021 Category: Emergency Medicine Source Type: research

“I wanted to participate in my own care”: Evaluation of a Patient Navigation Program
Introduction: Patient navigation programs can help people overcome barriers to outpatient care. Patient experiences with these programs are not well understood. The goal of this study was to understand patient experiences and satisfaction with an emergency department (ED)-initiated patient navigation (ED-PN) intervention for US Medicaid-enrolled frequent ED users.Methods: We conducted a mixed-methods evaluation of patient experiences and satisfaction with an ED-PN program for patients who visited the ED more than four times in the prior year. Participants were Medicaid-enrolled, English- or Spanish-speaking, New Haven-CT r...
Source: Western Journal of Emergency Medicine - February 22, 2021 Category: Emergency Medicine Source Type: research

Norepinephrine in Septic Shock: A Systematic Review and Meta-analysis
Introduction: Most experts recommend norepinephrine as the first-line agent in septic shock. Our objective was to determine the effectiveness and safety of norepinephrine in patients with septic shock. Methods: We searched the Cochrane Central Register of Controlled Trials and Epistemonikos, as well as MEDLINE from 1966 till August 2019. Screening of full texts, evaluation for eligibility, and data extraction were done by four independent reviewers. We estimated risk ratios (RR) and mean differences (MD) using a random-effects model with 95% confidence intervals (CI). The primary outcomes included the number of partic...
Source: Western Journal of Emergency Medicine - February 17, 2021 Category: Emergency Medicine Source Type: research

Emergency Department and Urgent Care Medical Malpractice Claims 2001 –15
This study reviews malpractice, also called medical professional liability (MPL), claims involving adult patients cared for in emergency departments (ED) and urgent care settings.Methods: We conducted a retrospective review of closed MPL claims of adults over 18 years, from the Medical Professional Liability Association ’s Data Sharing Project database from 2001–2015, identifying 6,779 closed claims. Data included the total amount, origin, top medical specialties named, chief medical factors, top medical conditions, severity of injury, resolution, average indemnity, and defense costs of closed claims.Results:Of...
Source: Western Journal of Emergency Medicine - February 15, 2021 Category: Emergency Medicine Source Type: research

Examining the Timeliness of ST-elevation Myocardial Infarction Transfers
Introduction:Despite large-scale quality improvement initiatives, substantial proportions of patients with ST-elevation myocardial infarction (STEMI) transferred to percutaneous coronary intervention centers do not receive percutaneous coronary intervention within the recommended 120 minutes. We sought to examine the contributory role of emergency medical services (EMS) activation relative to percutaneous coronary intervention center activation in the timeliness of care for patients transferred with STEMI.Methods:We conducted a retrospective analysis of interfacility transfers from emergency departments (ED) to a single pe...
Source: Western Journal of Emergency Medicine - February 15, 2021 Category: Emergency Medicine Source Type: research

Patterns and Predictors of Firearm-related Spinal Cord Injuries in Adult Trauma Patients
The objective of this study was to examine firearm-related spinal cord injuries and identify predictors of presence of such injuries in adult trauma patients.Methods:This retrospective cohort study examined adult trauma patients ( ≥16 years) with injuries from firearms included in the 2015 United States National Trauma Data Bank. We performed descriptive and bivariate analyses and compared two groups: patients with no spinal cord injury (SCI) or vertebral column injury (VCI); and patients with SCI and/or VCI. Predictors of SCI and/or VCI in patients with firearm-related injuries were identified using a multivariate logi...
Source: Western Journal of Emergency Medicine - February 15, 2021 Category: Emergency Medicine Source Type: research

Telephonic Medical Toxicology Service in a Low- Resource Setting: Setup, Challenges, and Opportunities
This report outlines the logistics involved in setting up such a service, including the challenges and opportunities that emerged from establishing medical toxicology teleconsult service in a low-resource setting.  (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - February 15, 2021 Category: Emergency Medicine Source Type: research

Randomized Controlled Trial of Ultrasound-guided Fluid Resuscitation of Sepsis-Induced Hypoperfusion and Septic Shock
Introduction: The ultrasound measurement of inferior vena cava (IVC) diameter change during respiratory phase to guide fluid resuscitation in shock patients is widely performed, but the benefit on reducing the mortality of sepsis patients is questionable. The study objective was to evaluate the 30-day mortality rate of patients with sepsis-induced tissue hypoperfusion (SITH) and septic shock (SS) treated with ultrasound-guided fluid management (UGFM) using ultrasonographic change of the IVC diameter during respiration compared with those treated with the usual-care strategy.Methods: This was a rand...
Source: Western Journal of Emergency Medicine - February 12, 2021 Category: Emergency Medicine Source Type: research

Emergency Physician Survey on Firearm Injury Prevention: Where Can We Improve?
Introduction: Firearm injury and death is increasingly prevalent in the United States. Emergency physicians (EP) may have a unique role in firearm injury prevention.The aim of this study was to describe EPs ’ beliefs, attitudes, practices, and barriers to identifying risk of and counseling on firearm injury prevention with patients. A secondary aim was assessment of perceived personal vulnerability to firearm injury while working in the emergency department (ED).Methods: We conducted a cross-sectional survey of a national convenience sample of EPs, using questions adapted from the American College of Surgeons ’...
Source: Western Journal of Emergency Medicine - February 9, 2021 Category: Emergency Medicine Source Type: research

Who Stayed Home Under Safer-at-Home? Impacts of COVID-19 on Volume and Patient-Mix at an Emergency Department
Introduction: To describe the impact of COVID-19 on a large, urban emergency department (ED) in Los Angeles, California, we sought to estimate the effect of the novel coronavirus 2019 (COVID-19) and “safer-at-home” declaration on ED visits, patient demographics, and diagnosis-mix compared to prior years.Methods: We used descriptive statistics to compare ED volume and rates of admission for patients presenting to the ED between January and early May of 2018, 2019, and 2020.Results: Immediately after California ’s “safer-at-home” declaration, ED utilization dropped by 11,000 visits (37%) compare...
Source: Western Journal of Emergency Medicine - February 8, 2021 Category: Emergency Medicine Source Type: research

Nobody Wants to Be Narcan ’d: A Pilot Qualitative Analysis of Drug Users’ Perspectives on Naloxone
In this study we sought to 1) evaluate whether individuals ’ drug use patterns have changed due to naloxone availability; and 2) explore individuals’ knowledge of, access to, experiences with, and perceptions of naloxone.Methods: We conducted a pilot study of adults presenting to the emergency department whose medical history included non-medical opioid use. Semi-structured interviews were conducted with participants and thematic analysis was used to code and analyze interview transcripts.Results: Ten participants completed the study. All were aware of naloxone by brand name (Narcan) and had... (Source: Western...
Source: Western Journal of Emergency Medicine - February 8, 2021 Category: Emergency Medicine Source Type: research

The Psychological Impact of COVID-19 on Hospital Staff
Introduction: The coronavirus 2019 (COVID-19) pandemic has created a mental health crisis among hospital staff who have been mentally and physically exhausted by uncertainty and unexpected stressors. However, the mental health challenges and complexities faced by hospital staff in the United States has not been fully elucidated. To address this gap, we conducted this study to examine the prevalence and correlates of depression and anxiety among hospital staff in light of the COVID-19 pandemic.Methods: The design is a single-center, cross-sectional, online survey evaluating depression and anxiety among all hospital employee...
Source: Western Journal of Emergency Medicine - February 8, 2021 Category: Emergency Medicine Source Type: research

Effect of Implementation of HEART Chest Pain Protocol on Emergency Department Disposition, Testing and Cost
In this study we aimed to analyze the effects of the adoption of this protocol. Prior studies have included only patients with chest pain. We included both patients with chest pain and patients with only atypical symptoms.Methods:This was a retrospective chart review of two cohorts. We identified ED charts from six-month periods prior to and after adoption of our HEART score-based protocol. Patients... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - February 5, 2021 Category: Emergency Medicine Source Type: research

First Pass Success Without Adverse Events Is Reduced Equally with Anatomically Difficult Airways and Physiologically Difficult Airways
This study evaluates the effects of both anatomically and physiologically difficult airways on FPS-AE in patients undergoing rapid sequence intubation (RSI) in the emergency department (ED).Methods: We analyzed prospectively recorded intubations in a continuous quality improvement database between July 1, 2014 –June 30, 2018. Emergency medicine (EM) or emergency medicine/pediatric (EM-PEDS) residents recorded patient, operator, and procedural characteristics on all consecutive adult RSIs performed using a direct or video laryngoscope. The presence of specific anatomically and physiologically difficult a irway charact...
Source: Western Journal of Emergency Medicine - February 2, 2021 Category: Emergency Medicine Source Type: research

Types and Timing of Teaching During Clinical Shifts in an Academic Emergency Department
In this study, we sought to characterize in detail what types of teaching occurred, how often they occurred, and how attending teaching styles differed at one academic emergency department (ED).Methods: We conducted this observational study in a large, urban, quaternary care, academic Level I trauma center with an emergency medicine (EM) residency. The on-shift activities of EM attending physicians (attendings) were observed and recorded over 42 hours by a fourth-year EM resident with co-observations by an EM education fellow. Teaching categories were identified, developed iteratively, and validated by the study team. We t...
Source: Western Journal of Emergency Medicine - January 29, 2021 Category: Emergency Medicine Source Type: research

Diagnostic Uncertainty in Dyspneic Patients with Cancer in the Emergency Department
This report characterizes the diagnostic uncertainty in patients with dyspnea and pneumonia presenting to an ED by establishing the rates of co-diagnosis, co-treatment, and misdiagnosis.Methods: Visits by individuals ≥18 years old with cancer who presented with a complaint of dyspnea were identified using the National Hospital Ambulatory Medical Care Survey between 2012-2014 and analyzed for rates of co-diagnosis, co-treatment (treatment or diagnosis for>1 of pneumonia, chronic obstructive pulmonary disease [COPD], and heart failure), and misdiagnosis of pneumonia. Additionally, we assessed rates of diagnostic uncert...
Source: Western Journal of Emergency Medicine - January 29, 2021 Category: Emergency Medicine Source Type: research

The Utility of Pain Scale to Assess Verifiable vs Non- Verifiable Pain in United States Emergency Departments
Introduction: We sought to examine the utility of self-reported pain scale by comparing emergency department (ED) triage pain scores of self-reported but non-verifiable painful conditions with those of verifiable painful conditions using a large, nationally representative sample.Methods: We analyzed the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2015. Verifiable painful conditions were identified based on the final diagnoses in the five included International Classification of Diseases 9th revision codes. Non-verifiable painful conditions were identified by the five main reasons for visit. Only adults 18 yea...
Source: Western Journal of Emergency Medicine - January 29, 2021 Category: Emergency Medicine Source Type: research

Point-of-care Ultrasound to Evaluate Breast Pathology in the Emergency Department
This study evaluates the utility of POCUS for the assessment of patients with breast complaints who present to the ED and the impact of POCUS on medical decision-making and patient management in the ED.Methods: This was a retrospective review of ED patients presenting with breast symptoms who received a POCUS examination. An ED POCUS database was reviewed for breast POCUS examinations. We then reviewed electronic health records for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and impact of the POCUS study on patient care and disposition.Results:... (Source: Wes...
Source: Western Journal of Emergency Medicine - January 29, 2021 Category: Emergency Medicine Source Type: research

Performance of Prognostication Scores for Mortality in Injured Patients in Rwanda
This study evaluated the Kampala Trauma Score (KTS), Revised Trauma Score (RTS), and Triage Early Warning Score (TEWS) for accuracy in predicting mortality among injured patients seeking emergency department (ED) care at the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda.Methods: A retrospective, randomly sampled cohort of ED patients presenting with injury was accrued from August 2015 –July 2016. Primary outcome was 14-day mortality and secondary outcome was overall facility-based mortality. We evaluated summary statistics of the cohort. Bootstrap regression models were used to compare areas under recei...
Source: Western Journal of Emergency Medicine - January 23, 2021 Category: Emergency Medicine Source Type: research

Intensive Cryotherapy in the Emergency Department (ICED): A Randomized Controlled Trial
Introduction: Pain control is an essential component of musculoskeletal injury treatment in the emergency department (ED). We evaluated the most effective type of cryotherapy for analgesia of acute musculoskeletal injury and the impact on opioid utilization.Methods: This was a prospective, randomized, single-blind controlled trial of adult ED patients who presented with acute musculoskeletal pain. Patients were randomized to either intensive targeted cryotherapy (crushed wetted ice in a plastic bag) or agitated chemical cold pack applied to the injury site for 20 minutes. All other diagnostic and therapeutic orders were at...
Source: Western Journal of Emergency Medicine - January 22, 2021 Category: Emergency Medicine Source Type: research

California ACEP Firearm Injury Prevention Policy
Firearm-related deaths and injuries are a serious public health problem in California and the United States. The rate of firearm-related deaths is many times higher in the US than other democratic, industrialized nations, yet many of the deaths and injuries are preventable. The California American College of Emergency Physicians Firearm Injury Prevention Policy was approved and adopted in 2013 as an evidence-based, apolitical statement to promote harm reduction. It recognizes and frames firearm injuries as a public health epidemic requiring allocation of robust resources, including increased governmental funding of high-qu...
Source: Western Journal of Emergency Medicine - January 21, 2021 Category: Emergency Medicine Source Type: research

Central Venous Catheter Adverse Events Are not Associated with Crowding Indicators
Objective:Crowding in the emergency department (ED) impacts a number of important quality and safety metrics. We studied ED crowding measures associated with adverse events (AE) resulting from central venous catheters (CVC) inserted in the ED, as well as the relationship between crowding and the frequency of CVC insertions in an ED cohort admitted to the intensive care unit (ICU).Methods: We conducted a retrospective observational study from 2008 –2010 in an academic tertiary care center. Participants undergoing CVC in the ED or admitted to an ICU were categorized by quartile based on the following: National Emergenc...
Source: Western Journal of Emergency Medicine - January 20, 2021 Category: Emergency Medicine Source Type: research

POCUS to Confirm Intubation in a Trauma Setting
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - January 20, 2021 Category: Emergency Medicine Source Type: research

Suicide Among the EMS Occupation in the United States
The objective of this study was to determine the proportionate mortality ratio (PMR) of suicide among firefighters and emergency medical technicians (EMT) compared to the general US working population.Methods: We analyzed over five million adult decedent death records from the National Occupational Mortality Surveillance database for 26 states over a 10-year non-consecutive period including 1999, 2003 –2004, and 2007–2013.... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - January 20, 2021 Category: Emergency Medicine Source Type: research

Association of Videolaryngoscopy Utilization and Junior Trainee Intubation Attempts: A National Emergency Airway Registry Study
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - January 14, 2021 Category: Emergency Medicine Source Type: research