Leveraging Remote Research Associates During a Pandemic
Introduction:The coronavirus disease 2019 (COVID-19) pandemic has seriously impacted clinical research operations in academic medical centers due to social distancing measures and stay-at-home orders. The purpose of this paper is to describe the implementation of a program to continue clinical research based out of an emergency department (ED) using remote research associates (RA).Methods: Remote RAs were trained and granted remote access to the electronic health record (EHR) by the health system ’s core information technology team. Upon gaining access, remote RAs used a dual-authentication process to gain access to ...
Source: Western Journal of Emergency Medicine - July 22, 2020 Category: Emergency Medicine Source Type: research

The Bullets He Carried
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - July 21, 2020 Category: Emergency Medicine Source Type: research

Mastery Learning Ensures Correct Personal Protective Equipment Use in Simulated Clinical Encounters of COVID-19
Introduction:The correct use of personal protective equipment (PPE) limits transmission of serious communicable diseases to healthcare workers, which is critically important in the era of coronavirus disease 2019 (COVID-19). However, prior studies illustrated that healthcare workers frequently err during application and removal of PPE. The goal of this study was to determine whether a simulation-based, mastery learning intervention with deliberate practice improves correct use of PPE by physicians during a simulated clinical encounter with a COVID-19 patient.Methods:This was a pretest-posttest study performed in the emerge...
Source: Western Journal of Emergency Medicine - July 21, 2020 Category: Emergency Medicine Source Type: research

COVID-19: Implications for Advanced Care Planning and End-of-Life Care
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - July 21, 2020 Category: Emergency Medicine Source Type: research

Volume 21, Issue 4 - July
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - July 17, 2020 Category: Emergency Medicine Source Type: research

Emergency Department-based Hepatitis A Vaccination Program in Response to an Outbreak
This study examines the impact of an ED-based hepatitis A vaccination program, developed in partnership with the PDPH, on incidence of hepatitis A infection and hospital admission.Methods: We conducted a retrospective review of all ED visits in the 12-week period centered around the implementation of the ED-based hepatitis A vaccination program. All adult patients presenting to the ED were offered vaccination, with vaccines supplied free of charge by the PDPH. We compared the incidence of diagnosis and of hospital admission for treatment of hepatitis A before and after implementation of the program.Results: There were 10,0...
Source: Western Journal of Emergency Medicine - July 11, 2020 Category: Emergency Medicine Source Type: research

A Novel Multimodal Approach to Point-of-Care Ultrasound Education in Low-Resource Settings
Point-of-care ultrasound (POCUS) enables physicians to make critical diagnosis and treatment decisions at the bedside. However, access to and expertise with this technology remain limited in Peru. Establishing longitudinal POCUS educational curriculums in remote, low-resource settings can be challenging due to geographical distances, encumbering the ability to provide ongoing hands-on support. Previously described educational interventions have focused on training individual users on clinical applications of POCUS, rather than training physicians how to teach POCUS, thereby limiting scalability and sustainable impact. We t...
Source: Western Journal of Emergency Medicine - July 10, 2020 Category: Emergency Medicine Source Type: research

Necrotizing Fasciitis Within 72 hours After Presentation with Skin and Skin Structure Infection
We present the incidence of patients with skin infections who developed NF and their baseline lactates.Methods: In four phase-3 trials, 2883 adults with complicated or acute bacterial skin and skin structure infections were randomized to dalbavancin or comparator, with early and late follow-up visits through Day 28. We prospectively collected baseline plasma lactates in one trial to assess an association with NF.Results: NF was diagnosed in 3/2883 patients (0.1%); all... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - July 10, 2020 Category: Emergency Medicine Source Type: research

The Utility of Color Doppler to Confirm Endotracheal Tube Placement: A Pilot Study
Introduction:Grayscale ultrasound (US) imaging has been used as an adjunct for confirming endotracheal tube (ETT) placement in recent years. The addition of color Doppler imaging (CDI) has been proposed to improve identification but has not been well studied. The aim of this study was to assess whether CDI improves correct localization of ETT placement.Methods: A convenience sample of emergency and critical care physicians at various levels of training and experience participated in an online assessment. Participants viewed US video clips of patients, which included either tracheal or esophageal intubations captured in gra...
Source: Western Journal of Emergency Medicine - July 10, 2020 Category: Emergency Medicine Source Type: research

Visual Estimation of Tricuspid Annular Plane Systolic Excursion by Emergency Medicine Clinicians
The objective of this study was to evaluate whether emergency clinicians can visually estimate RV function using TAPSE in a set of video clips compared to a reference standard M-mode measurement.Methods: Emergency clinicians were shown a five-minute educational video on TAPSE. Participants then viewed 20 apical four-chamber point-of-care ultrasound (POCUS) echocardiography clips and recorded their estimate of TAPSE distance in centimeters (cm), as well as whether TAPSE was normal (>1.9 cm), borderline (1.5-1.9 cm), or abnormal (
Source: Western Journal of Emergency Medicine - July 10, 2020 Category: Emergency Medicine Source Type: research

Fall Prevention Knowledge, Attitudes, and Behaviors: A Survey of Emergency Providers
Introduction: Falls are a frequent reason geriatric patients visit the emergency department (ED). To help providers, the Geriatric Emergency Department Guidelines were created to establish a standard of care for geriatric patients in the ED. We conducted a survey of emergency providers to assess 1) their knowledge of fall epidemiology and the geriatric ED guidelines; 2) their current ED practice for geriatric fall patients; and 3) their willingness to conduct fall-prevention interventions.Methods:We conducted an anonymous survey of emergency providers including attending physicians, residents, and physician assistants at a...
Source: Western Journal of Emergency Medicine - July 10, 2020 Category: Emergency Medicine Source Type: research

Identifying Patients at Greatest Risk of Mortality due to COVID-19: A New England Perspective
We examined the factors that increase the risk of mortality among hospitalized COVID-19 patients.Methods: This was a retrospective cohort study including confirmed COVID-19 patients admitted to the four Trinity Health of New England hospitals (THONE) in Connecticut and Massachusetts who either died or were discharged between March 1 –April 22, 2020. Demographics, comorbidities, and outcomes of care were extracted... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - July 9, 2020 Category: Emergency Medicine Source Type: research

Rural Interfacility Emergency Department Transfers: Framework and Qualitative Analysis
Introduction: Interfacility transfers from rural emergency departments (EDs) are an important means of access to timely and specialized care.Methods: Our goal was to identify and explore facilitators and barriers in transfer processes and their implications for emergency rural care and access. Semi-structured interviews with ED staff at five rural and two urban Veterans Health Administration (VHA) hospitals were recorded, transcribed, coded, and analyzed using an iterative inductive-deductive approach to identify themes and construct a conceptual framework.Results: From 81 interviews with clinical and administrative staff ...
Source: Western Journal of Emergency Medicine - July 9, 2020 Category: Emergency Medicine Source Type: research

Impact of Emergency Department Crowding on Delays in Acute Stroke Care
Introduction:Delays in identification and treatment of acute stroke contribute to significant morbidity and mortality. Multiple clinical factors have been associated with delays in acute stroke care. We aimed to determine the relationship between emergency department (ED) crowding and the delivery of timely emergency stroke care.Methods:We used prospectively collected data from our institutional Get with the Guidelines-Stroke registry to identify consecutive acute ischemic stroke patients presenting to our urban academic ED from July 2016 –August 2018. We used capacity logs to determine the degree of ED crowding at t...
Source: Western Journal of Emergency Medicine - July 8, 2020 Category: Emergency Medicine Source Type: research

Consensus Guidelines for Digital Scholarship in Academic Promotion
Introduction:As scholarship moves into the digital sphere, applicant and promotion and tenure (P&T) committee members lack formal guidance on evaluating the impact of digital scholarly work. The P&T process requires the appraisal of individual scholarly impact in comparison to scholars across institutions and disciplines. As dissemination methods evolve in the digital era, we must adapt traditional P&T processes to include emerging forms of digital scholarship.  Methods:We conducted a blended, expert consensus procedure using a nominal group process to create a consensus document at the Council of Emergenc...
Source: Western Journal of Emergency Medicine - July 8, 2020 Category: Emergency Medicine Source Type: research

Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions
This study was intended to assess the prevalence of GoC discussions in IHT patients with early mortality, defined as death within 72 hours of transfer, and prevalence of primary diagnoses associated with in-hospital mortality.Methods: This was a retrospective study of IHT patients aged 18 and older who died within 72 hours of transfer to Wake Forest Baptist Medical Center between October 1, 2016-October 2018. Documentation of GoC discussions within the electronic health record (EHR) prior to transfer was the primary outcome. We also assessed... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - July 8, 2020 Category: Emergency Medicine Source Type: research

Predictors of Mortality in Adult Population Admitted with COVID-19: A Retrospective Cohort Study from New York City
Introduction:Rapid spread of coronavirus disease 2019 (COVID-19) in the United States, especially in New York City (NYC), led to a tremendous increase in hospitalizations and mortality. There is very limited data available that associates outcomes during hospitalization in patients with COVID-19.Methods: In this retrospective cohort study, we reviewed the health records of patients with COVID-19 who were admitted from March 9 –April 9, 2020, to a community hospital in NYC. Subjects with confirmed reverse transcriptase-polymerase chain reaction (RT-PCR) of the nasopharyngeal swab for severe acute respiratory syndrome ...
Source: Western Journal of Emergency Medicine - July 8, 2020 Category: Emergency Medicine Source Type: research

Emergency Department-based Intensive Care Unit Use Peaks Near Emergency Department Shift Turnover
Introduction: The Emergency Critical Care Center (EC3) is an emergency department-based intensive care unit (ED-ICU) designed to improve timely access to critical care for ED patients. ED patients requiring intensive care are initially evaluated and managed in the main ED prior to transfer to a separate group of ED-ICU clinicians. The timing of patient transfers to the ED-ICU may decrease the number of handoffs between main ED teams and have an impact on both patient outcomes and optimal provider staffing models, but has not previously been studied. We aimed to analyze patterns of transfer to the ED-ICU and the relationshi...
Source: Western Journal of Emergency Medicine - July 7, 2020 Category: Emergency Medicine Source Type: research

Food Insecurity and Insulin Use in Hyperglycemic Patients Presenting to the Emergency Department
We examined the prevalence of food insecurity and subtherapeutic insulin use among patients who presented to the ED with a blood glucose level of greater than 250 milligrams per deciliter.Methods: This was a single-center, cross-sectional survey of clinically stable, hyperglycemic adults in the ED for food insecurity using the Hunger Vital Sign screening tool. Patients who were insulin dependent were asked about insulin usage and rationing.Results: Of the 85 eligible patients, 76 (89.4%) were enrolled; 35 (46%) screened positive for food insecurity. Food insecure patients were 1.9 times more likely to be hospitalized than ...
Source: Western Journal of Emergency Medicine - July 4, 2020 Category: Emergency Medicine Source Type: research

Current Understanding of the Neurobiology of Agitation
Introduction:  Managing agitation in the clinical setting is a challenge that many practitioners faceregularly. Our evolving understanding of the etiological factors involved in aggressive acts has betterinformed our interventions through pharmacologic and behavioral strategies. This paper reviews theliterature on the neurobiological underpinnings of aggressive behaviors, linking psychopathology withproposed mechanisms of action of psychiatric medications shown to be effective in mitigating agitation. Methods:  We performed a review of the extant literature using PubMed as a primary database.Investigation focused...
Source: Western Journal of Emergency Medicine - July 3, 2020 Category: Emergency Medicine Source Type: research

Conference Didactic Planning and Structure: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors
Emergency medicine residency programs around the country develop didactic conferences to prepare residents for board exams and independent practice. To our knowledge, there is not currently an evidence-based set of guidelines for programs to follow to ensure maximal benefit of didactics for learners. This paper offers expert guidelines for didactic instruction from members of the Council of Emergency Medicine Residency Directors Best Practices Subcommittee, based on best available evidence. Programs can use these recommendations to further optimize their resident conference structure and content. Recommendations in this ma...
Source: Western Journal of Emergency Medicine - July 3, 2020 Category: Emergency Medicine Source Type: research

Clinical Teaching: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors
Clinical teaching is the primary educational tool use to train learners from day one of medical school all the way to the completion of fellowship. However, concerns over time constraints and patient census have led to a decline in bedside teaching. This paper provides a critical review of the literature on clinical teaching with a focus on instructor teaching strategies, clinical teaching models, and suggestions for incorporating technology. Recommendations for instructor-related teaching factors include adequate preparation, awareness of effective teacher attributes, using evidence-based-knowledge dissemination strategie...
Source: Western Journal of Emergency Medicine - July 3, 2020 Category: Emergency Medicine Source Type: research

The Incidence of QT Prolongation and Torsades des Pointes in Patients Receiving Droperidol in an Urban Emergency Department
Introduction:Droperidol carries a boxed warning from the United States Food and Drug Administration for QT prolongation and torsades des pointes (TdP). After a six-year hiatus, droperidol again became widely available in the US in early 2019. With its return, clinicians must again make decisions regarding the boxed warning. Thus, the objective of this study was to report the incidence of QT prolongation or TdP in patients receiving droperidol in the ED.Methods: Patients receiving droperidol at an urban Level I trauma center from 1997 –2001 were identified via electronic health record query. All patients were reviewed...
Source: Western Journal of Emergency Medicine - July 2, 2020 Category: Emergency Medicine Source Type: research

A Review of Journal Impact Metrics and Characteristics to Assist Emergency Medicine Investigators with Manuscript Submission Decisions
In this report, we sought to 1) review emergency medicine (EM) journal impact metrics, and 2) provide a comprehensive list of pertinent journal characteristics that may influence researchers ’ choice of submission.Methods: We systematically reviewed five impact metrics (IF, H Index, CiteScore, Source-Normalized Impact per Paper, and... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - July 2, 2020 Category: Emergency Medicine Source Type: research

Diagnostic accuracy of point-of-care ultrasound for intussusception in children presenting to the emergency department: a systematic review and meta-analysis
Introduction:Ileocolic intussusception is a common cause of pediatric bowel obstruction in youngchildren but can be difficult to diagnose clinically due to vague abdominal complaints. If left untreated,it may cause significant morbidity. Point-of-care ultrasound (POCUS) is a rapid, bedside method ofassessment that may potentially aid in the diagnosis of intussusception. The purpose of this systematicreview and meta-analysis was to determine the diagnostic accuracy of POCUS for children withsuspected ileocolic intussusception by emergency physicians (EP).Methods:We conducted a systematic search on PubMed, Embase, CINAHL, LI...
Source: Western Journal of Emergency Medicine - July 2, 2020 Category: Emergency Medicine Source Type: research

Rabies Vaccination Compliance and Reasons for Incompletion
The objective of this study was to determine the reasons why patients in the US do not complete rabies treatment.Methods: We performed a retrospective study to evaluate rabies post-exposure prophylaxis completion in the emergency department of an academic suburban hospital between June 2014 –  July 2017. Further review was performed for patients who received inadequate vaccination to determine the cause of treatment incompletion.... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - July 2, 2020 Category: Emergency Medicine Source Type: research

Novel Barrier Enclosure for Aerosol and Droplet Protection Model
This study aimed to determine degree of droplet contamination to the intubator utilizing a novel barr ier enclosure with a fluorescent simulated respiratory contagion. This model confirmed both added protection to the providers preforming intubation, and reduction of spread of the droplets when such a device is applied to patient care. (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - June 30, 2020 Category: Emergency Medicine Source Type: research

Novel Barrier Enclosure for Both Aerosol and Droplet Protection Model
This study aimed to determine degree of droplet contamination to the intubator utilizing a novel barr ier enclosure with a fluorescent simulated respiratory contagion. This model confirmed both added protection to the providers preforming intubation, and reduction of spread of the droplets when such a device is applied to patient care. (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - June 29, 2020 Category: Emergency Medicine Source Type: research

Practice Gap in Atrial Fibrillation Oral Anticoagulation Prescribing at Emergency Department Home Discharge
Introduction: Current U.S. cardiology guidelines recommend oral anticoagulation (OAC) to reduce stroke risk in selected patients with atrial fibrillation (AF), but no formal AF OAC recommendations exist to guide emergency medicine clinicians in the acute care setting. We sought to characterize emergency department (ED) OAC prescribing practices after an ED AF diagnosis.Methods: This retrospective study included index visits for OAC-naive patients ≥18 years old who were discharged home from the ED at an urban, academic, tertiary hospital with a primary diagnosis of AF from 2012-2014. Five hypothesis-blinded, chart review...
Source: Western Journal of Emergency Medicine - June 29, 2020 Category: Emergency Medicine Source Type: research

Adult Patients with Respiratory Distress: Current Evidence-based Recommendations for Prehospital Care
Introduction:We developed evidence-based recommendations for prehospital evaluation and treatment of adult patients with respiratory distress. These recommendations are compared with current protocols used by the 33 local emergency medical services agencies (LEMSA) in California.Methods:We performed a review of the evidence in the prehospital treatment of adult patients with respiratory distress. The quality of evidence was rated and used to form guidelines. We then compared the respiratory distress protocols of each of the 33 LEMSAs for consistency with these recommendations.Results:PICO (population/problem, intervention,...
Source: Western Journal of Emergency Medicine - June 26, 2020 Category: Emergency Medicine Source Type: research

Fever Incidence Is Much Lower in the Morning than the Evening: Boston and US National Triage Data
Introduction: In this observational study, we evaluated time-of-day variation in the incidence of fever that is seen at triage. The observed incidence of fever could change greatly over the day because body temperatures generally rise and fall in a daily cycle, yet fever is identified using a temperature threshold that is unchanging, such as ≥38.0° Celsius (C) (≥100.4° Fahrenheit [F]).Methods: We analyzed 93,225 triage temperature measurements from a Boston emergency department (ED) (2009-2012) and 264,617 triage temperature measurements from the National Hospital Ambulatory Medical Care Survey (NHAMCS, 2002-...
Source: Western Journal of Emergency Medicine - June 25, 2020 Category: Emergency Medicine Source Type: research

Emergency Department Admissions During COVID-19: Implications from the 2002-2004 SARS Epidemic
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - June 24, 2020 Category: Emergency Medicine Source Type: research

Novice Physician Ultrasound Evaluation of Pediatric Tricuspid Regurgitant Jet Velocity
We present descriptive statistics, binomial proportions, kappa coefficients, and logistic... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - June 24, 2020 Category: Emergency Medicine Source Type: research

Social Determinants of Hallway Bed Use
Introduction:Hallway beds in the emergency department (ED) produce lower patient satisfaction and inferior care. We sought to determine whether socioeconomic factors influence which visits are assigned to hallway beds, independent of clinical characteristics at triage.Methods: We studied 332,919 visits, across 189,326 patients, to two academic EDs from 2013-2016. We estimated a logistic model of hallway bed assignment, conditioning on payor, demographics, triage acuity, chief complaint, patient visit frequency, and ED volume. Because payor is not generally known at the time of triage, we interpreted it as a proxy for other...
Source: Western Journal of Emergency Medicine - June 24, 2020 Category: Emergency Medicine Source Type: research

Patient and Community Organization Perspectives on Accessing Social Resources from the Emergency Department: A Qualitative Study
We examined the perspectives of patients and community organizations regarding social risk screening and linkage from the ED.Methods: Qualitative interviews were conducted with a purposive sample of ED patients and local community organization staff. Participants completed a brief demographic survey, health literacy assessment, and qualitative interview focused on barriers/facilitators to social risk screening in the ED, and ideas for screening and linkage interventions in the ED. Interviews were conducted in English or Spanish, recorded, transcribed, and coded. Themes were identified by consensus.Results:We conducted 22 i...
Source: Western Journal of Emergency Medicine - June 24, 2020 Category: Emergency Medicine Source Type: research

Assessment of Emergency Medicine Residents ’ Clinical Reasoning: Validation of a Script Concordance Test
This study aimed to externally validate the script concordance test in emergency medicine (SCT-EM), an assessment tool designed for this purpose.Methods: Using established methodology for the SCT-EM, we compared EM residents ’ performance on the SCT-EM to an expert panel of emergency physicians at three urban academic centers. We performed adjusted pairwise t-tests to compare differences between all residents and attending physicians, as well as among resident postgraduate year (PGY) levels. We tested correlation betw een SCT-EM and Accreditation Council for Graduate Medical Education Milestone scores using Pearson&r...
Source: Western Journal of Emergency Medicine - June 24, 2020 Category: Emergency Medicine Source Type: research

Telehealth Solutions for In-hospital Communication with Patients Under Isolation During COVID-19
The coronavirus disease 2019 (COVID-19) pandemic is a public health crisis that has quickly overwhelmed our healthcare system. It has led to significant shortages in personal protective equipment (PPE), ventilators, and intensive care unit beds across the nation. As the initial entry point for patients with suspected COVID illness, emergency departments (ED) have had to adapt quickly to prioritize the safety of patients and providers while still delivering optimal, timely patient care. COVID-19 has presented many challenges for the ED that also extend to all inpatient services. Some of these key challenges are the fundamen...
Source: Western Journal of Emergency Medicine - June 23, 2020 Category: Emergency Medicine Source Type: research

Mobilization of a Simulation Platform to Facilitate a System-wide Response to the COVID-19 Pandemic
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - June 23, 2020 Category: Emergency Medicine Source Type: research

Prevalence and Predictors of Driving after Prescription Opioid Use in an Adult ED Sample
We examined the prevalence and correlates of driving after taking prescription opioids (DAPO) among adults seeking emergency department (ED) treatment.Methods: Participants (aged 25-60) seeking ED care at a Level I trauma center completed a computerized survey. Validated instruments measured prescription opioid use, driving behaviors, and risky driving. Patients who reported past three-month prescription opioid use and drove at least twice weekly were administered an extended study survey measuring DAPO, depression, pain, and substance use.Results:Among participants completing the screening survey (n = 756; mean age = 42.8...
Source: Western Journal of Emergency Medicine - June 20, 2020 Category: Emergency Medicine Source Type: research

Point-of-care Lung Ultrasound Is More Sensitive than Chest Radiograph for Evaluation of COVID-19
Introduction: Current recommendations for diagnostic imaging for moderately to severely ill patients with suspected coronavirus disease 2019 (COVID-19) include chest radiograph (CXR). Our primary objective was to determine whether lung ultrasound (LUS) B-lines, when excluding patients with alternative etiologies for B-lines, are more sensitive for the associated diagnosis of COVID-19 than CXR.Methods:This was a retrospective cohort study of all patients who presented to a single, academic emergency department in the United States between March 20 and April 6, 2020, and received LUS, CXR, and viral testing for COVID-19 as p...
Source: Western Journal of Emergency Medicine - June 19, 2020 Category: Emergency Medicine Source Type: research

Documentation Displaces Teaching in an Academic Emergency Department
Introduction: Adverse effects of administrative burden on emergency physicians have been described previously, but the impact of electronic health record documentation by academic emergency attendings on resident education is not known. In this observational study of a quaternary care, academic emergency department, we sought to assess whether the amount of time attending physicians spent on documentation affected the amount of time they spent teaching.Methods: A fourth-year emergency medicine (EM) resident observed 10 attending physicians over 42 hours during 11 shifts, recording their activities every 30 seconds. Activit...
Source: Western Journal of Emergency Medicine - June 15, 2020 Category: Emergency Medicine Source Type: research

Patient Safety Event Reporting and Opportunities for Emergency Medicine Resident Education
This study analyzes reports from the Virginia Commonwealth University Health System to understand how the reports are categorized and how it relates to opportunities for resident education.Methods:Identifying categories from the literature, three subject matter experts (attending physician, nursing director, registered nurse) categorized an initial 20 reports to resolve category gaps and then 100 reports to determine inter-rater reliability.... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - June 15, 2020 Category: Emergency Medicine Source Type: research

Home-based Testing for SARS-CoV-2: Leveraging Prehospital Resources for Vulnerable Populations
Conclusion: Facility-based... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - June 15, 2020 Category: Emergency Medicine Source Type: research

Recommendations for Prehospital Airway Management in Patients with Suspected COVID-19 Infection
In light of the rapid spread of coronavirus disease 2019 (COVID-19) across the United States, the Centers for Disease Control and Prevention (CDC) and hospitals nationwide have developed new protocols to address infection control as well as the care of critical patients. Airway management has been particularly difficult; the challenge of quickly establishing an airway in patients must be balanced by the risk of aerosolizing respiratory secretions and putting the provider at risk of infection. Significant attention has been given to developing protocols for the emergency department and critical care units, but little guidan...
Source: Western Journal of Emergency Medicine - June 15, 2020 Category: Emergency Medicine Source Type: research

In Young Adults with COVID-19, Obesity Is Associated with Adverse Outcomes
Introduction: For patients with COVID-19, several characteristics have been identified that may be associated with adverse outcomes. However, there is a paucity of data regarding the effect of obesity on young adult patients with COVID-19. We sought to identify whether adverse outcomes are associated with obesity, particularly in COVID-19 patients 45 years and younger.Methods: This was a two-center, retrospective cohort study that included 210 patients. Eligible patients were between the ages of 18-45 years old, had tested positive for SARS-CoV-2 on real-time reverse transcription polymerase chain reaction via nasopharynge...
Source: Western Journal of Emergency Medicine - June 15, 2020 Category: Emergency Medicine Source Type: research

The Next Pandemic: Prepare for “Disease X”
The organism that will cause the next pandemic, which WHO labels “Disease X,” probably already exists. The COVID-19 pandemic will, slowly, and with some hiccups and many tragedies, pass into memory. This coronavirus may disappear and later recur, continue endemically under vaccine control, or simply attenuate and vanish. The economy and healthcare systems wil l return to a new normal, some parts more quickly than others. Like the multiple plagues humanity has endured since our ancestors gathered into cities, it will generate recriminations for slow and misguided responses, profiteering, and over- or under react...
Source: Western Journal of Emergency Medicine - June 9, 2020 Category: Emergency Medicine Source Type: research

COVID-19 Pandemic and Care of Older Adults at Risk for Delirium and Cognitive Vulnerability
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - June 5, 2020 Category: Emergency Medicine Source Type: research

Brief Review of Chloroquine and Hydroxychloroquine Toxicity and Management
As of April 21, 2020, more than 2.5 million cases of coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, have been reported in 210 countries and territories, with the death toll at 171,810. Both chloroquine and hydroxychloroquine have gained considerable media attention as possible therapies, resulting in a significant surge in demand. In overdose, both medications can cause severe, potentially life-threatening effects. Here, we present a brief overview of the pharmacology of chloroquine and hydroxychloroquine, manifestations of toxicity, and treatment considerations. (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - June 4, 2020 Category: Emergency Medicine Source Type: research

A Multidisciplinary Intubation Algorithm for Suspected COVID-19 Patients in the Emergency Department
Introduction: Intubation of patients suspected of having coronavirus disease 2019 (COVID-19) is considered to be a high-risk procedure due to the aerosolization of viral particles. In an effort to minimize the risk of exposure and optimize patient care, we sought to develop, test, provide training, and implement a standardized algorithm for intubating these high-risk patients at our institution.Methods: We developed an initial intubation algorithm, incorporating strategic use of equipment and incorporating emerging best practices. By combining simulation-based training sessions and rapid-cycle improvement methodology with ...
Source: Western Journal of Emergency Medicine - June 3, 2020 Category: Emergency Medicine Source Type: research

First Do No Harm With COVID-19: Corona Collateral Damage Syndrome
Language matters and communication has consequences, sometimes unforseen.   During the Covid-19 public health emergency, public health and elected leaders messaged "Stay at Home" to encourage social distancing to reduce viral transmission. The message in combination with a widespread public fear of acquiring Covid-19 at hospital emergency rooms, resulted in a steep decli ne in ER visits, even for time sensitive conditions. The Corona Collateral Damage Syndrome is described. A public health messaging course correction is suggested to encourage people with emergencies to come to the emergency room for care. (S...
Source: Western Journal of Emergency Medicine - May 23, 2020 Category: Emergency Medicine Source Type: research