Ratio of Oxygen Saturation to Inspired Oxygen, ROX Index, Modified ROX Index to Predict High Flow Cannula Success in COVID-19 Patients: Multicenter Validation Study
Introduction: High-flow nasal cannula (HFNC) is a respiratory support measure for coronavirus 2019 (COVID-19) patients that has been increasingly used in the emergency department (ED). Although the respiratory rate oxygenation (ROX) index can predict HFNC success, its utility in emergency COVID-19 patients has not been well-established. Also, no studies have compared it to its simpler component, the oxygen saturation to fraction of inspired oxygen (SpO2/FiO2 [SF]) ratio, or its modified version incorporating heart rate. Therefore, we aimed to compare the utility of the SF ratio, the ROX index (SF ratio/respiratory rate), a...
Source: Western Journal of Emergency Medicine - April 28, 2023 Category: Emergency Medicine Authors: Ruangsomboon, Onlak Source Type: research

Pediatric Application of Cuffed Endotracheal Tube
A young child ’s larynx was formerly believed to be narrowest at the cricoid level, circular in section, and funnel shaped. This supported the routine use of uncuffed endotracheal tubes (ETTs) in young children despite the benefits of cuffed ETTs, such as lower risk for air leakage and aspiration. In the late 1 990s, evidence supporting the pediatric use of cuffed tubes emerged largely from anesthesiology studies, while some technical flaws of the tubes remained a concern. Since the 2000s, imaging-based studies have clarified laryngeal anatomy, revealing that it is narrowest at the glottis, elliptical in s ection, and cy...
Source: Western Journal of Emergency Medicine - April 28, 2023 Category: Emergency Medicine Authors: Kim, Jung Heon Source Type: research

Disparities Exist in the Application of Low Tidal-volume Ventilation in the Emergency Department
In this study our aim was to evaluate whether rates of LTVV are associated with demographic and physical characteristics in the ED.Methods: We conducted a retrospective observational cohort study using a dataset of patients who underwent mechanical ventilation at three EDs in two health systems from January 2016 –June 2019. Demographic, mechanical ventilation, and outcome data including mortality and hospital-free days were abstracted by automatic query. A LTVV approach was defined as a tidal volume ≤8 mL/kg ideal body weight. We performed descriptive statistics and univariate analysis as indicated, and created a multi...
Source: Western Journal of Emergency Medicine - April 27, 2023 Category: Emergency Medicine Authors: Self, Michael Source Type: research

Characterizing Social Insecurity in a Rural North Carolina Emergency Department
In this study we explored, characterized, and quantified the social insecurity profile of ED patients at a rural teaching hospital in southeastern North Carolina with a large Native American population.Methods: A paper survey questionnaire was administered by trained research assistants between May –June 2018 to patients who presented to the ED and consented to participate in this cross-sectional, single-center study. The survey was anonymous with no identifying information collected on the respondents. A general demographic section and questions derived from the literature... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - April 27, 2023 Category: Emergency Medicine Authors: Gignac, Elizabeth Source Type: research

Emergency Department Preparedness to Care for Sexual Assault Survivors: A Nationwide Study
Introduction: Emergency departments (ED) provide trauma-informed care to sexual assault (SA) survivors and connect them with comprehensive services. Through surveying SA survivor advocates, we aimed to 1) document updated trends in the quality of care and resources offered to SA survivors and 2) identify potential disparities according to geographic regions in the US, urban vs rural clinic locations, and the availability of sexual assault nurse examiners (SANE).Methods: We conducted a cross-sectional study between June-August 2021, surveying SA advocates who were dispatched from rape crisis centers to support survivors dur...
Source: Western Journal of Emergency Medicine - April 26, 2023 Category: Emergency Medicine Authors: Chalmers, Kristen Source Type: research

End-tidal Carbon Dioxide + Return of Spontaneous Circulation After Cardiac Arrest (RACA) Score to Predict Outcomes After Out-of-hospital Cardiac Arrest
Introduction: The return of spontaneous circulation after cardiac arrest (RACA) score is a well-validated model for estimating the probability of return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA) by incorporating several variables, including gender, age, arrest aetiology, witness status, arrest location, initial cardiac rhythms, bystander cardiopulmonary resuscitation (CPR), and emergency medical services (EMS) arrival time. The RACA score was initially designed for comparisons between different EMS systems by standardising ROSC rates. End-tidal carbon dioxide (EtCO2) is a qual...
Source: Western Journal of Emergency Medicine - April 3, 2023 Category: Emergency Medicine Authors: Wu, Cheng-Yi Source Type: research

Characteristics of Suspected COVID-19 Discharged Emergency Department Patients Who Returned During the First Wave
In this study we aimed to identify predictors of ED return within 72 hours for patients with suspected COVID-19.Methods: Incorporating data from 14 EDs within an integrated healthcare network in the New York metropolitan region from March 2 –April 27, 2020, we analyzed this data on predictors for a return ED visit—including demographics, comorbidities, vital signs, and laboratory results.Results: In total, 18,599 patients were included in the study. The median age was 46 years old [interquartile range 34-58]), 50.74% were female, and 49.26% were male. Overall, 532 (2.86%) returned to the ED within 72 hours, and 95.49% ...
Source: Western Journal of Emergency Medicine - April 3, 2023 Category: Emergency Medicine Authors: Gong, Jonathan Source Type: research

Effectiveness of Hospital-directed Wellness Interventions in COVID-19: A Cross-sectional Survey
Introduction: Hospitals have implemented various wellness interventions to offset the negative effects of coronavirus disease 2019 (COVID-19) on emergency physician morale and burnout. There is limited high quality evidence regarding effectiveness of hospital-directed wellness interventions, leaving hospitals without guidance on best practices. We sought to determine intervention effectiveness and frequency of use in the spring/summer 2020. The goal was to facilitate evidence-based guidance for hospital wellness program planning. Methods: This cross-sectional observational study we used a novel survey tool piloted at ...
Source: Western Journal of Emergency Medicine - March 22, 2023 Category: Emergency Medicine Authors: Cotarelo, Adrian Source Type: research

Winter Walk
is a photo essay meant to be an inspirational commentary on emergency medicine ’s role in meeting the needs of our most vulnerable patients. Oftentimes, the social determinants of health, now well reviewed in the modern medical school curriculum, become intangible concepts that get lost amongst the busy environment of the emergency department. The photos within this commenta ry are striking and will move readers in various ways. The authors hope that these powerful images generate a mix of emotion that ultimately motivates emergency physicians to embrace the emerging role in addressing the social needs of our patients b...
Source: Western Journal of Emergency Medicine - March 22, 2023 Category: Emergency Medicine Authors: Hazekamp, Corey S. Source Type: research

WestJEM Full-text issue
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - March 17, 2023 Category: Emergency Medicine Authors: Lam, Jordan Source Type: research

Emergency Department Use of a Restraint Chair is Associated with Shorter Restraint Periods and Less Medication Use than the Use of 4-point Restraints
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - March 9, 2023 Category: Emergency Medicine Authors: Isenberger, Kurt M. Source Type: research

Risk Assessment Clinical Pathway
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - March 8, 2023 Category: Emergency Medicine Authors: Pastusek, Amber Source Type: research

Racial Disparities in Emergency Restraint Use for Agitated Patients
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - March 8, 2023 Category: Emergency Medicine Authors: Stone, Daniel Source Type: research

The Utility of the Columbia-Suicide Severity Rating Scale in Determining a Patient ‚ Imminent Risk for Suicide in the Emergency Department
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - March 8, 2023 Category: Emergency Medicine Authors: Takatsuka, Adam Source Type: research

NUBE Abstract Issue
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - March 8, 2023 Category: Emergency Medicine Authors: Saucedo, Cassandra Source Type: research