Western Journal of Emergency Medicine This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

Implementation and Impacts of California Senate Bill 1152 on Homeless Discharge Protocols
Introduction: In recent decades, there has been a growing focus on addressing social needs in healthcare settings. California has been at the forefront of making state-level investments to improve care for patients with complex social and medical needs, including patients experiencing homelessness (PEH). Examples include Medicaid 1115 waivers such as the Whole Person Care pilot program and California Advancing and Innovating Medi-Cal (CalAIM). To date, California is also the only state to have passed a legislative mandate to address concerns related to the hospital discharge of PEH who lack suf ficient resources to suppor...
Source: Western Journal of Emergency Medicine - November 8, 2023 Category: Emergency Medicine Authors: Aridomi, Haruna Source Type: research

Epinephrine in Cardiac Arrest: Identifying a Potential Limit for Resuscitation
Introduction: Epinephrine continues to be a fundamental part of the Advanced Cardiac Life Support algorithm despite a lack of evidence that it improves neurologically intact survival. Our aim was both to identify a potential upper limit of epinephrine use in resuscitations and to demonstrate real-world epinephrine use in different patient subgroups.Methods: This was a single-center, retrospective cohort study, conducted between August 1, 2016 –July 1, 2021, of patients with medical cardiac arrest who were administered a known number of epinephrine doses. The primary outcome was neurologically intact discharge defined by...
Source: Western Journal of Emergency Medicine - November 8, 2023 Category: Emergency Medicine Authors: Boivin, Zachary Source Type: research

Prospective Cohort Study of Emergency Department Visit Frequency and Diagnoses Before and During COVID-19 Pandemic in Urban, Low-Income, US- and Foreign-Born Mothers in Boston, MA
In this study we sought to understand how ED utilization evolved during the COVID-19 pandemic among traditionally understudied, low-income, racially diverse US- and foreign-born mothers.Methods: This is a secondary analysis of a pre-existing dataset of 3,073 participants enrolled in the Boston Birth Cohort at birth and followed prospectively. We obtained ED visit diagnoses from 2019 and 2020 via electronic health records, categorized according to the International Classi fication of Diseases, 10th Revision, and compared them using graph plots, chi-square, and negative binomial... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - November 8, 2023 Category: Emergency Medicine Authors: Osula, Valerie Source Type: research

Time to Treat the Climate and Nature Crisis as One Indivisible Global Health Emergency
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - November 1, 2023 Category: Emergency Medicine Authors: Abbasi, Kamran Source Type: research

Large-scale Implementation of a COVID-19 Remote Patient Monitoring Program
Introduction: We implemented a large-scale remote patient monitoring (RPM) program for patients diagnosed with coronavirus 2019 (COVID-19) at a not-for-pro fit regional healthcare system. In this retrospective observational study, patients from nine emergency department (ED) sites were provided a pulse oximeter and enrolled onto a monitoring platform upon discharge.Methods:The RPM team captured oxygen saturation (SpO2), heart rate, temperature, and symptom progression data over a 16-day monitoring period, and the team engaged patients via video call, phone call, and chat within the platform. Abnormal vital signs were fla...
Source: Western Journal of Emergency Medicine - October 27, 2023 Category: Emergency Medicine Authors: Wang, Lulu Source Type: research

Clinical Characteristics of SARS-CoV-2 Acute Pulmonary Embolism and Adjusted D-dimer for Emergency Department Patients
Introduction:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and acute pulmonary embolism (APE) present a diagnostic challenge in the emergency department (ED) setting. We aimed to identify key clinical characteristics and D-dimer thresholds associated with APE in SARS-CoV-2 positive ED patients.Methods: We performed a multicenter, retrospective cohort study for adult patients who were diagnosed with coronavirus 2019 (COVID-19) and had computed tomography pulmonary angiogram (CTPA) performed between March 17, 2020 –January 31, 2021. We performed univariate analysis to determine numeric medians, chi-square va...
Source: Western Journal of Emergency Medicine - October 25, 2023 Category: Emergency Medicine Authors: Husain, Iltifat Source Type: research

Special Issue on Social Emergency Medicine
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - October 14, 2023 Category: Emergency Medicine Authors: Saucedo, Cassandra Source Type: research

Quality Improvement Curriculum for Intensive Care Unit Upgrades
Patients admitted to the hospital ward from the emergency department (ED) occasionally decompensate and require transfer to the intensive care unit (ICU). An emergency medicine (EM) curriculum focused on review of these ICU upgrade cases could improve resident knowledge related to patient acuity, critical illness, and appropriate disposition. Furthermore, initial identi fication of critical pathology in the ED and earlier admission to the ICU could reduce delays in care and improve patient outcomes.We performed a retrospective analysis to determine the effectiveness of a resident quality improvement curriculum evaluating ...
Source: Western Journal of Emergency Medicine - October 11, 2023 Category: Emergency Medicine Authors: Bohman, Seth R. Source Type: research

Simulation-based Comparison of British and Australian Advanced Life Support Guidelines
Introduction: Cardiac arrest is a major health concern that has been linked to poor disease outcomes. Cardiopulmonary resuscitation (CPR) is a critical protocol for restoring spontaneous circulation. The guidelines used by medical staff differ across different countries. A comparison of these guidelines can help in designing more ef ficient Advanced Life Support (ALS) protocols. The goal in this study was to compare the guidelines for interruption of compression during CPR (hands-off time) for ALS protocols provided by Australian and United Kingdom (UK) resuscitation councils.Methods:The author designed a simulation-based...
Source: Western Journal of Emergency Medicine - October 11, 2023 Category: Emergency Medicine Authors: Altuwaijri, Fawaz Source Type: research

Beyond the Basics: A Novel Approach to Integrating a Social Determinants of Health Curriculum into an Emergency Medicine Course
The objectives were as follows:Assess the SDoH, risk factors, and barriers to healthcare facing patients from diverse socioeconomic and cultural backgrounds in the ED.Examine how social work consult services operate in the ED setting and how to identify appropriate referrals, resources, and treatment plans for patients in the ED.Examine and interpret the impact health disparities have on patients in the ED and develop potential solutions to reduce these disparities to improve health outcomes.Analyze the experiences and lessons learned and use them to inform future patient interactions.Curricular Design:The curriculum was d...
Source: Western Journal of Emergency Medicine - October 11, 2023 Category: Emergency Medicine Authors: Turgeon, Nikkole J. Source Type: research

Sustainable Purchasing Practices: A Comparison of Single-use and Reusable Pulse Oximeters in the Emergency Department
Background: Delivering healthcare requires signi ficant resources and creates waste that pollutes the environment, contributes to the climate crisis, and harms human health. Prior studies have generally shown durable, reusable medical devices to be environmentally superior to disposables, but this has not been investigated for pulse oximetry prob es.Objective: Our goal was to compare the daily carbon footprint of single-use and reusable pulse oximeters in the emergency department (ED).Methods: Using a Life Cycle Assessment (LCA), we analyzed greenhouse gas (GHG) emissions from pulse oximeter use in an urban, tertiary care...
Source: Western Journal of Emergency Medicine - September 26, 2023 Category: Emergency Medicine Authors: Duffy, Juliana Source Type: research

Is Two Better Than Three? A Systematic Review of Two-bag Intravenous N-acetylcysteine Regimens for Acetaminophen Poisoning
Introduction: Acetaminophen poisoning is commonly treated by emergency physicians. First-line therapy is N-acetylcysteine (NAC), traditionally administered intravenously via a US Food and Drug Administration (FDA)-approved three-bag protocol in which each bag has a unique concentration and infusion duration. Recently, simpli fied, off-label two-bag NAC infusion protocols have become more common. The purpose of this review is to summarize the effectiveness and safety of two-bag NAC.Methods: We undertook a comprehensive search of PubMed, EMBASE, and MEDLINE from inception to December 13, 2022, for articles describing human ...
Source: Western Journal of Emergency Medicine - September 25, 2023 Category: Emergency Medicine Authors: Cole, Jon B. Source Type: research

Prognostic Accuracy of SpO2-based Respiratory Sequential Organ Failure Assessment for Predicting In-hospital Mortality
In this study we aimed to investigate the prognostic accuracy for predicting in-hospital mortality using respiratory Sequential Organ Failure Assessment (SOFA) scores by the conventional method of missing-value imputation with normal partial pressure of oxygen (PaO2)- and oxygen saturation (SpO2)-based estimation methods.Methods: This was a single-center, retrospective cohort study of patients with suspected infection in the emergency department. The primary outcome was in-hospital mortality. We compared the area under the receiver operating characteristics curve (AUROC) and calibration results of the conventional method (...
Source: Western Journal of Emergency Medicine - September 25, 2023 Category: Emergency Medicine Authors: Jeong, Daun Source Type: research

Euglycemic Diabetic Ketoacidosis: Experience with 44 Patients and Comparison to Hyperglycemic Diabetic Ketoacidosis
Introduction: Euglycemic diabetic ketoacidosis (DKA) (glucose<250 milligrams per deciliter (mg/dL) has increased in recognition since introduction of sodium-glucose co-transporter 2 (SGLT2) inhibitors but remains challenging to diagnose and manage without the hyperglycemia that is otherwise central to diagnosing DKA, and with increased risk for hypoglycemia with insulin use. Our objective was to compare key resource utilization and safety outcomes between patients with euglycemic and hyperglycemic DKA from the same period.Methods: This is a retrospective review of adult emergency department patients in DKA at an academi...
Source: Western Journal of Emergency Medicine - September 25, 2023 Category: Emergency Medicine Authors: Sell, Jordan Source Type: research

Characteristics and Outcomes of Patients in the Emergency Department with Left Ventricular Assist Devices
Introduction: Left ventricular assist devices (LVAD) are increasingly common among patients with heart failure. The unique physiologic characteristics of patients with LVADs present a challenge to emergency clinicians making treatment and disposition decisions. Despite the increasing prevalence of LVADs, literature describing emergency department (ED) visits among this population is sparse. We aimed to describe clinical characteristics and outcomes among patients with LVADs seen in two quaternary-care EDs in a five-year period. Secondarily, we sought to evaluate mortality rates and ED return rates for bridge to transplant...
Source: Western Journal of Emergency Medicine - September 25, 2023 Category: Emergency Medicine Authors: Finch, Alexander S. Source Type: research