Thyroid stimulating hormone testing in ED evaluation of patients with atrial fibrillation and various psychiatric diagnoses.

Background: Previous studies of thyroid stimulating hormone (TSH) levels in Emergency Department (ED) patients largely have centered on patients with atrial fibrillation (AF). In our ED patients with AF as well as patients with Psychiatric diagnoses (psych) are screened. The purpose of the present study was to compare TSH levels in the 2 groups.

Assessing the Prevalence and Predictors of Bullying Among Emergency Medical Service Providers.

Bullying as a stressor in the workplace has been evaluated in numerous settings. It has never been evaluated in the emergency medical service (EMS) environment where bullying can occur from many different sources. The Negative Acts Questionnaire-Revised (NAQ-R) is a 22-question validated tool for evaluating bullying.

Bathing Habits in Emergency Department Patients with Cellulitis or Abscess Versus Controls.

Objective: Cellulitis is a leading cause of emergency department (ED) visits, with more than 200 cases per 100,000 people per year. Although many risk factors have been identified, including edema, skin breakdown, and penetrance of the skin, there are few data available on whether personal hygiene habits (bathing and clean clothes) are associated with increased risk for soft tissue infection. Studies looking at chlorhexidine baths in the intensive care unit to prevent soft tissue infections have shown conflicting and limited efficacy.

A Comparison of QTc Intervals in Alcohol Withdrawal Patients Versus Acute Coronary Syndrome Patients.

Objectives: Patients with an alcohol use disorder experiencing acute intoxication or withdrawal may be at risk for electrocardiograph (ECG) abnormalities, including prolongation of repolarization (long QTc [corrected QT]) that may contribute to arrhythmias and may be associated with a threefold increase in the likelihood of sudden cardiac events. Patients with acute coronary syndrome may have prolonged QTc as well. To our knowledge, no previous studies have compared the QTc of ACS with acute ethanol (EtOH) withdrawal syndromes in the emergency department (ED).

Comparison of QTc and Troponin Levels in ST Elevation MIs Compared with Non-ST Elevation MIs.

Objectives: ST elevation myocardial infarctions (STEMIs) and non-ST elevation myocardial infarctions (NSTEMIs) have differences that can be important to differentiate. Our primary hypothesis was that corrected QT (QTc) duration and troponin I levels were higher in STEMIs compared with NSTEMIs. The objective of our study was to compare STEMIs with NSTEMIs for QTc duration and troponin levels.

The meaning of elevated troponin I levels: not always acute coronary syndromes.

Background: Troponin elevation can be caused by etiologies other than acute coronary syndromes (ACS). Our hypothesis was that elevated troponins occur more frequently in non-ACS cases but that ACS cases (type 1 ST-elevation myocardial infarction [STEMI] and type 1 non-STEMI [NSTEMI]) have significantly higher troponin elevations.

Methods: This was a cross-sectional cohort analysis of a random subset of all patients with elevated troponins (defined as ≥0.

Disparity in Patients' Self-Reported and Charted Medication Allergy Information.

Objectives: The objective of this study was to compare current adverse drug/allergy reaction reporting in patient electronic medical records/charts against information gathered during patient interviews in the emergency department. Our hypothesis was that current methods for allergy reporting results in significant discrepancy between what is documented and the actual allergy history upon interviewing the patient.

Methods: The study was conducted between December 2011 and April 2012 in an academic emergency department.

Acute sigmoid diverticulitis within a nonincarcerated hernia.

Separately, diverticulitis and inguinal hernias are both common findings in emergency medicine. However, diverticulitis within a reducible hernia has not been previously reported.We present a case of sigmoid diverticulitis within a non incarcerated easily reducible hernia treated with conservative management.

Emergency department orthopedics observation unit as an alternative to admission.

Objectives: Inclusion of select orthopedic problems in the orthopedics observation unit (OOU) may reduce hospital admissions. Our system allows OOU status for 24 hours, but the effect on admissions is unknown. Our primary hypothesis was that we could predict which OOU patients required admission based on the presence of uncontrolled pain.

Evaluating community ED crowding: the Community ED Overcrowding Scale study.

Objectives: The goals of this study were to (1) identify valid variables that correlate with emergency department (ED) crowding and (2) determine a model that could be used to accurately reflect the degree of ED crowding.

Methods: A site sampling form was applied to convenience sampling of 13 community hospitals in California between April 6, 2011, and May 1, 2011. The outcome variable was average perception of crowding by the ED physician and charge nurse on a 100-mm visual analog scale.

No difference in emergency department length of stay for patients with limited proficiency in English.

Objectives: The population of the United States continues to diversify, with an increasing percentage of individuals who have limited English proficiency (LEP). A major concern facing emergency departments (EDs) around the country is increasing length of stay (LOS). Although multiple studies have shown racial and ethnic disparities in waiting time and LOS, no studies have examined specifically whether patients with LEP have a different LOS than English-speaking (ES) patients.

Does the addition of Vocera hands-free communication device improve interruptions in an academic emergency department?

Objective: Emergency department (ED) interruptions occur frequently. Recently, a hands-free communication device (HCD; Vocera) was added to the population of communications devices (a cellular telephone and a pager) in our ED. The research purpose was to determine whether this addition improved interruption times and our hypothesis was the device would decrease length of interruptions.

Occult pneumothoraces in acute trauma patients.

Introduction: Many traumatic pneumothoraces (PTX) are not seen on initial chest radiograph (CR) (occult PTX) but are detected only on computed tomography (CT). Although CR remains the first tool for detecting PTX, most trauma patients with significant thoracoabdominal injuries will receive both CT and CR. The primary objective of this study was to retrospectively determine the effectiveness of CR for detecting PTX in trauma patients.

Unusual cause of neck pain: septic arthritis of a cervical facet.

Neck pain is a common cause for presentation to an emergency department. Most causes are benign and often secondary to arthritis or injuries. We present a case of septic cervical facet arthritis, a very rare cause of neck pain.

Derivation and validation of a short emergency department screening tool for perpetrators of intimate partner violence: the PErpetrator RaPid Scale (PERPS).

Background: There is no short screening tool for perpetrators of intimate partner violence (IPV), although one is needed.

Objective: To retrospectively derive and prospectively validate a brief screening tool for perpetrators of IPV: the PErpetration RaPid Scale (PERPS).

Methods: In the derivation phase of the study, we developed the PERPS based on historical data.

Brief intervention for perpetration of intimate partner violence (IPV): simulation versus instruction alone.

Objective: To compare two brief randomized computer-based interventions about perpetration of intimate partner violence (IPV).

Methods: The study was a prospective cross-sectional cohort study of patients during randomized 4-hour shifts in an urban hospital-based emergency department setting with an emergency medicine residency. The site is a level 1 trauma center emergency department with an annual census of 60,000 adults.

On-site pharmacists in the ED improve medical errors.

Objective: The objective of the study was to compare errors in the emergency department (ED) with pharmacists present (PPs) for resuscitations and traumas vs with pharmacists absent (PAs). Our hypothesis was that errors would be significantly fewer during PP than PA times. We also hypothesized that times with PP would affect patients greater when disposition was to more critical areas (intensive care unit, or ICUs).

Usefulness of CRP and ESR in predicting septic joints.

Objective: To determine whether erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), or a combination of both was better in diagnosing a septic joint.

Methods: A retrospective chart review was done in all patients who had serum assays for ESR or CRP as well as joint fluid analysis over a two-year period. Based on lab and operative findings, patients (cohorts) were categorized as having normal, inflammatory, or septic joints.

Adult intimate partner violence perpetrators are significantly more likely to have witnessed intimate partner violence as a child than nonperpetrators.

Background: In a previous study, no association was found between intimate partner violence (IPV) victims and being an adult who witnessed IPV as a child (ACW).

Objective: The objective of the present study was to determine whether perpetrators of IPV (Perps) could be identified in a busy emergency department (ED) and whether Perps were more likely than non-Perps to be ACWs. The hypothesis was that Perps differed significantly from non-Perps in being ACWs, in being victims of IPV, and in demographics.

The relationship between paramedics' level of education and degree of commitment.

Introduction: Emergency medical services (EMS) personnel attrition is a serious concern. Two fundamental psychological constructs linked to attrition are organizational and occupational commitment.

Objective: To determine if there is a relationship between a paramedic's degree of occupational/organizational commitment and the following: (1) levels of education and (2) type of employment.