Reduction in Radiation Exposure through a Stress Test Algorithm in an Emergency Department Observation Unit.

Introduction: Clinicians are urged to decrease radiation exposure from unnecessary medical procedures. Many emergency department (ED) patients placed in an observation unit (EDOU) do not require chest pain evaluation with a nuclear stress test (NucST). We sought to implement a simple ST algorithm that favors non-nuclear stress test (Non-NucST) options to evaluate the effect of the algorithm on the proportion of patients exposed to radiation by comparing use of NucST versus Non-NucST pre- and post-algorithm.

Multicellularity and antibiotic resistance in Klebsiella pneumoniae grown under bloodstream-mimicking fluid dynamic conditions.

Background: While the importance of fluid dynamical conditions is well recognized in the growth of biofilms, their role during bacteremia is unknown. We examined the impact of physiological fluid shear forces on the development of multicellular aggregates of Klebsiella pneumoniae.

Methods: Wild-type and O-antigen or capsular mutants of K.

A case report of cerebral air embolism after esophagogastroduodenoscopy: diagnosis and management in the emergency department.

Background: Esophagogastroduodenoscopy (EGD) is a rare cause of cerebral air embolism (CAE). To our knowledge, there are only eight previously reported such cases in the history of the procedure.

Objective: To identify clinical causes of CAE that can present to the emergency department (ED) and to understand the appropriate management of CAE.

Should trauma patients with a Glasgow Coma Scale score of 3 be intubated prior to hospital arrival?

Introduction: Previous studies of heterogeneous populations (Glasgow Coma Scale (GCS) scores<9) suggest that endotracheal intubation of trauma patients prior to hospital arrival (i.e., prehospital intubated) is associated with an increased mortality compared to those patients not intubated in the prehospital setting.

The role of the Society for Academic Emergency Medicine in the development of guidelines and performance measures.

Measurement of adherence to clinical standards has become increasingly important to the practice of emergency medicine (EM). In recent years, along with a proliferation of evidence-based practice guidelines and performance measures, there has been a movement to incorporate measurement into reimbursement strategies, many of which affect EM practice. On behalf of the Society for Academic Emergency Medicine (SAEM) Guidelines Committee 2009-2010, the purposes of this document are to: 1) differentiate the processes of guideline and performance measure development, 2) describe how performance measures are currently and will be used in pay-for-performance initiatives, and 3) discuss opportunities for SAEM to affect future guideline and performance measurement development for emergency care.

Effect of race and insurance on outcome of pediatric trauma.

Objectives: This study sought to determine if insurance or race status affect trauma outcomes in pediatric trauma patients.

Methods: Using the National Trauma Data Bank (NTDB; v6.2), the following variables were extracted: age (0-17 years), payment type (insured, Medicaid/Medicare, or self-pay), race (white, Black/African American, or Hispanic), Injury Severity Score (ISS > 8), type of trauma (blunt or penetrating), and discharge status (alive or dead).

Research using emergency department-related data sets: current status and future directions.

The 2009 Academic Emergency Medicine consensus conference focused on "Public Health in the ED: Surveillance, Screening and Intervention." One conference breakout session discussed the significant research value of health-related data sets. This article represents the proceedings from that session, primarily focusing on emergency department (ED)-related data sets and includes examples of the use of a data set based on ED visits for research purposes.

Confusion about epinephrine dosing leading to iatrogenic overdose: a life-threatening problem with a potential solution.

Epinephrine is indicated for various medical emergencies, including cardiac arrest and anaphylaxis, but the dose and route of administration are different for each indication. For anaphylaxis, it is given intramuscularly at a low dose, whereas for cardiac arrest a higher dose is required intravenously. We encountered a patient with suspected anaphylaxis who developed transient severe systolic dysfunction because of inappropriately received cardiac arrest dose, ie, larger dose given as an intravenous push.

Emergency department Chlamydia screening through partnership with the public health department.

Background: The emergency department (ED) serves a population that may benefit from numerous screening initiatives but screening in the ED is challenging due to crowding as well as resource and time constraints. One option may be to collect specimens in the ED and then partner with the public health department (PHD) to analyze the specimens off-site and arrange follow-up treatment.

Objectives: The objective was to explore the feasibility of chlamydia screening in females using a partnership model in which the ED is responsible for urine collection and the PHD is responsible for chlamydia testing, notification, and treatment.

Ethical considerations for emergency care providers during pandemic influenza--ready or not..

When an infectious pandemic occurs in the United States, emergency care providers (ECPs) will be on the frontlines caring for infected, potentially infected, and non-infected patients. Logistically, the current emergency care system is not ready for a pandemic, but are the providers ethically ready? Some of the most difficult and challenging issues that will be raised during a pandemic will be ethical in nature. An ECP likely will be confronted with ethical values and value conflicts underlying restriction of liberty, duty to care, and resource allocation.

Survey of hospital healthcare personnel response during a potential avian influenza pandemic: will they come to work?

Introduction: In order to prepare for pandemics, it is important to assess the likelihood that hospital personnel would report to work and to identify the issues that may affect this decision.

Objective: To survey hospital personnel regarding their attendance at work in the hypothetical event of avian influenza pandemic, and what factors might influence this decision.

Methods: A voluntary, confidential, institutional review board-approved survey was offered to a convenience sample of hospital workers regarding their willingness to report to work and what issues would be important in making this decision.

Management of evacuee surge from a disaster area: solutions to avoid non-emergent, emergency department visits.

Introduction: Many emergency departments (EDs) in the United States experience daily overcrowding, and a rapid influx of evacuees fleeing a disaster area can pose a substantial burden. Some of these evacuees may require ED care. However, others lack an alternative to the ED to address non-emergent medical concerns (prescription refills or outpatient referral).

The use of health care policy to facilitate evidence-based knowledge translation in emergency medicine.

Health care policy can facilitate emergency medicine knowledge translation (KT). Because of this, the 2007 Academic Emergency Medicine Consensus Conference on KT identified a specific theme regarding issues of health care policy and KT. Six months before the Consensus Conference, international experts in the area were invited to communicate on health care policies regarding all areas of KT via e-mail and "Google groups.

Respiratory hygiene in the emergency department.

The emergency department (ED) is an essential component of the public health response plan for control of acute respiratory infectious threats. Effective respiratory hygiene in the ED is imperative to limit the spread of dangerous respiratory pathogens, including influenza, severe acute respiratory syndrome, avian influenza, and bioterrorism agents, particularly given that these agents may not be immediately identifiable. Sustaining effective respiratory control measures is especially challenging in the ED because of patient crowding, inadequate staffing and resources, and ever-increasing numbers of immunocompromised patients.

Respiratory hygiene in the emergency department.

The emergency department (ED) is an essential component of the public health response plan for control of acute respiratory infectious threats. Effective respiratory hygiene in the ED is imperative to limit the spread of dangerous respiratory pathogens, including influenza, severe acute respiratory syndrome, avian influenza, and bioterrorism agents, particularly given that these agents may not be immediately identifiable. Sustaining effective respiratory control measures is especially challenging in the ED because of patient crowding, inadequate staffing and resources, and ever-increasing numbers of immunocompromised patients.

A single ventilator for multiple simulated patients to meet disaster surge.

Objectives: To determine if a ventilator available in an emergency department could quickly be modified to provide ventilation for four adults simultaneously.

Methods: Using lung simulators, readily available plastic tubing, and ventilators (840 Series Ventilator; Puritan-Bennett), human lung simulators were added in parallel until the ventilator was ventilating the equivalent of four adults. Data collected included peak pressure, positive end-expiratory pressure, total tidal volume, and total minute ventilation.

Are there disparities in emergency care for uninsured, medicaid, and privately insured patients?

Objectives: To determine if there are any differences in proportion of high-acuity care and low-acuity care provided to uninsured, Medicaid-insured, and privately insured emergency department (ED) patients.

Methods: This was a retrospective, observational study using physician level of service provided as a marker for acuity. The study used computerized billing data (2000-2001) from an urban, teaching, Level I trauma center with 75,000 visits per year.

Financial impact on emergency physicians for nonreimbursed care for the uninsured.

Study Objective: The financial impact on emergency physicians' reimbursement for uninsured patient care has not been previously evaluated. We conducted this study to estimate the amount of emergency physicians' nonreimbursed care for uninsured patients in Michigan.

Methods: This retrospective observational study used a convenience sample of reimbursement information from 29 hospitals.

Syndromic analysis of computerized emergency department patients' chief complaints: an opportunity for bioterrorism and influenza surveillance.

Study Objective: Emergency department computerized triage logs might be useful for automated ED surveillance and potentially for early identification of bioterrorism events. We describe a Web-based surveillance program and its feasibility for surveillance.

Methods: A Web-based surveillance program that receives computerized chief complaint data daily from a large academic urban teaching hospital and performs syndromic analysis on these data was developed.

Central line mechanical complication rate in emergency medicine patients.

Unlabelled: Central line (CL) placement in the emergency department (ED) is a common practice. Previously published small-scale studies have quoted mechanical complication rates in emergency medicine patients of 10-15%.

Objective: To determine the mechanical complication rate of central venous catheterization in a large (65,000 visits/year) academic urban ED.

Retrospective evaluation of potential medicare admission denials using interqual and millman and roberts admission criteria.

Published in: Acad Emerg Med. 2000; 7: 543.

Accuracy of interqual criteria in determining the hospitalization need in medicare patients with gastrointestinal bleeding.

Published in: Acad Emerg Med. 2000; 7: 552-3.