Using an Online Vaccination Registry to Confirm Tetanus Status in Children with Tetanus-prone Wounds.

Introduction: Tetanus vaccination status is an important consideration for emergency physicians managing patients with tetanus-prone wounds. Physicians must identify at-risk patients, but vaccination histories are often unknown and commonly lack documentation. The study objective was to determine the potential impact of an online immunization registry (Florida SHOTS - State Health Online Tracking System) on the appropriate administration of tetanus prophylaxis for pediatric patients managed in the emergency department (ED).

Ultrasound-Guided Peripheral Intravenous Catheter Training Results in Physician-Level Success for Emergency Department Technicians.

Objectives: To report our success and complication rates with emergency department (ED) technician-performed ultrasound (US)-guided peripheral intravenous (IV) catheter placement and to compare our results to similar studies in the literature.

Methods: We conducted a retrospective review of a prospective database of patients who underwent US-guided peripheral IV catheter placement attempts for clinical care in the ED. All patients meeting difficult IV access criteria who had a US-guided peripheral IV catheter placement attempted by a trained ED technician were included.

The long-term burden of severe sepsis and septic shock: Sepsis recidivism and organ dysfunction.

Background: Severe sepsis and septic shock mortality has improved; however, rates of persistent (28-90 days) and long-term (>90 day) organ dysfunction in sepsis survivors are unknown.

Methods: Secondary analysis of a prospective cohort of adult emergency department patients with severe sepsis.

Results: Of 110 sepsis admissions, we obtained follow-up on 51 of 78 survivors of whom 41% (21 of 51) had persistent organ dysfunction: pulmonary, 18% (9 of 51); renal, 22% (11 of 51); coagulopathy, 10% (5 of 51); cardiovascular, 6% (3 of 51); hepatic, 2% (1 of 51); and neurologic, 3% (3 of 51).

The relationship of intravenous fluid chloride content to kidney function in patients with severe sepsis or septic shock.

Background: Previous studies suggest a relationship between chloride-rich intravenous fluids and acute kidney injury in critically ill patients.

Objectives: The aim of this study was to evaluate the relationship of intravenous fluid chloride content to kidney function in patients with severe sepsis or septic shock.

Methods: A retrospective chart review was performed to determine (1) quantity and type of bolus intravenous fluids, (2) serum creatinine (Cr) at presentation and upon discharge, and (3) need for emergent hemodialysis (HD) or renal replacement therapy (RRT).

The bubble study: ultrasound confirmation of central venous catheter placement.

Study Objective: The objective was to determine if ultrasound (US) can more rapidly confirm central venous catheter (CVC) position in comparison to chest radiography (CXR) in the emergency department.

Methods: The study included a convenience sample of emergency department patients with supradiaphragmatic CVCs and a CXR for confirmation. Ultrasound was used for CVC confirmation by visualizing microbubble artifact in the right atrium after injection of saline through the distal port.

End-tidal carbon dioxide as a goal of early sepsis therapy.

Objective: To determine the use of end-tidal carbon dioxide (etco2) as an end point of sepsis resuscitation.

Methods: This was a prospective, observational, single-center cohort study of emergency department patients receiving treatment for severe sepsis with a quantitative resuscitation protocol. Three etco2 readings were taken during a 1-minute time frame at 0, 3, and 6 hours of treatment.

A 6-year retrospective review of pediatric firearm injuries: do patients < 14 years of age differ from those 15-18 years of age?

Background: Pediatric firearm injuries are an increasing source of morbidity. Firearm injuries in adolescents are common but not well studied in younger children. The aims were to describe the epidemiology of firearm injuries in patients 0 year to 18 years old, with a case study of patients 14 years or younger for determining shooting characteristics and epidemiologic trends.

Impact of an abbreviated cardiac enzyme protocol to aid rapid discharge of patients with cocaine-associated chest pain in the clinical decision unit.

Introduction: In 2007 there were 64,000 visits to the emergency department (ED) for possible myocardial infarction (MI) related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9-12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain.

Naloxone Triggering the RRT: A Human Antidote?

Objectives: At our institution, we observed an increase in opioid-related adverse events after instituting a new pain treatment protocol. To prevent this, we programmed the Omnicell drug dispensing system to page the RRT whenever naloxone was withdrawn on the general wards.

Methods: Retrospective review of a prospectively collected database with a before and after design.

Persistent organ dysfunction after severe sepsis: a systematic review.

Objective: Sepsis is a prevalent disease with high mortality. Survivors of sepsis often suffer significant resultant morbidity, including organ dysfunction. However, little is known about persistent or long-term organ dysfunction in this patient population.

Proactive rounding by the rapid response team reduces inpatient cardiac arrests.

Objective: Rapid response teams (RRTs) are frequently employed to respond to deteriorating inpatients. Proactive rounding (PR) consists of the RRT nurse rounding through the inpatient wards identifying high risk patients and intervening preemptively. At our institution, PR began in July of 2007.

Ultrasound evaluation of cranial and long bone fractures in a cadaver model.

Background: Ultrasound has been utilized in various settings for evaluation and treatment of skeletal injuries. Bone has different tissue acoustic impedance than soft tissue allowing visualization of the cortical disruption found in fractures.

Objective: To determine emergency physicians' accuracy in diagnosing cranial and long bone fractures using ultrasound.

Reduced use of occult bacteremia blood screens by emergency medicine physicians using immunization registry for children presenting with fever without a source.

Objectives: This study examined whether utilization of the Florida State Health Online Tracking System (SHOTS) immunization registry to determine Haemophilus influenzae type B and heptavalent pneumococcal conjugate (PCV7) vaccine status impacts the protocolized decision to perform a screening blood draw for occult bacteremia (OB) in young children.

Methods: A convenience sample of children 6 to 24 months of age presenting to the pediatric emergency department with fever of greater than 39°C without a source was enrolled. Physicians were trained to use the SHOTS immunization registry and reviewed the emergency department's fever protocol.

Color coded medication safety system reduces community pediatric emergency nursing medication errors.

Objectives: To compare the performance of current systems in place for preparation and administration of pediatric medications in community emergency departments to the color-coded medication safety (CCMS) system among nurses.

Methods: Community ED nurses participated in simulated pediatric emergency scenarios using traditional dosing references then the CCMS system. We measured preintervention/postintervention: (1) time to task completion from physician order to medication administration; (2) accuracy of conversion to milliliters, dilution, and time for medication administration; and (3) recognition of 10-fold physician errors.

Stabilization and treatment of dental avulsions and fractures by emergency physicians using just-in-time training.

Study Objective: The objective of this investigation is to use a dental simulation model to compare splinting and bandaging methods for managing tooth avulsions and fractures, as measured by dentist evaluators for quality and time to complete each stabilization procedure.

Methods: This was a randomized crossover study comparing 3 splinting techniques for managing a traumatically avulsed tooth (periodontal pack, wire, and bondable reinforcement ribbon) and 2 bandage techniques for managing a fractured tooth (calcium hydroxide paste and light-cured composite). After viewing a Just-in-Time training video, a convenience sample of emergency physicians performed the 5 stabilization techniques on dental models containing extracted teeth embedded in clay to simulate a segment of the human dentition.