In situ medical simulation investigation of emergency department procedural sedation with randomized trial of experimental bedside clinical process guidance intervention.

Introduction: Patient safety during emergency department procedural sedation (EDPS) can be difficult to study. Investigators sought to delineate and experimentally assess EDPS performance and safety practices of senior-level emergency medicine residents through in situ simulation.

Methods: Study sessions used 2 pilot-tested EDPS scenarios with critical action checklists, institutional forms, embedded probes, and situational awareness questionnaires.

Use of in situ simulation and human factors engineering to assess and improve emergency department clinical systems for timely telemetry-based detection of life-threatening arrhythmias.

Background And Objectives: Medical simulation and human factors engineering (HFE) may help investigate and improve clinical telemetry systems. Investigators sought to (1) determine the baseline performance characteristics of an Emergency Department (ED) telemetry system implementation at detecting simulated arrhythmias and (2) improve system performance through HFE-based intervention.

Methods: The prospective study was conducted in a regional referral ED over three 2-week periods from 2010 to 2012.

Bedside sonographic measurement of the inferior vena cava caval index is a poor predictor of fluid responsiveness in emergency department patients.

Objectives: Sonographic measurement of the inferior vena cava (IVC) caval index predicts central venous pressure in ED patients. Fluid responsiveness (FR) is a measure of preload dependence defined as an increase in cardiac output secondary to volume expansion. We sought to determine if the caval index is an accurate measurement of FR in ED patients.

Correlation of C-reactive protein to severity of symptoms in acute influenza A infection.

Background: Currently there is no objective measure to determine disease severity in patients with acute influenza infection. During acute viral infections, C-reactive protein (CRP) has been shown to be elevated.

Aim: To study the relationship between the symptoms of acute influenza A infection and correlate them with the level of inflammation as measured by serum CRP levels.

Increased granzyme levels in cytotoxic T lymphocytes are associated with disease severity in emergency department patients with severe sepsis.

Exocytosis of granules containing the cytolytic effector (CE) molecules granzyme A (GzmA), granzyme B (GzmB), and perforin is one major pathway of lymphocyte-mediated cytotoxicity. Studies in murine models and the finding of elevated granzyme levels in the plasma of septic patients have implicated cytotoxic lymphocytes in the pathogenesis of sepsis. We sought to evaluate the role of cytotoxic cells and CE in sepsis and determine if intracellular levels of CE in cytotoxic cells correlate with disease severity.

Bedside ultrasonography detects significant femoral vessel overlap: implications for central venous cannulation.

Objective: Our goal was to gain a better understanding of the femoral vessel anatomy as it relates to central venous cannulation. The primary objective of this study was to use bedside ultrasonography to determine the amount of exposed femoral vein at three sites corresponding to surface anatomy of the landmark-based procedure.

Methods: This cross-sectional study enrolled a random sample of 180 adult patients presenting to a large urban academic emergency department.

Web survey and embedded intervention on emergency department personnel perceptions of role in patient experience.

Investigators examined emergency department (ED) personnel's perceived job responsibilities and insights into determinants of patient experience. Surveys queried subjects on their perceptions of select clinical care-related actions (CCAs) to assess discipline-specific and service-specific CCA ownership and valuation. Investigators surveyed 153 of 634 ED personnel.

Prognostic value of noninvasive measures of contractility in emergency department patients with severe sepsis and septic shock undergoing early goal-directed therapy.

Purpose: Reversible ventricular dysfunction is common in sepsis. Impedance cardiography allows for noninvasive measurement of contractility through time interval or amplitude-based measures. This study evaluates the prognostic capacity of these measures in patients with severe sepsis or septic shock in the emergency department.

Tissue oxygenation does not predict central venous oxygenation in emergency department patients with severe sepsis and septic shock.

Objectives: This study sought to determine whether tissue oxygenation (StO(2)) could be used as a surrogate for central venous oxygenation (ScVO(2)) in early goal-directed therapy (EGDT).

Methods: The study enrolled a prospective convenience sample of patients aged > or =18 years with sepsis and systolic blood pressure <90 mm Hg after 2 L of normal saline or lactate >4 mmol, who received a continuous central venous oximetry catheter. StO(2) and ScVO(2) were measured at 15-minute intervals.