Opioid Use and Disposal Patterns of Emergency Department Patients.

Introduction: To date, there is limited literature to guide emergency providers (EPs) on the proper dosing of prescription opioids. Our study aims to assess the self-reported opioid use, storage, and disposal practices of patients presenting to the emergency department (ED) with acute pain.

Methods: This prospective cohort study employed a validated, cross-sectional survey of subjects identified using electronic medical records.

Augmentation of peripheral venous diameter for ultrasound-guided peripheral intravenous line insertion.

Objectives: Ultrasound-guided intravenous line placement is utilized often in the emergency department for venous access in patients whose veins are difficult to cannulate by traditional methods. This study aims to identify specific interventions that will augment venous cross-sectional area.

Methods: Residents and medical students volunteers each had their basilic vein identified using the linear array probe on an ultrasound.

History, ECG, Risk Factors (HER) Scoring for Cardiac Risk Stratification in Patients <45 Years of Age Presenting With Chest Pain.

Background Chest pain is a common chief complaint of patients presenting to the emergency department. Acute coronary syndrome (ACS) is found to be the etiology of this symptom in a minority of these patient encounters. This study aimed to determine the utility of using the History, ECG, Risk Factors (HER) components of the History, ECG, Age, Risk Factors, Troponin (HEART) score in ruling out 30-day Major Adverse Cardiac Event (MACE), ACS, ventricular tachycardia, and ventricular fibrillation in patients aged less than 45.

Comparison of Early and Late Intubation in COVID-19 and Its Effect on Mortality.

Background: Best practices for management of COVID-19 patients with acute respiratory failure continue to evolve. Initial debate existed over whether patients should be intubated in the emergency department or trialed on noninvasive methods prior to intubation outside the emergency department.

Objectives: To determine whether emergency department intubations in COVID-19 affect mortality.

Patients' sex and race are independent predictors of HEART score documentation by emergency medicine providers.

Introduction: The HEART score is a widely used clinical decision tool that provides emergency providers with objective risk stratification for patients presenting to the emergency department (ED) with undifferentiated chest pain (CP). There is no data as to which patients undergo formal risk stratification with a HEART score, and whether patient demographics influence decisions to apply the HEART score. Our objective was to determine if sex or race independently predict documentation of patients' HEART scores in CP patients.

Predicting 30 - Day outcomes in emergency department patients discharged with COVID-19.

Introduction: Determining disposition for COVID-19 patients can be difficult for emergency medicine clinicians. Previous studies have demonstrated risk factors which predict severe infection and mortality however little is known about which risk factors are associated with failure of outpatient management and subsequent admission for COVID-19 patients.

Methods: We conducted a retrospective observational chart review of patients who had a confirmed positive COVID-19 test collected during an ED visit between March 1, 2020 and October 11, 2020.

The use of N-acetylcysteine in the prevention of hangover: a randomized trial.

Hangovers resulting from alcohol intoxication can lead to adverse effects ranging from generalized discomfort and work-related absenteeism to emergency department visits from patients seeking symptomatic care. The purpose of this study was to evaluate the efficacy of a low dose (600-1800 mg) of N-Acetylcysteine (NAC) vs placebo on mitigating hangover symptoms. This was a randomized, double-blinded, placebo controlled crossover study involving 49 volunteers who consumed beer to obtain a breath alcohol content (BrAC) of 0.

Personal Assessment of Ability to Drive Under the Influence of Alcohol vs. Objective Measurement.

Background: Alcohol intoxication often affects patient management in the emergency department.

Objective: This study evaluates participants' subjective sense of impairment using ability to drive as a reference compared with measured breath alcohol concentrations (BrAC) and evaluate whether there is a gender difference.

Methods: In this prospective study, 55 volunteers consumed one beer and estimated their BrAC and their ability to drive.

Physician Wellness During a Pandemic.

Introduction: We are currently in the midst of the coronavirus disease 2019 (COVID-19) pandemic. Research into previous infectious disease outbreaks has shown that healthcare workers are at increased risk for burnout during these dire times, with those on the front lines at greatest risk. The purpose of this prospective study was to determine the effect that the COVID-19 pandemic has had on the wellness of emergency physicians (EP).

Manipulation of Breath Alcohol Tests: Can Specific Techniques Alter Breath Alcohol Content?

Objective: The most common form of measurement of breath alcohol content (BrAC) is through the use of a diode catheter. This study aims to test the accuracy of breath alcohol analysis through different manipulations.

Methods: BrAC was measured after individuals consumed each standardized beer until they reached a 0.

Exploring the association between initial serum alcohol concentration and polysubstance use: More than a simple "gateway drug" effect?

Introduction: Polysubstance abuse (PSA) is a significant problem affecting our society. In addition to negatively affecting the health and well-being of substance users, alcohol and/or drug abuse is also associated with heavy injury burden. The goal of this study was to determine if elevated serum alcohol (EtOH) levels on initial trauma evaluation correlate with the simultaneous presence of other substances of abuse (SOAs).

The Impact of a Standardized Checklist on Transition of Care During Emergency Department Resident Physician Change of Shift.

Introduction: Transitions of patient care during physicians' change of shift introduce the potential for critical information to be missed or distorted, resulting in possible morbidity. The Joint Commission, the Accreditation Council for Graduate Medical Education, and the Society of Hospital Medicine jointly encourage a structured format for patient care sign-out. This study's objective was to examine the impact of a standardized checklist on the quality of emergency medicine (EM) resident physicians' patient-care transition at shift change.

An observational study of patients' attitudes to tattoos and piercings on their physicians: the ART study.

Introduction: Perceptions regarding body art change over time as societal norms change. Previous research regarding patients' perceptions of physicians with exposed body art have been hampered by flaws in design methodology that incorporate biases into patient responses. This study was performed to determine whether emergency department (ED) patients perceived a difference in physician competence, professionalism, caring, approachability, trustworthiness and reliability in the setting of exposed body art.

Endocarditis: An Easy Miss.

Subacute endocarditis often presents with an indolent course. A potentially lethal form generated by infection with may be easily overlooked early in its presentation. This report discusses the case of an 18-year-old male discovered to have severe endocarditis after presenting to the emergency department with the chief complaint of foot pain.

Pain Perception in Latino vs. Caucasian and Male vs. Female Patients: Is There Really a Difference?

Introduction: Pain is a common emergency department (ED) complaint. It is important to understand the differences in pain perception among different ethnic and demographic populations.

Methods: We applied a standardized painful stimulus to Caucasian and Latino adult patients to determine whether the level of pain reported differed depending on ethnicity (N=100; 50 Caucasian [C], 50 Latino [L] patients) and gender (N=100; 59 female, 41 male).

The infected heart: ventriculoseptal abscess and intracardiac fistulization.

Infective endocarditis is a rare but potentially deadly infection of the endocardial layer, which can involve the valves of the heart among other structures. The extraordinarily rare complication seen in this case involves extensive damage manifesting in an aortic root abscess resulting in an abnormal communication between the aorta and the atrium known as an aortocavitary fistula (Eur Heart J 2005;26:288-297; Pediatr Cardiol 2011;32:1057-1059; J Am Coll Cardiol 1991;18:663-667). As the disease progresses, wading through the complex symptoms, which may seem unrelated, represents a key challenge in diagnosis.