Impact of Bedside Ultrasound on Emergency Department Length of Stay and Admission in Patients With a Suspected Peritonsillar Abscess.

Introduction Patients presenting to the Emergency Department (ED) with a suspected peritonsillar abscess (PTA) often pose a diagnostic dilemma, as clinical impression is often unreliable and traditional diagnostic methods have multiple downsides. Bedside ultrasonography has been cited as a modality to improve the diagnosis and management of PTA. We aimed to determine the impact bedside ultrasound (US) could have in suspected PTA on ED length of stay (LOS) and hospital admission rates.

More Accessible COVID-19 Treatment Through Monoclonal Antibody Infusion in the Emergency Department.

Introduction: Monoclonal antibody (MAB) infusion is the first treatment to manage coronavirus 2019 (COVID-19) in an outpatient setting. Yet increased risk of severe COVID-19 illness may occur from inequities in social determinants of health including access to quality healthcare. Given the safety-net nature of emergency departments (ED), a model that puts them at the center of MAB infusion may better reach underserved patients than models that require physician referral and distribute MAB at outpatient infusion centers.

Profiling single-cell level phagocytic activity distribution with blood lactate levels.

The ability to kill infecting microbes is an essential facet of our immune response to an infection. However, phagocytic ability is often overlooked as a part of immunological profile in infected patients' diagnosis, as the understanding of phagocytic capabilities in disease states is incomplete. In this work, we have evaluated for the first time the relationship between blood lactate level and the neutrophil phagocytic activity at a single-cell level.

Antibiotic Selection for Suspected Neisseria gonorrhoeae Infection Among Penicillin-Allergic Patients in the Emergency Department.

Objectives While penicillin allergies are commonly reported, their cross-reactivity with beta-lactam antibiotics is minimal. First-line treatment of gonorrheal infections includes a cephalosporin. In emergency department (ED) environments, physicians must consider these potential allergies when selecting antibiotics for a patient with symptoms concerning for sexually transmitted infection (STI).

Characterization of predictors of ESBL-producing enterobacteriaceae in urine cultures of emergency department patients.

Study Objective: With increasing prevalence of extended-spectrum beta-lactamase-producing enterobacteriaceae (ESBLE), more reliable identification of predictors for ESBLE urinary tract infection (UTI) in the emergency department (ED) is needed. Our objective was to evaluate risk factors and their predictive ability for ED patients with ESBLE UTI.

Methods: This was a retrospective case-control study at an urban academic medical center.

Nontrivial amplification below the threshold for excitable cell signaling.

In many asymptotically stable fluid systems, arbitrarily small fluctuations can grow by orders of magnitude before eventually decaying, dramatically enhancing the fluctuation variance beyond the minimum predicted by linear stability theory. Here using influential quantitative models drawn from the mathematical biology literature, we establish that dramatic amplification of arbitrarily small fluctuations is found in excitable cell signaling systems as well. Our analysis highlights how positive and negative feedback, proximity to bifurcations, and strong separation of timescales can generate nontrivial fluctuations without nudging these systems across their excitation thresholds.

Feasibility of Health Literacy Tools for Older Patients in the Emergency Department.

Introduction: This study evaluates the feasibility of using a volunteer research associate (RA) to administer two separate health literacy assessment tools in the emergency department (ED), specifically in an older population of patients. The outcomes measured were administration time and interruptions.

Methods: Using a prospective, cross-sectional study with a convenience sample, adult patients over the age of 55 presenting between June-August 2018 to one urban, academic ED were evaluated by a volunteer RA using either the Newest Vital Sign (NVS) or the Short Assessment of Health Literacy (SAHL).

Self-reported modifying effects of resilience factors on perceptions of workload, patient outcomes, and burnout in physician-attendees of an international emergency medicine conference.

Emergency medicine has one of the highest rates of burnout of all medical specialties. Recent research has identified putative sources of burnout in emergency medicine, including stress of overnight shifts, psychological demands of handling emergency patients, and perceived poor departmental support systems. This burnout is detrimental to the quality of patient care, and thus represents an important target to simultaneously improve both physician wellness and patient outcomes.

Impact of physician workload on burnout in the emergency department.

Emergency medicine is one of the medical fields with the highest rates of physician burnout. Research demonstrates hospitalists believe increasing workloads contribute to decreases in patient safety and satisfaction, and increases in morbidity and mortality. Our objective was to identify if emergency physicians who believe workload impacts patient care also experience worse rates of burnout symptoms.

EMS providers do not use FOAM for education.

Background: Free open access to medical education (FOAM, #FOAM) is the free availability of educational materials on various medicine topics. We hope to evaluate the use of social media and FOAM by emergency medical services (EMS) providers.

Methods: We designed an online survey distributed to EMS providers with questions about demographics and social media/FOAM use by providers.

Procedure rates performed by emergency medicine residents: a retrospective review.

Background: The purpose of our study is to investigate rates of individual procedures performed by residents in our emergency medicine (EM) residency program. Different programs expose residents to different training environments. Our hypothesis is that ultrasound examinations are the most commonly performed procedure in our residency.

Recognizing thyrotoxic hypokalemic periodic paralysis.

Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare but potentially serious complication of thyrotoxicosis. The resulting muscle weakness is profound, associated with more severe hypokalemia, yet reversible. However, clinicians must be cautious because patients can develop life-threatening hyperkalemia during treatment.

EMS Dispatches during Hurricanes Irene and Sandy in New Jersey.

Background: Hurricanes Irene and Sandy heavily impacted New Jersey. Investigating EMS dispatch trends during these storms may allow us to prepare for future disasters.

Objectives: Our objectives to characterize the types of EMS dispatches immediately before, during, and after landfall compared to a control period.

Transient amplification limits noise suppression in biochemical networks.

Cell physiology is orchestrated, on a molecular level, through complex networks of biochemical reactions. The propagation of random fluctuations through these networks can significantly impact cell behavior, raising challenging questions about how network design shapes the cell's ability to suppress or exploit these fluctuations. Here, drawing on insights from statistical physics, fluid dynamics, and systems biology, we explore how transient amplification phenomena arising from network connectivity naturally limit a biochemical system's ability to suppress small fluctuations around steady-state behaviors.

How Does Emergency Department Crowding Affect Medical Student Test Scores and Clerkship Evaluations?

Introduction: The effect of emergency department (ED) crowding has been recognized as a concern for more than 20 years; its effect on productivity, medical errors, and patient satisfaction has been studied extensively. Little research has reviewed the effect of ED crowding on medical education. Prior studies that have considered this effect have shown no correlation between ED crowding and resident perception of quality of medical education.

Hand Washing Practices Among Emergency Medical Services Providers.

Introduction: Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS) workers, respectively.

Methods: We designed a survey about hand hygiene practices.

Reduced Hospital Duration of Stay Associated with Revised Emergency Department-Intensive Care Unit Admission Policy: A before and after Study.

Background: Emergency department (ED) and hospital crowding adversely impacts patient care. Although reduction methods for duration of stay in the ED have been explored, few focus on medical intensive care unit (MICU) patients.

Objective: To quantify duration of stay or mortality changes associated with a policy intervention that changed the role of an MICU resident to "screen" and write MICU admission orders in the ED to instead meet the patient and write orders in the MICU if there was an available bed.

Use of an Intravascular Heat Exchange Catheter and Intravenous Lipid Emulsion for Hypothermic Cardiac Arrest After Cyclobenzaprine Overdose.

In this case report, a 22-year-old male developed severe hypothermia after an accidental overdose of cyclobenzaprine. During transport, the patient developed cardiac arrest. He received active rewarming measures, including pleural lavage, gastric lavage, an intravascular heat exchange catheter, and cardiopulmonary bypass.

Diagnosis and Treatment of Acute Gout at a University Hospital Emergency Department.

Background: Acute gout attacks account for a substantial number of visits to the emergency department (ED). Our aim was to evaluate acute gout diagnosis and treatment at a University Hospital ED.

Methods: Our study was a retrospective chart review of consecutive patients with a diagnosis of acute gout seen in the ED 1/01/2004 - 12/31/2010.

A multi-axis confocal rheoscope for studying shear flow of structured fluids.

We present a new design for a confocal rheoscope that enables uniform uniaxial or biaxial shear. The design consists of two precisely positioned parallel plates with a gap that can be adjusted down to 2 ±0.1 μm, allowing for the exploration of confinement effects.