Impact and feasibility of an emergency department-based ventilator-associated pneumonia bundle for patients intubated in an academic emergency department.

Background: Ventilator-associated pneumonia (VAP) has been linked to emergency department (ED) intubation and length of stay (LOS). We assessed VAP prevalence in ED intubated patients, feasibility of ED VAP prevention, and effect on VAP rates.

Methods: This was a quality improvement initiative using a pre/post design.

Physician documentation of sepsis syndrome is associated with more aggressive treatment.

Introduction: Timely recognition and treatment of sepsis improves survival. The objective is to examine the association between recognition of sepsis and timeliness of treatments.

Methods: We identified a retrospective cohort of emergency department (ED) patients with positive blood cultures from May 2007 to January 2009, and reviewed vital signs, imaging, laboratory data, and physician/nursing charts.

An innovative longitudinal curriculum to increase emergency medicine residents' exposure to rarely encountered and technically challenging procedures.

Background: Procedural skills have historically been taught at the bedside. In this study, we aimed to increase resident knowledge of uncommon emergency medical procedures to increase residents' procedural skills in common and uncommon emergency medical procedures and to integrate cognitive training with hands-on procedural instruction using high- and low-fidelity simulation.

Methods: We developed 13 anatomically/physiologically-based procedure modules focusing on uncommon clinical procedures and/or those requiring higher levels of technical skills.

The distribution of the h-index among academic emergency physicians in the United States.

Background: Hirsch's h-index (h) attempts to measure the combined academic impact and productivity of a scientist by counting the number of publications by an author, ranked in descending order by number of citations, until the paper number equals the number of citations. This approach provides a natural number or index of the number of publications and the number of citations per publication. H was first described in physics and was demonstrated to be highly predictive of continued academic activity, including recognized measures of scientific excellence such as membership in the National Academy of Sciences and being a Nobel laureate.

Alternative methods to central venous pressure for assessing volume status in critically ill patients.

Introduction: Early goal-directed therapy increases survival in persons with sepsis but requires placement of a central line. We evaluate alternative methods to measuring central venous pressure (CVP) to assess volume status, including peripheral venous pressure (PVP) and stroke volume variation (SVV), which may facilitate nurse-driven resuscitation protocols.

Methods: Patients were enrolled in the emergency department or ICU of an academic medical center.

Course of untreated high blood pressure in the emergency department.

Introduction: No clear understanding exists about the course of a patient's blood pressure (BP) during an emergency department (ED) visit. Prior investigations have demonstrated that BP can be reduced by removing patients from treatment areas or by placing patients supine and observing them for several hours. However, modern EDs are chaotic and noisy places where patients and their families wait for long periods in an unfamiliar environment.

Retinal oximeter for the blue-green oximetry technique.

Retinal oximetry offers potential for noninvasive assessment of central venous oxyhemoglobin saturation (SO(2)) via the retinal vessels but requires a calibrated accuracy of ±3% saturation in order to be clinically useful. Prior oximeter designs have been hampered by poor saturation calibration accuracy. We demonstrate that the blue-green oximetry (BGO) technique can provide accuracy within ±3% in swine when multiply scattered light from blood within a retinal vessel is isolated.

Agreement between emergency medical services and expert blood pressure measurements.

Background: Emergency Medical Services (EMS)-measured blood pressures (BPs) are utilized for administering medications in the field and for triage decisions. Retrospective work has demonstrated poor agreement between EMS and Emergency Department (ED) BP but has lacked a valid, reliable reference standard.

Study Objectives: To compare EMS BP measurements with those of trained research assistants (RA) and observe measurement technique for sources of error.

Analysis of automated external defibrillator device failures reported to the Food and Drug Administration.

Study Objective: Automated external defibrillators are essential for treatment of cardiac arrest by lay rescuers and must determine when to shock and if they are functioning correctly. We seek to characterize automated external defibrillator failures reported to the Food and Drug Administration (FDA) and whether battery failures are properly detected by automated external defibrillators.

Methods: FDA adverse event reports are catalogued in the Manufacturer and User Device Experience (MAUDE) database.

Sepsis bundles and compliance with clinical guidelines.

Realizing the vast medical benefits of validated protocols, recommendations and practice guidelines requires acceptance and implementation by frontline care providers. Knowledge translation is the science of accelerating the transfer of knowledge to practice by understanding and creatively addressing the barriers that prevent adoption of new professional standards. In an attempt to improve patient care and reduce mortality, the Surviving Sepsis Campaign and The Institute for Healthcare Improvement created the resuscitation and management bundles for patients with severe sepsis and septic shock.

United States-Mexico border crossing: experiences and risk perceptions of undocumented male immigrants.

Undocumented immigrants crossing the US-Mexico border face many hazards as they attempt to enter the United States, including heat and cold injury, dehydration, and wild animal encounters. In the Tucson sector of the US-Mexico border, there are over 100 deaths a year from heat-related injuries alone. Public awareness campaigns have been undertaken to disseminate information on the dangers inherent in crossing.

Description and evaluation of a canine volunteer blood donor program.

Human volunteer blood donor programs are commonplace, but the concept of nonhuman animal blood banking is relatively new. Few studies exist regarding efficacy, donor screening, and safety for volunteer companion animals. This retrospective study evaluated a nonprofit, community-based canine volunteer donor program using community blood drives.

The validity of emergency department triage blood pressure measurements.

Objective: Automated blood pressure (ABP) devices are ubiquitous at emergency department (ED) triage. Previous studies failed to evaluate ABP devices against accepted reference standards or demonstrate triage readings as accurate reflections of blood pressure (BP). This study evaluated ED triage measurements made using an ABP device and assessed agreement between triage BP and BP taken under recommended conditions.