Rabies post-exposure prophylaxis in the emergency department.

Study Objectives: Rabies is a zoonotic single-stranded RNA lyssavirus that can cause acute infections of the central nervous system (CNS) including encephalomyelitis, encephalitis, and meningoencephalitis that is progressively fatal. Rabies is more common in developing countries, but approximately 23,000 people in the United States (US) are estimated to have been exposed or to have received post exposure prophylaxis (PEP) yearly. Nebraska Medicine follows the Advisory Committee on Immunization Practices (ACIP) guidelines for the vaccination series, as well as the 20 units/kg administration of immunoglobulin (RIG).

Incidence of unknown COVID-19 infection in a cohort of emergency physicians and advance practice providers.

Introduction: In United States, health care workers have been immersed in the COVID-19 pandemic since February 2020. Since availability of COVID-19 vaccines, there is limited literature investigating the incidence of unknown COVID-19 infections in physicians and Advanced Practitioner Providers (APPs) working in emergency departments (EDs). The primary objective is to determine the incidence unknown COVID-19 infection within a cohort of emergency physicians (EPs) and APPs.

Pandemic driven innovation: A pilot evaluation of an alternative respiratory pathogen collection device.

Background: The nasopharyngeal swab is the gold standard collection method for COVID-19, but is invasive and painful, subsequently resulting in poor patient acceptance. This investigation explores the process of developing and validating an alternative respiratory pathogen collection device that relies on a nasopharyngeal irrigation mechanic. The primary objective was to determine if sufficient pathological sampling can be achieved by mechanism of nasopharyngeal irrigation that is proportionate to the nasopharyngeal swab method.

Accuracy and Acceptance of a Self-Collection Model for Respiratory Tract Infection Diagnostics: A Concise Clinical Literature Review.

Background: Nurses are the primary clinicians who collect specimens for respiratory tract infection testing. The specimen collection procedure is time and resource-consuming, but more importantly, it places nurses at risk for potential infection. The practice of allowing patients to self-collect their diagnostic specimens may provide an alternative testing model for the current COVID-19 outbreaks.

Implementation of a COVID-19 cohort area resulted in no surface or air contamination in surrounding areas in one academic emergency department.

Introduction: As a result of the COVID-19 pandemic and highly contagious nature of SARS-CoV-2, emergency departments (EDs) have been forced to implement new measures and protocols to minimize the spread of the disease within their departments. The primary objective of this study was to determine if the implementation of a designated COVID-19 cohort area (hot zone) within a busy ED mitigated the dissemination of SARS-CoV-2 throughout the rest of the department.

Methods: In an ED of a tertiary academic medical center, with 64,000 annual visits, an eight room pod was designated for known COVID-19 or individuals with high suspicion for infection.

A description of teaching methods using an on-site instructor versus a distant site instructor to train laryngoscopy to medical students in Hanoi, Vietnam, from Omaha, Nebraska, by video communication.

This study demonstrated a method to train medical students at Hanoi Medical School in airway management from Omaha, Nebraska, using tele-mentoring techniques. Correct placement of the endotracheal tube was documented by tele-broncoscopy following intubation. This technology may increase medical training capabilities in remote or developing areas of the world.

Emergency Department Processes for the Evaluation and Management of Persons Under Investigation for Ebola Virus Disease.

Introduction: Due to the recent Ebola virus outbreak in West Africa, patients with epidemiologic risk for Ebola virus disease and symptoms consistent with Ebola virus disease are presenting to emergency departments (EDs) and clinics in the United States. These individuals, identified as a person under investigation for Ebola virus disease, are initially screened using a molecular assay for Ebola virus. If this initial test is negative and the person under investigation has been symptomatic for < 3 days, a repeat test is required after 3 days of symptoms to verify the negative result.

Assessment of a human cadaver model for training emergency medicine residents in the ultrasound diagnosis of pneumothorax.

Objectives: To assess a human cadaver model for training emergency medicine residents in the ultrasound diagnosis of pneumothorax.

Methods: Single-blinded observational study using a human cadaveric model at an academic medical center. Three lightly embalmed cadavers were used to create three "normal lungs" and three lungs modeling a "pneumothorax.

Comparison of cosyntropin versus caffeine for post-dural puncture headaches: A randomized double-blind trial.

Background: Cosyntropin has been reported to be effective in the treatment of post-dural puncture headaches, but there is a lack of data on its effectiveness. We compared the efficacy of cosyntropin with that of caffeine in the treatment of post-dural puncture headaches.

Methods: We performed an interim analysis of a prospective, double blinded, trial of adult patients presenting to the emergency department with a post-dural puncture headache.

Evaluation of an infrared thermal detection system for fever recognition during the H1N1 influenza pandemic.

Infrared thermal detection systems (ITDSs) have been utilized in several countries to screen for fever in travelers. Since fever screening with an ITDS is rapid and noninvasive, this technology may be useful as an infection control measure in clinical settings during a pandemic.

Assessment of a new model for femoral ultrasound-guided central venous access procedural training: a pilot study.

Objectives: Repetitive practice with feedback in residency training is essential in the development of procedural competency. Lightly embalmed cadaver laboratories provide excellent simulation models for a variety of procedures, but to the best of our knowledge, none describe a central venous access model that includes the key psychomotor feedback elements for the procedure, namely intravascular contents that allow for determination of correct needle position by either ultrasonographic imaging and/or aspiration or vascular contents.

Methods: A cadaver was lightly embalmed using a technique that preserves tissue texture and elasticity.

Painful dilemmas: an evidence-based look at challenging clinical scenarios.

Difficult clinical decisions are a part of every emergency practitioner's life. Dealing with difficult patients and recalcitrant consultants is seldom enjoyable, but can be made more palatable through the use of some of the clinical strategies contained in this article. Knowledge of the current best evidence and a willingness to discard outdated practice ideas will help ensure that emergency practitioners continue to provide state-of-the-art medical care.

Hemotympanums secondary to spontaneous epistaxis in a 7-year-old.

Hemotympanum is a well-known physical finding most often associated with basilar skull fractures and therapeutic nasal packing. A literature review demonstrated only five cases of hemotympanum associated with spontaneous epistaxis in adults. To our knowledge, there have been no reported cases in children.

Gynecologic infections.

The scope of gynecologic infections presenting to the emergency department is quite diverse. This article presents an update on the current literature for vaginitis, cervicitis, pelvic inflammatory disease, tubo-ovarian abscesses, the Fitz-Hugh-Curtis syndrome, herpes, and syphilis. Inadequate identification or treatment of these diseases can result is significant morbidity or mortality for the patient and for the fetus.