Dissolved gases from pressure changes in the lungs elicit an immune response in human peripheral blood.

Conventional dogma suggests that decompression sickness (DCS) is caused by nitrogen bubble nucleation in the blood vessels and/or tissues; however, the abundance of bubbles does not correlate with DCS severity. Since immune cells respond to chemical and environmental cues, we hypothesized that the elevated partial pressures of dissolved gases drive aberrant immune cell phenotypes in the alveolar vasculature. To test this hypothesis, we measured immune responses within human lung-on-a-chip devices established with primary alveolar cells and microvascular cells.

Emergency physicians perspectives of state continuing medical education requirements for medical licensure.

Objectives: This study aims to better understand the perspectives of emergency medicine physicians' on the role that state-mandated, topic-specific continuing medical education (CME) plays in addressing knowledge gaps, its relevance to current emergency practice, its reported burden and costs of CME activities to emergency physicians, and its perceived improvement in patient care.

Methods: A cross-sectional survey was designed by the Coalition of Board-Certified Emergency Physicians (COBCEP) and distributed in February 2023 to all American Board of Emergency Medicine (ABEM)-certified physicians. Statistical tests of significance (Pearson's chi-square and Fisher's exact test) assessed the cost and time spent on CME as well as the perceived value placed on CME by ABEM-certified physicians to improve patient care.

The Impact of the Critical Care Resuscitation Unit on Quaternary Care Accessibility for Rural Patients: A Comparative Analysis.

Background: Previous research suggests that patients from rural areas who are critically ill with complex medical needs or require time-sensitive subspecialty interventions face worse healthcare outcomes and delays in care when compared to those from urban areas. The critical care resuscitation unit (CCRU) at our quaternary care center was established to expedite the transfer of critically ill patients or those who need time-sensitive intervention. This study investigates if disparities exist in treatments and outcomes among patients transferred to the CCRU from rural versus urban hospitals.

Association between measures of resuscitation in the critical care resuscitation unit and in-hospital mortality among patients with sepsis.

Objectives: We hypothesized that lactate clearance and reduction of the Sequential Organ Failure Assessment (SOFA) score during patients' critical care resuscitation unit (CCRU) stay would be associated with lower in-hospital mortality.

Methods: This was a retrospective study of adult patients who had sepsis diagnoses and were admitted to the CCRU in 2018. Multivariable logistic regression analysis was performed to assess the association of clinical factors, lactate clearance, and SOFA reduction with hospital mortality.

The National Early Warning Score on admission predicts severe disease and in-hospital mortality of the coronavirus disease 2019 Delta variant: A retrospective cohort study.

Background: Clinical risk scores are widely used in emergency medicine, and some studies have evaluated their use in patients with coronavirus disease 2019 (COVID-19). However, no studies have evaluated their use in patients with the COVID-19 Delta variant. We aimed to study the performance of four different clinical scores (National Early Warning Score [NEWS], quick Sequential Organ Failure Assessment [qSOFA], Confusion, Respiratory rate, Blood pressure, and Age ≥65 [CRB-65], and Kanagawa score) in predicting the risk of severe disease (defined as the need for intubation and in-hospital mortality) in patients with the COVID-19 Delta variant.

Educator's blueprint: A guide for clinician-educators to achieve promotion in emergency medicine.

Promotion and tenure (P&T) can be a complex process, which many junior faculty in academic emergency medicine may struggle navigating. This paper presents perspectives and key considerations to guide faculty through the promotions process. We explore tips through three key phases: plotting the course for a successful academic career, collecting data to support academic advancement, and packaging materials into a compelling application portfolio.

Emergency physician professionalism versus wellness: A conceptual model.

Striking the balance between professional duties, obligations, and responsibility with protecting one's wellness as a physician and as an individual have been brought into sharper focus during COVID-19. The objective of this paper is to describe ethical principles in the balance between emergency physician wellness and professional responsibility to patients and the public. We propose a schematic that helps us as emergency physicians visualize continuously striving to be both well and professional.

Sex trafficking screening and intervention in the emergency department: A scoping review.

Introduction: Human sex trafficking is a global public health crisis. Emergency departments (EDs) are important access points for trafficked persons who seek medical care. However, because of victims' hesitancy to disclose their situation and health care practitioners' lack of training and institutional protocols, many trafficked persons go unrecognized.

Addressing end-of-life care in the chronically ill: Conversations in the emergency department.

Patients present to the emergency department in various stages of chronic illness. Advance directives (ADs) aid emergency physicians in making treatment decisions, but only a minority of Americans have completed an AD, and the percentage of those who have discussed their end-of-life wishes may be even lower. This article addresses the use of common ADs and roadblocks to their use from the perspectives of families, patients, and physicians.

National Awards and Female Emergency Physicians in the United States: Is the "Recognition Gap" Closing?

Background: Gender inequities in recognition, compensation, promotion, and leadership roles exist in emergency medicine. Formal recognition in the workplace and opportunities for advancement are vulnerable to bias.

Objective: To examine the gender distribution of national awards in emergency medicine, to analyze whether there is a gap, and to highlight notable trends.

Chest imaging of hypersensitivity pneumonitis induced by heroin abuse.

Long-term abuse of nasally inhaled substances such as heroin can result in life-threatening hypersensitivity pneumonitis and respiratory distress. In the setting of hypoxia, a chest CTA is often necessary to see the extent of the lung involvement and to rule out pulmonary emboli.

Beginning a new medical school curriculum amidst a global pandemic.

The University of Maryland School of Medicine embarked on our first major curriculum revision since 1994 with a plan to implement this Renaissance Curriculum in August 2020. However, in the Spring of 2020, the coronavirus disease (COVID-19) pandemic disrupted clinical care and medical education on a large scale requiring expeditious modifications to our Renaissance Curriculum as well as our traditional Legacy Curriculum in order to meet our goal of educating the next-generation of physicians. The rippling effects of the COVID-19 pandemic led to major changes in the delivery of the pre-clerkship curriculum, the way we assessed and evaluated students, entry into the clinical environment, length of clinical rotations, and orientation for our new medical students.

Boarding of critically Ill patients in the emergency department.

Objectives: Emergency department boarding is the practice of caring for admitted patients in the emergency department after hospital admission, and boarding has been a growing problem in the United States. Boarding of the critically ill has achieved specific attention because of its association with poor clinical outcomes. Accordingly, the Society of Critical Care Medicine and the American College of Emergency Physicians convened a Task Force to understand the implications of emergency department boarding of the critically ill.

Two pulmonary emboli in a psych pod.

Background: A female patient known to have schizoaffective disorder self-presented to an emergency department in a state of acute agitation and paranoia shortly after a 35-day inpatient stay at a psychiatric facility.

Case Report: The patient exhibited no signs or complaints of dyspnea or hypoxia, but later collapsed and became hypoxic after sleeping comfortably with sedation for 12 h in the psychiatric unit. She was intubated and a computed tomography angiogram revealed bilateral lobar pulmonary emboli and right heart strain.

A smartphone, a slit lamp, and an ophthalmology consult.

Clinicians should always consider capturing images with their phone when possible so that key clinical findings seen in the real-time physical examination can be memorialized in the electronic medical record.

The Standardized Video Interview: How Does It Affect the Likelihood to Invite for a Residency Interview?

Background: The Association of American Medical Colleges instituted a standardized video interview (SVI) for all applicants to emergency medicine (EM). It is unclear how the SVI affects a faculty reviewer's decision on likelihood to invite an applicant (LTI) for an interview.

Objectives: The objective was to determine whether the SVI affects the LTI.