1790: WARFARIN TRAUMA PATIENTS: COMPARING PROTHROMBIN COMPLEX CONCENTRATE TO VITAMIN K/FRESH FROZEN PLASMA.
WARFARIN; VITAMIN K; GLASGOW Coma Scale; INTERNATIONAL normalized ratio; PROTHROMBIN
B Learning Objectives: b There is scant data comparing Prothrombin Complex Concentrate (PCC) to Vitamin K/Fresh Frozen Plasma (FFP) in trauma patients. Patients that received PCC (PCC group) were compared to those who received Vitamin K/FFP (FFP group). [Extracted from the article]
Huang Gregory; Hileman Barbara; Chance Elisha; Gianetti Emily; Steiner Dena; Marchand Tiffany
Critical Care Medicine
2019
2019-01-02
Journal Article
<a href="http://doi.org/10.1097/01.ccm.0000552528.13105.55" target="_blank" rel="noreferrer noopener">10.1097/01.ccm.0000552528.13105.55</a>
American Board of Emergency Medicine Report on Residency and Fellowship Training Information (2018-2019)
medical education
The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine-sponsored residency and fellowship programs, residents and fellows training in those programs, and all fellows for whom ABEM issues subspecialty certifications. We present the 2019 annual report on the status of US emergency medicine training programs.
Nelson LS, Keim SM, <span style="text-decoration:underline;"><strong>Beeson MS</strong></span>, Chudnofsky CR, Gausche-Hill M, Gorgas DL, Goyal DG, Kowalenko T, Muelleman RL; Research Committee, American Board of Emergency Medicine, Joldersma KB, Johnston MM
Annals of Emergency Medicine
2019
https://orcid.org/0000-0001-9897-1275<a href="https://orcid.org/0000-0001-9897-1275" target="_blank" rel="noreferrer noopener">https://orcid.org/0000-0001-9897-1275</a>
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
10.1016/j.annemergmed.2019.03.024
Emergency Medicine Student End-of-Rotation Examinations: Where Are We Now?
medical education
Miller ES; Heitz C; Ross LP; <span style="text-decoration:underline;"><strong>Beeson MS</strong></span>
Western Journal of Emergency Medicine
2018
<a href="https://orcid.org/0000-0001-9897-1275">https://orcid.org/0000-0001-9897-1275</a>
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Journal Article
10.5811/westjem.2017.10.35144
Frequency of Abnormal and Critical Lab Results in Older Patients Presenting to the Emergency Department with Syncope
Syncope is a common and costly chief complaint among patients presenting to the emergency department (ED), accounting for 740,000 ED visits annually with an estimated annual cost of $2.4 billion per year in the United States.1,2 Syncope presents a diagnostic dilemma for clinicians in the ED since differentiating serious and benign causes of syncope can be challenging, particularly in the older adult. Routine laboratory testing with complete blood count (CBC) and basic metabolic panel (BMP) is commonly ordered for patients presenting to the ED with syncope.
Moore Andrew B; Su Erica; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
2019
2019-12-14
Journal Article
<a href="http://doi.org/10.1111/acem.13906" target="_blank" rel="noreferrer noopener">10.1111/acem.13906</a>
PMID: 31837233
Integrating Markov Model, Bivariate Gaussian Distribution and GPU Based Parallelization for Accurate Real-Time Diagnosis of Arrhythmia Subclasses
In this paper, we present the integration of SIMT (Single Instruction Multiple Threads), Markov model and bivariate Gaussian distribution as a general-purpose technique for real-time accurate diagnosis of subclasses of arrhythmia. The model improves the accuracy by integrating both morphological and temporal features of ECG. GPU based implementation exploits concurrent execution of multiple threads at the heart-beat level to improve the execution efficiency. The approach builds a bivariate Gaussian Markov model (BGMM) for each subclass of arrhythmia where each state includes bivariate distribution of temporal and morphological features of each waveform and ISO-lines using ECG records for each subclass from standard databases, and the edge-weights represent the transition probabilities between states. Limited 30-second subsequences of a patient's beats are used to develop bivariate Gaussian transition graphs (BGTG). BGTGs are matched with each of the BGMMs to derive the exact classification of BGTGs. Our approach exploits data-parallelism at the beat level for ECG preprocessing, building BGTGs and matching multiple BGTG-BGMM pairs. SIMT (Single Instruction Multiple Thread) available on CUDA resources in GPU has been utilized to exploit data-parallelism. Algorithms have been presented. The system has been implemented on a machine with NVIDIA CUDA based GPU. Test results on standard MIT- BIH database show that GPU based SIMT improves execution time further by 78% with an overall speedup of 4.5 while retaining the accuracy achieved by the sequential execution of the approach around 98%.
Gawde Purva R; Bansal Arvind K; Nielson Jeffery A
Proceedings of the Future Technologies Conference (ftc) 2018, Vol 1
2019
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Book Section
<a href="http://doi.org/10.1007/978-3-030-02686-8_43" target="_blank" rel="noreferrer noopener">10.1007/978-3-030-02686-8_43</a>
Integration of Entrustable Professional Activities with the Milestones for Emergency Medicine Residents
medical education
Abstract
INTRODUCTION:
Medical education is moving toward a competency-based framework with a focus on assessment using the Accreditation Council for Graduate Medical Education Milestones. Assessment of individual competencies through milestones can be challenging. While competencies describe characteristics of the person, the entrustable professional activities (EPAs) concept refers to work-related activities. EPAs would not replace the milestones but would be linked to them, integrating these frameworks. Many core specialties have already defined EPAs for resident trainees, but EPAs have not yet been created for emergency medicine (EM). This paper describes the development of milestone-linked EPAs for EM.
METHODS:
Ten EM educators from across North America formed a consensus working group to draft EM EPAs, using a modified Glaser state-of-the-art approach. A reactor panel with EPA experts from the United States, Canada and the Netherlands was created, and an iterative process with multiple revisions was performed based on reactor panel input. Following this, the EPAs were sent to the Council of Residency Directors for EM (CORD-EM) listserv for additional feedback.
RESULTS:
The product was 11 core EPAs that every trainee from every EM program should be able to perform independently by the time of graduation. Each EPA has associated knowledge, skills, attitudes and behaviors (KSAB), which are either milestones themselves or KSABs linked to individual milestones. We recognize that individual programs may have additional focus areas or work-based activities they want their trainees to achieve by graduation; therefore, programs are also encouraged to create additional program-specific EPAs.
CONCLUSION:
This set of 11 core, EM-resident EPAs can be used as an assessment tool by EM residency programs, allowing supervising physicians to document the multiple entrustment decisions they are already making during clinical shifts with trainees. The KSAB list within each EPA could assist supervisors in giving specific, actionable feedback to trainees and allow trainees to use this list as an assessment-for-learning tool. Linking each KSAB to individual EM milestones allows EPAs to directly inform milestone assessment for clinical competency committees. These EPAs serve as another option for workplace-based assessment, and are linked to the milestones to create an integrated framework.
Hart D, Franzen D, <span style="text-decoration:underline;"><strong>Beeson M</strong></span>, Bhat R, Kulkarni M, Thibodeau L, Weizberg M, Promes S
Western Journal of Emergency Medicine
2019
<a href="https://orcid.org/0000-0001-9897-1275">https://orcid.org/0000-0001-9897-1275</a>
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s)
Journal Article
<a href="https://doi.org/10.5811/westjem.2018.11.38912" target="_blank" rel="noreferrer noopener">10.5811/westjem.2018.11.38912</a>
The Benefit of Influenza Vaccines Beyond Prevention of Clinical Infection
clinical infection; influenza; vaccine
File Thomas M Jr
INFECTIOUS DISEASES IN CLINICAL PRACTICE
2019
2019-11
Journal Article
<a href="http://doi.org/10.1097/IPC.0000000000000804" target="_blank" rel="noreferrer noopener">10.1097/IPC.0000000000000804</a>
Throws of Death: Traumatic Coronary Artery Dissection Resulting From Jiu Jitsu Training
cardiac arrest; coronary dissection; myocardial infarction; myocardial injury; sports medicine; trauma
BACKGROUND: The risk of cardiac injury in blunt thoracic trauma is quite rare, occurring in only 0.1% of patients. The least common cardiac injury is coronary artery dissection. Most cardiac injuries result from high-energy mechanisms such as motor vehicle collisions. Even low-mechanism injuries that have been reported involved rapid deceleration. CASE REPORT: We present a case of traumatic coronary artery dissection that resulted from a low-energy blunt thoracic injury with no rapid deceleration. This patient had no other associated thoracic injuries, such as rib fractures or sternal fracture. Following presentation, our patient twice deteriorated into ventricular fibrillation and was successfully resuscitated each time. The coronary lesion was successfully stented and the patient was eventually discharged home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case underscores the importance of maintaining a high level of suspicion for coronary artery dissection even in low-energy mechanisms. An electrocardiogram should be obtained early, even in low-energy mechanisms. While patients with traumatic cardiac injuries will commonly present with other injuries, such as rib fractures, the absence of these injuries does not rule out cardiac injury.
Haywood Steven T; Patel Kush; Gallo Douglas; Silver Kevin; Jouriles Nicolas
The Journal of Emergency Medicine
2019
2019-11-16
Journal Article
<a href="http://doi.org/10.1016/j.jemermed.2019.09.037" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2019.09.037</a>
PMID: 31744712
Timeliness of Care for Injured Patients Initially Seen at Freestanding Emergency Departments: A Pilot Quality Improvement Project.
centers; delay; freestanding emergency department; golden hour; impact; injured patients; interfacility transfer; level I trauma center; mortality; Trauma; trauma patients; urgent care
BACKGROUND: The impact of freestanding emergency departments (FSEDs) on timeliness of care for trauma patients is not well understood. This quality improvement project had 2 objectives: (1) to determine whether significant delays in definitive care existed among trauma patients initially seen at FSEDs compared with those initially seen at other outlying sites prior to transfer to a level I trauma center; and (2) to determine the feasibility of identifying differences in time-to-definitive care and emergency department length of stay (ED LOS) based on initial treatment location. METHODS: Trauma registry data from January 1, 2017, through December 31, 2017, from a verified level I trauma center were analyzed by location of initial presentation. Appropriate statistical tests are used to make comparisons across transport groups. RESULTS: Patients initially seen at non-FSEDs experienced ED LOS that were, on average, 24.5 minutes greater than patients seen initially at FSEDs, although the difference was not statistically significant (P = .3112). Several challenges were identified in the feasibility analysis that will inform the design for a larger study including large quantities of missing time stamp data and potential selection bias. Prospective solutions were identified. CONCLUSION: This project found that there were not significant differences in ED LOS for injured patients presenting initially to FSEDs or other non-FSED facilities, suggesting that timeliness of care was similar across location types.
Birmingham Lauren E; Richner Gwendolyn; Moran Mary; Hatridge Kindra M; George Richard L
Quality management in health care
2020
2020-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1097/QMH.0000000000000252" target="_blank" rel="noreferrer noopener">10.1097/QMH.0000000000000252</a>