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Prehospital Use of Ketamine in the Pediatric Population

Ashima Goyal, Revelle Gappy, Remle Crowe, John Frawley, Nai-Wei Chen, and Robert Swor

Publication Date: 1-2022
The Current State of Diagnostic Error Education in U.S. Medical Schools

Dakota Hall, Sandra LaBlance, and Brett Todd

Publication Date: 5-2-2022

Diagnostic error has been identified by the Institute of Medicine as a major cause of patient harm. Despite recent focus on the importance of diagnostic error, little is known about how medical schools are educating future physicians, specifically, the extent to which it is taught. We aimed to investigate the current state of diagnostic error education in U.S. medical schools.
POCUS Refresh- Applying a Modern Pedagogy to Emergency Residency Ultrasound Education

Steven Johnson, Dorothy Christie Lakis, Jessica Kuxhause, and Amit Bahl

Publication Date: 4-28-2022

Objectives

- To investigate the impact of a modern refresh to our emergency point of care ultrasound (POCUS) curriculum on resident end of rotation exam performance and satisfaction, including both flipped classroom and targeted image review using an interactive application.
Pediatric COVID-19 leading to MIS-C

Pradeep Johns, Benjamin Glines, and Adam Vieder

Publication Date: 5-2022

Introduction

• SARS COV-2 infection in pediatric patients can develop into a rare condition known as multisystem inflammatory syndrome in children (MIS-C). In the United States, the incidence of MIS-C is 2 cases per 100,000 pediatric COVID cases.

• MIS-C is defined by the CDC as a Kawasaki Disease (KD) like illness with the following characteristics: - ≤ 21 years old - Fever ≥ 38° Celsius for ≥ 24 hours - Elevated inflammatory markers (ferritin, ESR, CRP, procalcitonin, d-dimer, fibrinogen, etc) - Evidence of multi-organ dysfunction ≥ 2 organ systems - Symptoms must be otherwise unattributable to an alternative diagnosis - Positive Sars-CoV-2 RT PCR, positive antigen test, or COVID exposure within 40 days of symptom onset.

• Data from a tertiary pediatric center in New York from 2020 demonstrated that 28% of all pediatric COVID-19 admissions required ICU level of care.
The Dark Side of Diverticulitis

Pradeep Johns and Eric McDowell

Publication Date: 5-2022

Introduction • Current guidelines, including the American Gastroenterological Association, have recommended outpatient treatment of uncomplicated diverticulitis. • CT scan for uncomplicated diverticulitis may demonstrate bowel wall thickening (70%), pericolic fat stranding (98%) without evidence of abscess, perforation, or fistula formation • Treating uncomplicated diverticulitis with outpatient oral antibiotics needs to be weighed with the patient's comorbidities, the likelihood of follow-up and signs of sepsis
ConstiPatED: Evaluation in the Pediatric ED – Practice Patterns and Trends Amongst Provider Types

Dharshana Krishnaprasadh, Margaret Samberg, Lara Fawaz, Sara Grant, and Margaret Menoch

Publication Date: 4-28-2022

Objectives

-The aim of this study is to describe practice trends by provider type: Pediatric Emergency Medicine (PEM) physicians, Emergency Medicine (EM) physicians, advanced practice providers (APP) and resident/fellows for evaluation and treatment of pediatric constipation.
Broad Strokes, Dissections in Young Folks: A Case Study

Jessica Kuxhause and Margaret Menoch

Publication Date: 4-28-2022

Objectives

- Describe incidence of CCADs causing pediatric strokes

- Classify the presenting histories, signs, and symptoms of patients with CCADs

- Identify factors delaying diagnosis of CCADs
The Impact of medical scribes on emergency physician diagnostic testing and diagnosis charting

Lucas Nelson and Brett R. Todd

Publication Date: 5-2-2022

INTRODUCTION
Since the widespread adoption of electronic medical records (EMRs), medical scribes have been increasingly utilized in emergency department (ED) settings to offload the documentation burden of emergency physicians (EPs). Scribes have been shown to increase EP productivity and satisfaction; however, little is known about their effects on the EP’s diagnostic process. We aimed to assess what effect, if any, scribes have on EP diagnostic test ordering and their documentation of differential diagnoses.
Imaging for suspected pediatric appendicitis: Can ultrasound alone be trusted?

Ryan Nierstedt, Nafisa Bhuiyan, Michelle Jankowski, Lauren DeSantis, Aveh Bastani, and Shanna Jones

Publication Date: 5-2-2022

INTRODUCTION
Diagnosis of pediatric appendicitis relies on a combination of laboratory results, diagnostic imaging, and clinician judgement. However, the necessity of CT imaging has been questioned given radiation exposure. Therefore, ultrasound imaging has become a useful diagnostic tool, yet its sensitivity in identifying appendicitis is often lower in comparison to CT. This study aims to determine the sensitivity of US imaging for pediatric appendicitis and if differences exist in the diagnosis of appendicitis utilizing both CT and ultrasound or ultrasound alone.
Anaphyl Crisis: Rising Rates of Pediatric Anaphylaxis

Paul Patek, Dalia Owda, and Margaret Menoch

Publication Date: 4-28-2022

Objectives

- Determine the rates of pediatric anaphylaxis in SE Michigan between January 1, 2010 and December 31, 2019

- Describe the epidemiology of pediatric patients presenting to emergency centers in southeast Michigan with anaphylaxis
Risk Factors Affecting Delayed Diagnosis of Adult Acute Appendicitis

Nicholas W. Prewitt and Brett R. Todd

Publication Date: 5-2-2022

INTRODUCTION
The diagnosis of appendicitis is time-sensitive and delays increase the risk of morbidity and mortality through complications, including perforation, gangrene, and abscess formation. Nearly all cases of appendicitis are diagnosed in and admitted through the emergency department (ED). Therefore, improvements in the time to diagnosis of acute appendicitis in the ED may improve patient outcomes. However, it currently remains unclear what factors contribute to prolonged diagnostic times of appendicitis. This study aimed to determine if demographic, environmental, or provider-related factors result in delays in the diagnosis of adult acute appendicitis in the ED.
Cardiac Arrest Patient Length of Stay and Survival in Michigan Hospitals

Jaemin Song, David A. Berger, James H. Paxton, Joseph B. Miller, Joshua Reynolds, Nai-Wei Chen, and Robert Swor

Publication Date: 5-2-2022

INTRODUCTION
Current guidelines recommend deferring prognostic decisions for at least 72 hours following admission after Out of Hospital cardiac arrest (OHCA). Most non-survivors experience withdrawal of life-sustaining therapy (WLST), and early WLST may adversely impact survival. We sought to characterize the hospital length of stay (LOS) and timing of Do Not Resuscitate (DNR) orders (as surrogates for WLST) to assess their relationship to survival following cardiac arrest.
Ventricular assist device association in improving outcomes in patients resuscitated from out of hospital cardiac arrest

Julie Tram, Andrew Pressman, Nai-Wei Chen, David Berger, Joseph Miller, Robert Welch, Joshua Reynolds, James Pribble, Robert Swor, and CARES Surveillance Group

Publication Date: 5-2-2022

INTRODUCTION
There has been continued debate on the efficacy of ventricular assist devices (VAD) on improving survival outcomes in post cardiac arrest patients.
The objective of this study is to assess whether the use of VAD is associated with improved survival outcome in patients resuscitated from out-of-hospital cardiac arrest in Michigan.
Assessing Geriatric Patients in the Emergency Department Using A New Trauma Protocol

Benjamin Travers, Ali Beydoun, Patrick Karabon, Shanna Jones, Michael Opsommer, Aveh Bastani, and David Donaldson

Publication Date: 5-2-2022

INTRODUCTION
The Level III trauma protocol was implemented to reduce time to diagnosis and treatment for elderly patients (defined as patients aged > 65 who are taking anticoagulant/antiplatelet agents) presenting in the ED with a potential head injury after a fall. In 2017, approximately 11.4% of the patients triaged by the new Level III trauma protocol had an intracranial bleed, which is a population that had previously been overlooked as they have a low index of suspicion for an intracranial bleed. This study sought to determine if the recent implementation of the Level III trauma protocol in the Troy Beaumont Emergency Department (ED) has led to better health outcomes for this population.

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A Case Study of Lemeirre’s Syndrome

Kyle Wesley, Jarred Anderson, and Dawn Zelenka

Publication Date: 5-2022

Introduction Lemierre’s syndrome, a rare but severe disease process, is a clinical condition characterized by septic thrombophlebitis of the internal jugular vein most commonly caused by Fusobacterium necrophorum. Lemierre’s syndrome should be suspected in a pediatric or young adult patient who presents with acute signs of septicemia, pneumonia or lateral neck pain preceded by viral upper respiratory symptoms. Diagnosis is confirmed with radiographic evidence of internal jugular thrombophlebitis with either bacteremia or evidence of septic emboli2 . Treatment consists of prolonged targeted antibiotic course and, infrequently, anticoagulation therapy.
Outcomes for Patients with Congestive Heart Failure and Chronic Kidney Disease Receiving Fluid Resuscitation for Severe Sepsis or Septic Shock

Melany Wiczorek, Ronny Otero, Steven Knight, Kaitlin Ziadeh, James Blumline, and Zachary Rollins

Publication Date: 5-2-2022

INTRODUCTION
Sepsis core measures are an integral part of sepsis treatment. Current fluid administration guidelines consist of administering at least 30cc/kg of intravenous fluids (IVF) per ideal body weight (IBW) within the first three hours of sepsis diagnosis regardless of pre-existing comorbidities at risk for fluid overload. This study aims to evaluate the outcomes of patients with a history of congestive heart failure (CHF) and/or chronic kidney disease (CKD) who receive fluid resuscitation for the management of severe sepsis or septic shock.