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Estes M, Garcia J, Ren R, Olaf M, Moffett S, Galuska M, Chi Zhang X. Analysis of Anonymous Student Narratives About Experiences with Emergency Medicine Residency Programs. West J Emerg Med 2024; 25:191-196. [PMID: 38596917 PMCID: PMC11000561 DOI: 10.5811/westjem.17973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/18/2023] [Accepted: 11/21/2023] [Indexed: 04/11/2024] Open
Abstract
Background Academic emergency medicine (EM) communities have viewed anonymous online communities (AOC) such as Reddit or specialty-specific "applicant spreadsheets" as poor advising resources. Despite this, robust EM AOCs exist, with large user bases and heavy readership. Insights about applicants' authentic experiences can be critical for applicants and program leadership decision-making. To date, there are no EM studies to qualitatively assess EM AOC narratives during the application cycle. Our goal was to perform a qualitative analysis of students' EM program experiences through a publicly available AOC. Methods This was a qualitative analysis of a publicly available, time-stamped, user-locked AOC dataset: "Official 2020-2021 Emergency Medicine Applicant Spreadsheet." We extracted and then de-identified all data from selected sub-sheets entitled "Virtual Interview Impressions" and "Rotation Impressions." Four investigators used constant comparative method to analyze the data inductively, and they subsequently met to generate common themes discussed by students. Preliminary thematic analysis was conducted on a random sample of 37/183 (20%) independent narratives to create the initial codebook. This was used and updated iteratively to analyze the entire narrative set consisting of 841 discrete statements. Finally, two unique codes were created to distinguish whether the identified sub-themes, or program attributes, were likely "modifiable" or "non-modifiable." Results We identified six major themes: living and working conditions; interpersonal relationships; learning experiences, postgraduate readiness, and online/virtual supplements. Common sub-themes included patient population (13%); resident personality (7%); program leadership personality (7%); relationship with faculty/leadership (6%); geography (4%); practice setting (4%); program reputation (4%), and postgraduate year-3 experiences (4%). Modifiable sub-themes outnumbered non-modifiable sub-themes, 60.7% to 39.3%. Conclusion In this analysis of selected medical students' narratives in an AOC, the majority of identified themes represented topics that may serve as external feedback for EM residency programs and their clerkships. Selective use of AOCs may set a precedent for future program assessments by applicants and inform program leadership of important programmatic elements in the eyes of applicants. It elucidates important themes in their interactions or learning experiences with programs and creates opportunities for learner-centric program improvement.
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Affiliation(s)
- Molly Estes
- Loma Linda University, Department of Emergency Medicine, Loma Linda, California
| | - Jacob Garcia
- Mount Sinai Morningside/West, Department of Emergency Medicine, New York, New York
| | - Ronnie Ren
- University of Massachusetts, Department of Emergency Medicine, Boston, Massachusetts
- University of Florida Health Shands Hospital, Department of Emergency Medicine, Gainesville, Florida
| | - Mark Olaf
- Geisinger Commonwealth School of Medicine, Department of Emergency Medicine, Scranton, Pennsylvania
| | - Shannon Moffett
- Rutgers New Jersey Medical School, Department of Emergency Medicine, Newark, New Jersey
| | - Michael Galuska
- Conemaugh Memorial Medical Center, Department of Emergency Medicine, Johnstown, Pennsylvania
| | - Xiao Chi Zhang
- Thomas Jefferson University, Department of Emergency Medicine, Philadelphia, Pennsylvania
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Bourdages S, Olaf M, Schoenwetter D, Berger A. Mobile Integrated Health and Hospital Utilization for Congestive Heart Failure in a Rural Setting. PREHOSP EMERG CARE 2023; 28:186-191. [PMID: 37216642 DOI: 10.1080/10903127.2023.2217259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 05/08/2023] [Accepted: 05/14/2023] [Indexed: 05/24/2023]
Abstract
Background: Heart failure is a leading cause of hospitalization with a high readmission rate. Mobile integrated health care (MIH) programs have expanded the role of emergency medical services to provide community-based care to patients with chronic disease, such as heart failure. However, there is little data published on the outcomes of MIH programs.Objective: This study evaluated the effect of a rural MIH program on emergency department and inpatient utilization for patients with congestive heart failure.Methods: A retrospective propensity score matched case-control study patients was performed for patients who participated in the MIH program associated with a single rural Pennsylvania health system between April 2014 and June 2020. Cases and controls were matched based on demographics and comorbidities. Pre- and post-intervention utilization were examined at 30, 90, and 180 days from the index encounters within the treatment groups, and then compared to the change in utilization among controls.Results: 1237 patients were analyzed. The change in all-cause ED utilization among cases was significantly better than the change in ED utilization among controls at 30 (Δ = -3.6%; 95% CI: -6.1%, -1.1%) and 90 days (Δ = -3.5%; 95% CI: -6.7%, -0.2%). There was no significant change in all-cause inpatient utilization at 30, 90, or 180 days. Limiting to CHF-only encounters also showed no significant change in utilization between cases and controls at any of the time intervals.Conclusion: Analysis of this MIH program demonstrates efficacy in delivering community-based care to reduce all-cause ED utilization. Prospective studies should be conducted to better assess the effects on inpatient utilization, cost data, and patient satisfaction to evaluate the effectiveness of such programs more holistically.
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Affiliation(s)
- Sara Bourdages
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Mark Olaf
- Geisinger Medical Center, Emergency Medicine, Danville, Pennsylvania
| | - David Schoenwetter
- Geisinger Wyoming Valley, Emergency Medicine, Wilkes Barre, Pennsylvania
| | - Andrea Berger
- Geisinger Department of Population Health Sciences, Danville, Pennsylvania
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Boutin L, Caballero M, Guarrigue D, Hammad E, Rennuit I, Delhaye N, Neuschwander A, Meyer A, Bitot V, Mathais Q, Boutonnet M, Julia P, Olaf M, Duranteau J, Hamada S. Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Olaf M, Moffett S, Ledford M, Fix M, Smith L. Resource Utilization and Emergency Medicine Advisors' Approach to Video Interview Preparation. Cureus 2021; 13:e18504. [PMID: 34754664 PMCID: PMC8569643 DOI: 10.7759/cureus.18504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction The Standardized Video Interview (SVI) was a residency application component introduced by the Association of American Medical Colleges (AAMC) as a supplement to the existing process, which aimed to measure knowledge of professional behaviors and interpersonal skills. Given its novelty in both aim and execution, little advice or experience was available to inform preparation strategies. We sought to perform a cross-sectional analysis to explore advisors' practices in guiding students' preparation for the SVI. Methods An electronic questionnaire was developed and piloted for flow and usability, then distributed to all members of the Council of Residency Directors in Emergency Medicine (CORD EM), the professional society for emergency medicine educators, via listserv, comprised of 270 residency programs. Questions were both open- and closed-ended and therefore analyzed in a mixed-method fashion. Results We received 56 responses from a listserv representing 270 residency programs. Respondents cited personal experience and consensus opinions from national organizations as the primary sources for their advice. The most common resources offered to students were space for completing the SVI (41%) or technical support for completing the SVI (47%). The time committed to student advising specifically for the SVI ranged from zero to 20 hours. Estimated associated costs of preparation ranged from zero up to $10,000 (time plus resources). Two individuals reported recommending commercial preparation resources to students. Conclusion The SVI was a novel attempt to augment the resident application process. We found variability in resources and advice offered to students, including broad ranges of time dedicated, the monetary value of resources contributed, and the types of resources utilized. As the global COVID-19 pandemic has inspired a wave of innovation and process changes, we present this data for consideration as a snapshot of the variable responses to a single uniform process change.
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Affiliation(s)
- Mark Olaf
- Emergency Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
| | | | - Matthew Ledford
- Emergency Medicine, University of Connecticut School of Medicine, Farmington, USA
| | - Megan Fix
- Emergency Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - Liza Smith
- Emergency Medicine, Baystate Medical Center, Springfield, USA
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Ren R, Parekh K, Franzen D, Estes M, Camejo M, Olaf M, Zhang XC. Emergency medicine clerkship director experience adapting emergency remote learning during the onset of COVID-19 pandemic. AEM Educ Train 2021; 5:e10594. [PMID: 33786410 PMCID: PMC7994998 DOI: 10.1002/aet2.10594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/12/2021] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The recent outbreak of the COVID-19 altered the traditional paradigm of clinical medical education. While individual clerkships have shared their curricular adaptations via social and academic networking media, there is currently no organizational standard in establishing a nonclinical, emergency medicine (EM) virtual rotation (VR). The primary objective of this study was to describe EM clerkship directors' (CDs) perspectives on their experience adapting an EM VR curriculum during the onset of the COVID-19 pandemic. METHODS A 21-item survey with quantitative and qualitative questions was disseminated between June and August 2020 to EM CDs via the Clerkship Director of Emergency Medicine Listserv to describe their experience and perspectives in adapting a VR during spring 2020. RESULTS We analyzed 59 of 77 EM clerkship survey responses. Among respondents, 52% adapted a VR while 47.5% did not. Of those who adapted a VR, 71% of CDs had 2 weeks or less to develop the new curriculum, with 84% reporting usual or increased clinical load during that time. Clerkships significantly diversified their asynchronous educational content and utilized several instructional models to substitute the loss of clinical experience. Reflecting on the experience, 71% of CDs did not feel comfortable writing a standardized letter of evaluation for students based on the VR, with the majority citing inability to evaluate students' competencies in a clinical context. CONCLUSION A crisis such as COVID-19 necessitates change in all facets of medical education. While EM educators demonstrated the ability to create emergency remote learning with limited time, this was not equivalent to the formal development of preplanned VR experiences. Future faculty development and curriculum innovation are required to fully transition an in-person immersive experience to a noninferior virtual experience.
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Affiliation(s)
- Ronnie Ren
- Department of Emergency MedicineUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Kendra Parekh
- Department of Emergency MedicineVanderbilt UniversityNashvilleTennesseeUSA
| | - Doug Franzen
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Molly Estes
- Department of Emergency MedicineLoma Linda UniversityLoma LindaCaliforniaUSA
| | - Melanie Camejo
- Department of Emergency MedicineUniversity of Missouri–Kansas CityKansas CityMissouriUSA
| | - Mark Olaf
- Department of Emergency MedicineGeisinger Commonwealth School of MedicineDanvillePennsylvaniaUSA
| | - Xiao Chi Zhang
- Department of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
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Pelletier-Bui A, Franzen D, Smith L, Hopson L, Lutfy-Clayton L, Parekh K, Olaf M, Morrissey T, Gordon D, McDonough E, Schnapp BH, Edens MA, Kiemeney M. COVID-19: A Driver for Disruptive Innovation of the Emergency Medicine Residency Application Process. West J Emerg Med 2020; 21:1105-1113. [PMID: 32970562 PMCID: PMC7514416 DOI: 10.5811/westjem.2020.8.48234] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/07/2020] [Indexed: 11/11/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic has had a significant impact on undergraduate medical education with limitation of patient care activities and disruption to medical licensing examinations. In an effort to promote both safety and equity, the emergency medicine (EM) community has recommended no away rotations for EM applicants and entirely virtual interviews during this year's residency application cycle. These changes affect the components of the EM residency application most highly regarded by program directors - Standardized Letters of Evaluation from EM rotations, board scores, and interactions during the interview. The Council of Residency Directors in Emergency Medicine Application Process Improvement Committee suggests solutions not only for the upcoming year but also to address longstanding difficulties within the process, encouraging residency programs to leverage these challenges as an opportunity for disruptive innovation.
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Affiliation(s)
- Alexis Pelletier-Bui
- Cooper Medical School of Rowan University, Department of Emergency Medicine, Camden, New Jersey
| | - Doug Franzen
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Liza Smith
- University of Massachusetts Medical School Baystate Health, Department of Emergency Medicine, Springfield, Massachusetts
| | - Laura Hopson
- University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Lucienne Lutfy-Clayton
- University of Massachusetts Medical School Baystate Health, Department of Emergency Medicine, Springfield, Massachusetts
| | - Kendra Parekh
- Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, Tennessee
| | - Mark Olaf
- Geisinger Commonwealth School of Medicine, Department of Emergency Medicine, Scranton, Pennsylvania
| | - Tom Morrissey
- University of Florida College of Medicine-Jacksonville, Department of Emergency Medicine, Jacksonville, Florida
| | - David Gordon
- Duke University, Division of Emergency Medicine, Durham, North Carolina
| | - Erin McDonough
- University of Cincinnati College of Medicine, Department of Emergency Medicine, Cincinnati, Ohio
| | - Benjamin H Schnapp
- University of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin
| | - Mary Ann Edens
- Louisiana State University Health Shreveport, Department of Emergency Medicine, Shreveport, Louisiana
| | - Michael Kiemeney
- Loma Linda University School of Medicine, Department of Emergency Medicine, Loma Linda, California
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Katirji L, Smith L, Pelletier-Bui A, Hillman E, Zhang XC, Pasirstein M, Olaf M, Shaw J, Franzen D, Ren R. Addressing Challenges in Obtaining Emergency Medicine Away Rotations and Standardized Letters of Evaluation Due to COVID-19 Pandemic. West J Emerg Med 2020; 21:538-541. [PMID: 32302281 PMCID: PMC7234725 DOI: 10.5811/westjem.2020.3.47444] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 11/11/2022] Open
Abstract
The Council of Residency Directors in Emergency Medicine (CORD) Advising Students Committee in Emergency Medicine (ASC-EM) anticipates institutional and regional variability in both the spread and response to COVID-19. Travel restrictions and host institution rotation closures will impact the number of emergency medicine (EM) rotations EM-bound medical students can complete in an unprecedented manner. They may prevent students from completing any away rotations this academic cycle, challenging the students’ ability to obtain EM Standardized Letters of Evaluation (SLOEs). EM’s emphasis on residency group SLOEs over other letter types creates an undue burden on these vulnerable students and makes the application process intrinsically inequitable. This inequity warrants a reevaluation of the current application practice. This article outlines ASC-EM's proposed recommendations for all stakeholders, including EM program leadership, medical schools, and EM-bound medical students, to consider for the upcoming EM application cycle.
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Affiliation(s)
- Linda Katirji
- University of Kentucky, Department of Emergency Medicine, Lexington, Kentucky
| | - Liza Smith
- University of Massachusetts Medical School, Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts
| | - Alexis Pelletier-Bui
- Cooper Medical School of Rowan University, Department of Emergency Medicine, Camden, New Jersey
| | - Emily Hillman
- University of Missouri-Kansas City School of Medicine, Truman Medical Center, Department of Emergency Medicine, Kansas City, Missouri
| | - Xiao Chi Zhang
- Thomas Jefferson University, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Michael Pasirstein
- Drexel University College of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Mark Olaf
- Geisinger Commonwealth School of Medicine, Department of Emergency Medicine, Scranton, Pennsylvania
| | - Jazmyn Shaw
- University of Mississippi School of Medicine, Univeristy of Mississippi Medical Center, Jackson, Mississippi
| | - Douglas Franzen
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Ronnie Ren
- University of Massachusetts Medical School, Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts
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Olaf M, Duguet L. Mastoiditis with concomitant Lemierre's syndrome. Am J Emerg Med 2019; 37:1214.e1-1214.e3. [PMID: 30786966 DOI: 10.1016/j.ajem.2019.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022] Open
Abstract
Otalgia with mastoiditis is an infrequently encountered complication of acute otitis media (Pfaff and Moore, 2018). Even more rare is the development of infected jugular venous thrombosis, Lemierre's disease. We present a case of a six year-old girl with otalgia for over two months who presented to our Emergency Department (ED) with clinical mastoiditis, confirmed on CT scan, as well as an incidental diagnosis of complete thrombosis of the internal jugular (IJ) vein, Lemierre's syndrome. The true prevalence of Lemierre's from mastoiditis is difficult to discern. This clinical case highlights the importance of the consideration of these pathologies by the emergency physician.
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Affiliation(s)
- Mark Olaf
- Department of Emergency Medicine, Geisinger Health System, 100 North Academy Ave., Danville, PA 17822-2005, USA.
| | - Lindsey Duguet
- Department of Emergency Medicine, Geisinger Health System, 100 North Academy Ave., Danville, PA 17822-2005, USA
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Berry C, Kupas D, Olaf M, Knorr A, Berger A. Abstracts for the 2019 NAEMSP Scientific Assembly. PREHOSP EMERG CARE 2018; 23:1-251. [PMID: 30221576 DOI: 10.1080/10903127.2018.1521488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The approach to managing out-of-hospital cardiac arrest (OOHCA) has generally involved either minimal on-scene resuscitation to reduce time to arrival at hospital or extended care at the scene to increase the chance of return of spontaneous circulation (ROSC) before transport. This study compared patient outcomes across EMS agencies with respect to the duration of on-scene time. We hypothesized that EMS agencies with greater average time on-scene would have more favorable outcomes. METHODS The Cardiac Arrest Registry to Enhance Survival (CARES) was used to identify OOHCA cases, including characteristics and outcomes. EMS agencies were included if they submitted at least 80 OOHCAs from 2013 to 2017. To study outcomes based upon culture of OOHCA management, outcomes were studied by EMS agency rather than by individual patient cases. Agencies in the top and bottom quartiles of on-scene time duration were categorized as high (HOSTAs) and low on-scene time agencies (LOSTAs), respectively. Generalized estimating equation models compared HOSTAs and LOSTAs. RESULTS We classified 89 agencies as HOSTAs (24,114 patients, average ≥25 minutes on scene) and 89 agencies as LOSTAs (37,297 patients, average <18.9 minutes on-scene). Among patients transported, HOSTAs were more likely to have a shockable rhythm (28.4% vs. 22.2%, OR = 1.4, 95%CI 1.2 to 1.5), a witnessed arrest (65.1% vs. 53.6%, OR = 1.7, 95% CI 1.5 to 1.9), and receive bystander CPR (41.9% vs. 37.0%, OR = 1.3, 95% CI 1.1 to 1.5) than LOSTAs, all p < 0.001. When controlling for these and other patient characteristics, including mechanical CPR device use, HOSTAs had a higher proportion of ROSC on emergency department arrival (66.7% vs. 31.1%, OR = 4.6, 95%CI 3.5 to 6.0, p < 0.001), survival to discharge for transported patients (22.3% vs. 11.2%, OR = 2.6, 95%CI 2.0 to 3.4, p < 0.001), and good neurologic outcome among survivors (84.9% vs. 78.6%, OR = 1.3, 95%CI = 1.0 to 1.7, p = 0.04) than LOSTAs. CONCLUSIONS This study suggests that HOSTAs have more favorable patient outcomes compared to LOSTAs. RESULTS indicate that spending more time on-scene performing resuscitation is associated with higher rates of ROSC, survival and survival with good neurologic function.
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Affiliation(s)
- Christopher Berry
- a Division of EM , Geisinger Health System CATEGORY OF SUBMISSION: STUDENT, RESIDENT, FELLOW
| | - Douglas Kupas
- a Division of EM , Geisinger Health System CATEGORY OF SUBMISSION: STUDENT, RESIDENT, FELLOW
| | - Mark Olaf
- a Division of EM , Geisinger Health System CATEGORY OF SUBMISSION: STUDENT, RESIDENT, FELLOW
| | - Anne Knorr
- a Division of EM , Geisinger Health System CATEGORY OF SUBMISSION: STUDENT, RESIDENT, FELLOW
| | - Andrea Berger
- a Division of EM , Geisinger Health System CATEGORY OF SUBMISSION: STUDENT, RESIDENT, FELLOW
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Abstract
Deep venous thrombosis (DVT) is a frequently encountered condition that is often diagnosed and treated in the outpatient setting. Risk stratification is helpful and recommended in the evaluation of DVT. An evidence-based diagnostic approach is discussed here. Once diagnosed, the mainstay of DVT treatment is anticoagulation. The specific type and duration of anticoagulation depend upon the suspected etiology of the venous thromboembolism, as well as risks of bleeding and other patient comorbidities. Both specific details and a standardized approach to this vast treatment landscape are presented.
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Affiliation(s)
- Mark Olaf
- Department of Emergency Medicine, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17822-2005, USA.
| | - Robert Cooney
- Emergency Medicine Residency Program, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17822-2005, USA
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