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Kirbos C, Pagenhardt J, Minardi J, End B. Point-of-Care Ultrasound Diagnosis of Ventricular Septal Rupture Post Myocardial Infarction: A Case Report. J Emerg Med 2022; 63:777-780. [PMID: 36369118 DOI: 10.1016/j.jemermed.2022.09.026] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/16/2022] [Accepted: 09/04/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Ventricular septal rupture (VSR) is a rare but life-threatening complication of ST-elevation myocardial infarction. Point-of-care ultrasound (POCUS) is a rapid, noninvasive imaging modality that is easily accessible and highly effective in diagnosing VSR in the emergency department (ED) setting. CASE REPORT A 73-year-old man with a history of type II diabetes mellitus and hypertension presented with complaints of intermittent chest pain for 48 h that had since become constant, associated with diaphoresis and shortness of breath. Physical examination was notable for shock and a new, grade V/VI systolic murmur. An electrocardiogram showed evidence of an inferior ST-elevation myocardial infarction (MI) with associated Q waves. POCUS revealed a large ventricular septal rupture with new ventricular septal defect and associated left-to-right shunting. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POCUS in the ED setting is an effective and rapid tool for elucidating the etiology of various shock states. Emergency physicians should be aware of this particular case, as POCUS may help identify MI-related complications, including post-myocardial infarction VSR, that may necessitate surgical intervention as opposed to coronary reperfusion procedures.
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Affiliation(s)
- Catherine Kirbos
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia
| | - Justine Pagenhardt
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia
| | - Joseph Minardi
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia; Department of Medical Education, West Virginia University, Morgantown, West Virginia
| | - Bradley End
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia; Department of Medical Education, West Virginia University, Morgantown, West Virginia
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2
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Goldberg EM, Southerland LT, Meltzer AC, Pagenhardt J, Hoopes R, Camargo CA, Kline JA. Age-related differences in symptoms in older emergency department patients with COVID-19: Prevalence and outcomes in a multicenter cohort. J Am Geriatr Soc 2022; 70:1918-1930. [PMID: 35460268 PMCID: PMC9115070 DOI: 10.1111/jgs.17816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 12/01/2021] [Revised: 03/24/2022] [Accepted: 04/02/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Older adults represent a disproportionate share of severe COVID-19 presentations and fatalities, but we have limited understanding of the differences in presentation by age and the association between less typical emergency department (ED) presentations and clinical outcomes. METHODS This retrospective cohort study used the RECOVER Network registry, a research collaboration of 86 EDs in 27 U.S. states. We focused on encounters with a positive nasopharyngeal swab for SARS-CoV-2, and described their demographics, clinical presentation, and outcomes. Sequential multivariable logistic regressions examined the strength of association between age cohort and outcomes. RESULTS Of 4536 encounters, median patient age was 55 years, 49% were women, and 34% were non-Hispanic Black persons. Cough was the most common presenting complaint across age groups (18-64, 65-74, and 75+): 71%, 67%, and 59%, respectively (p < 0.001). Neurological symptoms, particularly altered mental status, were more common in older adults (2%, 11%, 26%; p < 0.001). Patients 75+ had the greatest odds of ED index visit admission of all age groups (adjusted odds ratio [aOR] 6.66; 95% CI 5.23-8.56), 30-day hospitalization (aOR 7.44; 95% CI 5.63-9.99), and severe COVID-19 (aOR 4.26; 95% CI 3.45-5.27). Compared to individuals with alternate presentations and adjusting for age, patients with typical symptoms (fever, cough and/or shortness of breath) had similar odds of ED index visit admission (aOR 1.01; 95% CI 0.81-1.24), potentially higher odds of 30-day hospitalization (aOR 1.23; 95% CI 1.00-1.53), and greater odds of severe COVID-19 (aOR 1.46; 95% CI 1.12-1.90). CONCLUSIONS Older patients with COVID-19 are more likely to have presentations without the most common symptoms. However, alternate presentations of COVID-19 in older ED patients are not associated with greater odds of mechanical ventilation and/or death. Our data highlights the importance of a liberal COVID-19 testing strategy among older ED patients to facilitate accurate diagnoses and timely treatment and prophylaxis.
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Affiliation(s)
| | | | - Andrew C. Meltzer
- Department of Emergency MedicineGeorge Washington School of Medicine & Health ServicesWashingtonDistrict of ColumbiaUSA
| | - Justine Pagenhardt
- Department of Emergency MedicineWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Ryan Hoopes
- Warren Alpert School of MedicineBrown UniversityProvidenceRhode IslandUSA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Jeffrey A. Kline
- Department of Emergency MedicineWayne State UniversityDetroitMichiganUSA
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3
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Kline JA, Adler DH, Alanis N, Bledsoe JR, Courtney DM, d'Etienne JP, Diercks DB, Garrett JS, Jones AE, Mackenzie DC, Madsen T, Matuskowitz AJ, Mumma BE, Nordenholz KE, Pagenhardt J, Runyon MS, Stubblefield WB, Willoughby CB. Monotherapy Anticoagulation to Expedite Home Treatment of Patients Diagnosed With Venous Thromboembolism in the Emergency Department: A Pragmatic Effectiveness Trial. Circ Cardiovasc Qual Outcomes 2021; 14:e007600. [PMID: 34148351 DOI: 10.1161/circoutcomes.120.007600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The objective was to test if low-risk emergency department patients with vitamin K antagonist (venous thromboembolism [VTE]; including venous thrombosis and pulmonary embolism [PE]) can be safely and effectively treated at home with direct acting oral (monotherapy) anticoagulation in a large-scale, real-world pragmatic effectiveness trial. METHODS This was a single-arm trial, conducted from 2016 to 2019 in accordance with the Standards for Reporting Implementation Studies guideline in 33 emergency departments in the United States. Participants had newly diagnosed VTE with low risk of death based upon either the modified Hestia criteria, or physician judgment plus the simplified PE severity index score of zero, together with nonhigh bleeding risk were eligible. Patients had to be discharged within 24 hours of triage and treated with either apixaban or rivaroxaban. Effectiveness was defined by the primary efficacy and safety outcomes, image-proven recurrent VTE and bleeding requiring hospitalization >24 hours, respectively, with an upper limit of the 95% CI for the 30-day frequency of VTE recurrence below 2.0% for both outcomes. RESULTS We enrolled 1421 patients with complete outcomes data, including 903 with venous thrombosis and 518 with PE. The recurrent VTE requiring hospitalization occurred in 14/1421 (1.0% [95% CI, 0.5%-1.7%]), and bleeding requiring hospitalization occurred in 12/1421 (0.8% [0.4%-1.5%). The rate of severe bleeding using International Society for Thrombosis and Haemostasis criteria was 2/1421 (0.1% [0%-0.5%]). No patient died, and serious adverse events occurred in 2.5% of venous thrombosis patients and 2.3% of patients with PE. Medication nonadherence was reported by patients in 8.0% (6.6%-9.5%) and was associated with a risk ratio of 6.0 (2.3-15.2) for VTE recurrence. Among all patients diagnosed with VTE in the emergency department during the period of study, 18% of venous thrombosis patients and 10% of patients with PE were enrolled. CONCLUSIONS Monotherapy treatment of low-risk patients with venous thrombosis or PE in the emergency department setting produced a low rate of bleeding and VTE recurrence, but may be underused. Patients with venous thrombosis and PE should undergo risk-stratification before home treatment. Improved patient adherence may reduce rate of recurrent VTE. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03404635.
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Affiliation(s)
- Jeffrey A Kline
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (J.A.K.)
| | - David H Adler
- Department of Emergency Medicine, University of Rochester, NY (D.H.A.)
| | - Naomi Alanis
- Department of Emergency Medicine, University of North Texas, Denton (N.A.)
| | - Joseph R Bledsoe
- Department of Emergency Medicine, Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, UT (J.R.B.)
| | - Daniel M Courtney
- Department of Emergency Medicine, University of Texas Southwestern, Dallas (D.M.C., D.B.D.)
| | - James P d'Etienne
- Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, TX (J.P.d.)
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas Southwestern, Dallas (D.M.C., D.B.D.)
| | - John S Garrett
- Department of Emergency Medicine, Baylor University Medical Center, Dallas, TX (J.S.G.)
| | - Alan E Jones
- Department of Emergency Medicine, University of Mississippi, Jackson (A.E.J.)
| | - David C Mackenzie
- Department of Emergency Medicine, Maine Medical Center, Portland (D.C.M.)
| | - Troy Madsen
- Department of Emergency Medicine, University of Utah, Salt Lake City (T.M.)
| | - Andrew J Matuskowitz
- Department of Emergency Medicine, Medical University of South Carolina, Charleston (A.J.M.)
| | - Bryn E Mumma
- Department of Emergency Medicine, University of California, Davis (B.E.M.)
| | | | - Justine Pagenhardt
- Department of Emergency Medicine, West Virginia University, Morgantown (J.P.)
| | - Michael S Runyon
- Department of Emergency Medicine, Atrium Health, Charlotte, NC (M.S.R.)
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville TN (W.B.S.)
| | - Christopher B Willoughby
- Department of Internal Medicine, Division of Emergency Medicine, Louisiana State University, New Orleans (C.B.W.)
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Pagenhardt J, Hayward I, Dilcher B, Quedado K, Kline J. Incidence of abnormal uterine bleeding in a multicenter implementation study using apixaban and rivaroxaban to treat venous thromboembolism. Thromb Res 2021; 204:29-31. [PMID: 34116403 DOI: 10.1016/j.thromres.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Justine Pagenhardt
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Isaac Hayward
- West Virginia University, Morgantown, WV, United States of America
| | - Brian Dilcher
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Kimberly Quedado
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Jeffrey Kline
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America.
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Kline JA, Camargo CA, Courtney DM, Kabrhel C, Nordenholz KE, Aufderheide T, Baugh JJ, Beiser DG, Bennett CL, Bledsoe J, Castillo E, Chisolm-Straker M, Goldberg EM, House H, House S, Jang T, Lim SC, Madsen TE, McCarthy DM, Meltzer A, Moore S, Newgard C, Pagenhardt J, Pettit KL, Pulia MS, Puskarich MA, Southerland LT, Sparks S, Turner-Lawrence D, Vrablik M, Wang A, Weekes AJ, Westafer L, Wilburn J. Clinical prediction rule for SARS-CoV-2 infection from 116 U.S. emergency departments 2-22-2021. PLoS One 2021; 16:e0248438. [PMID: 33690722 PMCID: PMC7946184 DOI: 10.1371/journal.pone.0248438] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/25/2021] [Indexed: 12/11/2022] Open
Abstract
Objectives Accurate and reliable criteria to rapidly estimate the probability of infection with the novel coronavirus-2 that causes the severe acute respiratory syndrome (SARS-CoV-2) and associated disease (COVID-19) remain an urgent unmet need, especially in emergency care. The objective was to derive and validate a clinical prediction score for SARS-CoV-2 infection that uses simple criteria widely available at the point of care. Methods Data came from the registry data from the national REgistry of suspected COVID-19 in EmeRgency care (RECOVER network) comprising 116 hospitals from 25 states in the US. Clinical variables and 30-day outcomes were abstracted from medical records of 19,850 emergency department (ED) patients tested for SARS-CoV-2. The criterion standard for diagnosis of SARS-CoV-2 required a positive molecular test from a swabbed sample or positive antibody testing within 30 days. The prediction score was derived from a 50% random sample (n = 9,925) using unadjusted analysis of 107 candidate variables as a screening step, followed by stepwise forward logistic regression on 72 variables. Results Multivariable regression yielded a 13-variable score, which was simplified to a 13-point score: +1 point each for age>50 years, measured temperature>37.5°C, oxygen saturation<95%, Black race, Hispanic or Latino ethnicity, household contact with known or suspected COVID-19, patient reported history of dry cough, anosmia/dysgeusia, myalgias or fever; and -1 point each for White race, no direct contact with infected person, or smoking. In the validation sample (n = 9,975), the probability from logistic regression score produced an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.79–0.81), and this level of accuracy was retained across patients enrolled from the early spring to summer of 2020. In the simplified score, a score of zero produced a sensitivity of 95.6% (94.8–96.3%), specificity of 20.0% (19.0–21.0%), negative likelihood ratio of 0.22 (0.19–0.26). Increasing points on the simplified score predicted higher probability of infection (e.g., >75% probability with +5 or more points). Conclusion Criteria that are available at the point of care can accurately predict the probability of SARS-CoV-2 infection. These criteria could assist with decisions about isolation and testing at high throughput checkpoints.
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Affiliation(s)
- Jeffrey A. Kline
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- * E-mail:
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - D. Mark Courtney
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, United States of America
| | - Christopher Kabrhel
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kristen E. Nordenholz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Thomas Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Joshua J. Baugh
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - David G. Beiser
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Christopher L. Bennett
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Joseph Bledsoe
- Department of Emergency Medicine, Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah, United States of America
| | - Edward Castillo
- Department of Emergency Medicine, University of California, San Diego, California, United States of America
| | - Makini Chisolm-Straker
- Department of Emergency Medicine, Mt. Sinai School of Medicine, New York, New York, United States of America
| | - Elizabeth M. Goldberg
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Hans House
- Department of Emergency Medicine, University of Iowa School of Medicine, Iowa City, Iowa, United States of America
| | - Stacey House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louise, Missouri, United States of America
| | - Timothy Jang
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Stephen C. Lim
- University Medical Center New Orleans, Louisiana State University School of Medicine, New Orleans, Louisiana, United States of America
| | - Troy E. Madsen
- Division of Emergency Medicine, Department Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Danielle M. McCarthy
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Andrew Meltzer
- Department of Emergency Medicine, George Washington University School of Medicine, Washington D.C., DC, United States of America
| | - Stephen Moore
- Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Craig Newgard
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Justine Pagenhardt
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Katherine L. Pettit
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Michael S. Pulia
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Michael A. Puskarich
- Department of Emergency Medicine, Hennepin County Medical Center and the University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Lauren T. Southerland
- Department of Emergency Medicine, Ohio State University Medical Center, Columbus, Ohio, United States of America
| | - Scott Sparks
- Department of Emergency Medicine, Riverside Regional Medical Center, Newport News, Virginia, United States of America
| | - Danielle Turner-Lawrence
- Department of Emergency Medicine, Beaumont Health, Royal Oak, Michigan, United States of America
| | - Marie Vrablik
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Alfred Wang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Anthony J. Weekes
- Department of Emergency Medicine, Carolinas Medical Center at Atrium Health, Charlotte, North Carolina, United States of America
| | - Lauren Westafer
- Department of Emergency Medicine, Baystate Health, Springfield, Massachusetts, United States of America
| | - John Wilburn
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
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6
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Shavor C, Pagenhardt J, Sun Y, Kraft C, End B, Minardi J. Ureteral Stone Mimics Appendicitis: A Point-of-care Ultrasound Case Report. Clin Pract Cases Emerg Med 2020; 4:555-558. [PMID: 33217271 PMCID: PMC7676809 DOI: 10.5811/cpcem.2020.7.48155] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/24/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Abdominal pain is a common complaint in the emergency department. Point-of-care ultrasound (POCUS) is a rapid modality to evaluate for the etiology. Case Report A teenage male presented with symptoms concerning for appendicitis. POCUS revealed a non-peristalsing, non-compressible, tubular structure containing an echogenic stone. This was determined to be a ureteral stone within a dilated ureter, not appendicitis. Conclusion We propose a syndromic sonographic approach to right lower quadrant pain (RLQ) that includes the gallbladder, right kidney, bladder, and right adnexa, in addition to RLQ landmarks. This case emphasizes the value of such an approach to avoid diagnostic error.
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Affiliation(s)
- Cindy Shavor
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - Justine Pagenhardt
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - YuanYuan Sun
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - Clara Kraft
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - Bradley End
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia.,West Virginia University School of Medicine, Department of Medical Education, Morgantown, West Virginia
| | - Joseph Minardi
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia.,West Virginia University School of Medicine, Department of Medical Education, Morgantown, West Virginia
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7
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Kline J, Adler D, Alanis N, Bledsoe J, Courtney D, D'Etienne J, B Diercks D, Garrett J, Jones AE, MacKenzie D, Madsen T, Matuskowitz A, Mumma B, Nordenholz K, Pagenhardt J, Runyon M, Stubblefield W, Willoughby C. Study protocol for a multicentre implementation trial of monotherapy anticoagulation to expedite home treatment of patients diagnosed with venous thromboembolism in the emergency department. BMJ Open 2020; 10:e038078. [PMID: 33004396 PMCID: PMC7534683 DOI: 10.1136/bmjopen-2020-038078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION In the USA, many emergency departments (EDs) have established protocols to treat patients with newly diagnosed deep vein thrombosis (DVT) as outpatients. Similar treatment of patients with pulmonary embolism (PE) has been proposed, but no large-scale study has been published to evaluate a comprehensive, integrated protocol that employs monotherapy anticoagulation to treat patients diagnosed with DVT and PE in the ED. METHODS AND ANALYSIS This protocol describes the implementation of the Monotherapy Anticoagulation To expedite Home treatment of Venous ThromboEmbolism (MATH-VTE) study at 33 hospitals in the USA. The study was designed and executed to meet the requirements for the Standards for Reporting Implementation Studies guideline. The study was funded by investigator-initiated awards from industry, with Indiana University as the sponsor. The study principal investigator and study associates travelled to each site to provide on-site training. The protocol identically screens patients with both DVT or PE to determine low risk of death using either the modified Hestia criteria or physician judgement plus a negative result from the simplified PE severity index. Patients must be discharged from the ED within 24 hours of triage and treated with either apixaban or rivaroxaban. Overall effectiveness is based upon the primary efficacy and safety outcomes of recurrent VTE and bleeding requiring hospitalisation respectively. Target enrolment of 1300 patients was estimated with efficacy success defined as the upper limit of the 95% CI for the 30-day frequency of VTE recurrence below 2.0%. Thirty-three hospitals in 17 states were initiated in 2016-2017. ETHICS AND DISSEMINATION All sites had Institutional Review Board approval. We anticipate completion of enrolment in June 2020; study data will be available after peer-reviewed publication. MATH-VTE will provide information from a large multicentre sample of US patients about the efficacy and safety of home treatment of VTE with monotherapy anticoagulation.
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Affiliation(s)
- Jeffrey Kline
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David Adler
- Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Naomi Alanis
- Emergency Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Joseph Bledsoe
- Emergency Medicine, Intermountain Health Care Inc, Salt Lake City, Utah, USA
| | - Daniel Courtney
- Emergency Medicine, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - James D'Etienne
- Emergency Medicine, John Peter Smith Hospital, Fort Worth, Texas, USA
| | - Deborah B Diercks
- Emergency Medicine, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - John Garrett
- Emergency Medicine, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Alan E Jones
- Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - David MacKenzie
- Emergency Medicine, Maine Medical Center, Portland, Maine, USA
| | - Troy Madsen
- Emergency Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Andrew Matuskowitz
- Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bryn Mumma
- Emergency Medicine, University of California Davis, Davis, California, USA
| | - Kristen Nordenholz
- Emergency Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Justine Pagenhardt
- Emergency Medicine, West Virginia University - Health Sciences Campus, Morgantown, West Virginia, USA
| | - Michael Runyon
- Emergency Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - William Stubblefield
- Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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8
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Thomas A, Pagenhardt J, Balcik B. Case Report Stimulant-Induced Atrial Flutter in a Remote Setting. J Spec Oper Med 2020; 20:37-39. [PMID: 32203603 DOI: 10.55460/xgyb-cihy] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2020] [Indexed: 06/10/2023]
Abstract
Atrial flutter and atrial fibrillation are among the most commonly encountered cardiac arrhythmias; however, there is a dearth of clinical trials or case studies regarding its occurrence in the setting of stimulants such as caffeine and nicotine in otherwise healthy young patients. Described here is a case of a 29-year-old physically fit white man without significant past medical history who presented in stable condition complaining only of palpitations. He was found to have atrial flutter without rapid ventricular response on cardiac monitoring, most likely due to concomitant presence of high levels of nicotine and caffeine via chewing tobacco and energy drinks. He was treated conservatively with vagal maneuvers and intravenous fluids with complete resolution of symptoms and electrocardiographic abnormalities within 14 hours. This demonstrates an alternate conservative treatment strategy in appropriately risk stratified patients who present in an austere field setting with limited resources.
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Choi J, Dorinzi N, Pagenhardt J, Steratore A, Sharon M, Minardi J. Sonographic Detection of a Torsed Meckel's Diverticulum Misinterpreted as Acute Appendicitis. Clin Pract Cases Emerg Med 2019; 3:278-281. [PMID: 31404174 PMCID: PMC6682254 DOI: 10.5811/cpcem.2019.5.42976] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/04/2019] [Accepted: 05/16/2019] [Indexed: 12/29/2022] Open
Abstract
A 38-year-old female presented to the emergency department (ED) with acute-onset right lower quadrant abdominal pain following two days of nausea and vomiting. Physical examination revealed right lower quadrant tenderness to palpation, rebound tenderness, and guarding. Point-of-care ultrasound (POCUS) of the right lower abdomen was performed and interpreted as probable appendicitis. However, upon laparoscopic examination of the abdomen, a benign-appearing appendix was visualized. Further investigation revealed the source of the patient’s pain to be a torsed Meckel’s diverticulum. Although rare, a torsed and inflamed Meckel’s diverticulum can be visualized by POCUS in the ED without the need for further imaging or delay.
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Affiliation(s)
- Justin Choi
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Nicole Dorinzi
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Justine Pagenhardt
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Anthony Steratore
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Melinda Sharon
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Joseph Minardi
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
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10
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Dorinzi N, Pagenhardt J, Sharon M, Robinson K, Setzer E, Denne N, Minardi J. Immediate Emergency Department Diagnosis of Pyloric Stenosis with Point-of-care Ultrasound. Clin Pract Cases Emerg Med 2017; 1:395-398. [PMID: 29849342 PMCID: PMC5965224 DOI: 10.5811/cpcem.2017.9.35016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/07/2017] [Accepted: 09/22/2017] [Indexed: 11/29/2022] Open
Abstract
A 15-day-old male who was born at term presented with non-bilious projectile vomiting. He was nontoxic and his abdomen was benign without masses. Point-of-care ultrasound (POCUS) showed hypertrophic pyloric stenosis (HPS). Typical findings include target sign; pyloric muscle thickness greater than three millimeters (mm); channel length greater than 15–18 mm; and lack of gastric emptying. The patient was admitted; consultative ultrasound (US) was negative, but repeated 48 hours later for persistent vomiting. This second US was interpreted as HPS, which was confirmed surgically. Pyloromyotomy was successful. Few reports describe POCUS by general emergency physicians to diagnose HPS. Here, we emphasize the value in repeat US for patients with persistent symptoms.
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Affiliation(s)
- Nicole Dorinzi
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Justine Pagenhardt
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Melinda Sharon
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Kristine Robinson
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Erin Setzer
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Nicolas Denne
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Joseph Minardi
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
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