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Open Access Publications from the University of California

Scholarly Works (8 results)

  • Article
  • Peer Reviewed
Journal of Education and Teaching in Emergency Medicine, Volume 2, Issue 4 (2017)
    Cover page: Acetabular FractureCreative Commons 'BY' version 4.0 license
    • Article
    • Peer Reviewed
    Journal of Education and Teaching in Emergency Medicine, Volume 3, Issue 4 (2018)
      Cover page: EndocarditisCreative Commons 'BY' version 4.0 license
      • Article
      • Peer Reviewed
      Clinical Practice and Cases in Emergency Medicine, Volume 3, Issue 2 (2019)
      We report a case of anterior loculated pericardial effusion misinterpreted on point-of-care ultrasound as a dilated right ventricle, and suggesting diagnosis of pulmonary embolism (PE), in a patient with renal failure. The compressed right ventricle from tamponade physiology appeared to be a thickened intraventricular septum. Heparin was given empirically for presumed PE. Later the same day, computed tomography of the chest showed the effusion, as did formal echocardiogram. The patient had drainage of 630 milliliters of fluid and recovered from tamponade. Loculated effusions comprise 15% of all pericardial effusions, and misdiagnosis of PE with heparin therapy could be fatal.
      • 1 supplemental video
      Cover page: Anterior Loculated Pericardial Effusion Misinterpreted as Right Heart Dilation Suggesting Pulmonary EmbolismCreative Commons 'BY' version 4.0 license
      • Article
      • Peer Reviewed
      Journal of Education and Teaching in Emergency Medicine, Volume 2, Issue 3 (2017)
        Cover page: VolvulusCreative Commons 'BY' version 4.0 license
        • Article
        • Peer Reviewed
        Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 18, Issue 1 (2017)

        Metallic corneal foreign bodies (MCFBs) are one of the most common causes of ocular injury presenting to the emergency department. Delays in removal, or forceful attempts to remove the MCFB can lead to infection, further injury to the eye, and worsening of vision. In order to prevent these underlying complications, it is imperative for the medical provider to properly master this technique. As current trends in simulation become more focused on patient safety, task-trainers can provide an invaluable learning experience for residents, medical students and physicians. Models made from bovine eyes, agar plates, gelatin, and corneas created from glass and paraffin wax have been previously been created. One study also used a rubber glove filled with water to simulate intraocular measurement with a Tonopen. However the use of corneas created from ballistics gel for MCFB removal and intraocular pressure measurement has not been studied. We propose a realistic, sustainable, cost-effective MCFB task-trainer to introduce the fundamental skills required for MCFB removal and measurement of intraocular pressure with a Tonopen.  A pilot survey study performed on medical students and emergency medicine resident physicians showed an increase in comfort levels performing both MCFB removal and measurement of intraocular pressure with a Tonopen after using this task-trainer.

          Cover page: Creation of a realistic model for removal of a metallic corneal foreign body for less than $75.Creative Commons 'BY' version 4.0 license
          • Article
          • Peer Reviewed
          Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 17, Issue 2 (2016)

          Introduction: Retinal detachment is an ocular emergency that commonly presents to the emergency department (ED). Ophthalmologists are able to accurately make this diagnosis with a dilated fundoscopic exam, scleral depression or ophthalmic ultrasound when a view to the retina is obstructed. Emergency physicians (EPs) are not trained to examine the peripheral retina, and thus ophthalmic ultrasound can be used to aid in diagnosis. We assessed the accuracy of ocular point-of-care ultrasound (POCUS) in diagnosing retinal detachment.

          Methods: We retrospectively reviewed charts of ED patients with suspected retinal detachment who underwent ocular POCUS between July 2012 and May 2015. Charts were reviewed for patients presenting to the ED with ocular complaints and clinical concern for retinal detachment. We compared ocular POCUS performed by EPs against the criterion reference of the consulting ophthalmologist’s diagnosis.

          Results: We enrolled a total of 109 patients. Of the 34 patients diagnosed with retinal detachment by the ophthalmologists, 31 were correctly identified as having retinal detachment by the EP using ocular POCUS. Of the 75 patients who did not have retinal detachment, 72 were ruled out by ocular POCUS by the EP. This resulted in a POCUS sensitivity of 91% (95% CI [76-98]) and specificity of 96% (95% CI [89-99]).

          Conclusion: This retrospective study suggests that ocular POCUS performed by EPs can aid in the diagnosis of retinal detachment in ED.

            Cover page: Retrospective Review of Ocular Point-of-Care Ultrasound for Detection of Retinal DetachmentCreative Commons 'BY' version 4.0 license
            • Article
            • Peer Reviewed
            UC Irvine Previously Published Works (2014)

            Objective

            To assess demographics, charges, and outcome measures by temporal and volume analysis in the treatment of vestibular schwannoma.

            Design

            Cross-sectional analysis.

            Setting, subjects, and methods

            The California Hospital Inpatient Discharge Databases from 1996 to 2010.

            Results

            A total of 6545 cases from 1996 to 2010 were identified. Of these, 86.2% occurred at high-volume centers (HVCs), and the number of annual cases decreased by 28.5%. Patients presenting for surgery were increasingly younger, non-Caucasian, and likely to have comorbidities. Total charges significantly increased over time (P < .001), with the median total charge in 2006-2010 being $91,338 compared with $38,607.92 in 1996-2000 after adjusting for inflation. Routine discharges (home or residence) were more likely at HVCs (odds ratio [OR] 5.48, P < .001) and less likely if patients had Medicaid (Medi-Cal; OR 0.51, P = .002) or Medicare (OR 0.55, P = .022), were 65 years or older (OR 0.56, P = .025), or had comorbidities (OR 0.54, P < .001). Shorter hospital stays were more likely at HVCs (OR 3.77, P < .001) and less likely if patients had Medicaid (OR 0.36, P < .001) or comorbidities (OR 0.61, P < .001). Lesser total charges were more likely at HVCs (OR 2.12, P = .002) and less likely if patients had comorbidities (OR 0.70, P < .001). Mortality was less likely at HVCs (OR 0.10, P = .011).

            Conclusion

            The profile of patients undergoing vestibular neuroma excision is changing. Surgical volume is decreasing, suggesting a trend toward more conservative management or stereotactic radiation. Patients are best served at HVCs, where routine discharges, shorter length of stay, decreased mortality, and lower total charges are more likely.
              Cover page: Trends in Demographics, Charges, and Outcomes of Patients Undergoing Excision of Sporadic Vestibular Schwannoma
              • Article
              • Peer Reviewed
              UC Irvine Previously Published Works (2016)

              Background

              Point-of-care ultrasound (US) is a proven diagnostic imaging tool in the emergency department (ED). Modern US devices are now more compact, affordable and portable, which has led to increased usage in austere environments. However, studies supporting the use of US in the prehospital setting are limited. The primary outcome of this pilot study was to determine if paramedics could perform cardiac ultrasound in the field and obtain images that were adequate for interpretation. A secondary outcome was whether paramedics could correctly identify cardiac activity or the lack thereof in cardiac arrest patients.

              Methods

              We performed a prospective educational study using a convenience sample of professional paramedics without ultrasound experience. Eligible paramedics participated in a 3-hour session on point-of-care US. The paramedics then used US during emergency calls and saved the scans for possible cardiac complaints including: chest pain, dyspnea, loss of consciousness, trauma, or cardiac arrest.

              Results

              Four paramedics from two distinct fire stations enrolled a total of 19 unique patients, of whom 17 were deemed adequate for clinical decision making (89%, 95%CI 67%-99%). Paramedics accurately recorded 17 cases of cardiac activity (100%, 95%CI 84%-100%) and 2 cases of cardiac standstill (100%, 95%CI 22%-100%).

              Conclusion

              Our pilot study suggests that with minimal training, paramedics can use US to obtain cardiac images that are adequate for interpretation and diagnose cardiac standstill. Further large-scale clinical trials are needed to determine if prehospital US can be used to guide care for patients with cardiac complaints.
                Cover page: Pre-hospital assessment with ultrasound in emergencies: implementation in the field.Creative Commons 'BY' version 4.0 license
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