This year's UW Department of Emergency Medicine Annual Research Showcase was conducted virtually and once again featured groundbreaking research from faculty, residents, and medical students!
Research topics included hemmhoragic shock, COVID-19, telehealth in refugee settlements in Uganda, ultrasound, sepsis, and intensive care.
- Aubrey Brown
Title: Evaluating the Risk of Acquiring COVID-19 Illness Among Emergency Medical Services Providers Following Aerosol Generating Procedures
Abstract Intro: Emergency Medical Services (EMS) providers may treat patients with SARS-CoV-2 (COVID-19) infection without knowing the patient’s COVID-19 status. Aerosol generating procedures (AGPs) are believed to increase occupational risk. The magnitude of risk from AGPs while wearing personal protective equipment (PPE) is unclear. We investigated the risk of COVID-19 transmission to EMS providers involved in the care of patients with COVID-19 stratified according to AGP use.
- Natalie Bulger
Title: Prehospital End Tidal Carbon Dioxide Predicts Hemhorragic Shock Upon Emergency Department Arrival
Abstract Intro: In addition to reflecting gas exchange within the lungs, end tidal carbon dioxide (ETCO₂) also reflects cardiac output based on CO2 delivery to the pulmonary parenchyma. We hypothesized that low prehospital ETCO₂ values would be predictive of hemorrhagic shock in intubated trauma patients.
- Gabriel Erion
Title: Cost-Aware Artificial Intelligence for Acute Traumatic Coagulopathy Prediction
Abstract Intro: Artificial intelligence (AI) based models have the potential to help emergency providers diagnose critical illness more quickly and accurately; however, using such predictive models requires additional resources and costs valuable time. Acute traumatic coagulopathy (ATC) is one such time-sensitive diagnosis, for which several prehospital risk scores have been developed but are not widely used. We hypothesized that an AI-based model emphasizing efficiency and incorporating medical expert opinion for feature selection would predict ATC faster without sacrificing accuracy.
- Robin Klabbers
Title: Dial-COVID: Remote Mitigation Through Telephone Symptom Surveillance in Refugee Settlements in Uganda
Abstract Intro: Persons living in refugee settlements in sub-Saharan Africa are at high risk for COVID-19 due to high-density housing, lack of water access, and limited information availability. We aimed to collect COVID-19 symptoms and exposures and disseminate public health information on COVID-19 in refugee settlements in Uganda using a telephone based interactive voice response (IVR) tool, “Dial-COVID."
- Sophie Morse
Title: Qualitative Study of People who use Methamphetamine during COVID-19 Informing Future ED Risk Mitigation Strategies
Abstract Intro: Morbidity and mortality related to methamphetamine (meth) are on the rise. The Washington state ‘Stay Home, Stay Healthy’ order issued in March 2020 shuttered non-essential business and encouraged social distancing to decrease transmission of COVID-19. The aim of this study was to explore concerns and COVID-19 risk mitigation strategies with patients who use meth to inform emergency department (ED)-based harm reduction approaches for this vulnerable population.
- Bonnie Snyder
Title: Association of Small Adult Ventilation Bags with Return of Spontaneous Circulation in Out of Hospital Cardiac Arrest
Abstract Intro: Excess minute ventilation adversely affects hemodynamics during cardiac arrest. Little is known about the consistency and efficacy of ventilations delivered by EMS to patients with out-of-hospital cardiac arrest (OHCA). In July 2017, this Seattle Fire Department began using smaller ventilation bags, delivering approximately 450mL per breath, in adults with OHCA. We hypothesized that the rate of return of spontaneous circulation (ROSC) at hospital arrival would increase after this change.
- Bart Grabman
Title: Changes in End-Tidal Carbon Dioxide After Defibrillation During Out-of-Hospital Cardiac Arrest
Abstract Intro: A large rise in end-tidal carbon dioxide (ETCO2) during out-of-hospital cardiac arrest (OHCA) has traditionally been considered a sensitive marker for return of spontaneous circulation (ROSC), despite a relative lack of evidence. National guidelines suggest increases in ETCO2 of 10 mm Hg or greater likely indicate ROSC, while research has found this value to be specific but non-sensitive for ROSC. While ETCO2 is considered the gold-standard for monitoring patients during OHCA, the prognostic value of changes post-defibrillation is poorly understood. The purpose of this study is to evaluate the association between ETCO2 and ROSC during defibrillation in out-of-hospital cardiac arrest.
- Axel Adams. MD, MS
Title: Aero-Tox: Characterizing Cases of Intoxication Aeromedically Retrieved by Airlift Northwest
Abstract Intro: Intoxicated patients are a significant proportion of patients transported by aeromedical care services; however, few case series have been published characterizing this population. In this retrospective observational case series we characterize the population of intoxicated patients transported by Airlift Northwest in the time period of September 2009-September 2020 with the aim of improving understanding of aeromedical transport of intoxicated patients, care processes in transport, and outcomes.
- Lucy Goodson, MD
Title: Systematic Review and Meta-Analysis of Remote Ischemic Conditioning in Patients With ST-Elevation Myocardial Infarction
Abstract Intro: Remote ischemic conditioning (RIC) induces non-lethal ischemia in an extremity by intermittent application of a cuff in order to reduce cell injury, morbidity and mortality associated with reperfusion injury. Multiple small randomized controlled trials suggest that RIC reduces infarct size in patients with ST-elevation myocardial infarction (STEMI). We sought to systematically review the effectiveness and safety of RIC versus standard care in patients with STEMI.
- Elinor Sveum, MD, MSPH
Title: Prevalence and Risk Factors for Hypertension and Diabetes Among Those Screened in a Refugee Settlement in Uganda
Abstract Intro: Diabetes and hypertension are increasingly prevalent in low- and middle-income countries, but they are not well-documented in refugee settlements in these settings. We sought to estimate the prevalence and associated characteristics of diabetes and hypertension among adults presenting for clinic-based HIV testing in Nakivale Refugee Settlement in Uganda.
- Jeremy Shin, MD, Bennett King, MD
Title: Simulation Based Mastery Learning for Ultrasound Guided Peripheral IV Insertion Leads to Improved Contrast Extravasation Rates with Computerized Tomography in the Emergency Department
Abstract Intro: Computerized tomography (CT) with intravenous (IV) contrast have become indispensable for the evaluation of patients in the emergency department (ED). Contrast extravasation (CE) occurs when contrast errantly infuses into the extravascular space. CEs may result in patient morbidity, delays, and increased costs. For patients with difficult IV access (DIVA), Ultrasound Guided Peripheral IVs (USGPIV) are increasingly used to facilitate enhanced CTs. However, studies have shown USGPIVs have high rates of CE compared traditional PIVs. While many factors may influence CE rates in USGPIV, the role of provider training has been unexplored. Our objective was to determine if training emergency nurses (ENs) using a novel simulation-based mastery learning (SBML) curriculum would improve CE rates at our institution.
Faculty & Fellow Presentations:
- Joshua Kreiger, MD
Title: Emergency department characteristics and associations with intensive care admission among patients with coronavirus disease 2019
Abstract Intro: There have been few descriptions in the literature to date specifically examining initial coronavirus disease 2019 (COVID‐19) patient presentation to the emergency department (ED) and the trajectory of patients who develop critical illness. Here we describe the ED presentation and outcomes of patients with COVID‐19 presenting during our initial local surge.
Title: “That Line Just Kept Moving”: Motivations of People Who Use Methamphetamine and Their Experiences in the Emergency Department
Abstract Intro: Methamphetamine (meth) use is on the rise nationwide with increasing emergency department (ED) visits and deaths related to overdose. Previous research notes that emergency providers describe meth use as a significant problem with high resource utilization, recidivism, and violence against staff, but little is known about the perspectives of patients. The objective of this study is to identify the motivations of people who use meth and their experiences in the ED in order to guide future ED-based approaches.
Title: The role of speciality identity on physician-to-physician interactions during hospital admission conversations
Abstract Intro: Communication and teamwork are core competencies for physicians. However, despite the use of structured hand-off tools, interpersonal interactions at the time of admitting a patient continue to be an underexplored source of workplace conflict. The goal of this study was to gain a more nuanced description of conflictual interpersonal interactions between physician colleagues in order to provide foundational guidance for how training communities can support best practices and curricular innovation regarding communication.
Title: Delivery of a resuscitation fluid cocktail containing fibrinogen and vasopressin as an infusion rather than boluses decreases hemorrhage in swine polytrauma model
Abstract Intro: Hemorrhage is a major contributor to the massive burden caused by trauma, and treatment of trauma victims in austere settings can be challenging. We have previously shown that a low-volume resuscitation fluid cocktail containing vasopressin and fibrinogen improves vital organ perfusion while minimizing hemorrhage when delivered in two boluses 30 minutes apart in a swine model of polytrauma. However, each bolus caused a spike in mean arterial pressure, possibly leading to thrombus failure and contributing to hemorrhage. If the vasoactive cocktail were administered in a slower fashion, it could blunt these blood pressure spikes and further mitigate blood loss. Our objective was to determine whether administration of this multifunctional resuscitation fluid cocktail as a continuous infusion rather than as two boluses can improve outcomes in a swine model of polytrauma.
Title: Rationale and Design of Hypothermia in Patients with ST-Elevation Myocardial Infarction Research Program
Abstract Intro: The overall objective is to assess whether IH to of 33°C before primary PCI significantly reduces IS and clinical outcomes versus standard care in patients with acute anterior STEMI.
Title: Time to antibiotics and in-hospital mortality are triage temperature dependent among ED patients with suspected sepsis
Abstract Intro: Emergency department (ED) triage temperature likely influences clinical decision making and relates to patient outcomes in sepsis. This study investigates the association between ED triage temperature, antibiotic order timing, and in-hospital mortality among ED patients with sepsis.
Title: Innovative Support for Patients with SARS-COV-2 Infections Registry (INSPIRE): a protocol to assess the sequalae of SARS-CoV-2 in the USA
- Canada Parrish, PhD
Title: Evaluating the Impact of Washington State’s Emergency Department Information Exchange
Abstract Intro: Health information exchange (HIE) has been promoted as a strategy to facilitate care coordination and reduce costs for high-needs Medicaid patients. In 2012, Washington state implemented an HIE referred to as the Emergency Department Information Exchange (EDIE) as part of its “ER is for Emergencies” program. To date, the impact of EDIE has not been systematically evaluated. The purpose of this study is to examine how EDIE influenced ED utilization, inpatient admissions, and expenditures for Medicaid beneficiaries.