Kyle R. Fischer, MD, MPH, Director of UMMC's Public Policy Fellowship, is the lead author of the review article titled “Trauma-Informed Care for Violently Injured Patients in the Emergency Department,” which has been accepted for publication by Annals of Emergency Medicine. Dr. Fischer and his co-authors from the University of Colorado, Drexel University, the University of Pennsylvania, Einstein Medical Center, Boston University, and the Medical College of Wisconsin are members of the National Network of Hospital-Based Violence Intervention Programs.
Zachary Dezman, MD, MS, MS, was contacted by the Associated Press to comment on Second Chance, an app developed at the University of Washington and now being tested for its ability to detect the shallow breathing that suggests opioid overdose. Installed on a smartphone, the software uses the microphone and speaker to send out inaudible sound waves and then record how they bounce back. Analysis of the signals indicates the slowing or cessation of breathing. In its current stage of development, the app requires a bystander to interpret the alarm and summon help for an opioid user in trouble. The developers are working on technology that would call for help independently when signs of overdose are detected.
The article, including Dr. Dezman's perspective, can be read here:
The app and its preliminary test results are described in the January issue of Science Translational Medicine.
At a press conference held at Baltimore’s City Hall on December 19, Mayor Catherine Pugh announced that the University of Maryland Medical Center’s midtown and downtown campuses have been awarded “Level 1” status, the highest certification in the city’s efforts toward addressing the opioid epidemic. The city’s Levels of Care initiative assesses hospitals’ ability to provide treatment to patients who screen positive for a substance use disorder, distribute naloxone to patients, and ensure physicians are prescribing opioids judiciously. Of the 11 hospitals assessed, UMMC and Midtown were the only two in the top tier of readiness and resources to offer comprehensive and timely treatment to ED patients struggling with opioid addiction."
Zachary D.W. Dezman, MD, MS, MS, chair of Midtown’s Opioid Task Force, noted that “a staggering 70% of patients who come to our EDs for care are struggling with addiction, behavioral health problems, or both. About one in every 50 patients treated at Midtown's ED is suffering from an overdose of some kind. We offer patients resources to put them on a path toward healing, including dispensing naloxone to those at high risk for overdose and providing peer recovery support services. Those peers can link patients with substance abuse problems to inpatient treatment programs within hours.”
UMMC’s Opioid Task Force is co-chaired by Christopher Welsh, MD, and R. Gentry Wilkerson, MD. Attendees at the Wednesday morning press conference included Reginald Brown, MD, ED Director, Bon Secours; Michael Jablonover, MD, MBA, CMO and Senior Vice President of UMMC; Mary Beth Haller, interim Baltimore Health Commissioner; and Alison Brown, MPH, President of UMMC’s Midtown Campus.
Jenny Guyther, MD, and Danya Khoujah, MBBS, were faculty members for the National Continued Competency Program Paramedic Refresher course, held at the University of Maryland, Baltimore County, during the week of October 30. Dr. Guyther’s lectures were titled “What a Pain! A Closer Look at Head and Neck Trauma” and “Challenging the Status Quo: Where the EMS Literature is Taking Us.” Dr. Khoujah presented three lectures: “Stroke: Beyond the Basics,” “Seizures,” and “Pearls and Pitfalls of Managing Psychiatric Emergency.” The course was sponsored by UMBC’s Department of Emergency Health Services.
Laura Diegelmann, MD, RDMS, was a site coordinator for an international study on the use of ultrasound in the assessment of nontrauma patients with hypotension without an obvious cause. The study involved patients from three medical centers in North America and three in South Africa. Point-of-care ultrasound conveyed no demonstrable outcome benefit to patients with undifferentiated shock. The results of this study were published as the article titled “Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients with Undifferentiated Hypotension? An International Randomized Controlled Trial from the Shoc-ED Investigators” in the October issue of Annals of Emergency Medicine.
Wendy Chang, MD, collaborated with investigators from the Departments of Neurology, Anesthesiology, and Surgery in an analysis of clinical information from patients enrolled in the Oximetry and Noninvasive Predictors of Intervention Need after Trauma (ONPOINT) study. They concluded that continuous vital sign variability and waveform analysis of the electrocardiogram or photoplethysmogram within the first hour after resuscitation constitutes a noninvasive marker of neurologic decline after traumatic brain injury.
Their work was published as the following article:
Melinosky C, Yang S, Hu P, Li H, Miller CHT, Khan I, Mackenzie C, Chang WT, Parikh G, Stein D, Badjatia N. Continuous vital sign analysis to predict secondary neurological decline after traumatic brain injury. Frontiers in Neurology 2018 Sep 25;9:761.
US Senator Chris Van Hollen (D-MD) visited UMMC's emergency department on November 1 to discuss the effects of the opioid crisis on ED operations, the use fentanyl among ED patients, and the administration of buprenorphine to patients seeking treatment or in withdrawal. Joining in that conversation were (left to right) Mohan Suntha, MD, MBA, President and Chief Executive Officer, University of Maryland Medical Center, Michael E. Winters, MD, MBA, Senator Van Hollen, Stephen R. Thom, MD, PhD, Zachary D.W. Dezman, MD, MS, MS, and Eric Weintraub, MD, Department of Psychiatry.
Amal Mattu, MD, conducted a 21-hour course on emergency cardiology in Sarasota, Florida, from October 22 to 26. The CME course, titled "Emergency Cardiology: Beyond A-B-C and ACLS," was sponsored by American Medical Seminars. Content included electrocardiographic workshops covering cardiac ischemia and its mimics, advanced dysrhythmia recognition and management, and critical ECG findings in patients with syncope. In addition, Dr. Mattu presented lectures on cardiogenic pulmonary edema, cardiac arrest, acute coronary syndromes, low-risk chest pain, and legal pitfalls in emergency cardiology. The course was attended by over 100 health care providers in emergency medicine, internal medicine, family medicine, anesthesiology, cardiology, cardiothoracic surgery, and critical care from the United States, Canada, and the Caribbean.
Zachary Dezman, MD, MS, MS, and Jon Mark Hirshon, MD, PhD, MHS, co-authored the article titled "Repeat Lactate Level Predicts Mortality Better Than Rate of Clearance," pubilshed in the November issue of American Journal of Emergency Medicine. Their collaborators in this project were three investigators who have been studying the fine points of trauma epidemiology and resuscitation for decades: Peter Hu, MS, PhD, and Colin Mackenzie, MD,ChB, from the Department of Anesthesiology, and Gordon Smith, MB,ChB, MPH, from the Department of Epidemiology and Pubic Health, as well as Thomas Scalea, MD, The Honorable Francis X. Kelly Distinguished Professor in Trauma Surgery. The statistician for this work was Angela Comer, MS, formerly affliated with the National Study Center for Trauma and Emergency Medical Systems.
The use of buprenorphine in the ED at UMMC’s Midtown Campus is discussed in a recent article in the Washington Post:
In that article, Dr. Zachary Dezman explains that opioid-addicted patients seen “after hours” are offered an initial dose of the anti-addiction medication rather than simply being sent home and advised to go to a treatment center. Numerous studies have shown this “jumpstart” on treatment to be effective in helping people seek help and eventually kick their habit.