FASTR II
What is the main chief complaint to look for when finding eligible patients for this study?
Heart failure
What is the alternative diagnostic tool (as opposed to CT scans) that this study evaluates?
Abdominal ultrasounds
What must the chest X-Ray be positive for?
Pneumonia
Who are we receiving patient feedback for?
The UCD Emergency Medicine Residents
11 to <18 years old
Yes, consent needs to be obtained, and the RCs obtain this consent.
What's an example of a blunt torso trauma resulting from a significant mechanism of injury?
- Motor vehicle collision: greater than 60 mph, ejection, or rollover
- Automobile versus pedestrian/bicycle: automobile speed > 25 mph
- Falls greater than 20 feet in height
- Crush injury to the torso
-Physical assault involving the abdomen
What are some of the chief complaints to look for?
Look for kids coming in with CC of cough, fever, flu-like illness, SOB, 944, especially if a chest x-ray is ordered at the same time
True or False: We click into the patient chart for patients that we think are approachable for QIs
False
What is the one exclusion criteria?
Patient or parent doesn't speak Spanish or English
Name three inclusion criterias
- Participants ≥ 22 years of age able to provide informed consent and comply with study procedures.
- Diagnosis of HF with expected hospitalization >24 hours, with >1 new or worsening symptom and >2 physical examination, laboratory, or invasive findings of HF, and receiving or with plans to receive a HF-specific treatment
- ≥10 lb. (4.5 kg) above dry weight as estimated by health care provider.
- Current outpatient prescription for daily loop diuretic.
- Elevated risk of diuretic resistance, as indicated by at least one of the following:
o Baseline hypochloremia [Chloride ≤ 100mmol/L], or
o Urine output <1L in the 6 hours following IV loop diuretic ≥40mg furosemide equivalent, or
o Spot urine sodium <100 mmol/L 1-2 hours after IV loop diuretic ≥40mg furosemide equivalent
Name three exclusion criteria
- Age-adjusted hypotension (hemodynamic instability)
-Penetrating trauma: Patients who are victims of stab or gunshot wounds
-Traumatic injury occurring > 24 hours prior to the time of presentation to the ED
-Transfer of the patient to the ED from an outside facility with abdominal CT scan, diagnostic peritoneal
lavage, or laparotomy previously performed
-Transferred with FAST exam already performed at outside hospital
-Initial GCS score ≤ 8
-Known pregnancy or is a prisoner
age ≥ 3 months to <18 years old)
When approaching a patient for a QI, they claim that they don't recognize the patient. What do you do?
Tell them that the resident might not have had the time to come by yet, and someone in the yellow shirts will come by later. Thank them for their time
Who is the PI for this study?
Dr. Nishijima
Who are the PI and Co-Investigator of this study?
PI: Bryn Mumma MD MAS
Co-Investigator: Angela Jarman MD
When do we get consent?
What part of the process do we gain consent from the patients for?
The follow up
Name four reasons why you shouldn't approach a patient for a QI
5150/ Psych patient, Prisoner, Unresponsive, Tested positive for COVID
What's the primary objective of this study?
To develop and validate a clinical tool to predict which adolescents with mTBIs are at an increased risk for developing significant new or worsening mental health issues.
What does FASTR stand for
Fluid management of Acute decompensated heart failure Subjects Treated with Reprieve System
Who are the PIs?
im Holmes MD, MPH & Nathan Kuppermann MD, MPH
Name three of the exclusion criterias
- Hospitalization within 30 days prior to ED presentation
-Immunodeficiency/Immunosuppression
-Chronic pulmonary diseases (except asthma)
-Physiologically significant cardiac disease
-Sickle Cell disease
- Neuromuscular disorders affecting respiration
-Previous enrollment within 30 days prior to this visit
-Transferred from another hospital
-Parental objection
-Ward of the state
What do you do if a patient answers that the resident has not yet been able to come back because they are still running tests, waiting on labs/scans, etc?
Leave that question blank
What does SEARCH-mtbi stand for?
Screening Emotions in Adolescents Receiving Care at the Hospital for mTBI