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Browsing by Author "Swinger, Nathan"
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Item Diabetic Ketoacidosis With Refractory Hypokalemia Leading to Cardiac Arrest(Cureus, 2022-03-24) Grout, Sarah; Maue, Danielle; Berrens, Zachary; Swinger, Nathan; Malin, Stefan; Pediatrics, School of MedicineDiabetic ketoacidosis (DKA) is known to cause total body potassium depletion, but during initial presentation, very few patients are hypokalemic, and even fewer patients experience clinical effects. As the correction of acidosis and insulin drive potassium intracellularly, measured serum potassium levels decrease and require repletion. This phenomenon is well described, and severe hypokalemia necessitates delaying insulin therapy. Less well described is the kaliuretic nature of treatments of cerebral edema. We present a case of an adolescent male with new-onset type 2 diabetes who presented in DKA with signs of cerebral edema, hyperosmolarity, and hypokalemia. As insulin and cerebral edema therapy were initiated, his hypokalemia worsened despite significant IV repletion, eventually leading to ventricular tachycardia and cardiac arrest. Over the following 36 hours, the patient received >590 milliequivalents (mEq) of potassium. He was discharged home 12 days after admission without sequelae of his cardiac arrest.Item Does Length of Emergency Medicine Training Matter for Leadership Skills in Pediatric Resuscitation? A Pilot Study(2023-04-28) Schoppel, Kyle; Keilman, Ashley; Fayyaz, Jabeen; Padlipsky, Patricia; Diaz, Maria Carmen G.; Wing, Robyn; Hughes, Mary; Franco, Marleny; Swinger, Nathan; Whitfill, Travis; Walsh, BarbaraBackground The majority of pediatric patients in the United States (US) are evaluated and treated at general emergency departments (GEDs) that are often ill prepared for pediatric patients. Despite rotating at large pediatric hospitals, during training Emergency Medicine (EM) residents care perform few pediatric resuscitations. It is possible that discrepancies in length of EM residency training may allow for variable exposure to pediatric patients, critical resuscitations, and didactic events. The goal of this study was to compare leadership skills of EM residents graduating from 3 vs. 4-year programs during simulated pediatric resuscitations using a previously validated leadership assessment tool, the Concise Assessment of Leader Management (CALM). Methods This was a prospective, multicenter, simulation-based cohort pilot study that included graduating 3rd- and 4th-year EM resident physicians from 6 EM residency programs. We measured leadership performance across three simulated pediatric resuscitations using the CALM tool and compared leadership scores between the 3rd- vs. 4th-year resident cohorts. We also correlated leadership to self-efficacy scores. Results Forty-seven residents (24 3rd-year residents and 23 4th-year residents) participated. Out of a total possible CALM score of 66, residents from 3-year programs scored 45.2 [SD ± 5.2], 46.8 [SD ± 5.0], and 46.6 [SD ± 4.7], whereas residents from 4-year programs scored 45.5 [SD ± 5.2], 46.4 [SD ± 5.0], 48.2 [SD ± 4.3] during the sepsis, seizure and cardiac arrest cases respectively. The Total Leadership Score (TLS) for the 3-year cohort was 46.2 [SD ± 4.8] vs. 46.7 [ SD ± 4.5] (p = 0.715) for the 4-year cohort. Conclusions These data suggest there may be no difference in leadership skills between 3rd- vs 4th-year EM residents in our study cohort. This pilot study provides the basis of future work that will assess a larger multicenter cohort with the hope to obtain a more generalizable dataset.