Browsing by Author "Coleman, Keel"
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- Evaluating Rescuer Performance in Response to Opioid Overdose in a Community Setting: Evidence for Medically Appropriate Process MeasuresEdwards, G. Franklin III; Mierisch, Cassandra; Strauss, Allison; Mutcheson, Brock; Coleman, Keel; Horn, Kimberly; Parker, Sarah H. (Elsevier, 2023-02)Overdose education and naloxone distribution (OEND) programs are widely accepted to reduce opioid overdose deaths. However, there is currently no validated instrument to evaluate the skills of learners completing these programs. Such an instrument could provide feedback to OEND instructors and allow researchers to compare different educational curricula. The aim of this study was to identify medically appropriate process measures with which to populate a simulation-based evaluation tool. Researchers conducted interviews with 17 content experts, including healthcare providers and OEND instructors from south-central Appalachia, to collect detailed descriptions of the skills taught in OEND programs. Researchers used three cycles of open coding, thematic analysis, and consulted currently available medical guidelines to identify thematic occurrences in qualitative data. There was consensus among content experts that the appropriate nature and sequence of potentially lifesaving actions during an opioid overdose is dependent on clinical presentation. Isolated respiratory depression requires a distinct response compared to opioid-associated cardiac arrest. To accommodate these different clinical presentations, raters populated an evaluation instrument with the detailed descriptions of overdose response skills, such as naloxone administration, rescue breathing, and chest compressions. Detailed descriptions of skills are essential to the development of an accurate and reliable scoring instrument. Furthermore, evaluation instruments, such as the one developed from this study, require a comprehensive validity argument. In future work, the authors will integrate the evaluation instrument in high-fidelity simulations, which are safe and controlled environments to study trainees’ application of hands-on skills, and conduct formative assessments.
- Methemoglobinemia Secondary to Babesia Microti Infection: A Novel Case ReportColeman, Keel; Brown, Andrew J. (2023)Background Tick-borne illnesses and methemoglobinemia have not been traditionally associated with each other or known to occur together in humans. Few cases have been documented in various animals of methemoglobinemia secondary to tick-borne infections. Case Report A 49-year-old male with no significant past medical history presented to the emergency department from an urgent care with hypoxia saturating in the mid 80’s. He also complained of a pruritic rash on his back and right shoulder as well as both of his lower extremities. The rash had been present for 4 days. The patient was tachycardic and hypoxic at 90% but denied shortness of breath. He had cyanosis of the lips and fingertips and multiple erythematous, raised, ovoid lesions on the right shoulder, left thigh and left lower extremity. Methemoglobin levels were elevated at 26%. He was treated with methylene blue, supplemental oxygen, and empiric doxycycline with improvement in his oxygenation. A tick-borne illness panel resulted two days later positive for Babesia microti infection. His skin lesions resolved with the above described treatment. Why should an emergency physician be aware of this? Both tick-borne illnesses and methemoglobinemia are typically easily treatable with proper antimicrobial coverage and methylene blue, respectively. The current literature is bare regarding concurrent tick-borne illnesses, specifically babesiosis, and methemoglobinemia. Without knowledge and documentation of a potential link between the two conditions, hypoxia, if found to be due to methemoglobinemia, may be treated adequately, while a potentially life-threatening tick-borne illness may continue to cause damage and disease to the patient if not tested for, identified and treated.