2023
Diagnosis, Workup, Risk Reduction of Transient Ischemic Attack in the Emergency Department Setting: A Scientific Statement From the American Heart Association
Amin H, Madsen T, Bravata D, Wira C, Johnston S, Ashcraft S, Burrus T, Panagos P, Wintermark M, Esenwa C, Disease O. Diagnosis, Workup, Risk Reduction of Transient Ischemic Attack in the Emergency Department Setting: A Scientific Statement From the American Heart Association. Stroke 2023, 54: e109-e121. PMID: 36655570, DOI: 10.1161/str.0000000000000418.Peer-Reviewed Original ResearchMeSH KeywordsAmerican Heart AssociationEmergency Service, HospitalHumansIschemic Attack, TransientRisk Reduction BehaviorStrokeUnited StatesConceptsTransient ischemic attackIschemic attackMaximal medical therapyHigh-risk patientsCorrect clinical diagnosisRisk stratification scaleAmerican Heart AssociationEmergency department settingFuture cerebrovascular eventsScientific statementTime of evaluationCerebrovascular eventsSecondary preventionStroke riskMedical therapyNeurological examinationAcute phaseIndex eventHeart AssociationDepartment settingPatient educationAncillary testingCerebral vasculatureConfirmatory testingClinical diagnosis
2017
Neurology Concepts: Young Women and Ischemic Stroke—Evaluation and Management in the Emergency Department
Chang BP, Wira C, Miller J, Akhter M, Barth BE, Willey J, Nentwich L, Madsen T. Neurology Concepts: Young Women and Ischemic Stroke—Evaluation and Management in the Emergency Department. Academic Emergency Medicine 2017, 25: 54-64. PMID: 28646558, PMCID: PMC6415947, DOI: 10.1111/acem.13243.Peer-Reviewed Original ResearchConceptsIschemic strokeYoung womenEmergency departmentRisk factorsSex-specific risk factorsIschemic stroke evaluationAcute ischemic strokeOral contraceptive useBoard-certified emergency physiciansPremenopausal womenAcute settingBroad differentialCerebral hemorrhageStroke evaluationVascular neurologistsNonpregnant individualsPostpartum periodLeading causeEmergency physiciansTimely diagnosisContraceptive useThrombolytic agentsCurrent evidenceStrokeOlder populationEvaluation of a novel 5-group classification system of sepsis by vasopressor use and initial serum lactate in the emergency department
Swenson KE, Dziura JD, Aydin A, Reynolds J, Wira CR. Evaluation of a novel 5-group classification system of sepsis by vasopressor use and initial serum lactate in the emergency department. Internal And Emergency Medicine 2017, 13: 257-268. PMID: 28132131, DOI: 10.1007/s11739-017-1607-y.Peer-Reviewed Original ResearchConceptsInitial serum lactate levelSerum lactate levelsEmergency departmentLactate elevationVasoplegic shockLactate levelsCryptic shockVasopressor useInfected patientsShock mortalityHigh-risk ED patientsGroup mortality rateInitial serum lactateVasopressor-dependent patientsIdentifiable risk factorsSepsis-3 definitionRisk-stratify patientsHigh-risk subgroupsInitial lactate levelProximal phaseVasopressor dependenceVasopressor requirementHospital outcomesED patientsSerum lactate
2016
The Advanced Reperfusion Era: Implications for Emergency Systems of Ischemic Stroke Care
Miller JB, Merck LH, Wira CR, Meurer WJ, Schrock JW, Nomura JT, Siket MS, Madsen TE, Wright DW, Panagos PD, Lewandowski C. The Advanced Reperfusion Era: Implications for Emergency Systems of Ischemic Stroke Care. Annals Of Emergency Medicine 2016, 69: 192-201. PMID: 27600649, DOI: 10.1016/j.annemergmed.2016.06.042.Peer-Reviewed Original ResearchMeSH KeywordsBlood Vessel ProsthesisEmergency Service, HospitalEndovascular ProceduresFibrinolytic AgentsHumansStentsStrokeThrombolytic TherapyConceptsStroke careLarge-vessel ischemic strokeEndovascular stroke treatmentIschemic stroke careEmergency medicine cliniciansEndovascular careReperfusion eraIschemic strokeStroke treatmentEndovascular treatmentTreatment paradigmLeading causeMedicine cliniciansTimely treatmentCarePatientsHospitalTreatmentMorbidityStrokeMortalityCliniciansCentral role
2015
Lactate Clearance Predicts Survival Among Patients in the Emergency Department with Severe Sepsis
Bhat SR, Swenson KE, Francis MW, Wira CR. Lactate Clearance Predicts Survival Among Patients in the Emergency Department with Severe Sepsis. Western Journal Of Emergency Medicine 2015, 16: 1118-1126. PMID: 26759665, PMCID: PMC4703153, DOI: 10.5811/westjem.2015.10.27577.Peer-Reviewed Original ResearchConceptsSevere sepsisSeptic shockLactate clearanceClearance groupLactate levelsPredictors of mortalityEmergency department patientsInitial lactate levelCross-sectional studySepsis registryVasopressor supportED stayDepartment patientsHospital interventionsMechanical ventilationEmergency departmentLactate changesSepsisPatientsMortality rateHigh mortalityHospital floorMortalityClearanceED
2014
Gender Differences in Neurologic Emergencies Part I: A Consensus Summary and Research Agenda on Cerebrovascular Disease
Madsen TE, Seigel TA, Mackenzie RS, Marcolini EG, Wira CR, Healy ME, Wright DW, Gentile NT. Gender Differences in Neurologic Emergencies Part I: A Consensus Summary and Research Agenda on Cerebrovascular Disease. Academic Emergency Medicine 2014, 21: 1403-1413. PMID: 25422086, DOI: 10.1111/acem.12528.Peer-Reviewed Original ResearchConceptsNeurologic emergencySubarachnoid hemorrhageEmergency departmentCause of deathPathophysiologic differencesHemorrhagic strokeCerebrovascular diseaseED providersOverall management planPatient evaluationED diagnosisEmergency physiciansGender differencesRole of sexNominal group techniqueOutcomes pertinentConsensus summaryDiagnosisMigraineSexStrokeEmergencyFuture research prioritiesTreatmentResearch prioritiesEarly Identification and Management of Patients with Severe Sepsis and Septic Shock in the Emergency Department
Keegan J, Wira CR. Early Identification and Management of Patients with Severe Sepsis and Septic Shock in the Emergency Department. Emergency Medicine Clinics Of North America 2014, 32: 759-776. PMID: 25441033, DOI: 10.1016/j.emc.2014.07.002.Peer-Reviewed Original ResearchMeSH KeywordsAlgorithmsEmergency Service, HospitalHumansRisk AssessmentSepsisShock, SepticVasoconstrictor AgentsMeta-analysis of Protocolized Goal-Directed Hemodynamic Optimization for the Management of Severe Sepsis and Septic Shock in the Emergency Department
Wira CR, Dodge K, Sather J, Dziura J. Meta-analysis of Protocolized Goal-Directed Hemodynamic Optimization for the Management of Severe Sepsis and Septic Shock in the Emergency Department. Western Journal Of Emergency Medicine 2014, 15: 51-59. PMID: 24696750, PMCID: PMC3952890, DOI: 10.5811/westjem.2013.7.6828.Peer-Reviewed Original ResearchMeSH KeywordsClinical ProtocolsEmergency Service, HospitalHemodynamicsHumansPatient Care PlanningSepsisShock, SepticTreatment OutcomeThe Shock Index as a Predictor of Vasopressor Use in Emergency Department Patients with Severe Sepsis
Wira CR, Francis MW, Bhat S, Ehrman R, Conner D, Siegel M. The Shock Index as a Predictor of Vasopressor Use in Emergency Department Patients with Severe Sepsis. Western Journal Of Emergency Medicine 2014, 15: 60-66. PMID: 24696751, PMCID: PMC3952891, DOI: 10.5811/westjem.2013.7.18472.Peer-Reviewed Original ResearchMeSH KeywordsAgedCross-Sectional StudiesEmergency Service, HospitalFemaleHumansMaleMiddle AgedRetrospective StudiesRisk AssessmentSepsisSeverity of Illness IndexVasoconstrictor AgentsConceptsSevere sepsisEmergency departmentVasopressor useCardiovascular collapseOrgan failureElevation groupEscalation of careEmergency department patientsCross-sectional studySepsis registryVasopressor dependenceED admissionDepartment patientsInitial presentationShock indexED patientsRisk stratificationLeading causeUseful modalityPatientsSepsisDisease escalationEarly identificationMean numberHigh rate
2012
Missed Opportunities for Recognition of Ischemic Stroke in the Emergency Department
Lever NM, Nyström KV, Schindler JL, Halliday J, Wira C, Funk M. Missed Opportunities for Recognition of Ischemic Stroke in the Emergency Department. Journal Of Emergency Nursing 2012, 39: 434-439. PMID: 22633790, DOI: 10.1016/j.jen.2012.02.011.Peer-Reviewed Original ResearchConceptsNontraditional symptomsIschemic strokeEmergency departmentSymptom presentationDiagnostic accuracyYale-New Haven HospitalComprehensive neurological evaluationGeneralized weaknessNeurological evaluationStroke symptomsMedical recordsMental statusEmergency nursesPatientsAppropriate managementSymptomsStrokeDiagnosisStrong associationSymptom typeHospitalPresentationMissed opportunityDescriptive statisticsAssociation