- Critical Care Medicine
Clinical Assistant Professor, Emergency Medicine
Residency: UCSF Fresno Emergency Medicine Residency (2011) CA
Medical Education: Columbia University College of Physicians and Surgeons (2016) NY
Board Certification: American Board of Emergency Medicine, Critical Care Medicine (2015)
Fellowship: University of Washington Medical Center (2015) WA
Board Certification: American Board of Emergency Medicine, Emergency Medicine (2012)
Internship: University of Illinois at Chicago College of Medicine (2007) IL
Graduate and Fellowship Programs
Critical Care Medicine (Fellowship Program)
Call of Duty - What are Physicians' Obligations During Crises?
The Journal of emergency medicine
BACKGROUND: Society allows physicians the privilege and responsibility of caring for patients. Those responsibilities demand that their knowledge and technical expertise meet standards defined and policed by their colleagues, through medical societies or governmental entities. However, the fiduciary duty that patients' interests are held above those of the physicians' is an ethical precept that is tested when society is under threat.DISCUSSION: Disasters that stress society are a constant and can present themselves in a myriad of ways to include medical, meteorological, or political. Minimizing the potential damage to the quality and quantity of life of the population is dependent upon public safety personnel and health care professionals who may put their health and safety in harm's way to care for patients. These acts may be taken for granted or assumed to be part of the professional obligations of physicians and other health care workers who work at the bedside. The obligations of physicians to their patients and society may differ from those not in the medical field, and the level of risk deemed acceptable by the physician and by society should be clearly delineated.CONCLUSION: Despite the conflict between normative and descriptive ethics, in times of disaster, physicians must respond to the call of duty. This duty is contingent on the responsibility being shared with governmental agencies and health care facilities, to mitigate the risks borne by those who answer the call.
View details for DOI 10.1016/j.jemermed.2022.07.017
View details for PubMedID 36229319
Cutting Edge Acute Ischemic Stroke Management.
Emergency medicine clinics of North America
2019; 37 (3): 365–79
Acute ischemic stroke (AIS) is a medical emergency that requires prompt recognition and streamlined work-up to ensure that time-dependent therapies are initiated to achieve the best outcomes. This article discusses frequently missed AIS in the emergency department, the role of various imagining modalities in the work-up of AIS, updates on the use of intravenous thrombolytics and endovascular therapy for AIS, pearls on supportive care management of AIS, and prehospital and hospital process improvements to shorten door-to-needle time.
View details for DOI 10.1016/j.emc.2019.03.001
View details for PubMedID 31262409
Radiographic and Clinical Predictors of Cardiac Dysfunction Following Isolated Traumatic Brain Injury
JOURNAL OF INTENSIVE CARE MEDICINE
2017; 32 (2): 151-157
Although cardiac dysfunction after traumatic brain injury (TBI) has been described, there is little data regarding the association of radiographic severity and particular lesions of TBI with the development of cardiac dysfunction. We hypothesize that the Rotterdam or Marshall scores and particular TBI lesions are associated with the development of cardiac dysfunction after isolated TBI.We performed a retrospective cohort study. Adult patients with isolated TBI who underwent echocardiography between 2003 and 2010 were included. A board-certified neuroradiologist assessed the first computed tomography head, assigning the Rotterdam and Marshall scores and the type of TBI. Cardiac dysfunction was defined as either systolic or all cause based on the first echocardiogram after TBI. Demographic, radiological, and clinical variables were used in our analysis.A total of 139 patients were identified, with 20 having isolated systolic dysfunction. The Marshall and Rotterdam scores were not associated with the development of cardiac dysfunction. Only head Abbreviated Injury Scale was found to be an independent predictor of systolic cardiac dysfunction (relative risk: 2.70, 95% confidence interval: 1.19-6.13; P = .02).No specific radiographic variable was found to be an independent predictor of cardiac dysfunction. Further study into clinical or radiological features that would warrant an echocardiogram is warranted, as it may direct patient management.
View details for DOI 10.1177/0885066615616907
View details for Web of Science ID 000394894200007
View details for PubMedID 26584593
CERVICAL SPINE INJURY: ANALYSIS AND COMPARISON OF PATIENTS BY MODE OF TRANSPORTATION
JOURNAL OF EMERGENCY MEDICINE
2013; 44 (2): 287-291
Cervical spine injury (CSI) studies have identified different factors contributing to CSI, but none compares the incidence and pattern of injury of patients arriving at the Emergency Department (ED) by private vehicle (PV).We compared the characteristics and injury patterns in CSI patients who were transported to the ED via Emergency Medical Services (EMS) versus PV.We conducted a three-hospital retrospective review of patients with CSI from January 1, 2000 to December 31, 2007. We excluded transfers and follow-up visits. Using a standardized data collection form, we reviewed demographics, mode of transport, mechanism of injury, imaging results, injury type and level, and neurologic deficits. Means and proportions were compared using t-tests and chi-squared as appropriate.Of 1174 charts identified, 718 met all study criteria; 671 arrived by EMS and 47 by PV. There was no difference between groups in age or gender. Ground-level fall was more likely in PV patients (32%, 95% confidence interval [CI] 20-46% vs. 6%, 95% CI 4-9%), whereas motor vehicle collision was less likely (32%, 95% CI 20-46% vs. 67%, 95% CI 63-70%). PV patients more often sustained a stable injury (66%, 95% CI 52-78% vs. 40%, 95% CI 36-44%), and were more often triaged to a lower-acuity area (25%, 95% CI 15-40% vs. 4%, 95% CI 3-6%). The incidence of neurologic deficit was similar (32%, 95% CI 20-46% vs. 24%, 95% CI 21-28%), though more PV patients had spinal cord injury without radiographic abnormality (21%, 95% CI 12-35% vs. 5%, 95% CI 4-7%).A small proportion of patients with CSI present to the ED by PV. Although most had stable injuries, a surprising number had unstable injuries with neurologic deficits, and were triaged to lower-acuity areas in the ED.
View details for DOI 10.1016/j.jemermed.2012.06.021
View details for Web of Science ID 000314665400039
View details for PubMedID 22917652