Jon B. Lee, MD

All Publications

• Serratus anterior plane block as a bridge to outpatient management of severe rib fractures: a case report CLINICAL AND EXPERIMENTAL EMERGENCY MEDICINE Lee, J. B., Nelson, A., Lahham, S. 2022; 9 (2): 155-159

  Abstract

  Rib fractures account for a significant number of emergency department visits each year. A patient's disposition often depends on the severity of rib fractures, comorbidities, and ability to achieve adequate analgesia. We present a 44-year-old male patient with severe pain secondary to rib fractures. The initial disposition was to admit for pain control. However, upon performing a serratus anterior plane block, patient was functionally appropriate for discharge with proper return precautions. Serratus anterior plane block is within the skillset of the emergency physician and can be used to achieve analgesia for rib fractures without the sedative and respiratory depressive effects associated with opioids.

  View details for DOI 10.15441/ceem.20.087

  View details for Web of Science ID 000827556100011

  View details for PubMedID 35843618

  View details for PubMedCentralID PMC9288881

• Positive Toxicology Results Are Not Associated with Emergency Physicians' Opioid Prescribing Behavior. The western journal of emergency medicine Lee, J. B., Ghanem, G., Saadat, S., Yanuck, J., Yeung, B., Chakravarthy, B., Nelson, A., Shah, S. 2021; 22 (5): 1067-1075

  Abstract

  Given the general lack of literature on opioid and naloxone prescribing guidelines for patients with substance use disorder, we aimed to explore how a physician's behavior and prescribing habits are altered by knowledge of the patient's concomitant use of psychotropic compounds as evident on urine and serum toxicology screens.We conducted a retrospective chart review study at a tertiary, academic, Level I trauma center between November 2017-October 2018 that included 358 patients who were discharged from the emergency department (ED) with a diagnosis of fracture, dislocation, or amputation and received an opioid prescription upon discharge. We extracted urine and serum toxicology results, number and amount of prescription opioids upon discharge, and the presence of a naloxone script.The study population was divided into five subgroups that included the following: negative urine and serum toxicology screen; depressants; stimulants; mixed; and no toxicology screens. When comparing the 103 patients in which toxicology screens were obtained to the 255 patients without toxicology screens, we found no statistically significant differences in the total prescribed morphine milligram equivalent (75.0 and 75.0, respectively) or in the number of pills prescribed (15.0 and 13.5, respectively). Notably, none of the 103 patients who had toxicology screens were prescribed naloxone upon discharge.Our study found no association between positive urine toxicology results for psychotropically active substances and the rates of opioid prescribing within a single-center, academic ED. Notably, none of the 103 patients who had toxicology screens were prescribed naloxone upon discharge. More research on the associations between illicit drug use, opioids, and naloxone prescriptions is necessary to help establish guidelines for high-risk patients.

  View details for DOI 10.5811/westjem.2021.5.52378

  View details for PubMedID 34546882

  View details for PubMedCentralID PMC8463062

• Accreditation Council for Graduate Medical Education Milestones for Emergency Medicine Residency Training Incorporated into First- and Second-Year Medical Student Elective. Journal of advances in medical education & professionalism Y Cantwell, C., B Lee, J., Saadat, S., Bove, N., Sakaria, S., Wiechmann, W., Wray, A., Toohey, S. 2021; 9 (3): 136-143

  Abstract

  As part of its Next Accreditation System, the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine describe 6 competencies containing 23 sub-competencies graded by milestones ranging from level 1 (expected of an incoming intern) to level 5 (demonstrates abilities of an attending) that are used to track resident training progression. To the best of our knowledge, there have been no studies introducing a milestones-based curriculum to medical students prior to their introduction to the wards, so we sought to determine the effects that a pre-clinical Emergency Medicine Interest Group (EMIG) Milestones Elective would have on preparing the students interested in Emergency Medicine (EM) as a specialty to meet the level 1 milestones prior to their intern year.The elective hosted 15 events throughout the academic year, and pre- and post-curriculum surveys were administered. Thirteen first- and second-year medical students at our institution who completed the elective self-reported their perception of preparedness for each level 1 milestone in the 19 sub-competencies. A repeated measures design was used through identical pre- and post-curriculum surveys to determine any changes in self-reported preparedness for meeting level 1 milestones after completing the elective using Wilcoxon Signed Ranks Test.There was a significant increase in the median scoring from 1 to 2 (p=0.027) in overall self-reported preparedness for meeting the level 1 milestones included in the elective, as well as significant increases in subcategories across competencies 1-4 outlined by the ACGME. There was no significant increase in preparedness for professionalism or interpersonal communication competencies. There was no significant increase in interest in EM as a result of the elective.Implementing a milestones-based curriculum during the pre-clinical years shows improved self-reported preparedness of students interested in pursuing EM for meeting level 1 milestones prior to residency. Additionally, a specialty-based elective such as this one offered through EMIG may further increase interest in the field during pre-clinical years.

  View details for DOI 10.30476/jamp.2021.88982.1360

  View details for PubMedID 34277844

  View details for PubMedCentralID PMC8273531

• Opioid Prescription Patterns for Discharged Patients from the Emergency Department PAIN RESEARCH & MANAGEMENT Yanuck, J., Lee, J. B., Saadat, S., Rouhi, J., Ghanem, G., Chakravarthy, B., Shah, S. 2021; 2021: 4980170

  Abstract

  It is important to analyze the types of etiologies and provider demographics that drive opioid prescription in our emergency departments. Our study aimed to determine which patients in the ED are receiving opioid prescriptions, as well as their strength and quantity. Secondary outcomes included identifying difference in prescribing between provider classes.We conducted a retrospective study at a tertiary care university-based, level-one trauma ED from November 2017 to October 2018. We identified and analyzed data from 2,259 patients who were sent home with an opioid prescription. We retrieved patient and provider demographics, diagnosis, etiologies, and prescription information.The mean age of a patient receiving an opioid prescription was 45, and 72.7% of patients were white. The most common diagnosis groups associated with an opioid prescription were abdominal pain (18.5%), nonfracture extremity pain (18.4%), and back/neck pain (12.5%). Hydrocodone-acetaminophen 5-325 mg was the most commonly prescribed (67.4%). The median total prescribed milligram morphine equivalent (MME) was highest for extremity fracture (75.0; IQR 54.0-100.0). The median total prescribed amount of pills was highest for patients with extremity fractures (15.0; IQR 12.0-20.0).Our study elucidates the prescribing patterns of an academic level 1 trauma center and should pave the way for future studies looking to maximize effectiveness at ways to curb ED opioid prescription.

  View details for DOI 10.1155/2021/4980170

  View details for Web of Science ID 000616180700002

  View details for PubMedID 33532010

  View details for PubMedCentralID PMC7837768

• Pragmatic Randomized Controlled Pilot Trial on Trigger Point Injections With 1% Lidocaine Versus Conventional Approaches for Myofascial Pain in the Emergency Department. The Journal of emergency medicine Yanuck, J., Saadat, S., Lee, J. B., Jen, M., Chakravarthy, B. 2020; 59 (3): 364-370

  Abstract

  Myofascial neck and back pain is an increasingly common chief symptom in the emergency department. Currently, there are no widely accepted conventional therapies, and there is little evidence on the efficacy of interventions such as trigger point injections (TPIs).This study evaluates whether TPIs with 1% lidocaine can improve myofascial back and neck pain compared with conventional therapies. Secondary outcomes include changes in length of stay and number of opioid prescriptions on discharge.This single-center, prospective, randomized, pragmatic trial was carried out in patients clinically determined to have myofascial back or neck pain. Patients were randomized into the experimental arm (TPI with 1% lidocaine) or the control arm (standard conventional approach). Numeric Rating Scores (NRS) for pain and additional surveys were obtained prior to and 20 min after the intervention.The NRS for pain was lower in the TPI group compared with the control group after adjustment for initial pain (median difference -3.01; 95% confidence interval -4.20 to -1.83; p < 0.001). Median length of stay was 2.61 h for the TPI group and 4.63 h for the control group (p < 0.001). More patients in the control group (47.4%) were discharged home with an opioid compared with the TPI group (2.9%) (p < 0.001).TPI is an effective method for managing myofascial pain in the emergency department. This study indicates it may improve pain compared with conventional methods, reduce length of stay in the emergency department, and reduce opioid prescriptions on discharge.

  View details for DOI 10.1016/j.jemermed.2020.06.015

  View details for PubMedID 32712034

• A Case Report on Paget-Schroetter Syndrome Presenting as Acute Localized Rhabdomyolysis. Clinical practice and cases in emergency medicine Lee, J. B., Kurzweil, A., Lahham, S. 2020; 4 (3): 358-361

  Abstract

  The life- or limb-threatening differential diagnosis for upper extremity swelling can include deep vein thrombosis (DVT), infectious processes, and compartment syndrome. Chronic anatomic abnormalities such as axillary vein stenosis are rarely a consideration in the emergency department.We present a 26-year-old female with history of Chiari type 1 malformation who presented with acute left arm swelling. Initial workup, including point-of-care ultrasound, revealed the presence of significant soft tissue swelling without evidence of DVT.Further workup revealed an early, localized rhabdomyolysis secondary to axillary vein stenosis or venous thoracic outlet syndrome, also known as Paget-Schroetter syndrome.

  View details for DOI 10.5811/cpcem.2020.6.47335

  View details for PubMedID 32926686

  View details for PubMedCentralID PMC7434234

• Trigger Point Injections with 1% Lidocaine for Myofascial Pain. Emergency Medicine Reviews and Perspectives. Yanuck, J., Lee, J., Saadat, S. Emergency Medical Abstracts. 2020

  Abstract

  https://www.emrap.org/episode/ema2020november/abstract20

• Stigma and negative self-perceptions of young people living with human immunodeficiency virus in Bandung, Indonesia: a case series. International health Aggarwal, S., Yu, L., Hasjim, B., Lee, D. H., Kim, E., Lee, J. B., Lee, K., Tse, C., Anshus, A., Yu, A. R., Louthan, M., Keown, T., Gabriel, C., Diamond, C. 2018; 10 (5): 401-403

  Abstract

  Young people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (PLWA) are at risk for HIV stigma.The HIV/AIDS Stigma Instrument for PLWA was administered to 36 young PLWA across six clinics in Bandung, Indonesia, to assess the fear of contagion (FC), verbal abuse (VA), social isolation (SI), workplace stigma (WS), health care neglect (HCN) and negative self-perception (NSP).The median scores for FC, VA, SI, WS and HCN were all 0 while the median score for NSP was 4. In the last 3 months approximately 45% of surveyed PLWA felt they did not deserve to live and 64% felt completely worthless.While these results are preliminary, access to mental health services should be a priority in the clinics that provide antiretroviral therapies.

  View details for DOI 10.1093/inthealth/ihy031

  View details for PubMedID 29897586

• Evaluation of a point of care ultrasound curriculum for Indonesian physicians taught by first-year medical students. World journal of emergency medicine Lee, J. B., Tse, C., Keown, T., Louthan, M., Gabriel, C., Anshus, A., Hasjim, B., Lee, K., Kim, E., Yu, L., Yu, A., Lahham, S., Bunch, S., Alvarado, M., Gari, A., Fox, J. C. 2017; 8 (4): 281-286

  Abstract

  The purpose of this study was to assess the short-term efficacy of a 4-week ultrasound curriculum taught by American first-year medical students to general practitioners working in public health care clinics, or puskesmas, in Bandung, Indonesia.We performed a prospective, observational study of Indonesian health care practitioners from public clinics in Bandung, Indonesia. These practitioners were enrolled in a 4-week ultrasound training course taught by first-year American medical students. A total of six sessions were held comprising of 38 ultrasound milestones. A pre-course and post-course written exam and practical exam was taken by each participant.We enrolled 41 clinicians in the course. The average pre-course exam score was 35.2% with a 2.4% pass rate, whereas the average post-course exam score was 82.0% with a 92.7% pass rate. The average practical score at the completion of the course was 83.2% (SD=0.145) with 82.9% of the class passing (score above 75.0%).Our data suggests that first-year medical students can effectively teach ultrasound to physicians in Indonesia using a 4-week intensive ultrasound training course. Future studies are needed to determine the amount of training required for proficiency and to evaluate the physicians' perceptions of the student-instructors' depth of knowledge and skill in point of care ultrasound.

  View details for DOI 10.5847/wjem.j.1920-8642.2017.04.006

  View details for PubMedID 29123606

  View details for PubMedCentralID PMC5675969

• Comparison of ultrasound-measured properties of the common carotid artery to tobacco smoke exposure in a cohort of Indonesian patients. World journal of emergency medicine Yu, A. R., Hasjim, B., Yu, L. E., Gabriel, C., Anshus, A., Lee, J. B., Louthan, M. J., Kim, E. C., Lee, K., Tse, C., Keown, T., Lahham, S., Alvarado, M., Bunch, S., Gari, A., Fox, J. C. 2017; 8 (3): 177-183

  Abstract

  The purpose of this study was to use point-of-care ultrasound (POCUS) to investigate the relationship between tobacco smoke exposure and the characteristics of the common carotid artery (CCA). The effect of both primary and secondary smoking on CCA properties was evaluated.We performed a prospective cross-sectional study across 20 primary care clinics in Bandung, West Java, Indonesia in July 2016. Point of care ultrasound was performed on a convenience sample of Indonesian patients presenting to clinic. The CCA wall stiffness and carotid intima-media thickness (CIMT) were measured during diastole and systole. These measurements were correlated with smoke exposure and cardiovascular disease.We enrolled 663 patients in the study, with 426 patients enrolled in the smoking category and 237 patients enrolled in the second-hand smoke category. There was an overall positive correlation with the measured lifestyle factors and the ultrasound-measured variables in the group of individuals who smoked. For all variables, age seemed to contribute the most out of all of the lifestyle factors for the positive changes in CIMT and CCA wall stiffness.Our data yielded correlations between CCA properties and cardiovascular risk, as well as between CIMT and arterial stiffness. We were also able to demonstrate an increase in thickness of the CIMT in patients who have been exposed by tobacco through the use of ultrasound. Further large scale studies comparing patients with multiple cardiac risk factors need to be performed to confirm the utility of ultrasound findings of cardiovascular disease and stroke.

  View details for DOI 10.5847/wjem.j.1920-8642.2017.03.003

  View details for PubMedID 28680513

  View details for PubMedCentralID PMC5496824

• Status Epilepticus in the Emergency Department Journal of Education and Teaching in Emergency Medicine 2 Lee, J. 2016
• Femoral Neck Fracture Journal of Education and Teaching in Emergency Medicine 1 Lee, J. 2016
• Rhabdomyolysis in obese trauma patients. The American surgeon Chan, J. L., Imai, T., Barmparas, G., Lee, J. B., Lamb, A. W., Melo, N., Margulies, D., Ley, E. J. 2014; 80 (10): 1012-7

  Abstract

  Patients sustaining traumatic injuries are at risk for development of rhabdomyolysis. The effect of obesity on this risk is unknown. This study attempted to characterize the role of obesity in the development of rhabdomyolysis after trauma. This was a retrospective review of all trauma patients with creatine kinase (CK) levels admitted to the surgical intensive care unit (SICU) at a Level I trauma center from February 2011 until July 2013. Patients were divided based on their body mass index (BMI): overweight/obese group with BMI 25 kg/m(2) or greater and nonoverweight/obese group with BMI less than 25 kg/m(2). Primary outcome was CK greater than 10,000 U/L. During the 30-month study period, 198 trauma patients with available CK levels were admitted to the SICU. The majority (27.8%) of patients were involved in a motor vehicle collision. There were 96 patients (48.4%) with BMI 25 kg/m(2) or greater and 102 (51.5%) with BMI less than 25 kg/m(2). There was no difference in creatinine levels between the two groups (1.5 ± 1.2 mg/dL vs 1.5 ± 1.4 mg/dL, P = 0.83). BMI 25 kg/m(2) or greater was independently associated with the development of CK greater than 10,000 U/L (14.6 vs 4.9%; adjusted odds ratio, 3.03; P = 0.04). Patients with BMI 25 kg/m(2) or greater are at a significantly higher risk for rhabdomyolysis after trauma. Aggressive CK level monitoring to prevent rhabdomyolysis in this population is strongly encouraged.

  View details for PubMedID 25264650