Bio


Dr. Htet is a board certified physician in Emergency Medicine and Critical Care Medicine. She earned her undergraduate degree in Biochemistry and Neuroscience at University of California Los Angeles (UCLA) and her masters degree in Physiological Science at UCLA. She received her M.D. degree from the University of Wisconsin School of Medicine and Public Health. During medical school, she was a part of leadership team for free clinics in the area, and performed research in the field of neuroimaging concurrent with her interest in undergraduate and graduate studies. She did her residency in Emergency Medicine at Advocate Christ Medical Center in Oak Lawn, near Chicago. She was involved in national emergency medicine organizations and mentor groups. She finished her fellowship training in Critical Care Medicine at Stanford and worked in intensive care units at Stanford, Veteran Affairs Hospital in Palo Alto, and Santa Clara Valley hospital. She practices in the Emergency Dept and ICU at Stanford. Her career interests involve medical education, critical care Echo, palliative care, diversity advocacy, hemodynamic monitoring and neurocritical care.

Clinical Focus


  • Critical Care
  • Medical Education
  • Patient education
  • Palliative Care
  • Emergency Medicine

Academic Appointments


  • Clinical Assistant Professor, Emergency Medicine

Honors & Awards


  • Emergency Medicine Foundation Grant, Advocate Christ Medical Center (2015)
  • Emergency Medicine Foundation Grant, Advocate Christ Medical Center (2014)
  • Don Bruechert Medical Scholarship, University of Wisconsin School of Medicine and Public Health (2012)
  • Student Leadership and Service Book Award, University of Wisconsin School of Medicine and Public Health (2011)
  • Shapiro Research Award, University of Wisconsin School of Medicine and Public Health (2010)

Boards, Advisory Committees, Professional Organizations


  • Member, Society of Academic Emergency Medicine, Critical Care Group and ADIEM (Academy for Diversity & Inclusion in Emergency Medicine) (2022 - Present)
  • Member, Society of Critical Care Medicine, Ultrasound Committee, Emergency Medicine (2018 - Present)
  • Member, American Thoracic Society (2017 - Present)
  • Member, American College of Emergency Physicians (2013 - Present)

Professional Education


  • Board Certification: American Board of Internal Medicine, Critical Care Medicine (2019)
  • Fellowship: Stanford University Pulmonary and Critical Care Fellowship (2018) CA
  • Board Certification: American Board of Emergency Medicine, Emergency Medicine (2017)
  • Residency: Advocate Christ Medical Center (2016) IL
  • Medical Education: University of Wisconsin Madison Office of the Registrar (2013) WI
  • M.D., University of Wisconsin School of Medicine and Public Health, Medicine (2013)
  • Residency, Advocate Christ Medical Center, Emergency Medicine (2016)
  • Fellowship, Stanford Medicine Critical Care Fellowship, Critical Care Medicine (2018)

Community and International Work


  • MEDiC (Student-Run Free Medical Clinics), Madison

    Topic

    Vice President-Finance

    Populations Served

    underserved

    Location

    US

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

Current Research and Scholarly Interests


Genetic phenotyping of patients in septic shock

Graduate and Fellowship Programs


  • Critical Care Medicine (Fellowship Program)

All Publications


  • Trend of Outcome Metrics in Recent Out-of-Hospital-Cardiac-Arrest Research: A Narrative Review of Clinical Trials. Journal of clinical medicine Htet, N. N., Jafari, D., Walker, J. A., Pourmand, A., Shaw, A., Dinh, K., Tran, Q. K. 2023; 12 (22)

    Abstract

    Cardiopulmonary resuscitation (CPR) research traditionally focuses on survival. In 2018, the International Liaison Committee on Resuscitation (ILCOR) proposed more patient-centered outcomes. Our narrative review assessed clinical trials after 2018 to identify the trends of outcome metrics in the field OHCA research. We performed a search of the PubMed database from 1 January 2019 to 22 September 2023. Prospective clinical trials involving adult humans were eligible. Studies that did not report any patient-related outcomes or were not available in full-text or English language were excluded. The articles were assessed for demographic information and primary and secondary outcomes. We included 89 studies for analysis. For the primary outcome, 31 (35%) studies assessed neurocognitive functions, and 27 (30%) used survival. For secondary outcomes, neurocognitive function was present in 20 (22%) studies, and survival was present in 10 (11%) studies. Twenty-six (29%) studies used both survival and neurocognitive function. Since the publication of the COSCA guidelines in 2018, there has been an increased focus on neurologic outcomes. Although survival outcomes are used frequently, we observed a trend toward fewer studies with ROSC as a primary outcome. There were no quality-of-life assessments, suggesting a need for more studies with patient-centered outcomes that can inform the guidelines for cardiac-arrest management.

    View details for DOI 10.3390/jcm12227196

    View details for PubMedID 38002808

  • Further advancing emergency department triage prediction. Resuscitation Levin, N. M., Gordon, A. J., Htet, N., Wilson, J. G. 2023; 191: 109930
  • USE OF POINT-OF-CARE ULTRASOUND IN EVALUATING UNSTABLE PATIENTS OUTSIDE INTENSIVE CARE UNITS Gupta, P., Lighthall, G., Htet, N. LIPPINCOTT WILLIAMS & WILKINS. 2023: 574
  • RARE CO-OCCURRENCE OF FAVISM-INDUCED HEMOLYSIS AND METHEMOGLOBINEMIA SECONDARY TO G6PD DEFICIENCY D'souza, M., Jones, J., Htet, N. LIPPINCOTT WILLIAMS & WILKINS. 2023: 153
  • IMPENDING UPPER AIRWAY OBSTRUCTION FROM UNILATERAL TONSILLAR ENLARGEMENT IN A PATIENT WITH MONKEYPOX Rozenbaum, D., Hua, S., Fellion, L., Higgins, T., Rahman, A., Oliveira, F., Boateng, A., Htet, N. LIPPINCOTT WILLIAMS & WILKINS. 2023: 180
  • Advanced Critical Care Ultrasound: Axillary Arterial Line- Oft Forgotten Slagle, D., Htet, N. EMRA. 2022
  • Comparison of Language and Memory Lateralization by Functional MRI and Wada Test in Epilepsy. Frontiers in neurology and neuroscience research Htet, N. N., Pizarro, R., Nair, V. A., Chu, D. Y., Meier, T., Tunnell, E., Rutecki, P., Hermann, B., Meyerand, E. M., Prabhakaran, V. 2021; 2

    Abstract

    The intracarotid sodium amobarbital procedure (ISAP or Wada test) lateralizes cerebral functions to the cerebral hemispheres preoperatively. Functional magnetic resonance imaging (fMRI) is increasingly used to characterize preoperative language and memory lateralization. In this study, concordance of fMRI with Wada was examined in patients with medically intractable seizures. The relationship of the distance between the epileptogenic focus to functional activation area with patients' post-operative deficits in language was also analyzed. 27 epilepsy patients with preoperative fMRI and Wada data were analyzed using established fMRI paradigms for language and memory. Activation of Broca's and Wernicke's areas were measured in three dimensions. Language and memory lateralization were determined, and standard neuropsychiatry Wada test procedures were used for comparison. The shortest distance between a language area to the border of surgical focus (LAD) was also measured and compared with postoperative language deficits. Our study found that concordance between fMRI and Wada testing was 0.41 (Kappa's 'fair to good' concordance) for language dominance and 0.1 (Kappa's 'poor' concordance) for memory. No significant correlation was found between LAD and post-op language deficit (p=0.439). A correlation was found between LAD and post-op memory deficit (p=0.049; the further distance from surgical lesion to language area is associated with less post-operative memory loss). Females demonstrated significantly increased postoperative seizure improvement (Fisher's p-value=0.0296; female=8; male=6). A significant association between handedness (right-handed subjects) and postoperative seizure improvement was found (p=0.02) as well as a significant trend for interaction of gender and handedness on postoperative seizure improvement (p=0.09). Overall, our results demonstrate fMRI as a useful preoperative adjunct to Wada testing for language lateralization in patients with medically intractable seizures.

    View details for PubMedID 34189523

  • Protocolized use of Factor Eight Inhibitor Bypassing Activity (FEIBA) for the reversal of warfarin induced coagulopathy AMERICAN JOURNAL OF EMERGENCY MEDICINE Htet, N. N., Barounis, D., Knight, C., Umunna, B., Hormese, M., Lovell, E. 2020; 38 (3): 539-544

    Abstract

    Coagulopathy due to warfarin in patients with major bleeding was traditionally reversed with fresh frozen plasma and intravenous (IV) vitamin K, but prothrombin complex concentrates (PCC) are increasingly used in the treatment of these patients. Factor Eight Inhibitor Bypassing Activity (FEIBA) is an activated four-factor PCC most commonly used in patients with hemophilia. We aimed to evaluate the efficacy and safety of FEIBA and IV vitamin K for the reversal of warfarin-associated coagulopathy in patients with major bleeding, by measuring the percentage of patients who achieved target INR ≤ 1.5 and the incidence of thrombotic adverse events (TAE).In this prospective observational study, we enrolled patients presenting to the Emergency Department (ED) with warfarin associated coagulopathy (INR > 1.5) and major bleeding. Patients received FEIBA using an INR based dosing strategy and IV vitamin K.In 43 patients, median initial INR was 4.0 (2.7, 7.3 interquartile range (IQR)). Median time to result the second INR was 45 min (38, 55 IQR) and the median INR was 1.4 (1.3, 1.6 IQR). Out of the 43 patients, 93% achieved the target INR of ≤1.5. In-hospital mortality was 40% (17 patients). There were 11 TAEs in 6 patients (14%); 4 events in 2 patients (5%) were attributed to FEIBA.A protocolized use of FEIBA and IV vitamin K resulted in the efficacious reversal of warfarin-induced coagulopathy in patients with major bleeding. TAEs occurred in 14% of patients and were attributed to FEIBA in 5% of patients.

    View details for DOI 10.1016/j.ajem.2019.05.047

    View details for Web of Science ID 000539260200016

    View details for PubMedID 31176578

  • Critical Care Education Day: A Novel, Multidisciplinary, and Interactive Critical Care Education Session for Emergency Medicine Residents. Cureus Htet, N. N., Gordon, A. J., Mitarai, T. 2020; 12 (1): e6785

    Abstract

    Critical care medicine (CCM) is central to emergency medicine (EM) resident education. We feel that the traditional lecture format is not the ideal way to teach EM critical care, which requires integration and prioritization of diagnostic workup and team-based resuscitation under time pressure. We describe a novel critical care education day where an interactive, practical, and multidisciplinary critical care educational experience was provided for EM residents using case-based small-group sessions and fast-paced simulation.

    View details for DOI 10.7759/cureus.6785

    View details for PubMedID 32140345

    View details for PubMedCentralID PMC7045984

  • Acute Respiratory Distress Syndrome: Etiology, Pathogenesis, and Summary on Management. Journal of intensive care medicine Kaku, S., Nguyen, C. D., Htet, N. N., Tutera, D., Barr, J., Paintal, H. S., Kuschner, W. G. 2019: 885066619855021

    Abstract

    The acute respiratory distress syndrome (ARDS) has multiple causes and is characterized by acute lung inflammation and increased pulmonary vascular permeability, leading to hypoxemic respiratory failure and bilateral pulmonary radiographic opacities. The acute respiratory distress syndrome is associated with substantial morbidity and mortality, and effective treatment strategies are limited. This review presents the current state of the literature regarding the etiology, pathogenesis, and management strategies for ARDS.

    View details for DOI 10.1177/0885066619855021

    View details for PubMedID 31208266

  • SEVERE INTRAVASCULAR HEMOLYSIS WITH CLOSTRIDIUM PERFRINGENS BACTEREMIA Htet, N., Alipanah, N., Chen, W. LIPPINCOTT WILLIAMS & WILKINS. 2018: 295
  • Needle-guided ultrasound technique for axillary artery catheter placement in critically ill patients: A case series and technique description. Journal of critical care Htet, N., Vaughn, J., Adigopula, S., Hennessey, E., Mihm, F. 2017; 41: 194-197

    Abstract

    Axillary arterial cannulation for blood pressure monitoring has been reported in adults since 1973. Reported failure rates using palpation landmarks are high. This report describes a needle-guided ultrasound technique for axillary arterial line placement in critically ill patients.A retrospective review of all patients requiring axillary arterial cannulation attempts with ultrasound-assisted needle guidance for hemodynamic monitoring was performed from July 2010 to June 2016 at a single institution.One hundred fifty nine (159) cannulation attempts were performed in 155 patients. The overall success rate was 97%, with a first pass success rate of 84%. Inexperienced operators performed 49% of procedures under direct faculty supervision, and had a 99% success rate, which was not different from experienced operators. Almost 20% of patients had moderate-to-severe coagulopathy (platelets<50k/uL, INR>2.0 or PTT>60s). Complications reported included the following: nonfunctioning of catheter (6%) and hematoma (6%). Ischemia was noted in 2 patients (1%), but only one was attributed to the arterial catheter.Use of the needle-guided ultrasound assisted approach for axillary arterial line placement is easily teachable and can be used to promote safe and successful placement of axillary arterial lines for novice learners.

    View details for DOI 10.1016/j.jcrc.2017.05.026

    View details for PubMedID 28577475

  • Biodistribution and predictive value of (IF)-I-18-fluorocyclophosphamide in mice bearing human breast cancer xenografts JOURNAL OF NUCLEAR MEDICINE Kesner, A. L., Hsueh, W., Htet, N. L., Pio, B. S., Czernin, J., Pegram, M. D., Phelps, M. E., Silverman, D. H. 2007; 48 (12): 2021-2027

    Abstract

    In mice bearing human breast cancer xenografts, we examined the biodistribution of (18)F-fluorocyclophosphamide ((18)F-F-CP) to evaluate its potential as a noninvasive prognostic tool for predicting the resistance of tumors to cyclophosphamide therapy.(18)F-F-CP was synthesized as we recently described, and PET data were acquired after administration of (18)F-F-CP in mice bearing human breast cancer xenografts (MCF-7 cells). Tracer biodistribution in reconstructed images was quantified by region-of-interest analysis. Distribution was also assessed by harvesting dissected organs, tumors, and blood, determining (18)F content in each tissue with a gamma-well counter. The mice were subsequently treated with cyclophosphamide, and tumor size was monitored for at least 3 wk after chemotherapy administration.The distribution of harvested activity correlated strongly with distribution observed in PET images. Target organs were related to routes of metabolism and excretion. (18)F-F-CP uptake was highest in kidneys, lowest in brain, and intermediate in tumors, as determined by both image-based and tissue-based measurements. (18)F-F-CP uptake was not inhibited by coadministration of an approximately x700 concentration of unlabeled cyclophosphamide. PET measures of (18)F-F-CP uptake in tumor predicted the magnitude of the response to subsequent administration of cyclophosphamide.Noninvasive assessment of (18)F-F-CP uptake using PET may potentially be helpful for predicting the response of breast tumors to cyclophosphamide before therapy begins.

    View details for DOI 10.2967/jnumed.107.045716

    View details for Web of Science ID 000252895100020

    View details for PubMedID 18006620