Scott Weingart | Mount Sinai School of Medicine (original) (raw)

Papers by Scott Weingart

Research paper thumbnail of Clinical policy: critical issues in the evaluation and management of emergency department patients with suspected appendicitis

Annals of Emergency Medicine, 2010

Physicians is an update of a 2000 clinical policy on the evaluation and management of patients pr... more Physicians is an update of a 2000 clinical policy on the evaluation and management of patients presenting with nontraumatic acute abdominal pain. 1 A writing subcommittee reviewed the literature to derive evidence-based recommendations to help clinicians answer the following critical questions: (1) Can clinical findings be used to guide decisionmaking in the risk stratification of patients with possible appendicitis? (2) In adult patients with suspected acute appendicitis who are undergoing a computed tomography scan, what is the role of contrast? (3) In children with suspected acute appendicitis who undergo diagnostic imaging, what are the roles of computed tomography and ultrasound in diagnosing acute appendicitis? Evidence was graded and recommendations were given based on the strength of the available data in the medical literature.

Research paper thumbnail of Additional thoughts on the controversy of lidocaine administration before rapid sequence intubation in patients with traumatic brain injuries

Annals of emergency medicine, 2007

« PreviousNext »Annals of Emergency Medicine Volume 50, Issue 3 , Page 353, September 2007. Addit... more « PreviousNext »Annals of Emergency Medicine Volume 50, Issue 3 , Page 353, September 2007. Additional Thoughts on the Controversy of Lidocaine Administration Before Rapid Sequence Intubation in Patients with Traumatic Brain Injuries. Scott Weingart, MD. ...

Research paper thumbnail of Ultrasound-guided axillary vein approach to the subclavian vein for central venous access

Annals of emergency …, 2008

European Journal of Cardiovascular Nursing, Volume 52, Issue 4, Pages 475-476, October 2008, Auth... more European Journal of Cardiovascular Nursing, Volume 52, Issue 4, Pages 475-476, October 2008, Authors:Suzanne K. Bentley, MD; Raghu Seethala, MD; Scott D. Weingart, MD, RDMS.

Research paper thumbnail of Rapid Ultrasound for Shock and Hypotension (RUSH)

Research paper thumbnail of Trauma patients can be safely extubated in the emergency department

Journal of Emergency Medicine, 2011

e Abstract-Background: Many trauma patients are intubated for conditions that fully resolve durin... more e Abstract-Background: Many trauma patients are intubated for conditions that fully resolve during their emergency department (ED) stay. Often, these patients remain intubated until after they leave the ED. Objective: The objective of this study was to examine the prognosis of patients extubated in the ED. Methods: Data from the records of adult trauma patients who were intubated and then extubated in the ED at a single trauma referral center were prospectively collected for a quality initiative. Two trained abstractors retrospectively recorded these data as well as additional information from the trauma registry and patient charts. The primary outcome was the need for unplanned reintubation during hospitalization. Additional outcomes were disposition and complications from the extubation. Results: There were 50 eligible patients identified and included in the study. Reasons for the intubation included combative behavior or decreased mental status before computed axial tomography (CT) scan in 24 patients (48%), sedation before the performance of a painful procedure in 18 patients (36%), and seizures before CT scan in 3 patients (6%). None of the patients (0%; 95% confidence interval 0 -6%) required unplanned reintubation. Eight (16%) of the patients were able to be discharged from the ED before admission. Conclusions: Although our findings must be verified in larger, controlled studies, it may be safe to extubate patients in the ED, if the condition necessitating intubation has fully resolved. This practice may reduce admission rates and limit the need for intensive care unit beds for the patients who are admitted.

Research paper thumbnail of Scott Weingart and Peter Wyer, Editors, Emergency Medicine Decision Making: Critical Choices in Chaotic Environments, McGraw-Hill, New York (2006) Soft Cover, 371 pages, $39.95

Journal of Emergency Medicine, 2007

Research paper thumbnail of Emergency Medicine Decision Making: Critical Choices in Chaotic Environments: By Scott Weingart, Peter Wyer. 2006, New York, NY, McGraw-Hill, 371 pages, $36.95 (softcover)

Academic Emergency Medicine, 2006

... Page 6. SW To Dr. Andy Jagoda for making me an Emergency Physician and Dr. Sabrina Bhagwan fo... more ... Page 6. SW To Dr. Andy Jagoda for making me an Emergency Physician and Dr. Sabrina Bhagwan for making me extremely happy. PW To my wife, Judith Rencoret de Wyer, for her loving support and for adding many new dimensions to my life. Page 7. Page 8. ...

Research paper thumbnail of Preoxygenation and Prevention of Desaturation During Emergency Airway Management

Annals of Emergency Medicine

Patients requiring emergency airway management are at great risk of hypoxemic hypoxia because of ... more Patients requiring emergency airway management are at great risk of hypoxemic hypoxia because of primary lung pathology, high metabolic demands, anemia, insufficient respiratory drive, and inability to protect their airway against aspiration. Tracheal intubation is often required before the complete information needed to assess the risk of periprocedural hypoxia is acquired, such as an arterial blood gas level, hemoglobin value, or even a chest radiograph. This article reviews preoxygenation and peri-intubation oxygenation techniques to minimize the risk of critical hypoxia and introduces a risk-stratification approach to emergency tracheal intubation. Techniques reviewed include positioning, preoxygenation and denitrogenation, positive end expiratory pressure devices, and passive apneic oxygenation. [Ann Emerg Med. 2011;xx:xxx.]

Research paper thumbnail of Optimizing ED Management of Severe Traumatic Brain Injury

Research paper thumbnail of Emergency medicine decision making: critical choices in chaotic environments

... Page 6. SW To Dr. Andy Jagoda for making me an Emergency Physician and Dr. Sabrina Bhagwan fo... more ... Page 6. SW To Dr. Andy Jagoda for making me an Emergency Physician and Dr. Sabrina Bhagwan for making me extremely happy. PW To my wife, Judith Rencoret de Wyer, for her loving support and for adding many new dimensions to my life. Page 7. Page 8. ...

Research paper thumbnail of Critical care monitoring in the emergency department

Research paper thumbnail of Comparison of Frequency of Inducible Myocardial Ischemia in Patients Presenting to Emergency Department With Typical Versus Atypical or Nonanginal Chest Pain

American Journal of Cardiology, 2010

The present study was designed to assess the value of the presenting symptom of &... more The present study was designed to assess the value of the presenting symptom of "typical" anginal pain, "atypical/nonanginal" pain, or the lack of chest pain in predicting the presence of inducible myocardial ischemia using cardiac stress testing in emergency department patients being evaluated for possible acute coronary syndrome. We performed a retrospective observational study of adult patients who were evaluated for acute coronary syndrome in an emergency department chest pain unit. The presenting symptoms were obtained from a structured questionnaire administered before stress testing. Patient chest pain was categorized according to the presence of substernal chest pain or discomfort that was provoked by exertion or emotional stress and was relieved by rest and/or nitroglycerin. Chest pain was classified as "typical" angina if all 3 descriptors were present and "atypical" or "nonanginal" if <3 descriptors were present. All patients underwent serial biomarker and cardiac stress testing before discharge. A total of 2,525 patients met the eligibility criteria. Inducible ischemia on stress testing was found in 33 (14%, 95% confidence interval 10% to 19%) of the 231 patients who had typical anginal pain, 238 (11%, 95% confidence interval 10% to 13%) of the 2,140 patients presenting with atypical/nonanginal chest pain, and 25 (16%, 95% confidence interval 11% to 22%) of the 153 patients who had no complaint of chest pain on presentation. Compared to patients with atypical or no chest pain, patients with typical chest pain were not significantly more likely to have inducible ischemia on stress testing (likelihood ratio +1.25, 95% confidence interval 0.89 to 1.78). In conclusion, in our study, the patients who presented with "typical" angina were no more likely to have inducible myocardial ischemia on stress testing than patients with other presenting symptoms.

Research paper thumbnail of Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia

Annals of Emergency Medicine, 2009

This clinical policy focuses on critical issues concerning the management of adult patients prese... more This clinical policy focuses on critical issues concerning the management of adult patients presenting to the emergency department (ED) with acute symptomatic carbon monoxide (CO) poisoning. The subcommittee reviewed the medical literature relevant to the questions posed. The critical questions are:

Research paper thumbnail of Preoxygenation, reoxygenation, and delayed sequence intubation in the emergency department

Journal of Emergency Medicine, 2011

e Abstract-Background: The goal of preoxygenation is to provide us with a safe buffer of time bef... more e Abstract-Background: The goal of preoxygenation is to provide us with a safe buffer of time before desaturation during Emergency Department intubation. For many intubations, the application of an oxygen mask is sufficient to provide us with ample time to safely intubate our patients. However, some patients are unable to achieve adequate saturations by conventional means and are at high risk for immediate desaturation during apnea and laryngoscopy. For these patients, more advanced methods to achieve preoxygenation and prevent desaturation are vital. Discussion: We will review the physiology of hypoxemia and the means to correct it before intubation. Next, we will discuss apneic oxygenation as a means to blunt desaturation and the optimal way to reoxygenate a patient if desaturation does occur. Last, we will discuss the new concept of delayed sequence intubation, a technique to be used when the discomfort and delirium of hypoxia and hypercapnia prevents patient tolerance of conventional preoxygenation. Conclusions: These new concepts in preoxygenation and reoxygenation may allow safer airway management of the high-risk patient.

Research paper thumbnail of Emergency medicine resident interest in critical care fellowship training increases if provided United States certification pathway

Critical Care Medicine, 2006

Many intensive care units do not meet Leapfrog guideline recommendations for intensivist staffing... more Many intensive care units do not meet Leapfrog guideline recommendations for intensivist staffing in the United States ( 1 ). This was demonstrated by Angus et al. ( 2 ) in a recent issue of Critical Care Medicine. Over one half of high-intensity intensive care units did not have intensivist ...

Research paper thumbnail of American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of emergency department patients with …

Research paper thumbnail of The limited utility of routine cardiac stress testing in emergency department chest pain patients younger than 40 years

Annals of Emergency Medicine, 2009

Study objective: This is a study designed to evaluate the utility of routine provocative cardiac ... more Study objective: This is a study designed to evaluate the utility of routine provocative cardiac testing in low-risk young adult (younger than 40 years) patients evaluated for an acute coronary syndrome in an emergency department (ED) setting.

Research paper thumbnail of New diagnostic and treatment modalities for pulmonary embolism

The Mount Sinai journal of medicine, 2006

Pulmonary embolism is one of the greatest diagnostic challenges in emergency medicine. New techni... more Pulmonary embolism is one of the greatest diagnostic challenges in emergency medicine. New techniques and strategies constantly arise for the diagnosis and treatment of this disease. A review of the new diagnostic and treatment modalities for pulmonary embolism (PE) suggests that it should be suspected in any patient with unexplained dyspnea, tachypnea, or chest pain. All patients suspected of PE must be risk stratified, ideally with a criteria-validated clinical decision rule. After assessing pre-test probability, D-dimer assays will reliably exclude PE in the low risk group and no further imaging is warranted. Computed tomography (CT) angiogram is the initial imaging study of choice for stable patients. V/Q scans should be used only when CT is not available or if the patient has a contraindication to CT scans or intravenous contrast. Bedside echocardiography or stabilization of the patient and CT angiogram are the initial tests for suspected massive PE. If PE is confirmed, hypotensive patients should be treated with thrombolytics. Both heparin and low molecular weight heparin are equally effective initial treatments for stable patients with suspected or confirmed PE.

Research paper thumbnail of Clinical policy: critical issues in the evaluation and management of emergency department patients with suspected appendicitis

Annals of Emergency Medicine, 2010

Physicians is an update of a 2000 clinical policy on the evaluation and management of patients pr... more Physicians is an update of a 2000 clinical policy on the evaluation and management of patients presenting with nontraumatic acute abdominal pain. 1 A writing subcommittee reviewed the literature to derive evidence-based recommendations to help clinicians answer the following critical questions: (1) Can clinical findings be used to guide decisionmaking in the risk stratification of patients with possible appendicitis? (2) In adult patients with suspected acute appendicitis who are undergoing a computed tomography scan, what is the role of contrast? (3) In children with suspected acute appendicitis who undergo diagnostic imaging, what are the roles of computed tomography and ultrasound in diagnosing acute appendicitis? Evidence was graded and recommendations were given based on the strength of the available data in the medical literature.

Research paper thumbnail of Additional thoughts on the controversy of lidocaine administration before rapid sequence intubation in patients with traumatic brain injuries

Annals of emergency medicine, 2007

« PreviousNext »Annals of Emergency Medicine Volume 50, Issue 3 , Page 353, September 2007. Addit... more « PreviousNext »Annals of Emergency Medicine Volume 50, Issue 3 , Page 353, September 2007. Additional Thoughts on the Controversy of Lidocaine Administration Before Rapid Sequence Intubation in Patients with Traumatic Brain Injuries. Scott Weingart, MD. ...

Research paper thumbnail of Ultrasound-guided axillary vein approach to the subclavian vein for central venous access

Annals of emergency …, 2008

European Journal of Cardiovascular Nursing, Volume 52, Issue 4, Pages 475-476, October 2008, Auth... more European Journal of Cardiovascular Nursing, Volume 52, Issue 4, Pages 475-476, October 2008, Authors:Suzanne K. Bentley, MD; Raghu Seethala, MD; Scott D. Weingart, MD, RDMS.

Research paper thumbnail of Rapid Ultrasound for Shock and Hypotension (RUSH)

Research paper thumbnail of Trauma patients can be safely extubated in the emergency department

Journal of Emergency Medicine, 2011

e Abstract-Background: Many trauma patients are intubated for conditions that fully resolve durin... more e Abstract-Background: Many trauma patients are intubated for conditions that fully resolve during their emergency department (ED) stay. Often, these patients remain intubated until after they leave the ED. Objective: The objective of this study was to examine the prognosis of patients extubated in the ED. Methods: Data from the records of adult trauma patients who were intubated and then extubated in the ED at a single trauma referral center were prospectively collected for a quality initiative. Two trained abstractors retrospectively recorded these data as well as additional information from the trauma registry and patient charts. The primary outcome was the need for unplanned reintubation during hospitalization. Additional outcomes were disposition and complications from the extubation. Results: There were 50 eligible patients identified and included in the study. Reasons for the intubation included combative behavior or decreased mental status before computed axial tomography (CT) scan in 24 patients (48%), sedation before the performance of a painful procedure in 18 patients (36%), and seizures before CT scan in 3 patients (6%). None of the patients (0%; 95% confidence interval 0 -6%) required unplanned reintubation. Eight (16%) of the patients were able to be discharged from the ED before admission. Conclusions: Although our findings must be verified in larger, controlled studies, it may be safe to extubate patients in the ED, if the condition necessitating intubation has fully resolved. This practice may reduce admission rates and limit the need for intensive care unit beds for the patients who are admitted.

Research paper thumbnail of Scott Weingart and Peter Wyer, Editors, Emergency Medicine Decision Making: Critical Choices in Chaotic Environments, McGraw-Hill, New York (2006) Soft Cover, 371 pages, $39.95

Journal of Emergency Medicine, 2007

Research paper thumbnail of Emergency Medicine Decision Making: Critical Choices in Chaotic Environments: By Scott Weingart, Peter Wyer. 2006, New York, NY, McGraw-Hill, 371 pages, $36.95 (softcover)

Academic Emergency Medicine, 2006

... Page 6. SW To Dr. Andy Jagoda for making me an Emergency Physician and Dr. Sabrina Bhagwan fo... more ... Page 6. SW To Dr. Andy Jagoda for making me an Emergency Physician and Dr. Sabrina Bhagwan for making me extremely happy. PW To my wife, Judith Rencoret de Wyer, for her loving support and for adding many new dimensions to my life. Page 7. Page 8. ...

Research paper thumbnail of Preoxygenation and Prevention of Desaturation During Emergency Airway Management

Annals of Emergency Medicine

Patients requiring emergency airway management are at great risk of hypoxemic hypoxia because of ... more Patients requiring emergency airway management are at great risk of hypoxemic hypoxia because of primary lung pathology, high metabolic demands, anemia, insufficient respiratory drive, and inability to protect their airway against aspiration. Tracheal intubation is often required before the complete information needed to assess the risk of periprocedural hypoxia is acquired, such as an arterial blood gas level, hemoglobin value, or even a chest radiograph. This article reviews preoxygenation and peri-intubation oxygenation techniques to minimize the risk of critical hypoxia and introduces a risk-stratification approach to emergency tracheal intubation. Techniques reviewed include positioning, preoxygenation and denitrogenation, positive end expiratory pressure devices, and passive apneic oxygenation. [Ann Emerg Med. 2011;xx:xxx.]

Research paper thumbnail of Optimizing ED Management of Severe Traumatic Brain Injury

Research paper thumbnail of Emergency medicine decision making: critical choices in chaotic environments

... Page 6. SW To Dr. Andy Jagoda for making me an Emergency Physician and Dr. Sabrina Bhagwan fo... more ... Page 6. SW To Dr. Andy Jagoda for making me an Emergency Physician and Dr. Sabrina Bhagwan for making me extremely happy. PW To my wife, Judith Rencoret de Wyer, for her loving support and for adding many new dimensions to my life. Page 7. Page 8. ...

Research paper thumbnail of Critical care monitoring in the emergency department

Research paper thumbnail of Comparison of Frequency of Inducible Myocardial Ischemia in Patients Presenting to Emergency Department With Typical Versus Atypical or Nonanginal Chest Pain

American Journal of Cardiology, 2010

The present study was designed to assess the value of the presenting symptom of &... more The present study was designed to assess the value of the presenting symptom of "typical" anginal pain, "atypical/nonanginal" pain, or the lack of chest pain in predicting the presence of inducible myocardial ischemia using cardiac stress testing in emergency department patients being evaluated for possible acute coronary syndrome. We performed a retrospective observational study of adult patients who were evaluated for acute coronary syndrome in an emergency department chest pain unit. The presenting symptoms were obtained from a structured questionnaire administered before stress testing. Patient chest pain was categorized according to the presence of substernal chest pain or discomfort that was provoked by exertion or emotional stress and was relieved by rest and/or nitroglycerin. Chest pain was classified as "typical" angina if all 3 descriptors were present and "atypical" or "nonanginal" if <3 descriptors were present. All patients underwent serial biomarker and cardiac stress testing before discharge. A total of 2,525 patients met the eligibility criteria. Inducible ischemia on stress testing was found in 33 (14%, 95% confidence interval 10% to 19%) of the 231 patients who had typical anginal pain, 238 (11%, 95% confidence interval 10% to 13%) of the 2,140 patients presenting with atypical/nonanginal chest pain, and 25 (16%, 95% confidence interval 11% to 22%) of the 153 patients who had no complaint of chest pain on presentation. Compared to patients with atypical or no chest pain, patients with typical chest pain were not significantly more likely to have inducible ischemia on stress testing (likelihood ratio +1.25, 95% confidence interval 0.89 to 1.78). In conclusion, in our study, the patients who presented with "typical" angina were no more likely to have inducible myocardial ischemia on stress testing than patients with other presenting symptoms.

Research paper thumbnail of Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia

Annals of Emergency Medicine, 2009

This clinical policy focuses on critical issues concerning the management of adult patients prese... more This clinical policy focuses on critical issues concerning the management of adult patients presenting to the emergency department (ED) with acute symptomatic carbon monoxide (CO) poisoning. The subcommittee reviewed the medical literature relevant to the questions posed. The critical questions are:

Research paper thumbnail of Preoxygenation, reoxygenation, and delayed sequence intubation in the emergency department

Journal of Emergency Medicine, 2011

e Abstract-Background: The goal of preoxygenation is to provide us with a safe buffer of time bef... more e Abstract-Background: The goal of preoxygenation is to provide us with a safe buffer of time before desaturation during Emergency Department intubation. For many intubations, the application of an oxygen mask is sufficient to provide us with ample time to safely intubate our patients. However, some patients are unable to achieve adequate saturations by conventional means and are at high risk for immediate desaturation during apnea and laryngoscopy. For these patients, more advanced methods to achieve preoxygenation and prevent desaturation are vital. Discussion: We will review the physiology of hypoxemia and the means to correct it before intubation. Next, we will discuss apneic oxygenation as a means to blunt desaturation and the optimal way to reoxygenate a patient if desaturation does occur. Last, we will discuss the new concept of delayed sequence intubation, a technique to be used when the discomfort and delirium of hypoxia and hypercapnia prevents patient tolerance of conventional preoxygenation. Conclusions: These new concepts in preoxygenation and reoxygenation may allow safer airway management of the high-risk patient.

Research paper thumbnail of Emergency medicine resident interest in critical care fellowship training increases if provided United States certification pathway

Critical Care Medicine, 2006

Many intensive care units do not meet Leapfrog guideline recommendations for intensivist staffing... more Many intensive care units do not meet Leapfrog guideline recommendations for intensivist staffing in the United States ( 1 ). This was demonstrated by Angus et al. ( 2 ) in a recent issue of Critical Care Medicine. Over one half of high-intensity intensive care units did not have intensivist ...

Research paper thumbnail of American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of emergency department patients with …

Research paper thumbnail of The limited utility of routine cardiac stress testing in emergency department chest pain patients younger than 40 years

Annals of Emergency Medicine, 2009

Study objective: This is a study designed to evaluate the utility of routine provocative cardiac ... more Study objective: This is a study designed to evaluate the utility of routine provocative cardiac testing in low-risk young adult (younger than 40 years) patients evaluated for an acute coronary syndrome in an emergency department (ED) setting.

Research paper thumbnail of New diagnostic and treatment modalities for pulmonary embolism

The Mount Sinai journal of medicine, 2006

Pulmonary embolism is one of the greatest diagnostic challenges in emergency medicine. New techni... more Pulmonary embolism is one of the greatest diagnostic challenges in emergency medicine. New techniques and strategies constantly arise for the diagnosis and treatment of this disease. A review of the new diagnostic and treatment modalities for pulmonary embolism (PE) suggests that it should be suspected in any patient with unexplained dyspnea, tachypnea, or chest pain. All patients suspected of PE must be risk stratified, ideally with a criteria-validated clinical decision rule. After assessing pre-test probability, D-dimer assays will reliably exclude PE in the low risk group and no further imaging is warranted. Computed tomography (CT) angiogram is the initial imaging study of choice for stable patients. V/Q scans should be used only when CT is not available or if the patient has a contraindication to CT scans or intravenous contrast. Bedside echocardiography or stabilization of the patient and CT angiogram are the initial tests for suspected massive PE. If PE is confirmed, hypotensive patients should be treated with thrombolytics. Both heparin and low molecular weight heparin are equally effective initial treatments for stable patients with suspected or confirmed PE.