Bryan McNeilly | University of Washington (original) (raw)

Papers by Bryan McNeilly

Clinical practice and cases in emergency medicine, May 31, 2023

Hemoptysis can be a highly alarming presentation in the emergency department (ED). Even seemingly... more Hemoptysis can be a highly alarming presentation in the emergency department (ED). Even seemingly minor cases may represent potentially lethal underlying pathology. It requires thorough evaluation and careful consideration of a broad differential diagnosis. Case Presentation: A 44-year-old man presented to the ED with a concern of hemoptysis in the setting of recent fever and myalgias. Discussion: This case takes the reader through how to approach the differential diagnosis and diagnostic work-up of hemoptysis in the ED setting and then reveals the surprising final diagnosis.

The Journal of emergency medicine, Apr 1, 2023

The Journal of emergency medicine, Jul 1, 2022

Background The mass immunization campaign against COVID 19 has resulted in more patients presenti... more Background The mass immunization campaign against COVID 19 has resulted in more patients presenting to the Emergency Department with concern for a vaccine reaction. Case Report A 68-year-old man presented to the emergency department (ED) reporting an allergic reaction to the COVID-19 vaccine. He initially noted swelling of his face, neck, and right arm after receiving the first dose of the vaccine. After his second dose of the vaccine, the swelling became more pronounced and prompted him to seek care. On exam, he had fullness of the neck and engorgement of the left external jugular vein, which were exacerbated when the patient raised his arms above his head, consistent with Pemberton's sign. Apart from the swelling of the head and neck, there were no other findings consistent with an allergic reaction. The presence of Pemberton's sign prompted a computed tomography (CT) scan of the chest with contrast, which revealed a para-tracheal mass measuring 4.5 × 2.0 cm with marked narrowing of the superior vena cava (SVC). The patient was admitted to the hospital for SVC syndrome, and further workup revealed a non-small cell lung cancer. Why Should an Emergency Physician Be Aware of This? Patients may misattribute their symptoms to a COVID vaccine reaction when they are in fact experiencing a more serious underlying disease. This case highlights the importance of a thorough physical exam and maintaining a broad differential diagnosis. In this case, the presence of Pemberton's sign raised suspicion for SVC syndrome, and prompted further workup.

Prehospital and Disaster Medicine, Mar 24, 2022

Introduction:Hospitals are vulnerable to terrorist attacks, as they must remain easily accessible... more Introduction:Hospitals are vulnerable to terrorist attacks, as they must remain easily accessible to the general public. Hospitals are also occupied with both staff and patients 24 hours a day, 365 days a year, meaning that any attack is almost guaranteed to inflict a multitude of casualties. In addition to the immediate effects of attacking a hospital, there are also uniquely devastating second- and third-order effects when hospitals are attacked.Methods:A focused search of the Global Terrorism Database (GTD) was performed to identify terrorist attacks against hospitals throughout the world. Data between the years 1970-2018 were selected, which included 191,465 entries in total. These entries were then searched for incidents containing the term “hospital” and the results were manually searched to identify trends in the number of incidents occurring per year, as well as the armament that was employed, and the regions of the world where the attacks occurred.Results:A total of 430 terrorist attacks on hospitals were identified in the GTD, resulting in 1,291 deaths and an additional 1,921 wounded. The frequency of terrorist attacks against hospitals has been steadily increasing over the last two decades and is disproportionate to the overall increase in terrorist attacks against all target types. Attacks have been carried out against hospitals in 61 different countries. The most common method used in these attacks was “bombing/explosion,” which accounted for 299 attacks. Of the known terrorist groups identified in the GTD, “Houthi extremists (Anshar Allah)” and “Islamic State of Iraq and the Levant (ISIL)” carried out the greatest number of attacks on hospitals.Conclusion:There has been a disproportionate rise in the frequency of terrorist attacks on hospitals when compared to other target types, highlighting the vulnerability of these key structures. Unsurprisingly, these attacks have inflicted large casualty counts in addition to disrupting community health care and disaster response. Attacks against hospitals have been reported on every inhabited continent except Australia, making their protection a matter of international security. The rate of terrorist attacks on hospitals has increased dramatically over the last two decades, creating an urgent need to develop improved defense strategies that will better ensure their protection.

American Journal of Disaster Medicine

During periods of civil unrest, emergency medical services (EMSs) clinicians will be called upon ... more During periods of civil unrest, emergency medical services (EMSs) clinicians will be called upon to provide care to those impacted, including those who are actively instigating violence. Working during periods of civil unrest poses significant operational and security challenges to EMS leadership and clinicians. This review provides best practices for EMS operating during periods of civil unrest through analysis of after action reports from Baltimore, Maryland; Charlottesville, North Carolina; Minneapolis, Minnesota; and Washington, DC.

Annals of Emergency Medicine, Mar 1, 2023

Clinical Practice and Cases in Emergency Medicine

Introduction: Hemoptysis can be a highly alarming presentation in the emergency department (ED). ... more Introduction: Hemoptysis can be a highly alarming presentation in the emergency department (ED). Even seemingly minor cases may represent potentially lethal underlying pathology. It requires thorough evaluation and careful consideration of a broad differential diagnosis.Case Presentation: A 44-year-old man presented to the ED with a concern of hemoptysis in the setting of recent fever and myalgias.Discussion: This case takes the reader through how to approach the differential diagnosis and diagnostic work-up of hemoptysis in the ED setting and then reveals the surprising final diagnosis.

The Journal of Emergency Medicine

Annals of Emergency Medicine

Prehospital and Disaster Medicine, 2022

Introduction:Hospitals are vulnerable to terrorist attacks, as they must remain easily accessible... more Introduction:Hospitals are vulnerable to terrorist attacks, as they must remain easily accessible to the general public. Hospitals are also occupied with both staff and patients 24 hours a day, 365 days a year, meaning that any attack is almost guaranteed to inflict a multitude of casualties. In addition to the immediate effects of attacking a hospital, there are also uniquely devastating second- and third-order effects when hospitals are attacked.Methods:A focused search of the Global Terrorism Database (GTD) was performed to identify terrorist attacks against hospitals throughout the world. Data between the years 1970-2018 were selected, which included 191,465 entries in total. These entries were then searched for incidents containing the term “hospital” and the results were manually searched to identify trends in the number of incidents occurring per year, as well as the armament that was employed, and the regions of the world where the attacks occurred.Results:A total of 430 ter...

The Journal of Emergency Medicine

Background The mass immunization campaign against COVID 19 has resulted in more patients presenti... more Background The mass immunization campaign against COVID 19 has resulted in more patients presenting to the Emergency Department with concern for a vaccine reaction. Case Report A 68-year-old man presented to the emergency department (ED) reporting an allergic reaction to the COVID-19 vaccine. He initially noted swelling of his face, neck, and right arm after receiving the first dose of the vaccine. After his second dose of the vaccine, the swelling became more pronounced and prompted him to seek care. On exam, he had fullness of the neck and engorgement of the left external jugular vein, which were exacerbated when the patient raised his arms above his head, consistent with Pemberton's sign. Apart from the swelling of the head and neck, there were no other findings consistent with an allergic reaction. The presence of Pemberton's sign prompted a computed tomography (CT) scan of the chest with contrast, which revealed a para-tracheal mass measuring 4.5 × 2.0 cm with marked narrowing of the superior vena cava (SVC). The patient was admitted to the hospital for SVC syndrome, and further workup revealed a non-small cell lung cancer. Why Should an Emergency Physician Be Aware of This? Patients may misattribute their symptoms to a COVID vaccine reaction when they are in fact experiencing a more serious underlying disease. This case highlights the importance of a thorough physical exam and maintaining a broad differential diagnosis. In this case, the presence of Pemberton's sign raised suspicion for SVC syndrome, and prompted further workup.

Clinical practice and cases in emergency medicine, May 31, 2023

Hemoptysis can be a highly alarming presentation in the emergency department (ED). Even seemingly... more Hemoptysis can be a highly alarming presentation in the emergency department (ED). Even seemingly minor cases may represent potentially lethal underlying pathology. It requires thorough evaluation and careful consideration of a broad differential diagnosis. Case Presentation: A 44-year-old man presented to the ED with a concern of hemoptysis in the setting of recent fever and myalgias. Discussion: This case takes the reader through how to approach the differential diagnosis and diagnostic work-up of hemoptysis in the ED setting and then reveals the surprising final diagnosis.

The Journal of emergency medicine, Apr 1, 2023

The Journal of emergency medicine, Jul 1, 2022

Background The mass immunization campaign against COVID 19 has resulted in more patients presenti... more Background The mass immunization campaign against COVID 19 has resulted in more patients presenting to the Emergency Department with concern for a vaccine reaction. Case Report A 68-year-old man presented to the emergency department (ED) reporting an allergic reaction to the COVID-19 vaccine. He initially noted swelling of his face, neck, and right arm after receiving the first dose of the vaccine. After his second dose of the vaccine, the swelling became more pronounced and prompted him to seek care. On exam, he had fullness of the neck and engorgement of the left external jugular vein, which were exacerbated when the patient raised his arms above his head, consistent with Pemberton's sign. Apart from the swelling of the head and neck, there were no other findings consistent with an allergic reaction. The presence of Pemberton's sign prompted a computed tomography (CT) scan of the chest with contrast, which revealed a para-tracheal mass measuring 4.5 × 2.0 cm with marked narrowing of the superior vena cava (SVC). The patient was admitted to the hospital for SVC syndrome, and further workup revealed a non-small cell lung cancer. Why Should an Emergency Physician Be Aware of This? Patients may misattribute their symptoms to a COVID vaccine reaction when they are in fact experiencing a more serious underlying disease. This case highlights the importance of a thorough physical exam and maintaining a broad differential diagnosis. In this case, the presence of Pemberton's sign raised suspicion for SVC syndrome, and prompted further workup.

Prehospital and Disaster Medicine, Mar 24, 2022

Introduction:Hospitals are vulnerable to terrorist attacks, as they must remain easily accessible... more Introduction:Hospitals are vulnerable to terrorist attacks, as they must remain easily accessible to the general public. Hospitals are also occupied with both staff and patients 24 hours a day, 365 days a year, meaning that any attack is almost guaranteed to inflict a multitude of casualties. In addition to the immediate effects of attacking a hospital, there are also uniquely devastating second- and third-order effects when hospitals are attacked.Methods:A focused search of the Global Terrorism Database (GTD) was performed to identify terrorist attacks against hospitals throughout the world. Data between the years 1970-2018 were selected, which included 191,465 entries in total. These entries were then searched for incidents containing the term “hospital” and the results were manually searched to identify trends in the number of incidents occurring per year, as well as the armament that was employed, and the regions of the world where the attacks occurred.Results:A total of 430 terrorist attacks on hospitals were identified in the GTD, resulting in 1,291 deaths and an additional 1,921 wounded. The frequency of terrorist attacks against hospitals has been steadily increasing over the last two decades and is disproportionate to the overall increase in terrorist attacks against all target types. Attacks have been carried out against hospitals in 61 different countries. The most common method used in these attacks was “bombing/explosion,” which accounted for 299 attacks. Of the known terrorist groups identified in the GTD, “Houthi extremists (Anshar Allah)” and “Islamic State of Iraq and the Levant (ISIL)” carried out the greatest number of attacks on hospitals.Conclusion:There has been a disproportionate rise in the frequency of terrorist attacks on hospitals when compared to other target types, highlighting the vulnerability of these key structures. Unsurprisingly, these attacks have inflicted large casualty counts in addition to disrupting community health care and disaster response. Attacks against hospitals have been reported on every inhabited continent except Australia, making their protection a matter of international security. The rate of terrorist attacks on hospitals has increased dramatically over the last two decades, creating an urgent need to develop improved defense strategies that will better ensure their protection.

American Journal of Disaster Medicine

During periods of civil unrest, emergency medical services (EMSs) clinicians will be called upon ... more During periods of civil unrest, emergency medical services (EMSs) clinicians will be called upon to provide care to those impacted, including those who are actively instigating violence. Working during periods of civil unrest poses significant operational and security challenges to EMS leadership and clinicians. This review provides best practices for EMS operating during periods of civil unrest through analysis of after action reports from Baltimore, Maryland; Charlottesville, North Carolina; Minneapolis, Minnesota; and Washington, DC.

Annals of Emergency Medicine, Mar 1, 2023

Clinical Practice and Cases in Emergency Medicine

Introduction: Hemoptysis can be a highly alarming presentation in the emergency department (ED). ... more Introduction: Hemoptysis can be a highly alarming presentation in the emergency department (ED). Even seemingly minor cases may represent potentially lethal underlying pathology. It requires thorough evaluation and careful consideration of a broad differential diagnosis.Case Presentation: A 44-year-old man presented to the ED with a concern of hemoptysis in the setting of recent fever and myalgias.Discussion: This case takes the reader through how to approach the differential diagnosis and diagnostic work-up of hemoptysis in the ED setting and then reveals the surprising final diagnosis.

The Journal of Emergency Medicine

Annals of Emergency Medicine

Prehospital and Disaster Medicine, 2022

Introduction:Hospitals are vulnerable to terrorist attacks, as they must remain easily accessible... more Introduction:Hospitals are vulnerable to terrorist attacks, as they must remain easily accessible to the general public. Hospitals are also occupied with both staff and patients 24 hours a day, 365 days a year, meaning that any attack is almost guaranteed to inflict a multitude of casualties. In addition to the immediate effects of attacking a hospital, there are also uniquely devastating second- and third-order effects when hospitals are attacked.Methods:A focused search of the Global Terrorism Database (GTD) was performed to identify terrorist attacks against hospitals throughout the world. Data between the years 1970-2018 were selected, which included 191,465 entries in total. These entries were then searched for incidents containing the term “hospital” and the results were manually searched to identify trends in the number of incidents occurring per year, as well as the armament that was employed, and the regions of the world where the attacks occurred.Results:A total of 430 ter...

The Journal of Emergency Medicine

Background The mass immunization campaign against COVID 19 has resulted in more patients presenti... more Background The mass immunization campaign against COVID 19 has resulted in more patients presenting to the Emergency Department with concern for a vaccine reaction. Case Report A 68-year-old man presented to the emergency department (ED) reporting an allergic reaction to the COVID-19 vaccine. He initially noted swelling of his face, neck, and right arm after receiving the first dose of the vaccine. After his second dose of the vaccine, the swelling became more pronounced and prompted him to seek care. On exam, he had fullness of the neck and engorgement of the left external jugular vein, which were exacerbated when the patient raised his arms above his head, consistent with Pemberton's sign. Apart from the swelling of the head and neck, there were no other findings consistent with an allergic reaction. The presence of Pemberton's sign prompted a computed tomography (CT) scan of the chest with contrast, which revealed a para-tracheal mass measuring 4.5 × 2.0 cm with marked narrowing of the superior vena cava (SVC). The patient was admitted to the hospital for SVC syndrome, and further workup revealed a non-small cell lung cancer. Why Should an Emergency Physician Be Aware of This? Patients may misattribute their symptoms to a COVID vaccine reaction when they are in fact experiencing a more serious underlying disease. This case highlights the importance of a thorough physical exam and maintaining a broad differential diagnosis. In this case, the presence of Pemberton's sign raised suspicion for SVC syndrome, and prompted further workup.