Bio

Clinical Focus


  • Emergency Medicine
  • Pediatric Emergency Medicine

Academic Appointments


Professional Education


  • Board Certification: Emergency Medicine, American Board of Emergency Medicine (2018)
  • Residency: UCSD Emergency Medicine Residency (2017) CA
  • Medical Education: University of Southern California Keck School of Medicine Registrar (2013) CA

Publications

All Publications


  • A Large Discrepancy between Oral versus Rectal Temperatures as an Early Warning Sign in a Patient with Acute Infrarenal Aortic Occlusion. The Journal of emergency medicine Pokrajac, N., Snyder, B. K. 2020

    Abstract

    Acute aortic occlusion is a rare condition that requires early diagnosis to help prevent considerable morbidity and mortality. Typical clinical findings, such as acute lower extremity pain, acute paralysis, and absent pedal pulses, may be masked by a variety of underlying medical conditions.We present a patient with altered mental status, hypothermia, and a large discrepancy between oral and rectal temperature measurements, who was ultimately diagnosed with aortic occlusion. This case report describes a marked difference between oral and rectal temperatures in a case of acute aortic occlusion. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Acute aortic occlusion is a true vascular emergency that, without early intervention, can lead to limb ischemia, bowel necrosis, paralysis, or death. Emergency physicians should consider acute aortic occlusion in a patient with a marked difference between oral and rectal temperature measurements who otherwise has a limited clinical evaluation.

    View details for DOI 10.1016/j.jemermed.2020.01.014

    View details for PubMedID 32204995

  • During the Emergency Department Evaluation of a Well-Appearing Neonate with Fever, Should Empiric Acyclovir Be Initiated? The Journal of emergency medicine Bruno, E., Pillus, D., Cheng, D., Vilke, G., Pokrajac, N. 2018; 54 (2): 261–65

    Abstract

    Herpes simplex virus (HSV) infection represents significant morbidity and mortality in the neonatal period. Although clear guidelines exist on the evaluation and management of the otherwise well-appearing febrile neonate pertaining to occult serious bacterial infections, there is no standardized approach regarding when to initiate testing and treatment for HSV infection. It is vital we establish a unified guideline based on available clinical research to aid in our decision to evaluate and initiate therapy for this disease.A PubMed search was performed using the keywords "neonate AND fever AND HSV" and "neonate AND fever AND acyclovir." The time period for the search was May 1982 to May 2016. Identified articles underwent further selection based on relevance to the clinical question. Selected articles then underwent detailed review and structured analysis.Our search identified 93 articles, of which 18 were found to be relevant to our clinical question. Recommendations were then made based on thorough review and analysis of the selected articles.Neonatal HSV infection carries significant morbidity and mortality if left untreated. High-quality clinical evidence on when to evaluate and treat for possible HSV infection is lacking. Based on available research, HSV infection in the febrile neonate should be strongly considered if age is < 21 days, or if presenting with concerning clinical features. If testing is performed, empiric treatment with high-dose acyclovir should be initiated. Additional research is needed to further clarify which cases mandate evaluation and treatment for HSV, and to better define treatment protocols.

    View details for DOI 10.1016/j.jemermed.2017.10.016

    View details for PubMedID 29198381

  • Factors and outcomes associated with inpatient cardiac arrest following emergent endotracheal intubation RESUSCITATION Wardi, G., Villar, J., Nguyen, T., Vyas, A., Pokrajac, N., Minokadeh, A., Lasoff, D., Tainter, C., Beitler, J. R., Sell, R. E. 2017; 121: 76–80

    Abstract

    Inpatient peri-intubation cardiac arrest (PICA) following emergent endotracheal intubation (ETI) is an uncommon but potentially preventable type of cardiac arrest (CA). Limited published data exist describing factors associated with inpatient PICA and patient outcomes. This study identifies risk factors associated with PICA among hospitalized patients emergently intubated out of the operating room and compares PICA to other types of inpatient CA.Retrospective case-control study of patients at our institution over a five-year period. Cases were defined as inpatients emergently intubated outside of the operating room that experienced cardiac arrest within 20min after ETI. The control group consisted of inpatients emergently intubated out of the operating room without CA. Predictors of PICA were identified through univariate and multivariate analysis. Clinical outcomes were compared between PICA and other inpatient CAs, identified through a prospectively enrolled CA registry at our institution.29 episodes of PICA occurred over 5 years, accounting for 5% of all inpatient arrests. Shock index ≥1.0, intubation within one hour of nursing shift change, and use of succinylcholine were independently associated with PICA. Sustained ROSC, survival to discharge, and neurocognitive outcome did not differ significantly between groups.Patients outcomes following PICA were comparable to other causes of inpatient CA. Potentially modifiable factors were associated with PICA. Hemodynamic resuscitation, optimized staffing strategies, and possible avoidance of succinylcholine were associated with decreased risk of PICA. Clinical trials testing targeted strategies to optimize peri-intubation care are needed to identify effective interventions to prevent this potentially avoidable type of CA.

    View details for PubMedID 29032298

  • Computed Tomography Imaging and Risk Factors for Clinically Important Diagnoses in Patients Presenting with Flank Pain. The Journal of emergency medicine Pokrajac, N., Corbett-Detig, J., Ly, B. T. 2017; 52 (1): 98–100

    View details for DOI 10.1016/j.jemermed.2016.08.024

    View details for PubMedID 27727046