Bio

Clinical Focus


  • Emergency Medicine
  • Pediatric Emergency Medicine

Academic Appointments


Administrative Appointments


  • Assistant Director of Faculty Development, Department of Emergency Medicine (2019 - Present)

Boards, Advisory Committees, Professional Organizations


  • Program Committee Member, Society of Academic Emergency Medicine (2020 - Present)
  • Education Committee Member, Society of Academic Emergency Medicine (2020 - Present)
  • Microsite Co-editor, Pediatric Emergency Medicine Section, American College of Emergency Physicians (2019 - Present)

Professional Education


  • Fellowship, Rady Children's Hospital and UC San Diego Health System, Pediatric Emergency Medicine (2019)
  • 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


  • The Tactics and Tools to Manage Pediatric Heart Failure Pediatric Emergency Medicine Reports Pokrajac, N., Wang, N. E. 2020
  • Risk Factors for Peri-intubation Cardiac Arrest in a Pediatric Emergency Department. Pediatric emergency care Pokrajac, N., Sbiroli, E., Hollenbach, K. A., Kohn, M. A., Contreras, E., Murray, M. 2020

    Abstract

    Cardiac arrest is a significant complication of emergent endotracheal intubation (ETI) within the pediatric population. No studies have evaluated risk factors for peri-intubation cardiac arrest (PICA) in a pediatric emergency department (ED) setting. This study identified risk factors for PICA among patients undergoing emergent ETI in a pediatric ED.We performed a nested case-control study within the cohort of children who underwent emergent ETI in our pediatric ED during a 9-year period. Cases were children with PICA within 20 minutes of ETI. Controls (4 per case) were randomly selected children without PICA after ETI. We analyzed potential risk factors based on published data and physiologic plausibility and created a simple risk model using univariate results, model fit statistics, and clinical judgment.In the cohort of patients undergoing ETI, PICA occurred in 21 of 543 subjects (3.9%; 95% confidence interval [CI], 2.2-5.9%), with return of spontaneous circulation in 16 of 21 (76.2%; 95% CI, 52.8-91.8%) and survival to discharge in 12 of 21 (57.1%; 95% CI, 34.0-78.2%). On univariate analysis, cases were more likely to be younger, have delayed capillary refill time, systolic or diastolic hypotension, hypoxia, greater than one intubation attempt, no sedative or paralytic used, and pulmonary disease compared with controls. Our 4-category risk model for PICA combined preintubation hypoxia (or an unobtainable pulse oximetry value) and younger than 1 year. The area under the receiver operating characteristic curve for this model was 0.87 (95% CI, 0.77-0.97).Hypoxia (or an unobtainable pulse oximetry value) was the strongest predictor for PICA among children after emergent ETI in our sample. A simple risk model combining pre-ETI hypoxia and younger than 1 year showed excellent discrimination in this sample. Our results require independent validation.

    View details for DOI 10.1097/PEC.0000000000002171

    View details for PubMedID 32576791

  • 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

  • Mastery Learning Ensures Correct Personal Protective Equipment Use in Simulated Clinical Encounters of COVID-19 Western Journal of Emergency Medicine Pokrajac, N., Schertzer, K., Poffenberger, C. M., Alvarez, A., Marin-Nevarez, P., Winstead-Derlega, C., Gisondi, M. A. 2020
  • Cardiac Implantable Electronic Device Infections Emergency Management of Infectious Diseases Fernandez, J., Pokrajac, N. edited by Chin, R. L. Cambridge University Press. 2018; 2nd: 14?17
  • 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

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