bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Ethanol in an Experimental Model of Combined Traumatic Brain Injury and Hemorrhagic Shock
Authors: Zink Brian J. , Stern Susan A. , Wang Xu , Chudnofsky Carl C. 
Published: March 2010

ABSTRACT Objectives: Given that clinical and laboratory studies suggest that ethanol and hemorrhagic shock (HS) potentiate traumatic brain injury (TBI), the authors studied the effects of ethanol in a model of combined TBI and HS. Methods: A controlled porcine model of combined TBI and HS was evaluated for the effect of ethanol on survival time, hemodynamic function, and cerebral tissue perfusion. Anesthetized swine (17–24 kg) were instrumented, splenectomized, and subjected to fluid percussion TBI with concurrent 25‐mL/kg graded hemorrhage over 30 minutes. Two groups were studied: control (n= 11) and ethanol (n= 11). Ethanol, 3.5 g/kg intragastric, was given 100 minutes prior to TBI/HS. Systemic and cerebral physiologic and metabolic parameters were monitored for 2 hours without resuscitation. Regional cerebral blood flow (rCBF) and renal blood flow were measured with dye‐labeled microspheres. Data were analyzed with 2‐sample t‐test and repeated‐measures ANOVA. Results: Ethanol levels at the time of injury were 162 ± 68 mg/dL. Average TBI was 2.65 ± 0.35 atm. Survival time was significantly shorter in the ethanol group (60 ± 27 min vs 94 ± 28 min, p = 0.011). The ethanol group had significantly lower mean arterial pressure, cerebral perfusion pressure, and cerebral venousO2 saturation in the postinjury period. Cerebral O2 extraction ratios and cerebral venous lactate levels were significantly higher in the ethanol group. A trend toward lower postinjury rCBF in all brain regions was observed in the ethanol group. Conclusion: In this TBI/HS model, ethanol administration decreased survival time, impaired the hemodynamic response, and worsened measures of cerebral tissue perfusion.
The Electrocardiographic Diagnosis of Acute Myocardial Infarction in Patients with Ventricular Paced Rhythms
Authors: Kozlowski Frederick H. , Brady William J. , Aufderheide Tom P. , Buckley Ralph S. 
Published: March 2010

ABSTRACTUse of the ECG for diagnosis of ischemic heart disease is more difficult in the setting of ventricular paced rhythms (VPRs). ST‐segment/T‐wave configurations are changed by the altered intraventricular conduction associated with ventricular pacing. The anticipated, or expected, morphology in patients with VPRs is one of QRS‐complex‐ST‐segment to T‐wave discordance. Several strategies are available to the physician to assist in the correct interpretation of the 12‐lead ECG in patients with permanent ventricular pacemakers, including: a knowledge of the anticipated ST‐segment‐T‐wave changes of VPRs and consequently the ability to recognize acute, ischemic morphologies; the performance of serial ECGs or ST‐segment trend monitoring demonstrating dynamic changes encountered in acutely ischemic patients; a comparison with previous ECGs; and, if appropriate, an analysis of the native, underlying rhythm. The first strategy, an awareness of the anticipated ST‐segment morphologies of VPRs, is the most important and not dependent on additional diagnostic testing, past medical records, or additional expertise in pacemaker function. Two cases are reported in which an analysis of the ECG in the setting of VPR assisted the treating physicians in establishing the correct diagnosis of acute myocardial infarction.
Evaluation of an Instructional Model for Emergency Ultrasonography
Authors: Lanoix Richard , Baker William E. , Mele Joanne M. , Dharmarajan Lekshmi 
Published: March 2010

ABSTRACT Objective: To evaluate a 4‐hour ultrasonography course in the setting of an emergency medicine (EM) training program. Methods: EM residents and faculty at a large urban center were provided a 4‐hour emergency ultrasonography course. Then, during an 18‐month period, a nonconsecutive sample of ultrasonographic examinations were videotaped and later reviewed. The interpretations of the emergency physician examinations were compared with the following reference standards: 1) an official ultrasound performed and interpreted by the departments of radiology or cardiology; 2) an operative report; 3) A CT scan or IV pyelogram (IVP); or 4) a cardiologist's or a radiologist's interpretation of the videotaped examinations. Results: Of 258 examinations reviewed, 28 (11%) of these were excluded because the cardiologist or radiologist reviewing the videotape determined them to be “technically limited” studies. Of the remaining 230 examinations, there were: 127 gallbladder studies [disease prevalence = 0.58; sensitivity = 0.89; specificity = 0.80; kappa (κ) = 0.69; 95% CI: 56–82%]; 39 echocardiograms to rule out pericardial effusions [disease prevalence = 0.15; sensitivity = 0.83; specificity = 0.97; κ= 0.80; 95% CI: 54–100%]; 25 abdominal ultrasounds to rule out free peritoneal fluid [disease prevalence = 0.32; sensitivity = 0.88; specificity = 0.94; κ= 0.81; 95% CI: 26–95%]; 16 renal ultrasounds to rule out hydronephrosis [disease prevalence = 0.25; sensitivity = 1.0; specificity = 0.92; κ= 0.84; 95% CI: 56–100%]; 12 pelvic ultrasounds to rule in an intrauterine pregnancy [disease prevalence = 0.67; sensitivity = 1.0; specificity = 0.75; κ= 0.80; 95% CI: 43–100%]; and 11 abdominal ultrasounds to rule out abdominal aortic aneurysms [disease prevalence = 0.09; sensitivity = 1.0; 95% CI: 2.5–91%; specificity = 1.0; 95% CI: 68–100%]. Conclusion: This 4‐hour ultrasonography course has potential to serve as a foundation for an instructional model for ultrasonography training in the setting of an EM residency program.
The Effect of Order on Pain of Local Anesthetic Infiltration
Authors: Bartfield Joel M. , Pauze Denis , Raccio‐Robak Nancy 
Published: March 2010

ABSTRACT Objective: To define the relationship between order of injection and pain of infiltration of buffered lidocaine. Methods: Volunteers ≥18 years of age were enrolled in a prospective, double‐blind experimental protocol.Subjects received a 0.5‐mL intradermal injection of anesthetic in each forearm. All injections were given by the same individual in the same manner. Immediately following each injection, the subjects rated the pain of infiltration on a standardized 100‐mm visual analog pain scale. Both the subjects and the individual giving the injections were blinded to the anesthetic being administered. They were told that the injections could be either plain or buffered lidocaine. They were further informed that any individual subject could receive 2 of the same anesthetics or 1 of each in either order. In reality, all injections were buffered lidocaine for all subjects. Pain scores were converted to a numerical score by making measurements to the nearest millimeter and analyzed by a Wilcoxon signed‐rank test with p < 0.05 considered significant. Results: Fifty subjects were enrolled. The first injection had a median pain score of 13.5 mm, compared with 23.5 mm for the second (p = 0.007). Conclusion: The second injection of buffered lidocaine was found to be statistically more painful than the first in this protocol that controlled for all variables except for order of injection. Future studies involving paired comparisons should take this information into account.
Does the Use of Topical Lidocaine, Epinephrine, and Tetracaine Solution Provide Sufficient Anesthesia for Laceration Repair?
Authors: Adler Adam J. , Dubinisky Isser , Eisen Jeff 
Published: March 2010

ABSTRACT Objective: To determine: 1) the effectiveness of lidocaine, epinephrine, and tetracaine (LET) solution in eliminating or reducing the pain experienced in suturing superficial lacerations in adult patients; and 2) the effectiveness of LET in reducing the pain of local anesthetic injection. Methods: A prospective, randomized, double‐blind study in which 60 adult patients with superficial lacerations were entered was conducted in the ED of a community‐based teaching hospital affiliated with the University of Toronto. Following application of the LET or placebo (sterile water) solution to the laceration, a visual analog pain scale was recorded by the patient upon needle probing of the wound margin. If probing was painless, the laceration was repaired using LET alone. If injection of local anesthetic was required, an additional pain scale was elicited to quantify the attenuation of the pain of injection by the prior application of LET. Results: Pain scale values on needle probing were significantly reduced in the LET group vs the placebo group (medians of 4.0 vs 5.0 cm, respectively; p < 0.05). Only 13 of the 30 patients in the LET group required additional anesthetic, while all 30 patients in the placebo group requested local anesthetic. Pain scale values on injection of local anesthetic were not significantly different between the LET and placebo groups (medians of 3.5 vs 5.0 cm, respectively; p = 0.09), although there was a trend for lower pain scale values for those patients who received LET. No adverse effects were noted after the application of either LET or placebo solution. Follow‐up was achieved for 54 of 60 patients with only 1 complication (a wound infection) reported in the LET group. Conclusions: Significantly fewer patients require an injectable anesthetic when LET is applied. Those who do require an injection may experience less discomfort. These advantages should be balanced against the 20 to 30 minutes necessary for the LET to take effect.
No Relationship between Emergency Department Activity and Triage Categorization
Authors: Richardson Drew 
Published: March 2010

ABSTRACT Objective: To examine the consistency of Australasian National Triage Scale (NTS) categorization in a large hospital ED, especially in relation to daily activity. Methods: This was a prospective, observational study of the relationship between NTS category, presenting features, and disposition in a large Australian adult ED. The “admission rate” was defined as the percentage of presentations whose dispositions were recorded as admitted to hospital, transferred to another hospital for admission, or died in the ED. A “busy” weekday was defined as one during which >140 presentations were recorded in the 24 hours from midnight. For a “busy” weekend day, a figure of 100 presentations in 24 hours was used. “Nonbusy” days were defined as those during which presentation numbers were less than or equal to these thresholds. Results: Data describing triage and disposition were available for 94,681 presentations in the 2‐year period, representing 100% of ED presentations. “Busy” weekday admission rates in the 5 triage categories were 93.2%, 67.6%, 43.6%, 15.4%, and 1.6%, respectively. “Nonbusy” weekday admission rates were 91.4%, 68.3%, 43.7%, 15.6%, and 2.0%. Weekend days had a higher admission rate in NTS category 4 and 5 patients, but none of the differences between “busy” and “nonbusy” days reached statistical significance at the 0.05 level. Admission rates varied according to the time of day of presentation and increased with age, but did not change significantly over the 2 years of the study. Conclusions: In this ED, triage categorization according to the Australasian NTS does not vary with daily activity and has been consistent over time. Further study in other settings is required, particularly to identify variation dependent on the presenting population.
Data Elements for Emergency Department Systems, Release 1.0 (DEEDS): A Summary Report
Authors:   DEEDS Writing Committee
Published: March 2010

ABSTRACTVariations in the way that data are entered in ED record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control is coordinating a public‐private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnership's initial product, Data Elements for Emergency Department Systems, Release 1.0 {DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems—such as data incompatibility and high costs of collecting, linking, and using data—can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0, sets a precedent for future review and revision of the initial recommendations.
Randomized, Controlled Trial of Inhaled Budesonide as an Adjunct to Oral Prednisone in Acute Asthma
Authors: Sung Lillian , Osmond Martin H. , Klassen Terry P. 
Published: March 2010

ABSTRACT Objective: To compare the clinical effect of nebulized budesonide with placebo in acute pediatric asthma. Methods: A randomized, controlled, double‐blind trial with parallel design was used in the ED of a tertiary care children's hospital. Children aged 6 months to 18 years with a moderate to severe exacerbation of asthma [Pulmonary Index Score (PIS) ≥5 or ≤11 after a salbutamol nebulization of 0.15 mg/kg] were eligible. All patients received prednisone 1 mg/kg orally and nebulized salbutamol (0.15 mg/kg) every 30 minutes for 3 doses and then every hour for 4 hours. The intervention was 2 mg (4 mL) of nebulized budesonide or 4 mL of nebulized normal saline. Results: Baseline characteristics were comparable in the budesonide group (n= 24) and in the placebo group (n ‐ 20). There were no significant differences in the primary outcome measure (PIS) between the 2 groups. However, the PIS at 1 hour had a tendency to be lower in the budesonide group (median = 5) as compared with the placebo group (median = 6; p = 0.07). Survival analysis of release/discharge from the ED/hospital showed a more rapid rate in the budesonide group as compared with the placebo group (p = 0.02). No adverse effects were seen. Conclusion: Although these preliminary results suggest that nebulized budesonide may be an effective adjunct to oral prednisone in the management of moderate to severe asthma exacerbations, a larger trial will be required before the widespread use of inhaled budesonide in acute asthma can be advocated.
Cutaneous Tape Stripping to Accelerate the Anesthetic Effects of EMLA Cream: A Randomized, Controlled Trial
Authors: Singer Adam J. , Shallat John , Valentine Sharon M. , Doyle Linda , Sayage Valerie , Thode Henry C. 
Published: March 2010

Abstract. Most medications are not absorbed topically due to the stratum corneum barrier. While effective as a topical anesthetic, EMLA cream is absorbed slowly, delaying its effects for up to one hour, thereby limiting its usefulness. Objective: To determine whether removal of the cornified layer of the skin by tape stripping (TS) would allow more rapid onset of anesthesia after topical application of EMLA cream prior to IV catheterization (IVC). Methods: This was a prospective, randomized, controlled trial comparing the levels of pain of IVC 15 minutes after topical application of EMLA cream in patients who had TS vs patients who did not. The setting was a suburban university‐affiliated ED. A convenience sample of 68 alert adult patients requiring IVC were enrolled. The primary outcomes measured were pain of IVC and pain of TS using a previously validated 100‐mm visual analog scale as well as the IVC success rate. Results: The pain of IVC was less for TS vs control patients [29.7 mm (95% CI = 20.4 to 39.0 mm) vs 15.9 mm (95% CI = 9.1 to 22.6 mm), p = 0.017]. The mean pain of TS was 4.8 ± 7.4 mm. The IVC success rate for TS vs control patients was 91% vs 74% (p = 0.056). There were no adverse events after TS. Conclusions: Removal of the cornified layer of the skin resulted in a more rapid anesthetic effect of EMLA cream as evidenced by lower IVC pain scores after TS. The effectiveness of TS for enhanced absorption of other medications should be investigated.
Academic Departments of Emergency Medicine: The Effects of Managed Care
Authors: Counselman Francis L. , Schafermeyer Robert W. , Perina Debra G. 
Published: March 2010

Abstract. Objective: To survey academic departments of emergency medicine (ADEMs) concerning the effects of managed care on their operation and practice. Methods: A 38‐question survey was mailed to the chairs of all 52 ADEMs in the United States requesting information concerning managed care activity and its effects on ADEMs in academic years 1994–1995 and 1995–1996. Results: Forty‐seven ADEMs (90.3%) responded. When comparing the 1995–1996 and 1994–1995 academic years, the following changes were noted: decreased overall growth in ED patient volume (38.3% vs 51.1%), larger percentage of respondents reporting an actual decrease in ED patient volume (38% vs 27.6%), less growth in ED gross revenue (43.7% vs 52.1%), larger percentage of ADEMs reporting actual decreased gross revenues (25% vs 12.5%), increase in ED patient acuity (76.6% vs 59.6%), and relative stability in the number of EM faculty (40.4% vs 44.7% reporting no change in faculty number). Two‐thirds of ADEMs used mid‐level providers (i.e., physician assistants, nurse practitioners), most commonly in a fast‐track setting (41%). Thirty percent of ADEMs reported that other academic departments actively directed patients away from the ED, with pediatrics, family medicine, and internal medicine the most active. Ninety‐eight percent of ADEMs reported ongoing negotiations between their institution or hospital and managed care organizations (MCOs); only 54.3% of ADEMs were involved in these negotiations. Twenty‐eight percent of ADEMs reported MCOs have had an effect on their emergency medical services system, with 37% indicating HMOs routinely discouraged their enrollees from using 9‐1‐1 services and 16% reporting HMOs provided 9‐1‐1 services to take patients only to participating hospital EDs. Conclusion: ADEMs have experienced significant changes in nearly every aspect of their practice over the two academic years under study, much of which is due to managed care. ADEMs must take a leadership role in dealing with MCOs.
Use of Emergency Departments by Elder Patients: A Five ‐year Follow‐up Study
Authors: Strange Gary R. , Chen Edwin H. 
Published: March 2010

Abstract. Objective: Tb compare the use of emergency medical care by elders in the United States in 1995 with that previously described for 1990. Methods: A computerized billing database of 88 EDs in 21 states was retrospectively reviewed for 1995, comparing elder and nonelder patients, estimating national use of emergency medical services by elders, and comparing the 1995 data with previously published results for 1990. Results: From 1990 to 1995, the number of ED visits in the United States increased from 92 million to 100 million. The number of visits made by patients aged 65 years or older increased from 13,639,400 (15%) to 15,666,300 (15.7%), but this increase did not reach statistical significance (p = 0.17). The admission rate for elder ED patients increased from 32% to 46% over the five‐year interval (p < 0.01). This represents more than 7 million hospital admissions for elder patients in 1995. The rate of intensive care unit (ICU) admission for elders decreased from 7% to 6% over the five‐year interval (p = 0.56), compared with 1.3% for nonelder patients for both years. Thirty percent of elder ED patients arrived by ambulance in 1990, compared with 33% in 1995 (p = 0.02). Based on 1995 data, elders comprised 39% of patients arriving by ambulance [odds ratio (OR) 4.75, 95% confidence interval (CI) = 4.71 to 4.79], 43% of all admissions (OR 6.59, 95% CI = 6.54 to 6.64), and 47% of ICU admissions (OR 5.00, 95% CI = 4.91 to 5.09). The comparable ORs in 1990 were 4.4, 5.6, and 5.5, respectively. Conclusions: From 1990 to 1995, the overall number of ED visits increased. The rate of increase was somewhat greater for elder patients. The use of ambulance services also disproportionately grew among elder patients, as did the rate of hospital admission. The overall rate of ICU admission was stable, but actually fell modestly for elder patients. Of these changes, only the increase in the rate of hospital admission for elders reached statistical significance.
1995–1996 SAEM Emergency Medicine Faculty Salary/Benefits Survey
Authors: Kristal Steve L. , Thompson Bruce M. , Marx John A. 
Published: March 2010

Abstract. Objective: The Society for Academic Emergency Medicine (SAEM) commissioned an emergency medicine (EM) faculty salary and benefit survey for all 1995 Residency Review Committee in Emergency Medicine (RRC‐EM)‐accredited programs using the SAEM third‐generation survey instrument. Responses were collected by SAEM and blinded from the investigators. Population: Seventy‐six of 112 (68%) accredited programs responded, yielding data for 1,032 full‐time faculty among the four Association of American Medical Colleges (AAMC) regions. Methods: Blinded program and individual faculty data were entered into a customized version of Filemaker Pro, a relational database program with a built‐in statistical package. Salary data were sorted by 115 separate criteria such as program regions, faculty title, American Board of Emergency Medicine (ABEM) certification, academic rank, years postresidency, program size, and whether data were reported to AAMC. Demographic data from 132 categories were analyzed and included number of staff and residents per shift, number of intensive care unit (ICU) beds, obstacles to hiring new staff, and specific type and value of fringe benefits offered. Data were compared with those from the 1990 and 1992 SAEM and the 1995‐96 AAMC studies. Results: Mean salaries were reported as follows: all faculty, $158,100; first‐year faculty, $131,074; programs reporting data to AAMC, $152,198; programs not reporting data to AAMC, $169,251. Mean salaries as reported by AAMC region: northeast, $155,909; south, $155,403; midwest, $172,260; west, $139,930. Mean salaries as reported by program financial source: community, $175,599; university, $152,878; municipal, $141,566. Conclusions: Reported salaries for full‐time EM residency faculty continue to rise. Salaries in programs reporting data to the AAMC are considerably lower than those not reporting. The gap between ABEM‐certified and non‐ABEM‐certified faculty continues to widen. Residency‐trained faculty are now shown to earn more than non‐residency‐trained faculty. Significant regional differences in salaries have been present in all three SAEM surveys.