bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Phlebotomy Technique on Serum Bicarbonate Values
Authors: Berns Scott D. , Matchett Jessica L. 
Published: March 2010

ABSTRACT Objectives: To determine whether the following phlebotomy technique factors result in spuriously low serum bicarbonate values: 1) small needle size, 2) prolonged tourniquet time, and 3) underfilling of Vacutainer tubes. Methods: Thirty‐eight healthy young adult student volunteers from Brown University (mean age = 22 years) were randomly assigned to 1 of 2 (24‐ga or 20‐ga) IV needle size groups. With a tourniquet applied, the subjects had blood sampled initially and then at 3 intervals 1 minute apart. In addition, the initial blood sample was separated into four 4‐mL Vacutainer tubes in blood volumes of 0.5, 1, 2, and 3 mL. Serum bicarbonate values (mmol/L) were compared using these techniques. Results:1) Small needle size did not affect serum bicarbonate values (p > 0.60); 2) prolonged tourniquet time resulted in a statistically significant serum bicarbonate elevation (32.0, 32.5, 33.8, and 33.6, respectively; p < 0.01); and 3) underfilling of Vacutainer tubes resulted in significantly lower serum bicarbonate values for all 4 Vacutainer blood volume groups (21.4, 23.0, 25.0, and 26.2, respectively; p < 0.001). Conclusions: Small needle size does not affect serum bicarbonate values. Prolonged tourniquet time results in a statistically significant elevation of serum bicarbonate, although this elevation may not be clinically meaningful. Underfilling of Vacutainer tubes significantly influences the accuracy of serum bicarbonate values.
Medical Student Career Advice Related to Emergency Medicine
Authors: Blumstein Howard A. , Cone David C. 
Published: March 2010

ABSTRACT Objective: To describe the advisors and the advice given to residency candidate interviewees interested in specializing in emergency medicine (EM). Methods: All interviewees at a university‐based EM residency program were surveyed. Data were collected anonymously and included demographic information, characteristics of each applicant's medical school, career advice by non‐EM faculty, and access to advisors who are residency‐trained in and practicing EM. Results: Of 114 interviewees, 104 (91%) completed the survey. Only 45% of the respondents reported they were assigned an emergency physician (EP) advisor by their school, and 38% sought advice informally from an EP. Of those students receiving advice from an EP, 70% reported their advisor was residency‐trained in EM. Most (57%) respondents reported receiving negative advice concerning a career in EM from non‐EM medical school faculty. Of the 59 students reporting negative advice, 18 (31%) received negative comments from non‐EM residency program directors, 23 (39%) from non‐EM department chairs, and 4 (7%) from medical school deans. The presence of a residency training program increased the chances of a student's being assigned an EP advisor, but neither an EP advisor nor the departmental status of EM within the students' institutions was associated with receipt of negative advice. Conclusions: Students considering specializing in EM often receive negative advice or have no assigned EP advisor. These factors may adversely affect entry into the field of EM.
Local Anesthesia for Lacerations: Pain of Infiltration inside vs outside the Wound
Authors: Bartfield Joel M. , Sokaris Stephen J. , Raccio‐Robak Nancy 
Published: March 2010

ABSTRACT Objective: To compare the pains of infiltration of a local anesthetic for simple lacerations when used from within the wound vs through intact skin. Methods: A randomized, prospective, single‐blind, experimental protocol was conducted on a convenience sample of adults with simple lacerations. Subjects received two 0.5‐mL injections of buffered lidocaine in each of the sites being compared. Immediately following each injection, pain was measured using a visual analog pain scale. Pain scores were converted to a numerical score and analyzed by a Wilcoxon signed‐rank test. Subjects also were asked which injection hurt more, the first or the second (analyzed by a x2 test). Results: A total of 63 subjects were enrolled. The first injection was within the wound and the second injection through intact skin (group 1) for 32 patients, and the order was reversed for 31 patients (group 2). Median pain scores for all inside‐the‐wound injections (14 mm) were lower than those with intact skin injections (37 mm; p < 0.0001). In group 1, 4 subjects reported the first injection (within wound) hurt most, 23 thought the second (intact skin) hurt most, and 5 found no difference. In group 2, 18 subjects reported the first injection (intact skin) hurt most, 5 believed the second injection (within wound) hurt most, and 8 found no difference, p < 0.0001. Conclusion: Local anesthesia is less painful when injected from within a laceration as compared with intact skin.
Effectiveness of 50% Nitrous Oxide/50% Oxygen during Laceration Repair in Children
Authors: Burton John H. , Auble Thomas E. , Fuchs Susan M. 
Published: March 2010

ABSTRACT Objective: To determine the effect of an inhaled 50% nitrous oxide/50% oxygen mixture on measures of observed anxiety in children during laceration repair. Methods: A prospective, randomized, placebo‐controlled, double‐blind comparison of an inhaled 50% nitrous oxide/50% oxygen mixture (treatment group) with 100% oxygen (control group) during repair of lacerations was performed. The study population was a convenience sample of children aged 2–7 years in an urban pediatric ED. The primary outcome variable was the change in scores before and during laceration repair with a 10‐point modified Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) assessment. The secondary outcome variable was a 4‐point anxiety scale measured before and during the procedure. Results: Thirty patients were entered into the study. Seventeen children inhaled the 50% nitrous oxide/oxygen mixture and 13 inhaled 100% oxygen during laceration repair. There was no statistically significant difference in initial CHEOPS and anxiety scores between the 2 groups (p = 0.687 and 0.809, respectively). The median CHEOPS scores in the treatment group decreased by 5 points, while those of the control patients increased by 3 (p < 0.001). The median anxiety scores in the treatment population decreased by 1 point, with an increase of 1 for the control patients (p < 0.001). Conclusion: Administration of a 50% nitrous oxide/50% oxygen mixture to children during their laceration repair resulted in a significant decrease in measures of anxiety when compared with inhalation of 100% oxygen.
Intramuscular Ketorolac vs Oral Ibuprofen in Emergency Department Patients with Acute Pain
Authors: Neighbor Martha L. , Puntillo Kathleen A. 
Published: March 2010

ABSTRACT Objective: To determine whether IM ketorolac is superior to oral ibuprofen in patients presenting to an ED in moderate to severe pain. Methods: This prospective, randomized, double‐blind study involved a convenience sample of 119 patients aged a 18 years who presented to an urban teaching hospital ED with a self‐assessed pain intensity score of 5, 6, 7, or 8 (on a numerical rating scale of 0–10). Patients were randomized to receive either 60 mg of IM ketorolac and a placebo capsule or 800 mg of oral ibuprofen and a saline injection. Pain scores were measured at 0, 15, 30, 45, 60, 90, and 120 minutes after dosing. Supplemental analgesics were allowed in accordance with standard medical practice. Results: There were 18 patients excluded who did not remain in the ED for the full 2‐hour study period. Of those completing the trial, 53 patients received ketorolac and 48 patients received ibuprofen. There were no significant differences in pain scores between ketorolac and ibuprofen at any time during the study. However, there was a statistically significant decrease in pain over time in both treatment groups. Yet, 40% of the patients continued to report pain intensity scores of 5–8 at 2 hours after treatment. Conclusions: IM ketorolac and oral ibuprofen provide comparable levels of analgesia in ED patients presenting with moderate to severe pain. Unfortunately, 40% of all the patients had inadequate pain relief (pain score ≥5) from either ketorolac or ibuprofen.
Emergency Medical Technician Schedule Modification: Impact and Implications during Short‐ and Long‐term Follow‐up
Authors: Boudreaux Edwin , Mandry Cris , Brantley Phillip J. 
Published: March 2010

ABSTRACT Objective: To determine whether modifying work schedules from 24‐ to 12‐hour shifts results in favorable improvements across a range of psychological and social variables among emergency medical technicians (EMTs). Method: Sequential (before and after) surveys were completed voluntarily by EMTs at 1 month prior to, 2 months after, and 1 year after a workshift modification (change from 24‐ to 12‐hour shifts). The surveys assessed job satisfaction, occupational burnout, and attitudes toward work schedules. The questionnaires were completed at emergency medical service stations. Results: Of 70 EMTs in the system, 51 (73%) completed the first 2 stages of this study; 35 (50%) completed all 3 stages. Paired‐sample t‐tests revealed significant differences between baseline and 2‐month posttest scores on the following variables: the Maslach Burnout Inventory: Emotional Exhaustion Scale (less perceived exhaustion at 2 months); the Schedule Attitudes Survey: General Affect (perceived more positive view toward schedule at 2 months); Social/Family Impact (perceived less disruption of social/family life at 2 months); and Composite (less overall disruption in quality of life at 2 months). Statistically significant differences between baseline and 1‐year posttest scores were found on the following: Schedule Attitudes Survey: General Affect (more positive view toward schedule at 1 year); Social/Family Impact (less disruption in social/family life at 1 year); and Composite (less overall disruption in quality of life at 1 year). Conclusion: Modifying EMTs' work schedules from 24‐ to 12‐hour shifts was associated with improvements in EMTs' general attitudes toward their schedules, less disruption of social and family life, and decreased levels of emotional exhaustion at 2 months after the change. While the improvements in EMTs' attitudes toward their schedules persisted at the 1‐year follow‐up, the measure of emotional exhaustion returned to baseline.
Emergency Physicians' Attitudes toward and Use of Clinical Decision Rules for Radiography
Authors: Graham Ian D. , Stiell Ian G. , Laupacis Andreas , O'Connor Annette M. , Wells George A. 
Published: March 2010

ABSTRACT Objectives:1) To assess Canadian emergency physicians' (EPs') use of and attitudes toward 2 radiographic clinical decision rules that have recently been developed and to identify physician characteristics associated with decision rule use; 2) to determine the use of CT head and cervical spine radiography by EPs and their beliefs about the appropriateness of expert recommendations supporting the routine use of these radiographic procedures; and 3) to determine the potential acceptance of clinical decision rules for CT scan in patients with minor head injury and cervical spine radiography in trauma patients. Methods: A cross‐sectional anonymous mail survey of a random sample of 300 members of the Canadian Association of Emergency Physicians using Dillman's Total Design Method for mail surveys. Results: Of 288 eligible physicians, 232 (81%) responded. More than 95% of the respondents stated they currently used the Ottawa Ankle Rules and were willing to consider using the newly developed Ottawa Knee Rule. Physician characteristics related to frequent use of the Ottawa Ankle Rules were younger age, fewer years since graduating from medical school, part time or resident employment status, working in a hospital without a CT scanner, and believing that decision rules are not oversimplified cookbook medicine or too rigid to apply. Eighty‐five percent did not agree that all patients with minor head injuries should receive a CT head scan and only 3.5% stated they always refer such patients for CT scan. Similarly, 78.5% of the respondents did not agree that all trauma patients should receive cervical spine radiography and only 13.2% said they always refer such patients for cervical spine radiography. Ninety‐seven and 98% stated they would be willing to consider using well‐validated decision rules for CT scan of the head and cervical spine radiography, respectively. Fifty‐two percent and 67% of the respondents required the proposed CT and C‐spine to be 100% sensitive for identifying serious injuries, respectively. Conclusions: Canadian EPs are generally supportive of clinical decision rules and, in particular, have very positive attitudes toward the Ottawa Ankle and Knee Rules. Furthermore, EPs disagree with recommendations for routine use of CT head and cervical spine radiography and strongly support the development of well‐validated decision rules for the use of CT head and cervical spine radiography. Most EPs expected the latter rules to be 100% sensitive for acute clinically significant lesions.
Collaboration in Emergency Medicine Research: A Consensus Statement
Authors: Lewis Lawrence M. , Callaham Michael L. , Kellermann Arthur L. , Marx John A. , White J. Douglas 
Published: March 2010

ABSTRACTThe role of collaboration in medical research and how it applies to emergency medicine (EM) research are discussed. The guidance of the Division of Health Sciences Policy of the Institute of Medicine is reviewed. Application of the principles of collaborative efforts and recognition of each individual's contribution are overviewed. Emergency physicians can and should be invaluable contributors to collaborative research. Collaborative research relationships, whether established at individual institutions or through national clinical trials, must be developed deliberately. The specialty of EM must make the necessary commitment of time and resources to ensure that these occur.
Development of New Methods to Assess the Outcomes of Emergency Care
Authors: Cairns Charles B. , Garrison Herbert G. , Hedges Jerris R. , Schriger David L. , Valenzuela Terence D. 
Published: March 2010

ABSTRACTThis article provides information supporting the need for new outcome measures in emergency care. It also addresses the use of these measures in emergency care, the impact of emergency care, identification of at‐risk groups, new approaches to measuring patient satisfaction, quality of life, and cost‐effectiveness, and the related unique implications for emergency medicine.
Funding Strategies for Emergency Medicine Research
Authors: Carden Donna L. , Dronen Steven C. , Gehrig George , Zalenski Robert J. 
Published: March 2010

ABSTRACTThe importance of adequate funding for sustaining research efforts cannot be overemphasized. This article addresses funding strategies for emergency physicians, including the necessity of establishing a research track record, developing a well‐written grant proposal, and anticipating the grant review process. Funding sources are reviewed with an emphasis on federal institute support and private foundations (including the Emergency Medicine Foundation) in the United States. Sources of current grant support information available from the Internet are provided. Recommendations for enhancing research funding in emergency medicine (EM) are made, including enhancement of formal research training, promotion of EM research and investigators, federal study section membership, and collaboration with established investigators.
The Potential Benefit of a Home Fire Safety Intervention during Emergency Medical Services Calls
Authors: Pirrallo Ronald G. , Rubin Jonathan M. , Murawsky Gloria A. 
Published: March 2010

ABSTRACT Objective: To determine how often house fires occur at 1‐ and 2‐family dwellings visited previously by emergency medical services (EMS) personnel and whether these visits were missed opportunities for a point‐of‐contact home fire safety intervention. Methods: A retrospective, consecutive, case series analysis of all Milwaukee Fire Department alarm responses during 1994 was performed. Measurements included date of service, type of response, property type, dollar loss estimate, number of injuries and fatalities, cause of alarm, and presence of an operational smoke detector. Descriptive, x2. and relative risk statistics were used to describe the relationship between EMS responses and fire responses at 1‐ and 2‐family dwellings. Results: The Milwaukee Fire Department dispatched 94,378 requests for service to 43,556 addresses. 16, 150 addresses generated multiple requests; 7.2% (1,162/16,150) were for an “alarm of fire” response [relative risk 1.83 (95% CI: 1.69–1.99) for addresses with multiple requests vs those with a single request for service]. Most [62% (721/1,162)] of the addresses were visited by EMS personnel prior to the alarm; 28% (205/721) were 1‐ and 2‐family dwellings. A mean of 1.8 (376/205) EMS responses occurred prior to the “alarm of fire” response; 121 addresses received 1 response, 46 received 2, 18 received 3, and 20 received s4 responses. Of 169 addresses with complete data, there was a total fire dollar loss of $1,963,020 (1994) along with 32 injuries and 0 fatalities. While 47% (80/169) of the 1‐ and 2‐family dwellings had a smoke detector present, only 17% (29/169) of the dwellings had an operational smoke detector. Conclusions: A point‐of‐contact home fire safety intervention appears of potential benefit for frequent users of EMS care. Determination of the presence of an operational smoke detector in 1‐ and 2‐family dwellings may be a useful injury prevention act during such EMS calls.
Autonomic Regulation of Gastric Ulcerogenesis after Cervical Cord Transection in the Rat
Authors: Waldrop Ron D. , Strain George M. 
Published: March 2010

ABSTRACT Objective: To examine the role of anticholinergic and sympathomimetic drugs in preventing gastric ulcerogenesis after cervical cord transection (CCT) in the rat. Methods: A randomized, prospective, interventional trial was performed comparing pirenzepine (muscarinic type I receptor antagonist) and ephedrine (nonspecific sympathomimetic) in the prevention of gastric ulcerogenesis after CCT in the rat. After isoflurane‐induced general anesthesia, group 1 (n= 12) received sham CCT with no pretreatment, group 2 received CCT with no pretreatment, group 3 received CCT with pirenzepine pretreatment (0.01/mg/kg IP), and group 4 received CCT with ephedrine pretreatment (3 mg/kg IP). Six hours after intervention, all the rats were euthanized with isoflurane, stomachs were dissected, and a gastric ulcer index was determined. Results: The mean (± SD) ulcer index was 0.08 ± 0.1 for group 1, 2.33 ± 0.5 for group 2 (p = 0.01), 0.41 ± 0.7 for group 3 (p = 0.037 compared with group 2), and 0.75 ± 0.7 for group 4 (p = 0.0005 compared with group 2). Groups 3 and 4 were not significantly different from each other (p = 0.30). Conclusions: Gastric ulcerogenesis after CCT in the rat is decreased by anticholinergic and sympathomimetic drug pretreatment.
Incorporation of a “Coping with the Death of a Child” Module into the Pediatric Advanced Life Support (PALS) Curriculum
Authors: Wolfram R. Wayne , Timmel Daniel J. , Doyle Cindy R. , Ackerman Alice D. , Lebet Ruth 
Published: March 2010

ABSTRACT Objective: To develop an educational module for health professionals (HPs) addressing the clinical reality of death as an outcome of pediatric resuscitation efforts. Module goals were to: 1) reduce HPs' discomfort with situations involving patient death and survivor grief, 2) assist HPs coping with their own emotions surrounding a patient death, and 3) provide specific strategies useful in clinical management. The module was designed to be presented as part of the American Heart Association (AHA) and the American Academy of Pediatrics (AAP) Pediatric Advanced Life Support (PALS) provider course. Methods: A multidisciplinary team created a module addressing both survivors' and HPs' needs regarding a PALS course “Coping with the Death of a Child” module. The module was presented to 964 PALS course participants. Content was revised after analysis of survey data collected from these participants. Results: The revised module was presented to 601 PALS course participants; evaluations were obtained from 590 participants. On a 4‐point Likert scale, ratings were: 79%“excellent,” 18%“good,” 2%“fair,” and <1%“poor.” Conclusion: The PALS course offers an opportunity to target HPs likely to encounter pediatric deaths for special education. While this is a challenging and potentially controversial topic to present to a diverse audience, incorporation of a “Coping with the Death of a Child” module into the PALS provider curriculum appears to be both feasible and useful.
Program for Reducing Pedestrian‐Motor Vehicle Crashes
Authors: Macias Darryl , Olson Lenora , Sandvig Joan , Collins Kimberly , Sklar David 
Published: March 2010

ABSTRACTInjury prevention has been identified as a component of emergency medicine. However, involvement of emergency physicians in injury prevention has been hindered by clinical responsibilities, lack of financial support, and limited expertise in skills necessary for effective injury prevention programs. This article describes the development and content of a statewide pedestrian safety plan prepared by the Department of Emergency Medicine at the University of New Mexico. The plan included a written document, community input through focus groups, and a public information campaign. The written document included a synthesis of published literature, state‐specific data, information on community interventions, and recommendations for state agencies and other groups interested in reducing pedestrian injuries. This project can be modeled at other academic EDs with an interest in injury prevention and pedestrian safety.
Incidence and Characteristics of Fall‐related Emergency Department Visits
Authors: Mathers Lawrence J. , Weiss Harold B. 
Published: March 2010

Abstract. Objective: Unintentional falls are the leading cause of injury and the second most common cause of unintentional injury deaths in the United States, and place a great burden on EDs. In this study, the objective was to describe the incidence and characteristics of ED visits associated with unintentional falls in the United States. Methods: The authors performed a secondary analysis on data from the National Center for Health Statistics' National Hospital Ambulatory Medical Care Survey for 1992–1994. An ED visit was defined as fall‐related if an ICD‐9‐CM cause of injury code was reported as E880.0–886.9 or E888. Results: There were an estimated 7,946,000 fall‐related ED visits per year, corresponding to an annual rate of 3.1 per 100 persons (95% CI = 2.8 to 3.4). Children under 5 years of age comprised the largest proportion of visits (14%). Among those visits coded with respect to place of occurrence, the rate of visits associated with falls occurring at home (1.7/100; 95% CI = 1.6 to 1.9) was significantly higher than that associated with falls occurring in all other locations combined (1.1/100; 95% CI = 1.0 to 1.2). The mean injury severity score increased significantly with the age of the patient. Fall‐related ED visits resulted in an estimated 860,000 hospitalizations, 62% of which involved individuals aged 65 years and older. An estimated $2.45 billion per year was paid for fall‐related ED visits. Government sources paid all or part of 41% of visits. Conclusions: This study reports nationally representative data describing the incidence and characteristics of fall‐related ED visits. These data expand what is known about the epidemiology of falls and help to define the burden that fall injuries place on EDs in the United States. The results of this study could serve as a benchmark to evaluate the effectiveness of future fall prevention efforts.