bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ketorolac TVomethamine Use in a University‐based Emergency Department
Authors: Bartfield Joel M. , Kern Audrey M. , Raccio‐Robak Nancy , Snyder Howard S. , Baevsky Robert H. 
Published: August 2010

ABSTRACT Objective: To assess the use of parenteral ketorolac tromethamine (KT) in the emergency department (ED). Methods: During a six‐month period, KT was administered in an uncontrolled, nonblinded fashion to a series of ED patients experiencing acute pain. The patients rated pain on a previously validated visual analog pain scale before receiving KT. They repeated this procedure one hour after KT administration, prior to additional analgesia, or preceding release, whichever came first. Analgesic response was assessed by comparing pretreatment and posttreatment pain scores for the entire study population by the Wilcoxon rank sum test. Possible effects of specific variables (patient age, gender, race, indication for KT, route, dose, previous use of NSAIDs, and concurrent administration of muscle relax‐ants) were assessed using the Kruskal‐Wallis test. Results: Of the 445 patients enrolled, 375 (84%) reported pain relief with KT, only seven (2%) worsened, and the remainder (14%) reported no change. Overall pain reduction was 37.6 ± 27.2 (SD) mm (100‐mm scale) for the entire study population. The pain scores obtained after KT administration were significantly lower than those obtained prior to KT administration (p < 0.001). The only variable that significantly influenced pain score reduction was indication for KT (p = 0.0001). Nephro‐lithiasis and toothache patients had the largest mean reductions in pain. No significant side effect was reported. Conclusion: Parenteral KT is a useful and safe analgesic for ED patients. The agent generally provides analgesia and is particularly promising for patients with nephrolithiasis or toothache.
Ketorolac vs Meperidine for the Management of Pain in the Emergency Department
Authors: Koenig Kristi L. , Hodgson Laurel , Kozak Richard , Jordan Kathy , Sexton Thomas R. , Leiken Alan M. 
Published: August 2010

ABSTRACT Objective: To compare the pain relief, sedation, and common side effect profiles of ketorolac tromethamine and meperidine for the management of acute pain in the emergency department (ED). Methods: A prospective, double‐blind, randomized clinical trial was conducted over a 12‐month period using consecutive adult patients presenting to a university teaching hospital ED (annual census: 32,000), who required IM analgesia for acute pain. Adult patients with acute pain of various etiologies were randomly assigned to receive a single fixed IM dose of ketorolac (60 mg) or meperidine (100 mg). Results: Ninety‐three patients were enrolled in the study; 46 were randomized to meperidine and 47 to ketorolac. Using a visual analog scale, there was no difference in pain relief between the ketorolac and meperidine groups even after adjusting for baseline pain level. Ketorolac caused significantly (p < 0.005) less sedation than did meperidine at one hour. Rescue analgesia was required for seven of the 46 (15.2%) patients receiving meperidine and five of the 47 (10.6%) patients receiving ketorolac (p = NS). Seventeen of 45 (38%) patients receiving meperidine experienced side effects compared with eight of the 47 (17%) patients receiving ketorolac (p = 0.0452). Conclusions: When used to treat patients who had acute pain states, 60 mg of IM ketorolac produced analgesia similar to that produced by 100 mg of IM meperidine; however, the ketorolac produced fewer subjective side effects and less sedation than did the meperidine.
Air Embolism Death of a Pregnant Woman Secondary to Orogenital Sex
Authors: Kaiser Rachel T. 
Published: August 2010

ABSTRACTAir embolism produced by vaginal insufflation is an unusual but potentially lethal consequence of sexual activity, especially in the pregnant patient. Reported here is the case of a young pregnant woman who presented to the ED in full cardiac arrest, with little history to explain her condition. Despite aggressive resuscitative measures, the patient died, but her infant son was delivered via perimortem cesarean section and survived. A high level of suspicion for air embolism should be maintained for young women who unexpectedly develop cardiac arrest, particularly during sexual activity. Air embolism patients may require vigorous medical resuscitation, hyperbaric oxygen therapy, or surgical intervention to survive. The emergency physician should be familiar with the indications for perimortem cesarean delivery in the third‐trimester patient presenting to the ED with cardiac arrest.
Gynecologic Disorders in the Older Patient
Authors: Jones Jeffrey S. , Montgomery Matthew 
Published: August 2010

ABSTRACTThis review addresses the presentation and management of gynecologic disorders in older women. While these conditions are often managed by a primary caregiver, many women may present to the ED because they lack a primary gynecologic caregiver, their established gynecologic caregiver is not available, they are embarrassed to discuss their symptoms with an established caregiver, or they seek immediate relief of symptoms and reassurance. The emergency physician (EP) must be aware of the normal physiologic changes that occur with aging and how these changes may produce symptoms in older women. This review addresses physiologic changes and pathophysiologic conditions. Knowledge of these conditions and their management will facilitate reassurance of the patient, expedite appropriate initial therapy, and enable the EP to efficiently refer patients requiring further gynecologic assessment.
Outcome of Acute Otitis Media with Abnormal Tympanometric Patterns in Children
Authors: Green Steven M. , Rothrock Steven G. , Nesper Timothy P. , Hummel Christopher B. 
Published: August 2010

ABSTRACT Objective: To assess the ability of ED tympanometry to identify those children with acute otitis media who are at greater risk for treatment failure, recurrent infection, or persistent middle ear effusion. Methods: A prospective observational study was performed in the EDs of a county hospital and a university medical center. One hundred seventeen children, aged 5 months to 5 years, with acute otitis media and abnormal tympanometric patterns were categorized into three groups —low compliance, high pressure, and low pressure—based on the initial patterns. All the children received oral amoxicillin for ten days. They had repeat tympanometry and otoscopy at 14‐ and 60‐day follow‐up visits, and were followed to determine clinical outcomes. Results: Initial treatment success was equivalent for all groups: low compliance 93% (95% confidence interval 81%‐97%), high pressure 91% (95% CI 71%‐98%), and low pressure 89% (95% CI 59–99%). Rates of relapse, reinfection, 90‐day non‐recurrence, and persistent otoscopic and tympanometric middle ear effusion did not differ significantly between groups. Conclusion: ED tympanometry of children with acute otitis media is unable to provide prognostic information regarding treatment failure, recurrent infection, or persistent middle ear effusion.
A Comparison of Proparacaine and Tetracaine Eye Anesthetics
Authors: Bartfield Joel M. , Holmes Thomas J. , Raccio‐Robak Nancy 
Published: August 2010

ABSTRACT Objective: To compare two topical eye anesthetics, proparacaine and tetracaine, for pain of instillation and duration of activity. Methods: Volunteers received both anesthetics in a prospective, randomized, double‐masked protocol. The subjects were given one drop of a study solution in the lower lid fornix of the left eye. Immediately after receiving the medication, they rated the pain of instillation on a previously validated visual‐analog pain scale. This procedure was then repeated in the right eye with the other study solution. Pain scales were quantified by making measurements to the nearest millimeter from the point of scale origin to the point marked by the patient. The time interval until return of the corneal blink reflex was determined using a cotton wisp. Pain scores and the time to return of corneal reflex were analyzed by the Sign test and Wilcoxon rank‐sum test, respectively, with significance defined as p < 0.05. Results: Twenty‐three subjects were available for analysis. Twenty subjects reported proparacaine hurt less than tetracaine, two felt the pain was the same for the two agents, and only one reported that proparacaine was more painful. The mean pain score for tetracaine was 24 mm (100 mm maximum) higher than that for proparacaine (p < 0.0002). Proparacaine lasted 1.3 minutes longer than tetracaine, 10.7 minutes versus 9.4 minutes (p = 0.0001). Conclusion: Proparacaine eye drops cause less pain than tetracaine eye drops upon instillation. Anesthesia from proparacaine lasts slightly longer. These properties make proparacaine preferable to tetracaine.
Emergency Thoracotomy: Comparison of Medical Student, Resident, and Faculty Performances on Written, Computer, and Animal‐model Assessments
Authors: Chapman Dane M. , Marx John A. , Honigman Ben , Rosen Peter , Cavanaugh Sally H. 
Published: August 2010

ABSTRACT Objective: In clinical practice, thoracotomy and other critical emergency procedures are rarely required. Consequently, medical students and residents have difficulty acquiring procedural competency in these critical procedures. The authors developed objective written, computer, and animal‐model assessments of thoracotomy procedural competency to permit comparison of the reliability and validity of these three procedural assessment modalities. Methods: Thoracotomy procedural competency was evaluated for 18 persons at three levels of training (medical student, resident, faculty), using written, computer, and animal‐model assessments. A prospective, sequential assessment design was used, with the examinees serving as their own controls. Procedural competency was defined in terms of performance time (animal time scale) and performance accuracy (written accuracy, computer accuracy, and animal accuracy scales) for three thoracotomy procedures (opening the chest, pericardiotomy, and aortic cross‐clamping). Level of training was the independent variable, and procedural competency scores were the outcome measures. Confounding variables included previous thoracotomy and computer experience. Results: Computer and animal‐model assessments produced reliable results (Chronbach's alpha > 0.50). The animal time scale and computer accuracy scale best reflected the expected skill differences among levels of physician training, providing support for construct validity. In contrast, written and animal accuracy scale scores did not significantly differ by level of physician training. Moreover, previous thoracotomy experience (i.e., number of procedures previously performed) was not a significant predictor of procedural competency. Conclusions: This study demonstrates that critical emergency medicine procedures can be evaluated reliably and validly using computer simulation and animal‐model assessments. Neither previous thoracotomy experience nor knowledge of procedure content adequately predicts thoracotomy competency.
Variations in the Electrocardiograms of Young Adults: Are Revised Criteria for Thrombolysis Needed?
Authors: Hollander Judd E. , Lozano Michael , Goldstein Evan , Gennis Paul , Slater William , Fairweather Philip , Thode Henry C. , Gallagher E. John 
Published: August 2010

ABSTRACTObjective:The evaluation of chest pain in young adults has changed with the recognition of cocaine‐induced myocardial ischemia. The high frequency of abnormal electrocardiograms (56–84%) in the cocaine‐user population is largely due to “normal” electrocardiographic variants (early repolarization). The authors sought to determine the frequency of these “normal” variants in a young population, and whether these findings can be confused with acute ischemia.Methods:A prospective convenience sample of subjects aged 18 to 35 without known heart disease was interviewed and had 12‐lead electrocardiographic tracings performed. An emergency physician (physician 1) and a cardiologist (physician 2) read the tracings while blinded to patient history, age, and race. When the physicians disagreed, another physician adjudicated the diagnosis.Results:Four hundred fourteen subjects (127 black, 175 Hispanic, and 112 Caucasian) were enrolled. Overall, 154 tracings (37%) were normal, 245 (59%) were abnormal but nondiagnostic for ischemia, and 15 (4%) were consistent with ischemia. Frequencies of repolarization “abnormalities” as determined by physicians 1 and 2, respectively, were: blacks, 32%, 51%; Hispanics, 26%, 35%; Caucasians, 17%, 27%; chi‐squared, p = 0.02 and 0.0004. Patients with ischemic electrocardiograms according to physician 1 had a high frequency of repolarization “abnormalities” according to physician 2, and vice versa (100%, 61%). Electrocardiographic criteria for thrombolytic use per physician 2 were present in 31 patients (7%): blacks, 9%; Hispanics, 10%; and Caucasians, 2%; chi‐squared, p = 0.03.Conclusions:Repolarization “abnormalities” in young patients are common. These “normal” electrocardiographic variants can be confused with ischemia. Based on the degree of ST‐segment elevation, these variants commonly meet current criteria for thrombolytic therapy.
Recovery from Severe Cyclic Antidepressant Overdose with Hypertonic Saline/Dextran in a Swine Model
Authors: McCabe James L. , Menegazzi James J. , Cobaugh Daniel J. , Auble Thomas E. 
Published: August 2010

ABSTRACTObjective:To determine the effect of a hypertonic saline and dextran (HSD) solution on blood pressure and QRS duration during severe cyclic antidepressant (CA) toxicity in swine.Methods:Ten domestic swine weighing 20–24 kg were anesthetized and placed on mechanical ventilation. Nortriptyline solution was infused intravenously to achieve hypotension (systolic blood pressure equal to 50% of baseline) and a QRS duration of 120 msec. After reaching toxicity, the animals received in a randomized fashion either 10 mL/kg of a 7.5% saline/6% dextran solution or an equal volume of 0.9% saline as a rapid intravenous bolus. The animals were observed for one hour or until they died. Blood pressure and ECG were recorded continuously. Arterial pH was maintained in the physiologic range by controlled ventilation.Results:Mean systolic blood pressure 10 minutes after treatment was 45 ± 8 torr in the normal‐saline group compared with 115 ± 12 torr in the HSD group (p < 0.05). Mean QRS duration 10 minutes after treatment was 180 ± 8 msec in the normal‐saline group; it was 88 ± 13 msec in the HSD group (p < 0.05). All normal‐saline‐group animals died within 20 minutes, and four of the five animals in the HSD group survived to 60 minutes (p < 0.05). The mean peak sodium concentration was 157 mmol/dL (mEq/dL) in the HSD group, and this was transient.Conclusions:In this swine model of severe CA toxicity, a solution of 7.5% saline/6% dextran significantly reversed hypotension and QRS prolongation. HSD also improved survival to 60 minutes.
Survey of Follow‐up Systems in Emergency Medicine Residencies: Analysis and Proposal
Authors: Bentley Burton , DeBehnke Daniel , Ma O. John 
Published: August 2010

ABSTRACTObjective:For educational purposes, the Residency Review Committee for Emergency Medicine requires that emergency medicine residencies “provide a mechanism for each resident to obtain information on outcomes of patients the resident has evaluated in the emergency department.” The authors analyzed the current patient follow‐up systems of emergency medicine residencies and, based upon survey results, propose a comprehensive organized system of follow‐up.Methods:The 84 emergency medicine residency directors listed in the 1991 Society for Academic Emergency Medicine Handbook were polled regarding the current follow‐up systems at all hospitals affiliated with their residencies. The survey contained 11 items, including two five‐point Likert scales for rating system effectiveness and satisfaction. A description of each hospital's follow‐up system was requested, and other comments were reviewed.Results:The 72 (86%) respondents represented residencies with a total of 138 affiliated hospitals, of which 89 (64.5%) had formal follow‐up systems. Of those 89 hospitals, 39% (n= 80) residency directors reported that fewer than half of their residents used the systems, 63% (n= 87) had mandatory compliance policies; 53% had the capability for residents to obtain discharge summaries on admitted patients; and 66% (n= 83) had mechanisms for follow‐up of patients released from the emergency department. Twenty‐three percent of the systems were considered effective, with ratings of 4 or higher, and only 31% received satisfaction ratings of 4 or more.Conclusion:Most emergency medicine residency‐affiliated hospitals in our survey had follow‐up systems in place. Of existing systems, only a minority were rated by residency directors as effective or satisfactory. A model for a comprehensive system of patient follow‐up is proposed.
Emergency Physicians' Perspectives on Smallpox Vaccination
Authors: Kwon Nancy , Raven Maria C. , Chiang William K. , Moran Gregory J. , Jui Jon , Carter Richard A. , Goldfrank Lewis ,   The EMERGEncy ID Net Study Group
Published: August 2010

Abstract Objective: To evaluate emergency physician (EP) attitudes toward smallpox vaccination, the treatment of patients with suspected smallpox, and the threat of a bioterrorist attack. Methods: This was a prospective study utilizing a standardized survey instrument that was distributed on November 16, 2002, and collected by February 1, 2003. EPs from a sample of 50 accredited emergency medicine programs were surveyed regarding their perspectives on smallpox vaccination. Results: A total of 989 surveys were collected from 42 emergency medicine programs. Of the respondents, 43.4% would currently volunteer for smallpox vaccination. EPs previously vaccinated against smallpox were 1.46 times more likely to volunteer for vaccination (95% CI = 1.14 to 1.93). EPs who believed they were at risk for complications were less than half as likely to volunteer for vaccination. EPs who perceived a significant risk of a bioterrorist attack were 2.7 times more likely to volunteer for the vaccine compared with those who thought the risk was minimal (95% CI = 2.06 to 3.47). Of the respondents, 34.4% believed the risks of the vaccination outweighed the benefits, 33% did not, and 32.6% were unsure. Conclusions: Currently, fewer than half of EPs surveyed would volunteer for smallpox vaccination. Factors associated with a willingness to be vaccinated include previous smallpox vaccination and the perceived threat of a bioterrorist attack. The variation in EP attitudes toward smallpox vaccination may be due to uncertain risk‐to‐benefit ratio. The opinions and actions of EPs may be influential on current and future government policy and public opinion.
The Pediatric Emergency Care Applied Research Network (PECARN): Rationale, Development, and First Steps*
Authors:   The Pediatric Emergency Care Applied Research Network
Published: August 2010

AbstractSince its formal recognition as a medical specialty, the field of pediatric emergency medicine has made substantial advances with respect to its scope and sophistication. These advances have occurred in clinical practice as well as in the research base to improve clinical practice. There remain, however, many areas in emergency medical services for children (EMSC), in the out‐of‐hospital as well as the emergency department (ED) and hospital settings, that suffer from a lack of data to guide practice. In an effort to expand the quality and quantity of research in pediatric emergency care, the Pediatric Emergency Care Applied Research Network (PECARN) was created in October 2001. PECARN is the first federally funded national network for research in EMSC. PECARN is the result of Cooperative Agreement grants funded through the Health Resources and Services Administration (HRSA) with the purpose of developing an infrastructure capable of overcoming inherent barriers to pediatric EMSC research. Among these recognized barriers are low incidence rates of serious pediatric emergency events, the need for large numbers of children from varied backgrounds to achieve broadly representative study samples, lack of an infrastructure to test the efficacy of pediatric emergency care, and the need for a mechanism to translate study results into clinical practice. PECARN will serve as a national platform for collaborative research involving the continuum of care within the EMSC system, including out‐of‐hospital care, patient transport, ED and in‐hospital care, and rehabilitation. This article describes the history of EMSC, the need for a national collaborative research network in EMSC, the organization and development of PECARN, and the work plan for the Network.
Smallpox Vaccination for Emergency Physicians*
Authors:   AAEM/SAEM Smallpox Vaccination Working Group
Published: August 2010

AbstractOn December 13, 2002, President Bush formally announced the national smallpox vaccination program. The plan involves vaccinating health care workers who would respond to possible smallpox cases, including emergency physicians. Although not all aspects of the program are clearly established, it appears that vaccination of health care workers will occur in the near future. This joint statement has been used by the American Academy of Emergency Medicine and the Society for Academic Emergency Medicine regarding smallpox vaccination for emergency physicians.
Tobacco is Going, Going … But Where?
Authors: Stull Donald D. 
Published: August 2010

AbstractTobacco is America's most vilified agricultural product. It is also the eighth most valuable crop in the United States, and its immense economic value and historic depth made it an agricultural cornerstone and a cultural focus in the Upper South. The federal tobacco program limited production and ensured a fair price to growers, helping many small family farms survive at no net cost to the American taxpayer. Kentucky ranks second in tobacco production and is the most tobacco‐dependent state. This paper examines what has happened to tobacco farmers in western Kentucky since the federal tobacco program was terminated in 2004 and its broader implications.
Sowing the Seeds: Anthropological Contributions to Agrobiodiversity Studies
Authors: Veteto James R. , Skarbø Kristine 
Published: August 2010

AbstractAgrobiodiversity studies have been a longstanding and current research focus of anthropological inquiry. This article gives an overview of important ongoing anthropological topics of agrobiodiversity research including conservation, cultural memory, farmer decision making, and homegarden studies. It also points to future directions in agrobiodiversity research that have been understudied to date including agrobiodiversity and its relationship to climate change and migration, the potential marriage of agrobiodiversity and food studies, agrobiodiversity in the Global North, and the incorporation of agrobiodiversity into emergent sustainable/alternative agriculture systems. Agricultural anthropology is suggested as a potential holistic subdiscipline for incorporating anthropological studies of agrobiodiversity, which are currently not unified by any theoretical framework.