bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Topical Lidocaine Attenuate the Pain of Infiltration of Buffered Lidocaine?
Authors: Bartfield Joel M. , Raccio‐Robak Nancy , Salluzzo Richard F. 
Published: September 2008

ABSTRACTObjective: To determine whether topical lidocaine attenuates the pain of buffered lidocaine infiltration.Methods: This was a prospective, randomized, double‐blind, placebo‐controlled trial conducted at a university‐based ED. The subjects were adults who had lacerations being repaired using local anesthesia. Two 0.5‐mL injections of buffered lidocaine were given in a standardized manner. The first was given prior to application of topical study solution. The second was given on the opposite side of the laceration after topical application of study solution, which was 5 mL of either 2% lidocaine or saline placebo. The pain of each infiltration was measured using a visual analog pain scale. Pain scores were calculated and compared using a Wilcoxon test with significance defined as p 0.05.Results: A total of 54 subjects participated; 29 received lidocaine topically and 25 received placebo. The groups were similar with respect to age, gender, wound length, wound location, and initial pain score. Pain scores decreased by 11.6 ± 18.6 mm for lidocaine and 10.9 ± 20.9 mm for placebo (p > 0.5). The study had the power to detect a 15‐mm pain score difference (α = 0.05 and β = 0.20) on a 100‐mm scale.Conclusion: Topical 2% lidocaine does not attenuate the pain of infiltration of buffered lidocaine more than does topical normal saline. Investigation of other topical anesthetics with and without epinephrine in conjunction with buffered lidocaine is warranted.
Emergency Department Presentation of Patients with Conversion Disorder
Authors: Dula David J. , DeNaples Louis 
Published: September 2008

ABSTRACTObjective: To describe the presenting symptoms and other features of ED patients diagnosed as having conversion disorder.Methods: A retrospective chart review was carried out on the records of ED patients who had had final ED or in‐hospital diagnoses of conversion disorder. Cases from 1982 to 1992 at a 566‐bed rural tertiary care hospital with a residency program in emergency medicine were reviewed for patient age and gender, presenting signs and symptoms, ED diagnostic evaluation, disposition, and comorbidity.Results: Of 42 patients who had conversion disorder diagnoses, 24 were women and 18 were men. Twenty‐one (50%) of the patients were diagnosed in the ED, and of those patients, ten were released home from the ED. Patient age ranged from 5 to 70 years, with a mean age of 33 years for women and 34 years for men. Most clinical symptoms mimicked neurologic disorders (weakness, pain, seizurelike activity, loss of consciousness, etc). Thirty patients (71%) received laboratory studies in the ED and two others received laboratory studies on admission. Seventeen (40%) patients had computed tomography of the head and five (12%) patients had magnetic resonance imaging of the head. Twelve (29%) patients had previous histories of psychiatric disorders, four (10%) had histories of alcohol and drug abuse, two (5%) had prior conversion reactions, three (7%) had chronic illnesses, and four (10%) had been victims of previous head trauma.Conclusion: Patients with conversion disorder in the ED usually present with neurologic symptoms and undergo multiple diagnostic tests. Comorbidity is common. Early psychiatric evaluation may assist in the diagnosis and evaluation of patients with suspected conversion disorder in the ED.
Violence and General Security in the Emergency Department
Authors: Ordog Gary J. , Wasserberger Jonathan , Ordog Cindy , Ackroyd Syama Atluri, Greg 
Published: September 2008

ABSTRACTObjective: To describe cases of violence related to weapons in a university hospital and urban county ED and to provide related recommendations for ED staff security.Methods: Descriptive analysis and case examples of weapons‐related assaults in one urban ED for the period 1979–1993.Results: Over a 14‐year period, 115 “incidents” of weapons‐related violence were identified during the management of approximately 980,000 patients. Examples of ED violence are described.Conclusion: Emergency department staff should prepare for the possibility of violence by 1) recognizing the danger, 2) rehearsing response mechanisms, and 3) debriefing after incidents. In particular, plans must be made and practiced for the time when external violence follows the surviving victims of gang activity through the “sacrosanct” hospital doors. Protection of patients and ED personnel must be ensured. In many urban settings, appropriately armed security guards must be immediately accessible to the ED staff. Other suggestions for ED protection are given.
Evaluation of a Portable Clinical Blood Analyzer in the Emergency Department
Authors: Sands Vicki M. , Auerbach Paul S. , Birnbaum Jonathan , Green Maurice 
Published: September 2008

ABSTRACTObjective: To assess the potential effects of rapid bedside blood analysis on patient management in the ED.Methods: A prospective, nonrandomized clinical study was conducted over a consecutive ten‐month period (August 1992 to May 1993). Blood samples drawn from a convenience sample of 960 patients for analysis of Na +, K +, Cl‐, BUN, glucose, and/or hematocrit (Hct) were simultaneously analyzed by portable clinical analyzer (PCA) and by routine methods in the central laboratory. Caregivers were blinded to the PCA values; patient care was based solely on central laboratory results. Physicians were surveyed after the completion of patient care.Results: The PCA results were available 31 minutes (mean) sooner than were the central laboratory results for Hct, 43 minutes faster for Na +, K+, and Cl‐, and 44 minutes faster for BUN and glucose. Except for Hct and glucose, the values obtained from the PCA were not significantly different from the central clinical blood analyzer laboratory values. When surveyed, the physicians caring for the patients reported that had the PCA results been available, a different or an earlier therapeutic approach would have resulted in 9.5% of the cases. The decision to release or admit the patient was based on one or more of the laboratory values for 10.7% of patients sampled. In no case in this series did a physician report that final ED clinical outcome would have been affected.Conclusions: In our ED, the PCA yielded faster reporting of laboratory values. These earlier results might have reduced the length of stay in the ED for 17.3% of patients studied. Selective use of a handheld portable analyzer might decrease time to therapeutic interventions and time to disposition.
Utility of Routine Admission Serum Chemistry Panels in Adult Trauma Patients
Authors: Tortella Bartholomew J. , Lavery Robert F. , Rekant Mark 
Published: September 2008

ABSTRACTObjectives: To determine the frequency of abnormal serum chemistries and whether they provide clinically useful information regarding trauma patients. To identify clinical criteria associated with critical serum chemistry values (CSCVs).Methods: The records of all trauma patients admitted to one urban, Level I Trauma Center were retrospectively reviewed for the period (July 1‐December 31, 1989). All trauma patients who had had serum chemistry determinations at hospital admission and at least once more prior to discharge were studied. The CSCVs were determined by a panel of experts prior to record review. Serum chemistry values, patient demographics, mechanisms of injury, and outcomes were statistically analyzed.Results: Most (814/913; 89%) trauma patients had abnormal serum chemistry values. However, only 54/913 (6%) had CSCVs and only six of these CSCVs had prompted a change in resuscitation or treatment (therapeutic K+ infusions). Age > 50 years, a history of hypertension therapy, and a Glasgow Coma Scale score ± 10 were associated with CSCVs; and CSCVs were correlated with increased mortality and critical care unit admission.Conclusion: Routine‐admission serum chemistry values, while frequently abnormal for major trauma patients, generally do not provide clinically useful information in the resuscitation and treatment of trauma patients. Hypoglycemia and metabolic acidosis were more rapidly determined using bedside glucose determination and arterial blood gas evaluation. The routine‐admission serum chemistry panel described in the study lacked utility for most trauma patients. Selective chemistry panel ordering should be used at the time of hospital admission for major trauma patients.
Noninvasive Evaluation of the Collateral Circulation to the Hand
Authors: Fuhrman Thomas M. , McSweeney Elaine 
Published: September 2008

ABSTRACTObjective: To compare four methods of evaluating collateral blood flow to the hand.Methods: The hands of 74 volunteers on the faculty or staff of a university hospital were studied prospectively. Only subjects without known peripheral vascular disease were included. Four tests were used in random order to assess radial and ulnar artery flow. Results of the assessments using the modified Allen's test, pulse oximetry, plethysmography, and laser Doppler perfusion monitoring were compared.Results: No interrupted palmar arch was found. The modified Allen's test was normal in all cases. Pulse oximetry detected a 5% incidence of noticeably reduced blood flow in one artery compared with the other artery. This dominance of one artery was identified in 69% of the hands by plethysmography. The laser Doppler noted a dominant artery in 64% of the hands. Plethysmography and the laser Doppler disagreed in their findings in only 9% of the hands evaluated. Numerical values of blood flow, attainable only by the laser Doppler, were significantly lower upon occlusion of the radial vs the ulnar arteries (p < 0.05; paired t‐test).Conclusion: All of the tests provide information about the collateral circulation to the hand. Only the laser Doppler provides quantitative blood flow. Further studies involving subjects most at risk for post‐cannulation ischemic injury are needed to guide the clinical application of these findings.
Artificial Surfactant Administration in an Animal Model of Near Drowning
Authors: Anker Anthony L. , Santora Thomas , Spivey William 
Published: September 2008

ABSTRACTObjective: To study the use of exogenous surfactant in a rabbit freshwater near‐drowning model.Methods: In a randomized, placebo‐controlled experiment, 21 rabbits were anesthetized, paralyzed, and subjected to near drowning with 6 mL/kg of distilled water. Vital signs, arterial blood gases, and pulmonary compliance were measured at predetermined intervals. The animals were randomized into two groups: a normal O2 group that had their pO2 levels adjusted to 75–150 torr using supplemental O2 as needed, and a high O2 group ventilated with an FiO2 = 100%. Ventilator settings were further adjusted to normalize pH and pCO2 levels prior to instillation of distilled water. The two groups were further divided and 15 minutes after simulated near drowning, the animals were either treated with surfactant (5 mL/kg instilled en‐dotracheally) or not treated. Data were analyzed by repeated‐measures analysis of variance.Results: Near drowning had no significant effect on heart rate or blood pressure. Acidosis was not changed by surfactant; hypoxia was worsened by surfactant: 158 ± 54 torr before and 66 ± 19 torr after administration (p < 0.01). Compliance did not change as a result of surfactant administration. Only the animals (n = 3) in the normal O2 plus surfactant group died during the 90‐minute post‐near‐drowning period of the study.Conclusions: Surfactant administration (5 mL/kg) in this animal model of freshwater near drowning offers no benefit over simple ventilation. Assessment of the merit of smaller volumes of surfactant should be investigated because administration of this solution may represent a second pulmonary insult, given current volume recommendations.
Efficacy of Tissue Glue for Laceration Repair in an Animal Model
Authors: Yawn Michael , Halperin Michael , Huffer William , Cairns Charles 
Published: September 2008

ABSTRACTObjective: To compare the efficacy of butyl‐2‐cyanoacrylate tissue glue (TG) for the repair of skin lacerations in rats with the efficacy of standard closure with sutures.Methods: In a prospective study, eight rats were anesthetized and an 8‐cm dorsal incision was made on each side of the midline. One wound was closed with a single layer of interrupted 5–0 Prolene suture and one by application of TG. The time required to close each wound was recorded. Sutures were removed at seven days; the TG was allowed to fall off spontaneously. The animals were sacrificed after 20 days and the wounds were judged for cosmetic outcome. Four 1 ± 3‐cm strips of skin were excised from each wound; one strip for histologic analysis and three for load extension testing using a tensiometer. Specimens were loaded to wound failure while displacement (D) and energy absorption (EA) were recorded. The paired t‐test was used for comparisons and reported as mean ± SE.Results: No significant difference between TG and suture was found in D (6.5 ± 0.4 vs 5.2 ± 0.4 mm), EA (0.18 ± 0.01 vs 0.17 ± 0.03 kg mm/cm2), or histologic features. The closure time was significantly less using TG (66 ± 5 vs 401 ± 17 sec; p < 0.0001).Conclusions: 1) Sutures and TG in rat skin repair result in similar wound strengths (EA), amounts of stretch (D), and histologic fea‐sures. 2) Wound closure is accomplished much more rapidly with TG.
Physician Medical Direction and Advanced Life Support in the United States
Authors: Tortella Bartholomew J. , Lavery Robert F. , Cody Ronald P. , Doran James 
Published: September 2008

ABSTRACTObjective: To determine the specialty training and responsibilities of urban U.S. emergency medical service (EMS) medical directors and how these factors relate to the type of service involved (fire, hospital, private, municipal).Methods: A single mailed survey of training officers—field supervisors of 211 urban advanced life support (ALS) services in the United States. The survey also requested information about medications carried, approved procedures, and who set these standards. Respondents also rated the EMS medical director's involvement in various activities (quality assurance, administrative, executive, run reviews, and in‐service/education).Results: Eighty‐five percent (n = 179) of the forms were returned, with 165 (78%) usable. The physician EMS medical directors were primarily trained in emergency medicine (77%) and were paid (75%) for EMS responsibilities. The number of medications carried and the number of approved procedures were not related to either the number of hours the physicians commit weekly to the EMS service or their degree of involvement in ALS activities. The physician EMS medical directors were most often involved in quality assurance and education and were less likely to devote time to executive or other administrative functions of ALS units, with the exception of fire‐based EMS physician medical directors, who contributed significantly to executive and administrative functions (p < 0.05). Overall practice standards were established by the medical director (46%), the state department of health (24%), and local/regional health authorities (23%).Conclusions: EMS training officers believe that urban ALS medical directors in the United States primarily provide quality assurance and educational support. With the exception of fire‐based EMS systems, physicians appear to have limited involvement in other EMS administrative and executive functions.
Exertional Heat Stroke in a Young Woman: Gender Differences in Response to Thermal Stress
Authors: Sidman Robert D. , Gallagher E. John 
Published: September 2008

ABSTRACTExertional heat stroke (EHS) is an acute life‐threatening emergency that necessitates the immediate institution of cooling measures. Reported here is a case of EHS in a nonacclimatized young woman who was undergoing strenuous exercise. The patient developed many of the characteristic features of EHS, including central nervous system disturbances, lactic acidosis, rhabdomyolysis, coagulopathy, and abnormal myocardial conduction. While EHS is relatively common in young men, the condition is rare in women. This case presentation addresses gender differences in the response to the thermal stress of intense physical activity.
Falsely Elevated Serum Digoxin Levels Secondary to Endogenous Digoxin‐like Immunoreactive Substances
Authors: Koobatian Thomas J. , Roberts James R. 
Published: September 2008

ABSTRACTEndogenous digoxin‐like immunoreactive substances (DLIS) are produced by the human body and can be significantly elevated in specific clinical conditions. Commercially available digoxin assays do not have the specificity to fully distinguish DLIS from exogenous digoxin, though DLIS do not possess the same therapeutic properties as do the drug. The resultant artificial elevation of a reported digoxin level or a completely factitious level in a patient not taking the drug can have clinically significant consequences.
Nonhemorrhagic Pontine Infarct in a Child Following Mild Head Trauma
Authors: Tannebaum Ross D. , Sloan Edward P. 
Published: September 2008

ABSTRACTA child who presented with hemiparesis secondary to a delayed nonhemorrhagic pontine infarction following mild head trauma is described. The results of the child's workup, including computed tomography (CT), were negative. The diagnosis of nonhemorrhagic pontine infarct was made by magnetic resonance imaging (MRI). The diagnostic evaluation excluded other possible etiologies of cerebral infarction, including vasculitides, CNS infection, congenital heart disease, hypercoagulable states, and demyelinating diseases. Although trauma cannot be proven as the cause of the infarct, other known causes of infarct were excluded. There are few cases of traumatic nonhemorrhagic cerebral infarction among children in the literature; none describes diagnostic MRI findings. MRI is important in these cases, because it may reveal delayed infarction from small–vessel injury, which is not apparent on CT. This article discusses the etiology of and the diagnostic evaluation of pediatric cerebrovascular accidents and suggests the need for emergency physicians to consider trauma as a potential cause of delayed nonhemorrhagic cerebral infarct in children.
The Health Consequences of Injury Questionnaire
Authors: McClure Roderick J. 
Published: September 2008

ABSTRACTObjective: To study the properties of a new survey instrument, the Health Consequences of Injury Questionnaire (HCIQ), for measuring the impact of injury on health and to compare the new instrument with the more detailed, previously developed Quality of Well–being (QWB) scale.Methods: The HCIQ is a three–page health status questionnaire, suitable for self–administration. Similar to the QWB scale, the HCIQ measures health on a unitary scale where 1 represents optimum health and 0, death. The HCIQ was developed and studied in representative samples of injured adults from an Australian population. The HCIQ was administered concurrently with the QWB instrument to a sample of injured subjects, and the QWB scale scores were compared with estimated scores from the HCIQ using QWB scale weightings. The reliability of the HCIQ was tested on a further sample of injured subjects using a mailed test–retest design.Results: Of the 211 subjects in the validity sample, 98 completed both the HCIQ and the QWB scales. The intraclass correlation coefficient for the scores obtained from the two questionnaires was 0.86 (95% CI = 0.66–1.00). The mean difference between the scores was 0.04 ± 0.09 (SD). The HCIQ had a median completion time of 15 minutes. Of the 129 subjects in the reliability study, 53 completed the HCIQ on both postal administrations. The reliability coefficient was 0.90 (95% CI = 0.62–1.00).Conclusion: The HCIQ is a practical and reliable questionnaire for identifying the health consequences of injury that, when used with QWB weights, successfully predicts the QWB score.
The Minor Injury Scale
Authors: McClure Roderick J. 
Published: September 2008

ABSTRACTObjective: To develop an injury scoring system suitable for non–life–threatening injuries.Methods: A prospective cohort study was conducted using a representative sample of 1,396 injured adults to identify the outcomes of a range of injuries. Data were collected between March 12, 1992, and March 11,1993, in the Australian Capital Territory, a geographically circumscribed urban community of 296,000 people served by two hospital EDs. Outcomes included “injury–related health status immediately following injury occurrence” and “accumulated health loss over the period of recovery.” The injury–related health status of each subject at the time of the injury occurrence was measured using the Health Consequences of Injury Questionnaire (HCIQ), which records this outcome as a value on a unitary scale. Injuries were then stratified by injury type, as identified by the Abbreviated Injury Scale numerical identifiers. The median health index value for each type of injury was designated the injury severity score for that injury type. The “accumulated health loss over time until recovery” for each injury was calculated from repeated administrations of the HCIQ over a six–month follow–up period, and the median outcome value for each injury type was designated the injury morbidity score for that injury.Results: Injury severity scores for 46 types of minor injury and injury morbidity scores for 39 types of minor injury were tabulated to form the Minor Injury Scale.Conclusion: This new injury scoring system provides a means of categorizing minor injury according to properties relevant to a public health approach to injury control. Expansion of the number of injury types scored requires further work, as does the testing of the results obtained to confirm the predictive power of the scales.
Practice Satisfaction, Occupational Stress, and Attrition of Emergency Physicians
Authors: Doan–Wiggins Lynnette , Zun Leslie , Cooper Mary Ann , Meyers David L. , Chen Edwin H. , Force For the Wellness Task 
Published: September 2008

ABSTRACTObjective: To define sources of job satisfaction and stress among emergency physicians and assess self–projected career longevity.Design: A survey containing questions regarding emergency medicine (EM) practice satisfaction was mailed to 1,317 diplomates of the American Board of Emergency Medicine (ABEM). Specific sources of practice satisfaction and dissatisfaction, self–reported burnout or impairment, and plans for remaining in the specialty were assessed. Data were compared between two groups of physicians, namely, those residency–trained in EM and those attaining certification through the practice or special category tracts.Results: Of the physicians returning the survey, 25.2% stated that they felt burned out or impaired and 23.1% planned to leave the practice of EM within five years. Perceptions of burnout/impairment and plans to stop practice were associated with less overall practice satisfaction but were not significantly different between the two groups of physicians. Burnout/impairment was linked with psychiatric, drug, or alcohol problems and the feeling that EM had contributed to that problem.Conclusion: This study confirms the relatively high levels of projected attrition in EM and supports the perception that stress and burnout are associated with the specialty. Differences in job satisfaction and stress between those ABEM diplomates who were residency–trained in EM and those who became eligible for the board examination through practice or special–category eligibility appear minor.