bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of a Prototype Esophageal Detection Device
Authors: Marley Charles D. , Eitel David R. , Anderson Thomas E. , Mum Alvin J. , Patterson Geraldine A. 
Published: September 2008

ABSTRACTObjective: To determine the ability of a prototype esophageal detection device (EDD) to identify esophageal misplacement of an endotracheal (ET) tube.Methods: A prospective, randomized, blinded study of detection of esophageal intubation was conducted using 51 elective surgical patients who met inclusion criteria. A squeeze–bulb aspirator that creates a negative pressure of – 80 to – 90 torr was used for detection of esophageal intubation. The bulb should reinflate rapidly if the tube is in the noncollapsible trachea, but should not reinflate if the tube is in the collapsible esophagus. Each patient was prepared for surgery in the usual manner. The anesthesiologist placed an ET tube into the trachea. An identical tube was advanced the same distance into the esophagus. The tubes were labeled “A” or “B” according to a computer–generated random number list. An evaluator, who was blinded to the placement of the tubes, assessed one tube with the EDD. For most patients, a second evaluator, who was blinded to both tube placement and the results of the first evaluator, assessed the other tube. During evaluation, the tube cuffs were deflated. After data collection, the esophageal tube was removed and surgery was completed.Results: All 45 esophageal tube placements were correctly identified. Thirty–five of the 40 ET tubes were correctly identified. Of the five ET tubes mislabeled, three were found in a mainstem bronchus. All had delayed bulb re–expansion.Conclusion: This prototype EDD is a useful method of identifying esophageal misplacement of an ET tube in anesthetized adult surgical patients.
Family Response to Out–of–hospital Death
Authors: Schmidt Terri A. , Harrahill Maureen A. 
Published: September 2008

ABSTRACTObjective: To better understand the perceptions, needs, and responses of family members after an out–of–hospital death.Methods: Over an 18–month period, phone interviews were conducted using a structured interview schedule modified from a similar study of survivors of in–hospital death. Subjects included 31 survivors of urban out–of–hospital deaths attended by paramedics from one ambulance company. Subjects were eligible if paramedics had arrived and death had been determined at the scene without transport. Survivors were interviewed 11 to 15 months after the death (mean = 12 months) to evaluate how well they coped with their loss, how they managed the experience of their loved ones' out–of–hospital deaths, and their feelings and beliefs about their loved ones' not being transported to a hospital.Results: None of the survivors believed their loved ones should have been transported to a hospital, and only one believed that something more could have been done for the individual. Although many of the survivors had suspected their loved ones had died, 64% had been informed of the death by emergency medical technicians (EMTs) or firefighters. Most thought the EMTs had informed them in a professional (81%) and gentle/supportive manner (74%). Some (29%) still had unanswered questions about the death, but most (58%) were adjusting well and no one had a “poor” adjustment.Conclusion: In this small sample, survivors of out–of–hospital death were generally satisfied with the care their loved ones had received. None of the survivors believed their loved ones should have been transported to the hospital. They also believed the paramedics had been supportive and met their needs at the time of death. It appears that paramedics may be able to meet the needs of a patient's survivors by terminating out–of–hospital resuscitation efforts on the patient.
Validation of a Rapid Urine Screening Assay for Cocaine Use among Pregnant Emergency Patients
Authors: Westdorp Ellen J. , Salomone Joseph A. , Roberts David K. , Mclntyre Malcolm K. , Watson William A. 
Published: September 2008

ABSTRACTObjectives: To determine the accuracy of the OnTrak rapid urine latex agglutination immunoassay (AIA) for testing pregnant ED patients for the cocaine metabolite benzoylecgonine (BE), and to determine the frequency of urine BE in pregnant ED patients and the association of test results with patient demographics.Methods: A test performance evaluation was conducted using an inception cohort of pregnant patients at an urban teaching hospital ED. Patients with positive urine chorionic gonadotropin tests who had adequate remaining urine samples were studied. Patient demographics, ED diagnoses, and assay results were recorded without patient identifiers. Urine was tested using the rapid AIA. The first 150 samples were confirmed using a second immunoassay and gas chromatography with a nitrogen phosphorus detector. All positive samples also were confirmed with thin‐layer chromatography, and quantification by gas chromatography‐mass spectrometry.Results: Twenty of 342 (5.9%, 95% CI 3.4–8.4%) pregnant patients had urine samples positive by AIA testing for BE. Confirmation testing demonstrated no false‐positive or ‐negative AIA result. Positive test results were not associated with specific patient diagnoses or demographics.Conclusions: ED screening for cocaine use among pregnant patients can be accurately performed using the On Trak AIA for BE. In the ED population screened, 5.9% of the pregnant women had urine samples positive for BE.
A New Model for Teaching Corneal Foreign Body Removal
Authors: Austin Paul E. , Ljung Martha , Dunn Kathleen A. 
Published: September 2008

ABSTRACTObjective:To determine whether a skills laboratory for corneal foreign body and rust ring removal improves self‐assessed skill and confidence.Methods: A prospective trial was conducted as part of the didactic curriculum of a university‐based residency program in emergency medicine (EM). A convenience sample of 26 EM residents and five fourth‐year medical students participated. The skills laboratory used model corneas made by coating 3.2‐cm glass spheres with a 1–2‐mm film of paraffin. Foreign bodies were simulated by embedding small pieces of metal into the paraffin. Rust rings were simulated by dipping a hot, straightened paper clip into a rust‐colored crayon and then into the paraffin. The model eyes fit into a life‐sized model of a human head. Participants removed the foreign bodies and rust rings under supervision, using the slit lamp. Each participant anonymously completed a questionnaire before and after participating in the skills laboratory. The questionnaire recorded educational level, previous experience, and self‐assessed comfort and skill levels (0 = lowest, 10 = highest).Results: Most (66%) of the participants had not previously removed a corneal foreign body; 86% had not previously removed a rust ring. On a ten‐point scale, the median comfort level for removing a foreign body rose from 2 to 7, and the self‐assessed skill level rose from 1 to 7 (p = 0.0001). Similar improvements in self‐assessed comfort and skill levels were seen for rust ring removal.Conclusions: Participation in this skills laboratory significantly improved the self‐reported comfort and self‐assessed skill levels in removing corneal foreign bodies and rust rings. This technique provides useful practice of a fine‐motor procedural skill requiring eye‐hand coordination prior to supervised application of these skills in clinical practice.
Evaluation of Hemoperitoneum Using a Single‐ vs Multiple‐view Ultrasonographic Examination
Authors: Ma O. John , Kefer Michael P. , Mateer James R. , Thoma Beth 
Published: September 2008

ABSTRACTObjective: To compare the sensitivities, specificities, and accuracies between a single‐view ultrasonography (US) technique and a multiple‐view technique for identifying hemoperitoneum in multiple‐trauma patients.Methods: Data from a prior prospective study of US for trauma diagnosis at a level I trauma center were retrospectively analyzed. A convenience sample of adult patients (≥ 18 years of age) who had presented with major blunt or penetrating torso trauma and had undergone rapid trauma US examinations to detect hemoperitoneum were reviewed. The US interpretations by emergency physicians had been recorded prior to obtaining other diagnostic tests. Five views were evaluated, including the right intercostal oblique view examining Morison's pouch. Evidence of free intraperitoneal fluid by exploratory laparotomy, CT, or diagnostic peritoneal lavage (DPL) was used as the criterion standard.Results: Of the 245 patients entered into the study, 37 had free intraperitoneal fluid, confirmed by CT, DPL, or exploratory laparotomy. With the multiple‐view technique, US was 87% (95% CI = 71%, 96%) sensitive, 100% (95% CI = 97%, 100%) specific, and 98% (95% CI = 95%, 100%) accurate. The single‐view technique, evaluating only Morison's pouch, was 51% (95% CI = 34%, 68%) sensitive, 100% (95% CI = 98%, 100%) specific, and 93% (95%. CI = 89%, 96%) accurate.Conclusions: An initial trauma US examination using a multiple‐view technique is more sensitive than that using a single‐view technique for detecting hemoperitoneum in trauma patients.
Multicenter Study of Case Finding in Elderly Emergency Department Patients
Authors: Gerson Lowell W. , Rousseau Elaine W. , Hogan Teresita M. , Bernstein Edward , Kalbfleisch Norman 
Published: September 2008

ABSTRACTObjectives: To assess the feasibility of a brief comprehensive case‐finding program for detecting functional, cognitive, and social impairments among elderly ED patients and to estimate the prevalence of unknown, undetected, or untreated impairments elderly patients may have.Methods: A multicenter prospective study conducted at five private and public hospital EDs in five different communities across the country. Patients aged 60 years and older released to their homes during 52 randomly selected evening and weekend shifts between February 1 and April 30, 1993, were eligible for the case‐finding program. They were evaluated by medical students who received special training (instructional videotape, supervised examinations, and conference calls) in the administration of a standardized 17‐item protocol that included an interview and simple tests of function. The patients' physicians were notified of the screening results and were asked to return a one‐month follow‐up questionnaire. The physicians answered whether the presumed problem had been confirmed and whether a treatment plan for a new problem had been developed.Results: Patient acceptance of the case‐finding program was good; 252 of 338 eligible patients (75%) agreed to participate, and 281 conditions were detected for 242 screened patients (96%). The most frequently reported problems were with: performing the activities of daily living (79%); vision (55%); lack of influenza vaccination (54%); home environment (49%); mental status (46%); general health (41%); falls (40%); and depression (36%). The physicians returned questionnaires for 153 patients (63%); 76 patients (50%) were evaluated at follow‐up visits, during which 47 newly identified problems (62%) were confirmed and treatment plans were developed for 25 problems (53%) among 21 patients. A mean time of 17.7 ± 10.2 minutes was required to complete the screen.Conclusions: A brief comprehensive case‐finding program for functional, cognitive, and social impairment among elderly ED patients is feasible. The screening uncovered a significant amount of morbidity among older patients visiting EDs.
Case Conference: Complete Heart Block in a Young Man
Authors: Huff J. Stephen , Syverud Scott A. , Tucci Mary Anne 
Published: September 2008

ABSTRACTA previously healthy 32‐year‐old man presented to the ED in complete heart block. Ischemic, infectious, and inflammatory conditions were considered in the differential diagnosis. Management options for complete heart block, the etiology of heart block in young adults, and treatment guidelines are reviewed.
Oral Intubation Using a Lighted Stylet vs Direct Laryngoscopy in Older Children with Cervical Immobilization
Authors: Berns Scott D. , Patel Ramesh I. , Chamberlain James M. 
Published: September 2008

ABSTRACTObjective:To compare the tracheal intubation success rates of blind oral intubation using a lighted stylet vs standard of direct laryngoscopy in anesthetized pediatric patients wearing rigid cervical collarsMethods: Seventy–eight children were randomly assigned to method of intubation (lighted stylet or direct laryngoscopy) and intubator; five patients were excluded after randomization. After sedation and paralysis, the patients were placed in rigid cervical spine collars to simulate intubating conditions for trauma patients. Three attempts at intubation were allowed. An observer recorded the following parameters during the procedure: 1) number of intubation attempts, 2) duration of each intubation attempt, and 3) complications. The intubators had limited prior experience with the lighted stylet technique.Results: Thirty–three patients were in the lighted stylet group and 40 were in the laryngoscopy group. The patients in the lighted stylet group required more attempts prior to successful intubation (2.2 vs 1.5, p < 0.01), and the success rate was higher for the laryngoscopy group (26/33 vs 39/40, p < 0.05).Conclusions: Blind oral intubation using a lighted stylet under controlled conditions took longer than direct laryngoscopy. However, among those successful on the first intubation attempt, the times to intubation were not significantly different between groups (44.5 vs 52.9 sec). The lighted stylet technique is a viable alternative technique for intubating children who have concurrent cervical spine immobilization.
Renal Gluconeogenesis and Blood Flow during Endotoxic Shock
Authors: Maitra Subir R. , Homan Clark S. , Pan Wansong , Geller Evan R. , Henry Mark C. , Jr. Henry C. Thode 
Published: September 2008

ABSTRACTObjectives: To determine whether endotoxic shock decreases the renal gluconeogenic capacity and the renal artery blood flow.Methods: An in‐vivo, murine, nonrecirculating kidney perfusion model was studied in a trauma research laboratory. Each of 12 fasted, male Holtzman rats (shock n = 6, control n = 6) was injected with 1 mL of normal saline or endotoxin (20 mg/kg). Five hours after the injection, all the rats were anesthetized and blood samples were obtained for the determination of the plasma glucose. Right renal artery blood flow was measured by an ultrasonic small‐animal flow meter. The kidney was then perfused via the renal artery with 37°C, oxygenated, glucose‐free Krebs‐Henseleit solution in the presence of 100 μmol of phloridzin to inhibit the cellular uptake of glucose. Renal glucose production was determined by measuring glucose in both renal vein effluent and urine. After 30 minutes of equilibration, 5 mmol of lactate and 0.5 mmol of pyruvate were added to the perfusate as a gluconeogenic substrate. Renal vein and ureteral effluent samples were collected after 5, 10, and 15 minutes.Results: The endotoxic shock group showed hypoglycemia (p < 0.05) as well as a decrease in renal artery blood flow (p < 0.05). Gluconeogenic stimulation was demonstrable in both the control and the endotoxic shock groups after 15 minutes of perfusion with substrate (p < 0.05). However, renal gluconeogenesis was significantly attenuated in the endotoxic shock group compared with the control.Conclusions: Renal glucose production in response to a gluconeogenic substrate is significantly attenuated during the hypoglycemic phase of endotoxic shock. Endotoxic shock also causes a significant decrease of renal artery blood flow
Leukocytosis: A New Look at an Old Marker for Acute Myocardial Infarction
Authors: Green Steven M. , Vowels John , Waterman Bruce , Rothrock Steven G. , Kuniyoshi Gary 
Published: September 2008

ABSTRACTObjective: To determine the test performance of leukocytosis for identifying acute myocardial infarction (AMI) in patients with nondiagnostic ECGs, admitted to rule out AMI.Methods: A retrospective, comparative test performance study was conducted using patients admitted to a university teaching hospital to rule out AMI. Clinical and laboratory information was reviewed and hospital laboratory ranges were used to define threshold elevations: total creatine kinase (CK), 275 U/L; CK‐MB, 7.5 μg/L; white blood cell (WBC) count, 11.5 × 109/L; and absolute neutrophil count (ANC), 8.0 × 109. Sensitivity, specificity, and predictive values of the total CK, CK‐MB, WBC count, and ANC were calculated, and receiver operating characteristic (ROC) curves constructed. Test performances of marker combinations also were determined.Results: The initial WBC count was significantly higher for the subjects who had AMI (11.1 vs 8.8 × 109/L, p < 0.001). For the 688 subjects who had nondiagnostic ECGs, sensitivities for the initial total CK, CK‐MB, WBC, and ANC were 39%, 73%, 35%, and 36%, respectively, while the corresponding specificities were 94%, 93%, 85%, and 86%. Logistic regression analysis confirmed leukocytosis as an independent predictor of AMI (adjusted odds ratio 4.08, 95% CI 1.73–9.63). While CK‐MB alone was 73% sensitive for AMI, the decision rule of either an elevated CK‐MB or an elevated WBC count increased this sensitivity to 88% (corresponding specificity 79%). Similarly, while CK‐MB alone was 93% specific for AMI, the combination of an elevated CK‐MB and an elevated WBC count increased this specificity to 99% (corresponding sensitivity 20%).Conclusions: Leukocytosis is significantly associated with AMI, and is a weak but independent laboratory predictor of this condition. In this preliminary study of admitted patients suspected of AMI, the combination of the WBC and the CK‐MB may have, additional diagnostic value over an isolated CK‐MB result. Neither parameter in isolation was satisfactorily sensitive for AMI. Prognostic assessment of the role of the WBC count in clinical decision making should address its complementary role to that of other clinical and ancillary test parameters.
Assessment of Visual Acuity in the Supine Position
Authors: Rees Sean M. , Goldfrank Lewis R. 
Published: September 2008

ABSTRACTObjective: To determine whether a modified Snellen eye chart could be used to accurately assess visual acuity (VA) in the supine position.Method: This was a prospective study involving ED staff volunteers comparing VA on a standard Snellen eye chart with VA on a size‐reduced ceiling‐mounted modified Snellen eye chart.Results: Fifty‐six volunteers participated. VA ranged from 20/10 to 20/200 on both of the cham, but 87% of the volunteers had VA of 20/50 or better. The VA results for the 2 charts were highly correlated; right eye r = 0.931 and left eye r = 0.953. Weighted ks showed substantial agreement for both eyes; k = 0.63 and 0.79 for the right and left eyes, respectively. In only 4 of 112 paired measurements did the VA recorded with the ceiling chart differ by >1 line from that recorded on the Snellen chart.Conclusion: There is an excellent correlation between VAs determined in the erect and the supine positions using the standard Snellen eye chart and the modified ceiling‐mounted version. Substantial agreement exists between readings using the 2 charts. Although, additional testing is warranted in an ophthalmologically diverse patient population, use of this chart for the assessment of VA in the supine ED patient may allow for earlier VA evaluation.
An Easy Cricothyrotomy Approach: The Rapid Four‐step Technique
Authors: Brofeldt Bo Tomas , Panacek Edward A. , Richards John R. 
Published: September 2008

ABSTRACTA simplified 4‐step cricothyrotomy technique is described. The procedure can be completed in <30 seconds without use of suction or additional light source. The only equipment needed is a #20 scalpel, a tracheal hook with a large radius, and a cuffed tracheostomy tube. The 4 steps are: 1) palpation, 2) stab incision, 3) inferior traction, and 4) tube insertion. This streamlined method is simple and quick. Because the operator's body position and hand movements (steps 3 and 4) are similar to those in orotracheal intubation, there is a feeling of familiarity that enhances retention of the procedure. The steps are illustrated and 4 cases using this technique are reported. Since the hands at each step are stabilized on the patient and no special equipment is needed, this technique also may be ideal for the out‐of‐hospital environment.
Funding Avenues for Research in Emergency Medicine at the National Institutes of Health and the National Heart, Lung, and Blood Institute
Authors: Simons‐Morton Denise G. 
Published: September 2008

SUMMARYThere are opportunities for research in EM at the NIH, which may be appropriate for a variety of Institutes, depending on the topic area. Most NIH‐funded research is through investigator‐initiated grant applications, and the PHS 398 application packet is a source of more information. RFAs and RFPs, which have set‐aside funding, are released for specific topic areas when an Institute identifies an area requiring multiple studies or multicenter research. PAs, which do not have set‐aside funding, announce areas of interest for an Institute. The NIH Guide to Grants and Contracts announces RFAs, RFPs, and PAs. It is important to become expert in a field of research to be successful in achieving research funding, whether investigator‐ or institute‐initiated.
Comparison Trial of Four Injectable Anesthetics for Laceration Repair
Authors: Ernst Amy A. , Marvez‐Valls Eduardo , Nick Todd G. , Wahle Mark 
Published: September 2008

ABSTRACTObjectives: To compare four injectable anesthetics (buffered 1% lidocaine, buffered 1% lidocaine with epinephrine, plain 1% lidocaine with epinephrine, and 0. 5% diphenhydramine with epinephrine) for pain of infiltration and effectiveness of anesthesia during suturing of minor lacerations.Methods: A prospective, randomized, double‐blind, comparison trial of the above agents was performed in an urban ED; adults with simple linear lacerations without vascular compromise were enrolled. Physicians and patients ranked the pain of injection and suturing according to a 10‐cm visual analog scale (VAS). Fisher's exact and Kruskal‐Wallis tests were used to compare demographic data, and Kruskal‐Wallis and Newman‐Keuls tests were used in analysis of VAS rankings. The power of the study was 0. 8 to detect a 1. 4‐cm difference in VAS readings, and 0. 9 to detect a 1. 7‐cm difference.Results: Seven of 200 enrolled patients were excluded due to improper data collection and 13 were removed from final statistical analysis due to need for additional anesthetic (treatment failures), leaving 180 subjects for final analysis. Demographic data were similar for the four groups (p > 0.05). Diphenhydramine with epinephrine was significantly more painful to inject than was buffered lidocaine or buffered lidocaine with epinephrine, according to both the patients (p = 0.0003) and the physicians (p = 0.0037). The two buffered compounds were slightly less painful to inject than was lidocaine with epinephrine, but statistical comparisons did not reach significance. For anesthesia effectiveness, lidocaine with epinephrine and buffered lidocaine with epinephrine were statistically better than buffered lidocaine or diphenhydramine with epinephrine (p = 0.0001 for the patients and the physicians).Conclusions: Buffered lidocaine with epinephrine and lidocaine with epinephrine were more effective anesthetics during suturing, according to both the physicians and the patients. There was a tendency toward less pain with infiltration in buffered solutions, compared with plain lidocaine with epinephrine, but the comparisons did not reach statistical significance. Diphenhydramine with epinephrine was more painful to inject than were buffered lidocaine with epinephrine and lidocaine with epinephrine, and was less effective anesthetically than the other three solutions.