bluuebunny/crossref_metadata_2025_split huggingface dataset:
Noninvasive Cardiac Index Monitoring in Gunshot Wound Victims
Authors: Bishop Michael H. , Shoemaker William C. , Shuleshko Julia , Wo Charles C. J. 
Published: September 2008

ABSTRACT Objective: To evaluate a bioimpedance device for the noninvasive measurement of cardiac index (CI) against standard thermodilution measurements in patients with gunshot wounds. Methods: A prospective open‐label performance evaluation was done using a convenience sample of gunshot wound victims initially treated in the resuscitation area of a high‐volume, urban ED. After initial resuscitation, patients had a flow‐directed pulmonary artery catheter placed for thermodilution cardiac output (CO) measurements. The CO measurements were made in triplicate and averaged. Estimates of body surface area were used to convert these measurements to CI estimates. Electrodes for bioimpedance measurements were placed as soon as practical after ED arrival. Simultaneous measurements of CI using the bioimpedance device were made as clinically indicated during each patient's hospital course. Results: There were 54 patients studied, with an overall mean (± SEM) age of 32 ± 3 years, Revised Trauma Score of 6.7 ± 0.4, and Injury Severity Scale score of 22 ± 3. There were 42 survivors and 12 nonsurvivors. The CI as estimated by bioimpedance correlated well with that measured by thermodilution (r = 0.79, ± 0.02). The precision of the invasive and noninvasive measurements was 1.1 L/min/m2; the bias was ‐0.011 L/min/m2. In 24 patients with thoracic injuries requiring tube thoracostomy or thoracic surgery, the correlation of the 2 devices was r = 0.71 with precision and bias of 1.4 L/min/m2 and ‐0.018 L/min/m2, respectively.Conclusions: Cardiac index can be noninvasively estimated in acutely injured patients with gunshot wounds using a bioimpedance device. Further study of bioimpedance measurements as a guide to volume therapy is warranted.
Emergency Department Utilization by the Elderly: Analysis of the National Hospital Ambulatory Medical Care Survey
Authors: Woford James L. , Schwartz Earl , Timerding Beverly L. , Folmar Steven , Ellis Shellie D. , Messick Catherine H. 
Published: September 2008

ABSTRACT Objective: To characterize the ED utilization patterns of the elderly population using nationally representative data. Methods: A secondary analysis was performed using the National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationwide, stratified probability sample of ED encounters. Using these physician‐reported data, the demographics, patient complaints, physician diagnoses, and dispositions were compared by age group, i.e., young‐old (age 65–84 years) vs old‐old (age ±85 years). Results: The elderly (age ±65 years) represented 5,038 (19.6%) of 25,646 ED encounters for all adults (age ±18 years). The geriatric age groups (ages 65–74, 75–84, and ±85 years) accounted for 45.3%, 37.4%, and 17.2% of all the encounters by the elderly. The proportions of female patients and white patients were higher with increasing age. The proportion of elderly patients hospitalized was 4 times that of younger adults and reflected monotonic increase with increasing age among elders. Patient complaints and physician diagnoses were generally similar for the young‐old (65–84 years) and the old‐old (±85 years). Conclusions: These findings are consistent with previous single‐center studies of geriatric ED patients. This data source may be useful for investigation of clinical issues related to the care of elderly ED patients.
Model Curriculum in Emergency Medical Services for Emergency Medicine Residency Programs
Authors: Verdile Vincent P , Krohmer Jon R. , Swor Robert A. , Spaite Daniel W ,   for the SAEM Emergency Medical Services Committee
Published: September 2008

ABSTRACTAn emergency medical services (EMS) curriculum, as developed by the SAEM Emergency Medical Services Committee, is provided for the training of emergency medicine residents in EMS.
Disaster Nomenclature–A Functional Impact Approach: The PICE System
Authors: Koenig Kristi L. , Dinerman Norm , Kuehl Alexander E. 
Published: September 2008

ABSTRACTA standard nomenclature that concisely describes any disaster is currently lacking. This article describes a model taxonomy system. Instead of the term “disaster,” a root word “PICE,”“potential injury‐creating event,” is used. Descriptive modifiers to account for all possible scenarios surround this root word, as illustrated. A modifier is chosen from each column and a stage is assigned to each PICE. Column A describes the potential for additional casualties. Column B describes whether resources are overwhelmed and, if so, whether they must simply be augmented (disruptive) or they must first be reconstituted (paralytic). Column C describes the extent of geographic involvement. “Stage” refers strictly to the likelihood that outside medical assistance will be needed. Stage 0 means there is little chance, stage I means there is a small chance (place outside help on “alert”), stage II means there is a moderate chance (place on “standby”), and stage III means local medical resources are clearly overwhelmed (immediately dispatch outside resources, commit personnel, prepare remote hospitals). For example, a multiple vehicle crash in a large city would be a ”static, controlled, local PICE, stage 0.” In conclusion, a new nomenclature for describing disasters is reported. A short phrase describes the incident and communicates the need for outside assistance. The model may be useful for disaster planning, management, and research.
A Pharmacokinetic Comparison of Acetaminophen Products (Tylenol Extended Relief vs Regular Tylenol)
Authors: Douglas Daniel R. , Sholal James B. , Smilkstein Martin J. 
Published: September 2008

ABSTRACTObiedive:To compare the pharmacokinetics of Tylenol Extended Relief (ER APAP) with those of immediate‐release acetaminophen (IR APAP) at supratherapeutic doses.Methods:A prospective, double‐blind, randomized, crossover comparison trial involving 14 adult volunteers. Each subject ingested 75 mgkg of either ER APAP or IR APAP and 1 week later received the other APAP preparation. On both occasions plasma APAP concentration ([APAP]) was determined 0.5, 1, 2, 3, 4, 6, 8, 12, and 16 hours after ingestion. The times to maximum [APAP] (Tmax); the maximum [APAP] values (Cmax); the elimination half‐lives 4–16 hours postingestion (t1/2), and the areas under the [APAP] vs time curve (AUC) for ER APAP and IR APAP were compared using the paired t‐test.Results:All the subjects completed both study phases. The mean APAP dose ingested was 5.6 g (range, 4.2–7.8 g). Both the AUC and the Cmaxwere less after ER APAP than after IR APAP; otherwise, there was no evident difference in any measure. Graphically, ER APAP yielded a flatter, plateau‐shaped curve initially, but after 4 hours the curve was nearly identical to that for IR APAP. Results are summarized in the table:Conclusion:In this model involving a single supratherapeutic dose, ER APAP evidenced no pharmacokinetic features that would suggest the need for an alternate poisoning screening strategy. When compared with IR APAP, ER APAP had a lower AUC, all peak [APAP] occurred in <4 hours, and terminal eliminations were identical. The data suggest that, in most cases, the diagnostic approach to an overdose of ER APAP need not deviate from that used for an IR APAP overdose.
Direct Detection of Epstein‐Barr Viral Antigen in Nasopharyngeal Swabs from Patients with Infectious Mononucleosis
Authors: Bills Nathan D. , Hinrichs Steven H. , Morse Jeffrey W 
Published: September 2008

ABSTRACTObjective: To determine whether direct immunologic detection of Epstein‐Barr virus (EBV) early antigen diffuse component (EA‐D) from nasopharyngeal swabs is a feasible approach to the development of a rapid diagnostic test for infectious mononucleosis (IM).Methods: Nasopharyngeal swabs from 20 patients presenting with a presumptive diagnosis of IM (having the classic triad of symptoms‐acute pharyngitis, fever, and lymphadenopathy) and 5 controls were assayed for EA‐D. EBV serologic testing and a heterophil antibody titer (HAT) test also were performed. EA‐D was assayed by polyacrylamide gel electrophoresis and subsequent transfer to a nylon membrane, followed by immunoblotting with a monoclonal antibody.Results: EA‐D was detected in 17 of 20 patients (85%) with presumptive diagnoses of IM and in 1 of 5 normal subjects and was highly significant in predicting IM (p < 0.01). There was no significant difference in numbers of positive and negative results using either EA‐D assay or HAT test in patients with IM (p < 0.35). Pharyngeal exudate in the 17 pharyngitis patients with this variable documented was significantly correlated with positive EA‐D (p< 0.01). but not with the HAT test (p < 1.00).Conclusions: Immunologic detection of EBV‐derived antigens from nasopharyngeal swabs is a potential early diagnostic tool for clinically suspected IM. Sensitivity and specificity in pediatric and adult populations, patients with other viral etiologies, and patients with streptoccocal pharyngitis should be determined in subsequent investigations.
Priapism: Etiology and Management
Authors: Mulhall John P. , Honig Stanton C. 
Published: September 2008

SUMMARYPriapism is a urologic emergency. All patients should receive prompt urologic consultation. Management is based on prompt recognition, differentiation between low‐ and high‐flow priapism, reversal of any potential precipitating factors, and the use of corporal aspirationhigation combined with intracavernosal α‐agonist injection therapy. It cannot be overemphasized that severely prolonged erections are associated with the development of irreversible problems with erectile function and, therefore, immediate and aggressive management is mandatory.
Delayed Diagnosis of Thoracolumbar Fractures in Multiple‐trauma Patients
Authors: Anderson Stephen , Biros Michelle H. , Reardon Robert F. 
Published: September 2008

ABSTRACTObjectives: To determine the frequency of delayed diagnosis of major thoracolumbar vertebral fractures (T‐L Fxs) in ED multiple‐trauma patients, and to determine the differences between cases of delayed and nondelayed diagnoses of T‐L Fx.Methods: A retrospective chart review was conducted of 181 trauma patients with 310 major T‐L Fxs (compression, burst, or chance Fxs or dislocations). Data collected included the time of the diagnosis of T‐L Fx, the patient's clinical presentation in the ED, the mechanism of injury, and the outcome.Results: Of the 181 patients with major T‐L Fxs, 138 were diagnosed in the ED (nondelayed group), and 43 were diagnosed after the patient left the ED (delayed group). Of these, 33 cases occurred in unstable patients requiring emergent medical imaging and/or operation, 7 occurred when emergency physicians failed to detect subtle compression Fxs on ED radiographs, and 3 occurred in stable patients who were not radiographed in the ED. The delayed group were more often critical, and hypotensive, and had lower Glasgow Coma Scale (GCS) scores than did the nondelayed group. The delayed group patients also had more cervical spine injuries, multiple noncontiguous spinal Fxs, high‐energy mechanisms of injury, and direct blunt assaults to the back than did the nondelayed group patients. There were 13 patients with T‐L Fxs, GCS scores = 15, and normal back examinations. There were 43 patients who had neurologic deficits associated with their injuries; 11 patients with incomplete cord lesions progressed, including 3 in the delayed group.Conclusions: A delay in the diagnosis of T‐L Fx in hospitalized trauma patients is frequently associated with an unstable patient condition that necessitates higher‐priority procedures than ED T‐L spine radiographs. Such patients should receive spinal precautions until more complete evaluation can be performed. The decision to selectively radiograph T‐L spines in multiple‐trauma patients should consider the mechanism of injury, the presence of possible confounders to physical examination, and clinical signs and symptoms of back injury.
Out‐of‐hospital Administration of Mannitol to Head‐injured Patients Does Not Change Systolic Blood Pressure
Authors: Sayre Michael R. , Daily Stephen W. , Stern Susan A. , Storer Daniel L. , van Loveren Harry R. , Hurst James M. 
Published: September 2008

ABSTRACTObjective: To determine the effect of out‐of‐hospital mannitol administration on systolic blood pressure (BP) in the head‐injured multiple‐trauma patient.Methods: This was a prospective, randomized, double‐blind, placebo‐controlled clinical trial involving a university‐based helicopter air medical service and level‐1 trauma center hospital. Endotracheally intubated head‐trauma victims with Glasgow Coma Scale (GCS) scores < 12 were enrolled from November 22, 1991, to November 20, 1992, if evaluated by the participating aeromedical transport team within 6 hours of injury. Patients were excluded if they were <18 years old, had already received mannitol or another diuretic, were potentially pregnant, or were receiving CPR. All patients were intubated prior to study drug (mannitol [1 g/ kg] or normal saline) use. Pulse and BP were measured every 15 minutes for 2 hours following study drug administration.Results: A total of 44 patients were enrolled. After exclusion of 3 patients who did not meet all inclusion criteria, there were 20 patients in the mannitol group and 21 patients in the placebo group. The groups were similar at baseline in age, pulse, systolic BP (baseline mannitol: 124 ± 47 mm Hg; placebo: 128 ± 32 mm Hg), GCS score, and Injury Severity Scale score. Systolic BP did not change significantly throughout the observation period in either group. This study had 83% power to detect a mean systolic BP drop to <90 mm Hg.Conclusion: Out‐of‐hospital administration of mannitol did not significantly change systolic BP in this group of head‐injured multiple‐trauma patients.
Intrasound Vibration Testing in Acute Ankle Injuries
Authors: Plewa Michael C. , Otto Raymond , Verbrugge John , Buderer Nancy M. Fenn , Vaughn Glen , Mattevi Patricia 
Published: September 2008

ABSTRACTObjectives: To determine the accuracy of intrasound vibration testing (IVT) in comparison with plain radiography in the diagnosis of acute ankle fractures.Methods: A group‐sequential, nonrandomized, double‐blind, observational study design was used. A convenience sample of patients were studied, aged <10 years, with acute ankle injuries, undergoing ankle radiography, evaluated at a community teaching hospital ED. Excluded were cases involving injuries of <24 hours' duration, inadequate documentation, protocol violation, or positive IVT on the uninjured ankle. IVT was performed with the intrasound apparatus placed on the anterior and posterior aspects of the medial and lateral malleoli of the uninjured and injured ankles; positive IVT was defined as patient withdrawal secondary to pain.Results: Of 105 patients enrolled, 8 were excluded; 1 for inadequate documentation, 5 for protocol violation, and 2 for positive IVT of the uninjured ankle. Of the 97 patients analyzed, 13 had fractures identified by radiography, including 9 lateral malleolar, 1 medial malleolar, 1 bimalleolar, and 2 talar fractures. Only 5 of the 13 fractures were detected with IVT (sensitivity = 39%; 95% CI: 14–68%). Seventy of 84 nonfractured ankles hadnegative IVT (specificity = 83%; 95% CI: 74–91%). Of the 19 with positive IVT, 5 had fractures (positive predictive value of 26%; 95% CI: 9–51%). Of the 78 with negative IVT, 70 had no fracture (negative predictive value of 90%; 95% CI: 81–96%). Overall, 75 of 97 IVTs were correct (77%), most of which were among patients without fractures.Conclusion: IVT was not a useful test for predicting fractures in patients with acute ankle injuries.
Management of Nontraumatic Subarachnoid Hemorrhage in a Patient with Sickle‐cell Disease: A Case Report
Authors: Rinnert Stephan , Scalea Thomas , Sinert Richard 
Published: September 2008

ABSTRACTSubarachnoid hemorrhage (SAH) due to sickle‐cell anemia is rare, but potentially devastating. However, with early recognition of SAH, aggressive support with exchange transfusion, cerebral angiography, and neurosurgical intervention, a positive outcome may be achieved. A case report of SAH managed in this fashion is reported. Based on similar cases in the literature, a suggested treatment protocol is provided for the management of nontraumatic SAH in sickle‐cell patients presenting to the ED.
Raeder's Paratrigeminal Syndrome: A Case Report
Authors: Murnane Matthew , Proano Lawrence 
Published: September 2008

ABSTRACTRaeder's paratrigeminal syndrome is an uncommon neurologic disorder characterized by oculosympathetic paralysis, including ptosis and miosis. In the ED, this syndrome can be easily confused with Horner's syndrome, although with Raeder's syndrome trigeminal nerve irritation and preservation of facial sweating are noted. This report reviews a case of a 62‐year‐old man who presented to the ED with signs and symptoms consistent with Raeder's syndrome. MRI with angiography revealed a carotid artery dissection, and the patient was admitted and anticoagulated. The syndrome has been associated with head trauma, hypertension, vasculitis, migraine headaches, parasellar mass lesions, and internal carotid artery dissections. Hence, treatment of the patient who has Raeder's syndrome is dependent on the specific underlying lesion.
Statistical Methodology: I. Incorporating the Prevalence of Disease into the Sample Size Calculation for Sensitivity and Specificity
Authors: Buderer Nancy M. Fenn 
Published: September 2008

ABSTRACTCareful consideration of statistical issues related to the choice of a sample size is critical for achieving meaningful results in research studies designed to evaluate diagnostic tests. When assessing the ability of a diagnostic test to screen for disease, the parameters sensitivity, specificity, and predictive values are of interest. Study sample size requirements can be calculated based on a clinically acceptable degree of precision, the hypothesized values of sensitivity and specificity, and the estimated prevalence of disease in the target population. The simple methods and tables in this paper guide the researcher when deciding how many subjects to sample in a study designed to estimate both the sensitivity and the specificity of a diagnostic test, given a specified precision and estimated disease prevalence.
Alcohol Abuse/Dependence in Motor Vehicle Crash Victims Presenting to the Emergency Department
Authors: Maio Ronald F. , Waller Patricia F. , Blow Frederic C. , Hill Elizabeth M. , Singer Kathleen M. 
Published: September 2008

ABSTRACTObjective: 1) To determine the prevalence of current alcohol abuse/alcohol dependence (AA/AD) among the full injury range of ED motor vehicle crash (MVC) patients; and 2) compare AA/AD and non‐AA/AD patient characteristics.Methods: This was a prospective cohort study using a stratified random sample of MVC patients aged ≥18 years presenting to a university hospital and university‐affiliated community hospital ED from May 1, 1992, to August 30, 1994. A diagnosis of current AA/AD was based on the alcohol section of the Diagnostic Interview Survey (DIS). Other measurements included the presence of blood alcohol (BAC +), Injury Severity Score (ISS‐85), occupant status (driver/passenger), age, gender, seat belt use, culpability for crash, and ED disposition (admitted vs released). A weighted prevalence was determined; subgroups were compared using t‐tests, χ2. 2‐factor analysis, and logistic regression modeling; α = 0.05.Results: 1,161 patients were studied. The weighted prevalence of current AA/AD was 22.5%; 53% of these patients were released from the ED. Almost 45% of the patients with current AA/AD were BAC —. When controlling for BAC and AA/AD, greater injury severity and culpability were associated with a BAC +, but not with current AA/AD.Conclusion: Almost 23% of ED MVC patients have current AA/AD; BAC testing does not accurately identify these patients. Intervention strategies must be directed to both admitted and released patients.
Impact of a Statewide Trauma System on Rural Emergency Department Patient Assessment Documentation
Authors: Hedges Jerris R. , Mann N. Clay , Mullins Richard J. , Rowland Donna , Worrall William , Zechnich Andrew D. ,   For the OHSU Rural Trauma Research Group
Published: September 2008

ABSTRACTObjective: To determine the association of rural ED patient assessment documentation with state trauma system implementation, hospital trauma categorization level (i.e., Level‐3 vs Level‐4), injury diagnosis, and patient demographics.Methods: A pre‐ vs post‐system implementation (historical control) analysis of trauma documentation was performed using a sample of rural ED trauma patients from 4 Level‐3 and 5 Level‐4 trauma hospitals. The medical records of patients with specific index diagnoses in 4 anatomic regions (head, chest, liver/spleen, and femur/open‐tibia) were reviewed for 3‐year periods before statewide trauma system implementation and after hospital categorization. Vital sign, % inspired O2, and O2 saturation determinations were identified relative to the first and the last vital signs documented on the ED record. If not documented in the medical chart within 5 minutes of the first or last ED vital sign assessment, these measurements were considered missing. Separately, neurologic documentation (initial and final) also was sought for patients meeting criteria for an index head injury.Results: Of 1,057 patients entered into the database, 532 were evaluated during the pre‐system period and 525 were evaluated during the post‐system period. Overall, 47% had a head injury, 34% had a chest injury, 23% had a femur/open‐tibia injury, and 12% had a spleen/liver injury. There were 142 (13%) patients with an injury in >1 index area. Except for initial systolic blood pressure, documentation of all other initial and final patient vital signs increased significantly (p < 0.05). Documentation of the Glasgow Coma Scale score (initial and final; p = 0.0001) and a final pupil examination on head‐injured patients (p = 0.025) also increased. The effects of hospital level, injury diagnosis, and patient demographics on documentation rate were minimal.Conclusion: The study found overall improved ED documentation of trauma patient status in association with implementation of a statewide trauma system. This improvement in documentation suggests an enhanced process of care with trauma system participation.