bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spontaneous Rupture of a Vesicourachal Diverticulum Manifesting as Acute Abdominal Pain
Authors: Lewis Jack B. , Morse Jeffrey W. , Eyolfson Michael F. , Schwartz Stephen L. 
Published: September 2008

ABSTRACTUrachal abnormalities are rare clinical entities. This article reports a case of a spontaneously ruptured vesicourachal diverticulum manifesting as acute abdominal pain in a healthy 38‐year‐old man. The embryology, clinical diagnosis, and management of urachal abnormalities are discussed. Emergency physicians should include this clinical entity in their differential diagnoses of patients who develop acute abdominal pain in the absence of trauma, especially when the pain immediately follows a maneuver that increases intra‐abdominal pressure.
Alcohol Use and Medical Care Utilization among Health Maintenance Organization Patients in the Emergency Department
Authors: Cherpitel Cheryl J. , Hurley Leo B. , Fireman Bruce H. , Soghikian Krikor 
Published: September 2008

ABSTRACTObjective: To determine the association of an alcohol–related ED visit with medical care utilization during a two–year period surrounding the ED visit in an HMO.Methods: A probability sample of ED patients were interviewed and underwent breath analysis in a large HMO in a Northern California county. Based on recent alcohol intake or documentation of an alcohol–related ED visit, the patients were assigned to an alcohol group (n = 91) or a non–alcohol group (n = 897). A 10% random sample of the health plan membership of the same county (n = 19, 968) served as a comparison group. Utilization data were obtained from computerized files. Multiple linear regression was used to determine differences in subsequent outpatient visit rates between the alcohol and the non–alcohol groups. Logistic regression was used to compare the risks of hospitalization in the two groups.Results: Annual outpatient visit rates were 7. 8 in the alcohol group and 8. 3 in the non–alcohol group (p = 0. 65), controlling for gender, age, and injury status, and were significantly different from the visit rate of 5. 5 for the random health plan sample (p = 0. 0001). No difference was found between the alcohol and the non–alcohol groups for risk of hospitalization; however, those in the health plan sample were less than half as likely to be hospitalized as were those in the non–alcohol group (odds ratio 0. 44, p = 0. 002).Conclusions: No difference was found in utilization of medical services between the alcohol and the nonalcohol groups in this predominantly white, well–educated HMO ED population. However, both groups used significantly more inpatient and outpatient services than did the general HMO membership.
Serum Neuron–specific Enolase as a Prognostic Marker for Irreversible Brain Damage in Comatose Cardiac Arrest Survivors
Authors: Martens Patrick 
Published: September 2008

ABSTRACTObjective: To assess the use of serum neuron–specific enolase (S–NSE) level as a noninvasive predictor of CNS injury irreversibility in comatose cardiac arrest survivors.Methods: An observational, prospective clinical study was performed in a community hospital ED and intensive care unit. All cardiac arrest survivors (n = 52) with impaired neurologic status admitted between February 1994 and May 1995 were followed until return of consciousness (1) or death due to CNS failure (0). Serum samples for S–NSE determination (ng/mL) using the radioimmunoassay technique were obtained 24 hours after cardiac arrest. Data were analyzed using stepwise logistic regression with dichotomized predictors to validate the correlation between S–NSE (X) and outcome (Y), where X = 0 if < median and 1 if > median S–NSE level. Adjustment was made for the following variables: glucose level on admission, total epinephrine dose used before return of spontaneous circulation, and best Glasgow Coma Scale score on admission. These data were all available in 34 cases. In 16 cases, CSF enzymes at 48 hours postarrest were obtained and compared with S–NSE.Results: The logistic equation determining the influence of S–NSE (X) on outcome (Y) was: Y = 0. 606–1. 785X (odds ratio = 6; p = 0. 020). There was no confounding effect of the other variables related to survival. The mean S–NSE value for all the patients was 34 (7. 9–188). All the patients recovering consciousness (n = 15) had an S–NSE mean ± SEM value of 17. 5 ± 2. 4, with a maximum of 47.Conclusion: These data support the conclusion that measurement of S–NSE at 24 hours post–cardiac arrest may supplement clinical assessment of hypoxic–ischemic encephalopathy after cardiac arrest.
The Effects of Endothelin–1 on Coronary Perfusion Pressure during Cardiopulmonary Resuscitation in a Canine Model
Authors: DeBehnke Daniel J. , Spreng David , Wickman Laurie L. , Crowe Dennis T. 
Published: September 2008

ABSTRACTObjective: To study the hemodynamic effects of exogenously administered endothelin–1 (ET–1), a peptide produced by endothelial cells with potent non–adrenergically mediated vasoconstrictor properties.Methods: A prospective drug intervention study was carried out in a resuscitation research laboratory.Fifteen mixed–breed dogs were anesthetized and instrumented for hemodynamic monitoring. Asphyxia arrest was produced by clamping the endotracheal tube. Hemodynamic data were collected continuously.Following loss of aortic fluctuations monitored by thoracic aortic catheter, the animals remained in pulseless electrical activity (PEA) for 10 minutes. After 10 minutes of no–flow PEA, closed–chest CPR was begun and the animals were randomized to one of three treatment groups (epi, 0. 02 mg/kg epinephrine IV every 3 minutes; endo, 100 μg ET–1 IV at 0 minutes; and epi/endo, a combination of the epi and endo treatments).Results: endo and epi alone produced similar coronary perfusion pressures (CPPs). The epi/endo combination produced significantly improved CPP compared with that of either epi or endo alone. In the epi group, the best mean CPP was 16 ± 14 mm Hg and occurred 7 minutes after drug administration. In the endo group, the best mean CPP was 28 ± 7 mm Hg and occurred 13 minutes after drug administration. In the epi/endo combination group, the best mean CPP was 61 ± 37 mm Hg and occurred 7 minutes after drug administration (p < 0. 05 compared with the epi and endo groups alone).Conclusion: ET–1 is a potent vasoconstrictor. The combination of epi and endo significantly improved CPP compared with that for either agent alone. ET–1 should be investigated further as a vasoconstrictor in cardiac arrest.
Identification of Hazardous/Harmful Drinking among Subcritically Injured Patients
Authors: Clifford Patrick R. , Sparadeo Frank , Minugh P. Allison , Nirenberg Ted D , Woolard Robert , Longabaugh Richard , Becker Bruce 
Published: September 2008

ABSTRACTObjectives: To examine the relationship between a saliva alcohol test (SAT) and hazardous/harmful drinking, as measured by the Alcohol Use Disorders Identification Test (AUDIT), among a sample of subcritically injured patients.Methods: Patients (n = 78) seeking treatment for a subcritical injury were saliva‐tested for alcohol and interviewed regarding their drinking behaviors and related difficulties. Associations of SAT values with AUDIT results were determined.Results: SAT results and hazardous/harmful drinking were not independent events (p < 0. 001). Estimates of sensitivity and specificity (using a dichotomous SAT result [≥ 4 mmol/L] to identify positive AUDIT patients) were 65. 2% and 83. 6%, respectively. SAT‐positive people had significantly higher AUDIT scores than did SAT‐negative individuals (p < 0. 0001). Patients experiencing assault‐type injuries were much more likely to be SAT‐positive than were patients incurring other types of injury. Discriminant function analysis suggests that AUDIT scores can successfully identify SAT‐positive and SAT‐negative patients; the analysis accounted for 42. 5% of the variance and correctly classified 84. 6% of the sample.Conclusions: The use of an easy‐to‐administer, noninvasive, routine SAT, among patients presenting for a subcritical injury in a hospital ED, provides a mechanism for the identification of individuals with a history of hazardous/harmful drinking. However, since discrimination of hazardous/harmful drinking is imperfect, some caution is warranted when conducting such screening activities.
“Inappropriate” Emergency Department Use: A Comparison of Three Methodologies for Identification
Authors: O'Brien Gail M. , Shapiro Marc J. , Woolard Robert W. , O'Sullivan Patricia S. , Stein Michael D. 
Published: September 2008

ABSTRACTObjective: To determine the level of agreement between the rates of “inappropriate” ED visits assigned to a cohort of ambulatory patients based on three methods of defining ED use appropriateness.Methods: Ambulatory adult patients seen at one urban, university‐based teaching hospital ED between 8 am and midnight during select days from April to June 1994 were assessed regarding‐the appropriateness of their ED visits. Patients triaged to acute resuscitation rooms in the ED were excluded. Eligible patients were asked to complete a 90–question survey including demographics and health service use (response rate 81%). The appropriateness of ED use was assessed for consenting respondents by 1) application of a list of 51 nonemergent complaints that have been used by managed care providers and previously published (triage), 2) use of ten explicit criteria (e. g., need for parenteral medication) from prior publications (explicit), and 3) the consensus of two emergency physicians (EPs) reviewing the records of ED patients (phys). All three methods were applied at the time of retrospective chart review. The agreement between methods was evaluated using kappa scores.Results: Of the 892 eligible respondents, 64% were white, 54% were employed, 50% were female, and 29% were uninsured. Of the respondents, 26% had no regular source of ambulatory care and 25% considered the ED their regular source of care. The assigned rates of “inappropriate” visits using the three definitions were triage, 58%; phys, 47%; and explicit, 42%. Of those deemed “inappropriate” by the explicit criteria, 81% also were judged as “inappropriate” by the triage criteria, and 72%, by the phys criteria. Of those patients deemed “inappropriate” by the triage criteria, 59% also were judged as “inappropriate” by the explicit criteria, and 66%, by the phys criteria. Levels of agreement (kappas) were triage/explicit, 0.39; triage/phys, 0.42; and explicit/phys, 0.42.Conclusion: There is only moderate agreement between different methods of determining appropriateness of ED use. Until further refinement is made in triage assessment, managed care organizations and EPs should remain cautious when implementing a protocol that defines and restricts “inappropriate” ED visits.
Drive–by Shootings by Violent Street Gangs in Los Angeles: A Five–year Review from 1989 to 1993
Authors: Hutson H. Range , Anglin Deirdre , Eckstein Marc 
Published: September 2008

ABSTRACTObjective: To determine trends in the numbers of drive–by shootings, individuals shot at, innocent bystanders shot at, and homicides by drive–by shootings in the city of Los Angeles from 1989 to 1993.Methods: A retrospective analysis of police records was performed for all gang–related drive–by shootings that occurred in the city of Los Angeles between 1989 and 1993.Results: From 1989 to 1993, there were 6,327 drive–by shootings, 9,053 people shot at, and 590 homicides. There was an increase in drive–by shootings, people shot at, and homicides between 1989 and 1991, followed by a decrease between 1991 and 1993. The case fatality ratio of individuals killed to individuals shot at increased from 1989 to 1993 (p = 0.0011). Forty–seven percent of the people shot at, and 23% of the homicide victims, were innocent bystanders.Conclusion: Drive–by shootings are a major public health problem in Los Angeles. While the rate of drive–by shootings decreased in 1992 and 1993, the proportion of fatal cases increased. To prevent drive–by shootings, the root causes of violent street gang formation must be addressed.
Sodium Polystyrene Sulfonate Treatment for Lithium Toxicity: Effects on Serum Potassium Concentrations
Authors: Linakis James G. , Hull Keith M. , Lacouture Peter G. , Lockhart Gregory R. , Lewander William J. , Maher Timothy J. 
Published: September 2008

ABSTRACTObjective: To examine the effects of sodium polystyrene sulfonate (SPS) on serum potassium (K) concentrations in mice pretreated with parenteral lithium (Li).Methods: A placebo–controlled murine model trial of SPS therapy following IV Li was performed. Sixty male CD–I mice weighing 18–22 g were administered either IV LiCl (125 mg/kg) or a control solution (normal saline). Half of the mice in each of these groups were then given orogastric water 20, 40, 90, 150, and 210 minutes after LiCl or normal saline; the other half received SPS (5 g/kg/dose) at equivalent times. Subgroups of each of these four groups were sacrificed at one, two, and six hours after pretreatment and the serum was analyzed for K concentration. Serum K concentrations for the various groups were compared with analysis of variance and Newman–Keuls tests for the comparison of multiple means.Results: A statistically significant reduction of serum K concentrations occurred in the animals that received SPS treatment following either IV saline or LiCl solutions. The degree of K reduction that resulted from the combination of LiCl and SPS treatment (35% reduction at six hours, compared with the placebo–treated controls) was larger than that which resulted from eimer IV Li with oral water (15% reduction) or IV saline with oral SPS (20% reduction).Conclusions: These findings suggest that development of hypokalemia may represent a potential limitation in the use of SPS in the treatment for Li toxicity.
Managing Law Enforcement (K–9) Dog Bites in the Emergency Department
Authors: Pineda Gilbert V. , Hutson H. Range , Anglin Deirdre , Flynn Christopher J. , Russell Marie A. 
Published: September 2008

ABSTRACTObjective: To review the types of injuries due to law enforcement (K–9) dog bites and address related management issues.Methods: A case series of law enforcement dog bite victims is reported and related literature reviewed.Results: Law enforcement dogs are taught a bite–and–hold technique for subduing individuals suspected of felony crimes. This bite–and–hold technique's greater applied force results in a unique spectrum of injuries, including deep puncture wounds, severe crush injuries, large tissue avulsions and lacerations, wounds necessitating surgical debridement, bony injuries ranging from cortical violations to displaced fractures, neurovascular damage, and other wounds at high risk for infection. The four reported cases highlight the types of injuries and complications associated with law enforcement dog bites.Conclusion: Attention to potential deep injuries of nerves, vessels, and the musculoskeletal system is essential with law enforcement dog bites. Injuries associated both with pursuit and arrest and with the bites themselves must be identified and assessed. Guidelines for the ED treatment of patients with law enforcement dog bite injuries are proposed.
The Efficacy of a Standard Training Program for Transillumination–guided Endotracheal Intubation
Authors: Margolis Gregg S. , Menegazzi James , Abdlelhak Mervat , Delbridge Theodore R. 
Published: September 2008

ABSTRACTObjective: To evaluate the success rate, intubation time, and complication rate of transillumination–guided intubation following two hours of instruction in the use of the Trachlight (TL) device.Methods: A prospective, randomized crossover laboratory trial was conducted at an emergency medical service training site with 30 nonpaid volunteer paramedic students, one month prior to their graduation. The students were instructed in the use of the TL in a standardized curriculum consisting of didactic, video, and demonstration sessions. Each student was required to successfully intubate a training manikin with the TL five times. Approximately three weeks later, the students were asked to intubate the manikin 20 times, alternating between direct laryngoscopy (DL) and TL.Results: The success rates were 94% for DL and 63% for TL (p < 0.0001). The mean intubation times were 14.6 seconds for DL and 16.8 seconds for TL (p < 0.001). The incidences of trauma were 7.3% for DL and 1.4% for TL (p < 0.001).Conclusion: A two–hour training session, including five successful light–guided intubations using the TL, was inadequate for producing acceptable success rates during manikin intubations by paramedic students. While TL intubation intervals were shorter when successful, the 2.2–second difference was not clinically meaningful. The incidence of trauma in our manikin model during TL intubations was significantly lower than that with DL.
Effect of Time of Day and Duration into Shift on Hazardous Exposures to Biological Fluids
Authors: Marias Darryl J. , II John Hafner , Brillman Judith C. , Tandberg Dan 
Published: September 2008

ABSTRACTObjective: To determine whether hospital employee biological hazardous exposure rates varied with time of day or increased with time interval'into shift.Methods: This was a retrospective occurrence report review conducted at a university hospital with an emergency medicine residency program. Health care worker biological hazardous exposure data over a 30–month period were reviewed. Professional status, date, time, and type of exposure (needlestick, laceration, splash), time interval into shift of exposure, and hospital location of exposure were recorded. Hourly employee counts and risky procedure counts were matched by location with each reported exposure, to determine hourly rates of biological hazardous exposures.Results: Analysis of 411 recorded exposures demonstrated that more people were exposed between 9:00 am and 1:00 am (p < 0.05), yet the exposure risk did not vary significantly when expressed as the number of exposures per worker or per procedure. Of the 393 exposures with data describing time interval into shift when the exposure occurred, significant numbers of exposures occurred during the first hour and at shift's end [when corrected for exposures per worker (p < 0.05) or exposures per procedure (p < 0.05)].Conclusion: While the number of exposures are increased in the am hours, the exposure rate (as a function of workers or procedures) does not vary with time of the day. However, the exposure rate is increased during the first hour and last 2 hours of a shift. Efforts to increase worker precautions at the beginning and end of shifts are warranted.
Reducing the Rate of Paramedic Needlesticks in Emergency Medical Services: The Role of Self‐capping Intravenous Catheters
Authors: O'Connor Robert E. , Krall Scott P , Megargel Ross E. , Tan Lawrence E. , Bouzoukis James K. 
Published: September 2008

ABSTRACT Objective: To determine whether the frequency of unintentional needlesticks can be reduced by replacing conventional IV catheters with self‐capping ones. Methods: Retrospective cohort, historically controlled study, conducted in an emergency medical services advanced life support (ALS) service. The ALS service annually transports 12,000 patients, for whom IV therapy is attempted in about 65% of cases. The needlestick rate per 1,000 patients receiving attempts at IV access was examined during the 2 10‐month periods, before and after introduction of a self‐capping IV catheter. Results: For the 2 periods, the percentage of patients for whom IV access was attempted remained constant at 65%. The success rate for IV access was statistically unchanged from 88% to 90% (p > 0.5, power = 0.995). During the period prior to use of the new datheter, 44 injuries were reported overall. Of these, 15 were due to unintentional needlesticks, 11 associated with contaminated needles. Following the system‐wide introduction of the new catheter, only 1 of 31 reported injuries was due to needlestick (uncontaminated). The extrapolated annual incidence of contaminated needlesticks decreased from 169 (95% CI; 85, 253) to 0 (95% CI; 0, 46) per 100,000 IV attempts. The extrapolated incidence for all needlesticks decreased from 231 (95% CI; 132, 330) to 15 (95% CI; 0, 40) per 100,000 IV attempts. The absolute number of needlesticks and the proportion of injuries due to needlesticks decreased significantly (p < 0.005). Conclusion: The use of IV catheters with self‐capping needles was associated with a significant reduction in the absolute number of inadvertent needlesticks as well as the proportion of injuries due to needlesticks among ALS providers. The use of self‐capping IV catheters was feasible and did not appear to be a deterrent to initiating IV therapy in the out‐of‐hospital environment.
Noninvasive Hemodynamic Monitoring of Critical Patients in the Emergency Department
Authors: Shoemaker William C. , Wo Charles C. J. , Bishop Michael H. , Thangathurai D. , Patil Ramish S. 
Published: September 2008

ABSTRACT Objective: To evaluate the feasibility of multicomponent noninvasive hemodynamic monitoring in critical emergency patients and to compare this technique with simultaneous invasive monitoring by the pulmonary artery thermodilution catheter. Methods: A prospective observational study was done comparing invasive monitoring and noninvasive monitoring in 60 critically ill or injured patients who required hemodynamic monitoring shortly after entering the ED of a university‐affiliated county hospital. Cardiac output (CO) values measured by the standard thennodilution pulmonary artery catheter technique were compared with simultaneously obtained measurements using a noninvasive bioimpedance method. Concurrent measurements were made of pulse oximetry to screen pulmonary function and transcutaneous oximetry to assess tissue perfusion. Results: The impedance CO values closely approximated those for the thermodilution method; r 0.81, p < 0.001. Significant circulatory abnormalities, including hypotension, reduced cardiac index, arterial hemoglobin desaturation, tissue hypoxia, reduced O2 delivery, and consumption, were found in 54 of the 60 (90%) patients. The cardiac index decreased in 44% of the patients, the transcutaneous O2 decreased in 39%. and the O2 saturation by pulse oximetry fell in 22% during the observation period in the ED (commonly lasting 2–8 hours).Conclusions: Noninvasive monitoring can provide hemodynamic and perfusion information previously available only by invasive thermodilution catheters. Such noninvasive monitoring can display continuous on‐line real‐time data, allowing immediate recognition of circulatory abnormalities and providing a means to titrate therapy to appropriate therapeutic goals.