bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Delayed Treatment with Sodium Polystyrene Sulfonate on Serum Lithium Concentrations in Mice
Authors: Linakis James G. , Hull Keith M. , Lee Calvin M. , Maher Timothy J. , Lewander William J. , Lacouture Peter G. 
Published: September 2008

ABSTRACTObjectives: To determine the efficacy of sodium polystyrene sulfonate (SPS) in lowering serum lithium (Li) concentrations. Specifically, to determine the effects of both different doses of SPS and different times to treatment with SPS on serum Li levels.Methods: The study was a controlled, single‐dose murine trial of SPS on serum Li levels. Male CD‐I mice (n = 525) were given orogastric LiCl and then divided into three main treatment groups: group SPS received a single orogastric administration of SPS in a dose of 5 gm/kg body weight at either 0, 15, 30, 45, or 90 minutes after LiCl; group half‐SPS received a single orogastric administration of SPS in a dose of 2.5 gm/kg body weight at times equivalent to those of group SPS; and the control group received orogastric deionized water in a volume equivalent to that of group SPS at 0, 15, 30, 45, or 90 minutes after LiCl. Subgroups of seven to ten mice in each of the four treatment groups were sacrificed at one, two, four, and eight hours after administration of LiCl, and their blood was analyzed for Li concentration.Results: 1) Single doses of SPS significantly lowered serum Li concentrations; 2) this effect was dose‐related; 3) the delays in administration of SPS used in this study did not significantly reduce its ability to lower serum Li concentrations; and 4) even when administered after peak serum Li concentrations had been achieved, a single dose of SPS was effective in lowering serum Li levels.Conclusions: SPS may be efficacious in the treatment for Li toxicity under certain circumstances, even when there is delay to treatment. Additional study is warranted to further characterize the ability of SPS to alter Li kinetics.
Chest Compression and Ventilation Rates during Cardiopulmonary Resuscitation: The Effects of Audible Tone Guidance
Authors: Milander Melinda M. , Hiscok Perry S. , Sanders Arthur B. , Kern Karl B. , Berg Robert A. , Ewy Gordon A. 
Published: September 2008

ABSTRACTObjectives: To determine: 1) whether chest compressions during CPR are being performed according to American Heart Association (AHA) guidelines during cardiac arrest; and 2) the effect of an audio prompt to guide chest compressions on compliance with AHA guidelines and hemodynamic parameters associated with successful resuscitation.Methods: An observational clinical report and laboratory study was conducted. A research observer responded to a convenience sample of cardiac arrests within a 300‐bed hospital and counted the rate of chest compressions and ventilations during CPR. To evaluate the effect of an audio prompt on CPR, health care providers performed chest compression without guidance using a porcine cardiac arrest model for 1 minute, followed by a second minute in which audio guidance was added. Chest compression rates, arterial and venous blood pressures, end‐tidal CO2 (ETCO2) levels, and coronary perfusion pressures were measured and compared for the two periods.Results: Twelve in‐hospital cardiac arrests were observed in the clinical part of the study. Only two of 12 patients had chest compressions performed within AHA guidelines. No patient had respirations performed within AHA guidelines. In the laboratory, 41 volunteers were tested, with 66% performing chest compressions outside the AHA standards for compression rate without audible tone guidance. With guided chest compressions, the mean (± SD) chest compression rate increased from 74 ± 22 to 100 ± 3/min (p < 0.01). End‐tidal CO2 levels increased from 15 ± 7 to 17 ± 7 torr (p < 0.01). Coronary perfusion pressure increased minimally with audible tone‐guided chest compressions.Conclusions: The majority of Basic Cardiac Life Support‐certified health care professionals did not perform CPR according to AHA‐recommended guidelines. The use of audible tones to guide chest compression resulted in significantly higher chest compression rates and ETCO2 levels.
Out‐of‐hospital Ventilation: Bag‐Valve Device vs Transport Ventilator
Authors: Johannigman Jay A. , Branson Richard D. , Johnson Daniel J. , Davis Kenneth , Hurst James M. 
Published: September 2008

ABSTRACTObjective: To examine the patterns of out‐of‐hospital airway management and to compare the efficacy of bag‐valve ventilation with that of the use of a transport ventilator for intubated patients.Methods: A prospective, nonrandomized, convenience sample of 160 patients requiring airway management in the out‐of‐hospital urban setting was analyzed. A survey inquiring about airway and ventilatory management was completed by emergency medical services (EMS) personnel, and arterial blood gas (ABG) samples were obtained within 5 minutes of patient arrival in the ED. The ABG parameters were compared for patients grouped by different airway techniques and presence or absence of cardiac arrest (systolic blood pressure <50 mm Hg) upon ED presentation.Results: Over a one‐year period, 160 surveys were returned. The majority (62%) of the patients were men; the population mean age was 61 ± 19 years. Presenting ABGs were obtained for 76 patients; 17% (13/76) had systemic perfusion and 83% (63/76) were in cardiac arrest. There was no difference in ABG parameters between the intubated cardiac arrest patients ventilated with a transport ventilator (pH 7.17 ± 0.17, Paco2 37 ± 20 torr, and Pao2 257 ± 142 torr) and those ventilated with a bag‐valve device (pH 7.20 ± 0.16, PaCO2 42 ± 21 torr, and Pao2 217 ± 138 torr). The patients ventilated via an esophageal obturator airway (EOA) device had impaired gas exchange, compared with the groups who had endotracheal (ET) intubation (pH 7.09 ± 0.13, Paco2 76 ± 30 torr, and Pao2 75 ± 35 torr). The intubated patients not in cardiac arrest had similar ABG parameters whether ventilated manually with a bag‐valve device or with a transport ventilator. Endotracheal intubation was successfully accomplished in 93% (123/132) of attempted cases.Conclusions: In this sample, ET intubation was the most frequently used airway by EMS providers. When ET intubation was accomplished, adequate ventilation could be achieved using either bag‐valve ventilation or a transport ventilator. Ventilation via the EOA proved inadequate.
Multicenter Study of Creatine Kinase‐MB Use: Effect on Chest Pain Clinical Decision Making
Authors: Hedges Jerris R. , Gibler W. Brian , Young Gary P. , Hoekstra James W. , Slovis Corey , Aghababian Richard , Smith Mark , Rubison Mike ,   For the EMCREG II Study Group
Published: September 2008

ABSTRACTObjective: To determine whether creatine kinase‐MB isomer (CK‐MB) levels affect initial physician decisions regarding patients with potential cardiac chest pain.Methods: A prospective, multicenter, observational cohort study was performed at seven university teaching hospital EDs. Hemodynamically stable chest pain patients >25 years old and without ST‐segment elevation on their ECGs were observed with one to two sets of CK‐MB level determinations obtained three hours apart prior to disposition. The physicians committed to a dichotomous (yes/no) absolute decision regarding the diagnosis of myocardial infarction (MI), need for hospital admission, and need for coronary care unit (CCU) admission both before and after enzyme results were obtained. The physicians ranked the perceived importance of initial history and physical, serial clinical observation, initial ECG, and CK‐MB level to their decision making (rank score: 1 = most important, 4 = least important).Results: Of the 1,042 patients enrolled, 777 (74.6%) were admitted to the hospital. For the 67 MI patients (8.6% of the admissions), changes in absolute decisions about the diagnosis of MI and planned CCU admission were associated with increased CK‐MB importance (p = 0.04 and p = 0.02, respectively). Of the 146 patients who had new‐onset angina or unstable angina, changes in absolute decisions were not associated with CK‐MB importance. No patient who had MI or unstable angina was released from the ED. There were three of 67 (4%) MI patients and one of 146 (1%) unstable/new‐onset angina patients initially slated for release home who were admitted to the hospital.Conclusions: For a minority of the patients who had subsequently proven MI, the CK‐MB result helped guide disposition decisions. The CK‐MB availability did not adversely impact the disposition of the patients who had unstable or new‐onset angina.
Cognitive Deficits in Presumed Minor Head‐injured Patients
Authors: Stewart Daniel P. , Kaylor Jeffrey , Koutanis Elaine 
Published: September 2008

ABSTRACTObjective:To determine the frequency of cognitive deficits in ED patients with presumed minor head injury and to identify factors in the initial history and physical examination predictive of cognitive deficits in these patients.Methods: A prospective clinical study was performed over a nine‐month period at a large community‐based ED (60,000 patient annual census). Consecutive patients between 16 and 50 years of age who presented to the ED with a history of blunt trauma or a deceleration injury to the head and a Glasgow Coma Scale (GCS) score of 14 or 15 were included. Patients who had previous head injury, mental retardation, or psychiatric problems were excluded. Patients who were admitted to the hospital or who had an abnormal imaging study of the skull or brain also were excluded. Detailed history and physical examination findings were collected using a standardized data form. Cognitive testing was done at one week postinjury (Halstead‐Reitan Neuropsychological Test Battery).Results: Seventy patients were originally entered into the study, and 36 completed the follow‐up. Those completing the study were more commonly employed and less likely to have used sensorium‐altering drugs or ethanol. Of the 36 patients who completed the study, 42% had either mild or moderate cognitive deficits at one week postinjury. Abnormal cerebellar function during the initial visit was associated with the presence of cognitive deficits at follow‐up (p = 0.004). However, only four of 15 (27%; 95% CI 8–55%) patients with a cognitive deficit had an abnormal cerebellar finding.Conclusion: Many patients with minor head injuries have cognitive deficits one week after injury. History and physical examination features are poor predictors of these deficits. Further studies are needed to evaluate the duration and final outcome of these cognitive deficits.
Improved Pediatric Patient Flow in a General Emergency Department by Altering Triage Criteria
Authors: Cain Patrick , Waldrop Ron D. , Jones John 
Published: September 2008

ABSTRACTObjective:To evaluate the effect of altering pediatric triage criteria on ED triage scoring and patient flow.Methods: A prospective observational study of a pediatric triage modification was performed. Data for all pediatric patients presenting to an urban general ED during a six‐month study period were collected. After the first three months, pediatric triage criteria were altered by elevating the acuity of several historical items and specifically listing abnormal signs and symptoms. Outcome measures included triage score assignment, criteria making the patient emergent, proportion of emergent or urgent triage assignments, and times to examination, disposition, and admission.Results: Altering pediatric triage criteria resulted in a significant (p < 0.05) increase in the number of patients triaged as emergent (2% vs 15%) or urgent (48% vs 55%). In addition, for emergent and urgent patients there was a significant decrease (p < 0.05) in the mean times to ED examination (50 vs 44 min), floor admission (355 vs 245 min), and intensive care unit admission (221 vs 132 min). The triage changes that had a significant impact on these results were a history of color change, decreased activity, and prematurity with complications.Conclusions: A significant improvement in pediatric patient flow occurred after posting age‐specific abnormal signs and symptoms as well as elevating triage acuity for specific historical clues.
De‐Solv‐It for Hot Paving Asphalt Burn: Case Report
Authors: Tsou Thomas J. , Hutson H. Range , Bear Michael , Glenn Casper , Hardin Eugene 
Published: September 2008

SummaryRemoval of tar or paving asphalt from skin specifically to evaluate underlying burn injuries and to facilitate their treatment can be a difficult problem. We report the successful use of De‐Solv‐It Multi‐Use solvent for cutaneous removal of adherent asphalt cement. This product should be considered for ED use. Controlled trials of this agent and further evaluation of any cutaneous or mucous membrane toxicity should be undertaken to further validate our experience.
A New Model of Uncontrolled Hemorrhage That Allows Correlation of Blood Pressure and Hemorrhage
Authors: Silbergleit Robert , Satz Wayne , McNamara Robert M. , Lee David C. , Schoffstall John M. 
Published: September 2008

ABSTRACTObjective: To compare hemodynamics, mortality rates, and bleeding rates at 3 severities of hemorrhage in a new model of uncontrolled intra‐abdominal bleeding that uses an injury of varying severity and geometry unfavorable to thrombosis.Methods: Ten swine were bled through a flow‐monitored shunt placed between the femoral artery and the peritoneal cavity. The shunt was connected to catheters of varying diameters placed in the femoral artery to create 3 rates of hemorrhage. Blood flow through the shunt was measured with an in‐line Doppler probe. Arterial pressures, cardiac output (CO), and ECGs were monitored. Survival and blood loss were calculated.Results: The model successfully produced 3 hemorrhage severities. At all 3 rates of bleeding, blood flow was linearly related to mean arterial pressure, with R2 > 0.72. Bleeding was continuous in all groups. The mean numbers of minutes until death were 53, 45, and 25, respectively, at the increasing shock severities. Blood pressure (BP) and CO decreased continuously in all groups, but did so more rapidly with increasing severity of hemorrhage.Conclusions: In this model of uncontrolled hemorrhage, bleeding was continuous and linearly related to BP. The hemodynamic response to uncontrolled bleeding in this model differs markedly from those in previous wire aortotomy models where wound geometry is favorable to thrombosis. Hence, when injury geometry is favorable to thrombosis (as in aortotomy), thrombosis formation affects hemorrhage rates and hemodynamic responses.
Orthostatic Change in Shock Index: Comparison with Traditional Tilt Test Definitions
Authors: Witting Michael D. , Smithline Howard A. 
Published: September 2008

ABSTRACTObjective: To determine whether the orthostatic change in the shock index or published tilt test criteria better discriminated normal individuals from those with moderate acute blood loss.Methods: Postural vital signs were recorded in a standardized manner before and after an elective 450‐mL phlebotomy associated with blood donation in healthy volunteers. Paired comparisons of the sensitivity of each of 3 published tilt test criteria were made against the sensitivity of an orthostatic change in shock index (OCSI) at the threshold for OCSI yielding the same specificity. Subjects were prospectively divided into group 1 (age < 65 years) and group 2 (age ≥ 65 years).Results: A total of 336 healthy euvolemic adult blood donors were studied over a 1‐year period (group 1 = 292; group 2 = 44). For each published criterion for a positive tilt test (for both groups), OCSI had the same or higher sensitivity for a chosen specificity. No sensitivity difference was statistically significant. An OCSI ≥ 0 was 99%/98% sensitive and 10%/10% specific (group l/group 2) for a 450‐mL blood loss; whereas an OCSI 2 0.25 was 28%/23% sensitive and 92%/100% specific (group l/group 2).Conclusion: The OCSI discriminates normal individuals from those with acute moderate blood loss as well as previously published tilt test definitions do.
Oregon Emergency Physicians' Experiences with, Attitudes toward, and Concerns about Physician‐assisted Suicide
Authors: Schmidt Terri A. , Zechnich Andrew D. , Tilden Virginia P. , Lee Melinda A. , Ganzini Linda , Nelson Heidi D. , Tolle Susan W. 
Published: September 2008

ABSTRACTObjective: To determine emergency physicians' (EPs') attitudes toward physician‐assisted suicide (PAS), factors associated with those attitudes, current experiences with attempted suicides in terminally ill persons, and concerns about the impact of legalizing PAS on emergency medicine practice.Methods: A cross‐sectional, anonymous mailed survey was taken of EPs in the state of Oregon.Results: Of 356 eligible physicians, 248 (70%) returned the survey. Of the respondents, 69% indicated that PAS should be legal, 65% considered PAS consistent with the physician's role, and 19% believed that it is immoral. The respondents were concerned that patients might feel pressure if they perceived themselves to be either a care burden on others (82%) or a financial stress to others (69%). Only 37% indicated that the Oregon initiative has enough safeguards to protect vulnerable persons. Support for legalization was not associated with gender, age, or practice location. Respondents with no religious affiliation were most supportive of PAS (p < 0.001), and Catholic respondents were least supportive (p = 0.03). A majority (58%) had treated at least 1 terminally ill patient after an apparent overdose. Most respondents (97%) indicated at least 1 circumstance for which they would sometimes be willing to let a terminally ill patient die without resuscitation after PAS if the Oregon initiative becomes law: if verified with an advance directive from the patient (81%), with documentation in writing from the physician (73%), after speaking to the primary physician (64%), if a competent patient verbally confirmed intent (60%). or if the family verbally confirmed intent (52%).Conclusions: Although the majority of Oregon EPs favor the concept of legalization of PAS, most have concerns that safeguards in the Oregon initiative are inadequate to protect vulnerable patients. These physicians would consider not resuscitating terminally ill patients who have attempted suicide under the law's provisions, only in the setting of documentation of the patient's intent.
Splenic Rupture Manifesting Two Years after Diagnosis of Injury
Authors: Fernandes Christopher M. B. 
Published: September 2008

ABSTRACTThe entity of delayed splenic rupture is often challenged. This case report describes a patient who presented with splenic rupture 2 years after a prior splenic injury from blunt trauma. The pathology report confirmed previous splenic injury. Delayed splenic rupture is possible for extended periods following splenic injury managed conservatively.
Evaluating Child Sexual Abuse in the Emergency Department: Clinical and Behavioral Indicators
Authors: Kini Narendra , Brady William J. , Lazoritz Stephen 
Published: September 2008

ABSTRACTChild sexual abuse is an increasingly common problem. This article reviews the current clinical and behavioral indicators that will aid the emergency physician when evaluating and managing this condition. The most common differential diagnoses are described and a general approach to this diagnosis is suggested. Adopting a multidisciplinary method when evaluating this problem will lessen the anxiety facing the examining physician and provide a better outcome for the child, parents, and community.
Incremental Benefit of Individual American College of Surgeons Trauma Triage Criteria
Authors: Henry Mark C. , Hollander Judd E. , Alicandro Jeanne M. , Cassara Guy , O'Malley Susan , Thode Henry C. 
Published: September 2008

ABSTRACTObjective: To determine the incremental benefit of individual American College of Surgeons (ACS) trauma triage criteria for prediction of severe injuries after consideration of concurrent physiologic, anatomic, mechanism, or “other” criteria.Methods: A prospective cross‐sectional study of motor vehicle crash victims transported to any of the 12 hospitals in a suburbadrural county by local ambulance services was performed. Demographic and individual ACS criteria were collected using structured data instruments. EDs provided patient disposition within 24 hours of patient arrival. Medical records were reviewed. Major outcomes were admission, operative interventions (OR), major nonorthopedic operative interventions or death (Maj‐OR), and injury severity score (ISS). To optimize sensitivity and specificity of out‐of‐hospital triage decision rules, receiver operating characteristic (ROC) curves were derived.Results: Of 1,545 patients, 13% were admitted; 6% had OR; 1% had Maj‐OR; and 3% had ISSs ≥16. For all outcomes, the most useful criteria were physiologic and anatomic. Some additional criteria (crash speed >20 mph, ≥30‐inch vehicle deformity, axle displacement) substantially worsened specificity. with minimal or no improvement in sensitivity. For example, the optimal ROC curve for Maj‐OR was determined by a systolic blood pressure <90 mm Hg, Glasgow Coma Scale (GCS) score 43, respiratory rate (RR) <10 or >29, death of a same‐car occupant, penetrating injury, and/or ≥24‐inch opposite‐side compartment intrusion (sensitivity, 85%; specificity, 87%). An ISS ≥16 was predicted by GCS score <13, RR <10 or >29, penetrating injury, 2 proximal long bone fractures, flail chest, ≥24‐inch opposite‐side compartment intrusion, patient ejection, rollover, and/or age <5 or >55 years (sensitivity, 86%; specificity, 70%).Conclusion: Physiologic and anatomic trauma triage criteria predicted increased hospital resource utilization and severe injury. On the other hand, when used concurrently with physiologic, anatomic, and “other” criteria, some mechanism criteria worsen specificity with negligible improvement in sensitivity. In particular, crash speed >20 mph and ≥30‐inch vehicle deformity had little predictive value for all outcomes.
Continuous vs Intermittent Nebulized Albuterol for Emergency Management of Asthma
Authors: Khine Hnin , Fuchs Susan M. , Saville Alan L. 
Published: September 2008

ABSTRACTObjective: To compare the efficacy and safety of continuous nebulized (CN) albuterol therapy with those of intermittent nebulized (IN) albuterol therapy in the ED treatment of children with moderate to severe asthma exacerbations.Methods: A prospective, randomized, single‐blind study was conducted at a children's hospital ED. Patients aged 2 to 18 years with a moderate to severe asthma exacerbation (asthma score ≥8) were enrolled. Patients were randomized to receive either IN albuterol (0.15 mg/kg/dose every 30 min) or CN albuterol (0.3 mg/kg/ hr) for a maximum of 2 hours. All patients received prednisone at entry. All released patients were evaluated by telephone, 48 hours after the ED visit. Estimates of respiratory therapist (RT) time commitments for the 2 delivery systems were calculated.Results: There were 35 patients assigned to IN therapy and 35 to CN therapy. Nine of the 35 patients (26%) in the IN group and 8 of the 35 patients (22%) in the CN group were hospitalized (p = NS). Although the durations of ED therapy were comparable in the 2 groups, the time spent by the RTs in delivering asthma therapy was significantly less for the CN group than it was for the IN group (30.3 min vs 51.9 min per patient; p < 0.001). There was no major adverse effect in either study group.Conclusion: There was no difference in efficacy or safety between CN therapy and IN therapy in the ED management of moderate to severe asthma exacerbations in children. Moreover, CN therapy provided a significant time savings in the delivery of asthma therapy to patients in a busy ED.