Terry A Adirim, Joseph L Wright, Emmanuel Lee, Tracy A Lomax, James M Chamberlain
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90184-5
Published in issue: October 1999
xIn this study we have tried to determine physician success in the collection of injury data during the emergency department visit. Prospective data were collected from all children between the ages of 0 to 18 treated for an injury. Data were collected at the time of the visit and by chart review the next day. At an urban, university-affiliated, children's hospital, data were collected on 2,156 injured children. Fifty-one percent of the data forms were completed by the treating physician. Physician completion rate was lower on the weekends (46%) than on weekdays (52%, P = .02).
William J Brady, John Moghtader, Daniel Cutcher, Charlie Exline, Jeffrey Young
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90185-7
Published in issue: October 1999
xDynamic cervical spine radiography (CSR) is used to detect ligamentous instability. We investigated the ED use of dynamic CSR through a retrospective descriptive review using a convenience sample study design at a university emergency department. Adult blunt trauma patients with static (lateral, AP, odontoid) and dynamic (flex, extend) CSR participated. 451 patients (52% male with mean age of 33.6 years) met entry criteria. Injury mechanisms were 74% MVA, 12% fall, 8% direct trauma, and 6% other.
Elisabeth Fowlie Mock, Keith D Wrenn, Seth W Wright, T.Chadwick Eustis, Corey M Slovis
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90186-9
Published in issue: October 1999
xWe tried to measure anxiety levels in emergency medical service (EMS) providers to determine the effects of (1) having had a violent encounter during a shift and (2) different shift schedules, conducting a prospective observational study over 3 months in an urban EMS system setting. A convenience sample of 23 EMTs and 40 EMT-Ps was observed. Anxiety levels were measured using the Spielberger State-Trait Anxiety Inventory. A total of 99 inventories were completed by 63 EMS providers. The mean state (32.6 ± 8) and trait (31.7 ± 7.1) scores were less than normative scores (35.7 ± 10.4 and 34.9 ± 9.2 respectively) for working adult males (P = .004 and .007, respectively).
Abby A.R Pudpud, Marc Y-R Linares, Barry Greenberg
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90187-0
Published in issue: October 1999
xIn this article we attempt to identify variables that may predict which pediatric patients presenting with supraventricular tachycardia to the emergency department are at risk for immediate recurrence or negative outcome. We studied an 11-year chart review and follow-up of pediatric patients presenting to the pediatric ED with a diagnosis of SVT. Recurrences of SVT during the first 24 hours after initial episode and occurrences of negative outcome (ie, respiratory distress, cardiac arrest) during hospital stay were measured.
Jeffrey S Jones, Janos Nevai, Martin P Freeman, Dale E McNinch
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90188-2
Published in issue: October 1999
xIdiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a syndrome characterized by an elevated intracranial pressure in the absence of a focal lesion, infective process, or hydrocephalus. New onset IIH may present to the emergency department in a variety of ways. To describe the etiologic associations and clinical features in this disorder, we performed a retrospective analysis of consecutive emergency department patients with new onset IIH during the calendar years 1987–1996. A total of 52 patients met all study criteria.
Stephen W Meldon, Charles L Emerman, Donald A Moffa, Daniel S.P Schubert
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90189-4
Published in issue: October 1999
xWe will determine if clinical characteristics can be useful in identifying depression in geriatric Emergency Department (ED) patients. We have provided a cross-sectional observational study of geriatric patients presenting to an urban university-affiliated public hospital. A brief self-rated depression scale (SRDS) was used to identify depression. Clinical characteristics, examined retrospectively, included chief complaint, chronic illnesses, mode and time of arrival and discharge disposition. Relative prevalence of depression was calculated for these clinical characteristics.
Charles L Emerman, Rita K Cydulka, Alfred Rimm
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90190-0
Published in issue: October 1999
xPrevious reports have found an increase in asthma prevalence and severity during the 1980s. The purpose of this study was to evaluate changes in asthma claims in a cohort of Medicaid enrollees from 1991 through 1994. A historical study used Ohio Medicaid claims data for fiscal years 1989 through 1994. Adult and pediatric enrollees with at least one claim for asthma care during fiscal year 1989 who subsequently were continuously eligible through fiscal year 1994 were divided into 2 cohorts consisting of those with (Cohort 1) or without (Cohort 2) an asthma claim in 1990.
Howard D Backer, Ellen Shopes, Sherrie L Collins, Howard Barkan
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90191-2
Published in issue: October 1999
xWe compared clinical presentation and course of exercise-associated hyponatremia with heat exhaustion among summertime hikers in Grand Canyon National Park. Cases were selected from among hikers who requested medical help from the National Park Service Emergency Medical Service (EMS) or who presented to the medical clinic on the rim of the canyon with complaints related to exercise in the heat. Of 44 patients who had serum samples analyzed, 7 had hyponatremia with clinically significant symptoms and serum sodium levels <130 mmol/L: 3 had grand mal seizures, 2 had other major central nervous system disorders, and 2 had minor neurological symptoms.
Adam J Singer, Clark S Homan, Michael Brody, Henry C Thode Jr, Judd E Hollander
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90192-4
Published in issue: October 1999
xThere has been a general trend in medicine toward greater sophistication in research design. To assess this trend in emergency medicine, we compared the characteristics of abstracts presented at the 1974, 1983, 1989, and 1997 annual scientific meetings of Academic Emergency Medicine. All 870 abstracts were reviewed by 1 of 3 investigators who determined research design attributes using a standardized classification scheme that has good interrater reliability. Over the last 25 years, the following trends were noted: more surveys (0% v1% v3% v8%, P = .002), more randomized studies (0% v 10% v 12% v 15%, P = .05), and more blinded studies (0% v 7% v 5% v 11%, P = .01).
Steven A Pace, Frederick P Fuller, Timothy J Dahlgren
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90193-6
Published in issue: October 1999
xTo determine the incidence of unused out-of-hospital intravenous line (IV) placements, we prospectively studied IV placement in emergency medical services (EMS) patients. Unused IV placement was defined as any patient having an EMS initiated IV that was not used for fluid bolus or medication administration in the field or in the emergency department (ED). Data were analyzed on placement and use of IV lines in the field and in the ED, transport time, years of paramedic practice, and paramedic student presence.
Takumi Taniguchi, Yuichi Koido, Jyunichi Aiboshi, Teruyo Yamashita, Shinichiro Suzaki, Akira Kurokawa
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90194-8
Published in issue: October 1999
xTo evaluate the relation between proinflammatory cytokines and antiinflammatory cytokines after major trauma, we measured pro-inflammatory cytokine (interleukin [IL]-6) and antiinflammatory cytokine (IL-10) concentrations after trauma, and evaluated the relationship between the ratio of IL-6 to IL-10 and injury severity. In 20 patients who sustained chest and abdominal trauma, IL-10, IL-6, and lactate concentrations were measured at 0, 1, 2, and 4 days. The Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation (APACHE) II score, and the ratio of IL-6 to IL-10 were calculated.
Catharine W Burt
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90195-X
Published in issue: October 1999
xIn this article we describe characteristics of emergency encounters for patients with a diagnosis of acute cardiac ischemia (ACI) and for patients with chest pain complaints. Data are from the National Hospital Ambulatory Medical Care Survey, which includes abstracts from the medical records of a national probability sample of visits to emergency departments (ED). Analysis was limited to records of patients 25 years of age and older with a diagnosis of either confirmed or suspected acute myocardial infarction (AMI) or unstable angina pectoris and records with a nontraumatic chest pain complaint.
Elizabeth M Datner, Frances S Shofer, Katerina Parmele, Sarah A Stahmer, C.Crawford Mechem
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90196-1
Published in issue: October 1999
xThis cross-sectional study was performed to determine (1) whether female victims of domestic violence (DV) are more likely to use the 911 system than nonvictims (NVs) and (2) whether DV and NVs call 911 for different reasons so that 911 may be used as a screening tool for abuse. The study was performed in an academic adult urban emergency department (ED). Ambulatory female patients presenting to the ED were studied. Eligible patients were administered a brief survey by trained research assistants.
Joseph Kosnik, Falah Shamsa, Elizabeth Raphael, R Huang, Zachary Malachias, Gregory M Georgiadis
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90197-3
Published in issue: October 1999
xA prospective, randomized, nonblinded clinical trial was undertaken to evaluate whether local intraarticular lidocaine injection (IAL) is equally effective in facilitating reduction of acute anterior shoulder dislocations (AASD) as intravenous analgesia/sedation (IVAS). The setting was an urban, Level 1, trauma center. Patients enrolled presented to the emergency department (ED) with radiographically confirmed AASD and were randomized either to the IVAS group or the IAL group. Ease of reduction and pain associated with reduction were measured subjectively using a 10-point scale.
Alfred Sacchetti, Edward Ramoska, Mary Ellen Moakes, Peg McDermott, Vern Moyer
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90198-5
Published in issue: October 1999
xAcute pulmonary edema (APE) is a common Emergency Department (ED) presentation requiring admission to an intensive care unit (ICU). This study was undertaken to examine the effect of ED management on the need for ICU admission in patients with APE. ED records of APE patients were abstracted for patient age, prehospital and ED pharmacological treatment, diagnoses, airway interventions, and ICU length of stay (LOS). Statistical analysis was through multiple regression, logistic regression, chi-square, and ANOVA.
Peter C Ferrera, Dennis P McKenna, Elizabeth A Gilman
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90199-7
Published in issue: October 1999
xSnowboarding is a winter sport that has shown a considerable increase in popularity during the last 2 decades. As a result, there has been a continued rise in the number of visits to the emergency department (ED) for injuries sustained while snowboarding. Previous studies have concluded that those injured tend to be male, younger, and more inexperienced than their alpine skiing counterparts. This study examines the injury patterns seen in one ED during peak winter sport recreational months over a 5-year period.
Lisa Chan, Donald Hill
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90200-0
Published in issue: October 1999
xAlthough peripartum cardiomyopathy is uncommon, emergency physicians should be knowledgeable of it because of its high morbidity and mortality. Emergency physicians should be alert to the fact that the clinical presentation of peripartum cardiomyopathy is nonspecific. Its clinical manifestations are found in other medical conditions that can present in the late prepartum or postpartum patient. We present a case of peripartum cardiomyopathy that illustrates how its nonspecific respiratory signs and symptoms led to an initial diagnosis of pulmonary embolism.
Raymond J Roberge, Debra Weinstein, Melissa M Thimons
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90201-2
Published in issue: October 1999
xTwo cases of perionychial infections associated with the use of sculptured fingernails are presented. Both patients developed paroncyhia necessitating incision and drainage. One patient, a diabetic, had a concomitant subungual abscess and felon which required repeat drainage and debridement as well as intravenous antibiotics over an extended period for complete resolution. Sculptured fingernails may be risk factors for the development of digit infections through various mechanisms, and users of these cosmetic devices, especially diabetics and immunocompromised people, should be made aware of their potential for infectious complications.
Seth Schonwald
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90202-4
Published in issue: October 1999
xThe exacerbation of asthma is a problem frequently encountered by emergency physicians. In addition to oxygen and beta adrenergic agonists, oral and intravenous corticosteroids are increasingly being used to alleviate bronchospasm and to prevent recurrence of dyspnea. Methylprednisolone sodium succinate has been advocated as an intravenous adjunct in the treatment of asthma. We present the case of a steroid-dependent, 17-year-old male asthmatic, who experienced anaphylaxis, with respiratory arrest, within minutes of receiving intravenous methylprednisolone.
Stephen H Thomas, Pierre Borczuk, Jay Shackelford, James Ostrander, David Silver, Michael Evans, Joshua Stein
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90203-6
Published in issue: October 1999
xWhereas controversy surrounds emergency department (ED) analgesia administration to patients with undifferentiated abdominal pain, few studies have addressed the level of patient-physician agreement on abdominal pain severity and need for opioid analgesia. This prospective study was undertaken to assess concordance between emergency physicians and patients on abdominal pain severity. Study subjects were a convenience sample of 30 adults seen in an urban university-affiliated tertiary care ED (annual census 65,000) who had undifferentiated abdominal pain meeting an initial severity threshold of 5 on a 10cm visual analog scale (VAS) marked by the patient.
Paul G Gauger, Ana I Guinea, Thomas S Reeve, Leigh W Delbridge
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90204-8
Published in issue: October 1999
xEmergency physicians frequently encounter patients with thyroid disease. However, it is unusual for these thyroid disorders to create acute, life-threatening situations. Critical airway compression attributable to benign or malignant thyroid enlargement may occur suddenly. Similarly, venous obstruction from thyroid tumors or severe physiological compromise from thyrotoxicosis may require urgent treatment. We reviewed a group of patients who were evaluated by emergency physicians for acute thyroid pathology and subsequently admitted for urgent thyroidectomy.
Diane Groth, Sean O Henderson
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90205-X
Published in issue: October 1999
xNecrotizing fasciitis, although rare, is one of the more serious, life-threatening complications of missed acute appendicitis. Patients who are predisposed to developing necrotizing fasciitis, regardless of the cause, are typically immunocompromised. We present a case of a 49-year-old immunocompetent female whose diagnosis of acute appendicitis was missed and who subsequently developed necrotizing fasciitis of the abdominal wall and flank. She recovered 1 month after admission due to aggressive surgical and medical therapy.
Elise M Jackson, Gordon M Bussard, Martin A Hoard, Richard F Edlich
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90206-1
Published in issue: October 1999
xA 38-year-old white woman came to the emergency department complaining of severe, unilateral jaw pain. She had consulted her primary care physician and dentist without achieving the correct diagnosis or significant relief of her symptoms. The emergency physician made the diagnosis of trigeminal neuralgia by obtaining a history of severe paroxysmal ipsilateral facial pain activated by numerous facial stimuli. A light stimulation of the trigger point precipitated the pain. Her pain relief from carbamazepine lent further credence to the diagnosis of trigeminal neuralgia and appropriate referral to a neurosurgeon.
Dominique Vanpee, Dominique Blommaert, Jean-Bernard Gillet, Luc De Roy
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90207-3
Published in issue: October 1999
xWe report on the case of a 33-year-old man with recurrent syncopes appearing suddenly due to sustained monomorphic ventricular tachycardias. The electrocardiogram (ECG) showed a right bundle branch block pattern and ST segment elevation in the precordial leads V1 to V2, not explained by ischemia, electrolyte disturbances, toxic ingestion, or structural heart disease (coronary and right ventricle angiograms as well as biopsies of the right ventricle were normal). ECG image was compatible with the so-called Brugada syndrome, first described in 1992.
Gregory M Purvis, Steven J Weiss, Francis A Gaffney
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90208-5
Published in issue: October 1999
xPrehospital electrocardiograms (ECGs) have been shown to decrease the time from onset of pain to onset of treatment. They are obtained prior to treatment while the patient is likely to have his/her most intense pain. With paramedics initiating care in the field, patient assessments may be clinically different by the time the patient reaches the hospital. Thus, obtaining an ECG as early as possible during treatment could aid in the access to treatment for the few patients whose ECGs improve with prehospital care.
Tighe Zimmers, Richard C Butler
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90209-7
Published in issue: October 1999
James Toby Vandenberg, David R Vinson
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90210-3
Published in issue: October 1999
xAirway management is the highest priority in any resuscitation. Suction equipment capable of rapidly clearing the oropharynx is mandatory for airway management. Inadequate oropharyngeal suction with standard equipment may be associated with major complications in emergency airway management. We report cases that illustrate the inadequacies of standard suction equipment. Available oropharyngeal aspirators and their limitations are discussed. Recent advances in the field of oropharyngeal suction also are described.
Christopher C Lee, Loudes R Ylagan, Khush Mittal
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90211-5
Published in issue: October 1999
Keri Thorn, Janet Williams
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90212-7
Published in issue: October 1999
Yasuki Nakata, Atsushi Hiraide, Takeshi Shimazu, Toshiharu Yoshioka, Hisashi Sugimoto
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90213-9
Published in issue: October 1999
Robert H Baevsky
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90214-0
Published in issue: October 1999
Chih-Ping Chen
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90215-2
Published in issue: October 1999
Joel A Fein, James M Callahan, Chris R Boardman
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90216-4
Published in issue: October 1999
Gretchen S Shaar, Eunice M Singletary
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90217-6
Published in issue: October 1999
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90218-8
Published in issue: October 1999
