Peter C Ferrera, Joel M Bartfield, Carl C D'Andrea
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90146-8
Published in issue: November 1999
xThis study was undertaken to investigate which patients 65 years of age or older have adverse outcomes after discharge from the emergency department (ED) after an injury. Patients were enrolled prospectively at an urban university center from September 15, 1996, until August 31, 1997. Patients sustaining any potentially serious form of injury were included. Data about comorbid conditions, preinjury medications, and types of injuries sustained were recorded. Patients were contacted at home at least 30 days after discharge and were questioned about their overall health, need for admission since ED discharge, and whether any complications developed.
Robert Davis, Stuart J Spitalnic, Liudvikas Jagminas
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90147-X
Published in issue: November 1999
xWe reviewed our experience with adenosine for the conversion of paroxysmal supraventricular tachycardia (PSVT) to determine whether the recommended dosing strategy of 6 mg, followed by 12 mg, is cost-effective in actual practice. We observed a 65% conversion rate to sinus rhythm with the initial dosage of 6 mg adenosine (95% CI, 54% to 75%), and, based on subsequent cost analysis, conclude that the current strategy should not be replaced by a 12-mg-first strategy. If the packaging of adenosine was changed so that 12 mg cost less than twice 6 mg, this analysis should be revisited.
Alda Moettus, David Sklar, Dan Tandberg
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90148-1
Published in issue: November 1999
xIn this article we try to determine if the examiner's gender affects women's perceived pain and embarrassment during emergency department pelvic examination, using a prospective comparative study in a university teaching hospital. Test subjects were taken from a convenience sample of female emergency department (ED) patients undergoing pelvic examination as part of their evaluation. 100 mm visual analog scales were used to gauge each subject's perceived pain and embarrassment. Subject age and complaint, and the examiner's gender and level of training were collected.
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)90149-3
Published in issue: November 1999
xThere has been a general trend in medicine towards greater sophistication in research design. In order 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% v 1% v 3% v 8%, P = 0.002), more randomized studies (0% v 10% v 12% v 15%, P = 0.05), and more blinded studies (0% v 7% v 5% v 11%, P = 0.01).
William Durston, Michael L Carl, Wayne Guerra
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90150-X
Published in issue: November 1999
xIn recent years, there has been considerable interest and controversy concerning the performance of ultrasound by emergency physicians (ED Sono), but patient satisfaction with ED Sono has not been well studied. The primary purpose of this investigation was to assess the level of patient satisfaction with ED Sono and to compare satisfaction with ED Sono with ultrasound by the Medical Imaging Department (MI Sono). A secondary objective was to assess the accuracy of ED Sono at our facility. During a 5-month period, which included the startup phase of a program for ED Sono, emergency physicians prospectively identified patients who were candidates for ultrasound as a part of their workup.
Gary Swart, William J Brady Jr, Daniel J DeBehnke, O John, Tom P Aufderheide
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90151-1
Published in issue: November 1999
xThe purpose of this study was to investigate the therapeutic response to atropine of patients experiencing hemodynamically compromising bradyarrhythmia related to acute myocardial infarction (AMI) in the prehospital (PH) setting and the therapeutic impact of the PH response to atropine on further Emergency Department (ED) care. In addition, the prevalence of AMI in patients presenting with atrioventricular block (AVB) is noted. Retrospective review of PH, emergency department (ED), and hospital records.
Michael Shuster, Riyad B Abu-Laban, Jeff Boyd
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90152-3
Published in issue: November 1999
xThe main study objective was to determine if experienced emergency physicians can accurately identify a subgroup of patients with anterior shoulder dislocation for whom prereduction radiographs do not alter patient management. Our prospective study evaluated 97 patients who presented to 2 ski-hill clinics and to our rural emergency department with possible shoulder dislocation between November 1996 and May 1997. Emergency physicians were certain of shoulder dislocation by clinical examination alone in 40 of 59 cases (67.8%) of possible dislocation.
Ülkü Ergene, Oktay Ergene, John Fowler, Ozan Kinay, Yildiray Çete, Cem Oktay, Cem Nazli
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90153-5
Published in issue: November 1999
xWe investigated the spontaneous conversion rate of new-onset atrial fibrillation (AF) in emergency department patients and the recurrence rate of AF during a 1 month follow-up period. Sixty-six consecutive hemodynamically stable patients presenting to a university hospital emergency department with new-onset atrial fibrillation (less than 72 hours duration) comprised the study population. Patients were initially monitored for 8 hours and observed for spontaneous conversion of AF to sinus rhythm.
Timothy J Mader, Stephen J Playe
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90154-7
Published in issue: November 1999
xThis project was undertaken to assess academic emergency physicians' awareness of emergency department charges for routine care. A 60-item worksheet requiring estimates of patient charges for selected emergency department services, supplies, medications, and composite scenarios was used. The study was conducted at a university-affiliated academic emergency department and included 20 emergency medicine attendings and 20 emergency medicine residents. The questionnaires were distributed to the participants, independently completed, and immediately returned without discussion or consultation.
J.Tobias Nagurney, David F.M Brown, Robert A Novelline, Jennifer Kim, Randy H Fischer
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90155-9
Published in issue: November 1999
xWe conducted a retrospective descriptive study to determine the value of plain abdominal radiographs in emergency department (ED) patients also receiving abdominal computed tomography scans (CT) for the evaluation of nontraumatic abdominal, back and flank pain (NTAP). Cases were identified through radiology log books. Medical records and radiology reports were reviewed to determine whether the CT confirmed the findings of the plain abdominal radiographs, and whether the clinical course confirmed the results of either.
Roberto Manfredini, Francesco Portaluppi, Raffaella Salmi, Paolo Zamboni, Olga La Cecilia, Hélène Kuwornu Afi, François Regoli, Maurizio Bigoni, Massimo Gallerani
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90156-0
Published in issue: November 1999
xResearch has identified circadian and seasonal patterns for several acute cardiovascular diseases. In order to investigate the possible existence of a seasonal variation in the onset of acute nontraumatic ruptures of thoracic aorta, this study considered all patients referred to the emergency department of St Anna Hospital of Ferrara, Italy, from January 1985 to December 1996. In the considered period, 85 patients (52 males, 33 females) of nontraumatic ruptures of thoracic aorta were observed. Cosinor analysis and partial Fourier series with up to 4 harmonics were applied to monthly data, and the best-fitting curves for circannual rhythmicity were calculated.
Raymond J Roberge, Walter J Kantor, Lari Scorza
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90157-2
Published in issue: November 1999
xA 31-year-old woman presented with complaints of increasingly severe right lower quadrant discomfort that had occurred for several days each month over the course of the previous 6 months. A tender mass of the abdominal wall was palpated on physical examination, and subsequent ultrasonography and magnetic resonance imaging disclosed a discrete mass of the body of the right rectus abdominis muscle which was confirmed as endometrial tissue on biopsy. Rectus abdominis endometrioma is a relatively rare cause of abdominal pain which may mimic an acute abdomen.
Shyr-Chyr Chen, Fang-Yue Lin, King-Jen Chang
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90158-4
Published in issue: November 1999
xPneumomediastinum, pneumothorax, and subcutaneous emphysema can occur occasionally after a surgical procedure. Facial swelling is a common complication of dental management. The occurrence of subcutaneous emphysema, pneumothorax, and pneumomediastinum after dental procedures is rare. We present a case with subcutaneous emphysema of the upper chest, neck, chin, and pneumomediastinum after a tooth extraction and discuss the possible mechanism of subcutaneous emphysema. To prevent these complications during dental procedures, dental hand pieces that have air coolant and turbines that exhaust air in the surgical field should not be used.
John R Richards, Emily B Johnson, Randy W Stark, Robert W Derlet
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90159-6
Published in issue: November 1999
xPatients with methamphetamine toxicity are presenting in greater numbers each year to emergency departments (ED) in the US. These patients are frequently agitated, violent, and often require physical and chemical restraint. The incidence and risk of rhabdomyolysis in this subpopulation is unknown. We conducted a 5-year retrospective review of all ED patients who received the final diagnosis of rhabdomyolysis. Patients with toxicology screens positive for methamphetamine were identified, and demographics, laboratory results, resource utilization, disposition, and outcome were compared to the remaining patients.
Natan Weksler, S Brill, A Tarnapolski, GM Gurman
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90160-2
Published in issue: November 1999
xBeta-two sympathomimetic drugs are the treatment of choice for asthmatic attack. Their main effect is to dilate the bronchi by a direct action on beta-two adrenoreceptors on the smooth muscle, and also by mediator release inhibition from mast cells. Salbutamol is widely used in the treatment of bronchial asthma, and is usually administered either by inhalation, orally, or parenterally. The nasal route seems to afford an effective way to administer medications, since the nasal mucosa has a relatively large surface area, and there is no gastrointestinal-hepatic first pass-effect, thus avoiding extensive loss of the administered drug.
Michael C Wadman, Robert L Muelleman
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90161-4
Published in issue: November 1999
xThe purpose of this study was to document prior emergency department (ED) use and injuries presented by victims of domestic violence (DV) homicides. We identified all female DV homicide cases investigated by Kansas City, Missouri, Police Department (KCPD) officials over 5 years. Medical Records from 12 hospitals were searched to determine how many homicide victims were in the ED within the 2 years preceding their homicide. The records were reviewed and classified according to the Flitcraft Criteria.
Nancy M.Fenn Buderer, Michael C Plewa
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90162-6
Published in issue: November 1999
xWe examined the statistical resources within emergency medicine residency programs, and the attitudes of emergency medicine physician researchers toward activities wherein collaboration with a statistician is useful. Anonymous surveys were mailed to 104 emergency medicine physician researchers (1/program). Sixty-four (62%) responses were analyzed. Sixty-seven percent of respondents were their program's research director. Their highest level of statistical training was self-taught/nondegree course work for 88% of respondents.
William J Brady Jr, Howard L Bright
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90163-8
Published in issue: November 1999
xAnaphylaxis, a multisystem allergic reaction, represents a true medical emergency. Anaphylaxis is characterized by a combination of the following: urticaria, angioedema, distributive shock, and respiratory failure. Most often, the patient is rapidly treated with prompt resolution of the anaphylaxis in either the out-of-hospital or emergency department (ED) setting. Infrequently, recurrent, or multiphasic, anaphylaxis is encountered, involving a reappearance of allergic phenomena after complete resolution of the original reaction.
Carlos Rodrigo, Gustavo Rodrigo
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90164-X
Published in issue: November 1999
xIn this article, we describe a case of a subarachnoid hemorrhage (SAH) in an acute severe asthma patient following mechanical hypoventilation. A 49-year-old man was admitted to an Intensive Care Unit with an acute exacerbation of asthma. After 3 days of mechanical ventilation (hypercapnia and normoxaemia), it was noted that his right pupil was fixed, dilated, and unreactive to light. Computed tomography (CT) scan showed localized SAH within the basilar cisterns and diffuse cerebral swelling. On the fourth day, a new CT scan showed hemorrhage resorption and a cerebral swelling decrease.
Syed I Rahmatullah, Ijaz A Khan, Vinod M Nair, Nicholas D Caccavo, Balendu C Vasavada, Terrence J Sacchi
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90165-1
Published in issue: November 1999
xAortic dissection is a medical emergency carrying high morbidity and mortality. Prompt diagnosis is sometimes difficult because of its varying presentations, but it is critical to the achievement of good clinical outcomes. This report describes 2 cases of painless aortic dissection that presented with aortic valve regurgitation. In both, the dissection was limited to the ascending aorta just distal to the aortic valve. These dissections were diagnosed by transthoracic and transesophageal echocardiography.
Janet G.H Eng, Steven E Aks, Rachel Waldron, Christopher Marcus, Stuart Issleib
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90166-3
Published in issue: November 1999
xComputed tomography (CT) imaging has been touted as one of the best techniques to detect body packets in body packers and stuffers. The majority of experience has been with body packers. We describe a case of a body stuffer who presented with abdominal pain after ingesting a large packet containing multiple small packets, with a falsely negative abdominal CT scan without contrast. This case raises questions regarding the best method of detection of body packets in body stuffers.
Mitchell H Rosner, William J Brady Jr, Michael P Kefer, Marcus L Martin
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90167-5
Published in issue: November 1999
xThe Wolff-Parkinson-White syndrome (WPW), estimated to occur in approximately 0.1% to 3% of the general population, is a form of ventricular preexcitation involving an accessory conduction pathway. The definition of WPW relies on the following electrocardiographic features: (1) a PR interval less than 0.12 seconds (2) with a slurring of the initial segment of the QRS complex, known as a delta wave, (3) a QRS complex widening with a total duration greater than 0.12 seconds, and (4) secondary repolarization changes reflected in ST segment-T wave changes that are generally directed opposite (discordant) to the major delta wave and QRS complex changes.
Steven L Orebaugh
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90168-7
Published in issue: November 1999
xSuccinylcholine has long been the favored neuromuscular blocking agent for emergent airway management because of its rapid onset, dependable effect, and short duration. However, it has a plethora of undesirable side effects, ranging from the inconsequential to the catastrophic. When patients requiring tracheal intubation present with potential contraindications to succinylcholine use, the emergency physician will need to substitute a rapid-onset nondepolarizing neuromuscular blocking agent, such as rocuronium or mivacurium.
Richard M Sobel, Barry W Morgan, Michael Murphy
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90169-9
Published in issue: November 1999
xThe safe and effective use of ketamine for sedation/analgesia by emergency physicians has been validated in the medical literature. Nonetheless, arbitrary restrictions of this medication to anesthesia practitioners have prohibited emergency physician use in some locations. We explore the scientific evidence related to the use of ketamine by emergency physicians for sedation/analgesia, the history of sedation, the operational definitions of conscious sedation and dissociative anesthesia, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) related standards.
Walter F Kuhn, David E Heape, Michael J Caudell
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90170-5
Published in issue: November 1999
Mansoor Ahmad, Faiaz M Rasul
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90171-7
Published in issue: November 1999
Catherine A Marco
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90172-9
Published in issue: November 1999
Robert June, Mera Yunus, William Gossman
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90173-0
Published in issue: November 1999
Dominique Vanpee, Jean-Bernard Gillet, Patrice Laloux
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90174-2
Published in issue: November 1999
Chih-Ping Chen, Wayseen Wang, Tao-Yeuan Wang
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90175-4
Published in issue: November 1999
David C Lee, Jonathan H Valente
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90176-6
Published in issue: November 1999
Gordon Mah, Kelly Wong, Isser Dubinsky
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90177-8
Published in issue: November 1999
William Gossman, Robert A June, Donald Wallace
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90178-X
Published in issue: November 1999
Francisca Prieto Valderrey, Guillermo Burillo Putze, Jorge Martinez Azario, Meliton Santana Ramos
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90179-1
Published in issue: November 1999
R.F Conway
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90180-8
Published in issue: November 1999
Charlene B Irvin
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90181-X
Published in issue: November 1999
Francis L Counselman, Richard T Griffey
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90182-1
Published in issue: November 1999
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90183-3
Published in issue: November 1999
