Medical Specialties Commons^™

Is The Treatment And Transport Of Asystolic Cardiac Arrest Patients To Hospital By Ambulance Services Appropriate?, Andy Symons

Theses: Doctorates and Masters

The Paramedic's role requires them to attend many patients in cardiac arrest. The victim' s survival depends on a variety of issues, such as previous medical history, pathological cause of cardiac arrest, presenting cardiac arrest dysrhythmias, and the time elapsed before medical aid is administered. The purpose of this present study was to review current practice advocated by St John Ambulance Service WA for the treatment of the cardiac arrest dysrhythmia `asystole'. At present, certain victims of an asystolic arrest are treated and transported to hospital irrespective of time in arrest. As such, questions are raised as to the suitability …

Narcotic Analgesics For Acute Migraine In The Emergency Room: Are We Meeting Headache Societies' Guidelines?, Mohammad Wasay, Khawaja Slaman Zaki, Saqib Uddin Khan, Rifat Rehmani

Department of Emergency Medicine

We analysed 161 patients with acute migraine in our emergency room (ER) to identify the use of narcotic analgesics as first-line treatment. Twenty-four percent of patients were treated with opioid analgesics and 76% patients were treated with non-opioid analgesics. Pain was completely relieved in 100 (62%) patients, partially relieved in 50 (31%) patients and was not relieved in 11 (7%) patients at the time of discharge. Pain relief was not related to the use of opioids vs. non-opioids. The treatment of acute migraine in our ER is in line with the guidelines of the Headache Societies and needs further improvement.

Don't Bring Me Your Tired, Your Poor: The Crowded State Of America's Emergency Departments, Jessamyn Taylor

National Health Policy Forum

If the time comes, people expect that the emergency department (ED) will have the resources necessary to treat them in a timely, high-quality manner. Increasingly, however, EDs may not be able to meet that expectation. Hospitals in urban areas with large populations, high population growth, and higher-than-average numbers of uninsured are particularly crowded: ambulances are often diverted to other hospitals and patients are frequently forced to “board” in the hallways (while they wait to be transferred to another facility or part of the hospital). This issue brief places EDs in the context of the U.S. health care system and its …

The Use Of The Tripartite Model Of Attitudes To Explain Ems Providers' Attitudes About The Ems Agenda For The Future, Carolyn Angela Rinaca

Health Services Research Dissertations

A dynamic and revolutionary health care system compels the Nation to develop a more cohesive, unified healthcare workforce. The Emergency Medical Services (EMS) profession has contributed to this development with the publication of the EMS Agenda for the Future. The EMS Agenda for the Future describes the future direction for emergency medical services agencies and organizations within the nation. It is a vision that integrates EMS systems with other health care professions. The EMS Agenda for the Future is designed to assist EMS professionals in realizing their full potential for proficiency and contributes to the development of the EMS profession. …

Resident Efficiency In A Pediatric Emergency Department., M Denise Dowd, Celeste Tarantino, Theodore M. Barnett, Laura Fitzmaurice, Jane F. Knapp

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: To measure the hourly rate of patients evaluated and treated by resident physicians in an academic pediatric emergency department (PED) and examine differences in the rate by subspecialty and year of training.

METHODS: For all residents rotating in an academic, urban children's hospital PED, the rate of patients seen per hour over the course of their rotation was calculated using an electronic tracking system, EmSTAT, for calendar year 2000. Rates are reported as the mean number of patients seen per resident hour worked. Mean differences are reported for resident subspecialties (emergency medicine, pediatrics, and family practice) and postgraduate year …

Dealing With A Terrorist Attack: A University Hospital Perspective, Muhammad Shahid, Rifat Rehmani, Muhammad Saleem Khan

Department of Emergency Medicine

No abstract provided.

The Feasibility Of The Advanced Practice Paramedic., Anthony John Paquette

UCHC Graduate School Masters Theses 2003 - 2010

No abstract provided.

Ponderal Index, Jabeen Fayyaz

Department of Emergency Medicine

No abstract provided.

Emergency Physicians' Practices And Attitudes Regarding Procedural Anaesthesia For Nasogastric Tube Insertion., G A. Juhl, Gregory P. Conners

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To determine practice and attitudes of emergency physicians regarding procedural anaesthesia for nasogastric tube insertion (NGT).

METHODS: Survey of resident/attending emergency physicians working in a tertiary care medical centre.

RESULTS: Of 68 physicians, 46 responded: 98% believed that awake and alert patients find NGT insertion uncomfortable/painful; 93% used measures to reduce this, most commonly lubricant gel, topical anaesthetic spray, lidocaine gel, and distraction/use of a child life worker; 28% believed these provided adequate pain control and 37% believed they were inadequate. Topical anaesthetic spray, lidocaine gel, and nebulised/atomised anaesthetics were believed the most practical to administer and 44% actually …

Non-Traumatic Aortic Emergencies - Experience From A Tertiary Care Centre In, Nadeem Khan Ullah Khan, Junaid A. Razzak, Hasanat Sharif, Saqib Hamid Qazi

Department of Emergency Medicine

Objective: To review the incidence, clinical presentation and outcome of Non traumatic Aortic emergencies in a tertiary care hospital and its evaluation in the Emergency department (ED).
Methods: We conducted a retrospective review of cases presented to the ED at Aga Khan University Hospital during 15 year period (1988 - 2002) who had final diagnosis of Aortic Dissection or Ruptured Aortic Aneurysm. Patients without confirmatory investigations were excluded. We aimed at looking for the incidence, clinical presentation, evaluation in the ED and final outcome.
Results: Of the 12 cases, 7 had aortic dissection while the remaining 5 had ruptured aortic …

Disaster Drill At A University Hospital, Rifat Rehmani

Department of Emergency Medicine

The course of a disaster drill held on 23 October 2001 at Aga Khan University, Karachi is reported. The Hospital Emergency Plan was put to trial on that day. Volunteers were invited to become simulated casualties in the drill. Briefing seminars had been conducted with the key players of the hospital. The scenario was a man-made type disaster. A 747 jumbo jet with 200 passengers had crashed at the end of the runway at Quaid-e-Azam International Airport while taking off in a thunderstorm. Fifty casualties were sent to Emergency Room by ambulance. The Plan was activated and relevant units were …

Identifying Inaccuracies On Emergency Medicine Residency Applications., Eric D Katz, Lee Shockley, Lawrence Kass, David Howes, Janis P Tupesis, Christopher Weaver, Osman R Sayan, Victoria Hogan, Jason Begue, Diamond Vrocher, Jackie Frazer, Timothy Evans, Gene Hern, Ralph Riviello, Antonio Rivera, Keith Kinoshita, Edward Ferguson

Department of Emergency Medicine Faculty Papers

BACKGROUND: Previous trials have showed a 10-30% rate of inaccuracies on applications to individual residency programs. No studies have attempted to corroborate this on a national level. Attempts by residency programs to diminish the frequency of inaccuracies on applications have not been reported. We seek to clarify the national incidence of inaccuracies on applications to emergency medicine residency programs. METHODS: This is a multi-center, single-blinded, randomized, cohort study of all applicants from LCME accredited schools to involved EM residency programs. Applications were randomly selected to investigate claims of AOA election, advanced degrees and publications. Errors were reported to applicants' deans …

An Emergency Department Staff Tackles The Healthy Workplace Initiative : A Staff Nurse Perspective., Paul Clark

Faculty and Staff Scholarship

This article describes the Healthy Workplace Initiative in the adult emergency department from the staff nurse perspective. Examples of one action planning team's processes and outcomes are delineated. The Rapid Diagnostics action planning team is delineated as lived while caring for patients in today's high-pressure emergency department. The Healthy Workplace Initiative empowers staff, with the guidance of facilitators, to make changes that improve the workplace and to create a healthy workplace for staff and patients. The result is greater staff ownership of the emergency department which leads to greater job satisfaction and improved patient care.

Long-Term Correction Of Ornithine Transcarbamylase Deficiency By Wpre-Mediated Overexpression Using A Helper-Dependent Adenovirus, Asad Mian, W. Michael Mccormack Jr, Viraj Mane, Soledad Kleppe, Philip Ng, Milton Finegold, William E. O'Brien, John R. Rodgers, Arthur L. Beaude, Brendan Lee

Department of Emergency Medicine

The urea cycle disorders (UCDs) are important models for developing gene replacement therapy for liver diseases. Long-term correction of the most common UCD, ornithine transcarbamylase (OTC) deficiency, has yet to be achieved in clinical or preclinical settings. The single human clinical trial using early-generation adenovirus (Ad) failed to show any biochemical correction. In adult OTC-deficient mice, an E1/E2-deleted Ad vector expressing the mouse OTC gene, but not the human, was only transiently therapeutic. By using post-transcriptional overexpression in the context of the less immunogenic helper-dependent adenoviral vector, we achieved metabolic correction of adult OTC-deficient mice for >6 months. Demonstrating this …

Orbital Cellulitis Masquerading As Cavernous Sinus Thrombosis: A Case Report, M. R. Shaikh, Syed Muhammad Baqir, N. Zakir

Department of Emergency Medicine

No abstract provided.

Emergency Medicine: A Relatively New Specialty, Rifat Rehmani

Department of Emergency Medicine

No abstract provided.

Emergency Section And Overcrowding In A University Hospital Of Karachi, Pakistan, R Rehmani

Department of Emergency Medicine

Objective: To quantify the extent of Emergency Section overcrowding at a tertiary care hospital and to identify possible solutions.Methods: This was a retrospective chart review of all the patients presented to the Aga Khan University Hospital's (AKUH) Emergency Section (ES). The ES information system has an automatic patient log and generates daily report for patients who stay longer than 6 hours. The charts of all patients who stayed longer than 6 hours were reviewed.Results: Among 9630 patients, 1999 (20.8%) were held in the ES for more than 6 hours. Of those 134 (6.7%) were discharged from the ES, while 1535 …

Ua61/6 Newsletter Issue 3, Wku Institute For Rural Health Development & Research

WKU Administration Documents

Newsletter created by and about the Institute for Rural Health Development & Research. This issue contains:

• Senator Mitch McConnell Earmarks Dollars for WKU Hispanic Initiative
• Dr. Louella Fong Directs Bilingual Program
• Give Kids a Smile Brightens Children’s Day – Dental Hygiene
• College of Health & Human Services Focuses on Gerontology Demands
• Partners Key to Successful Hispanic Health Fair & Screening Event
• Public Health Department Now Offers Worksite Health Promotion
• KEMSA Offers EMS Management Workshop – Kentucky Emergency Medical Services Academy

Informed Consent For Medical Research: Case Studies, Catherine A. Marco

Emergency Medicine Faculty Publications

Informed consent for medical research is an essential, but challenging, process to assure the protection of the rights of potential research subjects. Numerous barriers to the informed consent process exist among patients, including impaired decisional capacity, impaired cognition, language barriers, illiteracy, insufficient time and communication, and numerous others. Because of the inherent vulnerability of patients, particular attention should be paid to addressing barriers to adequate informed consent, and steps should be taken to ensure adequate delivery of information, understanding of the study and its risks and benefits, and voluntariness of the informed consent.

Ua61/6 Newsletter, Issue 2, Wku Institute For Rural Health Development & Research

WKU Administration Documents

Newsletter created by and about the Institute for Rural Health Development & Research. This issue contains:

• College of Health & Human Services Has New Dean – John Bonaguro
• Simpson, Staci. Institute Aims to Improve Oral Health of Children
• Whitfield, Beth. WKU Mobile Unit KICS Off Dental Event with Webster County – Kentucky Interdisciplinary Community Screening
• Stone, Glynda. TEACH KY: Teachers Exploring & Advocating Careers in Health in Kentucky
• Institute Sponsors Hispanic Health Fair
• HIV Prevention Counseling & Testing Training Program Initiated at WKU
• New Web-based Course Offered Through Communications Disorders Department at WKU
• Lashley, Donita. Child Passenger Safety Training
• Handy, …

Ua61/6 Newsletter, Issue 1, Wku Institute For Rural Development

WKU Administration Documents

Newsletter created by and about the Institute for Rural Development. This issue contents:

• Mobile Health & Wellness Unit
• The New Hazard & Emergency Awareness Training (HEAT) Mobile Unit Arrives at WKU
• Gardner, Marilyn. Emergency Medical Services Monograph Coming
• A Nursing Student’s Perspective
• Enhancing Rural Student Postsecondary Decisions
• Lu, Ning & Richard Wilson. Kentuckian Socioecomic Status, Health Behavior, Access to Medical Care, & Health Status
• Austin, Lynn. School-based Dental Sealant Program
• The Institute for Rural Health Development & Research

Utilization Of Emergency Policies And Procedures By Division I-A And Division I-Aa Intercollegiate Athletic Programs, Brandy A. Petty

Theses, Dissertations and Capstones

The need for an established emergency policy and procedures plan in the college and university setting has been confirmed by various organizations such as: National Safety Council (NSC), Federal Emergency Management Agency (FEMA), National Emergency Management Association (NEMA), National Athletic Trainers’ Association (NATA), National Collegiate Athletic Association (NCAA), and the American College of Sports Medicine (ACSM). The duty of these emergency policies and procedures is twofold. The first is to provide immediate care to student-athletes in an emergency situation. The second purpose is to avoid liability issues that may arise following an emergency situation. The premise behind the establishment and …

District Hospital Based Injury Data-Are They An Option In A Developing Country?, Junaid Abdul Razzak, David Marsh, S. Stansfield

Department of Emergency Medicine

No abstract provided.

Typical Symptoms Are Predictive Of Acute Coronary Syndromes In Women, Kerry A. Milner, Marjorie Funk, Amy L. Arnold, Viola Vaccarino

Nursing Faculty Publications

Background: Previous research suggests that the presentation of acute coronary syndromes (ACS) may differ in women and men. No study has prospectively evaluated the role of a comprehensive set of typical and atypical symptoms and whether different symptoms on presentation predict ACS diagnosis in women and men. Methods and Results: We directly observed 246 women and 276 men seen in the emergency department with symptoms suggestive of ACS and documented their symptoms verbatim. ACS was eventually diagnosed in 89 (36%) women and 124 (45%) men on the basis of standard electrocardiogram and cardiac enzyme criteria. Presence of typical symptoms (chest …

Retrospective Analysis Of Youth Evaluated For Suicide Attempt Or Suicidal Ideation In An Emergency Room Setting, Julie Hagedorn, Hatim A. Omar

Pediatrics Faculty Publications

Suicide is the third leading cause of death in adolescents and a major contributor to morbidity in this age group. The objective of this study was to look at the demographics, major stressors and factors leading to attempting suicide as well as the methods of attempted suicide in adolescents admitted to two hospitals in a medium size city. Medical records were reviewed of adolescents admitted to two area hospitals for attempted suicide between 7/1/97-12/31/99. Coroner's data on completed suicide were also reviewed. In the study period a total of 287 persons aged 21 years or under were admitted for attempted …

Predicting Work Stress Burnout In Rural And Urban Emergency Medical Technicians Through The Use Of Early Recollections, Susan M. Vettor

Dissertations

Problem . Literature on work-stress burnout among emergency medical technicians (EMTs) suggests that they have maintained the same levels of burnout and attrition rates for the past 20 years. The purpose of this study was to investigate the relationship between early recollections and burnout in EMTs working in urban and rural locations.

Method . A demographic questionnaire, the Staff Burnout Scale for Health Professionals (SBS-HP), and two early recollections, were used to survey 120 emergency medical technicians in Toronto, Ontario and Mojave County, Arizona to assess their level of burnout and to identify various themes in early recollections.

Results . …

Asymmetrical Response Of P38 Kinase Activation To Volume Changes In Primary Rat Astrocytes, Dazhong Xu, Ling Wang, James E. Olson, Luo Lu

Emergency Medicine Faculty Publications

Activation of p38 kinase by osmotic stress has been documented in many cells; however, no report has distinguished the effects of cell volume on p38 activity from the effects of the altered osmotic condition per se. Here we report asymmetrical activation of astrocyte p38 mitogen-activated protein (MAP) kinase in response to volume increases and volume decreases. We separate effects of cell volume changes from the effects of osmotic exposure on p38 activation. Exposure to 400, 500, or 600 mOsm phosphate-buffered saline (PBS) caused cell shrinkage and an osmolality-dependent increase in p38 activity to 175%, 409%, or 518%, respectively, compared with …

Sex And Race Differences In Electrocardiogram Use (The National Hospital Ambulatory Medical Care Survey), Amy L. Arnold, Kerry A. Milner, Viola Vaccarino

Nursing Faculty Publications

There are sex and race differences in many aspects of health care delivery. For example, blacks and women are less likely to receive aspirin and thrombolytic drugs. Blacks and women presenting with chest pain are less likely to be referred for cardiac catheterization. Blacks and women diagnosed with acute myocardial infarction (AMI) are also less likely to undergo cardiac catheterization. The gender differences in diagnostic evaluation after AMI appear more pronounced among younger women. The American College of Cardiology and the American Heart Association joint electrocardiography guidelines state that all patients presenting to the emergency department (ED) with chest pain …

Presentation And Symptom Predictors Of Coronary Heart Disease In Patients With And Without Diabetes, Marjorie Funk, Janice B. Naum, Kerry A. Milner, Deborah Chyun

Nursing Faculty Publications

The aims of this prospective, observational study were to compare: (1) symptom presentation of coronary heart disease (CHD) between patients with and without diabetes and (2) symptom predictors of CHD in patients with and without diabetes. We directly observed 528 patients with symptoms suggestive of CHD as they presented to the ED of a 900-bed cardiac referral center in the northeastern United States. There were no significant differences in symptom presentation of CHD between patients with and without diabetes, although patients with diabetes were slightly more likely to present with shortness of breath (P =.056). Patients with diabetes reported …

Spatial Modeling In Emergency Medical Systems: Analysis Of A Regional Trauma System With Two Centers, Christopher A. Bangs

Dissertations and Theses

The allocation of trauma patients to one of two trauma centers based on multiple criteria presents significant challenges in modeling network-based solutions for Emergency Medical Services (EMS). Capabilities in a desktop Geographic Information Systems (GIS) include spatial analysis and map visualizations that contribute to improved understanding of EMS and the trauma allocation. Using a common desktop GIS application and a statistical analysis application, key spatial and temporal characteristics of both penetrating and blunt trauma are described, and the EMS allocation system is analyzed.

As a sub-group of all emergencies, trauma-system patients represent the most severely injured. Understanding the spatial-temporal distributions …