Showing papers by "Lincoln Hospital published in 2000"

A preliminary evaluation of emergency ultrasound in the setting of an emergency medicine training program.

Abstract: In this article we seek to evaluate the diagnostic accuracy of emergency physicians performing emergency ultrasonography in the setting of an emergency medicine training program. A prospective observational study was performed at an inner city Level I trauma center with an emergency medicine residency training program. From July 1994 to December 1996 a convenience sample of ultrasound exams was recorded. The diagnostic quality (“acceptable or technically limited”) was determined by a board-certified cardiologist or radiologist with fellowship training in ultrasonography. The emergency department interpretations were then compared to those of the blinded cardiologist or radiologist. Four hundred and fifty-six ultrasound examinations were videotaped and entered into the study; 408 (89%) of the studies performed were determined to be “acceptable.” The diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of these studies were as follows: cardiac, to rule out effusion (n = 67; 0.83, 0.98, 0.88, 0.98); transbdominal, to rule out abdominal aortic aneurysms (AAA), cholelithiasis, or free peritoneal fluid (n = 263; 0.91, 0.89, 0.88, 0.92); renal, to rule out hydronephrosis (n = 45; 0.94, 0.96, 0.94, 0.96); pelvic, to rule in intrauterine pregnancy (n = 33; 1.0, 0.90, 0.96, 1.0). The 48 “technically limited studies” included: 39 transabdominal (33 gallbladder, 1 abdominal aortic aneurysm, 5 free peritoneal fluid), 6 cardiac, 2 renal, and 1 pelvic ultrasound. This study suggests that emergency physicians with a minimal amount of training display acceptable technical skill and interpretive acumen in their approach to emergency ultrasonography.

Abnormal signal-averaged electrocardiogram (SAECG) in obesity

Abstract: Objective: The occurrence of small high-frequency electrocardiogram (ECG) potentials (1 to 20 μV) seen at the end of the QRS complex and into the ST segment have been correlated with increased risk for ventricular arrhythmias and sudden cardiac death. Computer-assisted analysis of these “late potentials” by signal-averaged electrocardiography (SAECG) has been studied and utilized to predict the likelihood of ventricular arrhythmias in various clinical states. Obesity is associated with significant cardiovascular morbidity and sudden death. Ventricular arrhythmias are postulated causes. We studied the occurrence of late potentials in a randomly selected group of obese patients and healthy volunteers. Research Methods and Procedures: We performed SAECG on 105 subjects. Of these, 62 were obese ambulatory patients with body mass index (BMI) of >30 kg/m2, whereas 43 were healthy asymptomatic volunteers with a BMI of 114 ms, high-frequency low amplitude >38 ms, and root-mean-square voltage <20 μV. Patients were divided into four subgroups based on BMI values. The prevalence of SAECG abnormalities in each BMI subgroup was studied. We utilized multiple logistic regression analysis to study the effect of obesity, hypertension, and diabetes mellitus on abnormal SAECG results. Results: Compared to age- and sex-matched healthy volunteers with BMI of 30 kg/m2 had significantly more abnormalities on SAECG (4.6% vs. 55%). In the obese group, the prevalence and number of abnormalities increased with increase in BMI (35% in the BMI 31 to 40 kg/m2 subgroup, 86% in the BMI 41 to 50 kg/m2 subgroup, and 100% in patients with BMI of >50 kg/m2). Multiple logistic regression analysis shows that BMI is an independent predictor variable of abnormal SAECG results in obese patients (n = 62) with BMI of >30kg/m2 as well as in all study subjects (n = 105). BMI also predicts abnormality of each abnormal SAECG criterion in both obese and all subjects. Hypertension was found to influence the QRS duration alone in obese and all subjects. Discussion: Obesity is associated with increased occurrence of abnormal SAECG results. These abnormalities are found both in obese patients with and without hypertension and/or diabetes. Obesity is an independent predictor variable of abnormal SAECG results. A history of hypertension predicts abnormality of QRS duration only.

Abdominal pain secondary to stump appendicitis in a child.

Abstract: We report a case of an 11-year-old male who presented with abdominal pain and vomiting. The patient had a notable past medical history of having had an appendectomy at our institution 1 year previously. Because of progressive clinical signs of peritonitis, an exploratory laparotomy was performed and the patient was found to have stump appendicitis. The entity of stump appendicitis is always possible when evaluating patients with abdominal pain who have a history of appendectomy.

C-spine injury associated with gunshot wounds to the head: retrospective study and literature review.

Abstract: Objective To determine the incidence of C-spine injury (CSI) associated with gunshot wounds (GSWs) to the head Methods A retrospective chart review including patients with GSWs to the head and excluding those with penetrating facial/neck trauma was performed Cervical clearance was by clinical/radiologic criteria in survivors, and autopsy in nonsurvivors A MEDLINE literature search was performed and relevant articles reviewed Results One hundred seventy-four charts were available for review; 90 had C-spine radiographs (complete series [49], lateral [33], and computed tomographic scan [8]) Of 84 with no radiographs, 29 were clinically cleared, and 55 died (32 cleared at autopsy) Twenty-three died without evaluation None of the remaining 151 (87%) had CSI Literature search yielded only three relevant articles Combining the data from these articles yielded 534 patients, and CSI was excluded in 507 (95%) Conclusion C-spine immobilization and diagnostic radiography are probably not necessary in patients with isolated GSWs to the head and may complicate and delay emergency airway management

Acute arterial spasm in an extremity caused by inadvertent intra-arterial injection successfully treated in the emergency department.

Abstract: We present a case of limb ischemia in a young man. For acute alcohol withdrawal, this patient was given chlordiazepoxide (Librium) through an angiocatheter inadvertently placed into a brachial arterial line. This caused severe spasm of the brachial artery and its branches. These findings were confirmed by angiography. Successful treatment occurred with intra-arterial papaverin.

Bilateral Tubal Ectopic Pregnancy: A Tale of Caution

Abstract: . Diagnosis of ectopic pregnancy continues to be an important challenge facing emergency physicians. The authors present a case of bilateral tubal ectopic pregnency and discuss its clinical features and diagnositc difficulties. A review of the English-language literature on the subject is discussed. Suggestions are made on ways to increase diagnostic accuracy, reduce complications, and preserve future fertility in this group of patients.