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Biomedical subjects

A A Ernst

Publications and source records attributed to A A Ernst.

At least 19 recordsLinked to original sources
PubMed2001

A comparison of rural and urban ambulance crashes.

Ambulance crashes are a significant safety issue both to the EMTs and to patients transported in the vehicle. Safety issues are dependent on the environment and may be different in rural and urban settings. Ambulance crashes reported to the State EMS bureau during the years of 1993 to 1997 were evaluated. Counties with >250,000 population were considered urban. State population was 2 million urban and 2.8 million rural. Two investigators determined first if the crash was urban or rural. Outcome information was extracted on the degree of injury, citations given, and information on the ambulance and other vehicle condition. In addition, independent variables of weekend versus weekday, day versus night, posted speed, weather, road condition (wet versus dry), intersections, and use of seat belts were extracted. Results were compared using a 2-tailed Chi-square or Fisher's exact with significance at P <.05. Relative risks and 95% confidence intervals were calculated for each variable. There were a total of 183 Ambulance crashes, 115 urban (19/million pop/yr), and 68 rural (8/million pop/yr). Significantly lower percentage of injury crashes occurred in the urban setting (OR = 0. 49, 95% CI = 0.24 to 0.98) with fewer of these considered "severe" (OR = 0.0, 95% CI = 0.0 to 0.73). Citations were more likely to be issued to the urban ambulance driver (OR = 4.95, 95% CI = 1.09 to 45. 70) and the other urban vehicle driver (OR = 3.65, 95% CI = 1.37 to 11.31). However, the urban ambulance was less likely to be damaged (OR = 0.24, 95% CI = 0.10 to 0.55), disabled (OR = 0.41, 95% CI = 0. 20 to 0.84), or towed (OR = 0.40, 95% CI = 0.20 to 0.83). In the urban setting fewer vehicles were traveling in areas with posted speeds >54 mph (OR = 0.24, 95% CI = 0.06 to 0.78) and nonrestrained people were less likely to be injured (OR = 0.28, 95% CI = 0.06 to 1. 25). For injured persons there was no difference in independent variables in the urban versus rural settings. Although the rate of ambulance injuries was greater in the urban environment, the severity of the injuries was worse in the rural environments where crashes occurred at higher posted speeds. In the rural setting nonrestrained passengers were more likely to be injured.

Accidents, Traffic↗
PubMed2001

Use, understanding, and beliefs about complementary and alternative medicines among emergency department patients.

OBJECTIVES: To describe the extent of complementary and alternative medicine (CAM) use among emergency department (ED) patients, to evaluate patients' understanding of CAMs, and to determine gender differences in beliefs about CAMs. METHODS: This study was a convenience sampling of patients seen in an urban ED. Patient demographics were recorded. A questionnaire was administered that assessed patients' knowledge and use of CAMs. Patients were also asked about their beliefs on safety, medication interactions, and conveying information about these substances to their physicians. RESULTS: A total of 350 ED patients were included in the study; 87% had heard of at least one of the CAMs. There was no difference between genders or races concerning knowledge about CAMs. The most commonly known CAMs were ginseng (75%), ginkgo biloba (55%), eucalyptus (58%), and St. John's wort (57%). Forty-three percent of the responders had used CAMs at some time and 24% were presently using CAMs. The most commonly used CAMs were ginseng (13%), St. John's wort (6%), and ginkgo biloba (9%). All CAMs were considered to be safe by 16% of the patients. Only 67% would tell their doctors they were using CAMs. Females were more likely than males to believe that CAMs do not interact with other medications (15% vs 7%, difference 8%, 95% CI = 2% to 15%). CONCLUSIONS: Complementary and alternative medicines are familiar to most patients and used by many of them. Despite this, a large percentage of patients would not tell their physicians about their use of alternative medications. Emergency medicine providers should be aware of the commonly used CAMs, and questions about their use should be routinely included in ED exams.

Adult↗
PubMed2000

The effect of prior hypothermia on the physiological response to norepinephrine.

OBJECTIVE: this study determines the effect of prior hypothermia on the cardiovascular responses to norepinephrine (NE) after rewarming. METHODS: the experiment was a 2x2 controlled design with four groups of feline animals. The two variables were the presence or absence of previous cooling, and the use or non-use of NE after rewarming. During the 'cooling' phase, animals were either cooled using an external arterial-venous femoral shunt to 30 degrees C or maintained at 37 degrees C. After 'rewarming' animals were stratified to receive either NE at rates to deliver 0.2, 1.0 or 5 microg/kg per h or normal saline infusions. Animals were instrumented to measure mean arterial pressure (MAP) and cardiac output (CO) and systemic vascular resistance (SVR) was calculated. RESULTS: there were no differences between groups at baseline and low dose NE (0.2 microg/kg per min). At 1.0 microg/kg per min, NE caused a significant increase in CO (P<0.01) and no effect of MAP or SVR in the rewarmed animals when compared with normothermic controls. In rewarmed animals 5.0 microg/kg per min NE caused a significant increase in CO (P<0.01) and no effect on MAP or SVR. In normothermic controls there was a significant increase in SVR (P=0.02) and MAP (P=0.05) and no effect on CO. CONCLUSION: this study shows that the effect of prior hypothermia on cardiovascular responses to moderate and high doses of NE is an improved CO with no affect on SVR and MAP. This could alter the clinical utility of NE in this situation.

Animals↗
PubMed2000

EMT domestic violence knowledge and the results of an educational intervention.

The objective of this study was to determine levels of knowledge regarding domestic violence (DV), and the effectiveness of formal instruction about DV. A general knowledge survey of DV was given before and approximately 4 to 6 months after 3 hours of instruction given by Emergency Medicine and Law Enforcement faculty. A Emergency medical service (EMS) consisting of 73% paramedic-level providers in a metropolitan urban/suburban area. Differences in DV knowledge before and after the instruction were the main outcome measures. In the preinstruction series, 46 emergency medical technicians (EMTs) participated. After the instruction 19 EMTs participated (42%). Thirty-five percent of EMTs before instruction and 37% after instruction correctly identified the prevalence of DV against women as 15% to 30%. Thirty-five percent of EMTs before instruction and 63% after instruction (P < .05) correctly identified the prevalence of DV against men as 0% to 15%. Before instruction 54% knew that DV is equal among races, and 79% after instruction (P < .05). Before instruction 37% of EMTs knew that DV is equal in different socioeconomic groups and 68% after instruction (P < .05). The percent of EMTs who knew that the victim is not responsible for the abuse was 50% before instruction and 89% after instruction (P < .05). Before instruction, the results on a knowledge questionnaire were 54% correct, after instruction, results improved to 71% correct. Improvement in understanding of DV was shown for 4 of 11 questions after 3 hours of instruction. These results indicate the need for more instruction on DV for EMTs.

Adult↗
PubMed2000

Gender differences in state-wide EMS transports.

There are gender differences in emergency medical services (EMS) transports and management based on diagnosis. Data were extracted from the EMS State Ambulance Transport database. This database exists because of a legal requirement that all EMS transports generated by 911 calls and all interhospital transports be reported to the State EMS Bureau. All ambulance transports reported to the State EMS Division during 1995 were evaluated. Cases were excluded if they were aborted, admission or discharge transports, outpatient transports, or cases listed as "other" without a diagnosis. Gender-related treatment differences were determined for problems for which EMTs have specific treatment options. These were cardiac arrest, chest pain, allergic reactions, and extremity fractures. Results were compared using a two-tailed Chi squared or Fischer's Exact with significance at P < .05. Odds Ratios (OR) and 95% confidence intervals (CIs) were calculated. There were a total of 164,595 ambulance transports reported to the State EMS Division. Of these 76,074 (46%) were men and 88,521 (54%) were women. Of these, 50,211 were excluded. This left 52,607 injury transport and 61,777 illnesses transport. Men were significantly more likely than women to have injuries related to all-terrain vehicle accidents, motorcycle accidents, RV accidents, burns, gunshot wounds, and stab wounds. Men were significantly more likely than women to have illnesses related to cardiac arrest, dead on arrivals (DOAs), drowning, and smoke inhalation. For cardiac arrest transports, significantly more male patients presented ventricular fibrillation, more males received defibrillation, lidocaine, and bicarbonate, but more women received atropine. Male chest pain patients were more likely to receive oxygen and morphine and less likely to receive nitroglycerin. Male allergic reaction patients were more likely to receive an i.v. and subcutaneous epinephrine. Male extremity fracture patients were more likely to get an i.v. line, but there was no difference in morphine use or splinting. There are numerous disease-specific gender differences in the demographics of illness and injury transported by EMS. The use of various medications and procedures may also be related to gender. Understanding these differences may help in preparing EMS professionals for patient management.

Blood Pressure↗
PubMed2000

The utility of anoscopy and colposcopy in the evaluation of male sexual assault victims.

STUDY OBJECTIVE: We sought to compare the use of anoscopy and colposcopy in examinations of male sexual assault victims and to characterize the demographics of male sexual assault victims. METHODS: This is a case series of 67 male sexual assault victims evaluated over an 8-year period by the Sexual Assault Forensic Examination team. The setting is a university-based emergency department serving as the primary site for examination of sexual assault victims by trained nurse practitioners and physician's assistants. Police and victims' advocates are available at the time of the examination. Anoscopy was done routinely over the entire study period in all patients with any anal penetration or involvement. Colposcopy use started in 1994 to magnify and take pictures. Patients were categorized into 2 groups. Group 1 consisted of subjects receiving only anoscopy, and group 2 consisted of subjects receiving initial colposcopy. Anoscopy in group 1 and colposcopy in group 2 were compared for positive results. A positive result was defined as an additional finding to those obtained by means of gross examination by using the test being evaluated (anoscopy versus colposcopy). Colposcopy and anoscopy were also compared among the subjects receiving both tests. Groups were compared by using a Pearson chi(2) test. RESULTS: Sixty-seven male sexual assault victims were evaluated between 1991 and 1998. The average age was 26+/-8 years, and the distribution of races was 30% black, 62% white, and 8% Hispanic. Results of gross examination were positive in 42 (63%) subjects. Four patients did not receive either anoscopy or colposcopy. Of the remaining 63, 25 patients had anoscopy only (group 1), and 38 patients had initial colposcopy (group 2). There were no significant differences in age, race, or rate of positive gross examination results between groups. Findings in addition to those obtained by means of gross examination were revealed by means of anoscopy in 8 (32%) of 25 subjects in group 1 and colposcopy in 3 (8%) of 38 subjects in group 2 (P =.03, difference 24%, 95% confidence interval 4% to 44%). In the 36 subjects who had both examinations, the gross examination revealed at least one finding in 22 (61%). The combination of anoscopy and colposcopy yielded positive findings in 17 subjects, including 4 subjects who had no findings on gross examination (increasing the positive rate to 26/36 [72%]). CONCLUSION: In male sexual assault victims with anal penetration, anoscopy is significantly better for gathering evidence than is colposcopy. The addition of colposcopy and anoscopy increased the rate of cases with positive findings from 61% to 72%. These 2 methods together may be a valuable adjunct in gathering evidence of damage.

Adolescent↗
PubMed2000

Breast cancer knowledge and preventive behaviors: An urban emergency department-based survey.

OBJECTIVE: To assess general knowledge and preventive behaviors regarding breast cancer among women who present to an urban emergency department. METHODS: During a six-month study period, a convenience sampling of women aged 21 years and older who were in treatment and waiting areas was surveyed. The anonymous written survey asked about demographic variables, knowledge, and preventive behaviors regarding breast cancer. Knowledge was assessed with questions about the recommended frequency of breast self-examination and the recommended age for first mammography. Performance was assessed by questions about breast self-exam and mammography. Subgroup analysis was done by age (above and below 40 years old), race, income (above and below the median), insurance type, history of breast lump, and family history (FH) of breast cancer. RESULTS: Four hundred women completed surveys. Two hundred twelve (53%) correctly knew the answers to the two knowledge questions. Knowledge was greater in women with private insurance. Knowledge of the frequency of breast self-exam was significantly greater among whites and Native Americans than among African Americans, Asians, or Hispanics. Stated performance of preventive behaviors was 72% (288) for breast self-exam and for mammography. Preventive behaviors were significantly more likely to be performed by higher-income and privately-insured women. Breast self-exam was more likely to be done in older women, those with a history of a breast lump, and those with a FH of breast cancer. CONCLUSIONS: Women with lower income and without private insurance were less likely to be knowledgeable and practice preventive measures for detecting breast disease.

Adult↗
PubMed2000

Domestic violence in a university emergency department.

BACKGROUND: We attempted to determine the prevalence and demographics of domestic violence (DV) among male and female patients in a university emergency department (ED). METHODS: The validated Index of Spouse Abuse (ISA) was used. Patients aged 18 years or older seen during 28 randomly selected 4-hour shifts were eligible. RESULTS: Of the 97 participants in the study, 57 were female. One man and 3 women were victims of present physical DV, with 1 male and 2 female victims of present nonphysical abuse. Three of the 40 men and 22 of the 57 women had been victims of past physical violence. One man and 15 women had been victims of past nonphysical abuse. Alcohol use, suicidal ideation, family history, and psychiatric history were all strongly correlated with DV. CONCLUSIONS: The prevalence of DV past was significantly higher in the females. Present violence was more rare and less than that reported in other ED studies.

Adult↗
PubMed2000

Blood pressure in acute vaso-occlusive crises of sickle cell disease.

OBJECTIVE: We compared blood pressure (BP) in patients with sickle cell disease (SCD)-related crises and black patients without SCD. METHODS: We retrospectively reviewed charts of emergency department (ED) patients with SCD crises in a 2-year period, recording BPs and demographic and SCD data. A cohort of consecutive black patients without SCD was compared. RESULTS: Included were 459 SCD-related visits, 187 by men and 272 by women, representing 106 patients. Women had significantly lower BP than men, diastolic BP was significantly lower in patients with hemoglobin SS disease than in those with hemoglobin SC disease, and systolic BP was significantly lower in patients with bilateral versus unilateral pain. One SCD patient had a history of hypertension. The 125 non-SCD patients, excluding 25 with a history of hypertension, had significantly higher systolic and diastolic BP than patients in SCD crisis. CONCLUSION: No patients seen in SCD crisis were hypertensive. Patients who were female, had SS disease, or had bilateral pain had lower BP. Significantly higher BP and more hypertension occurred in black patients without SCD.

Acute Disease↗
PubMed2000

Domestic violence awareness in a medical school class: 2-year follow-up.

BACKGROUND: [corrected] Previous studies have examined short-term effectiveness of domestic violence instruction. We studied the long-term effectiveness (LTE) and long-term retention (LTR) of formal instruction about domestic violence. METHODS: A general knowledge survey on domestic violence was given before, 1 month after, and 2 years after 3 hours of instruction to medical students. Good LTE was defined as significant improvement in responses between the first and third surveys. Good LTR was defined as lack of a significant decrease in results between the second and third surveys. RESULTS: Two years after the instruction, 104 of 148 (70%) participated. Knowledge of rates of domestic violence against women showed neither good LTE nor good LTR. Responses showed good LTE and LTR concerning domestic violence incidence among men, ethnic and socioeconomic groups being equally represented, victims not being personally responsible for the abuse, and physicians not being required to report domestic violence in the survey state. Responses showed poor LTR and LTE regarding rates of domestic violence in women and abused persons being unable to simply leave their situation. CONCLUSIONS: Some improvement in domestic violence awareness was seen 2 years after instruction. However, some information was not retained. Domestic violence instruction should be reemphasized throughout medical school.

Adult↗
PubMed1999

Warmed versus room temperature saline solution for ear irrigation: a randomized clinical trial.

STUDY OBJECTIVE: To test the hypothesis that ear irrigation with warmed normal saline solution is more comfortable and results in fewer side effects than irrigation with room temperature saline solution in normal volunteers. METHODS: The study was a randomized, single-blind, crossover trial in which each subject received 30 mL warmed normal saline solution in 1 ear and 30 mL room temperature saline solution in the opposite ear. The solutions (warmed versus room temperature) and the order of irrigation (right versus left ear) were separately randomized. Investigators obtaining scores were blinded to solution temperature. Subjects rated the discomfort of irrigation, using separate visual analog scales, from 0 (no pain) to 100 mm (worst pain ever). RESULTS: Forty volunteers were enrolled in the study. The mean difference in visual analog scale scores favoring warmed over room temperature saline solution was 26 mm (95% confidence interval [CI], 19 to 33 mm; P <.0001). Twenty percent more patients reported dizziness with room temperature irrigation (95% CI, 6% to 34%). There was no gender effect or order effect for the 2 solutions. CONCLUSION: Warmed normal saline solution was both clinically and statistically more comfortable than room temperature saline solution as an ear irrigant in normal volunteers. Significantly less dizziness was reported with the warmed solution.

Adult↗
PubMed1999

Usefulness of the blood urea nitrogen/creatinine ratio in gastrointestinal bleeding.

This study was conducted to evaluate the blood urea nitrogen/creatinine (BUN/Cr) ratio for distinguishing an upper versus lower source of gastrointestinal (GI) bleeding. Charts of patients who presented to the emergency department (ED) with the diagnosis of GI bleeding from August 1995 to August 1996 were retrospectively reviewed for source of bleeding, initial BUN, Cr, BUN/Cr ratio, hematocrit (Hct), and need for transfusion. A total of 124 patients were eligible for inclusion, 71 (57%) of whom were male. A total of 63 (51%) presented with blood in stool and 53 (43%) with bloody emesis; 8 (6%) had blood in both emesis and stool. A total of 31 (25%) patients had a lower GI bleed, 88 (70%) had an upper, and 5 (4%) had both upper and lower bleeding sources. The mean BUN level was 24 mg/dL, the mean Cr level 1.03 mg/dL, and the mean BUN/Cr ratio was 24. The mean hemoglobin (Hb) level was 11.3 g/dL, the mean Hct was 32 g/dL, and 51% required transfusion. Upper GI bleeding was significantly correlated with age younger than 50 (P = .01) and male gender (P = .01; odds ratio, 3.13). Taking into account age and gender, the BUN/Cr ratio correlated significantly with an upper GI source of bleeding (P = .03), with a ratio greater than 36 having a sensitivity of 90% and a specificity of 27%. The area under the receiver operating characteristic curve using age, gender, and BUN/Cr ratio was .73 (95% confidence interval, .62 to .84).

Age Distribution↗
PubMed1998

Warmed versus room temperature saline solution for ocular irrigation: a randomized clinical trial.

STUDY OBJECTIVE: To test the hypothesis that ocular irrigation with warm saline solution is more comfortable than irrigation with room temperature saline solution in normal volunteers. METHODS: The study was a randomized, single-blind crossover trial, in which each subject received 30 mL warmed and 30 mL room temperature saline solution in opposite eyes. The solutions (warmed versus room temperature) and the order of irrigation (right eye versus left) were separately randomized. Physicians were blinded to solution temperature. Subjects rated the discomfort of irrigation on separate visual analog scales (VAS). The study had 80% power to detect at least a 12-mm difference in VAS readings. RESULTS: Thirty-five volunteers were enrolled in the study. There was no gender effect or order effect for the 2 solutions. The mean VAS score for warmed saline solution was 15 mm+/-15 mm (SD). The mean VAS score for room temperature saline was 34 mm+/-24 mm (SD), (95% confidence interval for difference of 19 mm [10 mm to 28 mm], P <.0001, Wilcoxon signed rank test). CONCLUSION: Warmed saline solution was both clinically and statistically more comfortable than room temperature saline solution as an ocular irrigant among normal volunteers.

Adult↗
PubMed1998

The physiological response to norepinephrine during hypothermia and rewarming.

Our purpose was to determine if core hypothermia influences physiological responses to norepinephrine (NE); and if rewarming reverses these effects. Animals were instrumented to measure mean arterial pressure (MAP) and cardiac output (CO). Core temperature was manipulated from 37.5 degrees C (normothermia), to 30 degrees C (hypothermia) and the back to 37.5 degrees C (rewarming) using an external arterial-venous femoral shunt. At each of these temperatures, baseline CO and MAP were measured. Norepinephrine (NE) was infused at rates to deliver 0.2, 1.0, or 5 microg kg(-1) per h. At each dose CO and MAP was measured again. Systemic vascular resistance (SVR) was calculated using the formula (SVR = (MAP/CO) x 80). Eight animals underwent all three phases of the protocol. The response to NE during normothermia was a significant increase in MAP to doses of 1 microg kg(-1) per min (P < 0.01) and 5 microg kg(-1) per min (P < 0.01) and SVR to doses of 1 microg kg(-1) per min (P < 0.01) and 5 microg kg(-1) per min (P < 0.01). The response to NE during hypothermia was a significant increase in MAP only at doses of 1 microg kg(-1) per min (P = 0.03) and 5 microg kg(-1) per min (P = 0.01). The response to NE after rewarming was a significant increase in MAP only at a dose of 5 microg kg(-1) per min (P = 0.03). This study shows that core hypothermia causes a change in physiological response to NE that rewarming does not reverse.

Adrenergic alpha-Agonists↗