Biomedical subjects

A Sucov

Publications and source records attributed to A Sucov.

7 recordsLinked to original sources

PubMed2000

Implementation of a disease-specific care plan changes clinician behaviors.

The study objective was to determine the impact on quality of care, resource use, and outcomes by developing an emergency department (ED)-based asthma-specific care plan. The design was a time based, prospective cohort and set at an urban university/trauma center, EM residency site, combined adult/pediatric department. Best practice was defined prospectively for ED asthma patients, leading to an asthma care plan (ACP). Triage nurses were instructed to begin use of ACP when patients presented with asthma as the primary complaint. Charts of all patients diagnosed with asthma during 3-month study period were retrospectively reviewed against predefined outcomes. Results were analyzed with chi2 or student's t tests. After ACP introduction, the timeliness of beta agonist treatments (three beta agonist treatments within 90 minutes; 86% versus 63%, P < .05) and ED length of stay (LOS) (3.39 +/- 1.88 hrs versus 3.87 +/- 2.12 hrs, P < .05) improved. After introduction of ACP, only 55% of patients diagnosed with asthma had care documented on the ACP (ACP+ group). ACP+ group had more timely beta agonist treatment (93% versus 74%, P < .01), shorter LOS (3.29 +/- 1.90 vs. 3.53 +/- 1.86 hrs, P < 0.5) more appropriate steroid dosages (67% versus 41%, P < .01), and fewer tests (41% versus 59%, P < .05). No improvements were noted in admission or relapse rates. In conclusion, care plans can improve quality of care and decrease LOS, but may have limited impact on outcomes of admission/discharge or relapse rates.

Adolescent↗

PubMed1995

Heterotopic pregnancy after in vitro fertilization.

Maternal mortality related to ruptured ectopic pregnancy remains elevated. A case is presented of heterotopic pregnancy in a patient whose pregnancy was assisted with in vitro fertilization. The patient's diagnosis was delayed, potentially because of lack of tachycardia associated with the hypotension. The clinical presentation of heterotopic pregnancy is similar to that of ectopic pregnancy. The risk factors for heterotopic pregnancy are the same as those for ectopic pregnancy, with the addition of in vitro fertilization, which increases the risk substantially.

Abdomen, Acute↗

PubMed1995

Ethanol-associated hypoglycemia is uncommon.

OBJECTIVE: To determine the association of ethanol intoxication with hypoglycemia in ED patients. METHODS: Retrospective, laboratory log review of 953 consecutive patients who were evaluated for ethanol intoxication in an urban university hospital ED over a three-month period. Simultaneous serum glucose determination was carried out for each patient and associations between ethanol level and glucose were sought. RESULTS: Glucose concentrations were unavailable for 16 patients (1.7%). Of the remaining patients, 584 patients had detectable ethanol concentrations (ethanol-positive), and 353 had no detectable ethanol (ethanol-negative). Ethanol concentrations (mean +/- SD) in the ethanol-positive group were 50.11 +/- 24.08 mmol/L (231 +/- 111 mg/dL), and glucose concentrations were 5.83 +/- 1.94 mmol/L (105 +/- 35 mg/dL). Hypoglycemia [glucose < 3.72 mmol/L (67 mg/dL)] was observed for five (0.9%) ethanol-positive patients. It was classified as mild-moderate [2.78-3.66 mmol/L (50-66 mg/dL)] for four patients (0.7%) and severe [< 2.78 mmol/L (50 mg/dL)] for one (0.2%). Ethanol concentrations ranged from 25.60 to 68.33 mmol/L (118 to 315 mg/dL). There was no correlation between ethanol and glucose concentrations in any subset of the ethanol-positive patients population. In the ethanol-positive group, patients who had several ethanol-positive visits (56 patients, mean 3.6 visits/patient) accounted for four of the five episodes of hypoglycemia, including the one episode of severe hypoglycemia. The frequency of hypoglycemia in repeat visitors (2.0%) was higher than that in the group of patients without repeat visits (0.2%). In the ethanol-negative group, there were four (1.1%) episodes of mild-moderate hypoglycemia and no severely hypoglycemic patients. Hypoglycemia was not more likely to occur among ethanol-positive patients than it was among ethanol-negative patients. CONCLUSION: Hypoglycemia was uncommonly associated with ethanol intoxication, and was found almost exclusively among patients with several ethanol-positive visits. Glucose and ethanol concentrations do not show any linear correlation; patients with higher ethanol concentrations are not at higher risk of hypoglycemia. Hypoglycemia is not more likely to occur in ethanol-positive than in ethanol-negative patients. Initial glucose screening does not appear to be necessary for all patients suspected of intoxication; selective screening may be more appropriate.

Adult↗

PubMedDate not supplied

Ludwig's angina: case report and review.

Modern dental care and use of antibiotics for oral infections have made Ludwig's angina rare. To avoid acute airway obstruction, emergency physicians must be able to rapidly recognize and treat this condition. A typical case of Ludwig's angina is presented, followed by a review of clinical findings and therapeutic modalities. Emphasis is made on airway management, antibiotics, and surgical drainage.

Acute Disease↗

PubMedDate not supplied

Retrospective denial of emergency department payments is inappropriate.

Third-party payers typically use patients' discharge diagnoses to determine "appropriate" Emergency Department (ED) usage. This analysis compared the resource intensity involved in ED evaluation for "inappropriate" and all other ED visits. In this retrospective database review, 11 discharge diagnoses (DX11) (chronic nasopharyngitis; chronic sinusitis; chronic pharyngitis; rhinitis; constipation; head cold; hemorrhoids; toothache; flu; headache; and tension headache) were identified by a third party payor as being "inappropriate" for ED evaluation. The chief complaints of all patients seen in 1994 and 1995 with one of the DX11 were identified along with their E & M billing level, ED length of stay (LOS), and the frequency of consultation. In this urban, university trauma center, 1994 and 1995 visits totaled 120,402. Eighty-two different chief complaints were associated with a final diagnosis of DX11; 79% of all ED patients presented with one of the chief complaints (AllCC). Four percent of patients with DX11 were admitted, and the AllCC group had comparable resource utilization to the entire ED population. Patients' presenting complaints are incapable of predicting diagnosis or disposition. Retrospective denial of payment by discharge diagnosis is inappropriate.

Emergency Service, Hospital↗

PubMedDate not supplied

Test ordering guidelines can alter ordering patterns in an academic emergency department.

To determine the impact of an educational program designed to modify test ordering behavior in an academic Emergency Department (ED), an observational, before-and-after study was conducted at a university tertiary referral center and Emergency Medicine (EM) residency site. Test ordering standards were developed by EM faculty, RNs, and NPs based upon group consensus and published data. The standards were given to all ED staff beginning February 1996, and included in the evidence-based medicine orientation and educational program for all residents and medical students prior to beginning their rotation. No restrictions were placed on actual test ordering. The number of laboratory tests (total and individual) ordered per 100 patients decreased significantly after the educational program began for: total testing, CBC, and liver function test (LFT). In addition, declines during individual months for these tests were statistically significant. Prothrombin time and blood culture testing showed no significant decreases in test ordering frequency. Chemistry test ordering frequency showed statistically significant increases. Overall, approximately $50,000 was saved by decreasing test ordering. Test ordering behavior can be modified and maintained by an educational program and may have significant economic effects.

Clinical Laboratory Techniques↗

PubMedDate not supplied

Serum ethanol clearance in intoxicated children and adolescents presenting to the ED.

OBJECTIVE: To determine the rate of serum ethanol clearance in 39 children and adolescents who presented intoxicated to one ED. METHODS: All pediatric patients presenting to a university hospital ED, for whom serial ethanol levels had been determined between January 1989 and May 1993, were evaluated. Age, gender, presenting complaint, initial serum glucose concentration, timed serum ethanol concentrations, and rate of serum clearance were determined retrospectively for all the patients. RESULTS: 39 pediatric patients had had serial serum ethanol concentrations determined. The patients ranged in age from 6 weeks to 17 years (mean 14.6 years). Initial serum ethanol levels ranged from 13.7 to 84.2 mmol/L (63-388 mg/dL) and the mean serum ethanol clearance rate was 4.0 mmol/L/hr (18.6 mg/dL/hr), consistent with clearance rates previously reported for adults. CONCLUSION: These data suggest that the rate of serum ethanol clearance in children and adolescents presenting to the ED approaches that previously reported for adults. Clinical diminution of intoxication should not be more rapid for children and adolescents than it is for adults.

Adolescent↗