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Biomedical subjects

C M Slovis

Publications and source records attributed to C M Slovis.

At least 19 recordsLinked to original sources
PubMed2001

Emergency department evaluation of the chest pain patient.

The emergency physician must have a high degree of suspicion for myocardial ischemia in patients presenting with no obvious for their chest pain. The role of the emergency physician is to determine a relative risk for each patient and to order the appropriate studies to minimize the risk of missed myocardial infarction as well as to recognize acute ischemia or infarction and manage it aggressively. It is not possible to rule out myocardial ischemia or infarction subjectively. It is the opinion of these authors that some form of further testing should be performed on patients in all categories, except those determined to be at very low risk.

Adult↗
PubMed2001

Selected controversies in cardiopulmonary resuscitation.

Cardiopulmonary resuscitation (CPR) is performed frequently by paramedics, emergency department personnel, and inpatient physicians. Unfortunately, after more than 40 years of practice and study, there are still many controversies and unresolved treatment issues. This article focuses on four current controversies in CPR: (1) the role of end-tidal CO2 (ETCO2) detection, (2) the use of bicarbonate, (3) whether epinephrine is the optimal alpha agonist, and (4) whether amiodarone should replace lidocaine as the initial antiarrhythmic of choice in the treatment of ventricular fibrillation.

Journal Article↗
PubMed2000

Hypophosphatemia in the emergency department therapeutics.

Although hypophosphatemia is relatively uncommon, it may be seen in anywhere from 20% to 80% of patients who present to the ED with alcoholic emergencies, diabetic ketoacidosis (DKA), and sepsis. Severe hypophosphatemia, as defined by a serum level below 1.0 mg/dL, may cause acute respiratory failure, myocardial depression, or seizures. Because hypophosphatemia is not as often treated by ED physicians, becoming familiar with a single intravenous phosphate solution and specific guidelines for phosphate repletion are essential. One mL of the most commonly available phosphate solution (K2PO4) contains 4.4 meq of potassium and 3 mmol (93 mgs) of phosphate. Administering K2PO4 at a rate of 1 mL per hour is almost always a very safe and appropriate treatment for hypophosphatemia. This article provides guidelines for phosphate therapy in hypophosphatemic ED patients including those in DKA, those presenting with alcohol-related complaints including alcoholic ketoacidosis and patients with acute exacerbation of asthma and chronic obstructive pulmonary disease.

Alcoholism↗
PubMed1999

Anxiety levels in EMS providers: effects of violence and shifts schedules.

We tried to measure anxiety levels in emergency medical service (EMS) providers to determine the effects of (1) having had a violent encounter during a shift and (2) different shift schedules, conducting a prospective observational study over 3 months in an urban EMS system setting. A convenience sample of 23 EMTs and 40 EMT-Ps was observed. Anxiety levels were measured using the Spielberger State-Trait Anxiety Inventory. A total of 99 inventories were completed by 63 EMS providers. The mean state (32.6+/-8) and trait (31.7+/-7.1) scores were less than normative scores (35.7+/-10.4 and 34.9+/-9.2 respectively) for working adult males (P = .004 and .007, respectively). Paramedics had lower anxiety scores than basic EMTs (P = .015 and .039) and years of experience also decreased anxiety scores (P < .0001). There was no significant difference in state scores between those EMS providers who had encountered violence during the preceding 12 hours and those providers who had not. Comparisons of state scores of providers assessed at hour 12 of a 12 hour shift, hour 12 of a 24 hour shift, and hour 24 of a 24 hour shift failed to show any significant differences. Although the working environment of the EMS provider contains numerous stressors and uncertainties, this population of providers were no more anxious than the general working public. Advanced training and years of experience decreased anxiety. Violent encounters during a shift did not appear to affect anxiety levels. There was no difference in anxiety levels in providers who worked 12 and 24 hour shifts.

Adult↗
PubMed1998

Prospective field study of violence in emergency medical services calls.

STUDY OBJECTIVE: To investigate the nature and frequency of violence encountered by EMS personnel. DESIGN: We conducted a prospective, observational case-series study of a city-county EMS system serving a population of 500,000. RESULTS: We analyzed 297 EMS runs over 737 hours of observation. The Overt Aggression Scale (OAS) was used to assess each violent episode. There were 239 (81%) nonviolent runs, 16 (5%) violent runs, and 42 (14%) violent runs that occurred after a violent episode had taken place (postviolent runs). This was a frequency of one violent episode for every four 12-hour shifts, or for every 19 runs. The violent behaviors included verbal aggression solely in 50% (n = 8), physical aggression solely in 13% (n = 2), and both verbal and physical aggression in 38% (n = 6). One episode involved an unsecured weapon. CONCLUSION: These data indicate that violent situations occur in 5% of calls in this EMS system. The fact that an additional 14% of calls are precipitated by the results of violence may influence perceptions by EMS personnel of danger and frequency of exposure to unstable situations. Exposure to violence is underreported in our EMS documentation.

Data Collection↗
PubMed1998

Alcohol on campus: alcohol-related emergencies in undergraduate college students.

OBJECTIVES: We reviewed demographic factors associated with alcohol-related disorders in undergraduates seen in the emergency department (ED) and determined the incidence of alcohol-related ED visits among undergraduates. METHODS: This prospective, observational study was done in a university-affiliated emergency department. Demographic variables and incidence of students with alcohol-related disorders were analyzed. RESULTS: Of the 616 students seen in the ED during 1 academic year, 101 (16%) had an alcohol-related disorder. White students and freshmen were overrepresented. There were equal numbers of male and female students. The overall annual incidence for an alcohol-related visit among undergraduates was 1.7% per academic year. The incidence for freshmen was 2.9%. Four students were admitted; one died of a severe head injury. CONCLUSIONS: We estimate that 1 of every 15 undergraduates at our college comes to our ED with an alcohol-related problem during their 4-year college career. Younger and nonminority students were more commonly seen; there was no difference by sex. Serious outcomes included one death. This study probably underestimates the true incidence of alcohol-related disorders among students on campus.

Adult↗
PubMed1997

Tenure track in emergency medicine.

STUDY OBJECTIVE: Tenure was designed to guarantee academic freedom through lifelong job security. Productive research, especially in the basic sciences, is the main criterion for tenure at most institutions; therefore faculty in more clinically focused specialties may experience more difficulty obtaining tenure. We examined the relationship between academic emergency medicine and tenure. METHODS: We used a questionnaire to survey the directors of all 108 approved US emergency medicine residency programs. The surveyed population was asked whether the program was affiliated with a medical school, the number of full-time faculty, and how many faculty members were tenured or on the tenure track. Follow-up mailings were sent to nonresponders. We also conducted a search of the Association of American Medical Colleges (AAMC) database to compare the number of emergency medicine faculty involved in the tenure process in other specialties. RESULTS: One hundred surveys (93%) were returned. At programs in which faculty were eligible for tenure, 9% (95% confidence interval [CI], 4% to 16%) were tenured and 27% (95% CI, 19% to 37%) were on the tenure track. Therefore only 36% of all EM faculty (95% CI, 27% to 46%) were tenured or on the tenure track. Among the 53 residency programs that offered tenure, 45% (95% CI, 32% to 60%) had no tenured faculty. At programs with academic department status, 74% of chairs were tenured, in contrast to only 32% of chiefs at institutions without academic department status (95% CI for difference of 42%, 14% to 71%). The AAMC survey revealed that about one-third as many emergency medicine faculty members were tenured compared with the other specialties. The proportion of faculty on the tenure track, however, was similar between the specialties. CONCLUSION: Most eligible emergency medicine faculty members are not tenured or on track to become tenured, and fewer emergency medicine faculty are tenured compared with the more traditional specialties. Emergency medicine may be vulnerable to being considered less academic unless its faculty members gain access to the tenure process.

Academic Medical Centers↗
PubMed1997

Attitudes toward the use of a metal detector in an urban emergency department.

STUDY OBJECTIVE: To determine the attitudes of patients, their family and friends, and ED staff toward a walk-through metal detector in the ED. METHODS: We conducted a survey of a convenience sample of ED patrons (patients and their friends and family) and staff at a university-affiliated Level I trauma center. RESULTS: We surveyed 176 patrons and 95 employees (35 nurses, 30 physicians, 16 security officers, and 14 staff members). Overall, 80% of the patrons and 85% of the employees said they liked the metal detector. Eighty-nine percent of the patrons and 73% of the employees said the metal detector made them feel safer. Only 12% of the patrons and 10% of the employees said the metal detector invaded their privacy or the privacy of others. Fewer than 1% of the patrons said they were less likely to return to our ED because of the metal detector, and 39% said it made them more likely to return. We detected no significant differences with regard to age, sex, or race. CONCLUSION: Most patrons and staff liked the metal detector and said it created a safer ED environment. Only a few disliked the presence of the metal detector or said it invaded their privacy. Institutions concerned about their employees' and patrons' perceptions of safety should consider installing metal detectors in their EDs.

Adolescent↗
PubMed1997

Lidocaine in the treatment of status epilepticus.

Intravenous lidocaine has the potential to control seizures. This article reviews the available evidence related to lidocaine's efficacy and clarifies its potential role in the management of status epilepticus (SE). Although there are no large, double-blind, placebo-controlled studies of lidocaine's efficacy in SE, numerous case reports and case series support its use. Most of the reported cases involve patients who were refractory to multiple antiseizure medications. Additional support for lidocaine's efficacy in SE comes from the pediatric literature, where lidocaine has been very effective in controlling SE in neonates who have not responded to barbiturates. Initial lidocaine doses used to stop seizures have ranged from 1 to 3 mg/kg. Most reports recommend a maintenance infusion of lidocaine after initial termination of SE, and a continuous infusion is almost universally recommended for neonates. Toxicity from a 1.5-2.0 mg/kg dose of lidocaine for the control of SE is rare; the authors found only 1 case of a possible side effect at that dose. The article provides a 5-step approach to treating SE that includes lidocaine.

Clinical Trials as Topic↗
PubMed1996

Drinking on campus. Undergraduate intoxication requiring emergency care.

OBJECTIVES: To (1) determine the incidence of undergraduate graduate students with alcohol intoxication who presented to our emergency department (ED), (2) examine the demographic correlates of the students, and (3) look at associated injuries that were sustained by the students. DESIGN: Retrospective case series. SETTING: A tertiary care medical center that was located on the campus of a major university. PATIENTS: Undergraduate students with alcohol intoxication who presented to the ED. MAIN OUTCOME MEASURES: Demographic data and associated injuries of intoxicated students who presented to the ED during 2 academic years. RESULTS: Forty-four students presented with alcohol intoxication for a yearly incidence of 3.9 per 1000 students. Freshmen were overrepresented compared with students in other higher classes, with an incidence of 9.3 per 1000 per year (P < .001). Nine (20%) of the 44 students sustained an injury from a fall, and 1 required mechanical ventilation for treatment of apnea. CONCLUSIONS: Alcohol intoxication that requires emergency care is not uncommon among college students, and many students with alcohol intoxication present to the ED following a fall. Freshmen are particularly likely to present for care in an ED.

Adolescent↗
PubMed1995

Using the "GI cocktail": a descriptive study.

STUDY OBJECTIVE: To determine practice patterns regarding administration of the "GI cocktail" (a mixture of liquid antacid, viscous lidocaine, and an anticholinergic) in the emergency department in a single hospital and the responses and final dispositions of patients who received the cocktails. DESIGN: A retrospective review of ED charts. SETTING: Urban university hospital ED with an annual census of 50,000 visits. PARTICIPANTS: Ninety-seven consecutive patients who received a GI cocktail in the ED. RESULTS: Forty-nine patients (50%) received a GI cocktail for a chief complaint of abdominal pain and 40 (41%) for a chief complaint of chest pain. The reason for administration of a GI cocktail was documented on only one chart. Sixty-six patients (68%) received at least one other drug, at a median time of 9 minutes before administration of the GI cocktail. The most commonly coadministered drug was a narcotic (56 patients), followed by nitroglycerin (22 patients), antiemetics (13 patients), H2-blockers (13 patients), and aspirin (10 patients). Thirty-three patients (34%) had symptomatic relief with the cocktail alone, 35 (36%) had symptomatic relief with the cocktail plus other drugs, 7 (7%) had no response to the GI cocktail alone, and 5 (5%) had no response to the cocktail with other drugs. In 17 patients (18%) the response was not documented. Chest pain patients and abdominal pain patients had a similar frequency of response. There was also similarity of response between admitted and discharged patients. CONCLUSION: Although symptomatic relief after administration of a GI cocktail is often noted, it is difficult to differentiate the effects of the cocktail from those of other coadministered medications such as morphine or nitroglycerin. We urge ED physicians to use the GI cocktail in a rational manner.

Abdominal Pain↗
PubMed1995

Compliance with recommendations for universal precautions among prehospital providers.

STUDY OBJECTIVE: To evaluate the compliance of emergency medical responders with local employer and Centers for Disease Control and Prevention recommendations for disposal of sharps and use of personal protective equipment in the prehospital environment. DESIGN: Prospective, single-blinded observational study of 297 ambulance runs conducted for 3 months. SETTING: A metropolitan emergency medical service system. PARTICIPANTS: Sixty-nine emergency medical technicians and paramedics. INTERVENTIONS: None. RESULTS: Observers recorded the handling of sharps and the use of personal protective equipment in four situations: i.v. line placement, endotracheal intubation, large-wound management, and body fluid hazard. Emergency medical workers properly handled sharps in 24 of 65 situations (37%). They were usually compliant with glove use during the observed procedures. However, compliance with the use of other personal protective equipment was poor. CONCLUSION: Sharps were often improperly handled. Most workers complied with recommendations for the use of gloves but often underused goggles, masks, and gowns. Although education and restructuring of the environment and equipment may improve compliance, strong consideration should be given to developing standardized and more practical recommendations for the prehospital environment.

Centers for Disease Control and Prevention, U.S.↗
PubMed1995

The technique of managing asystole. High-dose or standard-dose epinephrine: which is better?

Early, aggressive treatment is essential if patients with asystolic cardiac arrest are to survive. To maximize chances for success, use a five-phase protocol. Phase I: Confirm the diagnosis with a series of checks. Phase II: Intubate and hyperventilate the patient with 100% oxygen. Use an end-tidal carbon dioxide (ETCO2) detector to confirm tracheal intubation. Phase III: Initiate therapy with 1 mg of epinephrine and 1 mg of atropine. Consider defibrillation with a 360-wsec shock to reverse occult ventricular fibrillation. Phase IV: Repeat doses of epinephrine and atropine every 3 minutes. Phase V: Reevaluate the patient's chances of survival. If ETCO2 levels are undetectable or barely detectable (below 0.5%), survival is unlikely.

Clinical Protocols↗