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Biomedical subjects

C M Slovis

Publications and source records attributed to C M Slovis.

61 records · Page 4Linked to original sources
PubMedDate not supplied

"Occult" Boerhaave's syndrome.

Spontaneous rupture of the esophagus (Boerhaave's syndrome) usually presents in a dramatic fashion. Classically, following repeated episodes of vomiting, patients present with chest pain, dyspnea, cyanosis, shock, and cardiovascular collapse. We present a case of occult Boerhaave's syndrome diagnosed by an upper gastrointestinal series in a 33-year-old man who arrived at the emergency department with a chief complaint of hematemesis. This case report reviews the usual presenting signs and symptoms of Boerhaave's syndrome and concludes with a caution to physicians not to ignore the possibility of this disease entity in relatively stable patients.

Adult↗
PubMedDate not supplied

Sudden respiratory deterioration in the positive pressure ventilated patient: an organized approach to diagnosis and therapy.

A case of sudden deterioration in the respiratory status of a 28-year-old man being manually ventilated is presented. The patient's deterioration was presumed to be secondary to malfunction of the expiratory valve of the Ambu bag. The resulting high pressure generated in the system caused the patient to develop a bilateral pneumothorax, pneumomediastinum, and displacement of the endotracheal tube into the oropharynx. An organized approach to the diagnosis and treatment of the rapid deterioration in the respiratory status of a manually ventilated patient is presented.

Adult↗
PubMedDate not supplied

Self-reported cardiac risk factors in emergency department nurses and paramedics.

STUDY OBJECTIVE: Our objective was to assess the prevalence of cardiac risk factors in a sample of urban paramedics and emergency department (ED) nurses. METHODS: We asked 175 paramedics and ED nurses working at a busy, urban ED to complete a cardiovascular risk assessment. The survey asked subjects to report smoking history, diet, exercise habits, weight, stress levels, medication use, history of hypertension or cardiac disease, family history of cardiovascular disease (CVD), and cholesterol level (if known). RESULTS: 129 of 175 surveys were returned (74% return rate) by 85 paramedics and 44 nurses. The percentages of paramedics and nurses at high or very high risk for cardiac disease were 48% and 41%, respectively. Forty-one percent of female respondents and 46% of male respondents were at high or very high risk. Cigarette smoking was reported in 19% of the paramedics and 14% of the nurses. The percentages of paramedics and nurses who reported hypertension were 13% and 11%, respectively. High cholesterol was reported in 31% of paramedics and 16% of nurses. CONCLUSIONS: Forty-eight percent of paramedics and 41% of ED nurses at this center are at high or very high risk for cardiovascular disease, by self-report. Efforts should be made to better educate and intervene in this population of health-care providers in order to reduce their cardiac risk.

Adult↗
PubMedDate not supplied

Acute coronary syndrome: pharmacotherapy.

Acute coronary syndrome (ACS) refers to the spectrum of cardiac disease, from unstable angina to ST-segment-elevation myocardial infarction. In the emergency medical services (EMS) setting, ACS may be more broadly thought to include patients with chest pain or other symptoms believed to have a cardiac origin who have evidence of ischemia or acute myocardial infarction on a 12-lead electrocardiogram, or symptomatic patients with a previous cardiac event or known cardiac disease. Pharmacologic management of these patients is based on the use of three primary classes of drugs: those that affect clotting, those that establish and maintain hemodynamic control, and those that relieve pain. Many of these agents have been evaluated in large clinical trials for in-hospital use, and a number of ongoing studies are assessing their efficacy in the prehospital setting. The appropriateness of prehospital use of specific agents within each class depends on proper patient selection, the necessity of immediate intervention, ease of use in the field, expertise of EMS personnel, and cost-effectiveness of therapy. This consensus group reviewed agents from all three classes (including aspirin, GPIIb/IIIa inhibitors, unfractionated and low-molecular-weight heparins, fibrinolytics, beta-adrenergic blockers, calcium antagonists, nitrates, and morphine) for their overall indication, applicability to the prehospital setting, and current prehospital use.

Acute Disease↗
PubMedDate not supplied

Management of difficult airways in the field.

Establishing an airway is a critical first step in emergency management of comatose patients and those who have suffered head trauma, cardiac arrest, or respiratory failure. The use of succinylcholine, a paralytic, to assist with intubation is a safe and effective way to help establish an airway under difficult circumstances, in the prehospital setting. It requires excellent intubation skills, a thorough knowledge of the indications and contraindications of its use, and similar knowledge of any other medications employed. Succinylcholine-assisted intubation should never be implemented without close physician monitoring. Therefore, under the auspices of strong medical control, it is an effective way to establish adequate oxygenation and to control ventilation in some of the most critical patients encountered in the field. Additionally, because physical examination alone is not dependable for ensuring proper endotracheal tube placement, an objective confirmatory device such as an end-tidal carbon dioxide detector should be used.

Capnography↗
PubMedDate not supplied

Feedback to emergency medical services providers: the good, the bad, and the ignored.

HYPOTHESIS: To determine the type and frequency of immediate unsolicited feedback received by emergency medical service (EMS) providers from patients or their family members and emergency department (ED) personnel. METHODS: Prospective, observational study of 69 emergency medical services providers in an urban emergency medical service system and 12 metropolitan emergency departments. Feedback was rated by two medical student observers using a prospectively devised original scale. RESULTS: In 295 encounters with patients or family, feedback was rated as follows: 1) none in 224 (76%); 2) positive in 51 (17%); 3) negative in 19 (6%); and 4) mixed in one (< 1%). Feedback from 254 encounters with emergency department personnel was rated as: 1) none in 185 (73%); 2) positive in 46 (18%); 3) negative in 21 (8%); and 4) mixed in 2 (1%). Patients who had consumed alcohol were more likely to give negative feedback than were patients who had not consumed alcohol. Feedback from emergency department personnel occurred more often when the emergency medical service provider considered the patient to be critically ill. CONCLUSIONS: The two groups provided feedback to emergency medical service providers in approximately one quarter of the calls. When feedback was provided, it was positive more than twice as often as it was negative. Emergency physicians should give regular and constructive feedback to emergency medical services providers more often than currently is the case.

Attitude of Health Personnel↗