Development of emergency services in Costa Rica. A collaborative project in international health.
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Costa Rica↗
Biomedical subjects
D Doezema
Publications and source records attributed to D Doezema.
Magnetic resonance imaging in minor head injury.
STUDY OBJECTIVES: To investigate the role of cranial magnetic resonance (MR) imaging in evaluating patients discharged from the emergency department after minor head injury. DESIGN: A prospective blinded cohort study. SETTING: University hospital ED. TYPE OF PARTICIPANTS: Fifty-eight patients with minor head injury who were discharged from the ED with written head injury instructions. Patients admitted to the hospital were excluded. INTERVENTIONS: Ultra-low-field cranial MR scans were performed on patients within 24 hours of discharge. Scans were read blindly by two radiologists. MEASUREMENTS AND MAIN RESULTS: Fisher's exact test was used to compare symptoms in patients with abnormal and normal MR scans. There was no significant difference in symptoms between patients with abnormal and those with normal scans (P greater than .10). The proportion of abnormal MR scans was analyzed using the binomial distribution. Six of the 58 patients (10.3%) had traumatic intracranial abnormalities (proportion, 0.103; SD, 0.04; 95% CI, 0.04-0.21). Three had cortical contusions, and three had small subdural hematomas. Two of the six patients with abnormal MR scans, both with small subdural hematomas, had normal computed tomography scans. CONCLUSION: Ten percent of patients discharged from the ED after minor head injury had abnormal ultra-low-field cranial MR scans. Additional research is needed to establish the clinical importance of this unexpected observation.
Adolescent↗
Under-reporting of contaminated needlestick injuries in emergency health care workers.
STUDY HYPOTHESIS: There is considerable under-reporting of contaminated occupational needlestick and other sharp object injuries among emergency health care workers. POPULATION: A convenience sample of emergency physicians, emergency nurses, and emergency medical technicians (EMTs). METHODS: A survey instrument eliciting demographic and work-related factors was developed and administered; survey items included age, sex, occupation, years in occupation, number of procedures performed per week, number of contaminated needlestick (and other "sharps") injuries recalled, and number of these injuries formally reported during the previous five years. Nonsegmented visual analog scales were used to assess eight attitudes possibly associated with nonreporting. Analysis was by analysis of variance and multiple linear regression with stepwise variable election. RESULTS: Two hundred fifty-nine subjects recalled 643 contaminated exposures during the five-year study period, but only 228 (35%) were formally reported. One or more injuries occurred in 55% of EMTs compared with 72% of nurses and 80% of physicians (P less than .05). Physicians recalled a mean of 3.8 contaminated exposures, whereas nurses recalled 2.8 and EMTs recalled only 1.8 (P less than .05). Physicians formally reported a mean of 0.26 exposures, whereas EMTs reported 0.85 and nurses reported 1.25 (P less than .05). Physicians formally reported only one eighth of their injuries compared with EMTs and nurses, who each reported two thirds of these events (P less than .05). Perception of risk, occupation, years in occupation, and concern about excessive paperwork were the most powerful predictors of low reporting rate (P less than .05). CONCLUSIONS: Work-related contaminated sharp object injuries are under-reported by emergency health care workers, especially emergency physicians.
Accidents, Occupational↗
The effect of local anesthetics on bacterial proliferation: TAC versus lidocaine.
We compared the effect of topical 0.5% tetracaine, 1:2,000 epinephrine, and 11.8% cocaine (TAC) with 1% lidocaine infiltration on bacterial proliferation in experimental lacerations. Forty-eight lacerations were made on the backs of Hampshire pigs, inoculated by injection with infectious doses of Staphylococcus aureus and randomly anesthetized with either topical TAC or lidocaine infiltration. Wounds were sutured, and quantitative cultures were obtained by excision after 48 hours. The mean log10 bacteria per gram of tissue for wounds anesthetized with TAC was 6.818 (95% confidence interval [CI], 6.07 to 7.54) compared with 6.820 (95% CI, 5.91 to 7.75) for those treated with lidocaine; this difference was not significant (P less than .05 by paired two-tailed t test). The probability of failing to detect an intergroup difference of 0.5 log10 bacteria per gram was less than .0001. TAC does not increase bacterial proliferation more than lidocaine infiltration in contaminated experimental porcine lacerations.
Administration, Topical↗
Amebic liver abscess: emergency department diagnosis.
Twelve patients with amebic liver abscess were admitted to a university hospital. Ten of these patients were admitted through the emergency department. Patients, especially men from third world countries, with fever, right upper quadrant pain, and leukocytosis are at high risk for this disease and should have the diagnosis confirmed with amebic serology and ultrasonography or computed tomography.
Adolescent↗
Anaphylaxis following administration of intravenous methylprednisolone sodium succinate.
A 27-year-old man developed respiratory arrest following intravenous administration of methylprednisolone sodium succinate. Skin tests were positive to methylprednisolone sodium succinate but not to methylprednisolone acetate. Severe anaphylactic reactions to intravenous corticosteroid medications can occur and can require epinephrine administration or endotracheal intubation. Skin tests and drug challenge should be done to establish the safety of a particular corticosteroid drug.
Adult↗