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Biomedical subjects

D M Cline

Publications and source records attributed to D M Cline.

12 recordsLinked to original sources
PubMed2001

Factors affecting injury severity to rear-seated occupants in rural motor vehicle crashes.

Injury to rear-seat occupants (RSOs) has received little systematic study in the literature. Past studies have focused on patterns of injury presented to the emergency department, various aspects of restraint usage and injury, or specific populations of RSOs. This is the first systematic analysis of injury severity to RSOs. RSOs involved in motor vehicle crashes (MVCs) sustain injuries of equal severity as do front-seated occupants (FSOs) involved in the same crash. The setting was a rural North Carolina emergency department where patients were evaluated at the sole hospital for the county. The design was a 2-year retrospective review of all MVCs with RSOs occurring in Pitt County North Carolina in calendar years 1988 and 1989. The Wilcoxon Rank-Sum Test and Logistic Regression Analysis with Injury Severity Score (ISS) as the dependent variable were performed. Three hundred forty-six crashes involving 367 vehicles with RSOs and 1,273 occupants that sent 222 patients to the hospital. ISS was higher for unrestrained occupants (1.87 versus 0.51), occupants of vehicles driven by legally intoxicated drivers (4.04 versus 0.73), occupants between the ages of 30 and 59 years (1.06 versus 0.65) and FSOs (1.04 versus 0.85) (Wilcoxon Rank-Sum test P <.0002). Logistic regression analysis confirmed these findings with the exception of more severe injuries for the 30 to 59 age range and impact speed. The analysis failed in these 2 cases. Restraint usage offered the greatest protective effect (OR 0.37). Lesser protective effects were noted with rear seat occupancy (OR 0.43) and age < 13 years (OR 0.77). More severe injuries were predicted by driver intoxication (OR 2.5), and age > 60 years (OR 1.25). In our rural population, RSOs sustain less severe injuries than FSOs. Restraint usage and sober drivers provide a greater protective effect however. Seat location does not replace restraint usage or sobriety.

Accidents, Traffic↗
PubMed1995

Effect of acute ethanol ingestion on orthostatic vital signs.

STUDY OBJECTIVE: To determine the effect of acute ethanol intoxication on the results of orthostatic tilt testing. DESIGN: Prospective, randomized crossover study. Subjects received ethanol (1.1 gm/kg) or an equal volume of water added to nonalcoholic beer. Orthostatic vital signs, ethanol concentration, and relative volume status were checked initially and hourly for 8 hours. PARTICIPANTS: Twenty healthy human volunteers, 10 men, and 10 women. RESULTS: Peak ethanol concentration was 116 +/- 18 mg/dL (mean +/- SD) 1 hour after ingestion. ANOVA for repeated measures revealed a significant difference in orthostatic pulse change and relative volume deficit between the ethanol and placebo groups (P < .05). Post hoc testing revealed significant differences between the two groups at two, five, seven and eight hours post ingestion for pulse change, and two to eight hours for volume status (Bonferroni's corrected t test, P < .0055). At 2 and 5 to 8 hours, there were significantly more positive tilt tests (+/- 30 beat/minute increase) in the ethanol group than in the placebo group (P < .05). Starting at 2 hours, the ethanol group had a statistically significant relative fluid deficit averaging .5 L by 3 hours. There was no difference in postural blood pressure changes between the two groups. CONCLUSION: In healthy volunteers, ethanol intoxication resulted in exaggerated postural pulse changes and in a greater proportion of positive orthostatic tilt test results than in a placebo group. These changes were accompanied by significant relative fluid deficits.

Adult↗
PubMed1995

Physician compliance with advanced cardiac life support guidelines.

STUDY OBJECTIVE: To determine compliance with advanced cardiac life support (ACLS) guidelines among ACLS-certified and non-ACLS-certified physicians. DESIGN: Retrospective review of consecutive cardiac arrests between July 1989 and June 1990, including assessment of the resuscitation leaders' ACLS certification. SETTING AND PARTICIPANTS: All nontraumatic prehospital and hospital cardiac arrests in a rural university hospital. RESULTS: Two hundred seven arrests were studied for a total of 436 rhythms with a maximum of 4 rhythms per arrest. There were 78 resuscitations (36.3%) with return of spontaneous circulation. A total of 2,038 interventions were recorded for all rhythms, with 1,320 (64.8%) compliant with ACLS guidelines compared with 718 (35.2%) deviations. Synchronized cardioversion, calcium chloride and sodium bicarbonate were used with significantly higher noncompliance. Ventricular fibrillation had significantly higher mean rhythm deviation scores, whereas scores were significantly lower for sinus rhythm and stable bradycardia (P < .003). Resuscitations led by ACLS-certified and non-ACLS-certified physicians were compared for mean number of deviations per resuscitation attempt, and no differences were found. Resuscitations with return of spontaneous circulation were compared with unsuccessful resuscitations, and there was no difference between groups in controlled deviation scores. No differences could be found between ACLS-certified and non-ACLS-certified physicians for return of spontaneous circulation and survival-to-discharge rates. CONCLUSION: Despite biannual ACLS training of all medical residents and ICU nurses, noncompliance with ACLS guidelines was noted in 35.2% of treatments. We found no correlation between ACLS certification and ACLS guideline compliance.

Cardiopulmonary Resuscitation↗
PubMed1993

Injury prevention instruction in the emergency department.

STUDY OBJECTIVE: To describe preventable pediatric injuries and the proportion receiving documented injury prevention instruction by emergency department personnel. DESIGN: Retrospective chart review. SETTING: A rural Level I trauma center. TYPES OF PARTICIPANTS: All injured children aged birth through 15 years presenting to our hospital from January 1, 1987, through December 31, 1987. MEASUREMENTS AND MAIN RESULTS: During the study period, 1,449 injuries presented to the trauma center. Motor vehicle crashes caused the largest number of preventable injuries (71), although the proportion of preventable injuries was higher among poisonings, burns, and pedestrian-automobile collisions. Among the 1,313 patients available to ED personnel at discharge, injury prevention instruction was indicated in 27% of cases but documented in the medical record in only 3%. ED personnel were more likely to document instruction for preventing poisoning than other causes of injury. CONCLUSION: Most preventable pediatric injuries treated and released by ED personnel do not receive documented injury prevention instruction.

Adolescent↗
PubMed1989

Prehospital care by EMTs and EMT-Is in a rural setting: prolongation of scene times by ALS procedures.

Because the initiation of IV lines by emergency medical technicians-Intermediates (EMT-Is) appeared to delay the patient's transport to the hospital, we undertook a retrospective study of 370 patients to compare prehospital care rendered by EMTs (EMT-A equivalent) and EMT-Is in a rural setting. Our study was limited to acute medical conditions in which protocols called for IV lines (124 patients with chest pain, 122 with acute respiratory distress, 99 with seizures, and only 25 with cardiac arrest) (the cardiac arrest cases were too few for statistical significance). We found that the difference in scene times for EMTs and EMT-Is not attempting IV lines was 6.1 and 6.9 minutes, respectively. The average scene time of EMT-Is attempting an IV line was 19.6 minutes (P less than .001) compared with EMT times, or times for EMT-Is not attempting an IV line. One hundred twenty-eight of 370 patients received IV medication within ten minutes of arrival in the emergency department, and ten of these patients had their IV lines initiated successfully in the field. Thirty-nine percent of patients with ED IV lines received IV medication within ten minutes of arrival, while only 21% of patients with a field IV line received medication in this period (P less than .05). We conclude that initiating a field IV line in this specific patient population significantly increased scene time and did not improve the chances of these patients receiving IV medication within ten minutes of arrival in the emergency department.

Allied Health Personnel↗
PubMed1988

Observation of head trauma patients at home: a prospective study of compliance in the rural south.

A prospective study was conducted to test the reliability of at-home observation of head trauma victims in the rural South among a population of low educational level. During a four-month period, 99 patients entered and 90 patients finished the study. In all cases, an individual was identified as willing to accept the responsibility of observing the patient. The observer received written and verbal instructions to stay with the patient for 24 hours and to wake the patient every four hours during that time. Patients then were contacted seven to nine days after their injury and questioned as to their present symptoms and observer compliance. For patients under 15 years of age (n = 34), the observer was questioned. Thirteen percent of the observers did not remain with the patient for 24 hours, 16% passed the responsibility of observation to another individual, and 71% awoke the patient as instructed. Observers who were not the patient's mother were significantly more likely to abandon the patient during the first 24-hour period. Observer compliance for patient awakening significantly decreased with the increase in patient age. When spouses and live-in friends were combined as a group of observers and compared with parents, the parents awoke the patient significantly more often. The authors conclude that in this population, at-home observation of head trauma patients, particularly those more than 25 years old, may not be reliable. Special attention should be directed toward the care of these patients.

Adolescent↗
PubMedDate not supplied

Extortion in the emergency department.

We present the case of a 33-yr-old female patient who, along with members of her family, attempted to extort approximately $6000.00 from our institution and her insurance company. This attempted extortion was done under the guise of a missed retained foreign body. The patient initially presented to our emergency department with a laceration to her right forearm; X-ray studies obtained after the wound had been sutured revealed no foreign body. Several days later, the patient and family members approached our administrative staff demanding recompense for metal fragments discovered in the patient's wound at another facility. Comparison of radiographs revealed that the metallic fragments were placed in the wound after she was treated and released from our emergency department, and monetary compensation was denied.

Adult↗
PubMedDate not supplied

N-acetylcysteine in the treatment of human arsenic poisoning.

A 32-year-old man was brought to the emergency department 5 1/2 hours after ingesting a potentially lethal dose (900 mg) of sodium arsenate ant poison in a suicide attempt. The patient deteriorated progressively for 27 hours. After intramuscular dimercaprol and supportive measures failed to improve his condition, he was given N-acetylcysteine intravenously. The patient showed remarkable clinical improvement during the following 24 hours and was discharged from the hospital several days later.

Acetylcysteine↗