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Biomedical subjects

E J Allison

Publications and source records attributed to E J Allison.

At least 19 recordsLinked to original sources
PubMed1992

Acute myocardial infarction in chest pain patients with nondiagnostic ECGs: serial CK-MB sampling in the emergency department. The Emergency Medicine Cardiac Research Group.

STUDY OBJECTIVES: This study tested the hypothesis that serial creatine phosphokinase (CK)-MB sampling in the emergency department can identify acute myocardial infarction (AMI) in patients presenting to the ED with chest pain and nondiagnostic ECGs. DESIGN: Patients more than 30 years old who were evaluated initially in the ED and hospitalized for chest pain were studied. Serial CK-MB levels were analyzed prospectively using a rapid serum immunochemical assay for identification of AMI patients in the ED. Presenting ECGs showing new, greater than 1-mm ST elevation in two or more contiguous leads were considered diagnostic for AMI. All other ECGs were considered nondiagnostic ECGs. CK-MB levels were determined at ED presentation and hourly for three hours (total of four levels). Patients with at least one level of more than 7 ng/mL were considered to have a positive enzyme study. The in-hospital diagnosis of AMI was determined by the development of typical serial ECG changes or separate standard cardiac enzyme changes after admission. SETTING: Eight tertiary-care medical center hospitals. METHODS AND MAIN RESULTS: Of the 616 study patients, 108 (17.5%) were diagnosed in the hospital as AMI; 69 of these AMI patients (63.9%) had nondiagnostic ECGs in the ED. Of the patients with nondiagnostic ECGs, 55 (sensitivity, 79.7%) had a positive ED serial CK-MB enzyme study within three hours after presentation. Combining serial ED CK-MB assay results with diagnostic ECGs yielded an 88.4% sensitivity for AMI detection within three hours of ED presentation. The predictive value of a negative serial ED enzyme study for no AMI was 96.2% (specificity, 93.7%). CONCLUSION: Serial CK-MB determination in the ED can help identify AMI patients with initial nondiagnostic ECGs. Use of serial CK-MB analysis may facilitate optimal in-hospital disposition and help guide therapeutic interventions in patients with suspected AMI despite a nondiagnostic ECG.

Adult↗
PubMed1991

Autonomous departments of emergency medicine in contemporary academic medical centers.

There are currently 20 autonomous departments of emergency medicine in United States medical schools. EDs seeking autonomous status should institute a faculty development program to channel faculty energy into worthwhile research projects; establish protected time for clinical faculty to increase research productivity; develop expertise to compete for extramural funding; initiate an intramural research program so that faculty can learn the basics of grantsmanship; teach health care issues in ambulatory medicine; become involved in interdisciplinary teaching programs and curriculum development; maintain the present faculty commitment to 24-hour attending coverage; and develop university-based programs that originate from the ED. Program directors should establish liaisons with the medical school dean to acquaint him with the advantages of an autonomous department of emergency medicine; attempt to assess other relationships within the medical school to determine support for emergency medicine and to uncover and address opposition to autonomous departmental status; attempt to serve on medical school committees to meet other faculty, solve problems with them and develop trusting relationships; and develop broad-based support for autonomous departmental status both within and outside of the university. By devising and following a deliberate approach to attaining departmental status, emergency medicine will be assured of continued growth in the important decade ahead.

Academic Medical Centers↗
PubMed1991

Work-related stress and depression among physicians pursuing postgraduate training in emergency medicine: an international study.

STUDY OBJECTIVE: To compare the levels of work-related stress and depression reported by physicians-in-training in emergency medicine in three survey sites and to determine the effects of gender and marital status on stress and depression among these physicians. DESIGN: Cross-sectional mail surveys. SETTING AND TYPE OF PARTICIPANTS: Physicians-in-training in the United States, United Kingdom, and Australasia. INTERVENTION: Questionnaires requesting demographic information and including scales assessing work-related stress and depression were administered. MEASUREMENTS AND RESULTS: A 3 x 2 x 2 multivariate analysis of variance in which survey site, gender, and marital status were independent variables and stress and depression scale scores were dependent variables revealed significant differences when stress and depression were analyzed simultaneously. Univariate analyses of variance revealed significant differences in stress by survey site and gender and in depression for all three independent variables. Comparison of adjusted means revealed that respondents from the United Kingdom reported significantly higher levels of stress than did respondents from the United States and that women reported significantly higher levels than men. Respondents from the United States reported significantly higher levels of depression than did respondents from the other countries, women reported higher levels than men, and unmarried respondents reported higher levels than married respondents. CONCLUSION: Despite limitations resulting from self-report bias, cross-sectional survey methodology, sampling error, and differences in training among the three survey sites, the respondents experienced similar levels of stress and depression attributable to anticipated sources.

Australia↗
PubMed1990

Serum magnesium increases following severe hemorrhage in dogs blocked by verapamil treatment.

The opening of voltage sensitive calcium channels is an important event in the progression of irreversible shock, allowing the entry of toxic amounts of calcium (Ca2+) into the cells. Because intracellular magnesium (Mg2+) can efflux through these same channels, changes in serum Mg2+ may reflect the patency of these channels. In this study, electrolytes and selected serum enzymes were monitored in chronically instrumented conscious dogs to follow the progression of shock following a fixed volume hemorrhage. Plasma enzymes indicative of liver damage were elevated only in the terminal phase of hemorrhagic decompensation. A significant increase in serum Mg2+ was evident 60 min following hemorrhage, even though arterial pressure was still recovering. Serum Mg2+ continued to rise throughout the recovery and decompensating phases of shock. Verapamil treatment, which increased survival time and survival rate, significantly attenuated the changes in serum Mg2+ which normally followed hemorrhage. These results indicate that serum Mg2+ may be a useful indicator of the severity and the progression of hemorrhagic shock.

Alkaline Phosphatase↗
PubMed1990

Manpower needs in academic emergency medicine.

One of the value statements of the American College of Emergency Physicians states that, "Quality Emergency Medicine is best practiced by qualified, credentialed emergency physicians." To address this value ACEP has established the following goal: "The number of board-certified physicians will be sufficient to meet the manpower needs of the public." It is the position of ACEP that there is currently a severe shortage of appropriately trained and certified emergency physicians and, moreover, that the shortage will continue well into the next century. We discuss how ACEP arrived at this position and the role of academic emergency medicine in addressing this shortage. For many years, there has been a public debate as to whether there is a physician shortage or surplus. The Graduate Medical Education National Advisory Commission report of 1980 estimated that there would be 630,000 US physicians by 1990, with a surplus of 70,000. This report also identified emergency medicine as a shortage specialty, indicating there would be a need for 14,000 emergency physicians in 1990, with a supply of only 8,000. Schwartz included such factors as increased provision of administrative and research activity by physicians and concluded that there would be a shortage of 7,000 physicians by the year 2,000.

Certification↗
PubMed1989

Transcutaneous oxygen tension measurements during hemorrhagic hypoperfusion using Trendelenburg and the pneumatic antishock garment.

Transcutaneous oxygen tension (PtCO2) was observed during hemorrhagic hypoperfusion using four therapeutic modalities: pneumatic antishock garment (PASG), 20 degrees Trendelenburg positioning, combined PASG-Trendelenburg, and whole blood infusion. Anesthetized mongrel dogs were mechanically ventilated. A heated transcutaneous oxygen sensor was applied to the skin overlying the sternum. Animals were bled over 10 min of 25% of their calculated blood volume. A therapeutic intervention was applied at the onset of hemorrhage (PASG, Trendelenburg, PASG-Trendelenburg or control). All animals were observed for 20 min, then during a 10-min shed blood reinfusion period, and for 20 min thereafter. PtCO2 was measured continuously and the following were measured serially: cardiac output, mean arterial pressure (MAP), mixed venous oxygen tension (MvO2), and arterial oxygen tension (PaO2). Cardiac index (CI) and the oxygen extraction ratio were calculated. PtCO2 decreased immediately after hemorrhage in all animals. Control values remained consistently below values for active interventions during this time. All groups regained baseline levels of PtCO2 after reinfusion of shed blood volume. PaO2 remained nearly constant during all experiments. MAP and CI fell in all groups following hemorrhage but did so less precipitously in the PASG group. The PASG and PASG-Trendelenburg groups showed the greatest increase in CI during reinfusion. These results suggest that when PtCO2 is relied upon as an indicator of adequacy of resuscitation during moderate hemorrhagic shock, that cutaneous perfusion may be improved by the PASG or Trendelenburg position, and that perfusion is most effectively restored by blood infusion.

Animals↗
PubMed1989

Verapamil treatment of canine hemorrhagic shock.

The entry of calcium (Ca++) into ischemic cells is the first of a series of steps leading to irreversible cellular damage. This study examined the ability of verapamil, which may delay or diminish the injury-induced influx of Ca++, to prolong survival in three groups of chronically instrumented dogs subjected to a single, rapid hemorrhage. In untreated animals (group 1, N = 6), hemorrhage decreased mean arterial blood pressure from 101 +/- 3 mm Hg to 23 +/- 2 mm Hg. Following hemorrhage, arterial pressure recovered to 61 +/- 5 mm Hg before the secondary fall (decompensation) occurred. As decompensation progressed, arterial pressure fell to 25 mm Hg, and the animals were euthanized. In group 2 (N = 6), verapamil treatment (2 mg bolus, 1 mg/hr infusion) was initiated 30 minutes before the hemorrhage. This treatment significantly increased both the time to decompensation (184 +/- 15 minutes vs 72 +/- 9 minutes) and survival time (262 +/- 20 minutes vs 128 +/- 8 minutes). Arterial pressure recovery during the first 60 minutes following hemorrhage, however, was not affected by the verapamil pretreatment. Verapamil treatment immediately after the hemorrhage (group 3, N = 4) increased the survival rate to 75% (three of four animals). These results indicate that calcium channel blockade may be a useful initial intervention in the treatment of hemorrhagic shock.

Animals↗
PubMed1989

Factors associated with stress among emergency medicine residents.

A survey of members of the Emergency Medicine Residents Association was conducted to investigate the occupational stress and depression experienced by this group. The 488 respondents provided demographic information and completed measures of stress and depression. Multivariate analysis of variance revealed statistically significant differences in stress and depression by year of training (P less than .001), gender (P less than .01), and marital status (P less than .01). Univariate analyses of variance revealed overall differences in both stress and depression. Mean levels of stress and depression were higher for women residents, and unmarried residents reported more depressive symptomatology. The results indicate that women emergency medicine residents experience more stress and depression than men and that spouses can buffer some of the stress of residency training for men and women residents. No significant differences in stress or depression by year in training were revealed by univariate analysis of variance, which suggests that residents experience stress throughout the course of training. The similarities and differences in the occupational stress and depression experienced by emergency medicine residents in comparison with residents from other specialties suggest that additional study in emergency medicine is warranted.

Cross-Sectional Studies↗
PubMed1988

Single hemorrhage: a clinically relevant canine model of hemorrhagic shock.

Clinically encountered hemorrhagic shock is usually caused by a single, rapid hemorrhage secondary to trauma. Experimental models of shock, however, have utilized anesthetic agents and hemorrhage protocols which may compromise the clinical relevance of their findings. This report characterizes the response of conscious, splenectomized dogs to a single hemorrhage of varying rates and volumes, uncomplicated by the presence of anesthetic agents. The duration of a 40 ml kg-1 hemorrhage affected the magnitude of blood pressure recovery, but did not alter the decompensating drop in blood pressure. The shortest hemorrhage duration was chosen for further study, as the blood pressure profile for this hemorrhage duration demonstrated most clearly the recovery, plateau, and decompensation phases. Increasing the hemorrhage volume to 43 ml kg-1 caused a reproducible decrease in the magnitude of the blood pressure recovery, the time to decompensation, and the time to death. Splenectomized dogs, then, demonstrate a reproducible response to a fixed-volume hemorrhage, making chronically instrumented conscious dogs a good animal model with which to study the progression of hypovolemic shock.

Animals↗