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Biomedical subjects

G J Ordog

Publications and source records attributed to G J Ordog.

At least 19 recordsLinked to original sources
PubMed1995

Hospital costs of firearm injuries.

UNLABELLED: The purpose of this study was to provide economic, epidemiologic, and clinical data on initial hospitalizations of patients with firearm injuries. DESIGN: Concurrent prospective study; data obtained by medical records review. SETTING: A county university teaching hospital designated a level I trauma center. SUBJECTS: 34,893 persons first hospitalized for firearm injuries at the King/Drew Medical Center in Los Angeles from January 1978 through December 1992. RESULTS: The aggregate hospital cost for 34,893 firearm injuries, exclusive of professional fees, was $264,506,455.00, of which 96% was borne directly or indirectly by public funds. The charge for initial hospitalizations was $240,700,855.00. Mean and median initial charges per case were $6898.00 and $1,022.00, respectively (range, $944.00 to $296,232.00). The 5% of patients with charges greater than $100,000 accounted for 42% of all charges; 45% of all patient days were attributable to the 4% patients, with hospitalizations lasting more than 30 days. Three thousand thirty-one patients were rehospitalized a total of 4,578 times; charges for rehospitalization totaled $23,805,600.00. At least 55% (75% of identifiable weapon and missile injuries) of all charges resulted from handgun injuries. Treating the majority of patients on an outpatient basis and by using selective angiography for extremity wounds, a savings of more than $775,000,000.00 resulted. The potential cost of treating gunshot wounds at a single county hospital was more than $1 billion, or more than $100 million per year. CONCLUSIONS: The costs for hospital treatment of firearm injuries are substantial. A lack of rehabilitation facilities forces prolonged acute hospital admissions in many cases. Avoiding prolonged hospitalization may be helpful in controlling these costs, but will be difficult to achieve. Ninety-six percent of the patients in this report had their costs of care covered by the government, because they had no primary insurance coverage. Primary prevention of firearm injuries, especially those caused by handguns, may be the most effective cost-control measure.

Firearms↗
PubMed1995

Gunshot wounds seen at a county hospital before and after a riot and gang truce: Part Two.

An analysis was undertaken of the number of gunshot wound victims seen at a Los Angeles County hospital both before and after the Los Angeles riot. Since the LA riot the gang truce between the "Bloods" and the "Crips" resulted in a significant decrease in the number of gunshot wound victims seen at a level I trauma center in Los Angeles. Unfortunately, this lasted for only three months. The resurgence of shootings, mainly of the drive-by type (82%), to an occurrence rate higher than ever before, has negated any positive effect of the gang truce and indicates the need for additional measures to control gang violence.

Adolescent↗
PubMed1995

Prospective, randomized trial of survivor values of cardiac index, oxygen delivery, and oxygen consumption as resuscitation endpoints in severe trauma.

The objective was to test prospectively supranormal values of cardiac index (CI), oxygen delivery index (DO2I), and oxygen consumption index (VO2I) as resuscitation goals to improve outcome in severely traumatized patients. We included patients > or = 16 years of age who had either (1) an estimated blood loss > or = 2000 mL or (2) a pelvic fracture and/or two or more major long bone fractures with > or = four units of packed red cells given within six hours of admission. The protocol resuscitation goals were CI > or = 4.5 L/min/m2, DO2I > or = 670 mL/min/m2, and VO2I > or = 166 mL/min/m2 within 24 hours of admission. The control resuscitation goals were normal vital signs, urine output, and central venous pressure. The 50 protocol patients had a significantly lower mortality (9 of 50, 18% vs. 24 of 65, 37%) and fewer organ failures per patient (0.74 +/- 0.28 vs. 1.62 +/- 0.45) than did the 75 control patients. We conclude that increased CI, DO2I, and VO2I seen in survivors of severe trauma are primary compensations that have survival value; augmentation of these compensations compared to conventional therapy decreases mortality.

Adolescent↗
PubMed1995

Weapon carriage among major trauma victims in the emergency department.

OBJECTIVE: To determine the occurrence of weapon carriage by major trauma patients at a university/county hospital ED. METHODS: Retrospective observational study of major trauma patients seen in the ED of a major urban trauma center in Los Angeles from 1979 to 1993. All major trauma patients were searched routinely for weapons by the security police. Cases of violence in the ED caused by these weapons were reviewed. RESULTS: Over the 14-year period, 26.7% of the victims of major trauma presenting to ED were armed with lethal weapons. The occurrence of automatic weapon seizure increased significantly from an annual rate of only 0.2 in the first five years to an average of 17 over the last five years (p < 0.001). A total of 115 "incidents" of violence involving weapons in the ED were recorded during this period; 1.7% of the weapons brought to the ED led to violence and injury. There were four fatalities of armed and dangerous patients, but only six minor injuries to the staff. No other (unarmed) patient in the ED at the time of these incidents was injured. CONCLUSION: ED major trauma patients at one urban trauma center in Los Angeles frequently carry weapons, including automatic military weapons. In addition to violence prevention measures such as weapon confiscation, plans must be made and practiced for the management of violence within the "sacrosanct" hospital doors to protect both patients and ED personnel.

Adolescent↗
PubMed1995

Violence and general security in the emergency department.

OBJECTIVE: To describe cases of violence related to weapons in a university hospital and urban county ED and to provide related recommendations for ED staff security. METHODS: Descriptive analysis and case examples of weapons-related assaults in one urban ED for the period 1979-1993. RESULTS: Over a 14-year period, 115 "incidents" of weapons-related violence were identified during the management of approximately 980,000 patients. Examples of ED violence are described. CONCLUSION: Emergency department staff should prepare for the possibility of violence by 1) recognizing the danger, 2) rehearsing response mechanisms, and 3) debriefing after incidents. In particular, plans must be made and practiced for the time when external violence follows the surviving victims of gang activity through the "sacrosanct" hospital doors. Protection of patients and ED personnel must be ensured. In many urban settings, appropriately armed security guards must be immediately accessible to the ED staff. Other suggestions for ED protection are given.

Emergency Service, Hospital↗
PubMed1994

Spent bullets and their injuries: the result of firing weapons into the sky.

People often celebrate holidays by firing guns into the air without realizing that this can cause serious injury or death. The present study identified 118 patients treated since 1985 who were hit with spent bullets. Most (77%) were hit in the head. The mortality rate was 32%, which is significantly higher than for all gunshot wound victims in general seen at the same medical center. Laws have been enacted to help prevent people shooting into the sky, but more education and enforcement are required to prevent these serious and preventable injuries.

Adolescent↗
PubMed1989

Violence in a community emergency room.

Violence in both community and county hospitals in the USA is increasing. It caused significant physical, emotional and economic hardship to many emergency department employees. We describe an incident that caused significant injury to an innocent bystander in a quiet upper-class community emergency department and outline procedures that hospitals and emergency department employees can take to combat this violence. Policy, procedures, planning and methods must be available for appropriately trained and equipped police officers to respond to such incidents. The effects of such violent episodes on the emergency department staff are discussed. Methods to prevent such incidents are presented.

Adult↗
PubMed1989

Emergency department thoracotomy.

The best candidates for a community hospital emergency room thoracotomy are those victims who have decompensated following small-caliber gunshot wounds or stab wounds to the chest or abdomen who initially had signs of life in transport to the hospital or in the Emergency Department. Some of these patients can be successfully resuscitated by an emergency physician using the techniques described in this article.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Gunshot wounds in children under 10 years of age. A new epidemic.

Before 1980 we had not treated any children with gunshot wounds who were younger than 10 years of age, but the number has increased dramatically each year since then. Thirty-four children younger than 10 years of age were treated for gunshot wounds from 1980 to 1987. Sociologic and epidemiologic data were assessed by a child-abuse team and police. Other studies have concluded that gunshot wounds in young children were usually caused by unintentional injury, child abuse, or neglect. From our present study we add a further, and very disturbing, category, that of attempted or intentional pediatric homicide. The children in this category were shot in retaliation for gang activities of their older siblings. This study demonstrates that the majority of our patients' childhood gunshot wounds were related to gang violence and retaliation, the availability of handguns in the home, and child neglect. The prevalence of childhood gunshot wounds in the inner city is increasing dramatically.

California↗
PubMed1988

Shotgun wound ballistics.

Shotguns are popular world wide and more of these weapons exist than the rifled types. With an increasing incidence and prevalence of gunshot wounds it is important for traumatologists to be familiar with shotgun wound ballistics. Shotgun wounds differ from those of other missiles because the spectrum of wound severity is large owing to the fact that the pellets scatter as they travel. Close-range shotgun wounds can be as destructive as those from a high-velocity rifle, but longer weapon-victim ranges may produce only minimal injury. The type of shot (size and weight of pellets) used also determines the type of injury, with more serious injuries produced by the larger type of buckshot (greater than 0.14 inches in diameter). The severity of injury from birdshot depends mainly on the "effective" weapon-victim range which can be calculated from the shot size and shot pattern either clinically or from X-ray. Wounds may then be classified according to severity, yielding information on prognosis and extent of investigation and treatment required. We propose a four-level severity scale based upon birdshot pellet scatter patterns which correlate well with morbidity and mortality rates.

Firearms↗
PubMed1987

Intravenous prochlorperazine for the rapid control of nausea and vomiting in acute myocardial infarction: a clinical observation.

Sixteen patients with acute myocardial infarctions who were either vomiting or nauseated were given an intravenous injection of prochlorperazine. All patients obtained relief with exception of one patient who was in acute renal failure. No patient developed symptomatic hypotension. Intravenous prochlorperazine in the dose of 2.5 mg is a rapid, effective, and safe method to relieve vomiting and nausea in patients who have sustained an acute myocardial infarction.

Aged↗
PubMed1987

Transcutaneous electrical nerve stimulation versus oral analgesic: a randomized double-blind controlled study in acute traumatic pain.

A double-blind controlled analgesic study was undertaken in outpatients suffering acute traumatic pain. One hundred patients completed the study and were randomly assigned to four treatment groups, each receiving either functioning transcutaneous electrical nerve stimulators (TENS), placebo TENS, acetaminophen with codeine and a functioning TENS, or acetaminophen with codeine and a placebo TENS. Pain was assessed prior to treatment, at 48 hours, and at one month using a visual analog scale. A statistically significant difference in pain relief occurred between the placebo and functioning TENS groups. The TENS was approximately as effective as acetaminophen (300-600 mg) with codeine (30-60 mg) but had no side effects. Transcutaneous electrical nerve stimulators have been shown to be effective in the management of acute traumatic pain and may be indicated for patients who cannot be given medications.

Acetaminophen↗
PubMed1987

Emergency thoracotomy.

There continues to be a debate on the indications for and value of the emergency department thoracotomy, especially with regard to the subject of thoracotomy performed by the emergency physician. The current literature does not deal specifically with thoracotomies performed in the emergency department by an emergency physician on trauma patients. This article describes a technique for emergency department thoracotomy that can be performed by an emergency physician.

Adult↗
PubMed1987

Serum digoxin levels and mortality in 5,100 patients.

A retrospective study of 5,100 patients on digoxin, with a four-week follow up after digoxin levels were measured, was done to determine the mortality rate. A significant increase in mortality was correlated with an increasing serum digoxin level, up to 50% at a level of 6.0 ng/mL and more. Clinical toxicity was suspected in only 0.25% of all patients on digoxin, although almost 10% had levels above the therapeutic range. Deliberate digoxin overdoses were fatal in 50% of cases. This study shows a correlation between increasing digoxin levels and increasing mortality rates. We recommend the use of serum digoxin measurements to identify those asymptomatic patients with elevated levels. The physician should seriously consider the indications for initiating or continuing digoxin treatment in any patient because of an increased mortality in patients with levels of more than 1.0 ng/mL.

Adult↗