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Biomedical subjects

H N Wigder

Publications and source records attributed to H N Wigder.

12 recordsLinked to original sources
PubMed2001

Pressure support noninvasive positive pressure ventilation treatment of acute cardiogenic pulmonary edema.

We assessed cardiogenic pulmonary edema (CPE) patient response to full mask pressure support noninvasive positive pressure ventilation (NPPV). Adult patients presenting to the emergency department (ED) in acute respiratory failure who clinically required endotracheal intubation (ETI) were studied. In addition to routine therapy consisting of oxygen, nitrates, and diuretics, patients were started on full mask NPPV using a Puritan Bennett 7200 ventilator delivering pressure support 10 cm H(2)O, PEEP 5 cm H(2)O, FiO(2) 100%. Pressure support was titrated to achieve tidal volumes of 5 to 7 mL/kg, and PEEP titrated to achieve oxygen saturation (SaO(2)) > 90%. Outcome measures included arterial blood gas (ABG), Borg dyspnea score, vital signs, and need for ETI. Twenty patients mean age 74.7 +/- 14.3 years were entered on the study. Initial mean values on FiO(2) 100% by nonrebreather mask: pH 7.17 +/-.13, paCO(2) 65.5 +/- 19.4 mmHg, paO(2) 73.8 +/- 27.3 mm Hg, SaO(2) 89.7 +/- 10.0%, Borg score 8.1 +/- 1.4, and respiratory rate(RR) 38 +/- 6.3. At 60 minutes of NPPV, improvement was statistically significant: pH 7.28 (difference.11; 95% CI.04-.19), paCO(2) 45 (difference 20.5; 95% CI 8-33), Borg score 4.1 (difference 4.0; 95% CI 3-5), and RR 28.2 (difference 9.8; 95% CI 5-14). NPPV duration ranged from 30 minutes to 36 hours (median 2 hours, 45 minutes). Eighteen patients (90%) improved allowing cessation of NPPV. Two patients with concomitant severe chronic obstructive pulmonary disease (COPD) required ETI. There were no complications of NPPV. NPPV using full face mask and pressure support provided by a conventional volume ventilator is an effective treatment for CPE and may help prevent ETI.

Acute Disease↗
PubMed1996

Assessment of lung auscultation by paramedics.

STUDY OBJECTIVE: To determine how accurately paramedics interpret common lung sounds on an audiotape in comparison with emergency physicians. METHODS: We carried out a prospective comparison of blinded lung sound interpretation using a standard teaching tape. Our subjects were 67 experienced paramedics and 22 new paramedics from urban and suburban emergency medical services systems comprising municipal and private ambulance providers; and 18 emergency physicians. Five common lung sounds were played three times, in different sequences, and with additional patient history provided for each repetition. The members of each group listened to the same tape and were asked to identify the lung sounds. RESULTS: Emergency physicians had a median score of five of five possible correct responses in each of the three trials. This score was significantly higher than those of experienced and new paramedics. Experienced paramedics (P = .001) and new paramedics (P = .002) significantly increased their median scores over the three trials with additional medical history. We found no significant difference between experienced and new paramedics in any of the three trials. CONCLUSION: In our study, paramedics did not assess lung sounds as accurately as emergency physicians, and experienced paramedics did not interpret sounds more accurately than new paramedics. Correct identification of lung sounds improved significantly for paramedics when medical history was known.

Auscultation↗
PubMed1996

ACEP chest pain policy: emergency physician awareness.

STUDY OBJECTIVE: To assess emergency physician knowledge of and effect on clinical practice of the ACEP "Clinical Policy for Management of Adult Patients Presenting With a Chief Complaint of Chest Pain, With No History of Trauma." METHODS: We conducted a written survey of attending physicians by mail and in person at emergency medicine meetings. Residents were surveyed at their academic departments. The survey recipients were emergency physicians and residents from university, community teaching, urban, and rural hospitals. RESULTS: Of the 338 surveyed physicians, 163 (48%; 95% confidence interval [CI], 43% to 54%) said that they were aware of the policy. Fifty-four percent of ACEP members said they were aware of the policy, compared with 24% of nonmembers. Of the physicians who said they were aware of the policy, 63% did not know that the policy contains rules. Seventy-one percent of the physicians who were aware of the policy incorrectly believed the policy requires treatment with thrombolytic therapy in certain cases of myocardial infarction. Physicians said they learned about the policy by reading it (42%), by word of mouth (16%), or in department/quality assurance meetings (13%). Twelve percent of physicians believe the policy has changed their clinical practice. CONCLUSION: Fewer than half the emergency physicians we surveyed were aware of the policy. Of the physicians who said they had been aware of the policy, most did not know important specifics of the policy.

Academic Medical Centers↗
PubMed1995

Emergency department poison advice telephone calls.

STUDY OBJECTIVE: Requests for medical advice regarding treatment of poisonings are common in emergency departments. Although there are designated poison centers (PCs), most EDs are recognized by the community and medical staff as a poison information resource. The purpose of this study was to evaluate the accuracy and consistency of poison information given by ED personnel. DESIGN: A prospective, stratified-sample, telephone survey over a 6-month period of requests for medical advice about simulated poison ingestions. PARTICIPANTS: Fifty-two hospital EDs in urban and rural Illinois, all three PCs in Illinois, and three PCs from Indiana, Wisconsin, and Michigan. RESULTS: Hospital EDs responded correctly to only 100 of 156 calls (64.2%). PCs responded correctly to 17 of 18 calls (94.4%), whereas teaching hospitals responded correctly to 15 of 30 calls (50%, P = .002). ED night shift personnel were 5.5 times more likely to respond incorrectly than were personnel on other shifts (95% confidence interval, 2.72 to 11.12). Forty-eight percent of all calls to EDs resulted in advice to call the regional PC. CONCLUSION: Poison advice by ED personnel proved to be inaccurate and inconsistent. As a result, patients may be better served if advice calls are redirected to regional PCs.

Emergency Service, Hospital↗
PubMed1987

Relationship of bacteremia to antipyretic therapy in febrile children.

We undertook a prospective study of children from three to 24 months of age with rectal temperatures of greater than or equal to 40.0 degrees C (104.0 degrees F) to determine if children whose fevers fail to respond to antipyretic therapy are more likely to be bacteremic than children whose fevers are lowered by antipyretic measures. Children from two clinical settings were studied: primarily black lower-class children at an inner-city hospital (n = 188) and primarily white middle-class children at a suburban hospital (n = 45). We found an overall prevalence of bacteremia of 7.3%, which was not statistically different between two hospitals. A response to antipyretic therapy, defined as a decrease in temperature of at least 1 degrees C, was seen in 83.7% of children. Children who did not respond to antipyretics had no more increased prevalence of bacteremia than did responders. We conclude that lack of fever response to antipyretics is not a clinical marker for bacteremia in children.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1983

A comparative study of the prevalence, outcome, and prediction of bacteremia in children.

We undertook a prospective, concurrent comparison of the prevalence, predictability, and outcome of bacteremia in children from 3 to 24 months of age with temperatures greater than or equal to 39.5 degrees C in three diverse clinical settings: primarily black lower-class children at an inner-city hospital (n = 532), primarily white middle-class children at a suburban hospital (n = 160), and primarily white middle-class children in offices of pediatricians in private practice (n = 94). The prevalence of bacteremia for the entire study sample (3.1% to 7.4%) and outpatients only (1.9% to 5.9%) was not statistically different among the three groups. There were no statistically significant differences among the three groups in identifying children with bacteremia (P greater than 0.05). There was no racial, geographic, or socioeconomic predilection for bacteremia in infants. At the first visit, antibiotics were prescribed (most commonly for otitis media) for 23 of the 25 bacteremic patients who were not initially hospitalized. One patient with otitis media developed meningitis. The others had uncomplicated courses and were well by 96 hours (most by 48 hours). In office settings, private practitioners were no better in predicting bacteremia in familiar patients than they were with first-time patients. Information from blood culture did not appear to alter patient management. We conclude, therefore, that routine blood cultures are unnecessary for all highly febrile infants given antibiotics.

Child, Preschool↗
PubMedDate not supplied

Microcomputer-assisted transmission of disaster data by cellular telephone.

Voice communication of information during disasters is often inadequate. In particular, simultaneous transmission by multiple callers on the same frequency can result in blocked transmissions and miscommunications. In contrast, nonvoice transmission of data requires less time than does voice communication of the same data, and may be more accurate. We conducted a pilot study to test the feasibility of a microcomputer assisted communication (MAC) network linking the disaster scene and the command hospital. The radio chosen to transmit data from the field disaster site to the command hospital was a cellular telephone connected to the microcomputer by modem. Typed communications between the microcomputer operators enabled dialogue between the disaster site and the hospitals. A computer program using commercially available software (Symphony by Lotus, Inc.) was written to allow for data entry, data transmission, and reports. Patient data, including age, sex, severity of injury, identification number, major injuries, and hospital destination were successfully transmitted from the disaster site command post to the command hospital. This pilot test demonstrated the potential applicability of MAC for facilitating transmission of patient data during a disaster.

Computer Communication Networks↗
PubMedDate not supplied

The prevalence of hepatitis B serologic markers in suburban paramedics.

Urban emergency medical services personnel have documented hepatitis B virus (HBV) seropositivity rates ranging from 0.6% to 25%. We studied 85 suburban paramedics for Hepatitis B serologic markers. All paramedics answered a questionnaire describing age, race, duration of employment, known hepatitis exposure, blood transfusions, gamma globulin injections, and Hepatitis B vaccination. HBV surface antibodies (Anti-HBs) were present in 6/85 (7.1%) paramedics of whom one (1.2%) had reactive HBV core antibodies (Anti-HBc). No paramedic had HBV surface antigen (HBsAg). Seropositivity was not associated with duration of employment, or exposure to a patient with either jaundice (28.2%) or confirmed hepatitis B (20.0%) within the six months prior to testing. The 7.1% prevalence of HBV markers found in this group of suburban paramedics is intermediate between previously reported rates for urban paramedics. We conclude that prehospital personnel do not constitute a homogenous occupational category at risk for hepatitis B infection.

Adult↗
PubMedDate not supplied

Successful implementation of a guideline by peer comparisons, education, and positive physician feedback.

The objective of this study was to determine if peer comparisons, an educational intervention, and positive physician feedback would decrease ordering of knee X-ray studies. We prospectively studied the ordering of knee X-ray studies for patients presenting with knee injuries before and after an educational program to encourage use of the Ottawa decision rule for knee radiography. Physicians were able to privately compare their individual baseline X-ray utilization data with that of their colleagues. Although acceptance of the rule was voluntary, both oral and written feedback encouraged consideration of the rule in clinical decision-making. The percentage of knee injury patients who received X-ray studies, as well as the Percentage Abnormal Results (PAR, defined as the percentage of X-ray studies demonstrating a fracture or effusion), were calculated before and after the educational meeting. Results of the study showed that the percentage of patients presenting with knee injuries who received X-ray studies decreased 23%. In addition, the PAR increased 58.4% between the two study periods. In conclusion, physician behavior can be altered positively with reinforcement. Peer comparisons, education, and positive physician feedback decreased test ordering by physicians even without mandating use of a protocol. PAR is a useful outcome measure to track physician utilization.

Education, Medical, Continuing↗