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Jacob W Ufberg

Publications and source records attributed to Jacob W Ufberg.

14 recordsLinked to original sources
PubMed2006

Charlson Index is associated with one-year mortality in emergency department patients with suspected infection.

OBJECTIVES: A patient's baseline health status may affect the ability to survive an acute illness. Emergency medicine research requires tools to adjust for confounders such as comorbid illnesses. The Charlson Comorbidity Index has been validated in many settings but not extensively in the emergency department (ED). The purpose of this study was to examine the utility of the Charlson Index as a predictor of one-year mortality in a population of ED patients with suspected infection. METHODS: The comorbid illness components of the Charlson Index were prospectively abstracted from the medical records of adult (age older than 18 years) ED patients at risk for infection (indicated by the clinical decision to obtain a blood culture) and weighted. Charlson scores were grouped into four previously established indices: 0 points (none), 1-2 points (low), 3-4 points (moderate), and > or =5 points (high). The primary outcome was one-year mortality assessed using the National Death Index and medical records. Cox proportional-hazards ratios were calculated, adjusting for age, gender, and markers of 28-day in-hospital mortality. RESULTS: Between February 1, 2000, and February 1, 2001, 3,102 unique patients (96% of eligible patients) were enrolled at an urban teaching hospital. Overall one-year mortality was 22% (667/3,102). Mortality rates increased with increasing Charlson scores: none, 7% (95% confidence interval [CI] = 5.4% to 8.5%); low, 22% (95% CI = 19% to 24%); moderate, 31% (95% CI = 27% to 35%); and high, 40% (95% CI = 36% to 44%). Controlling for age, gender, and factors associated with 28-day mortality, and using the "none" group as a reference group, the Charlson Index predicted mortality as follows: low, odds ratio of 2.0; moderate, odds ratio of 2.5; and high, odds ratio of 4.7. CONCLUSIONS: This study suggests that the Charlson Index predicts one-year mortality among ED patients with suspected infection.

Adult↗
PubMed2006

Evaluation and treatment of patients with severely elevated blood pressure in academic emergency departments: a multicenter study.

STUDY OBJECTIVE: Current guidelines advise that emergency department (ED) patients with severely elevated blood pressure be evaluated for acute target organ damage, have their medical regimen adjusted, and be instructed to follow up promptly for reassessment. We examine factors associated with performance of recommended treatment of patients with severely elevated blood pressure. METHODS: Observational study performed during 1 week at 4 urban, academic EDs. Severely elevated blood pressure was defined as systolic blood pressure greater than or equal to 180 mm Hg or diastolic blood pressure greater than or equal to 110 mm Hg on at least 1 measurement. ED staff were blinded to the study purpose. Demographics, presenting complaints, vital signs, tests ordered, medications administered, disposition, and discharge instructions were recorded, and associations were tested in bivariate analyses. RESULTS: Severely elevated blood pressure was noted in 423 patients. Serum chemistry was obtained in 73% of patients, ECG in 53% of patients, chest radiograph in 46% of patients, urinalysis in 43% of patients, and funduscopy documented in 36% of patients. All studies were performed in 6% of patients and were associated with complaints of dyspnea (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.1 to 8.7) and chest pain (OR 3.0; 95% CI 1.2 to 7.6). Oral antihypertensives were administered to 36% of patients and were associated with blood pressure-related complaints (OR 2.0 [1.2 to 3.3]), patient-suspected severely elevated blood pressure (OR 5.6, 95% CI 2.0 to 15.3), and being uninsured (OR 2.0; 95% CI 1.2 to 3.3). Intravenous antihypertensives were given to 4% of patients, associated only with chest pain (OR 3.2; 95% CI 1.1 to 9.5). Modification of antihypertensive regimen was documented in 19% of discharged patients and associated with patient-suspected severely elevated blood pressure (OR 5.5; 95% CI 2.5 to 12.2) and being uninsured (OR 1.8; 95% CI 1.1 to 2.9). CONCLUSION: The majority of ED patients with severely elevated blood pressure do not receive the evaluation, medical regimen modification, and discharge instructions advised by current guidelines. Further study is necessary to determine whether these recommendations are appropriate in this setting.

Academic Medical Centers↗
PubMed2006

Bradydysrhythmias and atrioventricular conduction blocks.

Bradydysrhythimas include sinus bradycardia, junctional brady-cardia, and idioventricular rhythm, which can be distinguished by examining the tracing for the presence or absence of P waves,noting the morphology of these P waves, and determining the width of the QRS complex. Sinoatrial blocks may occur in either first, second, or third degree varieties. Only second degree sinoatrial block can be detected on the 12-lead ECG. Sinus pause and sinus arrest may mimic second degree sinoatrial block, but their periodicity is irregular. The cyclic variability of sinus arrhythmia is unique; as with the other bradydysrhythmias, it may be innocent or pathologic depending upon clinical circumstances. Atrioventricular blocks may occur, and, similar to sinoatrial blocks, they are also categorized as first-, second-, or third degree. These are of greater clinical relevance than their sinoatrial counterparts.

Bradycardia↗
PubMed2006

Peripheral venous cutdown.

Timely establishment of vascular access is a critical component of the care of the acutely ill or injured patient. Peripheral venous cutdown, once a mainstay in the care of the severely traumatized patient, has progressively lost favor since the introduction of the Seldinger technique of central venous line placement. In fact, recent editions of the Advanced Trauma Life Support (ATLS) text refer to saphenous venous cutdown as an optional skill to be taught at the discretion of the instructor. In certain patients, percutaneous vascular access may be impossible to achieve or result in unacceptable time delays. In these situations, the ability to rapidly and proficiently perform peripheral venous cutdown techniques may prove invaluable and potentially lifesaving. This article reviews the anatomy of the most common sites used for peripheral venous cutdown, peripheral venous cutdown techniques, and the complications associated with peripheral venous cutdown.

Catheterization↗
PubMed2005

Lack of relationship between hypertension-associated symptoms and blood pressure in hypertensive ED patients.

A number of cardiopulmonary and neurological symptoms are presumed to be associated with hypertension. We examined the prevalence of these symptoms in ED patients with elevated blood pressure (BP) and studied the relationship between symptom prevalence and BP value. We enrolled consecutive adult ED patients with sustained BP elevation (systolic BP>or=140 mm Hg, diastolic BP>or=90 mm Hg). BP values were categorized according to Joint National Committee on Prevention, Evaluation, and Treatment of High Blood Pressure, 6th Report criteria. Elevated BP was noted in 551 (29%) of 1908 patients. Unprompted complaints of hypertension-associated symptoms were noted in 26%, and there was no association between BP category and complaints other than dyspnea. Symptom interviews were conducted in 294 (56%) patients; 68% of this subset noted >or=1 current hypertension-associated symptom with no relationship between symptom prevalence and BP category. We conclude that symptoms putatively associated with hypertension are common among ED patients with elevated BP, and their prevalence appears unrelated to BP value.

Adult↗
PubMed2005

Aspiration of gastric contents: association with prehospital intubation.

We prospectively compared the incidence of pulmonary aspiration of gastric contents between patients endotracheally intubated in the prehospital (PH) setting and those intubated in the emergency department (ED). Tracheal aspirates were collected using a standard Leukens trap from all patients as soon as possible after endotracheal intubation. Tracheal aspirates were then tested for the presence of pepsin, a sensitive and specific marker of gastric contents, using a fibrinogen digestion technique. Over 8 months, 168 patients were enrolled. The pepsin assay was positive in 10 of 20 (50%) patients intubated in the PH group, as opposed to 33 of 148 (22%) of those intubated in the ED (chi2 P=.008; odds ratio, 3.5; 95% CI, 1.34-9.08). Patients endotracheally intubated in the PH setting are more likely to have aspirated gastric contents than those intubated in the ED.

Emergency Medical Services↗
PubMed2005

Elevated blood pressure in urban emergency department patients.

OBJECTIVES: There has been little systematic study of emergency department (ED) patients with elevated blood pressure (BP) values. The authors sought to characterize ED patients with elevated BP values, assess presenting symptoms, and determine the prevalence of elevated BP after discharge. METHODS: This was a cross-sectional study performed in four academic EDs. Adults presenting with systolic BP >or=140 mm Hg or diastolic BP >or=90 mm Hg were enrolled over a one-week equivalent period. Demographics, medical history, and symptoms were obtained by chart abstraction and structured interview. A random patient subset underwent a three-week follow-up interview. BP measurements were staged, using Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) criteria, according to the greatest value noted in the ED. RESULTS: A total of 1,396 patients were enrolled. Stage 1 BP values were noted in 44.3%, stage 2 in 25.3%, and stage 3 in 30.3%. African American patients more frequently had stage 2 and 3 BP values than other ethnic groups. BP measurements were repeated in 61.1% of patients and were the same or greater in 51.3% of patients. Dyspnea was associated with greater BP values. Among the 63.9% of patients who were interviewed, 52.7% were not being treated for hypertension, and 42.1% of those with hypertension had recently missed a medication dose. Follow-up was obtained in 74.7% of those targeted. A visit to a medical practitioner since discharge was reported by 63.2%; of these, 26.1% reported that their BP remained elevated. CONCLUSIONS: Elevated BP is common among ED patients. African American patients are more likely than those of other ethnic groups to have greater BP values. The ED visit may be a good opportunity to identify patients with unrecognized or poorly controlled hypertension.

Black or African American↗
PubMed2004

A new pepsin assay to detect pulmonary aspiration of gastric contents among newly intubated patients.

Aspiration of gastric contents by endotracheally intubated patients is associated with significant morbidity and mortality. Previous studies suggest that pepsin in tracheal aspirates may be a valuable marker of occult aspiration. We sought to show the sensitivity and specificity of a new, pepsin-specific assay in humans. A prospective, case-controlled study was conducted with subjects serving as their own controls. After planned endotracheal and nasogastric intubation for elective surgery, 20 participants had tracheal and gastric aspirates withdrawn. A blinded investigator tested samples for the presence of pepsin using the assay. Positive samples were then tested with pepstatin, a specific pepsin inhibitor, to ensure that positive results were due to pepsin. All tracheal aspirates tested negative and all gastric aspirates tested positive for pepsin. Pepstatin halted pepsin activity in all positive samples, ensuring that positive results were due to pepsin. A pepsin-specific assay is extremely reliable for detecting gastric contents in humans.

Adult↗
PubMed2004

Emergency evaluation and treatment of priapism.

Priapism is a fairly uncommon presentation to the Emergency Department, but when it does present, it represents a true urologic emergency. Prompt treatment will decrease the risk of permanent sequelae including impotence. Treatment should be based on etiology and follow an organized approach. Various cases will arise when conservative management will not remedy the priapism and more aggressive measures will be needed, particularly if emergent urological consultation is not available. This article reviews the causes of priapism and systematically reviews techniques and procedures used to manage and treat priapism.

Adrenergic alpha-Agonists↗
PubMed2004

Anterior shoulder dislocations: beyond traction-countertraction.

The shoulder is the most commonly dislocated large joint presenting to American Emergency Departments (ED). Anterior dislocations account for the great majority of these dislocations. Most anterior shoulder dislocations can be reduced in the ED using a variety of reduction techniques. The traction-countertraction technique is quite familiar to most Emergency Physicians, however, many other effective methods of reduction have been described. No method has proven 100% successful, and occasionally multiple attempts using different techniques are required to effect reduction. This article reviews some of the other techniques used to reduce anterior shoulder dislocations, variations reported on these techniques, and their success rates, advantages, and disadvantages.

Emergency Medical Services↗
PubMed2003

Ruptured renal artery aneurysm: an uncommon cause of acute abdominal pain.

Previously thought to be extremely rare, renal artery aneurysms are now being found more commonly as incidental findings during the evaluation of refractory hypertension. Symptoms related to the aneurysm are uncommon and rupture occurs infrequently, but with devastating consequences. Factors predisposing to rupture include pregnancy, polyarteritis nodosa, and lack of aneurysmal calcification. Angiography is the study of choice for diagnosing the presence of visceral aneurysm and rupture. We report a case of ruptured renal artery aneurysm that presented with sudden onset of abdominal pain but no significant findings on physical examination. The patient's size precluded the detection of a pulsatile abdominal mass or the ability to obtain an abdominal angiogram. Computed tomography scan with contrast revealed the correct diagnosis, and successful treatment was initiated.

Abdominal Pain↗
PubMedDate not supplied

Successful collaborative model for trauma skills training of surgical and emergency medicine residents in a laboratory setting.

OBJECTIVES: To determine whether interdepartmental educational and technical resources could be combined to successfully train surgery and emergency medicine residents in common diagnostic and therapeutic trauma skills outside the traditional hospital setting. DESIGN: Curriculum improvement survey. SETTING: Surgical Skills Laboratory, Temple University School of Medicine, Philadelphia, Pennsylvania. PARTICIPANTS: A total of 35 surgery residents (PGY 1 to 5) and 26 emergency medicine residents (PGY 1 to 3). METHODS: Emergency medicine attendings used human volunteers to train surgery residents in Focused Assessment with Sonography in Trauma (FAST). Trauma surgery attendings used a porcine model to teach emergency medicine residents tracheostomy, peripheral venous cutdown, diagnostic peritoneal lavage, tube thoracostomy, and bilateral thoracotomy. Upon completion of the courses, all residents were surveyed using a 5-point Likert scale to assess this teaching model. RESULTS: The percentage of residents reporting an improvement in knowledge levels after the course increased significantly (p < 0.003) for all skill modules (FAST, 14% vs 73%; tracheostomy, 20% vs 64%; peripheral venous cutdown, 25% vs 71%; diagnostic peritoneal lavage, 16% vs 60%; tube thoracostomy, 42% vs 92%; thoracotomy, 15% vs 42%). A significant (p < 0.05) increase in comfort levels during performance of the procedures in the clinical setting was also anticipated for all skills modules (FAST, 11% vs 60%; tracheostomy, 12% vs 50%; peripheral venous cutdown, 15% vs 31%; diagnostic peritoneal lavage, 12% vs 58%; tube thoracostomy, 35% vs 73%; thoracotomy, 0% vs 15%). PGY 1 to 4 surgery residents and PGY 1 and 2 emergency medicine residents perceived the greatest benefit (p < 0.05) from their respective courses. The overwhelming majority (89% to 100%) of surgery and emergency medicine residents felt the course was valuable and transferable to the clinical trauma setting. CONCLUSIONS: Interdepartmental collaboration between the Department of Surgery and Department of Emergency Medicine offered a unique training relationship that was a positive educational experience for all residents.

Emergency Medicine↗