Biomedical subjects

James E Svenson

Publications and source records attributed to James E Svenson.

4 recordsLinked to original sources

PubMed2007

Endotracheal intracuff pressures in the ED and prehospital setting: is there a problem?

INTRODUCTION: Cuffed endotracheal tubes are used to prevent gas leak and also pulmonary aspiration in ventilated patients. The pressure exerted on the tracheal wall is similar to intracuff pressure. The perfusion pressure for the tracheal mucosa is 40 cm H(2)O. Cuff pressures greater than 40 cm H(2)O may cause various ischemic changes and complications. High cuff pressures have also been implicated in postoperative sore throat and nonischemic complications. Postintubation endotracheal tube cuff pressures are not routinely measured in the ED or prehospital setting. The time spent in these settings may be long enough for pressure-induced tracheal mucosal injury to occur. The purpose of this study is to assess cuff pressures in intubated patients before aeromedical transport. METHODS: All intubated patients transported by an aeromedical transport program during a 3-month period were included in this study. Patients were intubated either by helicopter physicians or before helicopter arrival at the referring hospital or by ambulance personnel. Cuff pressure was measured using a manometer (Cuffpressure, Posey Co, USA). This measurement was recorded, and correction was performed, if necessary, to achieve a cuff pressure of 14 to 27 cm H(2)O while preventing an air leak. Data were analyzed for the distribution of intracuff pressures and incidence of elevated pressure on first measurement and the need for correction. RESULTS: There were 62 patients in this study. The mean first recorded pressure was 63 +/- 34 cm H(2)O. Initial cuff pressures were greater than 40 cm H(2)O in 36 (58%) patients and required correction. CONCLUSIONS: In this study, most cuff pressures exceeded safe pressure and required correction. Measurement of intracuff pressure is a simple and inexpensive procedure and should be done whenever a patient is intubated, in either the prehospital or hospital setting, because this may reduce long-term morbidity.

Air Ambulances↗

PubMed2005

Emergency department visits in Wisconsin 1998-2002: trends in usage and accuracy of reported data.

INTRODUCTION: There is a paucity of data regarding the utilization of emergency departments (EDs) across Wisconsin. It is unknown if national trends in increased utilization are consistent within our state. Several years ago, mandatory reporting of ED visits to the Department of Health and Family Services was instituted and, if accurate, may provide a method for tracking ED usage. METHODS: We conducted a survey of existing EDs to study the trend in patient visits for the 5-year time period 1998-2003. Data reported in the surveyed departments were compared to those reported to the state database. RESULTS: On average, all EDs reported a consistent yearly increase in patient visits over the time period (an average overall increase of 10%). On average, this increase was larger for smaller hospitals. Growth was consistent over the time period, but the yearly rate steadily slowed down. Data reported to the state consistently underreported the actual census. CONCLUSION: All sizes of EDs across Wisconsin continue to show increases in ED utilization. The growth rate is consistent but may be slowing. This has implications for planning for ED resources. Reported data have many discrepancies and need to be independently checked before they can be utilized in any research or planning.

Catchment Area, Health↗

PubMed2003

Limitations of electronic databases: a caution.

OBJECTIVE: The purpose of this study was to assess the completeness and accuracy of information from two electronic datasets, one of which is voluntarily submitted, the other submitted by mandate. METHODS: Emergency department (ED) data have been voluntarily submitted by several hospitals to the Kentucky Emergency Medical Services Information System (KEMSIS). Similar information on all patients admitted to the hospital has been submitted by mandate to the state under the Uniform Billing Act (UB92). UB92 data for patients with at least one diagnosis code > or = 800 were available. The KEMSIS and UB 92 data for one hospital were compared to those manually abstracted from the ED log and medical records for completeness and accuracy. RESULTS: There were 316 patients listed on the ED log that were subsequently admitted to the hospital. The KEMSIS database contained 266 (84%) of these records, but only 91 (34%) were classified as having been admitted. Of those correctly classified as admitted, only 25 (27%, or 9% of the total 266) were correctly classified as to the hospital of admission (directly to hospital or transferred to another facility). Discharge diagnoses in the KEMSIS database and hospital records were concordant in 240 (90%) of the patients, even for those misclassified as to disposition. There were 37 patients listed in the ED log admitted during the study period with at least one discharge diagnosis field > or = 800. Eight patients were transferred to another institution, making the total population available for study period 29. Only eight (28%) of these patients were included in the UB92 database. The diagnosis codes were concordant between the UB 92 data and ED log in all cases. CONCLUSIONS: There is significant misclassification and/or omission in electronic databases. This is true regardless of whether data is reported voluntarily or by mandate. Electronic data must be independently validated before they are used for policy or research purposes.

Databases, Factual↗

PubMedDate not supplied

Is air transport faster? A comparison of air versus ground transport times for interfacility transfers in a regional referral system.

INTRODUCTION: Helicopter transport is often considered in an effort to minimize time to critical interventions, such as cardiac catheterization or arterial thrombolysis in stroke patients. However, for interfacility transports, the extra time considerations for helicopter preparation, takeoff, and time to get to the transferring hospital may not offset the slower transport times for local ground ambulances. The purpose of this study was to compare transport times for helicopter with traditional ground ambulance for interfacility transfers within a regional referral system. METHODS: All patients transported from an outside hospital to the intensive care unit of the University of Wisconsin were eligible for this study. Equal numbers of patients transferred by ground and by helicopter from each facility were sequentially selected. The following intervals were compared: time from call to dispatch, time from dispatch to arrival at the referring hospital, time at the referring hospital, transport time to the receiving hospital, and total transport time. RESULTS: One hundred forty-five patients were included in this study, transferred from 20 hospitals within the UW referral system. Dispatch times and time at the referring hospital were location independent, and each was shorter for ground transport. Ground dispatch times were 5+/-6 minutes, whereas for helicopter transport dispatch times were 17+/-8 (P<.001). Times at the referral hospital were on average longer for helicopter transport (31+/-11 minutes for air ambulance, 25+/-13 for ground; P=.008). Other intervals were location dependent. Arrivals were much more variable for ground transport, reflecting the fact that private ambulance services may have to travel some distance to reach the referring hospital (helicopter 18+/-8 minutes, ground 19+/-18 minutes). As expected, transport time from the referring hospital was shorter for helicopter transport. From each of the hospitals, average helicopter transport was as fast as the best ground transport. CONCLUSION: Helicopter transport was faster than ground transport for interfacility transfer of patients from all hospitals studied in our referral system. Under optimal dispatch and transport conditions, the time difference from several hospitals was minimal. For stable patients for whom the only issue is time to critical procedure, it may be reasonable for those hospitals to try ground transport first if timely service is available to transport in that way. Even for those hospitals, helicopter transport should be considered for these patients if ground transport is not optimally available, as well as for patients in whom minimizing time outside of the hospital is a significant consideration, or when transport of such patients impacts emergency medical services availability to the community for a significant time.

Air Ambulances↗