PubMed Health⌕ Search

Biomedical subjects

Joseph D Losek

Publications and source records attributed to Joseph D Losek.

11 recordsLinked to original sources
PubMed2006

Effects of initial pain treatment on sedation recovery time in pediatric emergency care.

OBJECTIVE: The purpose of this study is to compare the sedation recovery times of children receiving ketamine/midazolam (K/M) versus K/M and initial pain treatment (morphine or meperidine) in pediatric emergency care. METHODS: Study method was a retrospective cross-sectional study of children receiving K/M for procedural sedation analgesia in an urban children's hospital pediatric emergency department (ED). A uniform data collection form was completed for each child. RESULTS: During an 18-month period, 116 children received K/M for procedural sedation analgesia in the ED. For this study, 80 children met inclusion criteria: 33 patients received K/M only; 32 received K/M and morphine, and 15 received K/M and meperidine. In comparing the K/M only group with the K/M morphine and K/M meperidine groups, the mean ketamine and midazolam doses (mg/kg) were not significantly different. In comparing the recovery times (minutes) for the K/M only group (29.7; SD, 15.7) with the K/M morphine (41.1; SD, 22.4) and K/M meperidine (50.1; SD, 24.9) groups, there was a significant difference for both comparisons (95% confidence interval for difference between 2 means, -20.9 to -1.76 and -32.2 to -8.4, respectively). CONCLUSION: Sedation (K/M) recovery time is significantly greater for children receiving initial pain treatment (morphine or meperidine). Children receiving meperidine had the longest recovery time. Considering this prolonged recovery time and the unique adverse effects of meperidine compared with morphine, we recommend meperidine not be used for initial ED pain treatment of children.

Adolescent↗
PubMed2005

Hypoglycemia complicating dehydration in children with acute gastroenteritis.

A study was done to estimate the prevalence of hypoglycemia among children with dehydration due to acute gastroenteritis, and to identify clinical variables associated with hypoglycemia in these children. A retrospective case series of children older than 1 month of age and younger than 5 years of age who presented to an urban children's hospital Emergency Department with acute gastroenteritis and dehydration was performed. Medical records were reviewed; demographic and clinical data, including pretreatment serum glucose concentrations, were recorded. There were 196 children comprising the study population. Eighteen children (9.2%) were hypoglycemic. The duration of vomiting was longer for the children with hypoglycemia (2.6 days, SD +/- 1.5) than for those without hypoglycemia (1.6, SD +/- 1.8), 95% CI 0.13 to 1.88. Hypoglycemia may complicate dehydration due to acute gastroenteritis in young children. Clinicians should examine the serum glucose concentration in these children.

Acute Disease↗
PubMed2005

Myasthenia gravis: myasthenia vs. cholinergic crisis.

A serious complication of myasthenia gravis is respiratory failure. This may be secondary to an exacerbation of myasthenia (myasthenia crisis) or to treatment with excess doses of a cholinesterase inhibitor (cholinergic crisis). Managing respiratory failure and differentiating a myasthenia from a cholinergic crisis is reviewed. Due to the unpredictable development of respiratory failure, hospitalization is recommended for most patients with exacerbations or complications of myasthenia gravis.

Acetylcholine↗
PubMed2005

Survey of academic pediatric emergency departments regarding use of evaluation and management codes.

OBJECTIVE: The aims of the study were to determine the frequency at which each emergency medicine evaluation and management (E/M) code is used, to identify factors associated with their use by academic pediatric emergency departments (PEDs), and to compare PED E/M code utilization rates with rates reported by Centers for Medicare and Medicaid Services for general emergency departments (EDs). METHOD: A 24-question survey was sent to 42 academic PED medical directors. Questions pertained to PED demographics, physician staff, records/documentation, billing education, and E/M coding data for 1 year. The general ED E/M code utilization rates were obtained from the published Centers for Medicare and Medicaid Services database. Descriptive statistics and odds ratios were used to report and compare the data. RESULTS: Twenty (48%) of the surveys were returned, and 9 (21%) completed the E/M coding data questions. From these 9 departments, the mean PED annual census was 46,065 (range, 23,531-92,910). The methods of PED medical record documentation were template (6), handwritten (2), and dictation/transcription (1). Charge documents were completed by the PED physician (3), professional service coders (4), and hospital coders (2). Coding/documentation in-services were provided to the physicians of 7 PEDs, and billing audits were performed in 5 PEDs. The total number of charges for the 9 PEDs was 325,129, 78.4% of the census. Multiple reasons were given for the discrepancy between census and charges. The percentage of each of the 5 levels of service billed was calculated for each of the 9 PEDs. The 2 lowest levels of service were used 38.3% of the time, whereas the 2 highest were used 19.2% of the time. The range for the highest level of service varied widely from 5.3% to 53.3%. Approximately 65% of E/M codes used by general EDs were for the 2 highest levels of service. The PED with the highest percentage of upper level charges (53.4%) was the only PED that used dictation/transcription for documentation. CONCLUSION: Although the response rate was low, and thus the validity of the results was limited, the findings may serve as a benchmark for E/M code utilization in PEDs. The large variation in use of the E/M codes among the PED in our study and the lower rate of using the highest E/M codes by the PEDs compared with the general EDs suggest potential opportunities for academic PEDs to improve billing practices.

Academic Medical Centers↗
PubMed2004

Acetaminophen dose accuracy and pediatric emergency care.

OBJECTIVE: To describe the demographic and clinical characteristics of children who receive acetaminophen per emergency department standing orders and identify factors associated with supratherapeutic doses (>or=16 mg/kg). METHODS: A cross-sectional retrospective study of consecutive children who received acetaminophen at an urban children's hospital emergency department. RESULTS: Over a 1-week period, 156 (24%) of 661 emergency department children were treated with acetaminophen. Of the children receiving acetaminophen, 64 (41%) were less than 2 years and 92 (59%) were males. The indication for acetaminophen was fever in 140 (90%) children, and 70 (50%) had temperatures >or=39degreesC. The route of administration was oral [133 (85%)] and rectal [23 (15%)]. There were 122 (78%) correct doses (standing order dose range of 10 to 15 mg/kg), 15 (10%) doses of <10 mg/kg, and 19 (12%, 95% CI, 8% to 18%) doses of >or=16 mg/kg. In comparison, children who received acetaminophen at normal or low doses (<16 mg/kg) versus supratherapeutic doses (>or=16 mg/kg) showed a significant difference in route. The rate of rectal route was significantly greater in the supratherapeutic doses (95% CI for changes in proportion, 14% to 48%). CONCLUSIONS: Review of acetaminophen dose accuracy, particularly the rectal route, is recommended for emergency departments with standing orders for acetaminophen.

Acetaminophen↗
PubMed2004

Post-tonsillectomy hemorrhage and pediatric emergency care.

A cross-sectional, retrospective review of consecutive patients who presented to 1 of 2 pediatric emergency departments with post-tonsillectomy hemorrhage was undertaken. The study population included children who had secondary hemorrhage (bleeding at greater than 24 hours after tonsillectomy). Over a period of 2 years, 90 children received emergency care for secondary post-tonsillectomy hemorrhage. The average age was 8.5 years and there were 40 (44%) males. The average time from tonsillectomy to emergency department (ED) presentation was 7.3 days. One patient was hypotensive, and 7 had hemoglobins <10 mg/dL. Signs of bleeding on examination of the tonsillar fossa were active (4), oozing (18), clots (48), and none (14). Of the 70 children with signs of bleeding, 63 (90%) were treated surgically and 7 (10%) were observed. Four (6%) of the 63 children who had signs of bleeding and were managed surgically and 3 (43%) of the 7 children who had signs of bleeding and were managed by observation had repeat episodes of bleeding. Of the 14 patients with no signs of bleeding, all were observed and none had repeat episodes of bleeding. Signs of bleeding were not documented in 6 patients. Active hemorrhage and cardiovascular compromise were uncommon in this study population. Surgical management is recommended for children who have signs of bleeding, while observation appears to be appropriate for children who have no signs of bleeding.

Adolescent↗
PubMed2003

Pediatric pericardial tamponade presenting as altered mental status.

The purpose of this case report is to illustrate the diagnostic difficulties of pericardial tamponade and to suggest that focused cardiac ultrasound be included in the resuscitative care of pediatric shock. Three cases of cardiac tamponade are presented. Each patient had a syncopal episode and presented with altered mental status and hypotension. Muffled heart tones, distended neck veins, and electrocardiogram and chest radiograph abnormalities were not present. Hypotension was not responsive to intravenous volume expansion treatment. Diagnostic delays would have been prevented if focused cardiac ultrasound had been included in the resuscitative care of shock.

Adolescent↗