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Biomedical subjects

L Jagminas

Publications and source records attributed to L Jagminas.

13 recordsLinked to original sources
PubMed2004

Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum?

OBJECTIVE: To determine if high fidelity simulation based team training can improve clinical team performance when added to an existing didactic teamwork curriculum. SETTING: Level 1 trauma center and academic emergency medicine training program. PARTICIPANTS: Emergency department (ED) staff including nurses, technicians, emergency medicine residents, and attending physicians. INTERVENTION: ED staff who had recently received didactic training in the Emergency Team Coordination Course (ETCC) also received an 8 hour intensive experience in an ED simulator in which three scenarios of graduated difficulty were encountered. A comparison group, also ETCC trained, was assigned to work together in the ED for one 8 hour shift. Experimental and comparison teams were observed in the ED before and after the intervention. DESIGN: Single, crossover, prospective, blinded and controlled observational study. Teamwork ratings using previously validated behaviorally anchored rating scales (BARS) were completed by outside trained observers in the ED. Observers were blinded to the identification of the teams. RESULTS: There were no significant differences between experimental and comparison groups at baseline. The experimental team showed a trend towards improvement in the quality of team behavior (p = 0.07); the comparison group showed no change in team behavior during the two observation periods (p = 0.55). Members of the experimental team rated simulation based training as a useful educational method. CONCLUSION: High fidelity medical simulation appears to be a promising method for enhancing didactic teamwork training. This approach, using a number of patients, is more representative of clinical care and is therefore the proper paradigm in which to perform teamwork training. It is, however, unclear how much simulator based training must augment didactic teamwork training for clinically meaningful differences to become apparent.

Adult↗
PubMed1999

Cost-effective adenosine dosing for the treatment of PSVT.

We reviewed our experience with adenosine for the conversion of paroxysmal supraventricular tachycardia (PSVT) to determine whether the recommended dosing strategy of 6 mg, followed by 12 mg, is cost-effective in actual practice. We observed a 65% conversion rate to sinus rhythm with the initial dosage of 6 mg adenosine (95% CI, 54% to 75%), and, based on subsequent cost analysis, conclude that the current strategy should not be replaced by a 12-mg-first strategy. If the packaging of adenosine was changed so that 12 mg cost less than twice 6 mg, this analysis should be revisited.

Adenosine↗
PubMed1999

Frightening dreams and spells: a case of ventricular asystole from Lyme disease.

We present a case of a 20-year-old woman who presented with a febrile illness, frightening dreams and repeated short episodes of apparent seizure activity. Third degree heart block and ventricular asystole were noted on the monitor when the patient experienced a spell during conscious sedation for a lumbar puncture. The combination of heart block and a predominantly lymphocytic cerebrospinal fluid led to the diagnosis of Lyme disease. Lyme titres were strongly positive and subsequently confirmed by Western Blot analysis. Cardiac aetiologies and specifically heart block associated with Lyme disease should be considered in patients from endemic areas presenting with fever and unexplained spells or seizure-like activity.

Adult↗
PubMed1999

Spontaneous esophageal rupture: a frequently missed diagnosis.

The objective of this study was to determine the diagnostic features of spontaneous esophageal rupture and compare them with those traditionally applied in making this diagnosis. A retrospective 15-year chart review was performed on all cases listing esophageal rupture as a diagnosis. Only those cases diagnosed by contrast studies or direct visual confirmation were included. Facets of the history, physical examination, laboratory results, and X-ray procedures were examined and compared with the "classic" presentation of this diagnosis as noted in current medical texts. Fourteen cases of confirmed esophageal rupture were found. Only a small minority of cases presented in a fashion resembling a classic case. Esophageal rupture was the admitting diagnosis in 29 per cent of the cases. Laboratory values associated with esophageal rupture included elevated white blood cell count and hypoxia. The chest X-ray was abnormal in all but one patient, with findings of pneumothorax and/or pleural effusion in the majority. We conclude that reliance on classic findings will lead to misdiagnosis in the vast majority of cases presenting to the Emergency Department. Conversely, toxic appearance, pleural effusion, pneumothorax, elevated white blood cell count, azotemia, and hypoxia are all positively associated with this disease. In toxic-appearing patients with pleural effusions and/or pneumothoraces, spontaneous esophageal rupture should be considered.

Adult↗
PubMed1996

Boerhaave's syndrome presenting with abdominal pain and right hydropneumothorax.

This case of Boerhaave's Syndrome had several unusual features including a delayed presentation and right-sided esophageal perforation. The patient's initial episode of hematemesis may have been caused by a small mucosal laceration in the area of the Barrett's lesion that later ruptured. On the other hand, if initially there was an esophageal rupture, it did not violate the parietal pleura or mediastinum. The overlying pleura remained intact until digested by gastric contents, thereby causing a right-sided hydropneumo thorax and a marked increase in symptoms, which promoted the patient to come to the ED. Because the patient initially appeared stable and had a history of emesis 4 days before presentation, and because an initial chest X-ray interpretation overlooked the right-sided apical pneumothorax, Boerhaave's Syndrome was not considered initially. Aspiration pneumonia, pancreatitis, alcoholic gastritis, or active peptide ulcer disease were in our initial differential. It was only after the repeat chest X-ray, which more obviously showed the pneumothorax, and insertion of the chest tube that the correct diagnosis was made. Had the pneumothorax not been overlooked initially, the diagnosis may have been made earlier. It is apparent from this case and a review of the literature that Boerhaave's Syndrome is an uncommon clinical entity and has varying modes of presentation, making the diagnosis a difficult clinical challenge. Boerhaave's Syndrome should be considered in all ill-appearing patients presenting with the combination of gastrointestinal and respiratory complaints. The single most important test may be the upright chest X-ray. However, if it is normal, and there is a high index of suspicion, esophagograms and or chest CT may be required to demonstrate the lesion. Because survival is directly related to the time to diagnosis and treatment, a high clinical suspicion can decrease the substantial morbidity and mortality associated with Boerhaave's Syndrome.

Abdominal Pain↗
PubMed1996

An association between snowfall and ED presentation of cardiac arrest.

Studies from several cities have reported increased cardiovascular mortality associated with snowfall; whether this weather also results in increased emergency department (ED) presentation of cardiac arrests is not known. A retrospective review was conducted of cardiac arrest patients presenting to a New England ED during the months of October through May, from 1991 to 1994. Comparing daily frequency of cardiac arrest patients with climactic data, a 27% increase was observed in the frequency of cardiac arrest presentation to the ED on days with snowfall (P = .0004). ED physicians and staff should anticipate an increased frequency of cardiac arrest patients on days with snowfall.

Emergencies↗
PubMed1995

Intravenous magnesium sulfate as an adjunct in the treatment of acute asthma.

STUDY OBJECTIVE: This study was conducted to determine whether intravenous magnesium sulfate (MgSO4), when used as part of a standardized treatment protocol, can improve pulmonary function and decrease admission rate in patients presenting to the emergency department with exacerbations of asthma. DESIGN: In this randomized double-blind placebo-controlled study, patients with acute asthma were treated with inhaled beta-agonists at regular intervals and intravenous (IV) steroids. At 30 min after entry, patients received either 2 g IV MgSO4 or IV placebo. Patients were monitored for up to 4 h with regular measurements of pulmonary function. Patients who were discharged from the emergency department were contacted at 1 day and 7 days for follow-up. SETTING: Emergency departments of a university-affiliated, voluntary hospital and municipal hospital. PARTICIPANTS: Asthmatics aged 18 to 65 years during acute exacerbation with FEV1 less than 75% predicted both before and after a single albuterol treatment. INTERVENTIONS: Patients were given 2 g of MgSO4 or placebo as an adjunct to standardized emergency department procedure for acute asthma. MEASUREMENTS AND RESULTS: One hundred thirty-five patients were studied. Hospital admission rates were 35.3% for placebo-treated group and 25.4% for the magnesium-treated group (p = 0.21). FEV1 measured at 120 min was 56% predicted for the placebo-treated group and 55% predicted for the magnesium-treated group. (p = 0.92) For subgroup analysis, patients were divided into "severe" (baseline FEV1 < 25% predicted on presentation) or "moderate" (baseline FEV1, 25 to 75% predicted on presentation). For the severe group, admission rates were 78.6% (11/14) for the placebo-treated group and 33.3% (7/21) for the magnesium-treated group (p = 0.009). For the moderate patients, admission rates were 22.4% (11/49) for the placebo-treated group and 22.2% (10/25) for the magnesium-treated group (p = 0.98). There was no significant improvement in FEV1 in the moderate group for magnesium-treated patients. However, in the severe group, there was a significant improvement in FEV1 at 120 min and 240 min (p = 0.014 and 0.026, respectively). CONCLUSION: Intravenous MgSO4 decreased admission rate and improved FEV1 in patients with acute severe asthma but did not cause significant improvement in patients with moderate asthma.

Acute Disease↗
PubMedDate not supplied

Fatal spontaneous rupture of a gravid uterus: case report and literature review of uterine rupture.

Spontaneous uterine rupture is a life-threatening obstetrical emergency encountered infrequently in the emergency department. The diagnosis of spontaneous uterine rupture is often missed or delayed, leading to maternal and fetal mortality. Emergency physicians must consider this diagnosis when presented with a pregnant patient in shock with abdominal pain. We present the case of a 38-year-old gravid female who presented to the emergency department in cardiac arrest 24 hours after an initial complaint of abdominal pain. We review the uterine rupture literature with specific focus on risk factors, signs and symptoms, diagnosis, treatment, and outcome.

Adult↗
PubMedDate not supplied

CT of blunt trauma bowel and mesenteric injury: typical findings and pitfalls in diagnosis.

Detection of bowel and mesenteric injury can be challenging in patients after blunt abdominal trauma. Early diagnosis and treatment are critical to decrease patient morbidity and mortality. Computed tomography (CT) has become the primary modality for the imaging of these patients. Signs of bowel perforation such as free air and contrast material are virtually pathognomonic. Bowel-wall thickening, free fluid, and mesenteric infiltration may be seen with this type of injury and partial thickness injuries. The authors present and discuss the range of CT findings seen with bowel and mesenteric injuries. Examples of observation and interpretation errors are also provided to highlight pitfalls encountered in the evaluation of abdominopelvic CT scans in patients after blunt trauma.

Abdominal Injuries↗
PubMedDate not supplied

Emergency medical services in the reconstruction phase following a major earthquake: a case study of the 1988 Armenia earthquake.

STUDY OBJECTIVE: To use the clinical activities of an ambulance service as a tool to assess the residual and unmet medical needs of a city in the aftermath of a major earthquake and to apply that assessment to the development of a training curriculum for the prehospital personnel. METHODS: The researchers conducted structured interviews with health care workers at all levels of the emergency health care delivery system in Gyumrii, Armenia, and carried out a retrospective frequency analysis of 29,010 ambulance runs for an 11-month period from February through December 1992. Runs first were assigned into the broad categories of: 1) Adult Medical; 2) Pediatric Medical; or 3) Trauma, and then, according to diagnosis. The runs then were classified further as: 1) Primary Care; 2) Basic Life Support (BLS); or 3) Advanced Life Support (ALS). RESULTS: Adult Medical calls represented 24,684 (85%), Pediatric Medical calls 459 (1.6%), and Trauma calls 3,867 (13%). Only 12% of all ambulance calls resulted in transport to a medical facility, although this percentage was higher in children. Thirty percent of Adult Medical patients were diagnosed by the emergency medical providers as having exclusively a psychiatric problem. CONCLUSION: In the late aftermath of a devastating earthquake, the ambulance service in Gyumrii, Armenia has been delivering a substantial proportion of non-emergency, primary care services. They have adopted this unconventional role to compensate for the deficit in health care facilities and personnel created by the disaster. The training program that the investigators developed reflected the actual work activities of the prehospital personnel demonstrated in their assessment.

Adult↗