Biomedical subjects

Leslie Upledger Ray

Publications and source records attributed to Leslie Upledger Ray.

4 recordsLinked to original sources

PubMed2005

Evaluation of pediatric glucose monitoring and hypoglycemic therapy in the field.

As specific indications for glucose monitoring in pediatric patients are not standardized, we sought to evaluate our EMS system regarding the use of this test, so that objective data can be used for prehospital provider education. We performed a 5-year electronic search of prehospital records to assess pediatric patients who had glucose monitoring performed, with subgroup analysis on those requiring therapy. We found that 6018 pediatric patients received glucose monitoring with the most common chief complaints for testing including: seizure, "other medical," trauma head/neck, and OD/poisoning. Of these, 270 (4.5%) required therapy for hypoglycemia with an additional 100 (1.7%) patients receiving treatment without use of the paramedic's monitor. Age breakdowns for therapy were as follows: 0-4 years, 44 (11.9%); 5-9, 36 (9.7%); 10-14, 58 (15.7%); 15-19, 232 (62.7%). In the prehospital setting, the need to treat hypoglycemia in pediatric patients is infrequent. The chief complaints associated with the highest frequencies of hypoglycemia are seizures and altered neurologic status.

Adolescent↗

PubMed2004

Community trial to decrease ambulance diversion hours: the San Diego county patient destination trial.

STUDY OBJECTIVE: Emergency department (ED) ambulance diversion is a major issue in many communities. When patients do not reach requested facilities, challenges in care are compounded by lack of available medical records and delays in transferring admitted patients back to the originally requested facility. We seek to evaluate a community intervention to reduce ambulance diversion. METHODS: This was a community intervention in a county of 2.8 million individuals. Ambulance diversion guidelines were revised for all ambulance agencies and EDs. Participation by EDs was voluntary, and main outcome measures, which included ambulance transports, ambulance diversions, and bypass hours, were compared for the pretrial, trial, and posttrial periods. RESULTS: A total of 235,766 patients were transported to an ED by advanced life support ambulance during the 2-year study period. There was a significant decrease in the number of patients who did not reach the requested facility because of ambulance diversion for the trial period (n=322) and posttrial period (n=449) compared with the pretrial period (n=1,320; -998 diverted patients per month [95% confidence interval (CI) -1,162 to -833 patients] and -871 diverted patients per month [95% CI -963 to -780 patients], respectively). There was also a significant decrease in average monthly hours on diversion for the trial period (n=1,079) and posttrial period (n=1,774) compared with the pretrial period (n=4,007; -2,928 hours on bypass [95% CI -3,936 to -1,919 hours on bypass] and -2,232 hours on bypass [95% CI -3,620 to -2,235 hours on bypass], respectively). CONCLUSION: A voluntary community-wide approach to reducing hospital ED diversion and getting more ambulance patients to requested facilities was effective.

Adolescent↗

PubMed2004

9-1-1 responses for shopping cart and stroller injuries.

BACKGROUND: On average, 24,000 children a year are treated in the emergency departments (EDs) for shopping cart injuries, with over 650 children a year requiring hospital admission. The authors sought to evaluate the incidence and outcomes of children in the community evaluated by paramedics because they were injured in shopping cart or stroller-related incidences. METHODS: Retrospective design in which prehospital patients records were searched for all patients under 14 years old who were injured in an incident involving a shopping cart or stroller and were responded to by paramedics. Records were reviewed for demographics, injury type, and disposition. RESULTS: During the 3 1/2 year study period, a total of 241 cases were identified with 120 being shopping cart-related and 121 stroller-related. The most frequent ages for stroller injuries were 0 to 6 months and for shopping cart injuries was one year of age. Falls were the most common mechanism of injury, 70.3% for shopping carts and 47.5% for strollers, with head injuries accounting for 53% and 59% of the primary injuries in each group. An additional 12% and 18% suffered primary facial injuries. 77% of patients were transported by paramedics to an ED for evaluation, with 19% of parents signing out against medical advice. 8.2% were admitted to the hospital and there were no deaths. CONCLUSIONS: Shopping cart and stroller-related injuries are a common mechanism of injury for pediatric patients responded to by paramedics. This is an area which continued parental education is needed.

Accidental Falls↗

PubMedDate not supplied

Airway obstruction in children aged less than 5 years: the prehospital experience.

BACKGROUND: Treatment of choking in children has been well studied, but few data are available on the various causes of the choking episodes in the pediatric population. OBJECTIVES: To assess frequency and to stratify etiologies of children less than 5 years of age who had a 911 advanced life support (ALS) ambulance response for airway obstruction. METHODS: A prehospital database was searched and information was collected defining type of obstruction, age of the child, parents' action, paramedic treatment, and incident outcome. RESULTS: There were 182 patients with airway obstruction under 5 years of age, of whom 99 (55%) were less than 1 year old. Liquid obstructions (i.e., formula, juices) were most common in the youngest children, whereas solid food and nonfood solid obstructions were most prevalent in children over 1 year old. One hundred seven (59%) of these obstructions resolved before paramedic arrival (69% of liquid obstructions, 72% of food, and 36% of nonfood solid objects). Interventions used by parents included bulb suction (3%), finger sweeps (6%), Heimlich maneuver (3%), and back blows (12%). Paramedics used ALS skills in only three cases. After paramedic evaluation, 47% of parents refused transport against medical advice (AMA). CONCLUSIONS: Although most episodes of pediatric airway obstruction will have been resolved by the time of paramedic arrival, age-specific and item-specific treatment skills need to be reinforced with parents and prehospital providers.

Age Factors↗