Biomedical subjects

M T Steele

Publications and source records attributed to M T Steele.

26 records · Page 2Linked to original sources

PubMed1996

Emergency medicine credentials in St Louis and Kansas City: does the presence of an emergency medicine residency program have a geographic difference?

STUDY OBJECTIVE: To compare emergency physician (EP) credentialing characteristics in two metropolitan areas of Missouri: Kansas City, which has had an emergency medicine (EM) residency program since 1973, and St Louis, which is without a program approved by the Accreditation Council for Graduate Medical Education. METHODS: A cross-sectional, descriptive survey concerning EP training, certification, and practice characteristics was administered by standardized telephone interviews. Participants were all emergency department directors in Kansas City and St Louis general hospital EDs serving more than 10,000 patients annually. RESULTS: Twenty Kansas City EDs, with an annual census of 20,250 +/- 7,200; and 30 St Louis EDs, with an annual census of 27,100 +/- 13,800, were surveyed. In Kansas City, 68% of practicing EPs were EM trained, versus 10% in St. Louis (P < .0005). The percentage of board-certified EPs was also greater in Kansas City than in St Louis (82% versus 42%, P < .0005). Eighty-six percent of ED directors in St Louis, compared with 30% in Kansas City, reported that they did not attempt to recruit EM-trained staff or that recruitment was difficult (P < .0005). CONCLUSION: The presence of an EM residency training program is associated with favorable EP credentialing characteristics in the Kansas City metropolitan area. This information may prove useful to institutions attempting to establish EM training programs in areas where none currently exist.

Certification↗

PubMed1996

Forced air speeds rewarming in accidental hypothermia.

STUDY OBJECTIVE: To compare the rates of rewarming of forced-air and passive insulation as a treatment for accidental hypothermia. METHODS: We carried out a prospective, randomized clinical trial in two urban, university-affiliated emergency departments. Our subjects were 16 adult hypothermia victims with core temperatures less than 32 degrees C. A convective cover inflated with air at about 43 degrees C (forced-air group) or cotton blankets (control group) were applied until the patient's core temperature reached 35 degrees C. Members of both groups were given IV fluids warmed to 38 degrees C and warmed, humidified oxygen at 40 degrees C by inhalation. RESULTS: The mean +/- SD initial temperature was 28.8 degrees +/- 2.5 degrees C (range, 25.5 degrees C to 31.9 degrees C) in the patients who underwent forced-air rewarming and 29.8 degrees +/- 1.5 degrees C (range, 28.2 degrees C to 31.9 degrees C) in those given blankets. Core temperature increased about 1 degree C/hour faster in patients treated with forced-air rewarming (about 2.4 degrees C/hour) than in patients given only cotton blankets (about 1.4 degrees C/hour, P = .01). Core-temperature afterdrop was detected in neither group. CONCLUSION: Forced air accelerated the rate of rewarming without producing apparent complications in hypothermic patients.

Adult↗

PubMed1995

Emergency medicine residency faculty scheduling: current practice and recent changes.

STUDY OBJECTIVE: To assess current emergency medicine faculty scheduling practices, preferences, and recent changes. DESIGN: Mail survey. PARTICIPANTS: All emergency medicine residency program directors and full-time faculty. INTERVENTIONS: Questions were asked about current faculty scheduling practices, preferences, and recent changes. RESULTS: Eighty-five percent (79 of 93) of the programs and 63% (606 of 961) of the full-time faculty responded. Faculty most commonly worked a combination of 8- and 12-hour shifts. Seventy-five percent of full-time faculty stated that they would prefer to work 8-hour shifts. Eighty-three percent of those who work some or all 8-hour shifts preferred 8-hour shifts; 21% of those working 12-hour shifts preferred the same (P < .0005; test of proportions difference, 62%; 95% confidence interval, 55% to 69%). Over the past 5 years, 40% of programs had shortened shift lengths, and the number of night shifts worked per month and/or the number of nights in a row worked per faculty decreased for 34%. CONCLUSION: Residency faculty prefer and have moved toward working shorter shifts. They are also working fewer night shifts per month and fewer night shifts in a row.

Academic Medical Centers↗

PubMed1995

Acute poisoning from gamma hydroxybutyrate (GHB).

Gamma hydroxybutyrate (GHB) is an illicitly marketed substance promoted by body builders as a growth hormone releaser. Poisoning can produce seizures and coma. Acute poisonings from GHB have primarily been reported on the West coast and the Southeast. We report two cases from Kansas City where the patients presented in, or developed profound coma. Physicians should suspect GHB poisoning in patients who present with unexplained seizures and/or coma, particularly if they are body builders, health food fanatics or dieters.

Acute Disease↗

PubMed1992

Foreign body retention in glass-caused wounds.

STUDY OBJECTIVE: To describe patient and wound characteristics that are clinically useful in identifying wounds that were caused by glass and retained a foreign body. DESIGN: Retrospective consecutive case review. SETTING: Urban, university-affiliated teaching hospital. TYPE OF PARTICIPANTS: Four hundred thirty consecutive patients with a total of 578 evaluable wounds caused by glass during a 12-month period. MEASUREMENTS AND RESULTS: Medical records were reviewed to determine patient demographics, primary wound data (eg, location, type, description), mechanism of injury, type of glass involved, and presence of foreign body sensation. Glass was found by examination in 7% of wounds. Eight percent of 137 radiographs were positive. Wounds with the highest prevalence of retained glass were puncture wounds (P < .0005), those caused by stepping on glass or by a motor vehicle accident (P < .005), and those of the head or foot (P < .003). CONCLUSION: Characteristics of wounds most likely to retain glass were identified in this retrospective study. The presence of these factors should increase the clinician's suspicion of a retained glass foreign body. The indications for radiography for the detection of retained glass in wounds should be clarified with prospective studies.

Adult↗

PubMed1989

Prophylactic penicillin for intraoral wounds.

We conducted a prospective, double-blind, placebo-controlled study in adult patients to determine whether prophylactic penicillin prevents infection in intraoral lacerations secondary to minor trauma or seizures. Uninfected full-thickness, mucosal-only, or through-and-through wounds presenting within 24 hours of injury were considered. Management consisted of cleansing, irrigation, debridement, and closure as indicated: no topical antibiotics were applied. Patients were randomly assigned to receive penicillin VK 500 mg or identically appearing placebo four times daily for five days. Home wound care was standardized and patients were followed for a minimum of four or five days. Infection was assessed clinically. Seventy-six patients were enrolled and 62 completed the study. Penicillin (30) and placebo (32) groups were similar in all parameters except wound etiology; assault was more common in the placebo group (P = .02). Two infections occurred in patients receiving penicillin, and six infections were seen among placebo-treated patients (P = .05, beta = 0.17). When patients poorly compliant with therapy were eliminated from analysis, none of the penicillin-treated patients and five of the placebo-treated patients developed infections (P = .027). Our data suggest that patients with intraoral wounds may benefit from prophylactic penicillin if compliant with their therapy. More studies are needed to further delineate the usefulness of prophylactic antibiotics for these wounds.

Administration, Oral↗

PubMed1989

Aerosolized metaproterenol in the treatment of asthmatics with severe airflow obstruction. Comparison of two delivery methods.

The bronchodilator response to metaproterenol delivered by metered-dose inhaler (MDI) with a spacer device (Aerochamber [A]) and by jet nebulizer was studied in 44 asthmatic patients who presented to the emergency department with acute severe (FEV1 less than 50 percent predicted) airflow obstruction. The delivery method was randomized, double-blinded and placebo controlled. The A group received one puff of metaproterenol every five minutes for a total of three puffs (1.95 mg). The jet nebulizer group received 15 mg of metaproterenol by continuous nebulization over ten minutes. Only about 2.75 mg of the original 15 mg delivered by jet nebulizer was calculated to be available for inhalation due to the inefficiencies of the delivery system. The mean percentage of improvement in FVC and FEV1 in the A group was 33.5 and 49.0 percent, respectively. The mean percentage of improvement in FVC and FEV1 in the jet nebulizer group was 22.8 and 33.0 percent, respectively. There was no significant difference in the mean percentage of improvement values between the two groups. We were unable to demonstrate a difference in bronchodilator response to metaproterenol delivered by MDI-A and jet nebulizer in emergency department asthmatics with acute severe airflow obstruction.

Adult↗

PubMed1987

An unusual presentation of bilateral facet dislocation of the cervical spine.

We report the case of a patient who presented complaining of neck pain after a fall. Initial physical examination was remarkable for an occipital scalp contusion and tenderness to palpation in the mid-cervical spine. Neurological examination demonstrated an absence of response to pinprick below approximately the T4 level. Upper extremities had equal withdrawal to pain and lower extremities were without movement. Initial cervical, thoracic, and lumbar spine films were normal. An emergency myelogram demonstrated a complete extradural block at the C6 level. Cross-table lateral cervical spine films revealed a C5-C6 bilateral facet dislocation. The patient subsequently underwent closed reduction with in-line-traction. He had a prolonged hospital course and was eventually transferred for rehabilitation, with some improvement in neurologic status.

Adult↗