Biomedical subjects

Philip Salen

Publications and source records attributed to Philip Salen.

5 recordsLinked to original sources

PubMed2005

Does the presence or absence of sonographically identified cardiac activity predict resuscitation outcomes of cardiac arrest patients?

This study evaluated the ability of cardiac sonography performed by emergency physicians to predict resuscitation outcomes of cardiac arrest patients. A convenience sample of cardiac arrest patients prospectively underwent bedside cardiac sonography at 4 emergency medicine residency-affiliated EDs as part of the Sonography Outcomes Assessment Program. Cardiac arrest patients in pulseless electrical activity (PEA) and asystole underwent transthoracic cardiac ultrasound B-mode examinations during their resuscitations to assess for the presence or absence of cardiac kinetic activity. Several end points were analyzed as potential predictors of resuscitations: presenting cardiac rhythms, the presence of sonographically detected cardiac activity, prehospital resuscitation time intervals, and ED resuscitation time intervals. Of 70 enrolled subjects, 36 were in asystole and 34 in PEA. Patients presenting without evidence of cardiac kinetic activity did not have return of spontaneous circulation (ROSC) regardless of their cardiac rhythm, asystole, or PEA. Of the 34 subjects presenting with PEA, 11 had sonographic evidence of cardiac kinetic activity, 8 had ROSC with subsequent admission to the hospital, and 1 had survived to hospital discharge with scores of 1 on the Glasgow-Pittsburgh Cerebral Performance scale and 1 in the Overall Performance category. The presence of sonographically identified cardiac kinetic motion was associated with ROSC. Time interval durations of cardiac resuscitative efforts in the prehospital environment and in the ED were not accurate predictors of ROSC for this cohort. Cardiac kinetic activity, or lack thereof, identified by transthoracic B-mode ultrasound may aid physicians' decision making regarding the care of cardiac arrest patients with PEA or asystole.

Adolescent↗

PubMed2005

Synchronized emergency department cardioversion of atrial dysrhythmias saves time, money and resources.

The strategy of elective synchronized cardioversion (EDCV) of new onset atrial fibrillation/flutter (AF/flutter) compares favorably to that of Emergency Department (ED) rate control and inpatient admission. This 1-year study comprised consecutive ED synchronized cardioversions performed on patients with new onset (< 48 h) AF/flutter; all were hemodynamically stable. A control group was obtained by chart review of all patients meeting the inclusion criteria admitted in the same year who were managed with rate control in the ED and inpatient admission. Thirty ED cardioversions were performed on 24 patients. Twenty-nine of 30 (97%) of ED cardioversions were successful. The mean hospital length of stay (LOS) for the EDCV group, including those admitted, was 22.8 h (95% CI: 1.7-44.0) compared to the control group: 55.6 h (all admitted) (95% CI: 41.6-69.6). Median LOS for the entire EDCV group was 4 h, compared with 39.3 h for the controls (p < 0.001). There was also a significant difference in median hospital charge, including ED care: EDCV group: $1598 vs. controls $4271 (p < 0.001). All of the study patients were contacted by telephone a minimum of 4 weeks after cardioversion to assess for complications, recidivism, and satisfaction. There were no complications in the EDCV group, and all expressed satisfaction with the procedure. Elective synchronized cardioversion in the ED is an effective strategy for management of new-onset AF/flutter and is associated with significant decreases in charges and length of stay as well as a high degree of patient satisfaction.

Adult↗

PubMed2003

Effect of physostigmine and gastric lavage in a Datura stramonium-induced anticholinergic poisoning epidemic.

This study examines the impact of the administration of physostigmine and of nasogastric evacuation of Jimsonweed seeds on intensive-care unit (ICU) use and the length of stay in the hospital after Jimsonweed poisoning. Clinical data for this retrospective study were gathered from records of consecutive patients treated for Jimsonweed poisoning from September to November 1997. Descriptive statistics, Fisher's exact test, and Student t-test were used to analyze important clinical and sociodemographic variables. There were 17 victims of the Jimsonweed ingestion epidemic, all of whom presented with an anticholinergic toxidrome 3 to 9 hours after ingestion. Reported quantities of seed ingestion ranged from a low of 7 seeds to as high as 200 seeds. Altered mentation, manifested by combative behavior, necessitated admission of 13 patients to the ICU. The administration of physostigmine did not reduce admissions to the ICU (P = 0.54) or reduce length of stay in the hospital (P = 0.45) compared with the use of benzodiazepines alone. Nasogastric lavage was performed in 14 (82%) and seeds were recovered in 8 (57%) of those lavaged. The successful removal of Jimsonweed seeds did not decrease ICU use rates (P = 0.68) or shorten length of stay in the hospital compared with not recovering seeds (P = 0.85). The use of physostigmine and the successful nasogastric lavage of Jimsonweed seeds did not result in decreased intensive-care use or shorter length of stay in the hospital for Jimsonweed-induced anticholinergic toxicity.

Adolescent↗

PubMed2003

Methodological and statistical techniques: what do residents really need to know about statistics?

The purpose of this study was to catalog the statistical methods used in six journals two each from the fields of Family Practice, Emergency Medicine, and Obstetrics and Gynecology. We reviewed the quantitative articles from January 1998 through December 2000 from the Journal of Family Practice, the Journal of Family Medicine, the Annals of Emergency Medicine, the Journal of Academic Emergency Medicine. Articles from January 2000 through December 2000 of Obstetrics and Gynecology and the American Journal of Obstetrics and Gynecology were also included. Case reports and editorials were not included in this analysis. There were a total of 1828 articles reviewed (666 from Emergency Medicine articles, 380 from Family Practice, and 782 from Obstetrics and Gynecology). The distribution of study types (cross-sectional or survey, retrospective, or prospective) did not differ between the selected journals within Emergency Medicine, Family Practice, or Obstetrics and Gynecology. Pearson's chi-square/Fisher's Exact test was the statistic of choice overall (47.5%) followed by Student's t-test (33.1%). Analysis-of-variance was used in 23.3% of the studies, nonparametric methods (8.1%), linear regression (17.6%), and odds ratios/logistic regression (17.4%). Other statistical procedures were used less than 10% of the time. These results show that a physician who comfortably comprehends the appropriate use of descriptive statistics Student's t-test, Pearson's chi-square/Fisher's Exact test will be able to read and interpret at least 70% of the published medical literature. Educational efforts should focus on appropriate study design and analysis.

Clinical Competence↗

PubMed2003

ED screening to identify abdominal aortic aneurysms in asymptomatic geriatric patients.

Although more than 5% of the geriatric male population is thought to have an abdominal aortic aneurysm, no study has evaluated the ability of ED physician sonographers to screen for this condition. The purpose of this study was to evaluate whether a screening program to sonographically identify abdominal aortic aneurysms would result in increased identification of this potentially lethal disease. This prospective clinical study used a convenience sample and was performed in a community teaching hospital ED. Hemodynamically stable male patients > or = 65 years of age presenting for reasons other than back, flank, or abdominal pain were eligible. After obtaining informed consent, patients underwent bedside ultrasound of the abdominal aorta by EPs. All participating physician sonographers met SAEM credentialing recommendations for performing sonography. The maximal transverse diameter of the aorta was measured at each of three locations: proximal, mid, and distal aorta. All patients with aortic diameters > or = 3.0 cm were confirmed by formal ultrasound in the radiology department. Over a 12-month period, 103 subjects were enrolled in the study. ED physician sonographers identified eight patients with abdominal aortic diameters > or = 3.0 cm. Abdominal aortic aneurysm was confirmed in 6 of 8 subjects, yielding a positive predictive value of 75%. An EP sonographic screening program can identify abdominal aortic aneurysms in asymptomatic men older than 65 years of age.

Aged↗