Biomedical subjects

R Sapien

Publications and source records attributed to R Sapien.

8 recordsLinked to original sources

PubMed2000

Repeat ambulance use by pediatric patients.

OBJECTIVE: To compare pediatric patients transported by ambulance on more than one occasion (repeat) with those transported only once. METHODS: The authors analyzed pediatric (patient < 21 years old) transports for 1992-1995 by the ambulance service that provides 99% of transports for a non-innercity metropolitan area. Repeat transports were compared with single transports with regard to patient age, gender, chief complaint, and payment source. RESULTS: There were 17,448 transports involving 15,168 patients. Nearly half (49.0%) of the repeat transports involved patients in the oldest age category, 17 to 20.9 years, contrasted with 38.0% of single transports (p < 0.00001). Females comprised 51.4% of the repeat transports and 48.5% of the single transports (p = 0.0008). Traumatic complaints accounted for one-third (33.0%) of the repeat transports and half (51.1%) of the single transports (p < 0.0001). Chief complaints of the patients with repeat transports were more likely to be seizure, assault, abdominal pain, and respiratory problems, and less likely to be falls and motor vehicle-related complaints, than chief complaints of the patients with single transports (p < 0.0001). More than one-third (39.0%) of the repeat transports were funded by Medicaid, in contrast with 19.8% of the single transports (p < 0.0001). CONCLUSIONS: Compared with single transports, repeat transports were more likely to involve patients more than 16 years of age, female, and with a chief complaint of seizure, assault, abdominal pain, or respiratory distress, and more likely to be funded by public insurance (Medicaid). Repeat pediatric transports warrant further investigation. This information may be useful in designing interventions targeted at reducing emergencies and hence ambulance use.

Adolescent↗

PubMed2000

Telephone triage

Explore the source record for details and available documents.

Journal Article↗

PubMed1998

Prehospital treatment of acute asthma in a rural state.

BACKGROUND: Acute asthma exacerbations can be life threatening and are recognizable to emergency medical service (EMS) personnel; however, the therapies and medications which these emergency service personnel can use to treat exacerbations are limited. Several studies have demonstrated the effective use of beta2-agonist therapy in the treatment of patients complaining of wheezing or dyspnea, yet few EMS personnel can administer them. OBJECTIVE: The purpose of this study was to determine what therapeutic interventions emergency personnel around the state of New Mexico could use when responding to a call for a severe asthma exacerbation. METHODS: Questionnaires were distributed over a period of three years, 1992-1994, to all Emergency Service Agencies in New Mexico. RESULTS: Eighty percent of the emergency medical personnel administer oxygen to patients experiencing acute asthma exacerbations. Seventeen percent of EMS personnel administer epinephrine, 4% administer steroids, and only 23% administer beta2 agonists. Only in more populated areas were EMS personnel allowed to administer beta2 agonists, and those personnel had to have at least intermediate-level training. Most emergency response teams in the state consisted of EMT Basics and provided only basic life support services. In rural New Mexico, transport to a hospital can often take over one hour, which left EMS crews feeling helpless. CONCLUSIONS: We conclude that due to the rural nature of New Mexico, EMS personnel should be trained in the use of beta2 agonists and allowed to administer them to patients with acute asthma exacerbations. In addition, standard protocols for the pre-hospital management of acute asthma exacerbations should be instituted.

Acute Disease↗

PubMed1993

Analysis of childhood pedestrian deaths in New Mexico, 1986-1990.

STUDY OBJECTIVE: To determine if the mechanism of fatal childhood pedestrian injuries correlated with location, injury pattern, and age of the pedestrian and to determine ethnic differences in fatality rates. DESIGN: Retrospective review of state medical investigator reports and autopsies from 1986 to 1990. Logistic regression and chi 2 were used to test for statistically significant differences between the groups in our data set. TYPE OF PARTICIPANTS: New Mexican children, 0 to 14 years old fatally injured by moving vehicles. RESULTS: Sixty-four children died for an overall fatality rate of 3.8 (per 100,000). Native American children and children younger than 5 years experienced the highest fatality rates. Children younger than 5 years were more likely to be crushed under the wheels of a slow-moving vehicle in both a nontraffic and a traffic location, whereas older children were found more often to have died from injuries from a high-speed impact event in a traffic location (P < .001). Leg fractures (P = .001) and spinal fractures (P = .02) occurred more frequently in impact than crush injuries. CONCLUSION: Young children are at risk for a crush injury in both the traffic and nontraffic environment.

Accidents, Traffic↗

PubMed1992

Intraosseous versus intravenous epinephrine infusions in lambs: pharmacokinetics and pharmacodynamics.

Intraosseous and intravenous administrations of epinephrine were compared in newborn lambs. Plasma epinephrine levels were measured during each route of drug administration and used to calculate steady-state epinephrine clearance rate and to compare cardiovascular responses with plasma levels. Epinephrine was administered at a dose of 0.5 to 5 micrograms/kg/min. We observed first-order (linear) clearance kinetics by both routes of drug administration. The plasma epinephrine clearance rate was 186 +/- 17 ml/kg/min by the intraosseous route versus 174 +/- 11 ml/kg/min by the intravenous route. Dose responses were analyzed by computerized fit to a threshold model. The plasma epinephrine threshold, or lowest plasma level beyond which discernible increases in blood pressure occur, was slightly lower after intravenous than after intraosseous drug administration, 2.0 +/- 0.6 ng/ml versus 4.0 +/- 0.9 ng/ml of epinephrine. Both thresholds were within the ranges of plasma epinephrine levels that would be achieved at doses of 0.4 to 0.6 microgram/kg/min by either route. Other hemodynamic responses, including the maximum systolic blood pressure and degree of reflex bradycardia, were comparable. These results support the effectiveness of the intraosseous route for epinephrine administration.

Animals↗

PubMed1992

Prolonged beta-agonist infusion does not induce desensitization or down-regulation of beta-adrenergic receptors in newborn sheep.

In adult animals, prolonged beta-agonist exposure leads to down-regulation of beta-adrenergic receptors and desensitization. Prior evidence from our lab suggests that this may not occur in developing animals. To study this, we measured the response to graded epinephrine infusion [2.7, 5.5, 13.6, 27.3 mumol/(kg.min), (0.5, 1.0, 2.5, 5.0 micrograms/(kg.min)], myocardial beta-agonist receptor density, and components of the receptor-cyclase system in newborn lambs before (n = 6) and after (n = 5) 3 d of continuous isoproterenol administration (2 micrograms/kg/min). beta-Adrenergic receptors were measured by radioligand binding. Epinephrine dose-response curves were analyzed for the threshold and slope for changes in mean blood pressure, systolic blood pressure, and heart rate versus plasma epinephrine levels. Despite 3 d of continuous isoproterenol infusion, we observed no desensitization of the hemodynamic response to epinephrine. There was a reduction in receptor density when expressed per membrane protein [155.3 +/- 19.5 (controls) versus 73.2 +/- 3.8 fmol/mg protein (agonist exposed), p less than 0.05], but no alteration in receptor density when expressed per g cardiac wet weight [258.8 +/- 39.9 (controls) versus 406.8 +/- 74.0 fmol/g wet weight (agonist exposed)]. There was no alteration in agonist affinity or in adenylyl cyclase activity after adjustment for membrane protein recovery. Prolonged beta-agonist infusion in newborn lambs does not desensitize hemodynamic responses to infused epinephrine. We propose that receptor regulation in developing animals is fundamentally different than in adult animals.

Adrenergic beta-Agonists↗

PubMed1990

Equipping and preparing the office for emergencies.

It is the practitioner's responsibility to have a prepared office to aid the emergently ill child. Basic equipment and staff training are essential. The pediatrician and family practitioner are on the front lines of pediatric emergency care and, with minimal equipment and training, can serve a vital role in the initial stabilization of the critically ill child.

Child↗

PubMedDate not supplied

Eleven-year-old male with high-voltage electrical injury and premature ventricular contractions.

We present a case of a boy with potential high-voltage electrical injury. The patient sustained electrical injuries after his kite became entangled in a high-power electrical line. He presented to the emergency department with minor external electrical burns and frequent premature ventricular contractions (PVCs). The patient's clinical course is outlined. A discussion of the epidemiology of high-voltage electrical injury in children and the clinical management of electrical-injury-induced cardiac complications is provided. Although cardiac abnormalities are found in a significant proportion of high-voltage electrical injuries, the vast majority are evident within 12 h, resolve spontaneously within a few days, and cause little or no long-term sequelae. A small proportion of normal children have clinically benign PVCs.

Child↗