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Biomedical subjects

S M Joyce

Publications and source records attributed to S M Joyce.

27 records · Page 2Linked to original sources
PubMed1983

Staphylococcal nasal carriage in medical students with varying clinical exposure.

Nasal carriage and antibiotic sensitivities of coagulase-positive and coagulase-negative staphylococci were assessed among medical students of three different years. Although carriage rates did not change, there was a trend towards multiple resistance with increasing hospital exposure. Gentamicin resistance in Staphylococcus albus showed a similar trend. The relevance of these findings to current views on the origin of gentamicin resistance is discussed.

Anti-Bacterial Agents↗
PubMed1983

Transcutaneous cardiac pacing: determination of myocardial injury in a canine model.

Transcutaneous cardiac pacing holds promise as the initial cardiac pacing technique for emergency patients. Determination of the extent of myocardial injury associated with the use of commercial transcutaneous pacemaker devices has been limited. This study was undertaken to document electrocardiographic, enzymatic, and histologic changes following transcutaneous pacing. Ten mongrel dogs were paced with a transcutaneous cardiac pacemaker for 30 minutes. Electrical pulses of 100 mA lasting 20 ms each were delivered at a rate of 80/min via cutaneous electrodes on the anterior and posterior thorax. Myocardial damage was assessed by serial electrocardiograms (ECGs), serial creatine kinase (CK) determinations with myocardial band (MB) fractionation, and gross and microscopic pathologic examination. Double blind reading of the ECGs showed no significant changes after pacing. CK levels peaked an average of 78 units over baseline levels at 4 hours; however, there was no rise in the CK MB fraction. Pathologic examination revealed micro-infarcts adjacent to intramural vessels in 5 animals, but no clinically significant myocardial injury in the 10 dogs. The absence of enzymatic, cardiographic, and clinically significant pathologic findings was statistically significant (P less than .05). Transcutaneous pacing at low currents and for short periods appears to be a safe technique. This pacing technique deserves further evaluation, and may hold promise as a clinical tool during resuscitation.

Animals↗
PubMedDate not supplied

Acute compartment syndrome following a minor athletic injury.

An athletic young male presented with right calf pain following a twisting injury during a soccer game. Other than apparently severe calf pain, no symptoms or signs of compartment syndrome were noted. The patient later returned with lateral and anterior compartment syndrome, and suffered partial loss of peroneal nerve and muscle function despite fasciotomy. Although rare, acute compartment syndrome resulting from seemingly minor injury or exertion has been reported. Pain out of proportion to the apparent injury and a history of chronic leg pain with exertion may be helpful in identifying these patients prior to development of more obvious signs and symptoms. The diagnosis of acute compartment syndrome may be confirmed by compartmental pressure measurement. Prompt intervention is indicated once the diagnosis is established.

Adult↗
PubMedDate not supplied

Beriberi heart disease in a schizophrenic with an unusual diet.

A 37-year-old male presented with peripheral edema of sudden onset. Other signs of heart failure were absent. Subsequent evaluation revealed that the patient was a schizophrenic whose diet consisted almost entirely of carbohydrates. A clinical diagnosis of beriberi heart disease was made and the patient improved dramatically within several days of thiamine supplementation. The presentation of beriberi heart disease in developed countries is discussed. Emphasis is placed on food faddists and psychiatric patients in whom clinical findings may be subtle or absent.

Adult↗
PubMedDate not supplied

Evaluation of a new cervical immobilization/extrication device.

UNLABELLED: A new cervical immobilization device (the Philadelphia Red E.M. Collar with Head Immobilizer/Stabilizer), has been introduced as an adjunct in extricating potentially neck-injured patients. This study compared the efficacy of immobilization using the collar to that of a short spine board. In addition, experienced EMS personnel rated the collar in simulated field situations. METHODS: In Part I of the study, the collar and a short spine board were applied to 25 adult volunteers in a sitting position, using standard methods. Each subject then exerted maximal force in flexion, extension, rotation, and abduction. Degrees of head motion from neutral position were measured in each direction. Mean values were compared using Student's t-test. For Part II, 10 EMS personnel were asked to apply the collar to volunteers. Each rated the performance of the collar on a scale of 1 (poor) to 4 (excellent) regarding: ease of application (sitting and supine), ease of extrication (lifting, logrolling, transfer), access to patient (chest auscultation, CPR, airway management), storage, and overall utility. RESULTS: The collar was significantly better than the short spine board in both lateral and rotational immobilization (p less than 0.001). There was no significant difference for flexion or extension (p greater than 0.05). The Red E.M. limited motion to a mean of 15 degrees or less in any direction. Ratings by EMS personnel for the device (mean+/- standard error) were: ease of application (sitting) 3.5+/-0.2, (supine) 2.7+/-0.2; ease of extrication 3.1+/-0.2; access to patient 3.4+/-0.2; storage 3.1+/-0.3; and overall utility 3.1+/-0.2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Epidemiology of pediatric EMS practice: a multistate analysis.

OBJECTIVE: To describe the epidemiology of pediatric emergency medical services (EMS) practice in a large patient population from several geographic areas. DESIGN: Retrospective computer analysis of EMS databases from four states using a common data set and analysis system. SETTING: Pennsylvania, Tennessee, Mississippi, and Nevada (except Clark County), 1990 through 1992. METHODS: All patient-care reports of patients 14 years old and younger were extracted from the EMS databases and analyzed for the following factors: age, gender, date, elapsed prehospital times, incident type, mechanism of injury, call disposition, illness or injuries encountered, severity of illness/injury (by abnormal vital signs), and basic life support (BLS) and advanced life support (ALS) treatment delivered. RESULTS: A total of 1,512,907 patient care reports were reviewed. Those of 61,132 children were extracted for analysis. These children comprised about 4% of prehospital responses. Male subjects predominated (56%), and children aged 7 through 14 years represented 46% of cases. Most calls occurred in the evening and daylight hours. Children were transported by ambulance in 89% of cases, and care was refused in 7.7%. Mean response time was 9 +/- 16 minutes, mean scene time 12 +/- 14 minutes, and mean transport time 14 +/- 20 minutes. Traumatic incidents predominated at 42%, with motor vehicle accidents and falls the most common mechanisms. Blunt injuries accounted for 94% of trauma, whereas respiratory problems, seizures, and poisoning/overdose were the most common medical problems. Vital signs were obtained in 56% of cases. Abnormal vital signs were noted in 21% of these, and the presumptive causes were similar in distribution to those of the general population, with the addition of cardiac arrest. The most commonly used treatments were spinal immobilization, oxygen administration, intravenous access and several ALS medications. An ALS capability was available in more than half the runs, but ALS treatment was delivered in only 14% of those cases. Outcome data were not available. CONCLUSION: This multistate analysis of pediatric EMS epidemiology confirms findings reported in smaller regional studies, with several exceptions. Excessive scene times were not noted. Few children had serious disorders as evidenced by abnormal vital signs. An ALS treatment, when available, was used infrequently. These findings have implications for EMS planners and educators.

Adolescent↗
PubMedDate not supplied

Efficacy of an EMS quality improvement program in improving documentation and performance.

OBJECTIVE: Change from quality assurance (QA) to quality improvement (QI) in EMS has been adopted by many systems. This study sought to determine whether QI is effective in this setting. METHODS: A QI program comprised of prospective, concurrent, and retrospective components was instituted in 1994 by the Salt Lake City Fire Department. The retrospective component of the program consisted of monthly random audits of approximately 6% of EMS patient care reports (PCRs), both ALS and BLS. PCRs were evaluated for adequate documentation of six patient assessment parameters, appropriate treatment, and short-term outcome. Time intervals and adherence to protocol were also evaluated. Overall documentation and performance were rated. Monthly and cumulative QI reports were circulated to all providers, and both positive feedback and negative feedback were provided to specific crews. Continuing medical education sessions were tailored to address problems identified by the QI audits and scene observation. Results of 1,862 reviews from 1994-1995 were compared with baseline figures from 1993. RESULTS: Response, scene, and transport times were acceptable in more than 90% of cases in both the baseline and the study periods. Statistically significant improvements were noted in the following parameters: documentation of patient assessment, protocol compliance, patient disposition, overall documentation, overall performance, and need for further review. In nontransport cases, both appropriateness of the release decision and acquisition of appropriate signatures improved, but not significantly. CONCLUSION: Significant improvements were noted in 13 of 19 parameters and goals were met in 14, with results sustained over the two-year study period. A quality improvement program can effect significant and sustained improvement in documentation and performance in an EMS system.

Documentation↗
PubMedDate not supplied

Outcomes of sudden cardiac arrest treated with defibrillation by emergency medical technicians (EMT-Ds) or paramedics in a two-tiered urban EMS system.

OBJECTIVE: Controversy exists as to the effectiveness of defibrillation by emergency medical technicians (EMT-Ds) in reducing mortality from cardiac arrest in two-tiered EMS systems. This study was performed to assess the impact of EMT-Ds on outcome of sudden cardiac death in a small, urban, modified two-tiered EMS system. METHODS: This was a retrospective, unmatched case-control study comparing the outcomes of patients suffering sudden cardiac death treated by EMT-Ds with paramedic (EMT-P) backup with the outcomes of patients treated by EMT-Ps as first responders. Outcomes were defined as survival to the following endpoints: hospital admission, hospital discharge, and discharge with normal neurologic function (neurologic survival). Differences between groups were considered significant if p < or = 0.05 by Fisher's exact test or t-test. RESULTS: Three hundred twenty-two patients suffered out-of hospital sudden cardiac deaths over a three-year period and met study inclusion criteria. There were no significant differences in mean age, sex distribution, or incidence of ventricular fibrillation as the presenting rhythm between the groups. Rates of survival to admission, survival to discharge, and neurologic survival were 25.8%, 8.1%, and 5.6%, respectively. Corresponding survival rates for 46 patients treated first by EMT-Ds were 19.6%, 8.7%, and 4.3%. For 276 patients treated by EMT-Ps as first responders, the rates were 26.8%, 8.0%, and 5.8%. There were no significant differences in survival rates between the two response modes, despite a significantly shorter response interval for EMT-Ds (3.6 +/- 1.8 min, vs 4.6 +/- 2.0 min for EMT-Ps). There were likewise no significant differences in survival rates between the two response modes when only patients in ventricular fibrillation or ventricular tachycardia were considered. There were no significant differences in survival rates grouped by presenting rhythm, with the exception of 9.6% neurologic survival in witnessed ventricular fibrillation as compared with 0% in asystole. CONCLUSION: EMT defibrillation had no impact on outcome of sudden cardiac death in this small, urban, two-tiered EMS system. Survival rates were similar to those reported for other such systems. However, power to detect significant differences was low, and further study is indicated. Controlled multicenter trials are recommended.

Aged↗