Biomedical subjects

Eric T Boie

Publications and source records attributed to Eric T Boie.

7 recordsLinked to original sources

PubMed2006

Initial approach to the patient who has chest pain.

The last decade has seen extraordinary advances in the cardiovascular arena, particularly in the evaluation and management of the patient who has acute coronary syndromes. From bedside markers of myocardial damage to drug-eluting stents, technical advances are proliferating. Efforts in developing an international registry for acute aortic dissection have helped elucidate the acute presentation, management, and prognosis of this uncommon but lethal disease. Finally, the multiple research efforts in coordinating clinical decision-making with serologic markers and advanced imaging for the diagnosis of pulmonary embolism is changing the approach to the patient at risk for thromboembolic disease.

Adult↗

PubMed2005

Initial evaluation of chest pain.

Chest pain is among the most frequently evaluated presenting complaints in the emergency department (ED). Diagnostic etiologies range from benign to life-threatening. Failure to diagnose the life-threatening chest emergencies-specifically acute coronary syndrome, aortic dissection, and pulmonary embolism-can lead to catastrophic medical and legal outcomes for the patient and physician respectively. This article focuses on clinical and risk management strategies to minimize misdiagnosis and produce favorable medical and medicolegal outcomes.

Aortic Rupture↗

PubMed2005

Survival of a neurologically intact patient with subarachnoid hemorrhage and cardiopulmonary arrest.

Subarachnold hemorrhage (SAH) is a relatively common cause of cardiopulmonary arrest (CPA). Long-term survival with SAH and CPA is rare, and the vast majority of those who survive have moderate to severe neurologic disability. To our knowledge, there are no prior reports of patients with SAH who experience CPA and survive without neurologic deficit. We describe a patient with SAH who experienced CPA shortly after hospital admission and survived without neurologic sequelae (Cerebral Performance Category 1). Prompt defibrillation of SAH-induced ventricular fibrillation and timely neurologic intervention are essential for good neurologic outcome.

Adult↗

PubMed2004

Evaluation of the educational utility of patient follow-up.

OBJECTIVES: To date, no studies in emergency medicine (EM) have addressed the educational value of the Residency Review Committee for Emergency Medicine's (RRC-EM) requirement for patient follow-up (FU). The authors examined whether performance of patient FU improved EM resident education. METHODS: All EM resident FU encounters from September 25, 2001, through September 24, 2002, were documented and analyzed. All EM residents at a regional tertiary referral emergency department (ED) initiated patient FU encounters by entering information regarding patients' initial ED presentations into a Web-based follow-up system (WBFUS), subsequently entered FU information, and indicated whether they thought that the specific FU encounters improved their education (yes/no). Supervising faculty members then reviewed the residents' completed FU entries. Blinded to residents' responses regarding educational utility, faculty members evaluated whether they thought the specific FU encounters were educational for the residents (yes/no). Data entered into the WBFUS were then summarized as percentages. RESULTS: Eight hundred forty-seven FU encounters were completed by 18 EM residents and 29 EM faculty. Ninety-three percent of the FU entries were deemed by at least one evaluator (resident or faculty) to have educational value. Residents found the act of performing FU educational in 81.3% of cases, whereas faculty thought 80.4% were educational for the resident. Although the residents and faculty agreed on the educational value in 75.4% of cases, the overall strength of the agreement was slight to fair (kappa statistic = 0.21). CONCLUSIONS: This study indicates that EM residents and faculty believe that the act of performing patient FU has educational value for EM residents; however, the interobserver agreement between residents and faculty was low.

Adolescent↗

PubMed2003

The left-without-being-seen patients: what would keep them from leaving?

STUDY OBJECTIVE: We determine which services, if any, an emergency department (ED) could provide to help a patient who left the ED without being seen by a physician wait longer to see a physician. METHODS: In this retrospective observational study, patients who had left the Saint Marys Hospital ED without being seen by a physician were surveyed by telephone. The Saint Marys Hospital ED is a 43-bed facility with an annual patient volume of 77600 located in a city of 82000. Responders were questioned regarding 15 specific services the Saint Marys Hospital ED could provide to help them wait longer. Eligible participants included willing adults, parents accompanying patients younger than 18 years of age, and patients between the ages of 13 and 18 years whose parents granted permission. Participants were excluded if they denied research authorization, did not speak English, refused to participate, or were unable to be contacted. RESULTS: Between April 9, 2001, and July 17, 2001, 20494 patients registered, 172 patients left without being seen, and 152 patients approved research authorization; we attempted to contact these patients. In total, 97 patients, their parents, or their caretakers completed the entire interview (56.4% of those who left without being seen, 63.8% of those with whom contact was attempted). Nearly 85% of responders retrospectively identified "more frequent updates on wait time" and 70.1% identified "the availability of immediate temporary treatments" as services that would have helped them wait longer. Other waiting room services were identified by fewer than half of the responders as potentially helpful in allowing them to wait longer. CONCLUSION: Communication of estimated waiting time and the availability of immediate treatments for minor injuries or symptoms might increase the time patients are willing to wait and therefore might decrease an ED's rate of patients leaving without being seen.

Adolescent↗

PubMed2003

Pulmonary embolism.

PE is one of the great challenges in medicine. It is a disease that carries with it a high mortality rate, yet no historical piece of information, physical examination finding, or diagnostic modality is perfect at excluding its possibility. Emergency physicians must be vigilant about considering PE in the differential diagnosis of a variety of presenting complaints and must use a variety of diagnostic and therapeutic options as they manage patients with suspected or confirmed PE. The diagnostic options range from bedside diagnostic tests to highly specialized imaging available at only specialized institutions. Knowing the advantages and disadvantages of each of the diagnostic modalities assists the physician in employing the best test. Therapeutic options also vary widely and include anticoagulation, vena caval interruption, systemic thrombolysis, embolectomy, and other therapeutic adjuncts, such as ECMO and inhaled nitric oxide. Similarly, awareness of the indications and contraindications to the varied therapeutic agents ensures appropriate therapy when the diagnosis is made.

Anticoagulants↗

PubMed2002

Should parents be present during emergency department procedures on children, and who should make that decision? A survey of emergency physician and nurse attitudes.

OBJECTIVE: To survey physician and nurse attitudes regarding parental presence during painful procedures on children performed in the emergency department (ED) and who should make that decision. METHODS: The design was an anonymous written survey consisting of six clinical scenarios distributed to all staff and resident physicians and nurses in ten EDs at institutions in the United States routinely caring for children. Participants were asked whether parents should remain with children undergoing intravenous (IV) placement, laceration repair, lumbar puncture, conscious sedation, major resuscitation, and major resuscitation with death. They also were asked who should make the decision. RESULTS: The percentage of physicians who responded that parents should be present was 91.3% for peripheral IV start, 93.3% for laceration repair, 65.7% for lumbar puncture, 83.1% for conscious sedation, 31.9% for major resuscitation, and 35.6% for major resuscitation where death was likely. The percentage of nurses who responded that parents should be present was 86.8% for peripheral IV start, 89.6% for laceration repair, 55.0% for lumbar puncture, 74.9% for conscious sedation, 41.4% for major resuscitation, and 54.3% for major resuscitation where death was likely. In 64.8% of the completed surveys, the physicians indicated that they alone or in conjunction with a parent should make the decision. In 61.5% of the completed surveys, the nurses indicated that they should be involved in the decision. CONCLUSIONS: A majority of emergency physicians and nurses indicated parents should be present for some invasive pediatric procedures. However, as the invasiveness of the pediatric procedures increased, fewer physicians and nurses believed that parents should be present.

Adult↗