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Biomedical subjects

J A Salomone

Publications and source records attributed to J A Salomone.

13 recordsLinked to original sources
PubMed1996

Patient understanding of emergency department discharge instructions.

Patients were interviewed immediately after discharge outside the emergency department to determine whether they could read their discharge instructions and recall their diagnosis and treatment plan. The association between frequency of correct responses and various characteristics of the patients was assessed. Of the patients completing the interview, 72% could read the discharge instructions. The illiteracy rate was higher for patients with less than 9 years of education and for patients aged 50 to 59 years. There was no association between patient race, sex, or literacy. The correct diagnosis was given by 79% of patients, correct treatment information by 49%, and correct follow-up information by 82%. Overall, 37% of patients answered all questions correctly and 8% answered all questions incorrectly. No association was found between frequency of correct responses and variables examined. Miscommunication of discharge information occurs frequently; illiteracy does not completely account for the observed low rates of recall.

Adolescent↗
PubMed1995

Validation of a rapid urine screening assay for cocaine use among pregnant emergency patients.

OBJECTIVES: To determine the accuracy of the OnTrak rapid urine latex agglutination immunoassay (AIA) for testing pregnant ED patients for the cocaine metabolite benzoylecgonine (BE), and to determine the frequency of urine BE in pregnant ED patients and the association of test results with patient demographics. METHODS: A test performance evaluation was conducted using an inception cohort of pregnant patients at an urban teaching hospital ED. Patients with positive urine chorionic gonadotropin tests who had adequate remaining urine samples were studied. Patient demographics, ED diagnoses, and assay results were recorded without patient identifiers. Urine was tested using the rapid AIA. The first 150 samples were confirmed using a second immunoassay and gas chromatography with a nitrogen phosphorus detector. All positive samples also were confirmed with thin-layer chromatography, and quantification by gas chromatography-mass spectrometry. RESULTS: Twenty of 342 (5.9%, 95% CI 3.4-8.4%) pregnant patients had urine samples positive by AIA testing for BE. Confirmation testing demonstrated no false-positive or -negative AIA result. Positive test results were not associated with specific patient diagnoses or demographics. CONCLUSIONS: ED screening for cocaine use among pregnant patients can be accurately performed using the OnTrak AIA for BE. In the ED population screened, 5.9% of the pregnant women had urine samples positive for BE.

Adult↗
PubMed1994

An evaluation of the role of the ED in the management of migraine headaches.

The objective of this study was to describe the characteristics and clinical course of patients who receive emergency department (ED) migraine treatment and their association with frequent ED visits. All migraine patient records during a 42-month period were reviewed retrospectively at an urban teaching hospital ED. One hundred eighty-five migraine patients had 339 total visits; 133 had a single visit; 31 had two visits; and 21 patients had three or more ED visits (range, 3 to 26 visits). Patients with three or more visits accounted for 42.5% of all ED migraine visits. Drugs were administered in 82.3%, and efficacy was documented in 49% of ED visits. Complete or considerable relief was noted in 64.5% of visits. Drug abuse was infrequently identified in migraine patients. Most migraine patients seem to use the ED appropriately. A small group (11.4%) of patients accounted for 42.5% of all ED visits. Given the nature of severe, frequent migraines and the current lack of consistently effective therapy, this may be a common ED phenomenon. More effective management strategies and therapy that will enable patients to reduce their dependence on the ED for treatment would be useful for patients with multiple ED visits.

Adult↗
PubMed1993

Ambulance arrival to patient contact: the hidden component of prehospital response time intervals.

STUDY OBJECTIVE: To determine the time between ambulance arrival at the scene to paramedic arrival at the patient (arrival to patient contact) and the effect of barriers to paramedic movement on this time interval. DESIGN: A prospective, observational study. Time intervals were collected by independent third-party riders on emergency (Code 1 and Code 2) calls. Potential barriers to paramedic movement were recorded. SETTING: Public utility model urban emergency medical services system. TYPE OF PARTICIPANTS: Two hundred thirty-two emergency ambulance calls were observed, and data were analyzed from 216. INTERVENTIONS: None. RESULTS: The median arrival-to-patient contact interval for all calls was 1.33 minutes (interquartile range, 0.67 to 4.13 minutes). Barriers prolonged the arrival-to-patient contact interval (P < .001, Kolmogorov-Smirnov test). The median arrival-to-patient contact interval was 2.29 minutes (1.01 to 4.82 minutes) for 122 runs with barriers and 0.82 minutes (0.37 to 1.96 minutes) for 94 runs without barriers. CONCLUSION: The arrival-to-patient contact interval adds a variable and potentially lengthy amount of time to the total prehospital response time interval, and barriers impeding paramedic movement to the patient prolong this time interval. In 25% of all observed paramedic calls, the arrival-to-patient contact interval was more than four minutes. Measurement of the time from ambulance arrival on the scene to paramedic arrival at the patient is necessary to appropriately determine the relationship among total prehospital response time, paramedic interventions, and patient outcome.

Ambulances↗
PubMed1990

Clinically significant radiograph misinterpretations at an emergency medicine residency program.

Radiographic misinterpretation rates have been suggested as a quality assurance tool for assessing emergency departments and individual physicians, but have not been defined for emergency medicine residency programs. A study was conducted to define misinterpretation rates for an emergency medicine residency program, compare misinterpretation rates among various radiographic studies, and determine differences with respect to level of training. A total of 12,395 radiographic studies interpreted by emergency physicians during a consecutive 12-month period were entered into a computerized data base as part of our quality assurance program. The radiologist's interpretation was defined as correct. Clinical significance of all discrepancies was determined prospectively by ED faculty. Four hundred seventy-five (3.4%) total errors and 350 (2.8%) clinically significant errors were found. There was a difference in clinically significant misinterpretation rates among the seven most frequently obtained radiograph studies (P less than .0005, chi 2), accounted for by the 9% misinterpretation rates for facial films. No difference (P = .421) was noted among full-time, part-time, third-year, second-year, and "other" physicians. This finding is likely due to faculty review of residents' readings. Evaluation of misinterpretation rates as a quality assurance tool is necessary to determine the role of radiographic quality assurance in emergency medicine resident training. Educational activities should be directed toward radiographic studies with higher-than-average reported misinterpretation rates.

Diagnostic Errors↗
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

Hemodynamic and respiratory effects of thyrotropin-releasing hormone and epinephrine in anaphylactic shock.

Thyrotropin-releasing hormone (TRH) has been shown to increase mean arterial pressure during anaphylactic shock. The hemodynamic mechanism of action and the effect of TRH on the respiratory system during anaphylactic shock are not known. A rabbit model of anaphylaxis was used to determine the effect of TRH, epinephrine (EPI), and normal saline (NS) on various cardiovascular and respiratory parameters during anaphylactic shock. Anaphylactic shock was induced by antigen challenge in 31 sensitized animals. After a 25% decrease in mean arterial pressure, they were randomly treated with TRH (2 mg/kg), EPI (0.005 mg/kg), or NS (10 mL/kg). Blood was drawn at baseline and at the end of the experiment for laboratory analysis. Cardiac and respiratory parameters were monitored continuously and measured at baseline, at onset of shock (time zero), and at time intervals for 30 minutes. Animals were treated with repeated doses during the first 15 minutes as needed to maintain mean arterial pressure above shock level. Five of ten TRH-, five of 11 EPI-, and six of ten NS-treated animals survived. The TRH-treated group required fewer doses than the other groups and had increased heart rate, mean arterial pressure, peripheral vascular resistance, respiratory rate, and minute ventilation as well as decreased stroke volume index and lung compliance compared with the NS-treated group. EPI treatment resulted in increased minute ventilation and decreased pulmonary airway resistance compared with NS treatment. The EPI group also had a higher postsurvival epinephrine level than the other groups. No difference in right atrial pressure, cardiac index, acid-base status, pO2, A- a gradient, lung weight, lactate, or norepinephrine levels was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Resistance↗
PubMed1989

Field times.

Explore the source record for details and available documents.

Emergency Medical Services↗
PubMed1988

Blood pressure effects of thyrotropin-releasing hormone and epinephrine in anaphylactic shock.

To compare the effects of a single dose of thyrotropin-releasing hormone (TRH), epinephrine, and control (normal saline) on mean arterial pressure (MAP) and survival over a one-hour observation period, we carried out a randomized, blinded study using a rabbit model of anaphylaxis. Epinephrine resulted in an increased MAP over normal saline and TRH at one minute after treatment (P less than .001). TRH resulted in an increased MAP over normal saline at two minutes (P less than .017) and over epinephrine at four minutes (P less than .011) after treatment. No differences in MAP were detected beyond four minutes after treatment. There was no difference in survival between treated and control animals (alpha less than .168). Although no difference in survival existed, TRH had a slower onset, but more sustained effect on MAP than did epinephrine and normal saline.

Anaphylaxis↗
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↗
PubMedDate not supplied

System implications of the ambulance arrival-to-patient contact interval on response interval compliance.

BACKGROUND: In some emergency medical services (EMS) system designs, response time intervals are mandated with monetary penalties for noncompliance. These times are set with the goal of providing rapid, definitive patient care. The time interval of vehicle at scene-to-patient access (VSPA) has been measured, but its effect on response time interval compliance has not been determined. PURPOSE: To determine the effect of the VSPA interval on the mandated code 1 (< 9 min) and code 2 (< 13 min) response time interval compliance in an urban, public-utility model system. METHODS: A prospective, observational study used independent third-party riders to collect the VSPA interval for emergency life-threatening (code 1) and emergency nonlife-threatening (code 2) calls. The VSPA interval was added to the 9-1-1 call-to-dispatch and vehicle dispatch-to-scene intervals to determine the total time interval from call received until paramedic access to the patient (9-1-1 call-to-patient access). Compliance with the mandated response time intervals was determined using the traditional time intervals (9-1-1 call-to-scene) plus the VSPA time intervals (9-1-1 call-to-patient access). Chi-square was used to determine statistical significance. RESULTS: Of the 216 observed calls, 198 were matched to the traditional time intervals. Sixty-three were code 1, and 135 were code 2. Of the code 1 calls, 90.5% were compliant using 9-1-1 call-to-scene intervals dropping to 63.5% using 9-1-1 call-to-patient access intervals (p < 0.0005). Of the code 2 calls, 94.1% were compliant using 9-1-1 call-to-scene intervals. Compliance decreased to 83.7% using 9-1-1 call-to-patient access intervals (p = 0.012). CONCLUSION: The addition of the VSPA interval to the traditional time intervals impacts system response time compliance. Using 9-1-1 call-to-scene compliance as a basis for measuring system performance underestimates the time for the delivery of definitive care. This must be considered when response time interval compliances are defined.

Ambulances↗