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Biomedical subjects

J Wasserberger

Publications and source records attributed to J Wasserberger.

At least 19 recordsLinked to original sources
PubMed2001

Use of V4R in patients who sustain blunt chest trauma.

OBJECTIVE: In blunt chest trauma, the right ventricle is more vulnerable than the left. The purpose of this study was to determine whether recording V4R in patients with blunt chest trauma would provide additional useful information to that already obtained from the standard 12-lead electrocardiogram (ECG). METHODS: Forty-five patients with blunt chest trauma and 40 unmatched control subjects without blunt chest trauma had standard 12-lead ECG and right precordial leads recorded. The ECGs were read blindly by three physicians. RESULTS: Patients with chest trauma were distinguishable from controls on the basis of the left-sided ECGs (odds ratio, 2.9; 95% confidence interval, 1.71-4.90). This was not the case using V4R (odds ratio, 1.23; 95% confidence interval, 0.59-2.0). CONCLUSION: Patients with a significant mechanism and physical findings of blunt chest trauma were more likely than controls to have an abnormal ECG. They were not more likely to have abnormalities in V4R. We recommend that a 12-lead ECG, but not V4R, be routinely obtained on these patients.

Adolescent↗
PubMed1995

Hospital costs of firearm injuries.

UNLABELLED: The purpose of this study was to provide economic, epidemiologic, and clinical data on initial hospitalizations of patients with firearm injuries. DESIGN: Concurrent prospective study; data obtained by medical records review. SETTING: A county university teaching hospital designated a level I trauma center. SUBJECTS: 34,893 persons first hospitalized for firearm injuries at the King/Drew Medical Center in Los Angeles from January 1978 through December 1992. RESULTS: The aggregate hospital cost for 34,893 firearm injuries, exclusive of professional fees, was $264,506,455.00, of which 96% was borne directly or indirectly by public funds. The charge for initial hospitalizations was $240,700,855.00. Mean and median initial charges per case were $6898.00 and $1,022.00, respectively (range, $944.00 to $296,232.00). The 5% of patients with charges greater than $100,000 accounted for 42% of all charges; 45% of all patient days were attributable to the 4% patients, with hospitalizations lasting more than 30 days. Three thousand thirty-one patients were rehospitalized a total of 4,578 times; charges for rehospitalization totaled $23,805,600.00. At least 55% (75% of identifiable weapon and missile injuries) of all charges resulted from handgun injuries. Treating the majority of patients on an outpatient basis and by using selective angiography for extremity wounds, a savings of more than $775,000,000.00 resulted. The potential cost of treating gunshot wounds at a single county hospital was more than $1 billion, or more than $100 million per year. CONCLUSIONS: The costs for hospital treatment of firearm injuries are substantial. A lack of rehabilitation facilities forces prolonged acute hospital admissions in many cases. Avoiding prolonged hospitalization may be helpful in controlling these costs, but will be difficult to achieve. Ninety-six percent of the patients in this report had their costs of care covered by the government, because they had no primary insurance coverage. Primary prevention of firearm injuries, especially those caused by handguns, may be the most effective cost-control measure.

Firearms↗
PubMed1995

Gunshot wounds seen at a county hospital before and after a riot and gang truce: Part Two.

An analysis was undertaken of the number of gunshot wound victims seen at a Los Angeles County hospital both before and after the Los Angeles riot. Since the LA riot the gang truce between the "Bloods" and the "Crips" resulted in a significant decrease in the number of gunshot wound victims seen at a level I trauma center in Los Angeles. Unfortunately, this lasted for only three months. The resurgence of shootings, mainly of the drive-by type (82%), to an occurrence rate higher than ever before, has negated any positive effect of the gang truce and indicates the need for additional measures to control gang violence.

Adolescent↗
PubMed1995

Prospective, randomized trial of survivor values of cardiac index, oxygen delivery, and oxygen consumption as resuscitation endpoints in severe trauma.

The objective was to test prospectively supranormal values of cardiac index (CI), oxygen delivery index (DO2I), and oxygen consumption index (VO2I) as resuscitation goals to improve outcome in severely traumatized patients. We included patients > or = 16 years of age who had either (1) an estimated blood loss > or = 2000 mL or (2) a pelvic fracture and/or two or more major long bone fractures with > or = four units of packed red cells given within six hours of admission. The protocol resuscitation goals were CI > or = 4.5 L/min/m2, DO2I > or = 670 mL/min/m2, and VO2I > or = 166 mL/min/m2 within 24 hours of admission. The control resuscitation goals were normal vital signs, urine output, and central venous pressure. The 50 protocol patients had a significantly lower mortality (9 of 50, 18% vs. 24 of 65, 37%) and fewer organ failures per patient (0.74 +/- 0.28 vs. 1.62 +/- 0.45) than did the 75 control patients. We conclude that increased CI, DO2I, and VO2I seen in survivors of severe trauma are primary compensations that have survival value; augmentation of these compensations compared to conventional therapy decreases mortality.

Adolescent↗
PubMed1995

Weapon carriage among major trauma victims in the emergency department.

OBJECTIVE: To determine the occurrence of weapon carriage by major trauma patients at a university/county hospital ED. METHODS: Retrospective observational study of major trauma patients seen in the ED of a major urban trauma center in Los Angeles from 1979 to 1993. All major trauma patients were searched routinely for weapons by the security police. Cases of violence in the ED caused by these weapons were reviewed. RESULTS: Over the 14-year period, 26.7% of the victims of major trauma presenting to ED were armed with lethal weapons. The occurrence of automatic weapon seizure increased significantly from an annual rate of only 0.2 in the first five years to an average of 17 over the last five years (p < 0.001). A total of 115 "incidents" of violence involving weapons in the ED were recorded during this period; 1.7% of the weapons brought to the ED led to violence and injury. There were four fatalities of armed and dangerous patients, but only six minor injuries to the staff. No other (unarmed) patient in the ED at the time of these incidents was injured. CONCLUSION: ED major trauma patients at one urban trauma center in Los Angeles frequently carry weapons, including automatic military weapons. In addition to violence prevention measures such as weapon confiscation, plans must be made and practiced for the management of violence within the "sacrosanct" hospital doors to protect both patients and ED personnel.

Adolescent↗
PubMed1995

Violence and general security in the emergency department.

OBJECTIVE: To describe cases of violence related to weapons in a university hospital and urban county ED and to provide related recommendations for ED staff security. METHODS: Descriptive analysis and case examples of weapons-related assaults in one urban ED for the period 1979-1993. RESULTS: Over a 14-year period, 115 "incidents" of weapons-related violence were identified during the management of approximately 980,000 patients. Examples of ED violence are described. CONCLUSION: Emergency department staff should prepare for the possibility of violence by 1) recognizing the danger, 2) rehearsing response mechanisms, and 3) debriefing after incidents. In particular, plans must be made and practiced for the time when external violence follows the surviving victims of gang activity through the "sacrosanct" hospital doors. Protection of patients and ED personnel must be ensured. In many urban settings, appropriately armed security guards must be immediately accessible to the ED staff. Other suggestions for ED protection are given.

Emergency Service, Hospital↗
PubMed1994

Asymptomatic stab wounds of the chest.

In a prospective study of 4,106 consecutive cases of initially asymptomatic stab wounds of the chest, 88% were successfully treated as outpatients after negative findings on a repeat chest x-ray film 6 hours after presentation, 12% of patients required tube thoracostomy for delayed pneumothoraces of hemothoraces, 0.2% required thoracotomy for delayed and continued bleeding or cardiac injuries, 1% of patients with small pneumothoraces (subjectively less than 20%) were observed, and 68% patients remained asymptomatic. The accuracy of the initial chest x-ray film was 95% overall, with a specificity of 99.9%. The negative predictive value of only 87.4% precludes the immediate outpatient management of these asymptomatic patients. The overall mortality was 0.1%, mortality during or following surgery was 50%. Of the four patients with initially unsuspected cardiac injuries, two patients died in the operating room. Asymptomatic patients (with normal findings on chest x-ray films) may be discharged after 8 hours of observation. Asymptomatic patients with nonprogressive small pneumothoraces (less than 20%) not requiring a chest tube may be discharged after 48 hours of observation. Thirty-two percent of those observed for initially small pneumothoraces on chest x-ray films, had progression of their injuries and required tube thoracostomy. All patients should have close outpatient follow-up.

Adult↗
PubMed1994

Spent bullets and their injuries: the result of firing weapons into the sky.

People often celebrate holidays by firing guns into the air without realizing that this can cause serious injury or death. The present study identified 118 patients treated since 1985 who were hit with spent bullets. Most (77%) were hit in the head. The mortality rate was 32%, which is significantly higher than for all gunshot wound victims in general seen at the same medical center. Laws have been enacted to help prevent people shooting into the sky, but more education and enforcement are required to prevent these serious and preventable injuries.

Adolescent↗
PubMed1994

Extremity gunshot wounds: Part one--Identification and treatment of patients at high risk of vascular injury.

Cost containment is important in this time of inner-city economic and health-care crisis. This paper examines patients who were treated for gunshot wounds (GSWs) of the extremities. During the study period 1978 through 1992, 16,316 patients (18,349 extremities) were treated for extremity GSWs. Nine patients with asymptomatic injuries in proximity to vascular structures who were treated before the use of duplex Doppler ultrasonography (DDU) were later found to have surgically treatable vascular injuries. These were identified and treated on an outpatient basis with no long-term morbidity or mortality. With the advent of DDU, asymptomatic vascular injuries were no longer missed. A conservative estimate of the cost savings from this study is more than $47,000,000.00. The use of DDU and the enclosed protocols for treating asymptomatic extremity wounds prevented 16,450 needless angiograms, with an additional savings of $32,900,000.00, for a total savings of more than $79,900,000.00. With a more liberal use of DDU and angiography to eliminate the rare missed vascular injuries (0.09%), and the use of protocols to analyze patients with asymptomatic injuries, many extremity GSW victims (79% in this study) can be safely treated as outpatients, eliminating the need for expensive in-hospital observation.

Algorithms↗
PubMed1994

Civilian gunshot wounds--outpatient management.

Cost containment is important in this time of inner-city economic and health-care crisis. Of 28,150 patients treated for gunshot wounds (GSWs) from 1977 through 1991, 16,892 (60%) were treated as outpatients after emergency department evaluation and treatment. The complication rate was 1.8% (mostly infections), and nine patients were later found to have vascular injuries requiring surgical treatment. These were identified later at outpatient follow-up and treated with no long-term morbidity or mortality. A conservative estimate of the cost savings from this study was more than $37 million. With a more liberal use of angiography to eliminate rare missed vascular injuries, many GSW victims can be safely treated as outpatients, eliminating the need for expensive in-hospital observation.

Adult↗
PubMed1989

Violence in a community emergency room.

Violence in both community and county hospitals in the USA is increasing. It caused significant physical, emotional and economic hardship to many emergency department employees. We describe an incident that caused significant injury to an innocent bystander in a quiet upper-class community emergency department and outline procedures that hospitals and emergency department employees can take to combat this violence. Policy, procedures, planning and methods must be available for appropriately trained and equipped police officers to respond to such incidents. The effects of such violent episodes on the emergency department staff are discussed. Methods to prevent such incidents are presented.

Adult↗
PubMed1989

Emergency department thoracotomy.

The best candidates for a community hospital emergency room thoracotomy are those victims who have decompensated following small-caliber gunshot wounds or stab wounds to the chest or abdomen who initially had signs of life in transport to the hospital or in the Emergency Department. Some of these patients can be successfully resuscitated by an emergency physician using the techniques described in this article.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Phenytoin toxicity: predictors of clinical course.

The records of 46 patients who were admitted to a general hospital with the diagnosis of phenytoin toxicity were retrospectively studied to identify factors present at the time of admission which correlated with severity of illness and which would therefore be of prognostic value. Length of hospital stay was used as a measure of severity of illness. Correlations were made between the length of hospital stay and 18 variables studied at the time of admission, including severity of symptoms, use of other drugs (sedative hypnotics, anticonvulsants and phenothiazines), history (seizures, cardiac arrhythmias, and alcohol abuse), laboratory evidence of liver disease or renal disease, electrolyte abnormalities, coagulopathies, prior suicide attempts, glucose levels, and white blood cell counts. Significant correlations related the length of hospital stay with the severity of symptoms, concurrent phenothiazine usage, and the presence of abnormal liver function tests on admission, but not with other factors studied. Admission phenytoin serum levels following an overdose were not a useful predictor of length of hospital stay in this series of patients.

Hospitals, General↗
PubMed1989

Phenytoin toxicity: a review of 94 cases.

Records of all patients admitted to an urban teaching hospital from 1977-1987 with a diagnosis of phenytoin toxicity were reviewed in order to determine indications for admission and discharge, and to assess the need for therapeutic intervention and monitoring. Of 94 patients identified, 57 were male and 37 were female. Ages ranged from 19 mo to 84 yr. Serum phenytoin levels ranged from 21.4-90 micrograms/ml, with a mean level 44.4 +/- 12.5 micrograms/ml. Ataxia was observed in 59/94 patients (63%), and of these 18 patients had fallen; 9 had suffered injury from falling sufficient to require medical care. No other factors were associated with morbidity. No hemodynamic instability was seen in any of the cases. Electrocardiographic records were available for 71/94 cases (76%). There were no abnormalities due to phenytoin. Symptoms of toxicity resolved with supportive care. There were no deaths in this series. Phenytoin is a relatively safe medication even in the toxic range as determined by baseline phenytoin levels. Hospital admission is indicated in symptomatic cases until a declining serum phenytoin level is observed and ataxia resolves. The data in this series do not support routine electrocardiographic monitoring in cases of phenytoin toxicity.

Adolescent↗
PubMed1988

Gunshot wounds in children under 10 years of age. A new epidemic.

Before 1980 we had not treated any children with gunshot wounds who were younger than 10 years of age, but the number has increased dramatically each year since then. Thirty-four children younger than 10 years of age were treated for gunshot wounds from 1980 to 1987. Sociologic and epidemiologic data were assessed by a child-abuse team and police. Other studies have concluded that gunshot wounds in young children were usually caused by unintentional injury, child abuse, or neglect. From our present study we add a further, and very disturbing, category, that of attempted or intentional pediatric homicide. The children in this category were shot in retaliation for gang activities of their older siblings. This study demonstrates that the majority of our patients' childhood gunshot wounds were related to gang violence and retaliation, the availability of handguns in the home, and child neglect. The prevalence of childhood gunshot wounds in the inner city is increasing dramatically.

California↗