Search PubMed⌕ Search

Biomedical subjects

M Hauswald

Publications and source records attributed to M Hauswald.

At least 37 records · Page 2Linked to original sources
PubMed1994

Floating nights: a 5-year experience with an innovative ED schedule.

An academic emergency group was surveyed to determine if scheduling night shifts in blocks ("floats") improved attitudes and functioning. Seven physicians worked most of their nights as floats. Another four chose only isolated nights. Float physicians were surveyed for isolated and block nights. Faculty in the float group had poorer attitudes compared with the nonfloat group when both worked isolated nights (P = .0053). Working night floats eliminated these differences. Float physicians had more difficulty with sleep regardless of their schedule. They took longer to recover from an isolated night shift, drank more coffee, and used more postcall sedatives than their colleagues (P = .0108). The ideal night float was 2 to 4 weeks with shifts less than 10 hours, but careful attention to sleep hygiene remained essential. Physicians have different adaptability to night work. For some, concentrating night shifts is a useful strategy for improving shift work. This would require shorter shifts and larger groups than are now commonplace.

Attitude↗
PubMed1993

Out-of-hospital resuscitation preferences of emergency health care workers.

The objective of this study was to assess the personal preferences of emergency physicians, nurses, and medical technicians regarding their own potential out-of-hospital resuscitation. An anonymous multiitem survey instrument was used at a statewide emergency medicine educational conference. Emergency personnel who regularly treat out-of-hospital cardiac arrest patients were enlisted to participate. Subjects picked the last intervention that they would wish for themselves in an optimally managed advanced cardiac life support (ACLS)-based resuscitation for ventricular fibrillation. One hundred millimeter visual analog scales were used to measure individual preferences for severe neurological disability or death. Hypothesis testing was by analysis of variance with Newman-Keuls, multiple regression with stepwise variable selection, and the chi 2 and binomial distributions. Of 185 survey instruments, 105 were returned completed by eligible subjects. There was little difference among the three occupational groups (P > .5), although older respondents favored shorter resuscitations (r = -.38; P = .002). Ten subjects did not want cardiopulmonary resuscitation started, and 65% wanted resuscitation stopped before the second dose of epinephrine. Only three subjects chose to undergo the entire ACLS sequence. Eighty-two percent of respondents preferred death to severe neurological disability. Emergency health care professionals have a unique personal awareness of issues surrounding out-of-hospital resuscitation. That a large majority would prefer death to severe disability and few would willingly undergo full resuscitation as currently practiced suggests that prevailing guidelines should be reevaluated.

Adult↗
PubMed1993

Fire fatalities among New Mexico children.

STUDY OBJECTIVE: To explore the relationship between social conditions and fire mortality rates among children. DESIGN: Retrospective analysis of fire fatalities in children 0 to 14 years old in New Mexico. SETTING: State Office of the Medical Investigator. TYPE OF PARTICIPANTS: All 57 New Mexico children 0 to 14 years old who died from fire-related injuries from 1981 through 1991. INTERVENTIONS: Medical investigator and autopsy records were reviewed and abstracted. Demographic and housing figures were obtained from US Census reports. Data were analyzed by chi 2 or by Fisher's exact test, with Bonferroni correction for multiple comparisons. RESULTS: Two thirds of decedents were male (P = .0014), and three fourths were less than 5 years old (P < .0001). Children living in mobile homes had triple the mortality rate of those in houses or apartments, and children in homes without plumbing (substandard) had more than ten times the mortality rate of those in houses or apartments (P < .0001). Two thirds of the victims in substandard homes were Native American (P < .0001). Errors or negligence of adults occurred in more than half of the deaths. Eighty-two percent of decedents died at the scene; only 11% reached a burn center. CONCLUSION: Substandard homes are associated with an increased fire mortality rate among children. Strategies to prevent childhood fire fatalities should address housing conditions and adult safety practices. Enhanced prehospital or burn unit care is unlikely to greatly affect childhood fire mortality rates.

Accidents, Home↗
PubMed1991

Cervical spine movement during airway management: cinefluoroscopic appraisal in human cadavers.

The objective of this study was to determine which airway maneuvers cause the least cervical spine movement. A controlled laboratory investigation was performed in a radiologic suite, using eight human traumatic arrest victims who were studied within 40 minutes of death. All subjects were ventilated by mask and intubated orally, over a lighted oral stylet and flexible laryngoscope, and nasally. Cinefluoroscopic measurement of maximum cervical displacement during each procedure was made with the subjects supine and secured by hard collar, backboard, and tape. The mean maximum cervical spine displacement was found to be 2.93 mm for mask ventilation, 1.51 mm for oral intubation, 1.65 mm for guided oral intubation, and 1.20 mm for nasal intubation. Ventilation by mask caused more cervical spine displacement than the other procedures studied (ANOVA: F = 9.298; P = .00004). It was concluded that mask ventilation moves the cervical spine more than any commonly used method of endotracheal intubation. Physicians should choose the intubation technique with which they have the greatest experience and skill.

Airway Obstruction↗
PubMed1991

Medical problem solving and uncertainty in the emergency department.

STUDY OBJECTIVE: To compare the diagnostic processes of experienced emergency physicians with those of novices. DESIGN: Prospective, convenience sample of patients. SETTING: Emergency department of a county university medical center in a large southwestern urban community. PARTICIPANTS: Experienced emergency physicians (attending and senior residents) and novice clinicians (junior residents and senior medical students). INTERVENTIONS: Participants developed initial diagnostic impressions after reviewing the chief complaint, nurse triage notes, and vital signs. Tests were then selected, and a final diagnostic impression was identified after results were known. Clinicians also marked a visual analog scale corresponding to their estimate that each diagnostic possibility was correct. RESULTS: Experienced physicians increased their certainty more than novices (P = .014). They deviated from a standard history-physical-laboratory sequence more often than novices (P = .008). CONCLUSION: Expertise in medical decision making is characterized by a moderate initial level of certainty concerning a diagnosis that significantly increases as the experienced clinician follows a flexible strategy of testing to arrive at a final diagnosis.

Academic Medical Centers↗
PubMed1990

Innovations in emergency medical services systems.

This article roughly follows the chronology of an EMS call and discusses innovations in prehospital care, including epidemiology and prevention; precall management (system status management and flexible response); intervention during the call (emergency medicine dispatch); finding the scene; and communications.

Computers↗
PubMed1989

The cost of smoking: an emergency department analysis.

A representative sample of emergency departments visits was taken to determine the incidence of tobacco-related illnesses. Seven percent of all visits and 12% of gross billings were for illnesses associated with tobacco use. After calculation of attributable risk it was determined that 3% of visits and 5% of gross billings were directly attributable to tobacco. When the latter figures are extrapolated to all emergency departments in the United States, the result is nearly 2.5 million visits and $0.5 billion per year.

Costs and Cost Analysis↗
PubMed1988

Amebic liver abscess: emergency department diagnosis.

Twelve patients with amebic liver abscess were admitted to a university hospital. Ten of these patients were admitted through the emergency department. Patients, especially men from third world countries, with fever, right upper quadrant pain, and leukocytosis are at high risk for this disease and should have the diagnosis confirmed with amebic serology and ultrasonography or computed tomography.

Adolescent↗
PubMed1987

Cortical blindness and late postpartum eclampsia.

Blindness developed in a 22-year-old woman five days postpartum. She developed recurrent generalized tonic-clonic seizures despite early institution of intravenous magnesium sulphate. After a loading dose of phenytoin was given, the seizures stopped and the blindness gradually resolved. A review of the literature pertaining to blindness and eclampsia is presented and the use of phenytoin is discussed.

Adult↗
PubMed1987

Benign juvenile myoclonic epilepsy.

Two patients with long-standing, poorly controlled seizures presented to a university hospital emergency department. Both patients had myoclonic jerks on waking and evidence of absence seizures as well as generalized tonic-clonic seizures. A diagnosis of benign juvenile myoclonic epilepsy was made, and the seizures were controlled with valproic acid.

Adolescent↗
PubMed1987

MAST conversion of paroxysmal supraventricular tachycardia in Wolff-Parkinson-White syndrome.

A 48-year-old man with Wolff-Parkinson-White syndrome presented with paroxysmal supraventricular tachycardia. Prior episodes had required inpatient drug therapy or cardioversion. Attempts at conversion to normal sinus rhythm with vagal maneuvers were unsuccessful. Inflation of military antishock trousers resulted in rapid termination of the arrhythmia and avoidance of hospitalization.

Anti-Arrhythmia Agents↗