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Michael P Poirier

Publications and source records attributed to Michael P Poirier.

17 recordsLinked to original sources

Prudent layperson definition of an emergent pediatric medical condition.

This study was designed to assess how well parents rated pediatric medical conditions based on their perceived degree of urgency so as to determine if the "Prudent Layperson Standard'' is reasonable. A self-administered, supervised survey was given to a convenience sample of 340 caregivers in the emergency department of an urban children's hospital. Respondents were asked to rank the urgency of 15 scenarios. A caregiver response within 1 point of the physician score was considered concordant with medical opinion. A 2-week-old infant with a rectal temperature of 103.7 degrees F was the only emergent scenario underestimated by caregivers. A 1 1/2-yr-old child with an upper respiratory tract infection, a 7-year-old child with ringworm, an 8-month-old infant with a simple forehead contusion, and a 4-year-old child with conjunctivitis were the non-urgent scenarios overestimated by caregivers. Laypeople are able to identify cases constructed to represent obvious pediatric medical emergencies. Several patient subgroups frequently overestimate medical urgency.

Adult↗

Near strangulation as a result of hair tourniquet syndrome.

Hair tourniquet syndrome has been a recognized clinical entity for many decades. In this syndrome, hair becomes tightly wrapped around an appendage, usually that of an infant. Body parts involved include the finger, toe, penis, clitoris, and uvula. The end result of necrosis is also well documented. In this report, an 11-month-old girl with hair tourniquet syndrome causing signs and symptoms of an acute strangulation is presented.

Airway Obstruction↗

Factors used by pediatric emergency medicine program directors to select their fellows.

BACKGROUND: Pediatric emergency medicine (PEM) recently has become a highly competitive subspecialty with twice the number of applicants for positions available. Little information exists on the characteristics that PEM programs desire in their applicants. We sought to assess the factors used by PEM program directors when ranking PEM fellow applicants in the National Resident Match Program (NRMP). METHODS: A 47-item questionnaire (adapted from a previously published questionnaire) was designed to assess the relative importance of various factors in the ranking of PEM fellow applicants in the NRMP. The questionnaire was mailed to all 43 PEM program directors that participated in the 2001 NRMP. The program directors were asked to grade selection factors based on a five-point Likert scale: 1, unimportant; 2, somewhat important; 3, important; 4, very important; 5, critical. The factors addressed in the questionnaire included academic criteria, letters of recommendation, applicant characteristics, and aspects of the interview. In addition, we asked 10 yes-or-no questions pertaining to specific aspects of each program. Responses were tabulated and means and standard deviations reported. RESULTS: A program response rate of 93% (40/43) was obtained. The most important factors in granting an interview were recommendations from colleagues in PEM (4.21 +/- 0.78), research potential (3.81 +/- 1.10), and reputation of the applicant's pediatric program (3.51 +/- 0.91). The least important factors in granting an interview were reputation of the applicant's undergraduate institution (1.76 +/- 0.86), medical school grades (1.83 +/- 0.87), and board scores (2.11 +/- 0.91). Letters from division chiefs of PEM (4.15 +/- 0.78) and clinical faculty in PEM (4.06 +/- 0.82) were considered the most important letters of recommendation, whereas letters from basic science faculty were considered the least important (1.89 +/- 0.96). Ability to work with a team (4.66 +/- 0.42), compatibility with the program (4.65 +/- 0.35), commitment to hard work (4.55 +/- 0.45), ability to grow in knowledge (4.41 +/- 0.58), ability to solve problems (4.36 +/- 0.63), ability to listen (4.34 +/- 0.65), and ability to articulate thoughts (4.32 +/- 0.59) were the most important characteristics in the final ranking of candidates. Thirty percent (12/40) of the program directors stated that it was important for the program to "match" its top choice. The majority of programs have a selection committee that contributes to the final ranking of applicants. CONCLUSIONS: The results of this study suggest that a rather subjective but uniform prioritization of criteria is used in evaluating PEM program applicants. Awareness of these factors would enable applicants to make a critical self-analysis of their strengths and weaknesses prior to the submission of their applications.

Clinical Competence↗

Academic dilemmas.

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Career Mobility↗

A prospective study of the "two-bag system'' in diabetic ketoacidosis management.

The "two-bag'' system, an adaptation of the euglycemic clamp technique, consists of simultaneous administration of 2 intravenous (IV) fluid bags of differing dextrose concentrations. Individualized therapy is dictated by adjustment of the infusion rate of each bag. We sought to assess the benefits of the two-bag system in the initial acute emergency department management of children in diabetic ketoacidosis (DKA). Thirty-three children presenting to an urban pediatric emergency department in DKA were randomized into 2 groups: patients managed with the two-bag system and patients managed with the traditional "one-bag'' system. Other aspects of the management were standardized. Outcome measures included rate of decline in serum glucose, rate of bicarbonate correction, time on IV insulin therapy, and response time for IV fluid changes. Study period was defined as time on IV insulin therapy. There were no differences between the 2 groups in demographic parameters, initial baseline metabolic parameters, or total time on IV insulin therapy. There were no differences between the groups in average rates of serum glucose decline: two-bag 33.1 mg/dL/hr (s.e. 5.57, 95% CI 22.2, 44), one-bag 30.2 mg/dL/hr (s.e. 5.72, 95% CI 19, 41.4); average rate of serum bicarbonate correction: two-bag 1.19 mEq/L/hr, one-bag 1.27 mEq/L/hr; or the average number of IV fluid bags used: two-bag 4.1 bags, one-bag 3.2 bags. However, there was a difference between the groups in regard to elapsed total time to make changes in the IV fluids: two-bag 1 minute, one-bag 42 minutes, (p < 0.001). The "two-bag'' system enables a faster response time in making IV fluid therapy changes. This efficiency makes this system ideal for use in the emergency department.

Adolescent↗