Biomedical subjects

O J Ma

Publications and source records attributed to O J Ma.

23 records · Page 2Linked to original sources

PubMed1995

Evaluation of hemoperitoneum using a single- vs multiple-view ultrasonographic examination.

OBJECTIVE: To compare the sensitivities, specificities, and accuracies between a single-view ultrasonography (US) technique and a multiple-view technique for identifying hemoperitoneum in multiple-trauma patients. METHODS: Data from a prior prospective study of US for trauma diagnosis at a level I trauma center were retrospectively analyzed. A convenience sample of adult patients (> or = 18 years of age) who had presented with major blunt or penetrating torso trauma and had undergone rapid trauma US examinations to detect hemoperitoneum were reviewed. The US interpretations by emergency physicians had been recorded prior to obtaining other diagnostic tests. Five views were evaluated, including the right intercostal oblique view examining Morison's pouch. Evidence of free intraperitoneal fluid by exploratory laparotomy, CT, or diagnostic peritoneal lavage (DPL) was used as the criterion standard. RESULTS: Of the 245 patients entered into the study, 37 had free intraperitoneal fluid, confirmed by CT, DPL, or exploratory laparotomy. With the multiple-view technique, US was 87% (95% CI = 71%, 96%) sensitive, 100% (95% CI = 97%, 100%) specific, and 98% (95% CI = 95%, 100%) accurate. The single-view technique, evaluating only Morison's pouch, was 51% (95% CI = 34%, 68%) sensitive, 100% (95% CI = 98%, 100%) specific, and 93% (95% CI = 89%, 96%) accurate. CONCLUSIONS: An initial trauma US examination using a multiple-view technique is more sensitive than that using a single-view technique for detecting hemoperitoneum in trauma patients.

Abdominal Injuries↗

PubMed1992

Aortic saddle embolus presenting with transient lower extremity paresthesia.

We report the case of a 58-year-old woman who developed acute onset of bilateral lower-extremity numbness and difficulty ambulating at home. On presentation to the emergency department, however, the patient's symptoms essentially had resolved. An aortic saddle embolus was suspected based on the patient's cardiac history and the absence of distal pulses in the lower extremities. This case illustrates that even with vague or resolving complaints, a high index of suspicion should be maintained for the diagnosis of aortic saddle embolus based on the patient's medical history and on physical examination.

Aorta, Abdominal↗

PubMedDate not supplied

Flight paramedic scope of practice: current level and breadth.

This study's objective was to determine the current level and breadth of flight paramedic scope of practice. A six-item survey of lead flight paramedics in 158 air medical programs addressed five issues: 1) Certifications required above state certification; 2) Procedures included in scope of practice; 3) Medications flight paramedics are allowed to administer; 4) Requirements needed to expand scope of practice; and 5) Views on establishing a National Flight Paramedic Certification to alter their scope of practice. Eighty programs out of the 90 respondents (89%) stated that they utilize flight paramedics. Of these 80 programs that use flight paramedics, 76 programs (95%) require certification in ACLS, 65 (81%) in PALS, and 50 (63%) in BCLS. Paramedics are allowed to perform cricothyroidotomy in 68 programs (85%), pericardiocentesis in 24 (30%), and tube thoracostomy in 23 (29%). Medications approved for administration include streptokinase in 37 programs (46 %), r-TPA in 48 (60%), and succinylcholine in 50 (63%). In 61 programs (76%), the scope of practice is determined solely by the air medical director. Eighteen respondents (23%) believe that the development of a National Flight Paramedic Certification Program would alter their scope of practice. In conclusion, flight paramedic scope of practice varies enormously. Since most medical directors have the authority to alter flight paramedic scope of practice and few programs believe that a National Flight Paramedic Certification would alter their practice, medical directors should work directly with flight paramedics to expand their scope of practice.

Air Ambulances↗

PubMedDate not supplied

Survey of medical services at major league baseball stadiums.

OBJECTIVE: To analyze the availability and level of medical services for fans at major league baseball games in the United States. METHODS: A 10-item questionnaire was sent to the operations managers of each of 28 major league baseball stadiums. The survey was distributed in cooperation with a major league baseball club. Telephone follow-up was used to complete missing responses. The survey addressed five areas of fan medical services: 1) health-care provider availability and compensation; 2) advanced cardiac life support (ACLS) capabilities, including equipment; 3) presence of on-site ambulance(s); 4) fan fatalities; and 5) alcohol consumption limitations. RESULTS: Survey response was 100%. Healthcare providers are on-site at all stadiums: nurses (86%), physicians (75%), emergency medical technicians (EMTs, [68%]), and paramedics (50%). Ninety-six percent use a combination of health-care providers. The most common medical teams are nurse+EMT+physician (25%) and nurse+EMT+paramedic+physician (18%). All health-care providers receive some form of compensation. All stadiums have at least one ACLS-certified provider; 96% have ACLS equipment. Ambulances are on-site 75% of the time. Sixty-eight percent of the clubs reported at least one fan fatality through the 1992 and 1993 seasons (mean 1.1, range 0-4). All clubs limit alcohol consumption; 96% use multiple approaches. The various approaches include: 1) specific inning discontinuation (86%); 2) maximum purchase (68%); 3) restricted sale locations (64%); and 4) crowd conduct (57%). Advertisement for responsible alcohol consumption is displayed at 75% of the stadiums; designated-driver programs exist at 46%. CONCLUSIONS: All major league baseball clubs provide medical services for fans. Furthermore, almost all stadiums have ACLS capabilities. Responsible alcohol consumption also is a recognized priority for fan safety.

Alcohol Drinking↗

PubMedDate not supplied

Survey of follow-up systems in emergency medicine residencies: analysis and proposal.

OBJECTIVE: For educational purposes, the Residency Review Committee for Emergency Medicine requires that emergency medicine residencies "provide a mechanism for each resident to obtain information on outcomes of patients the resident has evaluated in the emergency department." The authors analyzed the current patient follow-up systems of emergency medicine residencies and, based upon survey results propose a comprehensive organized system of follow-up. METHODS: The 84 emergency medicine residency directors listed in the 1991 Society for Academic Emergency Medicine Handbook were polled regarding the current follow- up systems at all hospitals affiliated with their residencies. The survey contained 11 items, including two five-point Likert scales for rating system effectiveness and satisfaction. A description of each hospital's follow-up system was requested, and other comments were reviewed. RESULTS: The 72 (86%) respondents represented residencies with a total of 138 affiliated hospitals, of which 89 (64.5%) had formal follow-up systems. Of those 89 hospitals, 39% (n = 80) residency directors reported that fewer than half of their residents used the systems, 63% (n = 87) had mandatory compliance policies; 53% had the capability for residents to obtain discharge summaries on admitted patients; and 66% (n = 83) had mechanisms for follow-up of patients released from the emergency department. Twenty-three percent of the systems were considered effective, with ratings of 4 or higher and only 31% received satisfaction ratings of 4 or more. CONCLUSIONS: Most emergency residency-affiliated hospitals in our survey had follow-up systems in place. Of existing systems, only a minority were rated by residency directors as effective or satisfactory. A model for a comprehensive system of patient follow-up is proposed.

Emergency Medicine↗