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Biomedical subjects

S G Gabram

Publications and source records attributed to S G Gabram.

34 records · Page 2Linked to original sources
PubMed1992

Delayed hemorrhagic pericardial effusion: case reports of a complication from severe blunt chest trauma.

The rare occurrence of delayed hemorrhagic pericardial effusion requiring treatment is reported following significant blunt chest trauma (AIS greater than or equal to 3) in three patients from 12 to 15 days after injury. Cardiomegaly was suspected on serial chest roentgenograms, and the pericardial effusion was confirmed by echocardiography. Two of three patients required systemic anticoagulation early after their admission to the hospital. It is currently unknown whether the number of delayed hemorrhagic pericardial effusions is increasing with the use of certain anticoagulation treatment regimens.

Adult↗
PubMed1992

Factors associated with outcome in blunt aortic injury: a population-based study.

A population-based study was conducted for two contiguous states representing a population of 9.1 million to determine whether age, injury severity score, major complications, and preexisting conditions contribute to the outcome of patients diagnosed with blunt traumatic aortic injury. A secondary analysis reviewed patients with blunt aortic injury admitted over a six-year period to a trauma center located in one of the states to examine other more detailed factors related to mortality. Age was the only variable that correlated statistically with mortality in both populations analyzed. (Region P = .004; trauma center P = .0012) The severity of injury showed a tendency for decreased survival with increasing injury severity score. The elderly (age > or = 55) in both data sets sustained higher mortality from blunt aortic injury. In the trauma center population, the elderly had more delay in diagnosis than the younger patient population.

Adult↗
PubMed1991

Roles of a helicopter emergency medical service in mass casualty incidents.

The Connecticut helicopter emergency medical service (HEMS) has responded to 12 mass casualty incidents (MCI) in two years. Eight were drills and four were actual events. An MCI response plan was instituted prior to the onset of the HEMS program. All MCIs were reviewed to determine actual victims, knowledge of MCI prior to lift-off, and roles of the HEMS. The actual roles were compared with the pre-established roles. The four actual MCIs (building explosion, hotel fire, bus rollover and plane crash) were reviewed. Sixty-seven victims were involved. Prenotification occurred in one MCI. The roles of the HEMS in each MCI were: triage (n = 4), medical treatment (n = 4), transport (n = 3), augmented response (n = 1), and air surveillance (n = 0). The roles of HEMS response to MCI should be well-defined prior to an event. Air medical benefits include response within a large geographic area, highest level of prehospital medical care, identification of trauma receiving hospitals, and facilitation of transport.

Aircraft↗
PubMed1991

A prospective analysis of a two-year experience using computed tomography as an adjunct for cervical spine clearance.

The role of CT scanning as an adjunct to plain roentgenograms of the cervical spine was reviewed in acutely injured blunt trauma patients. Following institution of a protocol to evaluate the cervical spine in all blunt trauma patients, 179 patients underwent CT scanning of their cervical spine. This was performed for patients whose x-ray findings were positive, for patients with plain x-ray films suggestive of a pathologic condition, for patients with plain x-ray films that did not reveal all of the cervical vertebrae, and for patients who had persistent pain or neurologic deficits despite normal plain x-ray films. Of 123 patients not able to have their cervical spine cleared by normal roentgenograms, 93% were cleared within 24 hours of admission based on CT scans. There were no missed injuries in this setting. A false-positive rate of 28% and a false-negative rate of 1.5% were found for plain roentgenograms. Computed tomographic scans detected 98% of the injuries in our study and when combined with a three-view plain x-ray series of the cervical spine, 100% of cervical spine injuries were detected. Computed tomographic scanning as an adjunct to plain x-ray films of the cervical spine is a highly accurate and expedient modality to clear the cervical spine of blunt trauma patients.

Adolescent↗
PubMed1991

Interhospital transport audit criteria for helicopter emergency medical services.

A quality assurance audit of all interhospital patient transports from 17 June 1985 through 31 December 1989 by Connecticut's critical care helicopter system was performed to determine the number of medically appropriate and justified flights. There were 1,839 transports reviewed using nationally established criteria. Flights not fulfilling any of these criteria (n = 401) were reviewed in detail by a panel consisting of medical and nursing representatives. During this case by case review, additional acceptable criteria for transport were developed. The audit determined that 1,792 (97%) of interhospital transfers were justified for helicopter emergency medical transport. The use of these national criteria along with the proposed additional criteria is recommended to health care personnel in the decision to transport a patient to a tertiary care hospital by air. In addition, these criteria should be prospectively utilized by aeromedical flight programs for quality assurance review of appropriateness of helicopter interhospital requests.

Aircraft↗
PubMed1990

The impact of emergency medical helicopters on prehospital care.

Emergency medical helicopter services have grown exponentially over the past seventeen years. These services offer rapid transport by flight crews to tertiary care centers with a higher level of medical capabilities. An impact because of helicopters on survival has been well-documented for trauma patients. Assessing usage for other critical care patients remains to be delineated further.

Aircraft↗
PubMed1989

A three-year report of the medical helicopter transportation system of Connecticut.

Over 63% of the patients transported by the LIFE STAR crew are the victims of trauma. The system has transported 2,215 ill and/or injured patients, the majority of whom are critical, either from the scene of an injury or from a medical facility to another of greater specialization. With the audit procedure indicating a 95% positive predictive value for summoning this service, LIFE STAR has contributed to the care of critically ill or injured persons in Connecticut and surrounding areas.

Adult↗
PubMed1989

Airway intubation in injured patients at the scene of an accident.

Trauma patients requiring intubation at the scene of the accident were entered into a study from June 1985 to June 1987 to determine: 1) the success rate of intubation by flight crews and 2) factors important in managing the difficult airway at the scene. One hundred thirty-six patients were reviewed. The success rate of trauma patients intubated in the field was 92.6%. The success rate of each procedure was, orotracheal 87%, and nasotracheal 77.6%. Six out of the 10 patients unsuccessfully intubated had vomiting or blood in the oropharynx which was cited as the reason for failure of intubation. All 24 patients requiring medications (paralytics and sedatives) for intubation were successfully intubated. Trismus and combativeness were the indications for medication usage. An aeromedical crew (MD, RN, RT) can successfully intubate trauma patients at the scene of the accident. Severe facial injuries with vomiting and blood in the oropharynx are factors in intubation failure. The use of muscle relaxants and sedatives facilitates difficult intubations.

Accidents↗
PubMed1988

A review of the Journal of Trauma.

Four hundred fifteen papers published in the Journal of Trauma from January 1985 through December 1986 were reviewed to document areas of future need. Analyses focused on: 1) the study design of each paper; 2) the quality of scientific reporting in 10% (n = 40) of randomly selected papers from four major study designs; 3) the subject material addressed in 242 trauma-related publications using the categories: acute care, epidemiology, biomechanics, prevention, and rehabilitation. Although the Journal of Trauma provides a consistent edifying mixture of study designs, there is a relative need for less descriptive retrospective/prospective reviews and case reports, and for more observational and interventional cohort designs. More precise documentation of specific research criteria would better substantiate scientific conclusions. In light of the contemporary ranges of issues as defined in Injury In America (1), broader multidisciplinary articles focusing on epidemiology, biomechanics, rehabilitation, and prevention of injury may benefit readers of the Journal of Trauma.

Periodicals as Topic↗
PubMedDate not supplied

Clinical management of blunt trauma patients with unilateral rib fractures: a randomized trial.

Optimal pain management is essential in blunt trauma patients sustaining significant chest trauma. The purpose of this randomized prospective trial was to measure the difference in pulmonary function in nonintubated patients with unilateral multiple rib fractures receiving two modalities of pain relief: systemic narcotic medications alone or local anesthetics given by intrapleural catheter (IPCs). Forty-two patients were randomized to receive systemic narcotic medications or IPCs for pain control. The patients with IPCs statistically had more compromised pulmonary function as measured by forced vital capacity (FVC) on admission; however, they tended toward a greater objective improvement of FVC on discharge. When analyzing a cohort of severely impaired patients (initial FVC < 20%), half of the systemic medication patients compared to only 10% of the IPC group failed and required another mode of therapy. Catheter complications were minor and did not contribute to overall morbidity. The IPC patients had fewer failures than the systemic medication patients.

Analgesia↗
PubMedDate not supplied

Recidivism in a helicopter emergency medical service.

This study was designed to determine the frequency of recidivism (patients using a service more than once for the same or different disease episodes) in a helicopter emergency service, with the premise that high levels of recidivism may constitute grounds for improving quality of care or patient education programs. A retrospective chart review was performed on records from June 1985 to September 1990. Patients were included if they required helicopter transport on more than one occasion for either different disease episodes (true recidivists) or for multiple transports during a single hospital admission. Twenty-one (0.6%) of the 3,543 patients transported were true recidivists and 20 (0.6%) patients required secondary transport during the same admission. Of the latter group, 17 secondary transports were within 24 hours of admission. This study showed that recidivism in this helicopter emergency service is low. Patients who were air transported more than once for the same illness or injury within a 24-hour period occurred in less than 1% of transports, well within the helicopter program's pre-established less than 2% threshold.

Aircraft↗
PubMedDate not supplied

Integrating emergency medicine residents into a well-established helicopter program.

INTRODUCTION: The institution of an emergency medicine residency in a university-affiliated Level 1 trauma center in July 1993 provided a challenge to develop a curriculum and on-line learning experience for emergency medicine residents in a well-established helicopter program. The purpose of this study was to survey flight crew members, emergency medicine at tending physicians, and emergency medicine residents on the anticipated roles and educational experience of integrating the emergency medicine residents from a new emergency medicine residency into the flight crew of a well-established helicopter program. METHODS: A survey consisting of multiple choice, Likert scale, and open-ended questions was distributed to flight crew members (RN, RT, pilots, communication specialists, EM attendings, and EM residents [n=72]). RESULTS: 92% of surveys were returned. These surveys identified specific issues of concern and those areas believed to be of academic importance for the emergency medicine residents. CONCLUSIONS: The results of this study allowed for the creation and implementation of a progressive flight experience for EM residents that incorporates increasing responsibility on the flight crew as experience is gained.

Air Ambulances↗
PubMedDate not supplied

A descriptive analysis of air medical directors in the United States.

INTRODUCTION: The purpose of this study was to describe the characteristics and functions of U.S. physician air medical directors. METHODS: This descriptive study included physician directors of U.S. rotor-wing and fixed-wing air medical services. Data were obtained using a standardized survey in regard to the training, education, and roles/responsibilities of directors of critical care air medical services (AMSs). RESULTS: Data from 153 of 276 surveys (55.4%) were analyzed and reported in this study. Air medical directors' residency training varied, but emergency medicine was the most frequently reported training type (38.0%). Most directors reported less than 5 years of job experience in AMS (57.3%), had neither residency/fellowship-based flight experience (63.9%) nor practical flight experience (60.5%), and performed director functions on a part-time basis (93.2%). The six most commonly reported medical director activities were medical protocol development (87.6%), quality improvement activities (86.3%), medical crew training (80.4%), administrative negotiations (79.1%), on-line medical control (71.9%), and personnel hiring (59.5%). The three most common sources of continuing education for medical directors were literature review (95.8%), attendance at medical conferences (79.2%), and participation in professional organizations (59.7%). CONCLUSION: These data describe the characteristics of U.S. air medical directors and identify physician contributions to patient care in the aviation environment.

Air Ambulances↗
PubMedDate not supplied

The integration of a helicopter emergency medical service in a mass casualty response system.

Since 1985, the state of Connecticut has been served by a hospital-based, advanced life support (ALS) helicopter air medical service. The service is stationed at a 1,000-bed, Level 1, trauma center that is responsible for its operation. Connecticut statute requires the hospital to file operations reports with the Office of Emergency Medical Services, which reports to the Connecticut Department of Public Health. Operations include response to requests for transportation of severely ill or injured patients from the scene of an incident, and patient transport from one hospital to a higher level, definitive-care hospital. This service also was charged to develop a disaster response plan to be integrated into the overall state plan for disaster responses. The helicopter disaster response involves all six New England states and three hospital-based emergency medical helicopter programs that operate in the New England states. This approach has allowed for joint planning and multi-agency, simulated drills. The helicopter emergency medical service has responded to 15 simulated emergencies (drills) and seven actual mass casualty incidents from May, 1985 to June, 1989. In Connecticut, the planning process conducted by the Department of Public Health and the Office of State EMS produced a coordinated, multi-jurisdictional, mass-casualty response plan.

Aircraft↗
PubMedDate not supplied

Why activity-based costing works.

With advancing technology and the quest for delineating the true cost of a procedure or diagnostic test, cost accounting techniques are being re-explored in the health care setting. Activity-based costing (ABC), adopted from other businesses, is one such example that has applications in the health industry. The purpose of this paper is to enhance the understanding of health care costs among physician providers, emphasizing a new approach--activity-based costing.

Accounting↗