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Biomedical subjects

Theodore C Chan

Publications and source records attributed to Theodore C Chan.

44 records · Page 3Linked to original sources
PubMedDate not supplied

Follow-up of elderly patients who refuse transport after accessing 9-1-1.

OBJECTIVE: To obtain medical follow-up and determine reasons why elderly patients access paramedics via 9-1-1 and then refuse transport. METHODS: A telephone survey of patients aged 65 years and older who refused transport and signed out against medical advice (AMA) after accessing paramedics via 9-1-1 was performed to obtain information about the patients' experiences, reasons why they refused, medical follow-up, and patient outcomes. RESULTS: One hundred of 121 (83%) patients who were contacted by telephone participated in the survey. Patients stated that financial concerns were a major determinant in refusing to be transported. Overall, 70% of the patients reported receiving follow-up medical care. Care was obtained at an emergency department (ED) via a second 9-1-1 call in 16% of cases, at an ED via private vehicle in 13%, at an urgent care clinic by a private vehicle in 35%, and with a family physician via private car in 38% of cases. Of the patients who obtained follow-up, there was a 32% hospital admission rate, with 39% of those admitted to an intensive care unit setting. Finally, 80% of the sample studied did not speak to a physician online, with 49% stating that they would have changed their minds if a physician had suggested transport. CONCLUSION: The majority of patients who were 65 years of age and older and refused transport received follow-up care, with a significant number requiring admission to the hospital at the time of their follow-up.

Aged↗
PubMedDate not supplied

Midazolam for the treatment of out-of-hospital pediatric seizures.

OBJECTIVE: To assess the effectiveness and safety of intravenous (IV) and intramuscular (IM) midazolam in the treatment of pediatric seizures by paramedics. METHODS: All cases in which paramedics treated patients under the age of 18 years with midazolam for seizures per county protocol were evaluated over a one-year period. Prehospital records were reviewed for treatment and reassessment, while the subgroup of patients who were transported to Children's Hospital were followed up for emergency department (ED) outcome. RESULTS: Midazolam was administered to 86 pediatric patients with ages ranging from 2 months to 14 years for the treatment of seizures per county protocol. There were 54 IV doses and 32 IM doses delivered. Of the 86 patients, post-intervention reevaluation was documented for 74 patients (86%) representing 49 IV and 25 IM doses. Improvement was reported for 91% (67/74) of patients. Greater success was reported with IV drug administration (47/49, 96%) as compared with 80% (20/25) with IM administration (p < 0.05). Four patients (three treated IM and one IV) had respiratory compromise necessitating field airway management. All four patients had respiratory compromise documented prior to midazolam administration. Forty-four patients were treated at Children's Hospital. Seven were intubated in the ED after having been given additional medications for seizures. None were intubated on arrival and none were felt to require intubation secondary to midazolam-induced respiratory depression. CONCLUSION: Prehospital IV midazolam is an effective intervention for pediatric seizures, while IM midazolam was associated with a 20% failure rate, with both having minimal risk of respiratory compromise.

Adolescent↗
PubMedDate not supplied

Impact of an after-hours on-call emergency physician on ambulance transports from a county jail.

OBJECTIVE: The authors sought to determine if the availability of an after-hours on-call emergency physician by telephone for consultation to the staff at a county jail would safely reduce ambulance emergency department (ED) transport of inmates in the community. METHODS: The authors conducted a prospective comparison study during the first ten months of an emergency physician on-call program for the county jail in which prospective data were collected on all consultations, including reason for call and disposition (ambulance, deputy, or no ED transport of inmate). They compared this time with a similar period a year before the program in terms of total ambulance transports from the jail. They also reviewed all hospital and jail medical records to assess for any adverse consequences within one month, or subsequent ambulance transport within 24 hours as a result of inmate care after the consultation call. RESULTS: Total after-hours ambulance transports from the jail decreased significantly from 30.3 transports/month (95% confidence interval [CI], 21.0-39.6) to 9.1 transports/month (95% CI, 4.1-14.0) (p < 0.05). The most common reasons for consultation calls were chest pain (16%), trauma (15%), and abnormal laboratory or radiology results (14%). Of all calls, only 30% resulted in ambulance transport to the ED. On review of records, no adverse outcome or subsequent ambulance transport was identified. CONCLUSIONS: The initiation of an on-call emergency physician program for after-hours consultation to jail nursing and law enforcement staff safely reduced ambulance transports from a county jail with no adverse outcomes identified.

After-Hours Care↗
PubMedDate not supplied

The use of etomidate for prehospital rapid-sequence intubation.

Prehospital hypoxia and hypotension increase morbidity and mortality in head-injured patients. Etomidate is a sedative agent with increasing use for emergent rapid-sequence intubation (RSI) because of its favorable hemodynamic profile. This prospective, observational study documents the authors' preliminary experience with etomidate as part of an aeromedical RSI protocol. Major trauma victims received etomidate 0.1 to 0.3 mg/kg intravenously (IV) before administration of a neuromuscular-blocking agent. After confirmation of endotracheal tube position, 1 to 2 mg midazolam IV was administered. The main outcome measure was systolic blood pressure (SBP) before and after the RSI procedure and the incidence of hypotension after RSI; individual patient plots of SBP versus time were also included for graphic analysis. An improvement in SBP after RSI with etomidate was observed (123 mm Hg to 136 mm Hg, p = 0.011) with a 9% incidence of hypotension, defined as a decrease in SBP to 90 mm Hg or less. Graphic analysis of individual SBP-time plots reveals hemodynamic stability, especially in patients with lower initial SBP values. These data suggest that the use of etomidate as part of a prehospital RSI protocol is associated with hemodynamic stability and a low incidence of hypotension.

Adolescent↗
PubMedDate not supplied

The efficacy of nebulized albuterol/ipratropium bromide versus albuterol alone in the prehospital treatment of suspected reactive airways disease.

OBJECTIVE: Ipratropium bromide has demonstrated efficacy when added to albuterol for the treatment of reactive airways disease (RAD). Its prehospital use has not been explored. METHODS: A before-and-after design was used. Prehospital and emergency department (ED) medical records were examined retrospectively six months before and six months after institution of a new protocol, which allowed the addition of ipratropium bromide to all nebulized treatments with albuterol. Primary outcome measures included: changes in vital signs (heart rate, respiratory rate, oxygen saturation), clinical improvement as assessed by paramedics, and admission rates. RESULTS: A total of 371 patients were included (n = 192 albuterol alone, n = 179 ipratropium/albuterol). There was no statistically significant difference between groups with regard to the change in heart rate, respiratory rate, or oxygen saturation. In addition, there was no difference in the proportion of patients with clinical improvement or deterioration as assessed by paramedics. There was no statistically significant difference in the admission rate from the ED except in the subgroup of patients using a metered-dose inhaler at the time of illness. Of note, more than one-third (133/371) of the patients were ultimately determined to have a diagnosis other than RAD, the majority of whom were diagnosed as having cardiac disease. CONCLUSIONS: The addition of ipratropium bromide to albuterol for the prehospital treatment of RAD does not appear to result in clinical outcome improvements. A substantial number of patients enrolled in the study were diagnosed as having cardiac disease.

Administration, Inhalation↗
PubMedDate not supplied

Adult foreign body airway obstruction in the prehospital setting.

BACKGROUND: Although the treatment of foreign body airway obstruction in adults has been well studied, few data exist on the characterization of prehospital experiences. OBJECTIVES: To describe the frequency, etiologies, and treatments of foreign body airway obstruction in adults in the prehospital setting and to discuss the relative efficacies of treatments and presenting factors that predict overall patient outcome. METHODS: A San Diego County prehospital database was retrospectively reviewed for all adult patients over a 17-month period with data extracted on demographic characteristics, incident outcome, patient disposition, item involved in obstruction, location of episode, initial vital signs, initial level of consciousness, pertinent medical history, treatments initiated by bystanders and paramedics, and response to those treatments. RESULTS: During the study period, there were 513 cases of foreign body airway obstruction in adults. Of these, 17 (3.3%) died. The mean age was 65.0 years, with increasing age correlating with worse outcome. The item causing obstruction varied widely, with medications and meat being the most common items. The Heimlich maneuver was the most commonly used intervention, with an 86.5% rate of patient improvement. Magill forceps proved useful for three cases refractory to the Heimlich maneuver. Presenting vital sign aberrations, particularly with respiratory rate, correlated with poorer patient outcome. CONCLUSIONS: Foreign body airway obstruction represents a true emergency in adults, with a 3.3% mortality rate in the current study. The Heimlich maneuver was used frequently and with good success.

Adolescent↗