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W A Wittlake

Publications and source records attributed to W A Wittlake.

9 recordsLinked to original sources
PubMed2005

Does leucocytosis identify bacterial infections in febrile neonates presenting to the emergency department?

OBJECTIVE: This study was undertaken to evaluate the discriminatory power of the peripheral white blood cell (WBC) count to identify bacterial infections in a cohort of febrile neonates ( or=38 degrees C, underwent lumbar puncture, and had a WBC count obtained were included. They were divided according to microbiological and radiographic findings into four groups: bacterial infections, viral infections, pneumonia, and negative sepsis evaluations. RESULTS: A total of 69 febrile neonates met the inclusion criteria. The number of neonates in each group was as follows: 8 with bacterial infections, 10 with viral infections, 3 with pneumonias, and 48 with negative sepsis evaluations. There was substantial overlap in WBC counts among the groups. The area under the ROC curve was 0.7231 (95% CI 0.5665 to 0.8797). CONCLUSION: In a cohort of febrile neonates evaluated in the emergency department, the WBC count had modest discriminatory power in identifying neonates with bacterial infections and demonstrated substantial overlap among groups. The present data suggest against the use of any WBC count threshold to identify bacterial infections in febrile neonates presenting to the emergency department.

Bacterial Infections↗
PubMed2000

Benefits of an informational videotape for emergency department patients.

To determine if an informational videotape affected patient's attitudes towards their emergency department visit, we conducted a prospective study using a convenience sample of patients waiting to be seen at a southern California emergency department. Patients waiting to be treated were randomized to view an informational videotape or to receive standard management (no videotape). The informational videotape lasted 6 minutes and served to orient the patients to the emergency department. It showed the sequence of steps from entry into the department to discharge, the nature of triage and causes for delays, the different services offered by the emergency department, and the roles of each of the department staff members. One week after discharge, patients were contacted at home by telephone and were asked to rate various aspects of their emergency department experience. A comparison of the telephone survey rankings between those who viewed the videotape (98 patients) and those who did not (100 patients) revealed statistically significant improvements in the former group on questions about level of anxiety and appropriateness of delays. An informational videotape for patients in waiting areas may be a useful tool to educate about emergency medical services, to reduce anxiety, and to improve satisfaction with the emergency department stay.

Adolescent↗
PubMed2000

Future of the emergency physician: subject or citizen?

Seventy-seven percent of emergency physicians (EPs) work as either employees or independent contractors (ICs). In contrast, other hospital-based physicians such as radiologists and anesthesiologists have a much higher percentage of ownership in their medical practices. The development of a high percentage of nonownership arrangements among EPs finds a useful historical comparison in the industrialization of nonhealth care workers over the past 100 years. Unless significant changes occur in emergency medicine (EM) organization and practice structures, EPs will have less self-determination over their practice compared with other specialties. This will inevitably result in less self-determination for their future. Combined with the great strides EM has achieved as a specialty, EPs' brightest future lies in being citizens of a broader, more expansive, all encompassing EM practice.

Contract Services↗
PubMed1999

What is the optimal dose of intramuscular ketamine for pediatric sedation?

OBJECTIVE: The optimal dose of i.m. ketamine for ED procedural sedation in children is not known. The authors wished to quantify the dose-response of ketamine with respect to sedation adequacy, time to discharge, and adverse effects in order to identify an optimal dose. METHODS: The study was a consecutive case series of 1,022 children < or = 15 years of age given i.m. ketamine in the EDs of a university medical center and an affiliated county hospital over a nine-year period. Adequacy of sedation, time to discharge, and adverse effects were compared with dose administered. RESULTS: Doses in the sample averaged 3.96+/-0.69 mg/kg, with a range of 0.48 to 9.09 mg/kg. Children judged to be adequately sedated received higher doses compared with those inadequately sedated (3.94+/-0.44 mg/kg vs 3.77+/-0.49 mg/kg, p=0.041), and a nonsignificant trend was noted toward uniformly adequate sedation with increasing dose (< or =91% at <4.00 mg/kg, 93% at 4.00-4.49 mg/kg, and 100% at > or = 4.50 mg/kg). No significant difference or trend in time to discharge or adverse effects was noted between the children receiving <4.00 mg/kg and those receiving > or = 4.00 mg/kg of ketamine, and the study had power (alpha=0.05, beta=0.20) to detect a 9-minute difference in times to discharge, a 3.3% difference in rates of airway complications, a 5.6% difference in rates of emesis, and a 12.3% difference in rates of recovery agitation. CONCLUSION: Ketamine doses of 4 to 5 mg/kg i.m. produced adequate sedation in 93%-100% of children, suggesting that this dosing range may be optimal for ED procedural sedation. No difference in time to discharge or adverse effects was observed for lower or higher doses.

Anesthetics, Dissociative↗
PubMed1999

Case report: reversal of an evolving myocardial infarction with intravenous thrombolysis.

This case, in many ways, represents the ideal: a timely and effective administration of thrombolytic agents. The rarity of this situation reinforces the need for earlier recognition and treatment of infarction. In an analysis of time delays in thrombolytic therapy, 38% were attributed to in-hospital issues, 22% to patients' delays, 21% to problems with transportation, and 19% to reperfusion time. The National Heart Attack Alert Program calls for treatment within 1 hour of the development of signs and symptoms, including administration of thrombolytic agents within 30 minutes of the patient's arrival in the emergency department. That program seeks heightened awareness among hospital and prehospital providers and public education about seeking immediate treatment for chest pain. The prompt acquisition of additional ECGs and the subsequent rapid administration of a thrombolytic agent were the clinical essentials. This fact suggests the need to look for measures of quality other than simple "door to drug" times. "Data to drug" times may be another indicator of quality to address cases in which the initial ECG findings are not diagnostic. Furthermore, emergency departments may see more patients with impending infarction if public education campaigns are successful. This case emphasizes the need to obtain follow-up ECGs in light of the potential benefits from thrombolysis.

Aged↗
PubMed1985

Radiation exposure.

Explore the source record for details and available documents.

Emergency Medical Services↗
PubMedDate not supplied

Enhancing the medical practice: consorting with the emergency department.

In 1994, the Department of Emergency Medicine at Loma Linda University Medical Center (LLUMC) set out to implement a comprehensive emergency department (ED) model: a model that headed in the opposite direction of popularized solutions of which the objective is to keep patients out of the ED. This model increases the number of services offered. It triages patients within its walls to an area cost effective for the patient's acuity and allows patients to immediately move to a higher level of care if the provider sees the need. Three years of data have determined the comprehensive ED model to be an effective, patient-focused alternative to the "demand management" methods. Low-acuity patients at LLUMC are treated in less costly areas. The high-tech-laden "MainED" is better utilized because of a 25% increase in complex patients since 1993. In addition, the comprehensive ED model appears to be a valuable resource that enhances the outpatient medical practice.

Comprehensive Health Care↗