John Guisto

Severe toxicity from crotalid envenomation after early resolution of symptoms

Initial observation of a patient who sustained a rattlesnake bite on the hand showed resolution of mild swelling over 3 hours. The patient left the emergency department against medical advice, only to return 12 hours later with severe pain and swelling, as well as a marked coagulopathy. This case illustrates the need for an observation period after crotalid bite, even when the envenomation seems to be minor or when symptoms resolve.

Analysis of Federally Imposed Penalties for Violations of the Consolidated Omnibus Reconciliation Act

STUDY OBJECTIVE To identify the incidence of federally imposed penalties for violations of the Consolidated Omnibus Reconciliation Act (COBRA). METHODS Under the Freedom of Information Act, we retrieved a copy of any document related to fines imposed on, settlements made by, or litigation against physicians or hospitals as a result of COBRA violations from the Office of the Inspector General. Under a separate inquiry, also under the Freedom of Information Act, we requested and received from the central office of the Health Care Financing Administration the National Composite Log showing the status of all complaint investigations pursuant to COBRA since the inception of the law. RESULTS One thousand seven hundred fifty-seven complaint investigations were authorized. Of the 1,729 investigations completed, 412 (24%) were found to be out of compliance with federal regulations. Of these, 27 cases resulted in fines imposed on hospitals. These fines ranged from

Sedative dosing of propofol for treatment of migraine headache in the emergency department: A case series

1,500 to

The feasibility of 12-gauge intravenous catheter use in the prehospital setting

150,000 with a mean of

Evidence-based Comprehensive Approach to Forearm Arterial Laceration

33,917, a median of

Use of Emergency Ultrasound in Arizona Community Emergency Departments

25,000, and standard deviation of

Rapid process redesign in a university-based emergency department: Decreasing waiting time intervals and improving patient satisfaction

35,899. The six fines that were imposed against physicians ranged in value from

Radiology Resident Evaluation of Head CT Scan Orders in the Emergency Department

2,500 to

Emergency Medical Service Systems Research: Problems of the Past, Challenges of the Future

20,000 with a mean of

Environmental thermal stress

8,500, a median of