Kevin M. Reilly

Complication rates of tube thoracostomy

This study compared the complication rates of tube thoracostomy performed in the emergency department (ED) versus the operating room (OR) and the inpatient ward (IW). A retrospective case series of all patients at an urban, university-based level 1 trauma center hospital who received tube thoracostomy for any indication between 1/1/93 and 12/31/93 was conducted. Complications were defined as empyema, unresolved pneumothorax (persistent air leak or residual pneumothorax), persistent effusion, or incorrect placement. The data for age and duration of tube placement were weighted for analysis of variance (ANOVA). A total of 352 tube thoracostomies was placed in 239 patients. Twenty-three patients had three or more chest tubes placed, 65 had two placed, and the remaining 181 had a single tube. Ninety-nine tubes were placed in the ED, 87 in the OR, and 166 on IW. The mean age of patients in the ED was 37 years, and differed significantly (P < .015) from those in the OR (48 years) and the IW (44 years). The duration of tube placement was similar for all groups (mean = 6.5 days). The overall complication rates related to tube insertion were: ED, 14.0%; OR, 9.2%; IW, 25.3%. Significance was achieved when comparing complication rates between the ED and IW, with less complications in the ED (P = .0436). When comparing complication rates between the ED and OR, there was no significant difference (P = .3643). A power calculation indicated too small of a sample size to truly determine an insignificant difference between complication rates between the ED and OR. Placement of emergent thoracostomy tubes in the ED does not result in an increased complication rate as compared to placement in the IW.

Variables That Affect Patient Throughput Times in an Academic Emergency Department

One of the most important parameters that influence patient satisfaction with emergency department care is their perception of throughput time. It is defined in our department as the time from patient arrival to time of discharge. Measurement of throughput time is one ob jective measure of efficiency that is feasible in most emer gency departments. The purpose of this study is to analyze the impact of certain demographic and resource utiliza tion factors on patient throughput times. Analysis of vari ants through multiple regression was used to determine associations between the average daily throughput time and factors commonly assumed to have significant influ ence on patient throughput time. Our data analysis found that patient throughput was significantly affected by the number of inpatient admissions from the emergency de partment, daily census in the main emergency depart ment, pediatric volume, and the number of ambulance arrivals. Several factors that were commonly assumed to affect patient throughput time, such as nursing hours worked and day of the week, were not significant.

The efficacy and safety of methohexital in the emergency department

STUDY OBJECTIVE To determine the efficacy and safety of methohexital sodium (MTX) in emergency department patients. DESIGN A consecutive case series; all ED patients who received MTX from July 1989 through July 1990 were studied in a prospective manner. SETTING A university hospital ED. PARTICIPANTS All 102 adult and pediatric patients who received MTX. INTERVENTIONS Emergency physicians trained in the use of MTX administered the drug. A study form was completed that provided data on dosage and response, indications for use, final diagnosis, hemodynamic and respiratory parameters, and an efficacy survey. RESULTS Average cumulative dose of MTX was 1.6 +/- 1.3 mg/kg. The average duration of action per dose was 7.6 +/- 5.0 minutes. Leading indications for use were orthopedic procedures (54), endotracheal intubation (18), head computed tomography scan (ten), and wound care (eight). Hemodynamic changes were minimal; the average change in systolic blood pressure five minutes after MTX was -1.8 +/- 20 mm Hg. Average heart rate change was 3.0 +/- 20 beats. Percent respiratory depression was 17 +/- 24%. There was no correlation between MTX dose and the degree of respiratory depression. Narcotics and/or benzodiazepines were given with MTX in 92 cases, with no significant increase in respiratory depression. No major complications attributable to MTX were identified. CONCLUSION MTX, when used by trained personnel who adhere to an established protocol, appears to be a safe and effective drug in selected ED patients.

Accuracy of blood ethanol determination using serum osmolality

A retrospective review of 81 emergency department patients was performed to determine the accuracy of blood ethanol levels (BEL) calculated from serum osmolality. The osmolar gap (measured-calculated serum osmolality) was used to determine the calculated BEL. The mean difference between calculated and measured BEL was 49.2 mg/dL. Calculated BEL overestimated measured BEL in 83% of patients. Adding a correction factor for unmeasured osmoles to the equation for calculated serum osmolality will reduce this error.

Odds of critical injuries in unrestrained pediatric victims of motor vehicle collision

Objectives: To compare morbidity and mortality between pediatric victims of motor vehicle collisions (MVC) who were unrestrained to those restrained and to describe compliance with child restraint usage in our population. Materials and Methods: A retrospective consecutive chart review study was performed on MVC victims 14 years old and younger who presented to our academic, level 1 trauma emergency department in 2003. Each patients emergency department and hospital course was reviewed and data were collected. Odds ratios (ORs) were calculated for unrestrained children with respect to restrained children for fractures; intraabdominal injuries, intrathoracic injuries, intracranial injuries, admission, surgery, blood transfusion, intubation; and deaths. Hospital charges and length of hospital stay were compared between those unrestrained and restrained. Percentage of children unrestrained was determined. Results: Of 336 patients, 81 (24%) were unrestrained. Mean hospital stay for unrestrained children was longer, 1.94 days (95% confidence interval [CI] 0.75-3.12) versus 0.098 days (95% CI 0.02-0.21). Unrestrained victims had higher mean charges,

The rational ordering of blood cultures in the emergency department.

14,754 (95% CI

An unusual presentation of cat scratch encephalitis

7676-

Atypical presentation of pulmonary embolism

21,831) versus

The Significance of Out‐of‐hospital Hypotension in Blunt Trauma Patients

1996 (95% CI

Theme-based teaching of point-of-care ultrasound in undergraduate medical education

1207-