LouAnn H. Woodward

Effect of routine pulse oximetry measurements on ED triage classification.

Pulse oximetry is commonly used to rapidly determine oxygen saturation and is incorporated in emergency triage as a screening for potential cardiopulmonary complications. This study examined the effect of routine pulse oximetry measurements on emergency department (ED) triage classification. Using a portable pulse oximeter, oxygen saturation of 1,235 adults presenting to a university-based, urban ED was obtained and each patient was assigned a classification of severity based on a standard 1-to-4 scale before and after the measurement. According to data obtained, a small but statistically significant group (2.8%) benefitted from the routine use of pulse oximetry in an emergency triage system and only 40% of these patients required admission or extended care. Although this group is small in number, the potential consequences of missing a hypoxic condition could be devastating for the individual patient. Since pulse oximetry is presently an inexpensive technology, it would seem to be a worthwhile screening tool for emergency triage.

Prevalence of Intubation Rescue by Air Medical Personnel During Transfers From Rural Emergency Departments

OBJECTIVE Non-emergency-trained providers in rural emergency departments (ED) often lack the skills required for emergency resuscitations and rely on air medical transport teams to provide the initial airway stabilization of these patients. In this study, we determined the prevalence with which endotracheal intubations are required of air medical personnel upon arrival to rural EDs including intubations that were first attempted by the local provider. METHODS A retrospective database review was conducted of all air medical transfers from rural hospitals for a 28-month period. Those patients requiring an airway were categorized according to which provider initiated the intubation procedure. The prevalence of intubations performed by air medical and local providers was recorded as the percent of the total number of intubations. RESULTS There were a total of 217 patients from 11 rural EDs requiring airway support. Air medical personnel were responsible for 85% of the intubations. Alternative airway support was necessary in 5% of the patients after unsuccessful intubation attempts. The failed intubations tended to be slightly older and female. CONCLUSION Our study suggests that the vast majority of the intubations for patients requiring a helicopter evacuation from these rural settings are performed by the air medical personnel.

Learning the process of research by using the scientific method

A decision to pursue an academic career is often based on experiences acquired during residency training (Sanders et al., 1992, Sanders et al., 1994; Pollack, 1994). One of the greatest impediments to convincing young physicians to seek an academic career is the knowledge that their advancement will be largely dependent upon their interest and ability to perform some type of research (Brancati et al., 1992). Most residents view the research requirement as only another obstacle to overcome for the completion of their residency (Pollack, 1994; Levitt et al., 1997). Even those who are academically inclined can be dissuaded by the seeming complexity of scienti® c inquiry. Furthermore, without a sense of an overall purpose to their investigation, the young researcher often becomes bored with the drudgery of data collection and analysis. It is difficult to interest young physicians in academics when their only experience of such a life is from their resident research requirement. In fact, there is a strong correlation between the quality of the resident’s research experience and a decision concerning academics as a career choice (Sanders et al., 1992; Sanders et al.,1994). Those who do choose a faculty track cite an impression of the value of research more than adequacy of research skills as a major factor in ̄ uencing their career decision (Sanders et al., 1994). With this in mind, we chose to re-examine the way that the research curriculum is presented and to develop a method of learning that would stimulate a greater interest in research among our residents and young faculty. Six years after implementation of a new curriculum that was ® rst described in a prior edition of this journal (Summers et al., 1998), current and past residents in our program were surveyed to judge the quality of their resident research experience and to determine the effectiveness of this method of learning to in ̄ uence their view of research and the academic environment.

Correlation of radiographic cardiothoracic ratio with cardiac function in patients with acute congestive heart failure

Objective: Plain film radiographs are routinely used as a part of the emergency department evaluation of patients with acute congestive heart failure. Determination of the cardiothoracic ratio (CT ratio) may provide insight into the severity and mechanism of the cardiac dysfunction. This study was designed to correlate the determined CT ratio with measures of systolic and diastolic function in patients with decompensated congestive heart failure (CHF). Methods: The CT ratio was retrospectively calculated from the routine upright anteroposterior plain film radiographs obtained during the evaluation of patients with acute CHF. Likewise, values for the diastolic time intervals such as isovolumic relaxation times and filling times (measures of diastolic dysfunction, IVRT, FT) and the Heather Index (a measure of systolic contractility, HI) were obtained from the tracings obtained by impedance cardiography (IC). These functional measures were then independently correlated with the CT ratio by multiple regression analysis. The degree of left ventricular hypertrophy (LVH) as determined by EKG voltage was also correlated to cardiac function measures for comparison. Results: In 45 patients there was no significant correlation (P < 0.05) of the measured IVRT and FT with the corresponding CT ratio. The HI was also significantly inversely correlated with the CT ratio (r = –0.36, P < 0.05). By comparison, the degree of LVH was not significantly related to the measures of systolic function but was highly correlated to the IVRT. Conclusion: CT ratios determined from plain film radiographs appear to correlate well with measures of cardiac systolic function and may be useful in determining the severity and mechanism of CHF in the acute setting.

Correlation of the radiographic cardiothoracic ratio with cardiac function in patients with acute congestive heart failure

Objective: Plain film radiographs are routinely used as a part of the emergency department evaluation of patients with acute congestive heart failure. Determination of the cardiothoracic ratio (CT ratio) may provide insight into the severity and mechanism of the cardiac dysfunction. This study was designed to correlate the determined CT ratio with measures of systolic and diastolic function in patients with decompensated congestive heart failure (CHF). Methods: The CT ratio was retrospectively calculated from the routine upright anteroposterior plain film radiographs obtained during the evaluation of patients with acute CHF. Likewise, values for the diastolic time intervals such as isovolumic relaxation times and filling times (measures of diastolic dysfunction, IVRT, FT) and the Heather Index (a measure of systolic contractility, HI) were obtained from the tracings obtained by impedance cardiography (IC). These functional measures were then independently correlated with the CT ratio by multiple regression analysis. The degree of left ventricular hypertrophy (LVH) as determined by EKG voltage was also correlated to cardiac function measures for comparison. Results: In 45 patients there was no significant correlation (P < 0.05) of the measured IVRT and FT with the corresponding CT ratio. The HI was also significantly inversely correlated with the CT ratio (r = –0.36, P < 0.05). By comparison, the degree of LVH was not significantly related to the measures of systolic function but was highly correlated to the IVRT. Conclusion: CT ratios determined from plain film radiographs appear to correlate well with measures of cardiac systolic function and may be useful in determining the severity and mechanism of CHF in the acute setting.