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ABSTRACT: 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.
07/2009; 6(2):215-217.
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ABSTRACT: Mandibular fractures occur primarily as the result of blunt trauma (e.g., motor vehicular crashes, assaults). Patients not only sustain single-system injuries but they must also be managed as multisystem trauma patients. The purpose of this article is to present a case of a patient with a mandibular fracture due to a fall. Patient assessment and management issues have been addressed in this article along with the imaging modalities utilized in the diagnosis of this patient with a mandibular fracture.
Advanced emergency nursing journal 03/2008; 30(2):102-111.
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ABSTRACT: Injuries of the tarsometatarsal, or Lisfranc, joint are rarely seen. Lisfranc fractures and fracture dislocations are among the most frequently misdiagnosed foot injuries in the emergency department. A misdiagnosed injury may have severe consequences including chronic pain and loss of foot biomechanics. Evaluation of a foot injury should include a high level of suspicion of a Lisfranc injury, and a thorough work-up is needed for correct diagnosis.
Advanced emergency nursing journal 31(4):269-76.
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[show abstract]
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ABSTRACT: To assess the effectiveness and safety of intravenous (IV) and intramuscular (IM) midazolam in the treatment of pediatric seizures by paramedics.
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.
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.
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.
Prehospital Emergency Care 6(2):215-7. · 1.78 Impact Factor
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ABSTRACT: The wildfires of October 2003 burned a total of 10% of the county of San Diego, California. Poor air quality contributed to an increased number of patients seeking emergency services, including healthcare providers affected by smoke and ash in hospital ventilation systems. Two large hospitals with special patient populations were threatened by rapidly approaching fires and had to plan for total evacuations in a very short time frame. A number of medical professionals were forced to prioritize responding to the hospital's call for increased staff during the disaster and the need to evacuate their own homes.
Disaster Management & Response 2(2):46-52.
