-
[show abstract]
[hide abstract]
ABSTRACT: Tracheal mucosal perfusion is compromised at an endotracheal tube (ETT) cuff pressure of 30 cm H(2)O, and blood flow is obstructed at a pressure of 50 cm H(2)O.
We measured the change in pressure of air-filled cuffs of 6.0 and 7.5 ETTs and a size 4 laryngeal mask airway (LMA) from sea level to 2400 m. The ETTs and LMA cuff measurements were done with the devices uncontained, and an additional 6.0 ETT was placed in a 10-mL syringe barrel to mimic placement in a trachea. This restricted cuff expansion simulating what would occur when it is placed within the trachea. The pressure of fluid-filled 6.0 ETT cuffs was also measured.
Intracuff pressure increases linearly with increasing altitude, in all air-filled ETT and LMAs. Water-filled cuffs demonstrated no significant change in pressure with changes in altitude. The rate of ETT cuff pressure increase was greater for the ETT restricted within the syringe barrel compared with the unrestricted ETT cuff. The rate of LMA cuff pressure increase was greater than the rate of increase for all the ETTs (restricted and unrestricted).
This model indicates that ETT cuffs inflated before air transport are likely to exceed critical pressure levels rapidly during flight. In addition, there will be loss of ETT cuff pressure, with loss of a good seal, during descent if a cuff is initially inflated at peak altitudes. Therefore, we suggest ETT cuff pressures should be monitored and adjusted continuously during ascent and decent.
Pediatric emergency care 05/2011; 27(5):367-70. · 0.92 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: While there are many reasons people choose not to donate blood, pain sustained during the venipuncture portion of the blood donation process is likely one deterrent to volunteer donation. The purpose of this study was to survey the improvement in likelihood of donation if participants were given the option of a topical anesthetic cream prior to venipuncture.
Over a three month period 316 adults (convenience sample) completed a one page survey consisting of twelve questions pertaining to blood donation. Participants were asked about their likelihood of donating blood in the near future (No Possibility, Possible, Likely, Certain). They were then informed of the possibility of using a topical anesthetic cream prior to donation. Subsequently, their likelihood of donating blood was reassessed.
Fifty (16%) subjects reported an increased likelihood of donating blood if offered a topical anesthetic (p〈0.0001). Of these respondents reporting an increase in donation likelihood, eleven improved by 2 or more likelihood categories. Amongst the 169 participants who never donated blood, 34 (20%) reported an increased likelihood of donation after being told about the topical anesthetic cream, compared to 16 (10%) of the 147 subjects who had previously donated blood (p=0.02).
The findings of this study suggest that providing a topical anesthetic had a positive effect on the study participants' likelihood of donating blood. This improvement was greater amongst those who have never donated blood.
Hawaii medical journal 02/2011; 70(2):28-9.
-
[show abstract]
[hide abstract]
ABSTRACT: The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are employed in the evaluation of patients with suspected septic arthritis, osteomyelitis, and acute rheumatic fever. The purpose of this study is to determine if one test has greater sensitivity (rises earlier) than the other. Laboratory data were retrieved for pediatric patients hospitalized with one of the above three conditions, who had both ESR and CRP tests done on or shortly prior to admission. Sensitivity calculations were performed for mild, moderate, and severe degrees of ESR and CRP elevation. Microcytic erythrocytes, as defined by mean corpuscular volume (MCV) <80 µL, were identified to see if this affects the ESR. ESR or CRP sensitivities depend on the cutoff value (threshold) chosen as a positive test. The sensitivities were similar for similar degrees of elevation. ESR and CRP discordance was not significantly related to MCV. We concluded that the CRP does not rise earlier than the ESR (their sensitivities are similar). Previously published conclusions are dependent on arbitrary thresholds. We could not find any evidence that MCV affects the ESR.
Pediatric reports 01/2010; 2(1):e10.
-
[show abstract]
[hide abstract]
ABSTRACT: Length-based dosing systems reduce errors associated with resuscitation drug dosing. Obese and thin children of the same length are dosed the same despite their different weights.
Length (height) and weight were measured in children after a body habitus icon assignment. Within each body habitus group, regression analysis was performed to generate a weight-estimation formula using body habitus and length (BHL). This BHL method was compared to the Broselow tape (BT).
Height and weight data were plotted to obtain visual scattergrams. Logarithmic regression yielded higher correlation coefficients than standard linear regression. Within body habitus groups, BHL epinephrine dose estimates were more accurate than BT dose estimates using 0.01 mg/kg as a dosing standard.
Adding body habitus information to the patient's length results in a more accurate weight estimate than length alone in children. The accuracy improvement is greater in children 3 years and older as compared to younger children.
The American journal of emergency medicine 10/2009; 27(7):810-5. · 1.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The effect of nail polish on pulse oximetry measurements in non-hypoxic subjects has been studied extensively. Some studies found that nail polish decreased pulse-oximetry (S(pO(2))) values, whereas others found no effects from nail polish.
To determine if nail polish affects S(pO(2)) measurements in mildly hypoxic subjects.
At high altitude, 5 investigators, whose mean oxygen saturation was 91.3% (mild hypoxia), and with 2 brands of pulse oximeter and oximetry probe, obtained S(pO(2)) measurements from a finger with nail polish and from the matching finger on the opposite hand without nail polish. We tested 9 different nail-polish colors and made 210 pairs of S(pO(2)) measurements.
The mean +/- SD S(pO(2)) values from the fingers with and without nail polish, respectively, were 91.4+/-4.1% and 91.2+/-3.5% (difference 0.2+/-3.2%, 95% confidence interval -0.2% to 0.4%).
With the pulse oximeters and oximetry probes we tested, nail-polish had no significant effect on S(pO(2)) in mildly hypoxic healthy subjects.
Respiratory care 12/2008; 53(11):1470-4. · 2.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study is to quantify the material children and adolescents are exposed to while watching prime-time television so that school educators, health professionals, and parents can focus on issues of maximum exposure that must be addressed.
Prime-time programming was recorded from 7 p.m. to 10 p.m. Hawaiian Standard Time daily for 2 weeks in July 2005. Recordings were then viewed to identify social behaviors of interest.
Each hour on average, sex was referenced 1.8 times, drugs 0.6 times, tobacco 0.3 times, alcohol 2.4 times, and violence/crime 6.0 times per network. Messages advocating exercise, anti-drug advocacy, and anti-smoking advocacy were each shown 0.2 times per hour; while anti-alcohol advocacy was shown 0.1 times per hour.
School educators, health professionals, and parents must recognize that prime-time television frequently exposes viewers to issues that are of critical importance to the health and social development of school-aged children and adolescents.
Hawaii medical journal 04/2008; 67(3):74-5, 83.
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study is to examine the epidemiology and trends of body size in college athletics. Data were coded from available athlete rosters from four division 1 college athletic programs for football, basketball, baseball, and men's/women's tennis for the period of 1950 to the present. Data on 17,500 football, 2,470 basketball, 3,868 baseball, 903 men's tennis, and 765 women's tennis athletes were entered. Increases in height, weight, and body mass index (BMI) were seen for all sports at most positions, but the greatest increases were observed in football offensive and defensive linemen. The largest increases in weight and (BMI) were observed amongst football offensive and defensive linemen, placing them at greatest risk for size-related medical complications. Other college sports exhibit increases in height, weight, and BMI as well, but the rates of increase were not as great.
Research in Sports Medicine An International Journal 02/2008; 16(2):111-27.
-
Loren G Yamamoto
[show abstract]
[hide abstract]
ABSTRACT: Advanced diagnostic procedures, imaging studies, and therapeutic procedures have combined to substantially increase the need for pediatric sedation. The objective of this study is to describe the initiation of a hospital-wide (nonemergency department) pediatric deep sedation service provided by pediatric emergency physicians. This article describes a consecutive cohort of pediatric patients undergoing deep sedation provided by a new hospital sedation service (excluding the emergency department). The results of 133 pediatric deep sedations are described. Propofol was used for most sedations. Mean infusion times were 55 minutes for MRI scans and 13 minutes for heme-oncology procedures. The risk of adverse events was low. This case series of pediatric deep sedation patients describes the initiation of a hospital-wide pediatric sedation service utilizing pediatric emergency physicians, which has resulted in improved patient care, and improved financial performance of several hospital units. The risk of adverse events is low if proper precautions are taken.
Clinical Pediatrics 02/2008; 47(1):37-48. · 1.15 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The outcome of refractory cardiac arrest is poor. The purpose of this report is to describe two cases presenting with fulminant myocarditis and refractory cardiac arrest treated with emergency department cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), with subsequent recovery.
Report of two cases.
Two patients presented with a new onset dysrhythmia heralding fulminant myocarditis and cardiac arrest refractory to advanced life support measures. Chest compressions and positive pressure ventilation maintained oxygenation and perfusion until CPB could be initiated in the ED followed by ECMO. Spontaneous cardiac recovery followed, associated with normal neurocognitive function.
While CPB and ECMO initiation in the ED is a rare event, this could provide patients with cardiac arrest presentations suggestive of myocarditis, additional time for recovery to occur. Clinical factors suggesting a good outcome are witnessed cardiac arrest in a previously healthy child with immediate initiation of effective CPR and good brain perfusion and function as evidence by substantial bodily movement during CPR. Significant dysrhythmias in a previously healthy child may herald substantial deterioration and cardiac arrest.
American Journal of Emergency Medicine 04/2007; 25(3):348-52. · 1.98 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Heptavalent conjugate pneumococcal vaccine (PCV7) is now routinely administered to infants. Medical records from a pediatric outpatient clinic were used to identify two study groups: 1) those born between January 1995-May 1997(controls), 2) those born between April 2000--May 2001 (PCV7 group). The PCV7 group showed a lower incidence of otitis media episodes, clinic visits for fever and respiratory symptoms, antibiotic prescriptions, ceftriaxone use, and hospitalizations (singled sided probabilities).
Hawaii medical journal 11/2006; 65(10):288-9.
-
[show abstract]
[hide abstract]
ABSTRACT: 100 teens ranked pain experienced for their most recent "shot"on three different scales: casual 0-10 scale (mean 3.3), faces scale (mean 2.8), and 10 cm visual analog scale (mean 2.4). All pain scores showed wide variation (poor validity). Pain severity values were not equivalent across the different pain scales with the casual 10 scale most likely to overestimate pain values.
Hawaii medical journal 10/2006; 65(9):257-9.
-
[show abstract]
[hide abstract]
ABSTRACT: Childhood and adolescent obesity is an increasing public health problem. Fast food consumption has been linked to obesity. The purpose of this study is to determine adolescent calorie and fat consumption patterns at different types of restaurants.
Study subjects (104 adolescents) were asked to order a dinner meal from 10 restaurant menus with an estimate of how much they would actually consume. A paired T-test was used to compare the calories and fat values for each restaurant vs. McDonald's.
Mean calories/fat (g) ordered at each restaurant were: California Pizza Kitchen (CPK).: 1284/70, Chili's (Ch). 1333/62, Denny's (Den): 1226/61, McDonald's (MD): 1016/45, Outback Steakhouse (OS): 1656/93, Panda Express (PE): 873/29, Red Lobster (RL): 1016/49, Stuart Anderson's (SA). 1058/52, Taco Bell (TB): 800/34, Wendy's (Wen): 879/32. Calorie/fat content of the ordered items were significantly higher at CPK, Ch, Den, and OS compared to McDonald's. RL and SA were not significantly different from MD. Calorie/fat content of the ordered items were significantly lower at PE, TB and Wen compared with McDonald's.
More calories/fat were ordered at many sit down restaurants compared to McDonald's. The lowest calories/fat were ordered at other fast food restaurants (Taco Bell, Wendy's and Panda Express).
Hawaii medical journal 09/2006; 65(8):231-6.
-
[show abstract]
[hide abstract]
ABSTRACT: TARGET AUDIENCE: Physicians, nurse practitioners and physician assistants who care for infants and children in the emergency department or in other ambulatory and acute care settings. In particular, physicians with administrative responsibilities will find this information useful. OBJECTIVES: 1. Describe the purpose and scope of an electronic medical record. 2. Point out the unique demands that the emergency department places upon an EMR. 3. List the advantages and disadvantages of computerized charting.
Pediatric emergency care 04/2006; 22(3):184-91; quiz 192. · 0.92 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine whether adolescents will modify their ordering behavior if calorie and fat nutrition information is posted on the restaurant menu.
Adolescent volunteers (aged 11 to 18 years) were asked to order a dinner of their choice from three different restaurant menus (McDonald's, Panda Express, and Denny's) and then from a second set of modified menus with calorie and fat content information posted next to each menu item. Total reported consumed calories, fat, and the price of the meal ordered were calculated for each meal.
For the first 106 adolescents enrolled, 75 did not change any of their orders after being shown the calorie and fat content information. For the 31 who did change some of their orders, 43 meals resulted in decreased calories and 11 meals resulted in increased calories (20 resulted in a more expensive meal, 23 resulted in a less expensive meal and 11 resulted in no change in the cost of the meal; average change 0.027 dollar increase). Of the 27 who rated themselves as too fat or slightly overweight, only 9 (33%) changed their orders.
The provision of calorie and fat content information on the menus did not modify the food ordering behavior for the majority of adolescents. However, the provision of the nutrition information should still be encouraged because it resulted in some calorie/fat reduction by some of the adolescents and it did not adversely affect the restaurants' revenue.
Journal of Adolescent Health 12/2005; 37(5):397-402. · 3.33 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Emergency procedures have been traditionally taught in live "hands on" workshops, which are expensive (tuition, travel, hotel, and leaving one's practice idle). This study was conducted to compare the teaching efficacy of a traditional live workshop to a procedure-in-a-box toolkit (PBT) method which contains audiovisual instructions and props to practice the procedures.
Four procedures, zipper release, intraosseous needle placement, fishhook removal, and splinting, were taught to 32 physician volunteers, using both teaching methods. Each participant was asked to evaluate the teaching method after each session.
The mean educational quality of each method were not significantly different from each other, but if given a choice study subjects preferred the live workshop more often.
The live workshop is the preferable method for teaching procedures but when considering expenses, most of the subjects felt that the PBT method is an adequate substitute method for the live workshop.
Hawaii medical journal 12/2005; 64(11):292, 294-5.
-
[show abstract]
[hide abstract]
ABSTRACT: Appropriate lumbar puncture (LP) needle length selection may be more difficult for less experienced practitioners or for patients who are of unusually large or small body habitus. The purpose of this study is to determine if there is a relationship between body height and weight, and the percutaneous depth to the spinal canal, which can more reliably assist in selecting an LP needle length.
This is a retrospective cohort study of patients who received an abdominal computed tomographic scan (for any reason) from July 1999 to December 2000. Lumbar puncture depth was measured on the computed tomographic scan and was used to derive a formula.
The final data pool consisted of 175 patients, aged 25 days to 80 years, with height of 48 to 181.5 cm, weight of 3.0 to 127.3 kg, and body mass index of 11.7 to 49.7 kg/m2. Using this data set, the formula for predicting the required LP depth is (weight in kilograms, height in centimeters): LP depth (cm) = 1 + 17 x weight/height. Using linear regression comparing the skin to mid-spinal canal depth measurements with the calculated LP depths, R2 was 0.81 (P < .001). This formula selected a needle that was too short in 6% (less than that of 4 other previously published LP needle length selection methods) and a needle that was too long in 31%.
Compared with other formulas, this formula might be a more reliable predictor for estimating the required LP needle length, but this must be validated by further studies. It should be noted that none of the formulas were perfect.
American Journal of Emergency Medicine 11/2005; 23(6):742-6. · 1.98 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The diagnosis of acute otitis media is based on several clinical factors. One of these factors is the color of the tympanic membrane (TM). Crying can cause flushing and hyperemia of the face. The purpose of this study is to determine whether crying affects the color of tympanic membranes. Infants and toddlers (age 30 months or less) evaluated in an outpatient clinic or primary care pediatrician's office for routine well-baby checks who received at least 2 parenteral immunizations were enrolled on a convenience basis. Ill children were excluded. The initial physician assessed crying and TM color/visibility. Following immunizations, a second physician assessed crying and the TM color/visibility. Color differences were stratified by the degree of crying. One hundred twenty-one study subjects received 2-5 parenteral immunizations. TM colors were most often in the pink range or less. Only 2 TMs were assessed as light red and none were assessed as red. Twenty-eight percent of the TMs with greater crying on the second exam were noted to be redder on the second exam compared to the first exam versus 11% for the comparison group (p=0.0007); 19% of the TMs with greater crying on the second exam were noted to be redder by 2 or more increment levels compared to the first exam versus 5% for the comparison group (p=0.0004); 31% of the TMs with greater crying on the second exam at the 3+ and 4+ level were noted to be redder on the second exam compared to the first exam versus 14% for the comparison group (p=0.003). Our data indicate that, in some instances, crying can result in an increase in pinkness of the TM. Crying in well children does not result in a red tympanic membrane.
Clinical Pediatrics 11/2005; 44(8):693-7. · 1.15 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There are several types of emergent zipper release methods described. The standard method can be difficult. The purpose of this study is to determine if an alternate method of zipper release can be easier to accomplish.
Subjects were provided with zippers and were taught 2 methods of emergent zipper release using a standard method (cutting the median bar of the actuator) and an alternate method (cutting the closed teeth of the zipper). The elapsed times to successful zipper release for both methods were measured.
Mean zipper release times were faster for the alternate method (10.5 seconds) compared with the standard method (75.8 seconds) ( P < .001).
The alternate method of zipper release is faster and easier than the standard method of zipper release; however, the optimal procedure is also dependent on the location of the entrapped tissue relative to the zipper actuator and the type of zipper.
American Journal of Emergency Medicine 07/2005; 23(4):480-2. · 1.98 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine the compliance rate in filling outpatient medication prescriptions written upon discharge from the emergency department (ED).
Emergency department records of children during a 3-month period were examined along with pharmacy claim data obtained in cooperation with the largest insurance carrier in the community (private and Medicaid). Pharmacy claim data were used to validate the prescription pick-up date.
Overall, 65% of high-urgency prescriptions were filled. The prescription pick-up rate in the 0-to 3-year age group (75%) was significantly higher than in the rest of the cohort (55%) ( P < .001). Children with private insurance were more likely to fill their prescriptions (68%) compared to children with Medicaid insurance (57%) ( P = .03).
This study demonstrates that filling a prescription after discharge from an ED represents a substantial barrier to medication compliance.
American Journal of Emergency Medicine 07/2005; 23(4):454-8. · 1.98 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Dental fracture is a complication of laryngoscopy and endotracheal intubation.
The purpose of this study is to compare the potential fracture rates in dental models using metal laryngoscope blades with those using plastic laryngoscope blades.
Size 3 Macintosh plastic and metal laryngoscope blades were applied against 4 different dental model materials at varying torques to determine when the dental model material would fracture.
The plastic blade did not fracture any of the dental model materials. The metal blade fractured the glass dental model material even at the lowest torque setting. At a moderate torque setting, the plastic blade showed evidence of structural failure, whereas the metal blade did not fail at any torque setting. Fracture of wooden dowel and ceramic teeth model materials occurred with the metal blade but only at torque settings higher than what the plastic blade could achieve.
Based on the dental fracture models studied, plastic laryngoscope blades have a lower potential for dental fracture compared with metal blades. Plastic laryngoscope blades would be best suited for trainees performing routine intubations under direct supervision. Metal blades would be more advantageous in difficult intubations preferably done by experienced intubators.
American Journal of Emergency Medicine 04/2005; 23(2):186-9. · 1.98 Impact Factor
