Wind disasters: A comprehensive review of current management strategies.

Wind disasters are responsible for tremendous physical destruction, injury, loss of life and economic damage. In this review, we discuss disaster preparedness and effective medical response to wind disasters. The epidemiology of disease and injury patterns observed in the early and late phases of wind disasters are reviewed.

Airway adjuncts.

Airway management is an essential component of the emergency medicine skill set. Management of the difficult airway may include airway adjuncts, including variants of laryngoscopic blades, supraglottic devices, stylets, and video laryngoscopy. These various airway adjuncts have certain advantages and disadvantages, and factors to be considered include ease of use, cost, maintenance, storage, and portability.

Implementation of an antibiotic nomogram improves postoperative antibiotic utilization and safety in patients undergoing coronary artery bypass grafting.

Background: Routine, initial, empiric vancomycin dosing by clinicians in postoperative coronary artery bypass grafting (CABG) patients was identified as a potential patient safety issue in the Cardiovascular Intensive Care Unit (CVICU) because the rate of postoperative acute renal insufficiency (ARI) and average patient Body Mass Index (BMI) > 35 kg/m2 were significantly higher in our institution than those of the Society of Thoracic Surgeons (STS) database. A vancomycin dosing nomogram was derived from the local patient population in the attempt to improve patient safety by convincing clinicians to use an evidence-based approach to vancomycin prescription.

Methods: We analyzed two different treatment strategies that were applied consecutively to an intensive care unit population.

Bilateral bronchial intubation through a tracheostomy incision after innominate artery laceration.

A 17-year-old adolescent boy presented for direct laryngoscopy, rigid bronchoscopy, laser ablation of tracheal scar, and possible tracheostomy. The innominate artery was lacerated during tracheostomy. We describe a unique approach toward ventilation in this case in which two separate endotracheal tubes were connected through a Carlens tube adaptor.

Pain perception among Emergency Department patients with headache: responses to standardized painful stimuli.

Perception of pain varies significantly across groups of patients. The primary objective of this study was to measure perceived pain among Emergency Department (ED) patients with headache in response to standardized painful stimuli, including blood pressure (BP) cuff inflation and intravenous catheterization (IVC). In this prospective, case-control series, ED patients undergoing IVC and with a headache were compared to those undergoing IVC but without a headache.

The verbal numeric pain scale: effects of patient education on self-reports of pain.

Background: Emergency department (ED) patients are frequently asked to provide a self-report of the level of pain experienced using a verbal numeric rating scale.

Objectives: To determine the effects of patient education regarding the verbal numeric rating scale on self-reports of pain among ED patients.

Methods: In this prospective, interventional study, 310 eligible ED patients with pain, aged 18 years and older, were randomized to view either a novel educational video (n = 155) or a novel print brochure (n = 155) as an educational intervention, both developed to deliver educational information about the verbal numeric pain scale and its use.

A preliminary study of 24-hour post-cesarean patient controlled analgesia: postoperative pain reports and morphine requests/utilization are greater in abstaining smokers than non-smokers.

Background: Previous clinical studies have not examined the relationship between nicotine abstinence and opioid use for postoperative analgesia. This may be important because tobacco smokers are routinely required to abstain from smoking just before and during acute post-surgical recovery. This study investigated IV morphine self-administration [patient controlled analgesia (PCA)], subjective pain/drug effects and other measures during post-operative (elective Cesarean section) recovery.

Machiavelli's advice to the hospital chief executive officer.

Hospital chief executive oficers (CEOs) have demanding jobs in which they must, at tims, function as if they are potentates of small principalities. Their ability to elicit loyalty and allegiance, hand out discipline and praise, foster alliances with other organizations, and commit the occasional hostile yet (it is hoped) successful foray onto a competitor's turf are skills that must be mastered for success and longevity. We have taken the thoughts and strategies of the Renaissance political master, Niccolo Machiavelli, and applied them to the modern hospital CEO for whom we feel they still hold elements of wisdom and guidance.

The virtual patient encounter--units of service in the electronic age.

A patient, preoperative evaluation center can reduce delays and cancellations, but it's critical to measure staff workload and determine the best ways to coordinate care. See how one clinic in Ohio is succeeding with this effort.

The obligation of physicians to medical outliers: a Kantian and Hegelian synthesis.

Background: Patients who present to medical practices without health insurance or with serious co-morbidities can become fiscal disasters to those who care for them. Their consumption of scarce resources has caused consternation among providers and institutions, especially as it concerns the amount and type of care they should receive. In fact, some providers may try to avoid caring for them altogether, or at least try to limit their institutional or practice exposure to them.

Influence of form structure on the anesthesia preoperative evaluation.

Study Objective: To determine the impact of changes in form design on the capture of administrative and clinical data elements.

Design: Randomized retrospective chart review.

Setting: Academic health center.

Influencing physician performance.

For physicians to change their behavior, they must internalize the need for change. One way to do this is to get the physicians to agree to the improvement. In this study, surgeons were asked to agree that documentation is important.

Why doctors are afraid of numbers.

Physicians are said to be data-driven. However, their behavior frequently is at odds with this belief. Physicians often protest when presented with unfavorable data, complaining that the data are not applicable to them.

Game theoretic approaches to operating room management.

All interactions between people can be considered games with rules and outcomes. However, modern business practices demand that the players in the game go beyond traditional game theory and look at new ways to improve the outcome of the game. Choosing the right strategy is important to a player's success.