28 results on '"Loza-Gomez, A"'
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2. Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)
- Author
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Edoardo Picetti, Andreas K. Demetriades, Fausto Catena, Bizhan Aarabi, Fikri M. Abu-Zidan, Oscar L. Alves, Luca Ansaloni, Rocco A. Armonda, Rafael Badenes, Miklosh Bala, Zsolt J. Balogh, Andrea Barbanera, Alessandro Bertuccio, Walter L. Biffl, Pierre Bouzat, Andras Buki, Ana Maria Castano-Leon, Davide Cerasti, Giuseppe Citerio, Federico Coccolini, Raul Coimbra, Carlo Coniglio, Francesco Costa, Federico De Iure, Bart Depreitere, Enrico Fainardi, Michael J. Fehlings, Nikolay Gabrovsky, Daniel Agustin Godoy, Peter Gruen, Deepak Gupta, Gregory W. J. Hawryluk, Raimund Helbok, Iftakher Hossain, Peter J. Hutchinson, Corrado Iaccarino, Kenji Inaba, Marcel Ivanov, Stanislav Kaprovoy, Andrew W. Kirkpatrick, Sam Klein, Angelos Kolias, Nikolay A. Konovalov, Alfonso Lagares, Laura Lippa, Angelica Loza-Gomez, Teemu M. Luoto, Andrew I. R. Maas, Andrzej Maciejczak, Ronald V. Maier, Niklas Marklund, Matthew J. Martin, Ilaria Melloni, Sergio Mendoza-Lattes, Geert Meyfroidt, Marina Munari, Lena M. Napolitano, David O. Okonkwo, Yasuhiro Otomo, Marios C. Papadopoulos, Ondra Petr, Wilco C. Peul, Aichholz K. Pudkrong, Zaffer Qasim, Frank Rasulo, Carla Reizinho, Florian Ringel, Sandro Rizoli, Elham Rostami, Andres M. Rubiano, Emanuele Russo, Aarti Sarwal, Jan M. Schwab, Franco Servadei, Deepak Sharma, Salman Sharif, Ehab Shiban, Lori Shutter, Philip F. Stahel, Fabio S. Taccone, Nicole A. Terpolilli, Claudius Thomé, Peter Toth, Parmenion P. Tsitsopoulos, Andrew Udy, Alexander R. Vaccaro, Albert J. Varon, Monica S. Vavilala, Alexander Younsi, Monika Zackova, Tommaso Zoerle, and Chiara Robba
- Subjects
Traumatic spinal cord injury ,Polytrauma ,Management ,Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies. Methods A multidisciplinary consensus panel of physicians selected for their established clinical and scientific expertise in the acute management of tSCI polytrauma patients with different specializations was established. The World Society of Emergency Surgery (WSES) and the European Association of Neurosurgical Societies (EANS) endorsed the consensus, and a modified Delphi approach was adopted. Results A total of 17 statements were proposed and discussed. A consensus was reached generating 17 recommendations (16 strong and 1 weak). Conclusions This consensus provides practical recommendations to support a clinician’s decision making in the management of tSCI polytrauma patients.
- Published
- 2024
- Full Text
- View/download PDF
3. Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)
- Author
-
Picetti, E, Demetriades, A, Catena, F, Aarabi, B, Abu-Zidan, F, Alves, O, Ansaloni, L, Armonda, R, Badenes, R, Bala, M, Balogh, Z, Barbanera, A, Bertuccio, A, Biffl, W, Bouzat, P, Buki, A, Castano-Leon, A, Cerasti, D, Citerio, G, Coccolini, F, Coimbra, R, Coniglio, C, Costa, F, De Iure, F, Depreitere, B, Fainardi, E, Fehlings, M, Gabrovsky, N, Godoy, D, Gruen, P, Gupta, D, Hawryluk, G, Helbok, R, Hossain, I, Hutchinson, P, Iaccarino, C, Inaba, K, Ivanov, M, Kaprovoy, S, Kirkpatrick, A, Klein, S, Kolias, A, Konovalov, N, Lagares, A, Lippa, L, Loza-Gomez, A, Luoto, T, Maas, A, Maciejczak, A, Maier, R, Marklund, N, Martin, M, Melloni, I, Mendoza-Lattes, S, Meyfroidt, G, Munari, M, Napolitano, L, Okonkwo, D, Otomo, Y, Papadopoulos, M, Petr, O, Peul, W, Pudkrong, A, Qasim, Z, Rasulo, F, Reizinho, C, Ringel, F, Rizoli, S, Rostami, E, Rubiano, A, Russo, E, Sarwal, A, Schwab, J, Servadei, F, Sharma, D, Sharif, S, Shiban, E, Shutter, L, Stahel, P, Taccone, F, Terpolilli, N, Thomé, C, Toth, P, Tsitsopoulos, P, Udy, A, Vaccaro, A, Varon, A, Vavilala, M, Younsi, A, Zackova, M, Zoerle, T, Robba, C, Picetti, Edoardo, Demetriades, Andreas K., Catena, Fausto, Aarabi, Bizhan, Abu-Zidan, Fikri M., Alves, Oscar L., Ansaloni, Luca, Armonda, Rocco A., Badenes, Rafael, Bala, Miklosh, Balogh, Zsolt J., Barbanera, Andrea, Bertuccio, Alessandro, Biffl, Walter L., Bouzat, Pierre, Buki, Andras, Castano-Leon, Ana Maria, Cerasti, Davide, Citerio, Giuseppe, Coccolini, Federico, Coimbra, Raul, Coniglio, Carlo, Costa, Francesco, De Iure, Federico, Depreitere, Bart, Fainardi, Enrico, Fehlings, Michael J., Gabrovsky, Nikolay, Godoy, Daniel Agustin, Gruen, Peter, Gupta, Deepak, Hawryluk, Gregory W. J., Helbok, Raimund, Hossain, Iftakher, Hutchinson, Peter J., Iaccarino, Corrado, Inaba, Kenji, Ivanov, Marcel, Kaprovoy, Stanislav, Kirkpatrick, Andrew W., Klein, Sam, Kolias, Angelos, Konovalov, Nikolay A., Lagares, Alfonso, Lippa, Laura, Loza-Gomez, Angelica, Luoto, Teemu M., Maas, Andrew I. R., Maciejczak, Andrzej, Maier, Ronald V., Marklund, Niklas, Martin, Matthew J., Melloni, Ilaria, Mendoza-Lattes, Sergio, Meyfroidt, Geert, Munari, Marina, Napolitano, Lena M., Okonkwo, David O., Otomo, Yasuhiro, Papadopoulos, Marios C., Petr, Ondra, Peul, Wilco C., Pudkrong, Aichholz K., Qasim, Zaffer, Rasulo, Frank, Reizinho, Carla, Ringel, Florian, Rizoli, Sandro, Rostami, Elham, Rubiano, Andres M., Russo, Emanuele, Sarwal, Aarti, Schwab, Jan M., Servadei, Franco, Sharma, Deepak, Sharif, Salman, Shiban, Ehab, Shutter, Lori, Stahel, Philip F., Taccone, Fabio S., Terpolilli, Nicole A., Thomé, Claudius, Toth, Peter, Tsitsopoulos, Parmenion P., Udy, Andrew, Vaccaro, Alexander R., Varon, Albert J., Vavilala, Monica S., Younsi, Alexander, Zackova, Monika, Zoerle, Tommaso, Robba, Chiara, Picetti, E, Demetriades, A, Catena, F, Aarabi, B, Abu-Zidan, F, Alves, O, Ansaloni, L, Armonda, R, Badenes, R, Bala, M, Balogh, Z, Barbanera, A, Bertuccio, A, Biffl, W, Bouzat, P, Buki, A, Castano-Leon, A, Cerasti, D, Citerio, G, Coccolini, F, Coimbra, R, Coniglio, C, Costa, F, De Iure, F, Depreitere, B, Fainardi, E, Fehlings, M, Gabrovsky, N, Godoy, D, Gruen, P, Gupta, D, Hawryluk, G, Helbok, R, Hossain, I, Hutchinson, P, Iaccarino, C, Inaba, K, Ivanov, M, Kaprovoy, S, Kirkpatrick, A, Klein, S, Kolias, A, Konovalov, N, Lagares, A, Lippa, L, Loza-Gomez, A, Luoto, T, Maas, A, Maciejczak, A, Maier, R, Marklund, N, Martin, M, Melloni, I, Mendoza-Lattes, S, Meyfroidt, G, Munari, M, Napolitano, L, Okonkwo, D, Otomo, Y, Papadopoulos, M, Petr, O, Peul, W, Pudkrong, A, Qasim, Z, Rasulo, F, Reizinho, C, Ringel, F, Rizoli, S, Rostami, E, Rubiano, A, Russo, E, Sarwal, A, Schwab, J, Servadei, F, Sharma, D, Sharif, S, Shiban, E, Shutter, L, Stahel, P, Taccone, F, Terpolilli, N, Thomé, C, Toth, P, Tsitsopoulos, P, Udy, A, Vaccaro, A, Varon, A, Vavilala, M, Younsi, A, Zackova, M, Zoerle, T, Robba, C, Picetti, Edoardo, Demetriades, Andreas K., Catena, Fausto, Aarabi, Bizhan, Abu-Zidan, Fikri M., Alves, Oscar L., Ansaloni, Luca, Armonda, Rocco A., Badenes, Rafael, Bala, Miklosh, Balogh, Zsolt J., Barbanera, Andrea, Bertuccio, Alessandro, Biffl, Walter L., Bouzat, Pierre, Buki, Andras, Castano-Leon, Ana Maria, Cerasti, Davide, Citerio, Giuseppe, Coccolini, Federico, Coimbra, Raul, Coniglio, Carlo, Costa, Francesco, De Iure, Federico, Depreitere, Bart, Fainardi, Enrico, Fehlings, Michael J., Gabrovsky, Nikolay, Godoy, Daniel Agustin, Gruen, Peter, Gupta, Deepak, Hawryluk, Gregory W. J., Helbok, Raimund, Hossain, Iftakher, Hutchinson, Peter J., Iaccarino, Corrado, Inaba, Kenji, Ivanov, Marcel, Kaprovoy, Stanislav, Kirkpatrick, Andrew W., Klein, Sam, Kolias, Angelos, Konovalov, Nikolay A., Lagares, Alfonso, Lippa, Laura, Loza-Gomez, Angelica, Luoto, Teemu M., Maas, Andrew I. R., Maciejczak, Andrzej, Maier, Ronald V., Marklund, Niklas, Martin, Matthew J., Melloni, Ilaria, Mendoza-Lattes, Sergio, Meyfroidt, Geert, Munari, Marina, Napolitano, Lena M., Okonkwo, David O., Otomo, Yasuhiro, Papadopoulos, Marios C., Petr, Ondra, Peul, Wilco C., Pudkrong, Aichholz K., Qasim, Zaffer, Rasulo, Frank, Reizinho, Carla, Ringel, Florian, Rizoli, Sandro, Rostami, Elham, Rubiano, Andres M., Russo, Emanuele, Sarwal, Aarti, Schwab, Jan M., Servadei, Franco, Sharma, Deepak, Sharif, Salman, Shiban, Ehab, Shutter, Lori, Stahel, Philip F., Taccone, Fabio S., Terpolilli, Nicole A., Thomé, Claudius, Toth, Peter, Tsitsopoulos, Parmenion P., Udy, Andrew, Vaccaro, Alexander R., Varon, Albert J., Vavilala, Monica S., Younsi, Alexander, Zackova, Monika, Zoerle, Tommaso, and Robba, Chiara
- Abstract
Background: The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies. Methods: A multidisciplinary consensus panel of physicians selected for their established clinical and scientific expertise in the acute management of tSCI polytrauma patients with different specializations was established. The World Society of Emergency Surgery (WSES) and the European Association of Neurosurgical Societies (EANS) endorsed the consensus, and a modified Delphi approach was adopted. Results: A total of 17 statements were proposed and discussed. A consensus was reached generating 17 recommendations (16 strong and 1 weak). Conclusions: This consensus provides practical recommendations to support a clinician’s decision making in the management of tSCI polytrauma patients.
- Published
- 2024
4. The Digital EMS California Academy of Learning: One State's Innovative Approach to EMS Fellow Education.
- Author
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Staats, Katherine, Mercer, Mary P, Bosson, Nichole, Joelle Donofrio, J, Schlesinger, Shira, Sanko, Stephen, Kazan, Clayton, Brown, John, Loza-Gomez, Angelica, Eckstein, Marc, and Gausche-Hill, Marianne
- Subjects
Health Services ,Clinical Research ,8.1 Organisation and delivery of services ,Health and social care services research - Abstract
IntroductionEmergency medical services (EMS) fellowships are growing in significance within the United States prehospital health care system. While fellowships represent a cornerstone of EMS subspecialty education, an individual learner's experiences are limited by local resources and practices. California EMS fellowships have developed an innovative method for expanding fellows' educational experiences outside their immediate programs.The innovative education methodEach month, fellows, fellowship directors, and local EMS medical directors from throughout the state participate in a video conference. This meeting is divided into four distinct components: book chapter presentation, board-style question review, call review, and an EMS literature review.Chapter reviewThe two-volume text Emergency Medical Services: Clinical Practice and Systems Oversight has been categorized into 12 modules, one for each month of the fellowship. Every meeting, one fellow prepares a didactic presentation summarizing the highlights from that month's chapters.Question reviewFellows each create five multiple-choice questions and answers, based on the section reading. Questions are assessed by the group, both for informational content and for appropriate formatting. After completion, these questions are submitted for future review for the EMS fellowship in-service examination.Call reviewBased on that month's module topics, a call is chosen and reviewed. Regional protocol and practice differences from different systems are discussed. The online medical oversight provided and the prehospital provider performance are evaluated by the group.Literature reviewFellows not assigned to present a call or didactic segment each choose one paper focusing on a subject relevant to the module or call. Strengths of the study design, analysis, outcomes, and relevance to EMS practice are discussed.OutcomesFellows and experienced EMS attendings are exposed to different protocol and system approaches in an interactive and accessible format. This partnership expands educational opportunities for fellows and promotes collaboration across EMS systems.
- Published
- 2019
5. Intraosseous Access Techniques
- Author
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Loza-Gomez, Angelica, primary and Strumwasser, Aaron, additional
- Published
- 2021
- Full Text
- View/download PDF
6. In situ biomonitoring of air quality in rural and urban environments of Mexico Valley through genotoxicity evaluated in wild plants
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Gómez-Arroyo, Sandra, Cortés-Eslava, Josefina, Loza-Gómez, Paola, Arenas-Huertero, Francisco, Grutter de la Mora, Michel, and Morton Bermea, Ofelia
- Published
- 2018
- Full Text
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7. Quantifying the Risk of Spinal Injury in Motor Vehicle Collisions According to Ambulatory Status: A Prospective Analytical Study
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McCoy, Christopher Eric, Loza-Gomez, Angelica, Lee Puckett, James, Costantini, Samantha, Penalosa, Patrick, Anderson, Craig, and Schultz, Carl
- Published
- 2017
- Full Text
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8. Active Seizures in Children Are Often Subtle and Unrecognized by Prehospital Providers
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Rose, Emily, Abramson, Tiffany M., Kearl, Yvette L., and Loza-Gomez, Angelica
- Published
- 2019
- Full Text
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9. Utility of Glucose Testing and Treatment of Hypoglycemia in Patients with Out-of-Hospital Cardiac Arrest
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Nichole Bosson, Angelica Loza-Gomez, Tiffany M Abramson, Marianne Gausche-Hill, and Marc Eckstein
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Adult ,Emergency Medical Services ,medicine.medical_specialty ,Adolescent ,Point-of-care testing ,030204 cardiovascular system & hematology ,Emergency Nursing ,Hypoglycemia ,Glucagon ,Out of hospital cardiac arrest ,Glucose testing ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Emergency medical services ,Humans ,In patient ,Retrospective Studies ,business.industry ,Glucose Measurement ,030208 emergency & critical care medicine ,medicine.disease ,Cardiopulmonary Resuscitation ,Glucose ,Emergency medicine ,Emergency Medicine ,business ,Out-of-Hospital Cardiac Arrest - Abstract
Objective: Many emergency medical services (EMS) protocols for out-of-hospital cardiac arrests (OHCA) include point-of-care (POC) glucose measurement and administration of dextrose, despite limited...
- Published
- 2021
10. Paramedic Identification of Pediatric Seizures: A Prospective Cohort Study
- Author
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Yvette L Kearl, Elizabeth Crow, Angelica Loza-Gomez, Tiffany M Abramson, Christianne J. Lane, and Emily Rose
- Subjects
Emergency Medical Services ,medicine.medical_specialty ,Adolescent ,business.industry ,Allied Health Personnel ,Status epilepticus ,Emergency Nursing ,Emergency Medical Technicians ,Identification (information) ,Seizures ,Emergency medicine ,Emergency Medicine ,Emergency medical services ,medicine ,Humans ,Prospective Studies ,medicine.symptom ,Child ,business ,Prospective cohort study - Abstract
Pediatric seizures commonly trigger emergency medical services (EMS) activation and account for approximately 5-15% of all pediatric 911-EMS calls. More than 50% of children with active seizure activity do not receive prehospital antiepileptic drugs, potentially because they are not recognized by EMS. The purpose of this study is to evaluate specificity and sensitivity of paramedic identification of pediatric seizures and to describe the characteristics of unrecognized seizures.This is an 18-month prospective cohort study at a single, pediatric emergency department (ED). EMS patients ≤15 years old with a prehospital provider impression of seizure were included. Upon ED arrival, a data collection form, which included the EMS verbal report and patient's clinical status, was completed by the attending emergency physician. The primary outcome was sensitivity and specificity of paramedic identification of active seizure. Secondary outcomes included characteristics of missed seizures, ED interventions, and disposition. Descriptive statistics, sensitivity, and specificity were computed. Patient characteristics and clinical outcomes were compared.Surveys were completed for 349 patients (Median 3, IQR = 3.4). Fifty-two of the patients (15%) were actively seizing upon arrival at the ED. Sensitivity was 54% and specificity was 96% for paramedic identification of active seizure. Common features of missed cases were abnormal vital signs (75%), gaze deviation (50%) and clenched jaw (33%). Of these, 37% required intubation and 53% were admitted to the intensive care unit.Paramedics were highly specific, but not sensitive in identifying active seizures on ED arrival. Patients with unrecognized seizures presented most commonly with abnormal vital signs and gaze deviation.
- Published
- 2020
11. Chest Compression Fraction Alone Does Not Adequately Measure Cardiopulmonary Resuscitation Quality in Out-of-Hospital Cardiac Arrest
- Author
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Loza-Gomez, Angelica, primary, Johnson, Megan, additional, Newby, Marianne, additional, LeGassick, Todd, additional, and Larmon, Baxter, additional
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- 2022
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- View/download PDF
12. Intraosseous Access Techniques
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Angelica Loza-Gomez and Aaron Strumwasser
- Published
- 2021
13. 293 Barriers in Telephone CPR Instruction by 911 Dispatchers for Out-of-Hospital Cardiac Arrest Before and During the COVID-19 Pandemic
- Author
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Loza-Gomez, A., primary, NokLam, C., additional, Arnold, E., additional, and Menchine, M., additional
- Published
- 2021
- Full Text
- View/download PDF
14. Active Seizures in Children Are Often Subtle and Unrecognized by Prehospital Providers
- Author
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Yvette L Kearl, Emily Rose, Tiffany M Abramson, and Angelica Loza-Gomez
- Subjects
Male ,Emergency Medical Services ,medicine.medical_specialty ,Adolescent ,MEDLINE ,Lorazepam ,03 medical and health sciences ,Status Epilepticus ,0302 clinical medicine ,Seizures ,030225 pediatrics ,medicine ,Humans ,Seizure activity ,Child ,Retrospective Studies ,business.industry ,030208 emergency & critical care medicine ,Retrospective cohort study ,General Medicine ,Emergency department ,Los Angeles ,humanities ,Early Diagnosis ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Emergency Medicine ,Administration, Intravenous ,Anticonvulsants ,Female ,Presentation (obstetrics) ,Emergency Service, Hospital ,business - Abstract
Early recognition and treatment of seizures is essential for optimal patient outcomes. Seizure activity, particularly in young children, can be subtle and often go unrecognized by providers. This case series retrospectively identified 7 cases of pediatric patients (14 years and younger) who presented to the emergency department with active seizure activity that was unrecognized by the prehospital care providers. The presentation of these patients, their clinical signs of seizure, and emergency department disposition are highlighted in this series.
- Published
- 2019
15. Severe sepsis and septic shock in patients transported by prehospital services versus walk in patients to the emergency department
- Author
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Loza-Gomez, Angelica, primary, Hofmann, Erik, additional, NokLam, Chun, additional, and Menchine, Michael, additional
- Published
- 2021
- Full Text
- View/download PDF
16. Utility of Glucose Testing and Treatment of Hypoglycemia in Patients with Out-of-Hospital Cardiac Arrest
- Author
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Abramson, Tiffany M., primary, Bosson, Nichole, additional, Loza-Gomez, Angelica, additional, Eckstein, Marc, additional, and Gausche-Hill, Marianne, additional
- Published
- 2021
- Full Text
- View/download PDF
17. Severe sepsis and septic shock in patients transported by prehospital services versus walk in patients to the emergency department
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Erik Hofmann, Michael Menchine, Angelica Loza-Gomez, and Chun NokLam
- Subjects
Male ,medicine.medical_specialty ,Emergency Medical Services ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Emergency medical services ,Humans ,Hospital Mortality ,Severe sepsis ,Cause of death ,Retrospective Studies ,Septic shock ,business.industry ,Walk-in ,030208 emergency & critical care medicine ,General Medicine ,Emergency department ,Middle Aged ,medicine.disease ,Triage ,Shock, Septic ,Outcome and Process Assessment, Health Care ,Emergency medicine ,Emergency Medicine ,Female ,Guideline Adherence ,business ,Emergency Service, Hospital - Abstract
Background Sepsis is a leading cause of death in the hospital for which aggressive treatment is recommended to improve patient outcomes. It is possible that sepsis patients brought in by emergency medical services (EMS) have a unique advantage in the emergency department (ED) which could improve sepsis bundle compliance. Objective To evaluate patient care processes and outcome differences between severe sepsis and septic shock patients in the emergency department who were brought in by EMS compared to non-EMS patients. Methods We performed a retrospective chart review of all severe sepsis and septic shock patients who declared in the ED during January 2012 thru December 2014. We compared differences in patient characteristics, patient care processes, sepsis bundle compliance metrics, and outcomes between both groups. Results Of the 1066 patients included in the study, 387 (36.6%) were brought in by EMS and 679 (63.7%) patients arrived via non-EMS transport. In the multivariate regression model, time of triage to sepsis declaration (coeff = −0.406; 95% CI = −0.809, −0.003; p = 0.048) and time of triage to physician (coeff = −0.543; 95% CI = −0.864, −0.221; p = 0.001) was significantly shorter for EMS patients. We found no statistical difference in adjusted individual sepsis compliance metrics, overall bundle compliance, or mortality between both groups. Conclusion EMS transported patients have quicker sepsis declaration times and are seen sooner by ED providers. However, we found no statistical difference in bundle compliance or patient outcomes between walk in patients and EMS transported patients.
- Published
- 2020
18. Paramedic Identification of Pediatric Seizures: A Prospective Cohort Study
- Author
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Abramson, Tiffany M., primary, Rose, Emily, additional, Crow, Elizabeth, additional, Lane, Christianne Joy, additional, Kearl, Yvette, additional, and Loza-Gomez, Angelica, additional
- Published
- 2020
- Full Text
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19. 293 Barriers in Telephone CPR Instruction by 911 Dispatchers for Out-of-Hospital Cardiac Arrest Before and During the COVID-19 Pandemic
- Author
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Michael Menchine, E. Arnold, C. NokLam, and Angelica Loza-Gomez
- Subjects
medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Emergency medicine ,Pandemic ,Emergency Medicine ,medicine ,business ,Out of hospital cardiac arrest - Published
- 2021
20. Utility of Glucose Testing and Treatment of Hypoglycemia in Patients with Out-of-Hospital Cardiac Arrest.
- Author
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Abramson, Tiffany M., Bosson, Nichole, Loza-Gomez, Angelica, Eckstein, Marc, and Gausche-Hill, Marianne
- Subjects
HYPOGLYCEMIA treatment ,ACQUISITION of data methodology ,RETROSPECTIVE studies ,CARDIAC arrest ,MEDICAL records ,GLUCOSE tolerance tests ,LONGITUDINAL method - Abstract
Objective: Many emergency medical services (EMS) protocols for out-of-hospital cardiac arrests (OHCA) include point-of-care (POC) glucose measurement and administration of dextrose, despite limited knowledge of benefit. The objective of this study was to describe the incidence of hypoglycemia and dextrose administration by EMS in OHCA and subsequent patient outcomes. Methods: This was a retrospective analysis of OHCA in a large, regional EMS system from 2011 to 2017. Patients ≥18 years old with non-traumatic OHCA and attempted field resuscitation by paramedics were included. The primary outcomes were frequency of POC glucose measurement, hypoglycemia (glucose <60 mg/dl), and dextrose/glucagon administration (treatment group). The secondary outcomes included field return of spontaneous circulation (ROSC), survival to hospital discharge (SHD), and survival with good neurologic outcome. Results: There were 46,211 OHCAs during the study period of which 33,851 (73%) had a POC glucose test performed. Glucose levels were documented in 32,780 (97%), of whom 2,335 (7%) were hypoglycemic. Among hypoglycemic patients, 41% (959) received dextrose and/or glucagon. Field ROSC was achieved in 30% (286) of hypoglycemic patients who received treatment. Final outcome was determined for 1,714 (73%) of the hypoglycemic cases, of whom 120 (7%) had SHD and 66 (55%) had a good neurologic outcome. Of the 32,780 patients with a documented POC glucose result who were identified as hypoglycemic, only 27 (0.08%) received field treatment, and survived to discharge with good neurologic outcome. 48 (6%) of patients in the treatment group had SHD vs. 72 (8%) without treatment, risk difference −2.0% (95%CI −4.4%, 0.4%), p = 0.1. Conclusion: In this EMS system, POC glucose testing was common in adult OHCA, yet survival to hospital discharge with good neurologic outcome did not differ between patients treated and untreated for hypoglycemia. These results question the common practice of measuring and treating hypoglycemia in OHCA patients. [ABSTRACT FROM AUTHOR]
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- 2022
- Full Text
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21. Recognition of Active Pediatric Seizures: Prehospital Provider Sensitivity and Specificity
- Author
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Kearl, Yvette, primary, Abramson, Tiffany M., additional, Crow, Elizabeth, additional, Lane, Christianne, additional, Rose, Emily, additional, and Loza-Gomez, Angelica, additional
- Published
- 2020
- Full Text
- View/download PDF
22. Recognition of Active Pediatric Seizures: Prehospital Provider Sensitivity and Specificity
- Author
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Yvette Kearl, Tiffany M. Abramson, Elizabeth Crow, Christianne Lane, Emily Rose, and Angelica Loza-Gomez
- Subjects
Pediatrics, Perinatology and Child Health - Published
- 2020
23. Paramedic Identification of Pediatric Seizures: A Prospective Cohort Study.
- Author
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Abramson, Tiffany M., Rose, Emily, Crow, Elizabeth, Lane, Christianne Joy, Kearl, Yvette, and Loza-Gomez, Angelica
- Subjects
HEALTH status indicators ,FISHER exact test ,MANN Whitney U Test ,TREATMENT effectiveness ,DESCRIPTIVE statistics ,CHI-squared test ,JOB performance ,SEIZURES (Medicine) ,DATA analysis software ,LONGITUDINAL method ,CHILDREN ,ADOLESCENCE - Abstract
Pediatric seizures commonly trigger emergency medical services (EMS) activation and account for approximately 5–15% of all pediatric 911-EMS calls. More than 50% of children with active seizure activity do not receive prehospital antiepileptic drugs, potentially because they are not recognized by EMS. The purpose of this study is to evaluate specificity and sensitivity of paramedic identification of pediatric seizures and to describe the characteristics of unrecognized seizures. This is an 18-month prospective cohort study at a single, pediatric emergency department (ED). EMS patients ≤15 years old with a prehospital provider impression of seizure were included. Upon ED arrival, a data collection form, which included the EMS verbal report and patient's clinical status, was completed by the attending emergency physician. The primary outcome was sensitivity and specificity of paramedic identification of active seizure. Secondary outcomes included characteristics of missed seizures, ED interventions, and disposition. Descriptive statistics, sensitivity, and specificity were computed. Patient characteristics and clinical outcomes were compared. Surveys were completed for 349 patients (Median 3, IQR = 3.4). Fifty-two of the patients (15%) were actively seizing upon arrival at the ED. Sensitivity was 54% and specificity was 96% for paramedic identification of active seizure. Common features of missed cases were abnormal vital signs (75%), gaze deviation (50%) and clenched jaw (33%). Of these, 37% required intubation and 53% were admitted to the intensive care unit. Paramedics were highly specific, but not sensitive in identifying active seizures on ED arrival. Patients with unrecognized seizures presented most commonly with abnormal vital signs and gaze deviation. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
24. The Digital EMS California Academy of Learning: One State's Innovative Approach to EMS Fellow Education
- Author
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Angelica Loza-Gomez, Stephen Sanko, Mary P. Mercer, Marianne Gausche-Hill, John F. Brown, Marc Eckstein, Katherine Staats, Clayton Kazan, J. Joelle Donofrio, Shira A. Schlesinger, and Nichole Bosson
- Subjects
0301 basic medicine ,Protocol (science) ,Medical education ,business.industry ,media_common.quotation_subject ,030106 microbiology ,Cornerstone ,Emergency Nursing ,computer.software_genre ,Subspecialty ,Education ,03 medical and health sciences ,Presentation ,030104 developmental biology ,Videoconferencing ,General partnership ,Health care ,Emergency Medicine ,Emergency medical services ,Innovations Reports ,Psychology ,business ,computer ,media_common - Abstract
Introduction Emergency medical services (EMS) fellowships are growing in significance within the United States prehospital health care system. While fellowships represent a cornerstone of EMS subspecialty education, an individual learner's experiences are limited by local resources and practices. California EMS fellowships have developed an innovative method for expanding fellows' educational experiences outside their immediate programs. The innovative education method Each month, fellows, fellowship directors, and local EMS medical directors from throughout the state participate in a video conference. This meeting is divided into four distinct components: book chapter presentation, board-style question review, call review, and an EMS literature review. Chapter review The two-volume text Emergency Medical Services: Clinical Practice and Systems Oversight has been categorized into 12 modules, one for each month of the fellowship. Every meeting, one fellow prepares a didactic presentation summarizing the highlights from that month's chapters. Question review Fellows each create five multiple-choice questions and answers, based on the section reading. Questions are assessed by the group, both for informational content and for appropriate formatting. After completion, these questions are submitted for future review for the EMS fellowship in-service examination. Call review Based on that month's module topics, a call is chosen and reviewed. Regional protocol and practice differences from different systems are discussed. The online medical oversight provided and the prehospital provider performance are evaluated by the group. Literature review Fellows not assigned to present a call or didactic segment each choose one paper focusing on a subject relevant to the module or call. Strengths of the study design, analysis, outcomes, and relevance to EMS practice are discussed. Outcomes Fellows and experienced EMS attendings are exposed to different protocol and system approaches in an interactive and accessible format. This partnership expands educational opportunities for fellows and promotes collaboration across EMS systems.
- Published
- 2018
25. The Digital EMS California Academy of Learning: One State's Innovative Approach to EMS Fellow Education
- Author
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Staats, Katherine, primary, Mercer, Mary P., additional, Bosson, Nichole, additional, Joelle Donofrio, J., additional, Schlesinger, Shira, additional, Sanko, Stephen, additional, Kazan, Clayton, additional, Brown, John, additional, Loza‐Gomez, Angelica, additional, Eckstein, Marc, additional, and Gausche‐Hill, Marianne, additional
- Published
- 2018
- Full Text
- View/download PDF
26. Quantifying the Risk of Spinal Injury in Motor Vehicle Collisions According to Ambulatory Status: A Prospective Analytical Study
- Author
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Craig L. Anderson, Angelica Loza-Gomez, Samantha J. Costantini, Patrick Penalosa, James L. Puckett, Christopher Eric McCoy, and Carl H. Schultz
- Subjects
Adult ,Male ,Risk ,medicine.medical_specialty ,Adolescent ,Walking ,California ,Cohort Studies ,03 medical and health sciences ,Immobilization ,0302 clinical medicine ,Odds Ratio ,Medicine ,Humans ,In patient ,Glasgow Coma Scale ,Prospective Studies ,Spinal injury ,Aged ,business.industry ,Ambulatory Status ,Accidents, Traffic ,030208 emergency & critical care medicine ,Middle Aged ,Motor Vehicles ,Traumatic injury ,Spinal Injuries ,Ambulatory ,Emergency Medicine ,Physical therapy ,Female ,business ,030217 neurology & neurosurgery ,Motor vehicle crash ,Cohort study - Abstract
The association between ambulation at the scene of a motor vehicle collision (MVC) and spinal injury has never been quantified.To evaluate the association between ambulation and spinal injury in patients involved in a MVC.Prospective analytical-observational cohort study. Inclusion: patients sustaining traumatic injury in a MVC. Exclusion:18 years old, pregnancy.spinal injury defined as injury to the cervical, thoracic, or lumbar spinal cord, bones, or ligaments. Secondary outcome: Injury resulting in neurological deficit, need for surgery, or death. A generalized linear model was used to evaluate the association between outcome and predictor variables. Risk ratios [RR] were reported with a point estimate and 95% confidence interval (CI). A two-tailed alpha of0.05 was the threshold for statistical significance.There were 704 patients analyzed. Nonambulatory patients were 2.29 times more likely to sustain a spinal injury, compared to ambulatory patients (RR 2.29, 95% CI 1.34-3.91). Patients ≥ 65 years of age were 3.27 times more likely to sustain a spinal injury (RR 3.27, 95% CI 1.66-6.45). Patients with a Glasgow Coma Scale score ≤ 8 were 4.93 times more likely to sustain a spinal injury (RR 4.93, 95% CI 1.86-13.10).In this prospective analytical-observational study evaluating the association between ambulatory status and spinal injury in patients involved in MVCs, we observed that those patients who were nonambulatory were more than two times as likely to have a spinal injury compared to those patients who were ambulatory at the scene.
- Published
- 2016
27. 38 Does EMS Transport of Septic Patients Improve Downstream Processes of Care?
- Author
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Hofmann, E., primary, Loza-Gomez, A., additional, Lam, J., additional, and Menchine, M., additional
- Published
- 2017
- Full Text
- View/download PDF
28. 38 Does EMS Transport of Septic Patients Improve Downstream Processes of Care?
- Author
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Erik Hofmann, J. Lam, Angelica Loza-Gomez, and Michael Menchine
- Subjects
Downstream (manufacturing) ,business.industry ,Emergency Medicine ,Medicine ,Process of care ,Water resource management ,business ,EMS transport - Published
- 2017
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