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1. Respiratory Emergencies, An Issue of Emergency Medicine Clinics of North America

Author

Robert J. Vissers, Michael A. Gibbs, Robert J. Vissers, and Michael A. Gibbs

Subjects
Respiratory organs--Diseases, Respiratory infections
Abstract

This issue of Emergency Medicine Clinics, edited by Drs. Robert Vissers and Michael Gibbs, focuses on Pulmonary Emergencies. Articles include: Approach to the Adult Patient with Acute Dyspnea,Approach to the Pediatric Patient with Acute Dyspnea,Advances in Pulmonary Imaging,Respiratory Monitoring,Management of Acute Asthma and COPD,Diagnosis and Treatment of Acute Pulmonary Embolus,Pulmonary Manifestations Of Systemic Diseases,Pleural Disease,Management of Hemoptysis, and more!

Published
2016

2. Pitfalls in Appendicitis

Author

Robert J. Vissers and William B. Lennarz

Subjects
Adult, Male, medicine.medical_specialty, Special populations, Adolescent, Diagnostic accuracy, Disease, Delayed diagnosis, Severity of Illness Index, Imaging modalities, Young Adult, Pregnancy, medicine, Appendectomy, Humans, Diagnostic Errors, Child, Intensive care medicine, Physical Examination, Aged, business.industry, Infant, Ultrasonography, Doppler, Middle Aged, Appendicitis, medicine.disease, Magnetic Resonance Imaging, Abdominal Pain, Laboratory test, Child, Preschool, Emergency Medicine, Female, Suspected appendicitis, Emergency Service, Hospital, Tomography, X-Ray Computed, business
Abstract

The diagnosis of appendicitis is fraught with potential pitfalls, and despite its prevalence, appendicitis continues to be a condition at high risk for missed and delayed diagnosis. There is no single historical or physical finding or laboratory test that can definitively make the diagnosis. This article discusses the value of presenting signs, symptoms, laboratory testing, and the rational use of various imaging modalities, such as CT scanning and ultrasound. Challenges of special populations, such as children, the elderly, and pregnant patients, are also discussed. Although appendicitis continues to be a source of medical legal risk and misdiagnosis, a clear understanding of the strengths and limitations of all tests in suspected appendicitis can improve the emergency physician's diagnostic accuracy in this high-risk disease.

Published
2010
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4. Underdosing of Midazolam in Emergency Endotracheal Intubation

Author

John C. Sakles, Mark J. Sagarin, Robert J. Vissers, Erik D. Barton, Vincent W. Chiang, and Ron M. Walls

Subjects
Adult, Adolescent, Midazolam, medicine.medical_treatment, Endotracheal intubation, Intubation, Intratracheal, medicine, Humans, Hypnotics and Sedatives, Intubation, Etomidate, Prospective Studies, Registries, Dosing, Practice Patterns, Physicians', Child, Prospective cohort study, business.industry, General Medicine, Emergency department, Rapid sequence induction, United States, Child, Preschool, Anesthesia, Neuromuscular Blockade, Emergency Medicine, Emergency Service, Hospital, Airway, business, medicine.drug
Abstract

To determine whether midazolam, when used as an induction agent for emergency department (ED) rapid-sequence intubation (RSI), is used in adequate and recommended induction doses (0.1 to 0.3 mg/kg), and to compare the accuracy of the dosing of midazolam for ED RSI with the accuracy of dosing of other agents.The authors conducted a systematic query of a prospectively collected database of ED intubations using the National Emergency Airway Registry data, gathered in 11 participating EDs over a 16-month period. A data form completed at the time of emergency department intubation (EDI) enabled analysis of patients' ages, weights, and indications for EDI, as well as the techniques and drugs used to facilitate EDI. Data were analyzed to determine whether midazolam is used in recommended doses during RSI. Patients intubated with midazolam alone were compared with patients who received other induction agents for RSI.Of 1,288 patients entered in the study, 1,023 (79%) underwent RSI. Of the 888 RSI patients with an age recorded, midazolam was used as the sole induction agent in 140 (16%). The mean (+/-SD) dosages of midazolam used in RSI were 2.6 (+/-1.7) mg in children (ageor = 18) and 3.7 (+/-2.5) mg in adults (ageor =19); the mean (+/-SD) dosages by weight were 0.08 (+/-0.04) mg/kg in children and 0.05 (+/-0.03) mg/kg in adults. More than half (56%) of the children, and nearly all (92%) of the adults, received dosages lower than the minimum recommended dosage (0.1 mg/kg). Of patients who received barbiturates, only 21% of children and 21% of adults received a dose lower than the minimum recommended. When combined with another induction agent, midazolam was dosed similarly to when it was used alone: mean adult doses were 3.1 (+/-1.2) mg and 0.04 (+/-0.02) mg/kg.Underdosing of midazolam during ED RSI is frequent, and appears to be related to incorrect dosage selection, rather than to a deliberate intention to reduce the dose used.

Published
2003
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5. Rapid sequence intubation for pediatric emergency airway management

Author

Erik D. Barton, Vincent W. Chiang, John C. Sakles, Ron M. Walls, Mark J. Sagarin, Richard E. Wolfe, and Robert J. Vissers

Subjects
Adult, Pediatric emergency, Artificial ventilation, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Pediatrics, Intubation, Intratracheal, medicine, Humans, Hypnotics and Sedatives, Intubation, Prospective Studies, Child, Intensive care medicine, Emergency Treatment, business.industry, Infant, General Medicine, Emergency department, United States, Airway Obstruction, Multicenter study, Current practice, Child, Preschool, Pediatrics, Perinatology and Child Health, Emergency medicine, Neuromuscular Blockade, Emergency Medicine, Airway management, Neuromuscular Blocking Agents, Emergency Service, Hospital, business
Abstract

To characterize current practice with respect to pediatric emergency airway management using a multicenter data set.A multicenter collaboration was undertaken to gather data prospectively regarding emergency intubation. Analysis of data on adult emergency department (ED) intubations clearly demonstrated that rapid sequence intubation (RSI) was the method used most often. We then conducted an observational study of the prospectively collected database of pediatric ED intubations (EDIs) using the National Emergency Airway Registry Phase One data, gathered in 11 participating EDs over a 16-month time period. A data form completed at the time of EDI enabled analysis of patients' ages, weights, and indications for EDI; personnel; methods employed to facilitate EDI; success rates; and adverse events. Data forms were analyzed regarding the methods of intubation employed, and frequencies, success rates, and adverse event rates among various intubation modalities were compared.Of 1288 EDIs, there were 156 documented pediatric patients. Initial intubation attempts were all oral, including rapid sequence intubation in 81%, without medications (NOM) in 13%, and sedation without neuromuscular blockade (SED) in 6%. Older children and trauma patients were more likely to be intubated with RSI compared to younger children and patients presenting with medical illnesses. Intubation using RSI was more successful on the first attempt (78%) compared with either NOM (47%,0.01) or SED (44%,0.05), though this finding is likely explainable by the age differences among groups. Intubation was successfully performed by the initial intubator in 85% of RSI, 75% of NOM, and 89% of SED attempts ( = NS for both comparisons vs RSI). Overall, successful intubation occurred in 99% of RSI and 97% of non-RSI intubation attempts ( = NS). Only one of 156 patients required surgical airway management. True complications occurred in 1%, 5%, and 0% of RSI, NOM, and SED attempts, respectively ( = NS for both comparisons vs RSI). The majority of initial intubation attempts were by emergency medicine residents (59%), pediatric emergency medicine fellows (17%), and pediatrics residents (10%). These groups were 77%, 77%, and 50% successful, respectively, on the first laryngoscopy attempt, and 89%, 89%, and 69% successful overall.A large, prospective, multicenter observational study of pediatric EDIs was conducted at university-affiliated EDs. RSI is the method of choice for the majority of pediatric emergency intubations; it is associated with a high success rate and a low rate of serious adverse events. Pediatric intubation as practiced in academic EDs, with most initial attempts by emergency and pediatrics residents and fellows under attending physician supervision, is safe and highly successful.

Published
2002
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6. Contributeurs

Author

Marschall S. Runge, M. Andrew Greganti, Adaora A. Adimora, Maha Alattar, Robert M. Aris, Victoria Lin Bae-Jump, Maria Q. Baggstrom, A. Sidney Barritt, Marc K. Bassim, Toby Bates, Anne W. Beaven, Robert G. Berger, Lee R. Berkowitz, Stephen A. Bernard, William S. Blau, John F. Boggess, Mary C. Bowman, Mark E. Brecher, Philip A. Bromberg, Sue A. Brown, Vickie Brown, Paul C. Bryson, Robert A. Buckmire, Elizabeth Bullitt, Craig Burkhart, M. Janette Busby-Whitehead, John B. Buse, Debra L. Bynum, Lisa A. Carey, Timothy S. Carey, Culley C. Carson, Patricia P. Chang, Sanjay Chaudhary, David R. Clemmons, James M. Coghill, Romulo E. Colindres, AnnaMarie Connolly, Benjamin J. Copeland, Todd Correll, Cynthia J. Denu-Ciocca, Thomas S. Devetski, Darren A. DeWalt, Luis A. Diaz, James F. Donohue, Mary Anne Dooley, Jean M. Dostou, Douglas A. Drossman, Carla Sueta Dupree, Rose J. Eapen, Charles S. Ebert, Nurum F. Erdem, Joseph J. Eron, Ronald J. Falk, Mary Katherine Farmer-Boatwright, Elizabeth A. Fasy, Alan G. Finkel, William F. Finn, David P. Fitzgerald, Carol A. Ford, Catherine A. Forneris, Amy M. Fowler, W. Craig Fowler, Wesley Caswell Fowler, Michael W. Fried, Don A. Gabriel, Shannon Galvin, Lisa M. Gangarosa, James C. Garbutt, Cynthia Gay, Susan A. Gaylord, Leonard S. Gettes, Andrew J. Ghio, John H. Gilmore, Paul A. Godley, Lee R. Goldberg, Richard M. Goldberg, Matthew N. Goldenberg, Brian P. Goldstein, Robert S. Greenwood, Ian S. Grimm, Steven H. Grossman, Robert E. Gwyther, John J. Haggerty, Russell P. Harris, William D. Heizer, Ashley G. Henderson, David C. Henke, Michael A. Hill, Alan L. Hinderliter, Albert R. Hinn, Gerald A. Hladik, Hal M. Hoffman, Mina C. Hosseinipour, James F. Howard, David Y. Huang, Xuemei Huang, Burton R. Hutto, Kim L. Isaacs, Bruce F. Israel, Thomas S. Ivester, Heidi T. Jacobe, Peter Lars Jacobson, Lukas Jantac, Jaspaul S. Jawanda, Sandra M. Johnson, Beth L. Jonas, Joanne M. Jordan, Jonathan J. Juliano, Kevin A. Kahn, Andrew H. Kaplan, Nigel S. Key, William Y. Kim, John S. Kizer, Caroline M. Klein, Philip J. Klemmer, Karen Kölln, Mark J. Koruda, James E. Kurz, Jeffrey LaCour, Alim M. Ladha, W. Derek Leight, Peter A. Leone, B. Anthony Lindsey, Ryan D. Madanick, Lawrence K. Mandelkehr, J. Douglas Mann, Silva Markovic-Plese, Allen F. Marshall, William D. Mattern, Celeste M. Mayer, Travis A. Meredith, William C. Miller, Beverly S. Mitchell, Stephan Moll, Douglas R. Morgan, Dean S. Morrell, M. Cristina Muñoz, Patrick H. Nachman, Kelly C. Nelson, Carla M. Nester, Linda M. Nicholas, E. Magnus Ohman, Bert H. O'Neil, David A. Ontjes, Robert Z. Orlowski, Daniel J. Parsons, Dhavalkumar D. Patel, Cam Patterson, Kristine B. Patterson, Amanda Peppercorn, Harold C. Pillsbury, W. Kimryn Rathmell, Daniel S. Reuland, Yehuda Ringel, M. Patricia Rivera, Craig N. Rosebrock, Pinchas Rosenberg, Robert A.S. Roubey, David S. Rubenstein, Susan Riggs Runge, Mark Russo, William A. Rutala, William E. Sanders, Hanna K. Sanoff, Scott L. Sanoff, Yolanda V. Scarlett, Emily J. Schwarz, Brent A. Senior, Jonathan S. Serody, Nicholas J. Shaheen, Thomas C. Shea, Richard G. Sheahan, William W. Shockley, Roshan Shrestha, Emily E. Sickbert-Bennett, Micah J. Sickel, Linmarie Sikich, Ross J. Simpson, Sidney C. Smith, Mark A. Socinski, P. Frederick Sparling, Thomas E. Stinchcombe, George A. Stouffer, Teresa K. Tarrant, Mark Taylor, Michael J. Thomas, Nancy E. Thomas, John M. Thorpe, Stephen L. Tilley, Jenny P. Ting, Robert S. Tomsick, Charles M. van der Horst, Bradley V. Vaughn, Pamela G. Vick, Robert J. Vissers, Peter M. Voorhees, Tracy Y. Wang, Lea C. Watson, David J. Weber, Robert S. Wehbie, Mark C. Weissler, Ellen C. Wells, Young E. Whang, Park W. Willis, John B. Winfield, Gary S. Winzelberg, David A. Wohl, Leslie P. Wong, Diem N. Wu, and Steven Zacks

Published
2011
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9. Contributors

Author

Marschall S. Runge, M. Andrew Greganti, Adaora A. Adimora, Maha Alattar, Robert M. Aris, Victoria Lin Bae-Jump, Maria Q. Baggstrom, A. Sidney Barritt, Marc K. Bassim, Toby Bates, Anne W. Beaven, Robert G. Berger, Lee R. Berkowitz, Stephen A. Bernard, William S. Blau, John F. Boggess, Mary C. Bowman, Mark E. Brecher, Philip A. Bromberg, Sue A. Brown, Vickie Brown, Paul C. Bryson, Robert A. Buckmire, Elizabeth Bullitt, Craig Burkhart, M. Janette Busby-Whitehead, John B. Buse, Debra L. Bynum, Lisa A. Carey, Timothy S. Carey, Culley C. Carson, Patricia P. Chang, Sanjay Chaudhary, David R. Clemmons, James M. Coghill, Romulo E. Colindres, AnnaMarie Connolly, Benjamin J. Copeland, Todd Correll, Cynthia J. Denu-Ciocca, Thomas S. Devetski, Darren A. DeWalt, Luis A. Diaz, James F. Donohue, Mary Anne Dooley, Jean M. Dostou, Douglas A. Drossman, Carla Sueta Dupree, Rose J. Eapen, Charles S. Ebert, Nurum F. Erdem, Joseph J. Eron, Ronald J. Falk, Mary Katherine Farmer-Boatwright, Elizabeth A. Fasy, Alan G. Finkel, William F. Finn, David P. Fitzgerald, Carol A. Ford, Catherine A. Forneris, Amy M. Fowler, W. Craig Fowler, Wesley Caswell Fowler, Michael W. Fried, Don A. Gabriel, Shannon Galvin, Lisa M. Gangarosa, James C. Garbutt, Cynthia Gay, Susan A. Gaylord, Leonard S. Gettes, Andrew J. Ghio, John H. Gilmore, Paul A. Godley, Lee R. Goldberg, Richard M. Goldberg, Matthew N. Goldenberg, Brian P. Goldstein, Robert S. Greenwood, Ian S. Grimm, Steven H. Grossman, Robert E. Gwyther, John J. Haggerty, Russell P. Harris, William D. Heizer, Ashley G. Henderson, David C. Henke, Michael A. Hill, Alan L. Hinderliter, Albert R. Hinn, Gerald A. Hladik, Hal M. Hoffman, Mina C. Hosseinipour, James F. Howard, David Y. Huang, Xuemei Huang, Burton R. Hutto, Kim L. Isaacs, Bruce F. Israel, Thomas S. Ivester, Heidi T. Jacobe, Peter Lars Jacobson, Lukas Jantac, Jaspaul S. Jawanda, Sandra M. Johnson, Beth L. Jonas, Joanne M. Jordan, Jonathan J. Juliano, Kevin A. Kahn, Andrew H. Kaplan, Nigel S. Key, William Y. Kim, John S. Kizer, Caroline M. Klein, Philip J. Klemmer, Karen Kölln, Mark J. Koruda, James E. Kurz, Jeffrey LaCour, Alim M. Ladha, W. Derek Leight, Peter A. Leone, B. Anthony Lindsey, Ryan D. Madanick, Lawrence K. Mandelkehr, J. Douglas Mann, Silva Markovic-Plese, Allen F. Marshall, William D. Mattern, Celeste M. Mayer, Travis A. Meredith, William C. Miller, Beverly S. Mitchell, Stephan Moll, Douglas R. Morgan, Dean S. Morrell, M. Cristina Muñoz, Patrick H. Nachman, Kelly C. Nelson, Carla M. Nester, Linda M. Nicholas, E. Magnus Ohman, Bert H. O'Neil, David A. Ontjes, Robert Z. Orlowski, Daniel J. Parsons, Dhavalkumar D. Patel, Cam Patterson, Kristine B. Patterson, Amanda Peppercorn, Harold C. Pillsbury, W. Kimryn Rathmell, Daniel S. Reuland, Yehuda Ringel, M. Patricia Rivera, Craig N. Rosebrock, Pinchas Rosenberg, Robert A.S. Roubey, David S. Rubenstein, Susan Riggs Runge, Mark Russo, William A. Rutala, William E. Sanders, Hanna K. Sanoff, Scott L. Sanoff, Yolanda V. Scarlett, Emily J. Schwarz, Brent A. Senior, Jonathan S. Serody, Nicholas J. Shaheen, Thomas C. Shea, Richard G. Sheahan, William W. Shockley, Roshan Shrestha, Emily E. Sickbert-Bennett, Micah J. Sickel, Linmarie Sikich, Ross J. Simpson, Sidney C. Smith, Mark A. Socinski, P. Frederick Sparling, Thomas E. Stinchcombe, George A. Stouffer, Teresa K. Tarrant, Mark Taylor, Michael J. Thomas, Nancy E. Thomas, John M. Thorpe, Stephen L. Tilley, Jenny P. Ting, Robert S. Tomsick, Charles M. van der Horst, Bradley V. Vaughn, Pamela G. Vick, Robert J. Vissers, Peter M. Voorhees, Tracy Y. Wang, Lea C. Watson, David J. Weber, Robert S. Wehbie, Mark C. Weissler, Ellen C. Wells, Young E. Whang, Park W. Willis, John B. Winfield, Gary S. Winzelberg, David A. Wohl, Leslie P. Wong, Diem N. Wu, and Steven Zacks

Published
2009
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10. Poisoning and Drug Overdose

Author

Robert J. Vissers

Subjects
medicine.medical_specialty, business.industry, Emergency medicine, Medicine, business, Drug overdose, medicine.disease
Published
2009
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11. Revolutionary advances in the management of traumatic wounds in the emergency department during the last 40 years: part I

Author

Margot E. Chase, Shelley S. Mason, Kant Y. Lin, George T. Rodeheaver, John G. Thacker, Richard F. Edlich, William B. Long, Curt Tribble, Courtney A. Wack, Robert J. Vissers, and David B. Drake

Subjects
medicine.medical_specialty, Emergency Medical Services, Scars, Wounds, Penetrating, Hair Removal, Asepsis, medicine, Prevalence, Humans, Surgical Tape, Intensive care medicine, Wound Healing, Infection Control, integumentary system, Sutures, business.industry, Tissue adhesives, Incidence, Suture Techniques, Emergency department, Bandages, Surgery, Anti-Bacterial Agents, Disinfection, Wound Closure Technique, Wound dressing, Emergency Medicine, Wound Infection, Wounds and Injuries, Tissue Adhesives, medicine.symptom, business, Surgical tape, Wound healing, Anesthesia, Local
Abstract

Background and Objectives: During the last four decades, our research team has devised advances in wound repair that are highlighted in Part II of this collective review. Discussion: There are several different methods to provide an accurate and secure approximation of the skin edges—sutures, tapes, staples, and tissue adhesives. Ideally, the selection of the wound closure technique will be based on the biologic interaction of the materials employed, tissue configuration, and biomechanical properties of the trauma wound. Selection of the appropriate wound dressing is another important consideration in the management of the trauma wound. Conclusion: On the basis of the comprehensive research and clinical studies, we have individualized the wound closure techniques for traumatic wounds so that healing can be achieved with more aesthetically pleasing scars.

Published
2008

12. Contributors

Author

Felice E. Agro, Anis Baraka, Robert F. Bedford, Elizabeth C. Behringer, Jacqueline A. Bello, Jonathan L. Benumof, James M. Berry, Nasir I. Bhatti, Michael J. Bishop, Archie I.J. Brain, Roy D. Cane, Robert A. Caplan, Jacques E. Chelly, T. Linda Chi, Chris C. Christodoulou, Neal H. Cohen, Tim M. Cook, Richard M. Cooper, Edward T. Crosby, Steven A. Deem, Stephen F. Dierdorf, D. John Doyle, Tiberiu Ezri, David Z. Ferson, Lorraine J. Foley, Michael Frass, Rainer Georgi, Michael A. Gibbs, David Goldenberg, Carin A. Hagberg, Gregory B. Hammer, Amy C. Hessel, Orlando R. Hung, Raj R. Iyer, Robert M. Kacmarek, P. Allan Klock, Stephen M. Koch, Karen M. Kost, Peter Krafft, David C. Kramer, Claude Krier, Robert G. Krohner, J. Adam Law, Stephen R. Luney, Atul Malhotra, Lynette Mark, John P. McGee, Richard J. Melker, James Michelson, David Mirsky, Ian R. Morris, Debra E. Morrison, Uma Munnur, Michael F. Murphy, Kevin F. O'Grady, Irene P. Osborn, Andranik Ovassapian, Donald H. Parks, C. Lee Parmley, Kevin D. Pereira, Karen L. Posner, Robert M. Pousman, Mary F. Rabb, Sivam Ramanathan, Allan P. Reed, William H. Rosenblatt, M. Ramez Salem, Antonio Sanchez, John J. Schaefer, Bettina U. Schmitz, David E. Schwartz, Roy Sheinbaum, George J. Sheplock, Ronald D. Stewart, Robert K. Stoelting, Maya S. Suresh, Peter Szmuk, Joseph W. Szokol, Mark D. Tasch, Andreas R. Thierbach, Ricardo M. Urtubia, Jeffrey S. Vender, Robert J. Vissers, Ashutosh Wali, Ron M. Walls, David O. Warner, R. David Warters, Melissa Wheeler, and William C. Wilson

Published
2007
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14. Pharmacology of emergency department pain management and conscious sedation

Author

Robert J. Vissers and Paul Blackburn

Subjects
Narcotics, medicine.medical_specialty, Analgesics, medicine.diagnostic_test, medicine.drug_class, business.industry, Sedation, MEDLINE, Conscious Sedation, Nitrous Oxide, Pain, Emergency department, Electroencephalography, Pain management, Analgesics, Non-Narcotic, Adrenal Cortex Hormones, Sedative, medicine, Emergency Medicine, Humans, Hypnotics and Sedatives, medicine.symptom, Intensive care medicine, business, Eeg monitoring
Abstract

The endpoints of sedation and analgesia have been more difficult than traditional physiologic parameters to measure adequately. Several clinical scoring systems have been developed in an attempt to provide more consistent and objective assessments of sedation, but the few that have been validated are cumbersome to use in the clinical setting and cannot accurately determine subtle changes in the level of sedation. Recent developments in EEG monitoring, particularly one using bispectral (BIS) analysis of the EEG signal obtained through a noninvasive forehead "lead," are promising. BIS monitoring has been used as a reliable measure of depth of midazolam-induced sedation during general anesthesia. Anesthesiologists have used this technology to prevent awareness during paralysis. One recently completed but as yet unpublished study in the ED demonstrated a high correlation with traditional sedation scales and found the device easy to use (UNC Hospitals Department of Emergency Medicine, personal communication, 1999). It is anticipated that with BIS monitoring, in combination with titratable, short-acting agents, appropriate levels of sedation can be more easily achieved while minimizing associated complications and duration of ED stay.

Published
2000

15. Amylase and lipase in the emergency department evaluation of acute pancreatitis

Author

Robert J. Vissers, Riyad B. Abu-Laban, and Damian F McHugh

Subjects
medicine.medical_specialty, Pancreatic disease, biology, business.industry, Emergency department, Serum amylase, Lipase, medicine.disease, Appropriate use, Surgery, Pancreatitis, Acute Disease, Amylases, Emergency Medicine, medicine, biology.protein, Acute pancreatitis, Humans, Amylase, Intensive care medicine, business, Emergency Service, Hospital
Abstract

Serum amylase and lipase levels are commonly obtained in the emergency department for the diagnosis of acute pancreatitis. The role of these enzymes has frequently been the subject of confusion and controversy. This article comprehensively reviews the history, biochemistry, clinical, and laboratory literature on both enzymes as used in the evaluation of pancreatitis. Specific guidelines are presented to assist the Emergency Physician in the appropriate use and interpretation of these clinical laboratory tests.

Published
1999

16. Iatrogenic magnesium overdose: two case reports

Author

Roy Purssell and Robert J. Vissers

Subjects
Adult, Male, medicine.medical_specialty, Iatrogenic Disease, chemistry.chemical_element, Drug overdose, Magnesium Sulfate, Fatal Outcome, Cardiac conduction, medicine, Humans, Asystole, Coma, Ethanol, business.industry, Magnesium, Apnea, Emergency department, Middle Aged, medicine.disease, Surgery, Substance Withdrawal Syndrome, chemistry, Anesthesia, Emergency Medicine, Anticonvulsants, Hypermagnesemia, medicine.symptom, Drug Overdose, Emergencies, business
Abstract

We report two cases of iatrogenic intravenous magnesium overdose. Both patients presented to the emergency department in alcohol withdrawal, and during the course of their therapy were ordered to receive 2 g of magnesium sulfate intravenously. The patients were erroneously given 20 g of magnesium sulfate, causing cardiac arrest in both cases. The patients were both successfully resuscitated. One patient was discharged neurologically intact and the other died three days later. Review of the literature identified one previous report of iatrogenic overdose of intravenous magnesium causing death. Hypermagnesemia is a rare occurrence, particularly in the absence of renal failure. The cause is often iatrogenic. The major life-threatening clinical manifestations are cardiac conduction delays, asystole, apnea, and coma. A particular hazard of intravenous magnesium therapy is the variety of units of measurement used in written orders and on drug labels. This can easily lead to errors in drug administration.

Published
1996

17. The Next Frontier: Medical Student Education

Author

Robert J. Vissers and Cherri Hobgood

Subjects
Clinical clerkship, Frontier, Medical education, business.industry, Emergency Medicine, Medicine, General Medicine, business, Faculty medical, Student education, Career choice
Published
2004
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19. Reply

Author

Riyad B Abu-Laban and Robert J Vissers

Subjects
Emergency Medicine
Published
2000
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20. Endotracheal Tube Introducer

Author

Robert J. Vissers, Daniel E. Gurr, Ron M. Walls, and Mark J. Sagarin

Subjects
medicine.medical_specialty, Endotracheal tube introducer, business.industry, medicine.medical_treatment, MEDLINE, Emergency Medicine, Medicine, Intubation, business, Treatment failure, Surgery
Published
2001
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