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Reardon RF, Robinson AE, Kornas R, Ho JD, Anzalone B, Carlson J, Levy M, Driver B. Prehospital Surgical Airway Management: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:96-101. [PMID: 35001821 DOI: 10.1080/10903127.2021.1995552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Bag-valve-mask ventilation and endotracheal intubation have been the mainstay of prehospital airway management for over four decades. Recently, supraglottic device use has risen due to various factors. The combination of bag-valve-mask ventilation, endotracheal intubation, and supraglottic devices allows for successful airway management in a majority of patients. However, there exists a small portion of patients who are unable to be intubated and cannot be adequately ventilated with either a facemask or a supraglottic airway. These patients require an emergent surgical airway. A surgical airway is an important component of all airway algorithms, and in some cases may be the only viable approach; therefore, it is imperative that EMS agencies that are credentialed to manage airways have the capability to perform surgical airways when appropriate. The National Association of Emergency Medical Services Physicians (NAEMSP) recommends the following for emergency medical services (EMS) agencies that provide advanced airway management.A surgical airway is reasonable in the prehospital setting when the airway cannot be secured by less invasive means.When indicated, a surgical airway should be performed without delay.A surgical airway is not a substitute for other airway management tools and techniques. It should not be the only rescue option available.Success of an open surgical approach using a scalpel is higher than that of percutaneous Seldinger techniques or needle-jet ventilation in the emergency setting.
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Short NA, Tungate AS, Bollen KA, Sullivan J, D'Anza T, Lechner M, Bell K, Black J, Buchanan J, Reese R, Ho JD, Reed GD, Platt MA, Riviello RJ, Rossi CH, Martin SL, Liberzon I, Rauch SAM, Kessler RC, Nugent N, McLean SA. Pain is common after sexual assault and posttraumatic arousal/reactivity symptoms mediate the development of new or worsening persistent pain. Pain 2022; 163:e121-e128. [PMID: 34224498 DOI: 10.1097/j.pain.0000000000002329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 04/22/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Clinically significant new or worsening pain (CSNWP) is a common, yet often overlooked, sequelae of sexual assault. Little is known regarding factors influencing the development of CSNWP in sexual assault survivors. The current study used data from a recently completed prospective study to evaluate whether posttraumatic alterations in arousal and reactivity in the early aftermath of sexual assault influence the transition from acute to clinically significant new or worsening persistent pain. Women ≥ 18 years of age (n = 706) presenting for emergency care after sexual assault to 13 emergency care sites were enrolled in the study. Women completed assessments at the time of presentation as well as at 1 week (n = 706, 100%) and 6 weeks (n = 630, 91%). Nearly 70% of women reported CSNWP at the time of emergency care (n = 475, 69%), which persisted to 6 weeks in approximately 2 in 5 survivors (n = 248, 41%). A structural equation model adjusted for age, race, past trauma exposure, and preassault pain levels suggested that posttraumatic alterations in arousal/reactivity symptoms 1 week after assault partially mediated the transition from acute to persistent CSNWP. A significant portion (41%) of women sexual assault survivors develop CSNWP 6 weeks postassault. Posttraumatic arousal/reactivity symptoms in the early aftermath of assault contribute to CSNWP development; such symptoms are potential targets for secondary preventive interventions to reduce chronic postassault pain.
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Affiliation(s)
- Nicole A Short
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Andrew S Tungate
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Kenneth A Bollen
- Psychology and Neuroscience, and Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jenyth Sullivan
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Teresa D'Anza
- Albuquerque SANE Collaborative, Albuquerque, NM, United States
| | - Megan Lechner
- Emergency Deprtment, UC Health Memorial Hospital, Colorado Springs, CO, United States
| | - Kathy Bell
- Tulsa Forensic Nursing Services, Tulsa, OK, United States
| | | | - Jennie Buchanan
- Department of Emergency Medicine, Denver Health, Denver, CO, United States
| | - Rhiannon Reese
- Crisis Center of Birmingham, Birmingham, AL, United States
| | - Jeffrey D Ho
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Gordon D Reed
- Department of Emergency Medicine, Christiana Care, Newark, DE, United States
| | - Melissa A Platt
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Ralph J Riviello
- Department of Emergency Medicine, University of Texas Health San Antonio, TX, United States
| | | | - Sandra L Martin
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Israel Liberzon
- Department of Psychiatry, Texas A&M University, Bryan, TX, United States
| | - Sheila A M Rauch
- Department of Psychiatry, Emory University, Atlanta, GA, VA Atlanta Healthcare System, Atlanta, GA, United States
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Nicole Nugent
- Departments of Psychiatry and Human Behavior, Pediatrics, and Emergency Medicine, Brown University, Providence, RI, United States
| | - Samuel A McLean
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
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Dawes DM, Ho JD, Miner JR. Partial characterization of bacteriocin-like compound (BLIS) produced by Burkholderia stagnalis strain K23/3 against Burkholderia pseudomallei. MJM 2021; 56:1078. [PMID: 21729085 DOI: 10.1111/j.1556-4029.2011.01788.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Lechner M, Bell K, Short NA, Martin SL, Black J, Buchanan JA, Reese R, Ho JD, Reed GD, Platt M, Riviello R, Rossi C, Nouhan P, Phillips C, Bollen KA, McLean SA. Perceived Care Quality Among Women Receiving Sexual Assault Nurse Examiner Care: Results From a 1-Week Postexamination Survey in a Large Multisite Prospective Study. J Emerg Nurs 2021; 47:449-458. [PMID: 33516463 DOI: 10.1016/j.jen.2020.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/04/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study examined the perspectives of female patients who had been sexually assaulted regarding the quality of care provided by sexual assault nurse examiners, including whether the patients' perspectives varied by their demographic characteristics and health status before the assault. METHODS A total of 695 female patients who received care from sexual assault nurse examiners at 13 United States emergency care centers and community-based programs completed standardized surveys 1 week after receiving sexual assault nurse examiners' care for sexual assault. RESULTS Most patients strongly agreed that the sexual assault nurse examiners provided high-quality care, including taking patients' needs/concerns seriously, not acting as though the assault was the patient's fault, showing care/compassion, explaining the sexual assault examination, and providing follow-up information. The perceptions did not vary by the patients' demographic characteristics or preassault health status. DISCUSSION Female patients who had been sexually assaulted and who were evaluated at 13 widely geographically distributed sexual assault nurse examiners' programs consistently reported that the sexual assault nurse examiners provided high-quality, compassionate care.
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Dawes DM, Ho JD, Halperin HR, Fink SJ, Driver BE, Klein LR. A comparison of three conducted electrical weapons in a surrogate swine cardiac safety model. J Forensic Leg Med 2020; 77:102088. [PMID: 33242742 DOI: 10.1016/j.jflm.2020.102088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 10/23/2022]
Abstract
We used a previously described methodology in a swine model to compare the relative cardiac safety of the Axon T7 Conducted Electrical Weapon (CEW), released in October of 2018, to two prior generations of Axon CEWs to include the X2 and the X26E. A total of 5 swine (252 total CEW exposures) were tested by alternating the three weapons at each chest exposure location. Our testing, using systemic hypotension as the quantitative surrogate for cardiac capture, demonstrated that the T7 and X2 were not statistically different. Both were superior, in terms of reduced hypotension during exposure, to the X26E. This study is important as it demonstrates that the newly released weapon is non-inferior to the X2 and superior to the X26E using this surrogate safety model. It is also important because it is the first study to examine the cardiac effects of simultaneous multi-bay exposures. Our prior study compared the X2 to the X26E but examined only single bay exposures from the X2. Lastly, we feel we have improved the methodology for studying the comparative cardiac effects of CEWs.
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Affiliation(s)
| | - Jeffrey D Ho
- Hennepin County Medical Center, Minneapolis, MN, United States.
| | | | - Sarah J Fink
- Johns Hopkins University, Baltimore, MD, United States
| | - Brian E Driver
- Hennepin County Medical Center, Minneapolis, MN, United States
| | - Lauren R Klein
- Hennepin County Medical Center, Minneapolis, MN, United States
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Miner JR, Klein LR, Cole JB, Driver BE, Moore JC, Ho JD. The Characteristics and Prevalence of Agitation in an Urban County Emergency Department. Ann Emerg Med 2018; 72:361-370. [DOI: 10.1016/j.annemergmed.2018.06.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 05/09/2018] [Accepted: 05/31/2018] [Indexed: 10/28/2022]
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Cole JB, Klein LR, Nystrom PC, Moore JC, Driver BE, Fryza BJ, Harrington J, Ho JD. A prospective study of ketamine as primary therapy for prehospital profound agitation. Am J Emerg Med 2018; 36:789-796. [DOI: 10.1016/j.ajem.2017.10.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 08/31/2017] [Accepted: 10/07/2017] [Indexed: 10/18/2022] Open
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Ho JD, Wirya SA, Al-Haseni AG, Larson A, Bhawan J. Hairless lesion on the scalp. Clin Exp Dermatol 2017; 43:80-82. [PMID: 28924973 DOI: 10.1111/ced.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
- J D Ho
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA.,Section of Dermatopathology, Boston University School of Medicine, Boston, MA, USA
| | - S A Wirya
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - A G Al-Haseni
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - A Larson
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - J Bhawan
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA.,Section of Dermatopathology, Boston University School of Medicine, Boston, MA, USA
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Mac Giolla Phadraig C, Ho JD, Guerin S, Yeoh YL, Mohamed Medhat M, Doody K, Hwang S, Hania M, Boggs S, Nolan A, Nunn J. Neither Basic Life Support knowledge nor self-efficacy are predictive of skills among dental students. Eur J Dent Educ 2017; 21:187-192. [PMID: 26991795 DOI: 10.1111/eje.12199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 06/05/2023]
Abstract
AIM Basic life support (BLS) is considered a core competence for the graduating dentist. This study aimed to measure BLS knowledge, self-efficacy and skills of undergraduate dental students in Dublin. METHODS This study consisted of a cross-sectional survey measuring BLS knowledge and self-efficacy, accompanied by a directly observed BLS skills assessment in a subsample of respondents. Data were collected in January 2014. Bivariate correlations between descriptive and outcome variables (knowledge, self-efficacy and skills) were tested using Pearson's chi-square. We included knowledge and self-efficacy as predictor variables, along with other variables showing association, into a binary logistic regression model with BLS skills as the outcome measure. RESULTS One hundred and thirty-five students participated. Almost all (n = 133, 98.5%) participants had BLS training within the last 2 years. One hundred and four (77%) felt that they were capable of providing effective BLS (self-efficacy), whilst only 46 (34.1%) scored >80% of knowledge items correct. Amongst the skills (n = 85) subsample, 38.8% (n = 33) were found to pass the BLS skills assessment. Controlling for gender, age and skills assessor, the regression model did not identify a predictive relationship between knowledge or self-efficacy and BLS skills. CONCLUSIONS Neither knowledge nor self-efficacy was predictive of BLS skills. Dental students had low levels of knowledge and skills in BLS. Despite this, their confidence in their ability to perform BLS was high and did not predict actual competence. There is a need for additional hands-on training, focusing on self-efficacy and BLS skills, particularly the use of AED.
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Affiliation(s)
- C Mac Giolla Phadraig
- Department of Child and Public Dental Health, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - J D Ho
- Department of Child and Public Dental Health, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - S Guerin
- Centre for Disability Studies, UCD, Belfield Co., Dublin, Ireland
| | - Y L Yeoh
- Department of Child and Public Dental Health, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - M Mohamed Medhat
- Department of Child and Public Dental Health, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - K Doody
- Department of Child and Public Dental Health, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - S Hwang
- Department of Child and Public Dental Health, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - M Hania
- Department of Child and Public Dental Health, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - S Boggs
- Department of Child and Public Dental Health, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - A Nolan
- Department of Child and Public Dental Health, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - J Nunn
- Department of Child and Public Dental Health, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
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Ho JD, Wolpowitz D, Phillips TJ. Breast nodularity and ulceration: diffuse dermal angiomatosis a corticosteroid responsive disease. Dermatol Online J 2016; 22:13030/qt1rr7z8b1. [PMID: 28329566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 06/06/2023] Open
Abstract
Diffuse dermal angiomatosis of the breast (DDAB) is an uncommon ulcerative angiomatosis, which occurs in middle aged women with large pendulous breasts, a history of cigarette smoking, and risk factors for atherosclerosis. Based on its rarity, no well-defined therapeutic regimen has been elucidated. We report a case of DDAB in a woman with no history of smoking or radiographic evidence of occluded vasculature who presented with ulceration and pain-associated breast nodularity. She had a complete reproducible response to oral corticosteroids.
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Affiliation(s)
- J D Ho
- Department of Dermatology, Boston University School of Medicine, Boston, MA Department of Dermatology and Section of Dermatopathology, Boston University School of Medicine, Boston, MA.
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Ho JD, Dawes DM, McKay EM, Taliercio JJ, White SD, Woodbury BJ, Sandefur MA, Miner JR. Effect of Body-Worn Cameras on EMS Documentation Accuracy: A Pilot Study. PREHOSP EMERG CARE 2016; 21:263-271. [DOI: 10.1080/10903127.2016.1218984] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Cole JB, Moore JC, Nystrom PC, Orozco BS, Stellpflug SJ, Kornas RL, Fryza BJ, Steinberg LW, O’Brien-Lambert A, Bache-Wiig P, Engebretsen KM, Ho JD. A prospective study of ketamine versus haloperidol for severe prehospital agitation. Clin Toxicol (Phila) 2016; 54:556-62. [DOI: 10.1080/15563650.2016.1177652] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jon B. Cole
- Minnesota Poison Control System, Minneapolis, MN, USA
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Johanna C. Moore
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Paul C. Nystrom
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Benjamin S. Orozco
- Minnesota Poison Control System, Minneapolis, MN, USA
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | | | - Rebecca L. Kornas
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Brandon J. Fryza
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Lila W. Steinberg
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Alex O’Brien-Lambert
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Peter Bache-Wiig
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | | | - Jeffrey D. Ho
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
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13
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Ho JD, Wolpowitz D, Phillips TJ. Breast nodularity and ulceration: diffuse dermal angiomatosis a corticosteroid responsive disease. Dermatol Online J 2016. [DOI: 10.5070/d32211033149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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14
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Affiliation(s)
- Jeffrey D Ho
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
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15
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Chung SD, Ho JD, Chen CH, Lin HC, Tsai MC, Sheu JJ. Dementia is associated with open-angle glaucoma: a population-based study. Eye (Lond) 2015; 29:1340-6. [PMID: 26160529 DOI: 10.1038/eye.2015.120] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/04/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Previous epidemiologic studies that focused on the association between open-angle glaucoma (OAG) and dementia showed inconsistent results. In the present study, we explored the association between OAG and dementia in an ethnic Chinese (i.e., Taiwanese) population using a population-based data set. METHODS We retrieved data on study subjects for this case-control study from the Longitudinal Health Insurance Database 2000. We identified 7770 patients who had a diagnosis of dementia as cases, and 7770 subjects matched in terms of sex and age, which were randomly extracted as controls. A conditional logistic regression conditioned on age group, sex, and index year was used to assess the association of dementia with previously diagnosed OAG among the sampled patients. RESULTS Of 15,540 patients, 1.70% had prior OAG, including 2.02% of the dementia group and 1.38% of the controls. After adjusting for patient socioeconomic characteristics and comorbid medical disorders, dementia patients were more likely to have had prior OAG than controls (odds ratio (OR): 1.44; 95% confidence interval (CI): 1.12-1.85; P<0.01). In addition, female dementia patients were more likely to have had prior OAG than controls (OR: 1.93; 95% CI: 1.35-2.77; P<0.001), whereas no statistical difference in prior OAG between male dementia patients and controls was found. CONCLUSIONS Female dementia patients were associated with a higher proportion of prior OAG than were the controls.
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Affiliation(s)
- S-D Chung
- Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan.,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - J D Ho
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan
| | - C H Chen
- Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei, Taiwan.,Mackay Medicine, Nursing, and Management College, Taipei, Taiwan
| | - H C Lin
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - M C Tsai
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.,Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan
| | - J J Sheu
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Perkins J, Ho JD, Vilke GM, DeMers G. American Academy of Emergency Medicine Position Statement: Safety of Droperidol Use in the Emergency Department. J Emerg Med 2015; 49:91-7. [DOI: 10.1016/j.jemermed.2014.12.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 12/21/2014] [Indexed: 11/25/2022]
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17
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Ho JD, Ansari RK, Page D. Hand Sanitization Rates in an Urban Emergency Medical Services System. J Emerg Med 2014; 47:163-8. [DOI: 10.1016/j.jemermed.2013.08.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 06/12/2013] [Accepted: 08/15/2013] [Indexed: 11/28/2022]
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18
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Ho JD, Dawes DM, Nystrom PC, Collins DP, Nelson RS, Moore JC, Miner JR. Reply to Strote, Lay person use of conducted electrical weapon research. Forensic Sci. Int. volume (2014) page XX-XX. Forensic Sci Int 2014; 238:e21-2. [PMID: 24646658 DOI: 10.1016/j.forsciint.2014.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jeffrey D Ho
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States; Meeker County Sheriff's Office, Litchfield, MN, United States.
| | - Donald M Dawes
- Department of Emergency Medicine, Lompoc Valley Medical Center, Lompoc, CA, United States; Santa Barbara Police Department, Santa Barbara, CA, United States
| | - Paul C Nystrom
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States; Meeker County Sheriff's Office, Litchfield, MN, United States
| | - Donal P Collins
- Occupational Medicine Service, An Garda Siochana, Dublin, Ireland
| | - Rebecca S Nelson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States
| | - Johanna C Moore
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States
| | - James R Miner
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States
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Oakley E, Ho JD, Johnson V, VanCamp J, Melson T, Hick JL. Splenic Artery Aneurysm: An Important Cause of Hemoperitoneum and Shock. J Emerg Med 2014; 46:e65-7. [DOI: 10.1016/j.jemermed.2013.04.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 03/15/2013] [Accepted: 04/30/2013] [Indexed: 11/17/2022]
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20
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Ho JD, Williams MF, Coplen MJ. Conducted electrical weapons within healthcare: a comprehensive use of force model. J Healthc Prot Manage 2014; 30:47-56. [PMID: 25181791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Healthcare settings are experiencing increased amounts of violent activity that are challenging to the health care security profession. There is difficulty in addressing this issue completely. Some of this difficulty is because of factors that include inexperienced and untrained clinicians and administrators that are often the decision-makers in the health care setting. As part of an effective solution, we propose that a security plan, including a comprehensive use of force program incorporating conducted electrical weapons, is a necessary and best-practice goal. This paper outlines the background of the problem and discusses the challenges we encountered in reaching this goal as well as the benefits we have discovered along the way. This paper will be beneficial to any healthcare security professional that is interested in enhancing or improving their current health care security use of force model to further counter the increasing violent activity in their respective healthcare setting.
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Ho JD, Dawes DM, Nystrom PC, Collins DP, Nelson RS, Moore JC, Miner JR. Markers of acidosis and stress in a sprint versus a conducted electrical weapon. Forensic Sci Int 2013; 233:84-9. [DOI: 10.1016/j.forsciint.2013.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 08/21/2013] [Accepted: 08/23/2013] [Indexed: 11/15/2022]
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Ho JD, Dawes DM, Chang RJ, Nelson RS, Miner JR. Physiologic effects of a new-generation conducted electrical weapon on human volunteers. J Emerg Med 2013; 46:428-35. [PMID: 24238599 DOI: 10.1016/j.jemermed.2013.08.069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 05/16/2013] [Accepted: 08/15/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Conducted electrical weapons (CEWs) are used by law enforcement to restrain or repel potentially violent persons. The TASER X2 CEW is a next-generation device with new technology, including new electrical waveform and output specifications. It has not previously been studied in humans. OBJECTIVE The objective of this study was to evaluate the human physiologic effect of a new-generation CEW. METHODS This was a prospective, observational human study. Volunteers received a 10-s exposure via deployed probes from an X2 CEW in the abdomen and upper thigh. Measured data included vital signs; 12-lead electrocardiograms; and blood serum biomarkers before, immediately after, and 24 h post exposure. Biomarkers measured included pH, lactate, potassium, creatine kinase (CK), and troponin-I. Real-time spirometry and echocardiography were performed before, during, and after the exposure. RESULTS Ten volunteers completed the study. There were no important changes in vital signs or potassium. Median increase in lactate as a consequence of the exposure was 1.2 mg/dL (range 0.6-2.8 mg/dL). Median change in pH was -0.031 (range -0.011 to -0.067). No subject had a positive troponin. Median change in CK at 24 h was 313 ng/mL (range -40 to 3418 ng/mL). There was no evidence of respiratory impairment. Baseline median minute ventilation was 14.2 L/min, increased to 21.6 L/min intra-exposure (p = 0.05), and remained elevated at 21.6 L/min post exposure (p = 0.01). CONCLUSIONS There was no evidence of dangerous physiology found in the measured parameters. The physiologic effects of the X2 CEW are similar to older-generation CEWs. We encourage further study to validate these results.
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Affiliation(s)
- Jeffrey D Ho
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Meeker County Sheriff's Office, Litchfield, Minnesota
| | - Donald M Dawes
- Department of Emergency Medicine, Lompoc Valley Medical Center, Lompoc, California; Santa Barbara Police Department, Santa Barbara, California
| | - Richard J Chang
- Department of Emergency Medicine, Providence Regional Medical Center, Everett, Washington
| | - Rebecca S Nelson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - James R Miner
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
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Olson KN, Smith SW, Kloss JS, Ho JD, Apple FS. Relationship Between Blood Alcohol Concentration and Observable Symptoms of Intoxication in Patients Presenting to an Emergency Department. Alcohol Alcohol 2013; 48:386-9. [DOI: 10.1093/alcalc/agt042] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dawes DM, Ho JD, Moore JC, Miner JR. Erratum to: An evaluation of two conducted electrical weapons and two probe designs using a swine comparative cardiac safety model. Forensic Sci Med Pathol 2013. [DOI: 10.1007/s12024-013-9451-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miner JR, Moore JC, Plummer D, Gray RO, Patel S, Ho JD. Randomized clinical trial of the effect of supplemental opioids in procedural sedation with propofol on serum catecholamines. Acad Emerg Med 2013; 20:330-7. [PMID: 23701339 DOI: 10.1111/acem.12110] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/03/2012] [Accepted: 10/05/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective was to assess the effect on stress biomarkers of supplemental opioid to a standard propofol dosing protocol for emergency department (ED) procedural sedation (PS). The hypothesis was that there is no difference in the change in serum catecholamines between PS using propofol with or without supplemental alfentanil. METHODS This was a randomized, nonblinded pilot study of adult patients undergoing PS in the ED for the reduction of fractures and dislocations. Patients with pain before the procedure were treated with intravenous (IV) morphine sulfate until their pain was adequately treated for at least 20 minutes before starting the procedure. Patients were randomized to receive either 10 μg/kg alfentanil followed by 1 mg/kg propofol, followed by 0.5 mg/kg every 3 minutes as needed, or propofol only, dosed in similar fashion without supplemental alfentanil. Doses, vital signs, nasal end-tidal CO2 (ETCO2), pulse oximetry, and bispectral electroencephalogram (EEG) analysis scores were recorded. Subclinical respiratory depression was defined as a change in ETCO2 > 10 mm Hg, an oxygen saturation of < 92% at any time, or an absent ETCO2 waveform at any time. Clinical events related to respiratory depression were noted during the procedure, including the addition of or increase in the flow rate of supplemental oxygen, the use of a bag-valve-mask apparatus, airway repositioning, or stimulation to induce breathing. Blood was drawn 1 minute prior to the administration of the medications for PS and again 1 minute after completion of the procedure for which the patient was sedated. Serum was tested for total catecholamines, epinephrine, norepinephrine, and dopamine. Postprocedure, patients were asked to report any pain perceived during the procedure. Data were analyzed using descriptive statistics, Wilcoxon rank sum tests, and chi-square tests, as appropriate. RESULTS Twenty patients were enrolled; 10 received propofol and 10 received propofol with alfentanil. No clinically significant complications were noted. Subclinical respiratory depression was seen in four of 10 (40%) patients in the propofol group and five of 10 (50%) patients in the propofol/alfentanil group (effect size = -10%, 95% confidence interval [CI] = -53% to 33%). There was no difference in the rate of clinical signs of respiratory depression between the two groups. Pain during the procedure was reported by two of 10 (20%) patients in the propofol group and five of 10 (50%) patients in the propofol/alfentanil group (effect size = -30%, 95% CI = -70% to 10%). Recall of some part of the procedure was reported by 0 of 10 (0%) patients in the propofol group and five of 10 (50%) of patients in the propofol/alfentanil group (effect size = -50%, 95% CI = -81% to -19%). There was no difference in the baseline or postprocedure catecholamine levels between the groups. CONCLUSIONS No difference in serum catecholamines was detected immediately after PS between patients who receive propofol with and without supplemental opioid in this small pilot study. PS using propofol only without supplemental opioid did not appear to induce markers of physiologic stress in this small pilot study.
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Affiliation(s)
- James R. Miner
- Department of Emergency Medicine; Hennepin County Medical Center; Minneapolis; MN
| | - Johanna C. Moore
- Department of Emergency Medicine; Hennepin County Medical Center; Minneapolis; MN
| | - David Plummer
- Department of Emergency Medicine; Hennepin County Medical Center; Minneapolis; MN
| | - Richard O. Gray
- Department of Emergency Medicine; Hennepin County Medical Center; Minneapolis; MN
| | - Sagar Patel
- Department of Emergency Medicine; Hennepin County Medical Center; Minneapolis; MN
| | - Jeffrey D. Ho
- Department of Emergency Medicine; Hennepin County Medical Center; Minneapolis; MN
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Ho JD, Smith SW, Nystrom PC, Dawes DM, Orozco BS, Cole JB, Heegaard WG. Successful Management of Excited Delirium Syndrome with Prehospital Ketamine: Two Case Examples. PREHOSP EMERG CARE 2012; 17:274-9. [DOI: 10.3109/10903127.2012.729129] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Jeffrey D. Ho
- From the Department of Emergency Medicine, Hennepin County Medical Center (JDH, SWS, PCN, BSO, JBC, WGH), Minneapolis, Minnesota; Meeker County Sheriff's Office (JDH), Litchfield, Minnesota; the Department of Emergency Medicine, Lompoc Valley Medical Center (DMD), Lompoc, California; the Santa Barbara Police Department (DMD), Santa Barbara, California; and Hennepin Regional Poison Center (BSO, JBC), Minneapolis, Minnesota
| | - Stephen W. Smith
- From the Department of Emergency Medicine, Hennepin County Medical Center (JDH, SWS, PCN, BSO, JBC, WGH), Minneapolis, Minnesota; Meeker County Sheriff's Office (JDH), Litchfield, Minnesota; the Department of Emergency Medicine, Lompoc Valley Medical Center (DMD), Lompoc, California; the Santa Barbara Police Department (DMD), Santa Barbara, California; and Hennepin Regional Poison Center (BSO, JBC), Minneapolis, Minnesota
| | - Paul C. Nystrom
- From the Department of Emergency Medicine, Hennepin County Medical Center (JDH, SWS, PCN, BSO, JBC, WGH), Minneapolis, Minnesota; Meeker County Sheriff's Office (JDH), Litchfield, Minnesota; the Department of Emergency Medicine, Lompoc Valley Medical Center (DMD), Lompoc, California; the Santa Barbara Police Department (DMD), Santa Barbara, California; and Hennepin Regional Poison Center (BSO, JBC), Minneapolis, Minnesota
| | - Donald M. Dawes
- From the Department of Emergency Medicine, Hennepin County Medical Center (JDH, SWS, PCN, BSO, JBC, WGH), Minneapolis, Minnesota; Meeker County Sheriff's Office (JDH), Litchfield, Minnesota; the Department of Emergency Medicine, Lompoc Valley Medical Center (DMD), Lompoc, California; the Santa Barbara Police Department (DMD), Santa Barbara, California; and Hennepin Regional Poison Center (BSO, JBC), Minneapolis, Minnesota
| | - Benjamin S. Orozco
- From the Department of Emergency Medicine, Hennepin County Medical Center (JDH, SWS, PCN, BSO, JBC, WGH), Minneapolis, Minnesota; Meeker County Sheriff's Office (JDH), Litchfield, Minnesota; the Department of Emergency Medicine, Lompoc Valley Medical Center (DMD), Lompoc, California; the Santa Barbara Police Department (DMD), Santa Barbara, California; and Hennepin Regional Poison Center (BSO, JBC), Minneapolis, Minnesota
| | - Jon B. Cole
- From the Department of Emergency Medicine, Hennepin County Medical Center (JDH, SWS, PCN, BSO, JBC, WGH), Minneapolis, Minnesota; Meeker County Sheriff's Office (JDH), Litchfield, Minnesota; the Department of Emergency Medicine, Lompoc Valley Medical Center (DMD), Lompoc, California; the Santa Barbara Police Department (DMD), Santa Barbara, California; and Hennepin Regional Poison Center (BSO, JBC), Minneapolis, Minnesota
| | - William G. Heegaard
- From the Department of Emergency Medicine, Hennepin County Medical Center (JDH, SWS, PCN, BSO, JBC, WGH), Minneapolis, Minnesota; Meeker County Sheriff's Office (JDH), Litchfield, Minnesota; the Department of Emergency Medicine, Lompoc Valley Medical Center (DMD), Lompoc, California; the Santa Barbara Police Department (DMD), Santa Barbara, California; and Hennepin Regional Poison Center (BSO, JBC), Minneapolis, Minnesota
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Vilke GM, DeBard ML, Chan TC, Ho JD, Dawes DM, Hall C, Curtis MD, Costello MW, Mash DC, Coffman SR, McMullen MJ, Metzger JC, Roberts JR, Sztajnkrcer MD, Henderson SO, Adler J, Czarnecki F, Heck J, Bozeman WP. Excited Delirium Syndrome (ExDS): Defining Based on a Review of the Literature. J Emerg Med 2012; 43:897-905. [DOI: 10.1016/j.jemermed.2011.02.017] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 08/31/2010] [Accepted: 02/20/2011] [Indexed: 11/15/2022]
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Ho JD, Nystrom PC, Calvo DV, Berris MS, Norlin JF, Clinton JE. Prehospital Chemical Restraint of a Noncommunicative Autistic Minor by Law Enforcement. PREHOSP EMERG CARE 2012; 16:407-11. [DOI: 10.3109/10903127.2011.640767] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ho JD, Dawes DM, Heegaard WG, Calkins HG, Moscati RM, Miner JR. Absence of Electrocardiographic Change after Prolonged Application of a Conducted Electrical Weapon in Physically Exhausted Adults. J Emerg Med 2011; 41:466-72. [PMID: 19443165 DOI: 10.1016/j.jemermed.2009.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2008] [Revised: 02/21/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
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Ho JD, Dawes DM, Moore JC, Caroon LV, Miner JR. Effect of position and weight force on inferior vena cava diameter – Implications for arrest-related death. Forensic Sci Int 2011; 212:256-9. [DOI: 10.1016/j.forsciint.2011.07.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 02/24/2011] [Accepted: 07/01/2011] [Indexed: 11/15/2022]
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Ho JD, Clinton JE, Lappe MA, Heegaard WG, Williams MF, Miner JR. Introduction of the Conducted Electrical Weapon into a Hospital Setting. J Emerg Med 2011; 41:317-23. [DOI: 10.1016/j.jemermed.2009.09.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 09/14/2009] [Accepted: 09/28/2009] [Indexed: 11/24/2022]
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Dawes DM, Ho JD. Re: Myocardial infarction after TASER exposure. J La State Med Soc 2010; 162: 291-295. J La State Med Soc 2011; 163:64-66. [PMID: 21667799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Ho JD, Dawes DM, Reardon RF, Strote SR, Kunz SN, Nelson RS, Lundin EJ, Orozco BS, Miner JR. Human cardiovascular effects of a new generation conducted electrical weapon. Forensic Sci Int 2011; 204:50-7. [PMID: 20537475 DOI: 10.1016/j.forsciint.2010.05.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 04/26/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
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Dawes DM, Ho JD, Sweeney JD, Lundin EJ, Kunz SN, Miner JR. The effect of an electronic control device on muscle injury as determined by creatine kinase enzyme. Forensic Sci Med Pathol 2010; 7:3-8. [PMID: 20683680 DOI: 10.1007/s12024-010-9187-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2010] [Indexed: 11/30/2022]
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Ho JD, Dawes DM, Nelson RS, Lundin EJ, Ryan FJ, Overton KG, Zeiders AJ, Miner JR. Acidosis and catecholamine evaluation following simulated law enforcement "use of force" encounters. Acad Emerg Med 2010; 17:e60-8. [PMID: 20653572 DOI: 10.1111/j.1553-2712.2010.00813.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Law enforcement authorities are often charged with controlling resisting suspects. These encounters sometimes result in the sudden and unexpected death of the suspect. Drug intoxication, excited delirium syndrome, or excessive uses of force are factors that are often blamed, but sometimes the mechanism of these deaths is not fully understood. It is possible that worsening acidosis or excessive catecholamine release play a part. The objective of this study was to determine the effect on markers of acidosis and catecholamines of various tasks intended to simulate common arrest-related situations. METHODS Subjects were assigned to one of five task groups: 1) a 150-meter sprint and wall hurdle (simulated flight from arrest); 2) 45 seconds of striking a heavy bag (simulated physical resistance); 3) a 10-second TASER X26 electronic control device exposure; 4) a fleeing and resistance exercise involving a law enforcement dog (K-9); or 5) an oleoresin capsicum (OC) exposure to the face and neck. Baseline serum pH, lactate, potassium, troponin I, catecholamines, and creatine kinase (CK) were evaluated. Serum catecholamines, pH, lactate, and potassium were sampled immediately after the task and every 2 minutes for 10 minutes posttask. Vital signs were repeated immediately after the task. Serum CK and troponin I were evaluated again at 24 hours posttask. RESULTS Sixty-six subjects were enrolled; four did not complete their assigned task. One subject lost the intravenous (IV) access after completing the task and did not have data collected, and one subject only received a 5-second TASER device exposure and was excluded from the study, leaving 12 subjects in each task group. The greatest changes in acidosis markers occurred in the sprint and heavy bag groups. Catecholamines increased the most in the heavy bag group and the sprint group and increased to a lesser degree in the TASER, OC, and K-9 groups. Only the sprint group showed an increase in CK at 24 hours. There were no elevations in troponin I in any group, nor any clinically important changes in potassium. CONCLUSIONS The simulations of physical resistance and fleeing on foot led to the greatest changes in markers of acidosis and catecholamines. These changes may be contributing or causal mechanisms in sudden custodial arrest-related deaths (ARDs). This initial work may have implications in guiding applications of force for law enforcement authorities (LEAs) when apprehending resisting subjects.
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Affiliation(s)
- Jeffrey D Ho
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
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Dawes DM, Ho JD, Reardon RF, Miner JR. The cardiovascular, respiratory, and metabolic effects of a long duration electronic control device exposure in human volunteers. Forensic Sci Med Pathol 2010; 6:268-74. [PMID: 20502988 DOI: 10.1007/s12024-010-9166-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2010] [Indexed: 11/24/2022]
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Dawes DM, Ho JD, Cole JB, Reardon RF, Lundin EJ, Terwey KS, Falvey DG, Miner JR. Effect of an electronic control device exposure on a methamphetamine-intoxicated animal model. Acad Emerg Med 2010; 17:436-43. [PMID: 20370784 DOI: 10.1111/j.1553-2712.2010.00708.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Because of the prevalence of methamphetamine abuse worldwide, it is not uncommon for subjects in law enforcement encounters to be methamphetamine-intoxicated. Methamphetamine has been present in arrest-related death cases in which an electronic control device (ECD) was used. The primary purpose of this study was to determine the cardiac effects of an ECD in a methamphetamine intoxication model. METHODS Sixteen anesthetized Dorset sheep (26-78 kg) received 0.0 mg/kg (control animals, n = 4), 0.5 mg/kg (n = 4), 1.0 mg/kg (n = 4), or 1.5 mg/kg (n = 4) of methamphetamine hydrochloride as a slow intravenous (IV) bolus during continuous cardiac monitoring. The animals received the following exposures in sequence from a TASER X26 ECD beginning at 30 minutes after the administration of the drug: 1) 5-second continuous exposure, 2) 15-second intermittent exposure, 3) 30-second intermittent exposure, and 4) 40-second intermittent exposure. Darts were inserted at the sternal notch and the cardiac apex, to a depth of 9 mm. Cardiac motion was determined by thoracotomy (smaller animals, < or = 32 kg) or echocardiography (larger animals, > 68 kg). Data were analyzed using descriptive statistics and chi-square tests. RESULTS Animals given methamphetamine demonstrated signs of methamphetamine toxicity with tachycardia, hypertension, and atrial and ventricular ectopy in the 30-minute period immediately after administration of the drug. Smaller animals (n = 8, < or = 32 kg, mean = 29.4 kg) had supraventricular dysrhythmias immediately after the ECD exposures. Larger animals (n = 8, > 68 kg, mean = 72.4) had only sinus tachycardia after the exposures. One of the smaller animals had frequent episodes of ventricular ectopy after two exposures, including runs of delayed onset, nonsustained six- to eight-beat unifocal and multifocal ventricular tachycardia that spontaneously resolved. This animal had significant ectopy prior to the exposures as well. Thoracotomy performed on three smaller animals demonstrated cardiac capture during ECD exposure consistent with previous animal studies. In the larger animals, none of the methamphetamine-intoxicated animals demonstrated cardiac capture. Two control sheep showed evidence of capture similar to the smaller animals. No ventricular fibrillation occurred after the exposure in any animal. CONCLUSIONS In smaller animals (32 kg or less), ECD exposure exacerbated atrial and ventricular irritability induced by methamphetamine intoxication, but this effect was not seen in larger, adult-sized animals. There were no episodes of ventricular fibrillation after exposure associated with ECD exposure in methamphetamine-intoxicated sheep.
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Affiliation(s)
- Donald M Dawes
- Department of Physiology and Biophysics, University of Louisville, Louisville, KY, USA
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Dawes DM, Ho JD, Reardon RF, Sweeney JD, Miner JR. The physiologic effects of multiple simultaneous electronic control device discharges. West J Emerg Med 2010; 11:49-56. [PMID: 20411076 PMCID: PMC2850854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 04/14/2009] [Accepted: 09/14/2009] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Law enforcement and military personnel use electronic control devices to control non-compliant and actively resistive subjects. The TASER((R)) Shockwave is a new electronic control device designed specifically as an area denial device capable of delivering multiple simultaneous discharges. This is the first study to examine the effects of multiple simultaneous device discharges in humans. METHODS Volunteers were exposed to multiple (two to three), simultaneous 5-second discharges from the Shockwave device to the chest, back, chest to abdomen, or thighs. Blood was analyzed before and after discharge for pH, lactate, potassium, creatine kinase (CK), and troponin. Continuous spirometry was performed before, during, and after the discharge. In addition, electrocardiograms (ECGs) before and after discharge were recorded, and echocardiography was used to determine the rhythm during discharge. RESULTS Small elevations of lactate occurred. Moderate increases in CK at 24 hours occurred and appeared to be related to the number of simultaneous discharges. There was a trend to a decrease in minute ventilation in the volunteers exposed to two simultaneous discharges, but it did not reach statistical significance. ECG changes only reflected an increase in vagal tone, and there was no evidence of capture by echocardiography. Five-second, simultaneous, multiple exposures to the TASER Shockwave device were reasonably tolerated by our human volunteers. CONCLUSION Our study suggests that this device may have a reasonable risk/benefit ratio when used to protect an area from a threat.
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Affiliation(s)
| | - Jeffrey D. Ho
- Hennepin County Medical Center, Minneapolis, MN,Address for Correspondence: Jeffrey Ho, MD, Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415.
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Ho JD, Dawes DM, Cole JB, Hottinger JC, Overton KG, Miner JR. Corrigendum to “Lactate and pH evaluation in exhausted humans with prolonged TASER X26 exposure or continued exertion” [Forensic Sci. Int. 190 (2009) 80–86]. Forensic Sci Int 2010. [DOI: 10.1016/j.forsciint.2009.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dawes DM, Ho JD, Reardon RF, Miner JR. Echocardiographic evaluation of TASER X26 probe deployment into the chests of human volunteers. Am J Emerg Med 2010; 28:49-55. [PMID: 20006201 DOI: 10.1016/j.ajem.2008.09.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 09/22/2008] [Accepted: 09/23/2008] [Indexed: 10/20/2022] Open
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Affiliation(s)
- Jeffrey D Ho
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
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Ho JD, Dawes DM, Bultman LL, Moscati RM, Janchar TA, Miner JR. Prolonged TASER use on exhausted humans does not worsen markers of acidosis. Am J Emerg Med 2009; 27:413-8. [PMID: 19555610 DOI: 10.1016/j.ajem.2008.03.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Revised: 02/11/2008] [Accepted: 03/06/2008] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE There are safety concerns about TASER conducted electrical weapon (CEW) use on humans, and there have been media reports of adverse human outcomes after CEW exposure. Conducted electrical weapons are often used on physically exhausted subjects. A single CEW application of a CEW is generally accepted to be 5 seconds of exposure. Some exposures in reality involve more than 5 seconds. We sought to determine if a prolonged (15 seconds) CEW exposure on exhausted humans caused acidosis, hyperkalemia, serum lactate change, or troponin change. METHODS This was a prospective study of generally healthy human volunteers. Medical histories and baseline serum values were obtained, and several of the volunteers did have acute or chronic medical problems. Subjects underwent an exercise protocol until subjective exhaustion. Exhaustion was defined by the volunteer no longer being able to perform the exercise at a given pace. Blood was drawn immediately (defined as within 20 seconds) after exercise and was immediately followed by a 15-second CEW exposure. Blood was drawn immediately after exposure and again at 16 to 24 hours after exposure. Blood was analyzed for pH, pco(2), potassium, lactate, and troponin. Data were compared using Wilcoxon signed rank tests. RESULTS There were 38 subjects enrolled with an average age of 39 years. The following health conditions were reported among the volunteers: hypertension (2), gastritis/reflux (2), active respiratory tract infections (3), asthma (2), chronic muscular pain conditions (4), pituitary adenoma (1) and glaucoma (1). Sixteen volunteers reported use of prescription medication at the time of their participation. The median initial pH of 7.38 (interquartile range [IQR], 7.35-7.40) decreased to 7.23 (IQR, 7.19-7.31) immediately after exercise. Immediately after exposure, median pH was 7.22 (IQR, 7.18-7.25). It was 7.39 (IQR, 7.37-7.43) at 24 hours. The pCO2 increased from 46.3 (IQR, 43.0-54.5) to 57.4 (IQR, 49.9-67.7) immediately after exercise, decreased to 51.3 (IQR, 44.4-65.0) immediately after exposure, and was 46.3 (IQR, 42.7-51.7) at 24 hours. Lactate increased from a median of 1.65 (IQR, 1.14-2.55) to 8.39 (IQR, 6.98-11.66) immediately after exercise, increased to 9.85 (IQR, 7.70-12.87) immediately after exposure, and was 1.02 (IQR, 0.91-1.57) at 24 hours. Serum potassium increased from 3.9 (IQR, 3.8-4.4) to 4.2 (IQR, 4.0-4.9) immediately after exercise, decreased to 3.8 (IQR, 3.7-4.4) immediately after exposure, and was 4.1 (IQR, 3.9-4.6) at 24 hours. No troponin elevations were detected. CONCLUSION Prolonged CEW application on exhausted humans was not associated with worsening change in pH or troponin. Decreases in pCO2 and potassium and a small increase in lactate were found. Worsening acidosis theories due to CEW use in this population are not supported by these data.
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Affiliation(s)
- Jeffrey D Ho
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
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Affiliation(s)
- John L Hick
- Department of Emergency Medicine, University of Minnesota, Hennepin County Medical Center, Minneapolis, Minnesota, 55415, USA.
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Ho JD, Heegaard WG, Dawes DM, Natarajan S, Reardon RF, Miner JR. Unexpected arrest-related deaths in america: 12 months of open source surveillance. West J Emerg Med 2009; 10:68-73. [PMID: 19561821 PMCID: PMC2691515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 08/07/2008] [Accepted: 11/28/2008] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Sudden, unexpected arrest-related death (ARD) has been associated with drug abuse, extreme delirium or certain police practices. There is insufficient surveillance and causation data available. We report 12 months of surveillance data using a novel data collection methodology. METHODS We used an open-source, prospective method to collect 12 consecutive months of data, including demographics, behavior, illicit substance use, control methods used, and time of collapse after law enforcement contact. Descriptive analysis and chi-square testing were applied. RESULTS There were 162 ARD events reported that met inclusion criteria. The majority were male with mean age 36 years, and involved bizarre, agitated behavior and reports of drug abuse just prior to death. Law enforcement control techniques included none (14%); empty-hand techniques (69%); intermediate weapons such as TASER((R)) device, impact weapon or chemical irritant spray (52%); and deadly force (12%). Time from contact to subject collapse included instantaneous (13%), within the first hour (53%) and 1-48 hours (35%). Significant collapse time associations occurred with the use of certain intermediate weapons. CONCLUSION This surveillance report can be a foundation for discussing ARD. These data support the premise that ARDs primarily occur in persons with a certain demographic and behavior profile that includes middle-aged males exhibiting agitated, bizarre behavior generally following illicit drug abuse. Collapse time associations were demonstrated with the use of TASER devices and impact weapons. We recommend further study in this area to validate our data collection method and findings.
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Affiliation(s)
- Jeffrey D. Ho
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, MN,Address for correspondence: Jeffrey D. Ho, MD, Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415.
| | - William G. Heegaard
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, MN
| | | | - Sridhar Natarajan
- Forensic Pathology and Medicine Consultant, Biodynamic Research Corporation, San Antonio, TX
| | - Robert F. Reardon
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, MN
| | - James R. Miner
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, MN
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Abstract
TASER Electronic Control Devices have become mainstream methods of applying electricity to control unruly suspects. There has been speculation that they may be associated with worsening human physiology or death. The lay impressions that these devices are unsafe are not founded on known human research findings. This presentation briefly reviews the most pertinent human research on this subject.
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Affiliation(s)
- Jeffrey D Ho
- Dept. of Emergency Medicine, University of Minnesota-Hennepin Co Medical Center, Minneapolis, Minnesota, USA
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Ho JD, Dawes DM, Reardon RF, Lapine AL, Dolan BJ, Lundin EJ, Miner JR. Echocardiographic evaluation of a TASER-X26 application in the ideal human cardiac axis. Acad Emerg Med 2008; 15:838-44. [PMID: 19244634 DOI: 10.1111/j.1553-2712.2008.00201.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES TASER electronic control devices (ECDs) are used by law enforcement to subdue aggressive persons. Some deaths temporally proximate to their use have occurred. There is speculation that these devices can cause dangerous cardiac rhythms. Swine research supports this hypothesis and has reported significant tachyarrhythmias. It is not known if this occurs in humans. The objective of this study was to determine the occurrence of tachyarrhythmias in human subjects subjected to an ECD application. METHODS This was a prospective, nonblinded study. Human volunteers underwent limited echocardiography before, during, and after a 10-second TASER X26 ECD application with preplaced thoracic electrodes positioned in the upper right sternal border and the cardiac apex. Images were analyzed using M-mode through the anterior leaflet of the mitral valve for evidence of arrhythmia. Heart rate (HR) and the presence of sinus rhythm were determined. Data were analyzed using descriptive statistics. RESULTS A total of 34 subjects were enrolled. There were no adverse events reported. The mean HR prior to starting the event was 108.7 beats/min (range 65 to 146 beats/min, 95% CI = 101.0 to 116.4 beats/min). During the ECD exposure, the mean HR was 120.1 beats/min (range 70 to 158 beats/min, 95% CI = 112.2 to 128.0 beats/min) and a mean of 94.1 beats/min (range 55 to 121 beats/min, 95% CI = 88.4 to 99.7 beats/min) at 1 minute after ECD exposure. Sinus rhythm was clearly demonstrated in 21 (61.7%) subjects during ECD exposure (mean HR 121.4 beats/min; range 75 to 158 beats/min, 95% CI = 111.5 to 131.4). Sinus rhythm was not clearly demonstrated in 12 subjects due to movement artifact (mean HR 117.8 beats/min, range 70 to 152 beats/min, 95% CI = 102.8 to 132.8 beats/min). CONCLUSIONS A 10-second ECD exposure in an ideal cardiac axis application did not demonstrate concerning tachyarrhythmias using human models. The swine model may have limitations when evaluating ECD technology.
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Affiliation(s)
- Jeffrey D Ho
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
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Ho JD, Miner JR, Dawes DM, Johnson MA, Lundin EJ. Reply. Am J Emerg Med 2008. [DOI: 10.1016/j.ajem.2008.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Dawes DM, Ho JD, Johnson MA, Lundin E, Janchar TA, Miner JR. 15-Second conducted electrical weapon exposure does not cause core temperature elevation in non-environmentally stressed resting adults. Forensic Sci Int 2008; 176:253-7. [PMID: 17983716 DOI: 10.1016/j.forsciint.2007.09.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 07/15/2007] [Accepted: 09/22/2007] [Indexed: 11/30/2022]
Affiliation(s)
- Donald M Dawes
- Emergency Department, Lompoc District Hospital, Lompoc, CA, USA
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