July 21, 1999
MEDICAL NEWS TIPS FROM THE DEPARTMENT OF EMERGENCY MEDICINE AT JOHNS HOPKINS MEDICAL INSTITUTIONS
To pursue any of these stories, please contact Karen Infeld at 410-955-1534 or [email protected].
1 IN 10 CHILDREN TREATED FOR TRAUMA TESTS POSITIVE FOR ALCOHOL, DRUGS
Nearly one in 10 children aged 10 to 14 treated for trauma in emergency departments and trauma centers tests positive for alcohol or drugs, a Johns Hopkins study shows.
Researchers looked at 11,357 patient records from the National Pediatric Trauma Registry, a database of child injuries treated at 76 hospitals in the United States and Canada. Patients were seen between 1990 and 1995. Of the 1,356 patients who underwent toxicology screening, 116 (9 percent) tested positive for alcohol or drugs such as marijuana or cocaine.
Children with behavioral disorders or depression were three times as likely to test positive. Alcohol or drug use also was more commonly involved in intentional injuries: 15 percent of shooting victims tested positive, as did 11 percent of beating victims and 10 percent of stabbing victims.
Study results were published in the June issue of the journal Injury Prevention.
"Normally, toxicology screening is only done in adult trauma patients, because of its high prevalence in trauma incidents," says Guohua Li, M.D., Dr.P.H., lead author of the study and associate professor of emergency medicine. "However, the average blood alcohol level for the children testing positive was high, similar to that of 16- to 20-year-olds. Unless we provide them with substance abuse counseling and treatment, these patients are at great risk for developing chronic substance abuse problems and for being injured again."
YOU CAN PREVENT IN-FLIGHT MEDICAL EMERGENCIES
Is there a doctor in the "house"? If you're traveling by plane, the chances are slim.
While the Federal Aviation Administration requires all air crews to be trained in first aid and cardiopulmonary resuscitation (CPR), there are no specific mechanisms beyond that to treat people having medical emergencies, says David D. Nicolaou, M.D., assistant professor of emergency medicine at Hopkins. Caring for these passengers is "ad hoc," he says, "only as the situation arises."
Commercial aircraft in the United States carry common devices and medications such as aspirin, glucose (for low blood sugar), nitroglycerin (for chest pain), epinephrine (for asthma) and in some cases, defibrillators (for cardiac arrest). But Nicolaou says if you're planning to travel, always carry your prescription medications with you.
Patients with chronic conditions like lung or heart disease should call the airline they're planning to fly before making reservations. Most airlines have sizeable medical divisions, with staff physicians trained in aerospace medicine. These doctors provide advice and sometimes even physical exams to make sure passengers are healthy enough to travel and screen medical equipment to make sure it's airworthy. They also can work out special arrangements for passengers, such as making sure there's an oxygen tank on board, and coordinating care with passengers' personal physicians.
Finally, travel can be difficult even if for the healthiest individuals. Avoid alcohol, caffeine and the use of sleep aids on longer flights, Nicolaou says. Eat meals that are low in fat, and, for a couple of days before your trip, gradually adjust your sleep schedule to be closer to the time zone you'll be visiting.
MYTHS AND REALITIES ON LIFE IN THE EMERGENCY DEPARTMENT
Movies and television shows, including the popular series, "ER," portray emergency departments in constant dramatic turmoil, with trauma victims being rushed in, telephones ringing wildly and personnel yelling for backup.
"In reality, even the busiest emergency teams work hard to maintain order and treat patients in a calm and professional manner," says Gabor D. Kelen, M.D., chairman of emergency medicine at Hopkins. "It's just one of the misconceptions about emergency departments."
Another is that emergency care costs too much. But for the level of quality, Kelen says, it's fairly inexpensive. Emergency care constitutes less than 2 percent of the national and HMO budget, he says. And the emergency department staff treat anyone regardless of appearance or insurance. They're also the ones most likely to first identify domestic abuse, alcoholism or HIV.
Yet another misconception involves the need for specialty care. Some E.D. visitors think that if they are having chest pain they need to ask for a cardiologist, or if they're having a headache, they need to ask for a neurologist. However, a particular symptom may not indicate an obvious problem. The diagnostic expertise of the emergency medicine staff, Kelen says, is considerable. "They see a wide variety of medical ills and if they can't treat you themselves, they will consult the appropriate specialists."
--JHMI--
RSS