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Denver, CO, United States

Bosch D.,Porter Adventist Hospital | Schmidt J.N.,University of Wisconsin - Madison | Kendall J.,Denver Health Medical Center
Journal of Medical Ultrasound | Year: 2016

Acute cholecystitis is a common etiology of acute right upper quadrant pain in patients presenting to the emergency department (ED). The use of ED-focused right upper quadrant ultrasound (RUQ US) is becoming more widely utilized to evaluate abdominal pain thought to be hepatobiliary in nature. We describe a case series of two patients with acute cholecystitis detected by serial ED-focused RUQ US. Case 1: A woman presented to the ED with epigastric pain of acute onset. She was initially found to have a mild leukocytosis and cholelithiasis detected by ED-focused RUQ US. Seventy-five minutes later, the patient had a repeat bedside ultrasound by the same sonographer that showed visual evidence of acute cholecystitis that was later confirmed by surgical pathology. She was treated operatively. Case 2: A man with known cholelithiasis presents to the ED with acute-onset RUQ pain. Initial RUQ ultrasound performed by the Department of Radiology (University of Colorado Hospital) was equivocal, showing cholelithiasis with a mildly thickened wall and no pericholecystic fluid. A repeat ED-focused RUQ ultrasound 5 hours later showed increased wall thickness and pericholecystic fluid. The patient was subsequently taken for same-day cholecystectomy. This case series demonstrates the dynamic and progressive nature of acute cholecystitis detected by ED-focused RUQ US. It also highlights how serial bedside ultrasonography can reduce harm, appropriately triage patients with hepatobiliary disease and lead to reductions in overall morbidity. © 2016

Kelts E.A.,Porter Adventist Hospital
NeuroRehabilitation | Year: 2010

Although Thoreau admonishes us that it is not what you look at that is important, I hope it is clear from the discussion above that what you look at directly affects what you see, making the two aspects of vision inseparable. As a result of this intertwined nature, healthy functioning of all of the system's representative parts is necessary for the visual system to work properly. But vision does not reside only in the eyes. I hope it is clear fromthe previous discussion that the human visual system is a very complicated network of afferent and efferent connections spread through several regions of the head, neck and upper thorax. It also follows that, because of the complexity of the visual system, it is very subject to trauma. As a result, it is very common for victims of motor vehicle accidents, accidental trauma, sportsrelated injuries, and domestic altercations to present with a visual complaint. © 2010 - IOS Press and the authors. All rights reserved.

Kelts E.A.,Porter Adventist Hospital
NeuroRehabilitation | Year: 2010

Traumatic Brain Injury is a common cause for visual dysfunction simply because of the proportion of the nervous systemdevoted to vision. However, because of the potential for healing and the opportunities presented by neural plasticity, many such injuries improve and some resolve completely. The first, and most important, step involved in helping patients with visual complaints after TBI is correct diagnosis. The second is treatment by an organized system of support, rehabilitation, and compassion. © 2010 - IOS Press and the authors. All rights reserved.

Haukoos J.S.,Denver Health Medical Center | Haukoos J.S.,University of Colorado at Denver | Witt G.,Denver Health Medical Center | Gravitz C.,Denver Health Medical Center | And 14 more authors.
Academic Emergency Medicine | Year: 2010

Objectives: The annual incidence of out-of-hospital cardiac arrest (OOHCA) in the United States is approximately 6 per 10,000 population and survival remains low. Relatively little is known about the performance characteristics of a two-tiered emergency medical services (EMS) system split between firebased basic life support (BLS) dispersed from fixed locations and hospital-based advanced life support (ALS) dispersed from nonfixed locations. The objectives of this study were to describe the incidence of OOHCA in Denver, Colorado, and to define the prevalence of survival with good neurologic function in the context of this particular EMS system. Methods: This was a retrospective cohort study using standardized abstraction methodology. A twotiered hospital-based EMS system for the County of Denver and 10 receiving hospitals were studied. Consecutive adult patients who experienced nontraumatic OOHCA from January 1, 2003, through December 31, 2004, were enrolled. Demographic, prehospital arrest characteristics, treatment data, and survival data using the Utstein template were collected. Good neurologic survival was defined by a Cerebral Performance Categories (CPC) score of 1 or 2. Results: During the study period, 1,985 arrests occurred. Of these, 715 (36%) had attempted resuscitation by paramedics and constitute our study sample. The median age was 65 years (interquartile range = 52-78 years), 69% were male, 41% had witnessed arrest, 25% had bystander cardiopulmonary resuscitation (CPR) performed, and 30% had ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as their initial rhythm. Of the 715 patients, 545 (76%) were transported to a hospital, 223 (31%) had return of spontaneous circulation (ROSC), 175 (25%) survived to hospital admission, 58 (8%) survived to hospital discharge, and 42 (6%, 95% confidence interval [CI] = 4% to 8%) had a good neurologic outcome. Conclusions: Out-of-hospital cardiac arrest survival in Denver, Colorado, is similar to that of other United States communities. This finding provides the basis for future epidemiologic and health services research in the out-of-hospital and ED settings in our community. © 2010 by the Society for Academic Emergency Medicine.

Campana J.,Porter Adventist Hospital | Ramakrishnan V.R.,Aurora University
JAMA Otolaryngology - Head and Neck Surgery | Year: 2014

IMPORTANCE: Large and complex nasal septal perforations may cause considerable patient discomfort and are challenging to repair. Posterior septal resection (PSR) is a simple procedure and can be incorporated into the surgical management algorithm for this patient population. OBJECTIVE: To evaluate PSR for the treatment of symptomatic complex and large nasal septal perforations. DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical chart review from 1995 through 2007 of patients who underwent PSR. Medical charts were reviewed, and a follow-up telephone questionnaire was performed. INTERVENTIONS: Posterior septal resection. MAIN OUTCOMES AND MEASURES: Improvement of selected symptoms after PSR. RESULTS: Twenty-one patients were identified, 16 patients had thorough documentation of perioperative information contained in their medical charts, and 12 patients were available for follow-up survey. All patients tolerated the procedure well without long-term sequelae from surgery. Overall nasal discomfort was significantly improved in 12 of 12 patients (P < .001). All nasal symptom scores of obstruction, pain, whistling, drainage, crusting, and epistaxis showed statistically significant (P < .05) improvement from preoperative values. Nasal obstruction and crusting were symptoms that improved with high statistical significance (P < .001). Patients reported on average a 79% improvement (range, 45%-100% improvement) in nasal airway, with only 1 patient reporting no improvement. All patients were satisfied with their surgery and would undergo the procedure again and recommend it to others. CONCLUSIONS AND RELEVANCE: Posterior septal resection provides overall patient satisfaction and improvement in subjective nasal symptom scores when used for large and complex septal perforations. This simple procedure may be included in the treatment algorithm of large and complex symptomatic septal perforations. Copyright 2014 American Medical Association. All rights reserved.

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