University of Puerto Rico Emergency Medicine Program: impact throughout the country

OBJECTIVES: Determine distribution, job description, and board certification status of the University of Puerto Rico Emergency Medicine Program (UPREMP) graduates. METHODS: A telephone survey was performed of all UPREMP graduates from 1995 to 2007, asking for the following information: practitioner or non practitioner, working place, job description (e.g. Fellow, Staff or Emergency Room Directors), and board certification status. In cases in which the person could not be reached by phone, the last information available at the UPREMRP department was used to fill the survey. The board certification was verified using The American Board of Medical Specialties web site. Worksheets were used to organize data and then analyzed statistically with Excel 2003. RESULTS: Of the 102 graduates, 59% are males and 41% are women, 50% are board certified, 30% are not and 20% are pending certification. Of the female graduates, 77% are board certified, while only 60% of male graduates are board certified. Sixty percent (60%) of the graduates stayed in Puerto Rico and 40% moved to the United States. The distribution of graduates among PR senatorial districts (counties) was as follows: San Juan 22%, Bayamón 17%, Arecibo 0%, Mayagüez 5%, Ponce, 23%, Guayama 6%, Humacao 12% and Carolina 20%. The job description among graduates was: 54% full time Emergency Department (ED) Staff, 3% part time ED staff, 23% academic faculty, 10% directors, 5% fellows and 5% other. CONCLUSION: From our study, we can conclude that although the vast majority of UPREMP graduates stay in PR after graduation, most of them practice in four of the eight PR senatorial districts. Further studies are needed to determine: the reasons why graduates have moved to the mainland US and for working mostly in four PR senatorial districts.

The use of therapeutic hypothermia after cardiopulmonary arrest

Actually recommended by the International Liaison Committee on Resuscitation (ILCOR), therapeutic hypothermia has been the only modality shown to improve neurological outcomes after cardiac arrest. This article provides the background for such recommendations as well as: pathophysiology, review of brain injury during cardiac arrest, discussion of beneficial effects of therapeutic hypothermia, different mechanisms used to induce it and the latest clinical trials results.

Descriptive study of cerebrovascular accidents among Hispanic population

BACKGROUND AND PURPOSE: Data characterizing stroke patients among Hispanic population are scant. The aim of this study was to describe this population and to assess baseline knowledge of stroke type, risk factors, and family history, among others. METHODS: A retrospective chart review of 253 stroke patients admitted to the University of Puerto Rico Hospital during the fiscal year July 2002 to June 2003 was done. A standardized data collection form was used to obtain the following information from patient records: patient age, gender, stroke type, time of symptom onset, patient risk factors, family risk factors, and patient outcome. RESULTS: We enrolled 253 patients, 120 (47%) males and 133 (53%) females. Patient age distribution was as follows: 18 (7%) were < 44 years, 79 (31%) were bwtween 45-64 years, 156 (62%) were > 65 years. Stroke type distribution was: ischemic 174 (69%), hemorrhagic 49 (19%), and transformation from ischemic to hemorrhagic 13 (5%). Ischemic stroke subtypes distribution was: large-artery occlusion 113 (65%), small-artery occlusion 60 (34%), cardio-embolism 1 (0.6%), 17 (7%) information was not recorded. Time of symptom onset: 153 (60%) > 3 hours, 14 (6%) < 3 hours, and 86 (34%) was unknown. Family history of risk factors was present in 103 (41%), not present 29 (11%) and 121 (49%) was unknown. Most common patient risk factors were: hypertension 212 (84%), > 65 years 156 (62%), male gender 120 (47%), diabetes mellitus 105 (42%), previous history of stroke 91 (36%), hyper-cholesterolemia 44 (17%), history of smoking 51 (20%), alcoholism 43 (17%). CONCLUSION: The data obtained from this Hispanic population is similar to that reported in the literature for the general population. The prevalence of ischemic strokes out numbered by far the occurrence of hemorrhagic strokes in the study group. Both men and women demonstrated an increasing tendency of stroke incidence with increasing age. Among death outcome, a difference was evident in the...

Bariatric surgery patients: reasons to visit emergency department after surgery

STUDY OBJECTIVE: Morbid obesity prevalence is reaching epidemic proportions in Western society. Long-term weight loss can be achieved by bariatric surgery. This surgery also has a positive impact in the reduction of obesity related co-morbid conditions. The purpose of this study is to determine the reasons that bariatric surgery patients had to visit the emergency department within a three month period after surgery. METHODS: A retrospective chart review study was performed at the UPR Hospital in Carolina. Patients with the diagnosis of morbid obesity who had bariatric surgery were identified. Of the 283 patients who met the criteria, the following information was obtained: gender, age, height, weight, pre-operative BMI, obesity-related comorbid conditions, post operative length of stay (LOS), and reasons and length of stay of Emergency Department (ED) visits within a 3 month period after surgery. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) Program. RESULTS: The same profile of gender and BMI was obtained between the population that had the surgery and the sample that visited the ED, the group of patients between 20-29 years old was more likely to visit the ED. No correlation was found between a longer post operative length of stay and an increased probability of visiting the ED. Of the population, 5% had to visit ED within a three month period. The most common post operative complications were: Abdominal Pain (46.2%), Emesis (38.5%), and Dehydration (30.8%). Other less frequent complications were nausea, DVT, pneumonia, dizziness, gastritis, infected wound and upper GI bleeding. CONCLUSION: The most common reasons that bariatric surgery patients had to visit the emergency department within a three month period after surgery were: abdominal pain, emesis, dehydration and nausea. These complications could most likely be attributed to patient poor compliance with diet, resulting in the classical symptoms of the dumping...