A telemedicine model for emergency care in a short-term correctional facility.

The primary objectives of this research were to determine the effectiveness of a personal computer-based telemedicine system for semi- and nonurgent complaints at a short-term correctional facility and to evaluate the system as a potential model for providing emergency care to remote locations. We performed a retrospective review of medical records of patients referred to the emergency department in person or via telemedicine during a 12-month period. The data included system utilization, chief complaints, physical examination, diagnostic testing, disposition, and outcomes in patients evaluated via telemedicine. Also identified were nursing diagnostic and procedure skills associated with successful evaluation via telemedicine. A total of 530 emergency care records were reviewed with 126 telemedicine consultations performed. Eighty-one of 126 (64%) telemedicine patients remained at the facility following consultation with the remaining 45 (36%) being transported to the emergency department. Rates of return to the emergency department within 7 days following consultation were comparable, patient acceptance and satisfaction was high, and there were no untoward outcomes in the group. Average total time of telemedicine consultation was 30 minutes versus a 2-hour and 45-minutes turnaround time for an emergency department evaluation. A variety of emergency complaints were managed effectively using relatively low-cost computer-based telemedicine technology, thereby eliminating the need for transportation of the patient to the emergency department. This system provides an emergency physician-nurse model for conduction limited emergency care in remote settings.

Material property determination of sub-surface objects in a viscoelastic environment.

Modeling human organs and soft tissue or anatomic regions for the purpose of medical training and simulation is a relatively new area. The data presented here is the groundwork for our ongoing development of a real-time haptic virtual environment for abdominal soft tissue palpation. The purpose of modeling the human abdomen is twofold. First, to provide a mathematical description of soft tissue and organs and second, to simulate the behavior of realistic interactions in real-time within a virtual environment. We have developed a, non-invasive, system that will allow us to determine mathematical functions that model the deformation of individual layers of soft tissue within the human abdomen. This system has been tested, experimentally, with a viscoelastic polyester foam model. We have been able to determine the stiffness and force/displacement function of an object beneath two layers of foam having different material characteristics. These experimental results correlate well with known polyester foam material characteristics. In general, the calculated stiffness constants were within 5% of the actual value. The data presented in this study shows that this system may be a viable tool for accurate measurement of human soft tissue properties and behavioral response to palpation.

Comparison of staples versus sutures in the repair of penetrating cardiac wounds.

BACKGROUND: Several literature reports advocate the use of skin staplers for repair of penetrating cardiac wounds during emergency thoracotomy. Our study goal was to objectively determine if stapling is a more efficient method of closure compared with suturing without compromising the strength of the repair. METHODS: This randomized, nonblinded study was conducted in a swine model. A total of four incisions, two per ventricle, were made in each animal. The 2-cm full-thickness incisions were repaired with either sutures or staples, and the time required to close each wound was recorded. After wound repair, the animals were killed. The four wounds were isolated by removing 4.0-cm strips of myocardium oriented perpendicular to the incision. Each strip was then placed on a tensile force testing machine, and the breaking strength of the sutures and staples was measured. RESULTS: The tensile force test showed that stapled and sutured wounds have equivalent mechanical strength. The mean time of closure for stapled wounds was substantially less than that for sutured wounds. CONCLUSION: In this swine model, stapling took significantly less time and had equal mechanical strength compared with suturing for repair of penetrating cardiac wounds. Stapling during emergent resuscitation may be preferable to suturing.

Wound irrigation with tap water.

OBJECTIVE: The study hypothesis was that irrigation with tap water is as efficacious as irrigation with sterile saline in removing bacteria from simple lacerations in preparation for wound closure. METHODS: The study was conducted in a laboratory rat model previously described in the literature for evaluating wound irrigation techniques. The study used a randomized, blinded crossover design using 10 animals. Two full-thickness skin lacerations were made on each animal and each wound was inoculated with standardized concentrations of a Staphylococcus aureus broth. Wounds were irrigated for 4 minutes with normal saline from a syringe or 4 minutes with tap water from a faucet. Tissue specimens were sampled from each laceration prior to and following irrigation. Bacterial counts per gram of tissue were determined for each specimen and compared pre- and postirrigation. RESULTS: Preirrigation bacterial counts were not significantly different for saline vs tap water specimens. The wounds irrigated with saline had a mean reduction in bacterial count of 54.7% (SD=+/-28%), while the wounds irrigated with tap water had a mean reduction in bacterial count of 80.6% (SD=+/-20%) (p < 0.05, 2-tailed, paired t-test). CONCLUSIONS: In this animal model, bacterial decontamination of simple lacerations was not compromised, and was actually improved using tap water irrigation. This is most likely due to the mechanical differences in the types of irrigation. In certain instances, such as with upper-extremity lacerations, tap water irrigation would likely be cheaper and less labor-intensive than irrigation with normal saline from a syringe.

Comparison of normal saline with tap water for wound irrigation.

This study compared irrigation with tap water versus saline for removing bacteria from simple skin lacerations. The study was conducted in an animal model with a randomized, nonblinded crossover design using 10 500-g laboratory rats. Two full-thickness skin lacerations were made on each animal and inoculated with standardized concentrations of Staphylococcus aureus broth. Tissue specimens were removed before and after irrigation with 250 cc of either normal saline from a sterile syringe or water from a faucet. Bacterial counts were determined for each specimen and compared before and after irrigation. There was a mean reduction in bacterial counts of 81.6% with saline and 65.3% with tap water (P = .34). One tap water specimen had markedly aberrant bacterial counts compared with others. Excluding this specimen, the mean reduction for tap water was 80.2%. In this model, reduction in bacterial contamination of simple lacerations was not different comparing tap water with normal saline as an irrigant.