4800 Linglestown Rd Ste 102
Harrisburg PA 17112
Medical School: Jefferson Medical College Of Thomas Jefferson University - 1955
Accepts Medicare: Yes
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: MD025077L
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Allowed By Medicare
|HCPCS Code:99213||Description:Office/outpatient visit est||Average Price:$76.49||Average Price Allowed
Medical Malpractice Cases
Medical Board Sanctions
The Airtraq Optical Laryngoscope in helicopter emergency medical services: a pilot trial. - Air medical journal
To determine the degree of success helicopter emergency medical services personnel have in placing an endotracheal tube using a relatively new device for endotracheal intubation (ETI) known as the Airtraq (AT) Optical Laryngoscope (King Systems Corp, Noblesville, IN), and to determine the frequency with which flight crews had to resort to other means for advanced airway management.This prospective, observational pilot trial evaluated the critical care flight team's ability to perform ETI using the AT as a first-line device in the prehospital setting. Flight crews were instructed to use the AT for any patient needing ETI. Teams completed a 30-minute training session followed by mannequin practice. They documented situations and outcomes: reason for ETI, success in placing the AT, reason for unsuccessful placement, end-tidal carbon dioxide concentration in expired air (ETCO2), and where patients were when they underwent intubation (field, ambulance, aircraft, hospital). Data were abstracted and analyzed using JMP software version 7.0 (SAS Institute, Inc, Cary, NC).Fifty cases involving use of the AT were analyzed. Median patient age was 51.5 years (range, 15-90; interquartile range, 36-64.5). Most patients were male (n = 37 [74%]). The primary reasons for intubation were unresponsiveness and altered loss of consciousness (n = 23 [46%]), respiratory distress or apnea (n = 8 [16%]), cardiac arrest (n = 10 [20%]), and combative behavior (n = 7 [14%]). AT was successful (n = 31[62%]) in 1 to 2 attempts. The primary reason for AT failure was blood or vomit in the airway (n = 8 [42.1%]); 48.1% (n = 25) of patients required a different management mode.HEMS crews had difficulty placing successful ET tubes with this device after minimal education with a single regular-sized device. Difficulty was pronounced when blood or vomit was present and obstructing the optical view. Further study is needed to evaluate the implementation time, training time required, and possible design advantages of the AT compared with those of traditional emergent airway management techniques.Copyright Â© 2013 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.
Neurologic recovery following prolonged out-of-hospital cardiac arrest with resuscitation guided by continuous capnography. - Mayo Clinic proceedings
A 54-year-old man with no known cardiac disease collapsed outdoors in a small rural community. The cardiac arrest was witnessed, and immediate cardiopulmonary resuscitation was begun by a bystander and a trained first responder who was nearby. The patient was moved into a building across the street for continued resuscitation. First responders arrived with an automated external defibrillator, and ventricular fibrillation was documented. First responders delivered 6 defibrillation shocks, 4 of which transiently restored an organized electrocardiographic rhythm but with no pulse at any time. Additional emergency medical services personnel from nearby communities and an advanced life support (ALS) flight crew arrived. The flight crew initiated ALS care. The trachea was intubated, ventilation controlled, and end-tidal carbon dioxide tension continuously monitored. Antiarrhythmic and inotropic drugs were administered intravenously. An additional 6 shocks were delivered using the ALS defibrillator. End-tidal carbon dioxide measurements confirmed good pulmonary blood flow with chest compressions, and resuscitation was continued until a stable cardiac rhythm was restored after 96 minutes of pulselessness. The patient was transported by helicopter to the hospital. He was in cardiogenic shock but maintained a spontaneous circulation. Coronary angiography confirmed a left anterior descending coronary artery thrombotic occlusion that was treated successfully. After hospital admission, the patient required circulatory and ventilatory support and hemodialysis for acute renal failure. He experienced a complete neurologic recovery to his pre-cardiac arrest state. To our knowledge, this is the longest duration of pulselessness in an out-of-hospital arrest with a good outcome. Good pulmonary blood flow was documented throughout by end-tidal carbon dioxide measurements.
Legal and regulatory issues in hospital laboratory outreach and partnering arrangements. - Clinical leadership & management review : the journal of CLMA
An independent laboratory's joint venture with a chain of five nonprofit hospitals unraveled in 1999. Despite substantial management control over the joint venture and 3 years spent investing in and managing a massive consolidation project, the laboratory operator was ousted by the hospital group in favor of a national laboratory competitor. In the process, it lost the $6 million commercial laboratory business it brought to the joint venture. The laboratory operator sued the hospital group for destroying its business. Were the hospital's actions legal? Could the laboratory operator have protected itself better? Although by no means the only causes of this disaster, regulatory restrictions and uncertain contract terms contributed to the problems experienced by the laboratory operator.
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4800 Linglestown Rd Ste 102 Harrisburg, PA 17112
2215 Forest Hills Dr Suite 38