John A Guisto

Interests

Research

Wilderness medicine, injury, ED operations

Teaching

Wilderness medicine, clinical simulations, ED operations

Courses

No activities entered.

Scholarly Contributions

Chapters

• Guisto, J. A. (2015). Diverticular Disease. In PEPID Emergency Medicine Suite.
• Guisto, J. A. (2016). Dysphagia and Odynophagia. In PEPID Emergency Suite.
• Shekell, T., & Guisto, J. A. (2014). Field Medicine: Fractures and Dislocations. In PEPID Emergency Medicine Suite.

Journals/Publications

• Guisto, J. A., & Iserson, K. V. (2016). The feasibility of 12-gauge intravenous catheter use in the prehospital setting. The Journal of emergency medicine, 8(2), 173-6.
  More info

  Intravenous fluid therapy is a mainstay in the treatment of trauma and hypovolemia. However, controversy exists as to its effective use by prehospital personnel. We reasoned that 12-gauge catheters, shown to have significantly greater fluid flow than 14- or 16-gauge catheters, might allow prehospital care providers to have a more significant role in patient resuscitation. This study was designed to see if 12-gauge intravenous catheters can successfully be placed and used in the prehospital care arena. During a six-month period, commercial peripheral 12-gauge catheter-over-needle intravenous units were placed in any hypovolemic or potentially hypovolemic patient in whom paramedics thought that rapid fluid therapy was, or might become, necessary. They experienced an overall success rate of 84% and a success-per-attempt rate of 74%. The catheters were placed under normal field conditions. Per preexisting protocols, departure from the scene and transport to the hospital were not delayed for any paramedic interventions, including starting intravenous lines. The 12-gauge catheters can be successfully used by paramedics, both to establish large bore intravenous access prior to arrival at the emergency department and to institute effective fluid therapy where time and circumstances allow.
• Thai, J. N., Pacheco, J. A., Margolis, D. S., Swartz, T., Massey, B. Z., Guisto, J. A., Smith, J. L., & Sheppard, J. E. (2015). Evidence-based Comprehensive Approach to Forearm Arterial Laceration. The western journal of emergency medicine, 16(7), 1127-34.
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  Penetrating injury to the forearm may cause an isolated radial or ulnar artery injury, or a complex injury involving other structures including veins, tendons and nerves. The management of forearm laceration with arterial injury involves both operative and nonoperative strategies. An evolution in management has emerged especially at urban trauma centers, where the multidisciplinary resource of trauma and hand subspecialties may invoke controversy pertaining to the optimal management of such injuries. The objective of this review was to provide an evidence-based, systematic, operative and nonoperative approach to the management of isolated and complex forearm lacerations. A comprehensive search of MedLine, Cochrane Library, Embase and the National Guideline Clearinghouse did not yield evidence-based management guidelines for forearm arterial laceration injury. No professional or societal consensus guidelines or best practice guidelines exist to our knowledge.
• Mosier, J., Roper, G., Hays, D., & Guisto, J. (2013). Sedative dosing of propofol for treatment of migraine headache in the emergency department: a case series. The western journal of emergency medicine, 14(6), 646-9.
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  Migraine headaches requiring an emergency department visit due to failed outpatient rescue therapy present a significant challenge in terms of length of stay (LOS) and financial costs. Propofol therapy may be effective at pain reduction and reduce that length of stay given its pharmacokinetic properties as a short acting intravenous sedative anesthetic and pharmacodynamics on GABA mediated chloride flux.
• Erly, W. K., Berger, W. G., Krupinski, E., Seeger, J. F., & Guisto, J. A. (2002). Radiology resident evaluation of head CT scan orders in the emergency department. AJNR. American journal of neuroradiology, 23(1), 103-7.
  More info

  Prior studies have revealed little difference in residents' abilities to interpret cranial CT scans. The purpose of this study was to assess the performance of radiology residents at different levels of training in the interpretation of emergency head CT images.
• Keim, S. M., Guisto, J. A., & Sullivan, J. B. (2002). Environmental thermal stress. Annals of agricultural and environmental medicine : AAEM, 9(1), 1-15.
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  Thermal stress from cold and heat can affect health and productivity in a wide range of environmental and workload conditions. Health risks typically occur in the outer zones of heat and cold stress, but are also related to workload. Environmental factors related to thermal stress are reviewed. Individuals undergo thermoregulatory physiologic changes to adapt and these changes are reviewed. Heat and cold related illnesses are reviewed as well as their appropriate therapy. Published standards, thresholds and recommendations regarding work practices, personal protection and types of thermal loads are reviewed.
• Spaite, D. W., Bartholomeaux, F., Guisto, J., Lindberg, E., Hull, B., Eyherabide, A., Lanyon, S., Criss, E. A., Valenzuela, T. D., & Conroy, C. (2002). Rapid process redesign in a university-based emergency department: decreasing waiting time intervals and improving patient satisfaction. Annals of emergency medicine, 39(2), 168-77.
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  Academic emergency departments are traditionally associated with inefficiency and long waits. The academic medical model presents unique barriers to system changes. Several non-university-based EDs have undertaken process redesign, with significant decreases in patient waiting time intervals. This is the presentation of a rapid process redesign in a university-based ED to reduce waiting time intervals. We present the application of a process-improvement team approach to evaluate and redesign patient flow. As a result of this effort, the median waiting room time interval (triage to patient room) decreased from 31 minutes in January 1998 to 4 minutes in July 1998. ED throughput times also decreased, from 4 hours, 21 minutes in January 1998 to 2 hours, 55 minutes in July 1998. Urgent care waiting room time intervals decreased from 52 minutes to 7 minutes and throughput times from 2 hours, 9 minutes to 1 hour, 10 minutes. Patient satisfaction evaluations by an independent institute demonstrated dramatic improvement and establishment of a new benchmark for academic EDs. Process redesign is possible in a busy, complex, tertiary-care ED, with decreases in waiting time intervals and improvement in patient satisfaction. Major sustained support from top-level hospital administrators and physician leadership are fundamental prerequisites. With these in place, a process improvement team approach for evaluating and redesigning the patient care system can be successful.
• Levine, R. J., Guisto, J. A., Meislin, H. W., & Spaite, D. W. (1996). Analysis of federally imposed penalties for violations of the Consolidated Omnibus Reconciliation Act. Annals of emergency medicine, 28(1), 45-50.
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  To identify the incidence of federally imposed penalties for violations of the Consolidated Omnibus Reconciliation Act (COBRA).
• Guisto, J. A. (1995). Severe toxicity from crotalid envenomation after early resolution of symptoms. Annals of emergency medicine, 26(3), 387-9.
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  Initial observation of a patient who sustained a rattlesnake bite on the hand showed resolution of mild swelling over 3 hours. The patient left the emergency department against medical advice, only to return 12 hours later with severe pain and swelling, as well as a marked coagulopathy. This case illustrates the need for an observation period after crotalid bite, even when the envenomation seems to be minor or when symptoms resolve.
• Spaite, D. W., Criss, E. A., Valenzuela, T. D., & Guisto, J. (1995). Emergency medical service systems research: problems of the past, challenges of the future. Annals of emergency medicine, 26(2), 146-52.
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  Out-of-hospital emergency care was designed around the concept of a system of interrelated events that combine to offer a patient the best care possible outside the hospital. However, in contrast to the actual operations of emergency medical service (EMS) systems, research has not typically used systems-based models as the method for evaluation. In this discussion we outline the weaknesses of component-based research models in EMS evaluation and attempt to provide a "systems-analysis" framework that can be used for future research. Incorporation of this multidiscipline approach into EMS research is essential if there is to be any hope of finding answers to many of the important questions that remain in the arena of out-of-hospital health care.