Eric A Weiss, MD, FACEP

Journal Articles

• Water is a safe and effective alternative to sterile normal saline for wound irrigation prior to suturing: a prospective, double-blind, randomised, controlled clinical trial BMJ OPEN Weiss, E. A., Oldham, G., Lin, M., Foster, T., Quinn, J. V. 2013; 3 (1)

  Abstract

  To determine if there is a significant difference in the infection rates of wounds irrigated with sterile normal saline (SS) versus tap water (TW), before primary wound closure.Single centre, prospective, randomised, double-blind controlled trial. Wound irrigation solution type was computer randomised and allocation was done on a sequential basis.Stanford University Medical Center Department of Emergency Medicine.Patients older than 1 year of age, who presented to the emergency department with a soft tissue laceration requiring repair, were entered into the study under informed consent. Exclusion criteria included any underlying immunocompromising illness, current use of antibiotics, puncture or bite wounds, underlying tendon or bone involvement, or wounds more than 9 h old.Non-caregivers used a computer generated randomisation code to prepare irrigation basins prior to treatment. Patients had their wounds irrigated either with TW or SS prior to closure, controlling for the volume and irrigation method used. The patient, the treating physician and the physician checking the wound for infection were all blind regarding solution type. Structured follow-up was completed at 48 h and 30 days to determine the presence of infection.The primary outcome measured was the difference in wound infection rates between the two randomised groups.During the 18-month study period, 663 consecutive patients were enrolled. After enrolment, 32 patients were later excluded; 29 patients because they were concurrently on antibiotics; two patients secondary to steroid use and one because of tendon involvement. Of the 631 remaining patients, 318 were randomised into the TW group and 313 into the SS group. Six patients were lost to follow-up (5 SS, 1 TW). A total of 625 patients were included in the statistical analysis. There were no differences in the demographic and clinical characteristics of the two groups. There were 20 infections 6.4% (95% CI 9.1% to 3.7%) in the SS group compared with 11 infections 3.5% (95% CI 5.5% to 1.5%) in the TW group, a difference of 2.9% (95% CI -0.4% to 5.7%).There is no difference in the infection rate of wounds irrigated with either TW or SS solution, with a clinical trend towards fewer wound infections in the TW group, making it a safe and cost-effective alternative to SS for wound irrigation.

  View details for DOI 10.1136/bmjopen-2012-001504

  View details for Web of Science ID 000315082400012

  View details for PubMedID 23325896

• D-Dimer Is Not Elevated in Asymptomatic High Altitude Climbers after Descent to 5340 m: The Mount Everest Deep Venous Thrombosis Study (Ev-DVT) HIGH ALTITUDE MEDICINE & BIOLOGY Zafren, K., Feldman, J., Becker, R. J., Williams, S. R., Weiss, E. A., Deloughery, T. 2011; 12 (3): 223-227

  Abstract

  We performed this study to determine the prevalence of elevated D-dimer, a marker for deep venous thrombosis (DVT), in asymptomatic high altitude climbers. On-site personnel enrolled a convenience sample of climbers at Mt. Everest Base Camp (Nepal), elevation 5340?m (17,500?ft), during a single spring climbing season. Subjects were enrolled after descent to base camp from higher elevation. The subjects completed a questionnaire to evaluate their risk factors for DVT. We then performed a D-dimer test in asymptomatic individuals. If the D-dimer test was negative, DVT was considered ruled out. Ultrasound was available to perform lower-extremity compression ultrasounds to evaluate for DVT in case the D-dimer was positive. We enrolled 76 high altitude climbers. None had a positive D-dimer test. The absence of positive D-dimer tests suggests a low prevalence of DVT in asymptomatic high altitude climbers.

  View details for DOI 10.1089/ham.2010.1101

  View details for Web of Science ID 000295406200005

  View details for PubMedID 21962065

• Drive-Through Medicine: A Novel Proposal for Rapid Evaluation of Patients During an Influenza Pandemic ANNALS OF EMERGENCY MEDICINE Weiss, E. A., Ngo, J., Gilbert, G. H., Quinn, J. V. 2010; 55 (3): 268-273

  Abstract

  During a pandemic, emergency departments (EDs) may be overwhelmed by an increase in patient visits and will foster an environment in which cross-infection can occur. We developed and tested a novel drive-through model to rapidly evaluate patients while they remain in or adjacent to their vehicles. The patient's automobile would provide a social distancing strategy to mitigate the person-to-person spread of infectious diseases.We conducted a full-scale exercise to test the feasibility of a drive-through influenza clinic and measure throughput times of simulated patients and carbon monoxide levels of staff. We also assessed the disposition decisions of the physicians who participated in the exercise. Charts of 38 patients with influenza-like illness who were treated in the Stanford Hospital ED during the initial H1N1 outbreak in April 2009 were used to create 38 patient scenarios for the drive-through influenza clinic.The total median length of stay was 26 minutes. During the exercise, physicians were able to identify those patients who were admitted and discharged during the real ED visit with 100% accuracy (95% confidence interval 91% to 100%). There were no significant increases of carboxyhemoglobin in participants tested.The drive-through model is a feasible alternative to a traditional walk-in ED or clinic and is associated with rapid throughput times. It provides a social distancing strategy, using the patient's vehicle as an isolation compartment to mitigate person-to-person spread of infectious diseases.

  View details for DOI 10.1016/j.annemergmed.2009.11.025

  View details for Web of Science ID 000275882400008

  View details for PubMedID 20079956

• Wilderness Improvisation Wilderness Medicine Weiss, E. 2007
• Topics in international and travel medicine. The California journal of emergency medicine / California Chapter of the American Academy of Emergency Medicine Chiao, A. R., Weiss, E. L. 2005; 6 (4): 74-75

  View details for PubMedID 20847870

• Travel Medical Kits Travel Medicine Weiss, E. 2004
• Medical considerations for wilderness and adventure travelers MEDICAL CLINICS OF NORTH AMERICA Weiss, E. A. 1999; 83 (4): 885-?

  Abstract

  Wilderness and adventure travel has attracted a growing number of participants. Many adventure travelers are inadequately prepared for their trip and are naive about the associated risks. Physicians are frequently asked to provide medical clearance and to complete medical release forms to travelers. To provide better advice, the physician should be familiar with the rigors and difficulty of these activities and must consider the potential environment hazards and remoteness of the intended area of travel. This article provides information on trip rating scales, environmental hazards, altitude illness, hypothermia, heat illness, and adventure travel medical kits.

  View details for Web of Science ID 000081884000003

  View details for PubMedID 10453255

• Medical Considerations for Wilderness and Adventure Travelers The Medical Clinics of North America Weiss, E. 1999