Dr. Cloonan is currently a staff emergency medicine physician at Pinnacle Health in Harrisburg, Pennsylvania. He is a retired Associate Professor at the Uniformed Services University of the Health Sciences in Bethesda Maryland. Prior to his retirement from the United States Army in January 2004 Dr. Cloonan was the Interim Chairman of the Department of Military and Emergency Medicine at the Uniformed Services University. From 1999 to 2002 he was the Consultant to the Surgeon General for Emergency Medicine and he served as the Department of Defense representative to the National Registry for Emergency Medicine Technicians from 2001 to 2004.
If thou examinest a man having a dislocation in a vertebra of his neck, shouldst thou find him un... more If thou examinest a man having a dislocation in a vertebra of his neck, shouldst thou find him unconscious of his two arms and his two legs on account of it, while his phallus is erected on account of it, and his urine drops from his member without his knowing it; His flesh has received wind; his two eyes are bloodshot; It is a 1(p 5) dislocation of a vertebra of his neck.
The number of patients undergoing long-term hemodialysis and peritoneal dialysis is growing in th... more The number of patients undergoing long-term hemodialysis and peritoneal dialysis is growing in the United States. To provide adequate emergent care to these patients emergency physicians must understand the alterations in normal physiologies present in these patients and how this may affect care. Cardiovascular disease and infection (especially Staphylococcus aureus sepsis) are the leading causes of death among dialysis patients. These patients are also subject to a significantly higher incidence of life-threatening electrolyte disturbances, particularly hyperkalemia and hypercalcemia, than the general population. Suicide, cardiac tamponade, intracranial hemorrhage, bleeding disorders, and bowel infarction are also much more frequent. The inability of dialysis patients to excrete drugs, metabolites, toxins, and fluids significantly alters their responses to common emergencies and should directly influence their care. Failure to recognize these differences in physiology may result in the use of standard forms of emergency therapy that may compound, rather than treat, the underlying disorder. Although most dialysis patients who come into an emergency department have conditions that can, and should, be managed by their nephrologist, the presence of a life threatening emergency requires prompt, appropriate therapy by the emergency physician.
The British Admiral Lord Horatio Nelson, at the time of his greatest victory, the defeat of Napol... more The British Admiral Lord Horatio Nelson, at the time of his greatest victory, the defeat of Napoleon's fleet at Trafalgar in 1805, was mortally wounded by a gunshot to his chest that struck his thoracic spine and caused paraplegia below the breast. Mr. Beatty, the ship's surgeon, was called and upon his arrival Nelson is reported to have said, "Ah, Mr. Beatty! I have sent for you to say what I forgot to tell you before, that all power of motion and feeling below my chest are gone and you very well know I can live but a short time...You know I am gone." Mr. Beatty's reply was: "My Lord, unhappily for our Country, nothing can be done for you." Nelson died a few hours later.
Breathing Breath is the bridge which connects life to consciousness, which unites your body to yo... more Breathing Breath is the bridge which connects life to consciousness, which unites your body to your thoughts. Courage is a matter of the red corpuscle. It is oxygen that makes every attack; without oxygen in his blood to back him, a man attacks nothing-not even a pie… Elbert Hubbard " Wounds of the chest, when taken as a class, are perhaps the most fatal of gunshot wounds " 1 (p.276)
Good Level I scientific evidence supporting the efficacy (decreased morbidity and mortality) of p... more Good Level I scientific evidence supporting the efficacy (decreased morbidity and mortality) of prehospital fluid administration by civilian Emergency Medical Services personnel is lacking. The efficacy of this procedure in the hands of army Combat Lifesavers is even less well substantiated. The purpose of this article is to look critically at the skill of intravenous fluid administration that is taught to army Combat Lifesavers and to consider whether or not the application of that skill is actually beneficial to the majority of patients who are recipients of this procedure. A method is described to assist medical educators in making decisions as to which skills should be taught to health care providers, and this method is loosely applied in the following discussion about whether Combat Lifesavers should receive training to start and administer intravenous fluids. Good scientific studies, based on valid data, need to be performed to determine the efficacy of intravenous fluid admin...
If thou examinest a man having a dislocation in a vertebra of his neck, shouldst thou find him un... more If thou examinest a man having a dislocation in a vertebra of his neck, shouldst thou find him unconscious of his two arms and his two legs on account of it, while his phallus is erected on account of it, and his urine drops from his member without his knowing it; His flesh has received wind; his two eyes are bloodshot; It is a 1(p 5) dislocation of a vertebra of his neck.
The number of patients undergoing long-term hemodialysis and peritoneal dialysis is growing in th... more The number of patients undergoing long-term hemodialysis and peritoneal dialysis is growing in the United States. To provide adequate emergent care to these patients emergency physicians must understand the alterations in normal physiologies present in these patients and how this may affect care. Cardiovascular disease and infection (especially Staphylococcus aureus sepsis) are the leading causes of death among dialysis patients. These patients are also subject to a significantly higher incidence of life-threatening electrolyte disturbances, particularly hyperkalemia and hypercalcemia, than the general population. Suicide, cardiac tamponade, intracranial hemorrhage, bleeding disorders, and bowel infarction are also much more frequent. The inability of dialysis patients to excrete drugs, metabolites, toxins, and fluids significantly alters their responses to common emergencies and should directly influence their care. Failure to recognize these differences in physiology may result in the use of standard forms of emergency therapy that may compound, rather than treat, the underlying disorder. Although most dialysis patients who come into an emergency department have conditions that can, and should, be managed by their nephrologist, the presence of a life threatening emergency requires prompt, appropriate therapy by the emergency physician.
The British Admiral Lord Horatio Nelson, at the time of his greatest victory, the defeat of Napol... more The British Admiral Lord Horatio Nelson, at the time of his greatest victory, the defeat of Napoleon's fleet at Trafalgar in 1805, was mortally wounded by a gunshot to his chest that struck his thoracic spine and caused paraplegia below the breast. Mr. Beatty, the ship's surgeon, was called and upon his arrival Nelson is reported to have said, "Ah, Mr. Beatty! I have sent for you to say what I forgot to tell you before, that all power of motion and feeling below my chest are gone and you very well know I can live but a short time...You know I am gone." Mr. Beatty's reply was: "My Lord, unhappily for our Country, nothing can be done for you." Nelson died a few hours later.
Breathing Breath is the bridge which connects life to consciousness, which unites your body to yo... more Breathing Breath is the bridge which connects life to consciousness, which unites your body to your thoughts. Courage is a matter of the red corpuscle. It is oxygen that makes every attack; without oxygen in his blood to back him, a man attacks nothing-not even a pie… Elbert Hubbard " Wounds of the chest, when taken as a class, are perhaps the most fatal of gunshot wounds " 1 (p.276)
Good Level I scientific evidence supporting the efficacy (decreased morbidity and mortality) of p... more Good Level I scientific evidence supporting the efficacy (decreased morbidity and mortality) of prehospital fluid administration by civilian Emergency Medical Services personnel is lacking. The efficacy of this procedure in the hands of army Combat Lifesavers is even less well substantiated. The purpose of this article is to look critically at the skill of intravenous fluid administration that is taught to army Combat Lifesavers and to consider whether or not the application of that skill is actually beneficial to the majority of patients who are recipients of this procedure. A method is described to assist medical educators in making decisions as to which skills should be taught to health care providers, and this method is loosely applied in the following discussion about whether Combat Lifesavers should receive training to start and administer intravenous fluids. Good scientific studies, based on valid data, need to be performed to determine the efficacy of intravenous fluid admin...
Uploads
Papers by Clifford Cloonan