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Biomedical subjects

B E Haynes

Publications and source records attributed to B E Haynes.

25 records · Page 2Linked to original sources
PubMed1984

Doppler ultrasound failure in testicular torsion.

Eighty adult patients with acute scrotal pain were evaluated during a one-year period using the Doppler ultrasonic stethoscope. Among the 16 patients with spermatic cord torsion, the Doppler examination was correct in seven (44%), indeterminate in four (25%), and falsely negative in five (31%), despite use of the funicular compression test. The mean duration of torsion was substantially different in the correct (15 hours), indeterminate (70 hours), and false-negative (50 hours) groups, although the correlation between Doppler result and torsion duration was not significant (P = .14). The large number of false-negative examinations makes the Doppler unsuitable for excluding the diagnosis of testicular torsion.

Adult↗
PubMed1983

The diagnosis of testicular torsion.

Prompt diagnosis of testicular torsion remains difficult. Since warning symptoms occur in one third of patients and salvage rates correspond to the interval between symptom onset and operation, higher salvage rates should be achievable. Separating torsion from epididymitis is complicated by overlapping ages of peak incidence, shared symptoms, and the need for rapid distinction of the two. Doppler studies (88% accuracy) and nuclear scans (95% accuracy) help confirm the diagnosis, but correct technique is essential, and their use should not delay prompt operation. The diagnosis of epididymitis should be made cautiously in persons younger than the age of 35 years.

Adolescent↗
PubMed1983

Catheter introducers for rapid fluid resuscitation.

Catheter introducer sets developed for placement of Swan-Ganz catheters are useful as temporary large-diameter lines in hypovolemic patients. The internal diameters of 8 F introducers exceed the diameter of standard intravenous tubing. We compared an 8 F introducer to other catheters and found the introducer had a significantly faster flow rate than did a 14-gauge cannula (P less than .05). Introducers were placed successfully, without any serious complications, in 42 of 47 severely ill patients. Because catheter introducers may be inserted percutaneously into any large vein above or below the diaphragm, they are ideal for rapid fluid resuscitation.

Cardiac Catheterization↗
PubMedDate not supplied

Diversion of 911 poisoning calls to a poison center.

OBJECTIVE: To determine the impact and safety of diverting poisoning calls from 911 to a regional poison center. METHODS: A prospective six-month review was performed of all calls transferred from 911 dispatchers to a regional poison center for management. Recommendations for management and transport were made by the poison center using existing protocols. Patients were followed with telephone contact by poison center staff until symptoms resolved or until hospital discharge. Medical outcomes were categorized using the American Association of Poison Control Center guidelines for medical outcome. RESULTS: A total of 262 cases were reviewed; four were excluded. The poison center was contacted prior to ambulance dispatch in 210 cases (81%). An ambulance was sent before the poison center was contacted 48 times (19%). The majority of patients originally calling 911 were managed at home (175/258; 68%). Patients experienced either no effect or minor effects in 254 cases (98%). Two patients developed moderate effects (0.8%), one developed a major effect (0.4%), and one died (0.04)%. No adverse effects or treatment delays resulted from diversion of calls to the poison center. CONCLUSIONS: Appropriate poisoning and toxic exposure cases may be diverted safely from emergency medical services dispatch to a regional poison center for management, reducing unnecessary responses, with substantial cost savings.

Adolescent↗
PubMedDate not supplied

A rural emergency medical technician with selected advanced skills.

OBJECTIVE: To educate rural emergency medical technician basics (EMTs) in selected advanced skills, and then evaluate the safety and effectiveness of practice. METHODS: After a minimum 72 hours of training, EMTs employed three skills (Combitube, glucometry, automated external defibrillation) and seven medications (albuterol, nitroglycerin, naloxone, epinephrine, glucagon, activated charcoal, and aspirin). Written patient care records and audiotapes were reviewed. Congruence between prehospital assessment and emergency department (ED) diagnosis was assessed, along with correct use of airway skills (18 of 36 months). The completeness of documentation, appropriateness of treatment, and patient response (by explicit criteria) were determined. Errors and complications were recorded. RESULTS: During three years of the program, 266 patients were treated, primarily for chest pain and respiratory distress. No significant errors or complications occurred. Treatment was judged 94% appropriate, with improvement in 60% of patients. Documentation had major omissions in 3% of cases. Field and ED diagnostic congruence was present in 97/129 (75%) when evaluated during the first 18 months. EMT skill levels were maintained. The mean time to traditional advanced life support (ALS) care was 41 minutes. CONCLUSIONS: Basic-level EMTs in rural areas can be trained in selected advanced skills, and provide ALS-level care quickly and appropriately. Close medical oversight involving review of care and follow-up education is an important part of the program.

Adolescent↗
PubMedDate not supplied

A statewide early defibrillation initiative including laypersons and outcome reporting.

Rapid delivery of defibrillatory shocks increases survival in patients with cardiac arrest. The automated external defibrillator interprets cardiac rhythms and delivers electrical shocks, permitting appropriate defibrillation by persons with minimal training. California initiated a program for early defibrillation by basic emergency medical technicians, using manual or automated external defibrillators, and by public safety personnel (fire fighters, peace officers, and public lifeguards), using automated external defibrillators. The program includes a system for reporting outcomes statewide. In the first 46 months under this program, 1487 patients received defibrillatory shocks; 1009 (68%) of these patients had witnessed ventricular fibrillation. Of the latter group, 191 were discharged from the hospital, representing 19% of those with witnessed ventricular fibrillation and 13% of all patients who had had shocks applied. California also implemented a framework of training and medical direction for defibrillation by laypersons using automated external defibrillators. Early defibrillation by basic emergency medical technicians and public safety personnel, encouraged by appropriate regulatory changes, results in gratifying survival rates.

California↗