Biomedical subjects

D A Jerrard

Publications and source records attributed to D A Jerrard.

12 recordsLinked to original sources

PubMed2001

Cerebrospinal fluid.

A quick and accurate diagnosis of maladies affecting the central nervous system (CNS) is imperative. Procurement and analysis of cerebrospinal fluid (CSF) are paramount in helping the clinician determine a patient's clinical condition. Various staining methods, measurement of white blood cell counts, glucose and protein levels, recognition of xanthochromia, and microbiologic studies are CSF parameters that are collectively important in the ultimate determination by a clinician of the presence or absence of a catastrophic CNS condition. Many of these CNS parameters have significant limitations that should be recognized to minimize under treating patients with catastrophic illness.

Bacterial Infections↗

PubMed2000

Syphilis testing.

The organism that causes syphilis, Treponema pallidum, is impossible to culture in the clinical laboratory. Direct visualization of the pathogen is one laboratory technique used in the diagnosis of syphilis. Currently, serologic testing is the most widely used laboratory technique in diagnosing syphilis and monitoring its course after treatment. Serologic tests are divided into two categories, the nontreponemal and treponemal antibody tests. Newer techniques such as enzyme immunoassays have shown excellent results.

Emergency Medicine↗

PubMed1997

Medical clearance and screening of psychiatric patients in the emergency department.

OBJECTIVES: To study the frequency of medical complaints and need for routine ED medical, laboratory, and toxicologic clearance for patients presenting with psychiatric chief complaints. METHODS: A retrospective, observational analysis of psychiatric patients seen in an urban teaching hospital ED over a 2-month period was performed. The individual sensitivities of history, physical examination, vital signs, and complete blood counts and chemistry panels for identifying medical problems were determined. The sensitivities and predictive values of patient self-reporting of recent illicit drug and ethanol use were also determined. RESULTS: 352 patients were seen with psychiatric chief complaints. A complete data set was available for 345 patients (98%). Of those with complete data, 65 (19%) had medical problems of any type. History, physical examination, vital signs, and laboratory testing had sensitivities of 94%, 51%, 17%, and 20%, respectively, for identifying these medical problems. Screening without universal laboratory testing would have missed 2 asymptomatic patients with mild hypokalemia. Patient self-reporting had a 92% sensitivity, a 91% specificity, an 88% positive predictive value (PPV), and a 94% negative predictive value (NPV) for identifying those with a positive drug screen, and a 96% sensitivity, an 87% specificity, a 73% PPV, and a 98% NPV for identifying those with a positive ethanol level. CONCLUSION: The vast majority of medical problems and substance abuse in ED psychiatric patients can be identified by initial vital signs and a basic history and physical examination. Universal laboratory and toxicologic screening of all patients with psychiatric complaints is of low yield.

Adolescent↗

PubMed1996

ED management of insect stings.

Allergic reactions to insect stings are a common and sometimes serious medical problem. Although most reactions to stinging insects are mild, a pool of individuals in the general population has experienced or will manifest an anaphylactic reaction to stings. Concern has been heightened with the introduction of stinging species not indigenous to the United States which have a proclivity for stinging frequently. The emergency physician needs to understand the pathophysiology of insect sting anaphylaxis, recognize its onset, and formulate an appropriate pharmacological treatment plan. In addition, the emergency physician must instruct the patient on avoidance of insects and on outpatient use of epinephrine. For the patient who truly has had an anaphylactic event, referral to an allergist is imperative.

Anaphylaxis↗

PubMed1996

Simultaneous uvulitis and epiglottitis without fever or leukocytosis.

A case is presented of simultaneous uvulitis and epiglottitis in an afebrile patient without elevation in the white blood cell count. This case is reported to illustrate the need for a high index of suspicion for the rare association of uvulitis and epiglottitis.

Emergencies↗

PubMed1995

Efficacy and safety of a rapid-sequence metaproterenol protocol in the treatment of acute adult asthma.

A 6-month prospective study was performed to examine the efficacy and safety of a rapid-sequence nebulized metaproterenol regimen for the treatment of acute asthma in adults. Patients 18 years of age or older who were not pregnant and who had not received beta 2-agonist therapy were identified and started on a rapid-sequence metaproterenol regimen (15 mg) by the triage nurse. Pretreatment and posttreatment peak flow, respiratory rate, pulse rate, and blood pressure were documented. Patients also gave a pretreatment and posttreatment rating of the clinical severity of their attack using a 1-to-10 visual analogue scale. Fifty patients were entered into the study, with an average age of 38 years (range, 19 to 87 years). Data were analyzed using the Wilcoxon matched-pairs signed rank test. Patients showed statistically significant increases in peak flow (193 to 328 L/min, P < .00001) and systolic blood pressure (136 to 143 mm Hg, P < .0054). Statistically significant decreases were shown for respiratory rate (25 to 22 beats/min, P < .0001) and clinical severity (6.2 to 3.2, P < .00001). Thirty-three patients (71%) who completed the protocol experienced an increase in pulse rate. Ten (21%) had a pulse rate increase of more than 30 beats/min. Two (4.2%) had pulse rate increases of more than 40 beats/min. Four patients were removed after one or two nebulizers because of severe side effects. One patient's pulse rate increased to more than 200 beats/min. Although effective in reversing bronchospasm, the side effects of metaproterenol when used in rapid sequence are of major concern.

Adult↗

PubMed1993

Pelvic fractures.

Extensive knowledge of pelvic fractures is a must for emergency physicians. The emergency physician must be able to distinguish the minor fracture from one that is more severe, one that may have associated injuries, and one that is quite possibly life threatening.

Abdominal Injuries↗

PubMed1992

Diving medicine.

Although the diving community attempts to train and educate its members with regard to the dangers of the deep, there are still a significant number of individuals each year who need treatment for painful and life-threatening illness incurred as a result of the dive. The emergency physician needs to identify these individuals quickly, stabilize them, and refer and transport as soon as possible to a recompression chamber.

Barotrauma↗

PubMed1990

Burns in the elderly patient.

Whether in the prehospital setting or in the Emergency Department, the emergency physician is usually the first care-giver to the burned elderly patient. Though the predominance of care over the long-term is by burn specialists, attention to the details of resuscitation and stabilization by the emergency physician in the initial stages has a vital role in the overall scheme of care.

Aged↗

PubMedDate not supplied

"Designer drugs"--a current perspective.

Since the late 1970s, in an effort to quench the ever burgeoning appetite for pharmacological substances of abuse and to satiate their own need for profit, unscrupulous chemists have set up clandestine laboratories to produce and market new drugs for street sale. Using fairly common industrial chemicals, they have altered or modified preexisting controlled substances such as fentanyl, meperidine, mescaline, amphetamine, and phencyclidine, producing derivatives of these parent compounds that, up until 1986, were able to temporarily elude the guidelines of the Federal Controlled Substances Act due to their new and unique chemical structures. Unsuspecting users continue to use the drugs recreationally. This article will present a comprehensive review of these "Designer Drugs" looking at historical data, pharmacokinetics, treatment, abuse trends, and some of the more recent additions to the social pharmacopoeia.

Amphetamines↗

PubMedDate not supplied

The erythrocyte sedimentation rate.

The erythrocyte sedimentation rate has been used for over 50 years for everything from predicting disease severity to assessing general sickness index. Its perceived utility has been based on medical myths and its use too often based only on a consultant's demand or a shotgun approach to diagnosis. This article focuses on examining the specific utility of the erythrocyte sedimentation rate in the emergency department as a tool for predicting both disease likelihood and severity.

Arthritis, Infectious↗

PubMedDate not supplied

Prescription noncompliance: contribution to emergency department visits and cost.

We randomly surveyed 100 patients in the acute care section of a large urban university hospital Emergency Department (ED) on 6 days with regard to the existence of and reasons for prescription noncompliance. Noncompliance was considered a major factor contributing to the ED visit if: (1) no medications had been taken for at least 48 h before the ED visit; (2) the medications, when previously taken, had routinely controlled the condition for which the patient was presenting to the ED; and (3) no other significant cause or illness was believed to have precipitated the ED visit. ED, admissions, and yearly medication costs were calculated for all patients. Noncompliance was found to be a contributing factor in the cases of 22 patients (22%). The most common medications involved were phenytoin and albuterol. Cost was the most common reason for noncompliance (11 [50%]). The average ED charge per noncompliant patient discharged was $576.61. Six noncompliant patients were admitted at an average cost of $4,834.62. The average cost of a year's medication was $520.72. Noncompliance with drug prescriptions is a significant contributor to ED visits and health care costs.

Adult↗