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Biomedical subjects

D Tandberg

Publications and source records attributed to D Tandberg.

At least 55 records · Page 3Linked to original sources
PubMed1991

Under-reporting of contaminated needlestick injuries in emergency health care workers.

STUDY HYPOTHESIS: There is considerable under-reporting of contaminated occupational needlestick and other sharp object injuries among emergency health care workers. POPULATION: A convenience sample of emergency physicians, emergency nurses, and emergency medical technicians (EMTs). METHODS: A survey instrument eliciting demographic and work-related factors was developed and administered; survey items included age, sex, occupation, years in occupation, number of procedures performed per week, number of contaminated needlestick (and other "sharps") injuries recalled, and number of these injuries formally reported during the previous five years. Nonsegmented visual analog scales were used to assess eight attitudes possibly associated with nonreporting. Analysis was by analysis of variance and multiple linear regression with stepwise variable election. RESULTS: Two hundred fifty-nine subjects recalled 643 contaminated exposures during the five-year study period, but only 228 (35%) were formally reported. One or more injuries occurred in 55% of EMTs compared with 72% of nurses and 80% of physicians (P less than .05). Physicians recalled a mean of 3.8 contaminated exposures, whereas nurses recalled 2.8 and EMTs recalled only 1.8 (P less than .05). Physicians formally reported a mean of 0.26 exposures, whereas EMTs reported 0.85 and nurses reported 1.25 (P less than .05). Physicians formally reported only one eighth of their injuries compared with EMTs and nurses, who each reported two thirds of these events (P less than .05). Perception of risk, occupation, years in occupation, and concern about excessive paperwork were the most powerful predictors of low reporting rate (P less than .05). CONCLUSIONS: Work-related contaminated sharp object injuries are under-reported by emergency health care workers, especially emergency physicians.

Accidents, Occupational↗
PubMed1990

Destruction of hearing aid by lightning strike.

A 20-year-old woman was struck by lightning while seeking shelter under a tree. The discharge entered at the site of the victim's behind-the-ear type hearing aid, destroying it. She suffered cardiorespiratory arrest, burns, left ventricular failure, and myoglobinuria, yet recovered fully. It is widely known that carrying a metallic object such as an umbrella or golf club above one's head increases the risk of being struck. However, few people know that small metallic objects worn on the head are similarly dangerous. Persons caught outside in a lightning storm might decrease the probability of being struck by removing all metallic objects from their head.

Adult↗
PubMed1990

Rapid visual colorimetry of peritoneal lavage fluid.

STUDY HYPOTHESIS: That visual colorimetry can be used to rapidly and precisely estimate the erythrocyte count of 1:5 dilutions of simulated peritoneal lavage fluid. POPULATION: Fifty-four normal adult human subjects. METHODS: The automated or chamber RBC count is often used on fluid obtained by peritoneal lavage in patients with abdominal trauma to help determine the need for surgery. Unfortunately, this method sometimes results in excessive delay. We designed and built a simple colorimeter that facilitated rapid direct visual comparison of unknown samples with known color standards. A radiograph view box was used as a light source. Standards were prepared in 16-mm glass tubes to simulate peritoneal lavage fluid with RBC counts ranging from 0 to 140,000 in 10,000 cell/microL increments; 1:5 dilutions with water were used throughout to reduce opacity. Thimerosal was added to unknowns and standards to stabilize color; all samples were kept refrigerated at 4 C when not in use. In a double-blind in-vitro study, each subject matched 20 randomly distributed unknowns ranging from 12,000 to 131,000 erythrocytes/microL to the nearest standard. RESULTS: The mean absolute error for all 1,080 determinations was 3,560 RBC/microL (95% CI = 4,290-4,830; SD = 4,560; t = 39.6; df = 1,079; P less than .001). This method correctly predicted the RBC count to within 9,000 cells/microL 95% of the time. CONCLUSION: Visual comparison of 1:5 dilutions of simulated peritoneal lavage fluid with known color standards can be used to rapidly and precisely estimate the erythrocyte count.

Abdominal Injuries↗
PubMed1990

The effect of local anesthetics on bacterial proliferation: TAC versus lidocaine.

We compared the effect of topical 0.5% tetracaine, 1:2,000 epinephrine, and 11.8% cocaine (TAC) with 1% lidocaine infiltration on bacterial proliferation in experimental lacerations. Forty-eight lacerations were made on the backs of Hampshire pigs, inoculated by injection with infectious doses of Staphylococcus aureus and randomly anesthetized with either topical TAC or lidocaine infiltration. Wounds were sutured, and quantitative cultures were obtained by excision after 48 hours. The mean log10 bacteria per gram of tissue for wounds anesthetized with TAC was 6.818 (95% confidence interval [CI], 6.07 to 7.54) compared with 6.820 (95% CI, 5.91 to 7.75) for those treated with lidocaine; this difference was not significant (P less than .05 by paired two-tailed t test). The probability of failing to detect an intergroup difference of 0.5 log10 bacteria per gram was less than .0001. TAC does not increase bacterial proliferation more than lidocaine infiltration in contaminated experimental porcine lacerations.

Administration, Topical↗
PubMed1989

The knee-chest position does not improve the efficacy of ipecac-induced emesis.

Previous studies have shown that ipecac-induced emesis, even if instituted very early, removes only a mean of 28% to 45% of an ingested tracer. Because vomiting is an ancient reflex that occurs in mammals, reptiles, and other animals, we speculated that, in humans, maintaining a sitting rather than a horizontal posture during induced emesis might decrease the efficacy of gastric emptying. To test this hypothesis, 20 normal fasting adult subjects underwent induced emesis in the knee-chest position on one day and in the sitting position on another. Twenty-five 100-micrograms tablets of cyanocobalamin were ingested as a tracer along with 250 mL tap water. Ten minutes after tracer ingestion, 30 mL ipecac syrup and 640 mL tap water were swallowed. All resulting vomitus was homogenized, frozen, and later assayed for cobalt using atomic absorption spectrophotometry. There was no difference in mean tracer recovery with the two positions: knee-chest, 47.2% v sitting, 46.9% (paired t test, P greater than .95). Analysis of cobalt recovery for all 40 episodes of emesis revealed a mean of 51.2 +/- 23.7 (SD) micrograms out of 108.7 micrograms total cobalt ingested (95% Cl, 43.6 to 58.7 micrograms). This represented 47.1% of the administered tracer dose (95% Cl, 40.1% to 54.0%). Even if initiated only ten minutes after an ingestion, ipecac-induced emesis removes an average of less than half of an ingested tracer dose, with a high degree of intersubject variability. Horizontal patient positioning does not appear to improve the efficacy of this procedure.

Adult↗
PubMed1989

Substances that interfere with guaiac card tests: implications for gastric aspirate testing.

Previous studies have shown that acidic pH and several ingestible substances can cause misleading guaiac tests of gastric aspirates. In this in vitro study, over 100 foods, beverages, and drugs were diluted to concentrations potentially present in the stomachs of outpatients being evaluated for gastrointestinal bleeding. These were mixed with known concentrations of blood and tested with different brands of guaiac cards. Decreased guaiac test sensitivity was associated with activated charcoal, dimethylaminoethanol, red chile, N-acetylcysteine, rifampin, red Jell-O (General Foods Corp, White Plains, NY), orange juice, Pepto-Bismol (Norwich Eaton Pharmaceuticals, Norwich, NY), simethicone, spaghetti sauce, and several red wines. Chlorophyll and methylene blue-containing tablets produced false-positive results, but other blue and blue-green colored tablets did not, except at high concentrations. Previously described false-negative results with vitamin C, bile, and certain antacids were confirmed, as were false-positive results with iodide, bromide, cupric sulfate, iron salts, and hypochlorite. Physicians should exercise caution when interpreting guaiac card tests of gastric aspirates, especially in the outpatient setting.

False Positive Reactions↗
PubMed1988

Ipecac-induced emesis and gastric lavage are equally unpleasant.

It has been widely held that gastric lavage is more unpleasant than ipecac-induced emesis. In fact, patients are occasionally threatened with large rubber tubes in order to persuade them to drink ipecac. To confirm that this assumption exists, we asked 41 emergency physicians and nurses who had never personally undergone either procedure to estimate the discomfort of each using a 10 cm unsegmented visual analog scale. This "naive" group thought that gastric lavage would be significantly more unpleasant than ipecac-induced emesis (mean scores: lavage = 6.46, emesis = 4.94; P less than .001, paired t-test). Using the same methods, we asked 16 health professionals who had undergone both procedures as part of another study to score the recalled unpleasantness of each procedure. Among these who had actually experienced both, there was no significant difference between the mean scores for lavage (4.09) and emesis (4.62) (P greater than 0.5, paired t-test). The mean score difference (lavage minus emesis) for the "naive" group was significantly greater than for the experimental group (1.52 vs -.53, P less than .001, unpaired t-test). Among normal volunteers, ipecac-induced emesis and gastric lavage are equally unpleasant gastric emptying procedures.

Gastric Lavage↗
PubMed1987

MAST conversion of paroxysmal supraventricular tachycardia in Wolff-Parkinson-White syndrome.

A 48-year-old man with Wolff-Parkinson-White syndrome presented with paroxysmal supraventricular tachycardia. Prior episodes had required inpatient drug therapy or cardioversion. Attempts at conversion to normal sinus rhythm with vagal maneuvers were unsuccessful. Inflation of military antishock trousers resulted in rapid termination of the arrhythmia and avoidance of hospitalization.

Anti-Arrhythmia Agents↗
PubMed1987

Household treatment for "chile burns" of the hands.

In New Mexico, chile peppers (Capsicum annum) are prepared by roasting and manually removing the skin from the fruit. Peeling is often done barehanded and may cause prolonged burning pain, irritation, and erythema but not vesication. In a survey of elderly Hispanic women, treatment with oils or cool tap water were frequently used home remedies. Twenty female subjects immersed their hands in a standardized slurry of green chile for 40 minutes, afterwards one hand was placed in cool tap water and the other in vegetable oil for a total of 75 minutes. Pain was scored using a visual analog scale while the hands were immersed in the chile slurry, test baths, and after drying. The difference in pain score was calculated for each subject. Analysis was by pooled regression. Cool tap water immersion initially provided more relief while vegetable oil provided better long-term relief from the pain of "chile burns".

Adult↗
PubMed1986

Ipecac-induced emesis versus gastric lavage: a controlled study in normal adults.

Ipecac-induced emesis and gastric lavage are the two procedures most widely used to evacuate the stomachs of patients who have ingested poisons. To resolve a long-standing controversy over the relative efficacy of these two methods, the authors carried out a controlled study in which they administered 25 100-micrograms tablets of cyanocobalamin (vitamin B12) to 18 fasting normal adult volunteers on two separate days. On one day, each subject had emesis induced with 30 ml of ipecac syrup followed by 1,000 ml of tap water; on another day, each underwent gastric aspiration and lavage with a 1.1-cm orogastric tube using 3 l of fluid. Both procedures were begun 10 minutes after the ingestion. The recovered vomitus or gastric washings from each procedure were then analyzed for elemental cobalt using atomic absorption spectrophotometry. The mean rate of recovery of the ingested tracer with ipecac-induced emesis was only 28%, whereas gastric lavage resulted in retrieval of 45% (paired t-test, P less than 0.005). In this study, carefully performed gastric lavage was the more effective method of gastric evacuation of tablets in the adult subject.

Adult↗
PubMed1985

Sinoatrial Wenckebach associated with blunt cardiac injury.

A 20-year-old man developed sinoatrial Wenckebach after moderate blunt chest and cardiac trauma from a motor vehicle accident. This unusual dysrhythmia is manifested by grouped beating, a constant PR interval, progressive shortening of the cycle length, and repetitive pauses. Sinoatrial Wenckebach has not previously been described in association with blunt cardiac injury.

Adult↗
PubMed1985

The effect of patient position and MAST inflation on carotid sinus diameter.

A comparison of several maneuvers that are believed to increase vagal tone was made by measuring the carotid sinus with an ultrasound device. For 20 healthy volunteers the mean carotid sinus diameter was 5.7 mm supine, 6.1 mm in the Trendelenberg position, 6.5 mm after supine medical antishock trousers (MAST) inflation, 7.0 mm after MAST inflation in the Trendelenberg position, and 7.3 mm during a headstand. Each mean value was significantly different (P less than .01) from each of the others. These results have important implications for the treatment of dysrhythmias such as paroxysmal supraventricular tachycardia.

Adult↗
PubMed1984

Successful treatment of paroxysmal supraventricular tachycardia with MAST.

We have noted that inflation of the military antishock trousers (MAST) successfully converted five of six patients with paroxysmal supraventricular tachycardia to normal sinus rhythm. In all patients the usual "vagal" maneuvers were tried first and were unsuccessful. MAST inflation may be a safe and useful addition to the traditional vagal maneuvers used to treat paroxysmal supraventricular tachycardia.

Adult↗
PubMed1984

Thoracic stab wound with delayed pneumoperitoneum and pneumomediastinum.

A 21-year-old man with an innocent-appearing, self-inflicted stab wound to the left upper anterior chest developed pneumoperitoneum and pneumomediastinum seven hours after the injury. At laparotomy he had lacerations of the left hemidiaphragm and anterior wall of the stomach, which were surgically repaired. He recovered without complications. Although brief (four- to six-hour) outpatient observation of patients with seemingly superficial thoracic stab wounds recently has been recommended, this case suggests that longer observation periods for such injuries may be appropriate.

Adult↗
PubMed1982

OPEC otitis.

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Adult↗