Biomedical subjects
Publications and source records attributed to D Tek.
Heat stroke is reviewed in detail. Particular attention is paid to diagnosis and current emergency department treatment, and a brief overview of pathophysiology is included. Early complications, with recommendations for prevention and management, are described. Minor heat related syndromes are also mentioned.
Medical planning requires the expedition physician to draw from many aspects of the knowledge base of wilderness and environmental medicine and to learn and use lessons from those that have gone before. The medical plan is dependent on parameters of the expedition objective, scope, and resources and is developed cooperatively with the overall operational plan. The gathering of medical intelligence is crucial to the planning process and includes data specific to the location of the objective area and the expedition party itself. Medical screening of individual participants should be done for extended- or high-performance ventures. Medical training of both medical and nonmedical expedition party members is the responsibility of the medical planner. The contents, configuration, and deployment of medical kits depends on several variables and must be tailored to the individual venture. Protocols for preventive medicine measures, medical communications, and casualty evacuation are all included in the medical plan. It is hoped that with the focus of attention and effort that appropriate medical planning requires, unnecessary suffering and death will be less frequent as the boundaries of human exploration continue to expand.
The present treatment for acute attacks of headache is empiric. Intramuscular nalbuphine (Nubain) and hydroxyzine (Vistaril) were assessed for pain relief in a prospective, double-blind clinical trial. Ninety-four patients were assigned randomly to treatment groups receiving nalbuphine 10 mg, nalbuphine 10 mg plus hydroxyzine 50 mg, hydroxyzine 50 mg, or placebo. The treatment groups were found to be adequately homogenous with regard to age, sex, type and duration of headaches, and history of prior narcotic use. All data were analyzed by one-way analysis of variance. Patients who had headaches diagnosed as other than classic migraine had significantly greater pain relief with nalbuphine compared to placebo (P less than .01). The combination of nalbuphine and hydroxyzine was not significantly more effective than other treatment groups. In 20 patients with classic migraine, none of the treatment regimens significantly outperformed placebo. There were no clinically significant adverse effects attributed to the study drugs. These findings are similar to others that showed a lack of efficacy of kappa receptor agonists in classic migraineurs. Nalbuphine appears to be clinically useful in other types of severe headache. This study does not support the routine addition of hydroxyzine for presumed synergistic effect.
Animal laboratories have been used for many years to teach procedures. Our department has a weekly swine laboratory devoted to training residents, interns and students in resuscitative procedures. Physicians who participated in our swine procedure laboratory over the past three years were queried as to their prelaboratory and postlaboratory comfort levels with six different resuscitative procedures, and 57 (76%) physicians responded. Statistical analysis of the data showed significant improvement in comfort levels for all six procedures. Every responder felt the swine laboratory helped or will help them perform the procedures on humans. We also surveyed all U.S. emergency medicine residency program directors from established programs regarding the status of their animal procedure laboratories, and 67 of the 68 (98%) directors responded. Of these responders, 62% offer an animal procedure laboratory. Overall, 97% of the residency directors rated the laboratory successful, and 97% of the residents rated the laboratory successful. Therefore, we conclude that an ongoing emergency medicine animal procedure laboratory is a valuable tool for improving physician-in-training ability and confidence.