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Biomedical subjects

E J Gallagher

Publications and source records attributed to E J Gallagher.

14 recordsLinked to original sources
PubMed1990

Performance characteristics of urine dipsticks stored in open containers.

Dip and read urinalysis is a laboratory test commonly performed by emergency physicians. Although the manufacturer states that the capped vials containing the dipsticks must be closed immediately after removal of a strip, this recommendation may not be followed in a busy emergency department. In a simple, two-part, blinded, and controlled trial the authors found that the reagents for determining leukocyte esterase, pH, protein, glucose, ketones, urobilinogen, bilirubin, and blood showed good reproducibility when fresh dipsticks were compared with dipsticks exposed to room temperature and humidity for 1 to 15 days. In contrast to this, the nitrite portion of the exposed dipsticks showed a rapid and cumulative loss of specificity over time. By the end of a week of exposure, one third of the nitrite tests gave false-positive readings. At the end of a second week, nearly three quarters gave false-positive readings for a specificity of only 28%. It is concluded that the nitrite reagent, in contrast to the other eight reagents on the Chemstrip-9 dipstick (Biodynamics, Indianapolis, IN), rapidly loses accuracy when stored in uncapped vials.

Bacteria↗
PubMed1990

Buffered versus plain lidocaine as a local anesthetic for simple laceration repair.

STUDY OBJECTIVE: Buffered lidocaine was compared with plain lidocaine as a local anesthetic for simple lacerations. DESIGN: Randomized, double-blind, prospective clinical trial. SETTING: Urban emergency department. TYPE OF PARTICIPANTS: Ninety-one adult patients with simple linear lacerations were enrolled. Patients with allergy to lidocaine and patients with an abnormal mental status were excluded. INTERVENTIONS: Each wound edge was anesthetized with either plain or buffered lidocaine using a randomized, double-blind protocol. The pain of infiltration was measured with a previously validated visual analog pain scale. MEASUREMENTS AND MAIN RESULTS: Analysis of pooled data and paired data (using patients as their own controls) revealed that infiltrating buffered lidocaine was significantly less painful than plain lidocaine (P = .03 and P = .02, respectively). There was no significant difference in the anesthetic effectiveness of the two agents during suturing. CONCLUSION: Buffered lidocaine is preferable to plain lidocaine as a local anesthetic agent for the repair of simple lacerations.

Adult↗
PubMed1988

Cost effectiveness of an accurate and rapid assay for serum human chorionic gonadotropin in suspected ectopic pregnancy.

The cost effectiveness and clinical utility of a simple, rapid, and accurate pregnancy test in the evaluation of suspected ectopic gestation were studied. The introduction of this qualitative serum assay for human chorionic gonadotropin into our outpatient department during a 1-month period was associated with a significant decrease in culdocenteses (p less than 0.001), ultrasound examinations (p less than 0.025), and hospital admissions (p less than 0.01), with a net projected institutional reduction in health care costs of +123,000 annually.

Adolescent↗
PubMed1987

Utility of a sensitive bedside serum pregnancy test.

We compared the performance characteristics of a rapid qualitative serum pregnancy test with a standardized quantitative assay for human chorionic gonadotropin in the evaluation of women with suspected ectopic pregnancy. At a threshold value of 25 mIU/mL, the rapid assay demonstrated a sensitivity of 100% and a specificity of 96%.

Adolescent↗
PubMed1987

The effect of restricting the indications for lumbosacral spine radiography in patients with acute back symptoms.

A prospective study was performed to evaluate the effect of using a special requisition form on the utilization of lumbosacral spine radiography for patients presenting in the emergency room with acute lower back complaints. Over a 1-year period, emergency room house officers were encouraged to complete a special form that listed only three acceptable indications for lumbosacral spine radiographs: history of trauma, evidence of focal neurologic abnormality, and "other." Neurologic abnormalities included hypesthesia, hyperesthesia or anesthesia of lumbar or sacral dermatomes, weakness or hyporeflexia of the lower extremities, and bladder or bowel incontinence. If the indication "other" was chosen, radiographs were done only if the form contained both a one- to two-sentence history and the signed approval of a supervising attending physician. The number and results of lumbosacral spine examinations were compared with those from the previous year, which served as a control. In the control year 1443 examinations were performed, and in the experimental year only 759 were done (a decrease of 47%). The percentage of patients with vertebral fractures increased from 5.1% to 5.8% in the experimental year if only the detection of new fractures was considered positive, and from 9.1% to 13.4% if the detection of fractures of all ages was regarded as significant. The use of the special requisition form appears to be a simple and effective means of reducing unnecessary lumbosacral radiography in the emergency room setting.

Acute Disease↗
PubMed1986

Effect of diazepam treatment on hepatic microsomal anesthetic defluorinase activity.

Different dosing regimens with diazepam were evaluated in male Fischer 344 rats for their ability to enhance the metabolism of several inhalation anesthetics. In vitro metabolism was assessed by the rate of microsomal anesthetic defluorination as measured by the appearance of inorganic fluoride ion (i.e., defluorinase activity). Single daily doses of diazepam, 40 mg/kg, were delivered by gavage for either 7 or 14 days; more continuous dosing was achieved by administration of diazepam at 0.03% or 0.10% in food pellets. Hepatic microsomes isolated from treated rats showed significant dose-related elevations in methoxyflurane defluorinase activity, but not in enflurane or isoflurane defluorinase activities. The microsomal content of cytochromes P-450 and b5 and the NADPH-cytochrome-c-reductase activity was not significantly different among treated and untreated groups. Para-nitroanisole O-demethylase activity expressed per nmole cytochrome P-450 increased in the diazepam-treated groups. Extrapolation of these animal data to humans suggests that surgical patients treated chronically with diazepam are probably not at increased risk for inorganic fluoride-induced nephrotoxicity due to increased metabolism of the fluorinated inhalation anesthetics.

Anesthetics↗
PubMed1985

The usefulness of peripheral venous blood in estimating acid-base status in acutely ill patients.

The usefulness of peripheral venous sampling in determining acid-base status in acutely ill patients was studied. A total of 171 nonarrest patients and 12 patients in cardiac arrest had paired samples of arterial and venous blood compared for correlation of blood gas results. Linear equations relating arterial and venous values of pH, PCO2, and bicarbonate were developed in both groups of patients; however, the accuracy of predicting arterial values from venous values was limited. Severe acid-base disturbances were essentially ruled out by normal or nearly normal venous blood gases. Extremely abnormal venous levels reliably reflected comparable arterial abnormalities. The results suggest that immediate intravenous bicarbonate therapy should be considered for patients with pH less than or equal to 7.05 and PCO2 less than or equal to 40 torr despite the possibility of inadvertent venous sampling. A larger series is needed to verify these results in the setting of cardiac arrest.

Acid-Base Imbalance↗
PubMed1985

Emergency skull radiography: the effect of restrictive criteria on skull radiography and CT use.

A prospective study was performed to determine the effect of restrictive criteria on the use of emergency skull radiography and computed tomography (CT) of the head. Emergency skull radiography required the completion of a special requisition form. Emergency CT of the head was done at the request of senior consultants and was available on a full-time basis. Over 1 year, 2,758 skull studies were performed, a decrease of 39.1% when compared with the year before restrictive criteria were instituted, during which 4,587 skull examinations were done. In the same period, the number of emergency CT scans of the head increased by 45.7%, from 471 in the control year to 686 in the experimental year. With the use of restrictive criteria, a net savings of +164,000 was achieved. Our results suggest that the use of restrictive criteria is a cost-effective means of limiting skull radiography when CT of the head is readily available.

Adolescent↗
PubMed1979

Self-administered nitrous oxide: an adjunct analgesic.

In a pilot study of 26 patients, a mixture of 50% nitrous oxide and 50% oxygen (N2O-O2) appeared to be an effective and safe analgesic for the incision and drainage of closed-space infections. The analgesic effect of N2O-O2, as measured by a Mean Analgesic Index, is augmented by both amnesic and dissociative effects, ie, patients remembered experiencing significantly less pain than they complained of during the procedure (p less than .01) and reported significantly more pain than they appeared to be having, as recorded by an observer (p less than .01). The patient's recollected pain, however, correlated well (r = .68) with the observer's assessment. Forty-two percent of patients had undergone a similar or identical procedure in the past without the benefit of N2O-O2 and made uniformly favorable comparative statement concerning the analgesic effect of the gas.

Abscess↗
PubMedDate not supplied

Circadian variation in the frequency of myocardial infarction and death associated with acute pulmonary edema.

The records of 103 patients hospitalized for acute pulmonary edema were reviewed to determine the relationship between short-term outcome and time of presentation to the emergency department. Although only 17% of the patients arrived in the emergency department during the early afternoon hours, half of the deaths in the study occurred in this group. Patients presenting between noon and four PM had a significantly higher incidence of acute myocardial infarction (76% v. 28%, p = 0.03) and death (47% v. 9% p = 0.03) compared with patients presenting at other times. Differences in the pathophysiology of daytime versus nocturnal acute pulmonary edema may account for some of the variation in outcome.

Adult↗
PubMedDate not supplied

The etiology of medical gridlock: causes of emergency department overcrowding in New York City.

Overcrowding of emergency departments in New York City is the most apparent symptom of a crumbling health care system. There is a growing need for the care of a largely impoverished population suffering from an increasing prevalence of AIDS, substance abuse, and psychiatric disease. Institutions crippled by critical shortages of inpatient beds and nurses lack the resources to meet this rising demand. Although the epidemic of medical gridlock began in New York City, it is spreading rapidly to involve other areas of the country. Short-term efforts to resolve this crisis have thus far been unsuccessful. Long-range solutions are likely to be costly and may require a reconfiguration of societal health care priorities.

Acquired Immunodeficiency Syndrome↗