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Biomedical subjects

G L Sternbach

Publications and source records attributed to G L Sternbach.

48 records · Page 3Linked to original sources

Cardiopulmonary resuscitation: lessons from the past.

One of the most startling ideas of modern medicine is that "sudden death" may be reversed; however, this idea was not reached easily. In its earliest forms, cardiopulmonary resuscitation (CPR) is probably as old as the human being. The evolution of CPR represents, as does the evolution of medicine as a whole, a history of human error and human discovery. Although it is common to ascribe the development of CPR to Kouwenhoven and colleagues at Johns Hopkins Hospital, in fact they refined and popularized a method that had been evolving over several millennia. This paper reviews the most important advances in resuscitation prior to the 20th century.

Cardiopulmonary Resuscitation↗

Adult respiratory distress syndrome associated with adult epiglottitis.

Adult respiratory distress syndrome (ARDS) is an increased permeability pulmonary edema syndrome known to be associated with a variety of direct and indirect pulmonary insults. ARDS occurred in a 37-year-old woman during an episode of epiglottitis. The patient was treated with endotracheal intubation and mechanical ventilation and recovered, to be discharged from the hospital 1 week after presentation. There are only two cases of ARDS reported in this setting, and in each case, pulmonary edema followed cardiac arrest and the patients had a fatal outcome.

Adult↗

Tension hydrothorax: a rare complication of continuous cyclical peritoneal dialysis.

Continuous cyclical peritoneal dialysis (CCPD) is a well-established, effective method of maintenance dialysis in patients with end-stage renal disease (ESRD). Massive hydrothorax producing hemodynamic compromise (tension hydrothorax) has been documented as an infrequent complication of both acute temporary peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD). We recently saw a patient with massive hydrothorax as a consequence of CCPD. The etiology of this rare condition is thought to be that of a diaphragmatic defect with a one-way valve mechanism. Diagnosis is made by aspiration of the pleural fluid and estimation of pleural fluid glucose. Management of these patients requires pleural drainage and changing to hemodialysis if possible.

Female↗

Acute pancreatitis secondary to ifosfamide.

Acute pancreatitis in cancer patients can be secondary to the malignant process itself. It is also a rare complication of antineoplastic agent administration. Ifosfamide is an effective drug in the treatment of several tumors and has known neurologic, renal, and hematologic toxicities. There is only one recent report in the literature of pancreatitis associated with ifosfamide. We report a case of a 65-year-old woman with small cell bronchogenic carcinoma without pancreatic metastases who developed acute pancreatitis after ifosfamide administration.

Acute Disease↗

Acute thoracic aortic dissection: the basics.

With an increasing incidence, aortic dissection is the most common acute illness of the aorta. In the setting of chronic hypertension, with or without other risk factors for aortic dissection, this diagnosis should be considered a diagnostic possibility in patients presenting to the emergency department with acute chest or back pain. Left untreated, about 75% of patients with dissections involving the ascending aorta die within 2 weeks of an acute episode. But with successful initial therapy, the 5-year survival rate increases to 75%. Hence, timely recognition of this disease entity coupled with urgent and appropriate management is the key to a successful outcome in a majority of the patients. This article reviews acute thoracic aortic dissection, including ED diagnosis and management.

Acute Disease↗

Mechanical ventilation: past and present.

Emergency physicians commonly manage patients with acute respiratory failure who require assisted mechanical ventilation. Several different modes of positive pressure mechanical ventilation can be used to manage these patients when they present to the emergency department. These modes of ventilation have evolved over the last three decades. A comprehensive review of the most important historical moments in mechanical ventilation as well as the different modes commonly used in the emergency department are presented. In addition, new techniques in noninvasive mechanical ventilation are presented.

Emergencies↗

Rupert Waterhouse and Carl Friderichsen: adrenal apoplexy.

The Waterhouse-Friderichsen (WFS) syndrome, also known as purpura fulminans, is described as acute hemorrhagic necrosis of the adrenal glands and is most often caused by meningococcal infection. This clinical entity is more frequently seen in the pediatric than the adult population and is associated with a high morbidity and mortality. The initial presenting complaints for patients with the WFS usually include a diversity of nonspecific, vague symptoms such as cough, dizziness, headache, sore throat, chills, rigors, weakness, malaise, restlessness, apprehension, myalgias, arthralgias, and fever. These symptoms are usually abrupt in their onset. Petechiae are present in approximately 50-60% of patients. The clinical diagnosis of WFS may be relatively straightforward or extremely challenging. Patients who appear in the initial and nontoxic-appearing stage without any skin lesions may be difficult to distinguish from a benign viral illness. When a patient presents with fever and petechiae, WFS must be considered, even when the patient has a non-toxic appearance. Due to the rapid progression and often devastating consequences, therapy should be instituted as soon as the diagnosis is suspected.

Denmark↗

Management of increased intracranial pressure: a review for clinicians.

Emergency physicians are frequently confronted with head-injured patients, many of whom have intracranial hypertension. Since direct correlations have been reported between increased intracranial pressure (ICP) and adverse outcome, it is important to rapidly identify and treat these patients. Furthermore, since the actual brain damage that occurs at the time of injury cannot be modified, the maximization of neurological recovery depends upon minimizing secondary insults to the brain, most notably preventing hypotension and hypoxemia. Volume resuscitation to maintain an adequate mean arterial pressure, airway control, and sedation and analgesia to prevent surges in ICP remain the cornerstone of early management. These principles and the emergency department management of the head-injured patient are reviewed in this paper.

Brain Injuries↗