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Biomedical subjects

G M Vilke

Publications and source records attributed to G M Vilke.

At least 37 records · Page 2Linked to original sources
PubMed1997

Restraint position and positional asphyxia.

STUDY OBJECTIVE: To determine whether the "hobble" or "hog-tie" restraint position results in clinically relevant respiratory dysfunction. METHODS: This was an experimental, crossover, controlled trial at a university-based pulmonary function laboratory involving 15 healthy men ages 18 through 40 years. Subjects were excluded for a positive urine toxicology screen, body mass index (BMI) greater than 30 kg/m2, or abnormal screening pulmonary function testing (PFT). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and maximal voluntary ventilation (MVV) were obtained with subjects in the sitting, supine, prone, and restraint positions. After a 4-minute exercise period, subjects rested in the sitting position while pulse, oxygen saturation, and arterial blood gases were monitored. The subjects repeated the exercise, then were placed in the restraint position with similar monitoring. RESULTS: There was a small, statistically significant decline in the mean FVC (from 5.31 +/- 1.01 L [101% +/- 10.5% of predicted] to 4.60 +/- .84 L [88% +/- 8.8% of predicted]), mean FEV1 (from 4.31 +/- .53 L [103% +/- 8.4%] to 3.70 +/- .45 L [89% +/- 7.7%]), and mean MVV (from 165.5 +/- 24.5 L/minute [111% +/- 17.3%] to 131.1 +/- 20.7 L/minute [88% +/- 16.6%]), comparing sitting with restraint position (all, P < .001). There was no evidence of hypoxia (mean oxygen tension [PO2] less than 95 mm Hg or co-oximetry less than 96%) in either position. The mean carbon dioxide tension (PCO2) for both groups was not different after 15 minutes of rest in the sitting versus the restraint position. There was no significant difference in heart rate recovery or oxygen saturation as measured by co-oximetry and pulse oximetry. CONCLUSION: In our study population of healthy subjects, the restraint position resulted in a restrictive pulmonary function pattern but did not result in clinically relevant changes in oxygenation or ventilation.

Adolescent↗
PubMed1996

Cervical spine epidural abscess in a patient with no predisposing risk factors.

We report a case of cervical spine epidural abscess in a 50-year-old man with a 4-day history of neck pain but no neurologic deficits or fever. The patient had no predisposing risk factors such as recent spinal surgery, trauma, instrumentation, distal site of infection, immunosuppression, diabetes, or i.v. drug abuse. A review of the literature follows.

Abscess↗
PubMed1996

Disaster preparedness of poison control centers in the United States.

OBJECTIVE: To assess the state of disaster readiness of poison control centers, a survey questionnaire was sent to all 96 institutional poison control center members of the American Association of Poison Control Centers in the US, both certified and noncertified programs. DESIGN: The data reported are the results and responses from 76 of 96 (79.2%) poison control centers. RESULTS: Fifty-four percent of responding centers have written disaster plans, with 25% having drills to practice the plans. Of the centers that do not have a written plan, the majority have policies and procedures in place to address physical plant damage, increased phone traffic, loss of phone systems and malfunction of computers. Eighty-six percent of respondents have a back up generator, and 82% have an uninterruptable power supply in place. Fifty-four percent have a back up phone system and 33% have cellular phone capacity. Forty-six percent of responding centers have arrangements with other agencies in the event of a disaster. Only half of the managing directors of the responding centers believe their center can meet the public's needs in the event of a disaster.

Disaster Planning↗
PubMedDate not supplied

Intubation techniques in the helicopter.

The purpose of this study is an analysis of 630 field intubations of trauma patients by flight personnel of the San Diego Life Flight program. We compared nasotracheal intubation to rapid sequence induction orotracheal intubation and noninduced orotracheal intubation. We measured success of intubation route, complications, and overall patient outcome. Flight records, quality assurance flight procedure data, and hospitalization data from the San Diego Trauma Registry were reviewed over a 4-year period, from 1988 to 1991. The results of our study show that rapid sequence induction orotracheal intubation has a higher success rate, fewer complications, and a better patient outcome compared to noninduced orotracheal intubation and blind nasotracheal intubation. We recommend that rapid sequence induction oral intubation be the standard method for prehospital airway management in trauma patients.

Adult↗
PubMedDate not supplied

The completeness of MEDLINE for papers published and abstracted in the Journal of Emergency Medicine.

The purpose of this paper is to assess whether MEDLINE, a common source for reviewing the medical literature, is complete with regard to referencing papers published and abstracted in The Journal of Emergency Medicine (JEM) over a 10-year period. In that time, 1178 abstracts and 843 original contributions were included in JEM. All papers were reviewed and classified as either a review of subject, case report with review of literature, editorial, or prospective or retrospective original research. Results showed 98.5% of all original work published in JEM and 99.74% of all abstracts referenced in JEM were found in MEDLINE, thus supporting the hypothesis that MEDLINE is a complete and thorough database for current literature.

Abstracting and Indexing↗
PubMedDate not supplied

Case reports of two patients with pneumothorax following acupuncture.

We report two patients who presented to the emergency department with pneumothorax related to acupuncture. The first patient developed pleuritic chest pain and shortness of breath while undergoing acupuncture therapy, and the second patient developed similar symptoms 10 min after acupuncture therapy. Neither patient had a previous history of pneumothorax, and both were undergoing acupuncture along the spine, paraspinal region, and shoulders. A review of the literature follows.

Acupuncture Therapy↗
PubMedDate not supplied

Inaccuracy in endotracheal tube verification using a Toomey syringe.

The Toomey syringe and other esophageal detection devices have been shown to be highly sensitive and specific for indicating whether an endotracheal (ET) tube is in the esophagus or the trachea. Many prehospital systems use the Toomey syringe method as the major determinant in deciding whether or not to remove an ET tube after an intubation attempt. We present three cases in which various pulmonary pathologies led to false positive results; that is, Toomey syringe aspiration indicated esophageal placement when the tube was correctly positioned in the trachea. A literature review follows the case reports.

Adult↗
PubMedDate not supplied

Cricothyrotomy technique: standard versus the Rapid Four-Step Technique.

Standard cricothyrotomy technique uses a tracheal hook cephalad to the opening to stabilize the trachea during endotracheal (ET) tube passage. A newly described Rapid Four-Step Technique (RFST) uses the tracheal hook caudal to the opening to stabilize the trachea during ET tube passage. This experimental crossover trial compared standard cephalad tracheal hook traction to caudad traction as recommended by RFST in a cadaver model of cricothyrotomy. Outcome measures included the incidence of complications and the size of ET tube able to be passed with each technique. The anterior necks of 30 formalin-fixed cadavers were dissected to completely reveal the cricothyroid membranes and surrounding structures. Two emergency medicine residents performed all cricothyrotomies. Each cadaver was randomly assigned to undergo either standard open technique followed by RFST, or RFST followed by standard open technique. Standard open technique was performed using a #11 scalpel blade, a Trousseau dilator for widening the opening, and a tracheal hook held cephalad through the thyroid cartilage. RFST was performed using a #11 scalpel blade and a tracheal hook held caudad through the cricoid cartilage. Cuffed ET tubes without stylettes were passed in progressively larger sizes until significant resistance was met as determined independently by two physicians. The size of the largest ET tube passed for each technique was recorded. After each attempt the trachea was inspected for evidence of structural damage and the balloon cuff was checked to assess for cuff rupture. There were no complications with standard technique; five cadavers (16.7%) had complications with RFST including one (3.3 %) with balloon cuff rupture and four (13.3 %) with cricoid cartilage fractures. Tracheal damage prevented standard technique performance on three of the cadavers. There was no significant difference between maximal ET tube sizes for standard technique (median size 7.0, mean 6.95 mm internal diameter) versus RFST (median size 7.0, mean 6.82 mm internal diameter). We conclude that RFST may be associated with a higher incidence of complications than standard technique as demonstrated by our cadaver model of cricothyrotomy. We were unable to demonstrate a difference between the two techniques with regards to size of ET tube able to be passed.

Aged↗
PubMedDate not supplied

Use of the Trousseau dilator in cricothyrotomy.

When performing cricothyrotomy, once the initial incision has been created, the scalpel handle may be inserted into the incision and rotated, or a Trousseau dilator may be used to widen the opening. During endotracheal (ET) tube passage, the Trousseau dilator may be left in place or a tracheal hook may be inserted for tracheal stabilization. This experimental crossover trial of cricothyrotomy in a cadaver model compared: 1) scalpel handle rotation to the use of a Trousseau dilator in widening the initial incision, and 2) the use of a tracheal hook to a Trousseau dilator during ET tube passage. Part 1: Cricothyrotomy incisions were made in 30 formalin-fixed cadavers using a #11 scalpel blade. The opening was initially widened using a Trousseau dilator or a scalpel handle rotated through 360 degrees. Progressively larger ET tubes were passed using a tracheal hook for stabilization at the thyroid cartilage, and the size of the largest ET tube passed without significant resistance was recorded. Each opening was then widened using the other technique and ET tubes again passed as above. The dimensions of the opening after initial dilatation and after final ET tube passage were also recorded. Part 2: A tracheal hook inserted cephalad at the thyroid cartilage or a Trousseau dilator was used to stabilize the trachea during passage of progressively larger ET tubes, and the size of the largest ET tube passed without significant resistance was recorded. The insertion techniques were then reversed and ET tubes again passed as above. The trachea was inspected for damage and the balloon cuff checked for rupture after each attempt. Descriptive statistics were applied using a paired t-test and a chi-square analysis. We found no significant difference between the two techniques with regard to initial opening dimensions, final opening dimensions, or maximal ET tube size. There was no damage to local tissue and no balloon cuff ruptures. We found that the average size of the largest ET tube passed was significantly greater with the use of a tracheal hook (internal diameter mean 7.0 mm, median 7.0 mm) than with a Trousseau dilator (internal diameter mean 5.7 mm, median 5.5 mm). There was no damage to local tissue and no cuff ruptures. We conclude that the scalpel handle rotation technique is equal to the use of the Trousseau dilator with regard to opening size and maximal ET tube size but that use of a tracheal hook rather than a Trousseau dilator allows for passage of a larger ET tube in a cadaver model of cricothyrotomy.

Airway Obstruction↗
PubMedDate not supplied

Emergency department airway management before and after an emergency medicine residency.

To determine whether the start of an Emergency Medicine (EM) training program affects the appropriateness, timeliness, and safety of Emergency Department (ED) intubations, all ED intubations performed 12 months before and after the start of an EM residency were reviewed. In addition, all patients intubated within 12 h after being admitted through the ED were reviewed. We found that all ED intubations before and after the start of a residency program were deemed appropriate. Of patients intubated after admission, 13 of 20 (65%) were felt to have warranted intubation while in the ED for the pre-residency group, compared with 9 of 29 patients (31%) for the post-residency group. There were no differences between the complication rates of these groups. We conclude that an EM residency program did not increase the number of inappropriate intubations or complications, and reduced the number of patients who required but did not receive intubation in the ED.

Adolescent↗
PubMedDate not supplied

Permanent cardiac pacemakers: issues relevant to the emergency physician, Part I.

Many people benefit from the implantation of cardiac pacemakers for management of certain cardiac dysrhythmias. These patients are seen regularly in the emergency department with a variety of pacemaker complications and malfunctions. The presence of a pacemaker may also affect management of unrelated medical problems. This two-part series reviews the medical issues related to patients with permanent pacemakers. Part I covers pacing modes and terminology, complications of the implant procedure, and the approach to a patient with a permanent pacemaker. Part II covers the causes, diagnosis and management of pacemaker malfunction; the pacemaker syndrome; the pacemaker Twiddler's syndrome; and other considerations in the paced patient including diagnosis of acute myocardial infarction, ACLS protocols, trauma, and sources of interference. Indications for permanent pacemaker implantation and temporary external pacing will not be covered.

Electrodes, Implanted↗
PubMedDate not supplied

Permanent cardiac pacemakers: issues relevant to the emergency physician, part II.

Many people benefit from the implantation of cardiac pacemakers for management of certain cardiac dysrhythmias. These patients are seen regularly in the Emergency Department with a variety of pacemaker complications and malfunctions. The presence of a pacemaker may also affect management of unrelated medical problems. This, the second of a two-part series, covers the causes, diagnosis, and management of pacemaker malfunction; the pacemaker syndrome; the pacemaker Twiddler's syndrome; and other considerations in the paced patient including diagnosis of acute myocardial infarction, ACLS protocols, trauma, and sources of interference.

Electrocardiography↗
PubMedDate not supplied

Nasotracheal intubation in the emergency department, revisited.

This retrospective study was designed to investigate the current practice of nasotracheal intubation (NTI) in the Emergency Department (ED) at the University of California, San Diego Medical Center. Over a 5-year period, 21% (105/501) of patients intubated in the ED had at least one NTI attempt. The most frequent primary diagnoses in these patients included drug overdose, congestive heart failure, and chronic obstructive pulmonary disease. We report an overall NTI success rate of 79% (83/105). Sixty-one percent (64/105) of the patients were nasally intubated on the first NTI attempt. Nasal dilators, topical neosynephrine, and sedation improved NTI success rates. Epistaxis and improper tube position were the most common immediate complications. Sinusitis, pneumonia, and sepsis were the most frequent late complications. Patients receiving thrombolytic therapy were at risk of developing severe epistaxis. A prior history of sinus disease may predispose a nasally intubated patient to sinusitis. The complication rates reported here are similar to those of previous studies. A survey of emergency medicine (EM) residency programs found that EM residents throughout the country perform an average of 2.8 NTIs during their residency training. Thus, there is limited exposure to this intubation technique in EM residency programs. Nasotracheal intubation is a useful alternative to oral intubation, particularly when oral access is compromised. While not the optimal approach, we conclude that NTI is still a valuable method for establishing an airway and should remain among the emergency physician's arsenal of intubation techniques.

Adolescent↗