Biomedical subjects
G Sternbach
Publications and source records attributed to G Sternbach.
Vertebral artery injury presenting with signs of middle cerebral artery occlusion. A case report.
Therapeutic manipulation of the neck has been shown to produced injury to the vertebral artery. The clinical syndromes produced by this arterial insufficiency generally reflect dysfunction of the brainstem or cerebellum. The authors present a case of such injury that presented with clinical findings, namely, hemiparesis and aphasia, suggestive of involvement of the dominant middle cerebral artery. These findings may have been the result of disruption of flow through the posterior cerebral artery to the thalamus, internal capsule, and cerebral peduncles.
A case of varicella complicated by streptococcal septic arthritis of the knee.
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Pacing hazards in helicopter aeromedical transport.
A 62-year-old man with third-degree atrioventricular block and hemodynamically unstable ventricular tachycardia had a cardiac arrest during helicopter transport to a specialized cardiac care unit. Before transport, his ventricular tachycardia had been successfully terminated by a rapid overdrive pacing technique. The failure of "burst suppression" and the absence of pacer spike artifact on the electrocardiographic monitor raise questions about the potential hazards of using various pacing techniques during helicopter transports. Most significantly, this case points to the possibility of interference by exogenous electromagnetic signals in the medical compartment of the helicopter.
Myocardial salvage: angioplasty and coronary artery bypass.
Percutaneous transluminal coronary angioplasty has shown great promise in the treatment of acute myocardial infarction, both alone and in combination with thrombolysis. Because of time constraints, intravenous thrombolysis probably will emerge as the initial therapy of choice in most settings. Because thrombolysis often has a high incidence of reocclusion and recurrent ischemia, angioplasty will continue to play a role in relieving residual coronary artery stenosis. Coronary artery bypass surgery is not often used currently as sole therapy for acute myocardial infarction. Nonetheless, like angioplasty, bypass surgery plays a supporting role in relieving post-thrombolytic stenosis, as well as in treating complications of angioplasty.
Myocardial salvage: thrombolytic therapy.
Thrombolytic therapy for acute myocardial infarction is an important advance in patient care. The intravenous administration of tissue plasminogen activator appears to be the most promising combination of route and agent but may need to be coupled with more definitive measures. Although the prehospital use of thrombolysis is largely unexplored, the interhospital use appears to be safe and effective. The administration of thrombolytic therapy must be a coordinated effort between the emergency physician and the cardiologist. Indications for thrombolytic therapy are still evolving and adverse effects will no doubt increase in incidence once the availability and use of effective thrombolytic agents is widespread. The emergency physician, especially, needs to tread the fine line between "minutes are myocardium" and "haste makes waste."
History and emergency medicine.
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The acute abdomen and Murphy's signs.
The history of the acute abdomen describes a shift from emphasis on prognosis to treatment through correlation of clinical and pathological findings. John B. Murphy was an acclaimed leader of American surgery whose name is associated with several diagnostic maneuvers used in the evaluation of the acute abdomen. These include deep-grip palpation used in examination for suspected biliary disease.
Time to be a room again?
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Abdominal ultrasound.
Abdominal ultrasound is an extremely useful diagnostic tool in the evaluation of the patient with abdominal symptoms. Its advantages include its being noninvasive, portable, and not requiring the use of radiographic contrast material. Sonography has great utility in the diagnosis of abdominal aortic aneurysm. For purposes of diagnosing ectopic pregnancy, ultrasound is best used in conjunction with beta-HCG radioimmunoassay. With respect to the patient with right upper quadrant abdominal pain, ultrasonic scanning has become the method of choice for visualizing the gallbladder and identifying cholelithiasis. The choice of ultrasound for demonstrating urinary obstruction due to ureterolithiasis is somewhat more controversial. Its use should particularly be considered in patients to whom the administration of radiographic contrast material is inadvisable.
Verapamil in the treatment of ventricular tachycardia.
Verapamil, the drug of choice for conversion of most cases of paroxysmal supraventricular tachycardia, has also displayed some efficacy in the treatment of ventricular tachycardia. A case in which the administration of intravenous verapamil resulted in conversion of ventricular tachycardia to sinus rhythm is presented. Experimental and clinical studies of verapamil in the treatment of this arrhythmia have revealed markedly variable results. Verapamil does not appear to be consistently effective in converting ventricular tachycardia. It has, however, demonstrated utility in some instances, especially in cases resistant to more traditional therapeutic agents, as well as relatively unusual forms of ventricular tachycardia. Verapamil may be most effective in suppressing ventricular tachycardia initiated by certain mechanisms.
Elective diagnostics in the emergency department.
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Henry Heimlich: a life-saving maneuver for food choking.
Since Henry Heimlich's description of a method for relieving food choking was presented, the management of foreign body upper airway obstruction has been enveloped in controversy. The major point of contention has been the approval by the American Red Cross and American Heart Association of the chest thrust and back blows, techniques that Heimlich considered inferior and dangerous. The body of clinical data regarding choking is largely retrospective and anecdotal. There have been few experimental physiologic studies. Most studies have found airway pressures generated by back blows to be higher than those produced by chest or abdominal thrusts. However, chest and abdominal thrusts produce their effects over a more sustained time period.
Abraham Colles: fracture of the carpal extremity of the radius.
Colles' fracture of the wrist is among the most common bony injuries encountered in emergency practice, and accounts for 10% to 20% of all fractures. Described in an excellent clinical treatise some 8 decades before the advent of radiographs, this fracture of the distal radius continues to pose a source of some disability to large numbers of patients. Complications include residual deformity, loss of mobility, median and ulnar nerve injury, shoulder-hand syndrome, and rupture of the extensor pollicis longus tendon. Although encountered in patients of either sex and in all age groups, this injury classically affects postmenopausal women, who are predisposed to it as a consequence of osteoporosis. The technique of immobilization appears not to be as important in influencing final outcome as does the precision of reduction.
Lumbar puncture.
Lumbar puncture has been in widespread clinical use for nearly a century. It is used in emergency medicine primarily as a tool for the diagnosis of meningoencephalitis and subarachnoid hemorrhage. The development of computed tomography has changed the position that lumbar puncture has held in the diagnostic sequence of a number of clinical entities. The procedure is contraindicated if there is soft-tissue infection adjacent to the puncture site and if there are findings of increased intracranial pressure due to a mass lesion. Performance in the setting of a coagulopathy may also be hazardous. The most serious potential complication is cerebral herniation. The commonest complication is postlumbar puncture headache, which is due to CSF hypotension resulting from persistent spinal fluid leakage through the meningeal puncture site. Spinal hematoma, diplopia, and intraspinal dermoid tumor formation are less common complications. Meningitis has been found to follow lumbar puncture in children with bacteremia. The lumbar puncture is a useful test for providing information regarding the cellular, chemical, and microbiologic composition of the CSF. Fluid obtained should be evaluated for cell count, Gram's stain, bacterial culture, glucose and protein levels, and other tests as clinically indicated.
Dermatitis.
Dermatitis, the inflammatory response of the skin to various factors, may present in a variety of forms. Atopic dermatitis, contact dermatitis, nummular eczema, seborrhea, and stasis dermatitis, conditions with which the patient may present to the emergency department, either in the acute stage or with exacerbation of a chronic condition, are reviewed in this article.
Ivan Magill: forceps for intratracheal anesthesia.
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