Biomedical subjects
J E Schunk
Publications and source records attributed to J E Schunk.
Felbamate overdose: a case report and discussion of a new antiepileptic drug.
Felbamate was approved in July 1993 for use alone or in combination with other antiepileptic drugs for partial seizures and Lennox-Gastaut syndrome. We report an overdose of felbamate in a teenage female patient who, in a suicide gesture, ingested eight times her maximum dose and suffered only mild side effects. This first report of a felbamate overdose is presented and followed by a discussion of felbamate's effectiveness, pharmacology, adverse effects, and drug interactions.
Fluoroscopic foley catheter removal of esophageal foreign bodies in children: experience with 415 episodes.
OBJECTIVE: This study sought to investigate the safety and efficacy of the fluoroscopic Foley catheter technique (FFCT) for removal of esophageal foreign bodies (EEBs) in children, and to identify factors associated with decreased success. DESIGN/SETTING/PATIENTS: An 11-year retrospective review of all pediatric patients undergoing the FFCT for removal of EFBs at a tertiary-care children's hospital was performed. RESULTS: Four-hundred and fifteen cases are reported. The median age was 29 months (range, 4 to 193); children < or = 24 months accounted for 45% (185) of the cases. Of all episodes 86% (355) involved children without known esophageal pathology. Coins comprised 76% (316) of the EFBs. The FFCT was successful in 91% (378) of the cases. In the 60 episodes involving children with underlying esophageal pathology, the technique had an 83% success rate compared to 92% in children without known pathology (P < .05). There were 290 patients where the duration of impaction was known. The success rate was 96% if the duration was 3 days or less compared to 50% if the duration was longer (P < .0001). Though the overall success in children < or = 24 months was less than older children (88% vs 94%, P < .05), this effect disappeared when corrected for duration of impaction. Minor complications occurred in 2% of the episodes, and major complications were noted in 1%. CONCLUSIONS: The FFCT appears to be a safe and effective method for removal of EFBs especially in children without underlying esophageal lesions and a duration of impaction < or = 3 days. Major complications are rare.
What dose of epinephrine is being used in pediatric resuscitation? Results of a survey.
Standard-dose epinephrine (SDE) currently recommended by the American Heart Association for pediatric resuscitation is 0.01 mg/kg (0.1 ml/kg of 1:10,000 solution). SDE has come under increasing scrutiny; many authors suggest that this dose is too small. We sought to determine current epinephrine dosing practices among physicians practicing pediatric emergency medicine. Half of the members of the American Academy of Pediatrics Emergency Medicine section, selected randomly, were surveyed by a mailed questionnaire. After two mailings, 105 of 162 surveys (65%) were completed by members in practice. Of the 105 responders, 59% described their practice as "pediatric emergency medicine"; 17% as "emergency medicine (children and adults)"; 10% as "general pediatric practice or clinic"; 10% as "critical care"; and 5% as "other." Fifty-one (49%) had completed fellowship training, and 81 (77%) were either PALS or APLS instructors (referred to as "instructors" below). Overall, 72% (76/105) indicated that they use doses larger than SDE. Sixty-five of these (86%) described their dosing practice as "recommended dose initially, then larger dose." Twenty-one percent use SDE less than half of the time, and 16% use a dose 10 to 20 times larger at least half of the time. No responder used doses smaller than SDE. Instructors were more likely to use larger doses than were noninstructors (83% compared with 38%; P < 0.001). In the instructor group, a significantly larger dose was being taught "informally" than "formally" (P < 0.001). This survey was undertaken to determine current dosing practices by a group of physicians who are knowledgeable and experienced in pediatric resuscitation, not to resolve the question of the optimal dose of epinephrine.(ABSTRACT TRUNCATED AT 250 WORDS)
The pediatric patient with altered level of consciousness: remember your "immunizations".
Explore the source record for details and available documents.
Trampolines revisited: a review of 114 pediatric recreational trampoline injuries.
A search of the medical literature failed to reveal any articles that discuss pediatric injuries acquired on privately owned recreational trampolines. This study was undertaken to quantify and qualify pediatric injuries from recreational trampoline use. A group of 114 patients who presented to the Emergency Department at Primary Children's Medical Center in Salt Lake City, Utah, with injuries directly related to use of a trampoline are discussed. There was a 1.2:1 male-female ratio. The average age was 8.0 years. Forty-eight percent of the patients were injured on their family's trampoline, with the remainder injured on a friend's, neighbor's, relative's, or gymnasium's equipment. The majority of injuries involved group use of the trampoline and the youngest person in a group was most often the injured participant. Extremity injuries were seen in 55% of the patient and head or neck injuries in 37%. Seventy-five percent of the patients required radiographs, 23% hospitalization, and 17% operative intervention. The history of the trampoline and medical literature discussions concerning injuries and safety are reviewed.
Radial head subluxation: epidemiology and treatment of 87 episodes.
Radial head subluxation is a frequent upper-extremity injury in children. Through a prospective study of patients seen in the emergency department, the epidemiology and treatment were reviewed, and two methods of reduction were compared. During a nine-month period, there were 87 episodes of radial head subluxation in 83 children with six cases in infants 6 months old or younger. A pull mechanism of injury was not identified in 49% of the cases. Girls were seen more often than boys, the left arm was more frequently involved, and the incidence of recurrence was 26.7%. The two reduction methods did not differ significantly in their initial success rate. The presence of a click during a reduction attempt had a positive predictive value of 92% and a negative predictive value of 76%. Most children (76.8%) had return of arm use in less than ten minutes. Slow return of arm use (more than ten minutes) was not associated with delay in reduction but was associated with age of less than 2 years (P less than .001).
Pediatric coin ingestions. A prospective study of coin location and symptoms.
Coins are the most common esophageal foreign body in children. We prospectively evaluated 52 consecutive children who had swallowed coins to determine the incidence of asymptomatic esophageal coins and the rate of spontaneous passage. All patients had a roentgenogram; coins were removed from the esophagus if the patient was symptomatic. children with asymptomatic esophageal coins were allowed less than 24 hours to pass the coin to the stomach. Thirty children had esophageal coins; of these, 9 (30%) were asymptomatic. The presence of symptoms was significantly associated with esophageal coins, but the absence of symptoms did not reliably exclude the possibility of an esophageal coin. All children who swallow coins should undergo roentgenographic evaluation.
Diphenhydramine toxicity from combined oral and topical use.
Explore the source record for details and available documents.
Cactus spine removal.
Explore the source record for details and available documents.
Drug-induced hemorrhagic cystitis.
A case of ticarcillin-induced hemorrhagic cystitis is presented, and the literature on drug-induced hemorrhagic cystitis is reviewed. A 12-year-old white boy with cystic fibrosis was hospitalized for an exacerbation of his pulmonary disease. Laboratory tests on admission showed an elevated white blood cell (WBC) count, 10-20 WBCs per high-power field (HPF) in urine, and normal BUN and serum creatinine. The patient was given ticarcillin i.v. (as the disodium salt) (final dosage of 320 mg/kg/day) in divided doses every six hours and netilmicin i.v. (as the sulfate salt) (final dosage of 4 mg/kg every eight hours). On day 7 the patient complained of painful urination, and urinalysis showed a 10-20 WBCs/HPF and 2-5 red blood cells (RBCs)/HPF. Two days later, the patient had gross hematuria, and urinalysis revealed 10-20 WBCs/HPF and 10-20 RBCs/HPF. Ticarcillin and netilmicin were discontinued and the patient's symptoms abated within 48 hours. Repeat urinalysis on day 11 showed no RBCs and 10-20 WBCs/HPF, with no casts or protein. Three months later, the patient was again hospitalized for an exacerbation of his cystic fibrosis. He was placed on tobramycin sulfate i.v. and ticarcillin i.v. (340 mg/kg/day). After the fourth dose of ticarcillin, the patient again complained of urinary pain and frequency and also reported gross hematuria. Urinalysis showed bacteria, 2-5 WBCs/HPF, and 5-10 RBCs/HPF; however, urine cultures were negative. Ticarcillin was discontinued and cefoxitin sodium i.v. was started. The patient's symptoms resolved within 36 hours, and a urinalysis on the fourth hospital day was normal.(ABSTRACT TRUNCATED AT 250 WORDS)
Mini-dose Bier block intravenous regional anesthesia in the emergency department treatment of pediatric upper-extremity injuries.
The safety and effectiveness of the "mini-dose" Bier block, a technique of i.v. regional anesthesia using low-dose lidocaine (1.5 mg/kg) without routine premedication, was evaluated in the emergency department treatment of pediatric upper-extremity fractures and dislocations. We prospectively studied 69 patients, aged from 2 to 16 years, treated at a pediatric primary care/referral-based emergency department. Good to excellent anesthesia was achieved during closed reduction in 90% of the cases. All patients achieved an acceptable reduction, as demonstrated by follow-up radiographs. None required further treatment of the injury under general anesthesia. No significant complications were noted. We conclude that the mini-dose Bier block provides safe, reliable, and cost-effective anesthesia for the outpatient reduction of pediatric upper-extremity injuries.