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Biomedical subjects

J L Falk

Publications and source records attributed to J L Falk.

151 records · Page 9Linked to original sources
PubMedDate not supplied

Chronic alcohol dependence and water-electrolyte status.

Altered water-electrolyte status resulting from chronic alcohol dependence has been reported, although the nature of any such derangement is controversial. To illuminate this problem, four groups of rats were exposed chronically to schedule-induced polydipsia conditions with a single fluid available: 5% ethanol, 0.9% NaCl solution of 5% ethanol, 0.9% NaCl solution, or distilled water. An ad lib control group was also used. The water-electrolyte status of these groups was evaluated in two ways. First, the diuretic response to hydrochlorothiazide doses (8-12 mg/kg) was measured after 3.5 months of chronic polydipsia. Second, after approximately two additional months of polydipsia, extracellular fluid volume, as well as plasma volume and electrolytes were measured. Both alcohol-intake groups drank approximately 11.5 g ethanol/kg/day over the course of the experiment. Urinary volume response to the diuretic agent did not reveal that chronic ethanol led to either water retention or dehydration, even when extra NaCl intake was imposed chronically (NaCl-EtoH group). Animals that were overdrinking either water or the 0.9% NaCl solution had extracellular fluid volumes that were greater than the NaCl-EtOH-polydipsic group, but they were not significantly larger than ad lib controls. There were no significant differences with respect to serum electrolyte concentration measures among the groups. In conclusion, animals that drank ethanol chronically in a pattern known to produce physical dependence revealed no altered water-electrolyte status when evaluated by acute responses to a diuretic agent, a chronically-imposed extra NaCl load, or body fluid compartment and electrolyte concentration measures.

Alcohol Drinking↗
PubMedDate not supplied

Preference history prevents schedule-induced preferential ethanol acceptance.

Two groups of rats were given differential schedule-induced polydipsia histories. One had a history of choosing between 5% ethanol and 0.7% glucose solution (dilute, mildly acceptable), in daily, 3-hr, fixed-time 1-min schedules of food-pellet delivery, while the other similarly treated group chose between 5% ethanol and 5% glucose (highly acceptable). A 30-day period, wherein only 5% ethanol was available during daily sessions, intervened before session-fluid preferences were evaluated by pitting a series of glucose solutions of increasing concentration (0.7-5.0%) against 5% ethanol. The group which had a remote history of having chosen 5% glucose solution in preference to 5% ethanol imbibed less 5% ethanol during the series of glucose-ethanol acceptability preference tests. Hence, they were less vulnerable to a continuance of their ethanol overindulgence than the group with the remote history of having chosen 5% ethanol over the dilute glucose solution.

Alcohol Drinking↗
PubMedDate not supplied

Confirmation of airway placement.

Proper airway management in the prehospital setting is essential. Recent data from Orange County, Florida, suggest that the problem of misplaced endotracheal tubes may be greater than previous studies have indicated. Strong medical direction, strict protocols, and active continuous quality improvement programs are needed to ensure that paramedics learn the correct techniques of endotracheal intubation, and that they verify tube placement with an end-tidal carbon dioxide monitor, and maintain ongoing monitoring of tube placement during transport.

Algorithms↗
PubMedDate not supplied

Infrared tympanic thermometry in the evaluation of pediatric acute otitis media.

OBJECTIVE: The reliability of infrared tympanic thermometry (ITT) in children and the effect of acute otitis media (AOM) on ITT are unsettled. This study assessed the effect of AOM on ITT and the utility of ITT in the diagnosis of AOM. METHODS: 520 consecutive children, aged 6 months to 6 years, presenting to the ED of an urban teaching hospital were eligible for this prospective observational study. Nurses recorded oral or rectal reference temperatures (RefTs) and bilateral ITT temperatures upon presentation. Emergency physicians were blinded to the ITT temperatures. AOM was diagnosed according to published clinical criteria. RESULTS: Among 520 patients, 108 had unilateral AOM and 78 had bilateral AOM. In patients with unilateral AOM, the infected ears were warmer (I = 100.4 +/- 1.8 degrees F) than the uninfected ears (U = 100.3 +/- 1.8 degrees F, p = 0.035). However, the disparity in TM temperatures in infected and uninfected ears with unilateral AOM (I - U = 0.2 +/- 0.9 degrees F) was similar to the difference between right and left ears in those without AOM (R - L = 0.1 +/- 0.8 degrees F, p = 0.60). Compared with patients without AOM, patients with AOM demonstrated no significant elevation of ITT temperatures over RefTs (I - RefT = -0.8 +/- 1.2 degrees F in AOM; ITT - RefT = -0.8 +/- 1.2 degrees F in non-AOM; p = 0.94). This study had >99% power to detect a 1.0 degrees F difference for all groups compared. CONCLUSIONS: Infrared tympanic temperature are not helpful in diagnosing AOM in children. AOM has little direct effect on ITT temperatures.

Acute Disease↗
PubMedDate not supplied

Colloid and crystalloid fluid resuscitation.

The choice of colloid or crystalloid solutions for fluid resuscitation of critically ill patients remains controversial. Marked reduction of extracellular water is considered an important defect in shock by proponents of crystalloid fluid therapy. Large volumes of crystalloid replenish this extracellular deficit. Hypovolemia is regarded as the primary defect in shock by those favoring colloid fluid therapy. Colloidal fluids promptly restore plasma volume and reestablish hemodynamic stability with substantially lesser volumes of fluid. However, only 8% of infused water and less than 25% of infused saline are retained in the intravascular fluid compartment after 1 h. On the other hand, almost the entire volume of iso-oncotic colloid is retained with the intravascular space after 1 h. Hypertonic saline decreases intracellular fluid volume. Hyperoncotic colloid decreases both interstitial and intracellular fluid volumes as it disproportionately expands intravascular volume. The choice of fluid is not only contingent on the restoration of intravascular volume, the rapidity with which it is accomplished and the duration of its effect, but also on the adverse effects that follow fluid resuscitation. This is of greatest moment in the fluid resuscitation of patients in whom circulatory shock follows volume depletion. Crystalloid fluid repletion which requires between 2- and 4-fold as much volume as colloidal fluid is of little risk in the young, traumatically injured patient. However, in older patients, the risk of pulmonary edema is increased.

Albumins↗