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Biomedical subjects

J W Odom

Publications and source records attributed to J W Odom.

16 recordsLinked to original sources
PubMed1997

Utilization of Special Forces medical assets during disaster relief: the Hurricane Andrew experience.

Special Forces units and their innate assets are presented as the ideal first-response unit to natural disasters due to their breadth of skill, speed of response, and ability to work independently in remote areas. "Green Beret" soldiers are particularly suited to work under the most extreme hardships, with little or no supervision, and can demonstrate tremendous amounts of initiative and creativity in unique and changing situations. The compact, versatile, and adaptable detachments of which Special Forces Groups are composed can serve as vital resources in humanitarian and disaster relief operations as well as in combat.

Disaster Planning↗
PubMed1994

Surgical prophylaxis for pulmonary embolism.

The trauma patient population is at special risk for fatal pulmonary embolism. We experienced 11 fatalities in one 12-month period. Specific risk factors for both deep venous thrombosis and pulmonary embolism can be identified among trauma patients. The latter usually cannot be offered prophylactic anticoagulation, and the nature of their injuries (e.g., long bone fractures) makes not only bedside surveillance difficult but also precludes use of pneumatic compression, etc. We have developed a protocol for prophylactic inferior vena caval filtration for our trauma patients deemed at particular risk for pulmonary embolism. Since 1986 we have inserted 205 Greenfield filters in 201 patients. Two hundred were inserted prophylactically. There was no mortality, and morbidity was minimal. No patient with a Greenfield filter sustained a fatal pulmonary embolism during this period. Four patients died from pulmonary embolism before vena caval filters could be inserted. We believe that the trauma patient, at risk for pulmonary embolism, should be offered a Greenfield filter prophylactically as soon after hospitalization as logistically possible.

Adult↗
PubMed1993

Primary hyperparathyroidism secondary to parathyroid carcinoma: report of a case.

Distinguishing parathyroid carcinoma from benign hyperparathyroidism is often difficult. Clinical features most commonly associated with parathyroid carcinoma, such as palpable cervical mass, markedly higher serum calcium, high parathyroid hormone immunoassay, and evidence of bone disease may not be present. Therefore, intraoperative recognition is essential. We report a case in which the presenting symptoms, physical examination, and laboratory analysis were consistent with benign disease. During surgery, the finding of an enlarged firm gland with surrounding inflammatory reaction altered the approach to include the possibility of parathyroid carcinoma. The gland and surrounding tissue were removed, and pathologic examination led to the diagnosis of carcinoma. At 18-month follow-up, the patient was free from recurrence. Any parathyroid gland with a gray appearance, firm texture, and surrounding inflammatory reaction should be treated as carcinoma. Initial intraoperative recognition offers the best chance for cure, since local recurrences are rarely curable.

Carcinoma↗
PubMed1992

Cost containment in the operating room: use of reusable versus disposable clothing.

The need for fiscal austerity has prompted the re-evaluation of many aspects of medical care. Recent events in the northeastern United States have caused an increased awareness of the need for environmental responsibility as well. With these considerations in mind, the costs incurred by the operating suites of two comparable teaching hospitals in New Jersey, one of which uses disposable operating room attire, were examined; the other employs reusable scrub suits and gowns. The reusable scrub suits and gowns resulted in a savings in excess of $100,000 compared to the center using disposables. The authors conclude that hospitals should re-evaluate their use of disposable operating room attire to reduce operating costs and the amount of medical waste generated.

Cost Savings↗
PubMed1992

Tropical pyomyositis.

Although rare, tropical pyomyositis can result from staphylococcal bacteremia and should be considered in the different diagnosis of fever associated with extremity pain. The diagnosis is readily made with a CT scan. Treatment is primarily medical with surgery reserved for refractory abscesses.

Abscess↗
PubMed1991

Resuscitative thoracotomy and combat casualty care.

Over the past few years, the indications for resuscitative thoracotomy in civilian trauma have been refined. The use of this procedure for military casualities has received only brief mention. We have described our experience with 93 consecutive thoracotomies performed in a level I trauma center and have attempted to better define the indications for this procedure in military medicine.

Adolescent↗
PubMed1990

Successful CPR in a severely hypothermic patient using continuous thoracostomy lavage.

Severe hypothermia with cardiopulmonary arrest often requires prolonged resuscitation while rewarming procedures are implemented. A 63-year-old male in cardiopulmonary arrest with a core body temperature of 23.7 C was resuscitated successfully after core rewarming by means of a two-chest-tube continuous thoracostomy lavage procedure. This lavage procedure resulted in effective and rapid rewarming after other conventional rewarming methods had failed.

Body Temperature↗
PubMed1990

Evaluation of an end-tidal carbon dioxide detector in the aeromedical setting.

Endotracheal intubation is a lifesaving technique performed by flight crews often under difficult circumstances. Inadvertent unrecognized esophageal intubation is reported to occur up to 8% of the time. Recently a new disposable device has been developed to assist in determining proper endotracheal tube placement. The FEF end-tidal carbon dioxide detector (Fenem Co.) was evaluated in this study. From June 1989 to January 1990, all patients intubated or transported with endotracheal tubes in place by LifeStar, helicopter Emergency Medical Service, had the FEF detector positioned on the endotracheal tube. Flight crews continuously monitored changes in the indicator of the FEF during transport. On arrival to the emergency department, tube position was verified with direct laryngoscopy by an emergency department physician or trauma surgeon. Thirty-five patients were entered into the study. Thirty-four were identified by direct laryngoscopy as having proper placement of the their endotracheal tube and one was found to be intubated in the esophagus. The FEF device properly identified the single esophageal intubation and accurately identified proper position of the endotracheal tube in thirty-two patients. Of the three patients in cardiopulmonary arrest, the FEF device was accurate in detecting tube position in each case. The overall sensitivity of the FEF detector in this aeromedical setting was 94%. Specificity was calculated as 100%. The overall positive predictive value of the FEF detector was 100%. We therefore conclude that indication of a tracheal intubation by the FEF detector is reliable after six breaths in the aeromedical setting and advocate its use as an adjunct for monitoring tube position while in flight.

Aircraft↗
PubMed1989

A modified percutaneous endoscopic gastrostomy.

We believe the procedure described herein overcomes the disadvantages of percutaneous endoscopic gastrostomy in that intraperitoneal leakage of gastric contents is prevented and injury to adjacent organs is obviated. At the same time, the desirable qualities of percutaneous endoscopic gastrostomy are retained. So far, the operation has been performed safely and quickly upon four patients who have had no morbidity or mortality.

Evaluation Studies as Topic↗
PubMed1989

The incidence of intra-abdominal surgery in acquired immunodeficiency syndrome: a statistical review of 904 patients.

This communication concerns the incidence of intra-abdominal surgery in 904 patients with acquired immunodeficiency syndrome who were admitted to the Cabrini Medical Center during a 3-year period from January 1985 to January 1988. It was found that 36, or 4.2%, of the patients underwent surgery, including 12 cholecystectomies, 7 splenectomies, 7 appendectomies, 6 laparotomies, and 6 other operations for miscellaneous conditions. It was pointed out that the high incidence of inflammatory involvement of the gallbladder, appendix, and intestines in AIDS patients was in all probability due to the nature of the blood supply to these organs. All receive blood from terminal arteries or vessels with few anastomoses, and therefore when vasculitis ensues it is often followed by gangrene or ulceration of mucosal surfaces. Surgical intervention was deemed advantageous for those patients with splenomegaly and accompanying pancytopenia, acute appendicitis, and lesions of the gastrointestinal tract, but not for those with cholecystitis. The high postoperative mortality rate, 22.2%, was attributed primarily to the immunodeficient state of the patients rather than to complications of their surgery.

Abdomen↗
PubMedDate not supplied

Airway control in trauma patients with cervical spine fractures.

INTRODUCTION: Proper airway control in trauma patients who have sustained cervical spine fracture remains controversial. PURPOSE: This study was undertaken to survey the preferred methods of airway management in cervical spine fracture (CSF) patients, to evaluate the experience of handling such patients at a level-I trauma center, and to contrast the findings with recommendations of the American College of Surgeons Committee on Trauma. HYPOTHESIS: The methods used for control of the airway in patients with fractures of their cervical spine support the recommendation of the American College of Surgeons (ACS) Committee on Trauma. METHODS: The study consisted of two parts: 1) a survey; and 2) a retrospective study. Survey questionnaires were sent to 199 members of the Eastern Association for the Surgery of Trauma and to 161 anesthesiology training programs throughout the United States. Three resuscitation scenarios were posed: 1) Elective airway--CSF--breathing spontaneously, stable vital signs; 2) Urgent airway--CSF--breathing spontaneously, unstable vital signs; and 3) Emergent airway--CSF--apneic, unstable. In addition, a three-year retrospective study was conducted at a level-I trauma center to determine the method of airway control in patients with cervical spine fractures. RESULTS: Responses to the questionnaires were received from 101 trauma surgeons (TS) and 58 anesthesiologists (ANESTH). Respondents indicated their preference of airway methods: Elective airway: Nasotracheal intubation: TS 69%, ANESTH 53%. Orotracheal intubation: TS and ANESTH 27%. Surgical airway: TS 4%. Intubation with fiberoptic bronchoscope (FOB): ANESTH 20%. Urgent airway: Nasotracheal intubation: TS 48%, ANESTH 38%. Orotracheal intubation: TS 47%, ANESTH 45%. Surgical airway: TS 4%. FOB: ANESTH 16%. Emergent airway: Orotracheal intubation: TS 81%, ANESTH 78%. Surgical Airway: TS 19%, ANESTH 7%. FOB: ANESTH 15%. The retrospective review at the trauma center indicated that 102 patients with CSF were admitted; 62 required intubation: four (6%) on the scene, seven (11%) en route, five (8%) in the emergency department, 42 (67%) in the operating room, and four (6%) on the general surgery floor. Airway control methods used were nasotracheal: 14 (22%); orotracheal: 27 (43%); FOB: 17 (27%); tracheostomy: one (2%); unknown: three (4%). No progression of the neurological status resulted from intubation. CONCLUSION: The choice of airway control in the trauma patient with CSF differs between anesthesiologists and surgeons. However, the method selected does not have an adverse affect on neurological status as long as in-line stabilization is maintained. The methods available are safe, effective, and acceptable. The recommendations of the American College of Surgeons Committee on Trauma for airway control with suspected cervical spine injury are useful. The technique utilized is dependent upon the judgment and experience of the intubator.

Anesthesiology↗