Biomedical subjects

K L Wallace

Publications and source records attributed to K L Wallace.

24 records · Page 2Linked to original sources

PubMed1993

Expediting the early hospital care of the adult patient with nontraumatic chest pain: impact of a modified ED triage protocol.

A prospective study that compared a traditional emergency department (ED) triage protocol with an expedited protocol was conducted to determine if minimizing the subjectivity of nursing triage would result in more efficient management of adult patients presenting with nontraumatic chest pain. The traditional protocol triaged 382 patients into 1 of 5 categories of acuity. The expedited study group (418 patients) were triaged as usual but subsequently were treated as if they were triage category 1 or 2 (medical evaluation within 15 minutes of arrival). Traditional triage led to 40% of acute myocardial infarction (AMI) patients being triaged into inappropriately low-acuity categories. The expedited protocol resulted in significant improvement in the following intervals: ED arrival to triage, triage to cubicle, ED arrival to cubicle, ED arrival to electrocardiogram (ECG) ordered, ED arrival to ECG available, ED arrival to physician evaluation, and ED arrival to decision to thrombolyse. Study patients with non-AMI cardiac chest pain and AMI cardiac chest pain were evaluated by a physician an average of 12 minutes and 8 minutes after ED arrival, respectively. Delays in interdepartmental processes, such as ECG-technician responsiveness, thrombolysis protocol fulfillment and thrombolytic agent delivery, negated benefits derived from improvements in internal processes. Effective coordination of the numerous processes involved in the initial ED management of adult patients with nontraumatic chest pain is required to make thrombolytic therapy for AMI within 30 minutes of patient arrival a routinely achievable goal.

Adult↗

PubMed1991

Relevant factors in the identification of hearing loss.

This study examined factors which may affect early identification of hearing loss. The medical records of 123 children with educationally significant hearing impairment were examined. Information about each child's degree and type of hearing loss, etiology, referral source, birth and medical history, additional handicaps, age of suspicion of loss, mode of identification, age of identification, and age at which aided was entered into a database for further analysis. The age range for identification was 7 weeks to 10 yr, with a median age of 2.1 yr. Children with a greater degree of hearing loss, an additional handicap, additional medical conditions, or an etiology strongly associated with hearing loss were identified earlier than those without these factors. Unexpectedly, children with a history of middle ear dysfunction were identified no later than those without, and children with a positive family history of hearing loss were identified later than those with a negative family history. These results agree with other studies which show that, in general, children are identified and habilitated at a later age than that recommended by both the American Speech-Language-Hearing Association Committee and the Joint Committee on Infant Hearing.

Age Factors↗

PubMed1990

Blunt aortic trauma: signs of high risk.

In the last 10 years, our center has managed 60 cases of aortic rupture from blunt chest trauma. Nineteen patients died (32%), 11 of whom were moribund on admission. Two patients out of ten who had undergone aortography at other institutions arrived at our hospital with massive bleeding in the left chest and died despite immediate operation. Six patients exsanguinated 1 to 2 1/2 hours after admission while aortography was being arranged or performed, and review of these cases to identify clinical signs of high risk revealed that left hemothorax, pseudocoarctation, and/or supraclavicular hematoma were present in five of the six. It appeared that the survival rate of patients suspected of blunt aortic trauma who had any of these clinical signs might be improved if they were taken directly to the operating room. To investigate this possibility we reviewed all cases from the past 10 years (excluding patients moribund on arrival or who had aortography elsewhere) in whom suspicion of aortic trauma led to aortography or surgery. Thirteen of the 17 patients (76%) with one or more signs of high risk had torn the aortic isthmus, compared to 26 of 154 patients (17%) without these signs. Five of the high-risk group (29%) exsanguinated, compared to one (less than 1%) of the others. No patient in this series died from unsuspected aortic trauma, which we attribute to the liberal use of aortography. Except for the patients with exsanguinating hemorrhage preoperatively, there were no operative or postoperative deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1987

Hepatic vein bullet embolus as a complication of left thoracic gunshot injury.

The case of a patient with a hepatic vein bullet embolus complicating a left ventricular gunshot injury is described. The patient presented hypotensive with a left midaxillary entrance wound. Initial radiographs showed a bullet fragment below the right hemidiaphragm. Emergency open thoracotomy was performed with release of a tense pericardial effusion and repair of a left ventricular penetrating wound. Surgical exploration failed to reveal direct penetrating injury to the diaphragm or abdominal viscera. After a hepatic venogram localized the bullet fragment in a branch of the right lobe hepatic vein, a periscopically directed catheter extraction of the fragment was successfully performed. A discussion of missile embolization, its pathology, clinical presentation, diagnosis, and management is presented.

Adult↗

PubMedDate not supplied

Reduced placental perfusion causes an increase in maternal serum leptin.

OBJECTIVE: We tested the hypothesis that the inadequately perfused placenta increases production of leptin, which can be detected in maternal serum. STUDY DESIGN: Sprague-Dawley rats (n=13), on day 14 of gestation, had placement of clips on the aorta and the ovarian arteries providing 35 per cent occlusion of the vessels. Eight rats had sham surgery and 14 rats served as non-surgical controls. All animals were sacrificed on day 19 of gestation. Maternal serum was obtained, and pups and placentae were weighed. RESULTS: Both placental weights and pup weights were reduced due to reduced uterine perfusion and were negatively correlated with maternal serum leptin (P=0.018 and 0.028, respectively). Maternal serum leptin was increased in the treatment group (2.21 ng/ml+/-64 ng/ml) compared to controls (1.66 ng/ml+/-38 ng/ml) (P=0.031). CONCLUSIONS: Our findings suggest that reduced placental perfusion results in an increase in maternal serum leptin. Further investigation is needed to determine if maternal serum leptin may be useful in identifying pregnancies with uteroplacental insufficiency.

Animals↗

PubMedDate not supplied

Self-inflicted burn injuries: an 11-year retrospective study.

The burns unit at the Royal Brisbane Hospital accepted a total of 2275 admissions from 1986 to 1996. During this 11-year period, 65 cases of self-inflicted burn injury were treated, which made up 2.9% of the total number of admissions. A mortality rate of 21.5% (14 patients) is noted, with all patients dying after admission to the hospital. A common feature of people that self-inflict burn injuries is a psychiatric history, with many patients having histories of self-harm or suicide attempts. Two distinct groups were identified--those with suicidal intent and those with intent of self-harm. Those patients with self-inflicted injuries have an increased mean of 31.4% total body surface area burned as compared with those patients whose injuries are accounted for as accidental, which have a mean total body surface area burned of 10%. Additionally, the mean length of stay in the hospital for patients with self-inflicted injuries was 40 days for acute injuries, which is prolonged; the mean length of stay for acute injuries that were not self-inflicted was 14 days. This investigation discovered 3 cases of repeated self-inflicted burn injury.

Adult↗