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Biomedical subjects

K V Iserson

Publications and source records attributed to K V Iserson.

At least 91 records · Page 5Linked to original sources
PubMed1987

Hepatitis B and vaccination in emergency physicians.

The seroprevalence of hepatitis B virus (HBV) markers in emergency physicians has been shown to be approximately 13%, roughly three times the prevalence in the general population. Frequent contact with blood and body secretions of potentially infectious patients undoubtedly is a major factor in the increased seroprevalence and risk of hepatitis B. The potential sequelae of HBV infection include chronic active hepatitis, cirrhosis, primary hepatocellular carcinoma, and development of the chronic carrier state, any of which may have a devastating impact on the personal health and professional career of the emergency physician. A vaccine against hepatitis B has been available since 1982 and has been found to be effective in approximately 90% of vaccinees. The vaccine is generally well tolerated; the most common side effects are reactions at the injection site, although systemic side effects may occur. The risk of serious illness due to the vaccine is very low. Using a risk/benefit analysis to assess the risks of hepatitis B and the risks and benefits of HBV vaccination, it is clear that HBV vaccination should be accepted by the emergency physician to minimize the risk of contracting hepatitis B.

Adult↗
PubMed1987

The origins of the gauge system for medical equipment.

The gauge system for sizing medical catheters and equipment is used widely around the world. Yet both its origins and its interpretation, in terms of conventional measurements, have long been obscure. The gauge, formally known as the Stubs Iron Wire Gauge, was developed in early 19th century England. Developed initially for use in wire manufacture, each gauge size arbitrarily correlates to multiples of .0010 inches. This sizing system was the first wire gauge recognized as a standard by any country (Great Britain, 1884). It was first used to measure needle sizes in the early 20th century. Today it is used in medicine to measure not only needles, but also catheters and suture wires. However, owing to the potential confusion inherent in using a gauge system, the iron wire gauge is rarely used in manufacture of nonmedical equipment.

Catheterization↗
PubMed1987

Use of the emergency department for hypertension screening: a prospective study.

There is controversy as to whether the emergency department is an inappropriate site for screening for hypertensive patients. The pain and apprehension associated with many ED visits have been thought to elevate blood pressure readings falsely in this setting. To resolve this question, all patients admitted to the ED of a university hospital during a one-year period were screened prospectively for hypertension. Follow-up was attempted for patients who, on admission and discharge, had systolic pressures higher than 159 mm Hg or diastolic pressures higher than 94 mm Hg. A total of 239 patients met these criteria, and follow-up was obtained in 45% of the cases. Significant hypertension (systolic greater than 159 mm Hg or diastolic greater than 94 mm Hg) was found in 35% of these patients on follow-up. Borderline hypertension (systolic, 140 to 159 mm Hg; or diastolic, 90 to 94 mm Hg) was documented in 33% of the patients. Thirty-two percent were found to be normotensive when evaluated in a follow-up visit. The number of patients experiencing pain at the time of their initial ED visit was similar among the three groups. Almost half the patients with hypertension on follow-up needed further workup or therapy. The ED can be a useful screening site for hypertension; elevated blood pressure on discharge should ensure referral for follow-up evaluation and therapy.

Adult↗
PubMed1987

Comparison of four ankle splint designs.

Plaster splinting is often considered the initial immobilization method for acute ankle injuries. Although the posterior splint design is most commonly recommended, clinical experience suggests that it is not the most durable in the outpatient setting. To determine the sturdiness of the four most common splint designs, each was tested for its resistance to plantar flexion 30 minutes after application. The splints tested were: standard posterior, ridged posterior, modified figure-of-eight, and sugar-tong. In six healthy subjects, significantly less plantar flexion was achieved with the sugar-tong splint than with the other designs. In addition, more force was generated per degree of plantar flexion achieved with the sugar-tong than with the other designs. These results suggest that the sugar-tong splint may be preferred in the acute treatment of ankle injuries based on its greater strength.

Ankle Injuries↗
PubMed1987

Admixture bloodwarming: a technique for rapid warming of erythrocytes.

Admixture of erythrocytes (packed red blood cells) with heated saline solutions may provide a faster and safer method of bloodwarming and infusion than is currently available. We developed and tested such a system for ease and efficacy. One-day-old aliquots of erythrocytes (6 to 10 C) were combined with equal amounts of saline that had been heated to a temperature of 50 or 60 C. After this rapid admixture, equilibrated temperatures were 29.1 and 34.0 C, respectively. The procedure also was performed using 35-day-old erythrocytes and 60-C saline. Samples were obtained for analysis immediately after admixture. There was no significant plasma hemoglobin elevation, indicating no significant hemolysis, in any sample at either temperature. Rapid admixture bloodwarming appears to be a technique in which erythrocytes and heated saline may be combined rapidly without causing significant hemolysis. However, further studies of red cell function and survival will be needed before this technique should be put into clinical practice.

Blood Transfusion↗
PubMed1987

Rapid fluid replacement for severe hypovolemia--human subject trials.

Successful resuscitation of a hypovolemic patient often requires rapid intravenous administration of massive amounts of fluid. A new fluid system, incorporating a 14 French percutaneous catheter and a fluid reservoir, was recently developed and successfully tested in animals. We report the system's use in five patients with severe hypovolemia following trauma. In two cases, the experimental high-flow system successfully resuscitated the patients, allowing them to be transferred for further care. Problems associated with the use of the system included complications with central line placement and physician acceptance. This system offers an alternative that delivers these fluids in one line at rates above most current commercial systems.

Fluid Therapy↗
PubMed1986

Combined effect of catheter and tubing size on fluid flow.

Several studies have evaluated the effect of large-bore tubing and various intravenous (IV) catheters on rapid fluid resuscitation. This study combines available equipment, which has been demonstrated to increase IV flow rate, into a system. This system is then compared with one commonly used for IV fluid infusion in hypovolemic patients. The new system requires significantly less (P less than 0.0005) time for both drainage of fluid and changing of IV containers. The improvement in flow rate can be attributed to the use of a rapid inflation/deflation pneumatic pressure device instead of the conventional hand-pumped pressure bag and the decrease in resistance through both the large-bore IV tubing and 12-gauge catheter. The rapid manipulation of IV bags is made possible by the rigid structure and the rapid inflation/deflation ability of the external pump. The possibility of faster change of IV bags and an increase in flow rate make this system a practical tool in the treatment of severely hypovolemic patients.

Catheterization↗
PubMed1986

Topical anesthesia for laceration repair: tetracaine versus TAC (tetracaine, adrenaline, and cocaine).

Topical anesthetics have always had a place in anesthetizing mucous membranes. The earliest writing in Greek medical literature makes reference to the use of these topical anesthetizing agents. Previous studies utilized a mixture of tetracaine, Adrenaline, and cocaine in the pediatric population with increased patient compliance. In contrast, another study cites the increased risk of infection in cases where topical anesthetics in combination with potent vasoconstrictors are used. To examine the efficacy and safety of a tetracaine and a tetracaine, Adrenalin, and cocaine mixture (TAC), a randomized, double-blind study was undertaken. A total of 68 patients participated in the study, with 36 receiving TAC and 32 receiving tetracaine. The results indicate that the most efficacious use of TAC is on facial lacerations, regardless of length or depth. Of the 46 participants available for follow-up, one patient in the tetracaine group reported a wound infection. A recommendation of increased use of TAC on facial lacerations, in both the adult and pediatric populations, is made based on the results of this study.

Administration, Topical↗
PubMed1986

Critical leadership.

Leadership is the process of motivating others to think or act in a specific manner. In critical clinical situations leadership is often lacking. This results from a failure both to understand the leadership role and the elements necessary to carry out this role. The basic elements and models of leadership are described. Eleven basic principles needed to understand and teach medical crisis management are developed.

Education, Medical↗
PubMed1986

Emergency pediatric tracheostomy: a usable technique and model for instruction.

Tracheostomies, although rarely performed, may be necessary in cases in which a cricothyrotomy is precluded by the small size of the cricothyroid space in infants and small children, when there is a high-grade upper airway obstruction, or when massive neck swelling or laryngeal fractures obscure the cricothyroid landmarks. A new technique for emergency pediatric tracheostomy and a model for practicing the procedure in cats has been developed. The technique uses a finder needle and a saline-filled syringe to locate the small and poorly defined trachea. Free-flowing saline or aspirated air bubbles indicate entrance of the locator needle into the tracheal lumen. A stabbing incision is made lateral to and against the needle, the stoma is spread, and an endotracheal tube is introduced. Kittens weighing 1,000 g to 1,500 g have a tracheal diameter of 5.5 mm to 6.0 mm, equivalent to a child less than 1 year old. Cats in the 2,000-g to 3,000-g range approximate the tracheal size for an older child. Either recently killed or anesthetized cats may be used. Using this model, emergency physicians can become more proficient in performing tracheostomies rapidly on small subjects. This technique, however, has not been studied in human beings of the pediatric age group.

Animals↗
PubMed1986

Intraosseous infusions: a usable technique.

Intraosseous infusions were widely used in pediatric patients during the 1930s and 1940s. Recent reports have re-introduced this concept and confirmed its safety and ready accessability for fluid and drug administration. However, these reports have not addressed the difficulties encountered during insertion of the intraosseous needle. Spinal needles, standard metal intravenous (IV) needles, and bone marrow biopsy needles have been suggested for intraosseous infusion. These needles were tested for ease of insertion on a pediatric cadaver leg. The site for needle placement was also evaluated during the study. It was found that the 13-gauge Kormed/Jamshidi disposable bone marrow/aspiration needle was the easiest to insert and did not plug with bone or tissue during insertion. An area proximal to the medial malleolus was found to provide a stable, relatively flat, and easily penetrable location for needle placement. This method was successfully utilized in ten pediatric and five adult patients. Intraosseous needle placement is a safe, rapid method to gain access to the venous circulation. By utilizing these techniques, a stable, usable fluid line can be established in even the most dehydrated pediatric patients.

Bone Marrow↗
PubMed1986

Pediatric venous cutdowns: utility in emergency situations.

Venous access in children can be difficult and, in rare cases, impossible to achieve in a timely fashion. The three methods normally utilized to gain access, peripheral and central venipuncture and venous cutdowns, all require different skill levels for use. However, venous cutdowns, the last resort in intravenous line placement, have no performance standards by which to gauge competence. Therefore, a survey was conducted of the members of the American Pediatric Surgical Association to assess the frequency with which the pediatric cutdown is performed, the amount of time needed for the procedure, and the usual anatomic location where it is performed. Three age groups were included: neonate, one month to five years, and six to 16 years. The performance of five physician groups was also surveyed: pediatric surgeon, pediatric resident, pediatrician, surgical resident, and general surgeon. Results showed that, on the average, 56 cutdowns are done per pediatric surgeon per year. They reported that it took them an average of 11 minutes (range, one to 90 minutes) to complete the procedure in the neonate, eight minutes (range, one to 60 minutes) in the one month to five year group, and six minutes (range, one to 30 minutes) for the six to 16 year olds. The cutdown was found to be rarely used by other physician groups. The time required to complete the procedure, even by experts, makes its use as a first choice in an emergency unrealistic for most clinicians. Utilization of the pediatric venous cutdown, in emergency situations, should be done only by those clinicians familiar with the technique, and only while other methods for venous access are being simultaneously attempted.

Adolescent↗
PubMed1985

Pressurization of i.v. bags: a new configuration and evaluation for use.

External pressure devices are often utilized to increase the flow rates of IV fluids in exsanguinating patients. However, increasing the flow rate by this method also increases the rate at which IV bags need changing. Time is lost and valuable personnel are preoccupied in maintaining the numerous hand-pumped external pressure devices and IV bags. A systematic evaluation comparing the hand-pumped device with a new, pneumatic external pressure device (Infusor-1, Medical Innovations, Inc., Phoenix, AZ) is presented. A new multiunit configuration (Infusor-Rack) for the pneumatic device is also described. We found a significant decrease in IV bag take-down/setup time with the new pneumatic pressure device. This system is faster, more reliable, and easier to use than the standard hand-pumped pressure bag and should be viewed as a practical improvement in the fluid delivery system.

Equipment Design↗