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Biomedical subjects

K Wrenn

Publications and source records attributed to K Wrenn.

49 records · Page 3Linked to original sources
PubMed1991

Hypothermia in the summer.

We have presented two cases of hypothermia associated with altered mental status occurring during the summer in the sunbelt. Both cases represent nonexposure hypothermia of multifactorial origin requiring prompt aggressive diagnostic and therapeutic intervention. The effects of phenothiazines, alcoholism, Wernicke's encephalopathy, Parkinson's disease, and altered mental status contributed to the development of hypothermia in these instances. Although both patients survived and were discharged from the hospital, it is likely that hypothermia in such situations has a higher mortality. Awareness of the broad differential of predisposing conditions is mandatory in treating such patients in a timely fashion.

Adult↗
PubMed1990

Tension hydrothorax and shock in a patient with a malignant pleural effusion.

A patient presented to the emergency department with a malignant pleural effusion associated with shortness of breath, and radiographic evidence of mediastinal shift and hypotension. Tube thoracostomy yielded serosanguinous pleural fluid under pressure and after 1 liter of fluid was drained, the patient's hemodynamic status stabilized. The entity of tension hydrothorax is rare but may be life threatening. The treatment should consist of prompt drainage and efforts to prevent recurrence. As physicians become more adept at prolonging the lives of patients with cancer, tension hydrothorax may become more common.

Breast Neoplasms↗
PubMed1990

Tissue plasminogen activator-associated lingual artery hemorrhage.

Reported is the case of a patient with vertebrobasilar artery ischemia who received tissue plasminogen activator with resulting hemorrhage into the tongue and nearly exsanguinating hemorrhage from a branch of the lingual artery. Suggestions for immediate management of the hemorrhage as well as prevention are presented. As the use of thrombolytic agents increases and the list of their indications expands, unusual life-threatening hemorrhagic problems other than gastrointestinal or intracranial bleeding will be seen, and management decisions may be life saving.

Brain Stem↗
PubMed1990

The delta (delta) gap: an approach to mixed acid-base disorders.

The anion gap (AG) is a helpful, yet underused, clinical tool. Not only does the presence of a high AG suggest a certain differential, but knowledge of the relationship between the rise in AG (delta AG) and the fall in bicarbonate (delta HCO3) is important in understanding mixed acid-based disorders. Simple arithmetic converts this relationship into a numerical value, the delta gap (delta gap). The delta gap = delta AG - delta HCO3. If the delta gap is significantly positive (greater than +6), a metabolic alkalosis is usually present because the rise in AG is more than the fall in HCO3. Conversely, if the delta gap is significantly negative (less than -6), then a hyperchloremic acidosis is usually present because the rise in AG is less than the fall in HCO3. Familarity with the relationship between the changes in AG and HCO3 can be useful in unmasking occult metabolic disorders.

Acid-Base Equilibrium↗
PubMed1990

The hazards of defibrillation through nitroglycerin patches.

A case is presented in which defibrillation produced a small explosion in a nitroglycerin patch over which a paddle had been placed. Arcing of the electrical current from the aluminum backing on the patches was the likely cause, but arcing has also occurred with nitroglycerin ointment and electrode gel. All patches and ointments should be removed from the chest of patients about to undergo defibrillation.

Administration, Cutaneous↗
PubMed1989

Fecal impaction.

Fecal impaction is a common disorder with variable presentation and many potential complications. Its pathophysiology is complex, and the treatment is often difficult and frustrating. Preventive measures are likely to be cost effective in populations at high risk, such as institutionalized or debilitated elderly people, mentally ill patients, those with chronic renal failure or cancer, and those who are neurologically impaired.

Aged↗
PubMedDate not supplied

Carbon monoxide poisoning during ice storms: a tale of two cities.

This is a retrospective case series conducted at two university hospital emergency departments of 68 patients with a discharge diagnosis of carbon monoxide (CO) poisoning presenting during two different ice storms (March 1991 and February 1994) in two cities (Rochester, NY, and Nashville, TN). Fifty-five patients were seen over 10 d in Rochester and 13 patients over 4 d in Nashville. The main sources of CO exposure were the indoor use of gasoline generators (40 patients), propane or kerosene heaters (9 patients), and charcoal grills (8 patients). Six patients did not speak English fluently (5 Asian patients in Nashville and 1 Greek patient in Rochester). The use of charcoal grills was the most common CO source in Nashville, occurring exclusively in patients of Asian descent, 5 of whom did not speak English. In Rochester, the use of gas generators was the most common CO source. Ice storms represent a significant threat to populations affected by prolonged power outages. Different cities will be affected in different ways. When ice storms occur, the media should distribute information about potential sources of CO exposure. In some cases, the message may need to be distributed by alternative methods to populations who do not speak English or do not have access to mainstream media.

Adolescent↗
PubMedDate not supplied

Social-work services in an emergency department: an integral part of the health care safety net.

OBJECTIVE: To quantify and describe the activities of social workers dedicated to a large urban emergency department (ED). METHODS: A retrospective case series of all patients seen by social workers in an urban university hospital ED over a period of six weeks. RESULTS: Social- work service was provided to 5% of ED patients. Three distinct groups of patients were usually seen by social workers: the elderly, young adults, and children less than 5 years of age. The median age of the group referred for social work services was greater than that of the ED population as a whole; triage acuity also was greater in the referred group. The types of services provided varied with age. Among those patients with social-work consultations, the average time spent with each patient was over one hour and did not vary according to the age, sex, race, or insurance status of the patient. More than 60% of the social worker's time was spent with patients or their significant others. CONCLUSION: Social workers provide valuable services to ED patients. The availability of social workers in the ED reduces the demands for emergency physicians and nurses to arrange home health care, nursing home placement, and other social-service functions. Cost savings through diversion of nonacute social admissions are possible. The types of services provided vary and depend to a large extent on patient age. The availability of dedicated social-work personnel in the ED and the education of emergency personnel regarding the services that they can provide should be beneficial for patients, staff, and the hospital served.

Adolescent↗