Biomedical subjects
M I Greenberg
Publications and source records attributed to M I Greenberg.
Fluid loading: neither safe nor efficacious in the treatment of the alcohol-intoxicated patient in the ED.
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Ascending hemorrhagic signs after a bite from a copperhead.
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Rectal administration of N-acetylcysteine in swine: a pilot study.
The purpose of this pilot study was to determine if N-acetylcysteine (NAC) administered via the rectal route in swine is absorbed into the systemic circulation. Fasting swine were anesthetized, intubated, monitored and i.v. access was obtained by femoral cutdown. NAC was administered into the rectal vault (2.0 g/kg) via a balloon-tipped Foley catheter inserted into the animals' rectum. NAC administered via the rectal route resulted in systemic absorption as determined by spectrophotometric methods in 5 of the 7 study animals. This study provides important information regarding the development of a potential alternative route for the administration of NAC.
Material safety data sheet: a useful resource for the emergency physician.
The large number of hazardous chemicals manufactured, transported, and stored in the United States creates the potential for significant toxic exposures to workers in industry today. Emergency physicians are likely to be called upon to evaluate many of these exposures when they occur in the acute setting. In addition to single-patient exposure, significant potential exists for such exposures in the setting of mass casualties. Emergency physicians need a source of readily available information regarding chemical hazards that can be helpful in the diagnosis and treatment of such exposures. The Material Safety Data Sheet (MSDS) is reviewed herein, with special attention given to the sort of information that can be found on the MSDS and how such information can be clinically helpful to emergency physicians. The significant drawbacks and limitations of MSDS documents are also reviewed.
Emergency drug administration via the endotracheal route.
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Comparison of deep and shallow endotracheal administration of dionosil in dogs and effect of manual hyperventilation.
The endotracheal route has been used as a second route of choice for administration of emergency drugs for several years; however, the optimal technique for administration of drugs by this route has not been clearly defined. One important aspect of technique involves the question of how distribution to the distal-most endobronchial tree is influenced by initial depth of endotracheally administered drug instillation and use of forced manual hyperventilation. This study demonstrates that depth of instillation of drugs administered by the endotracheal route may not be an important factor in the delivery of medications to absorptive sites in the lung. It appears, however, that forced manual hyperventilation is essential to assure bilateral and optimal distal delivery of endotracheally administered medications.
The use of endotracheal medication in cardiac emergencies.
The endotracheal route for drug administration provides a rapid means of accessing the systemic circulation when intravenous routes cannot be established in emergent situations. This route is relatively free of significant complications and has been documented as being successful numerous times in various clinical settings. Currently, the following drugs have been studied by this route: epinephrine, atropine, lidocaine, naloxone, bretylium, and diazepam. The paper reviews the current state of the art of endotracheal drug administration.
Drug selection and delivery in cardiopulmonary resuscitation.
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Endotracheal drugs: state of the art.
Endotracheal drug administration has become an acceptable practice in a variety of clinical settings when an intravenous route is not available. Although accepted, its clinical utility in many situations is unproven. Some of the problems that result are presented.
Successful use of emergency transthoracic pacing in bradyasystolic cardiac arrest.
We present the document successful resuscitation of six patients using emergency transthoracic pacing. Two patients were resuscitated from asystole, one had a slow supraventricular bradycardia following head trauma and spinal shock, and three patients had cardiovascular collapse secondary to complete A-V dissociation. One patient developed a non-fatal pericardial tamponade, but there were no cases of pneumothorax. All patients failed to respond to standard medical therapy. We believe that the initially successful resuscitation of these patients was related directly to the pacing procedure. Three patients had underlying pathology that did not allow longterm survival. Three patients were discharged from the hospital without neurologic sequelae. Although emergency transthoracic pacing has a relatively low success rate in bradyasystolic cardiac arrest and may be associated with serious complications, the procedure may be life-saving in selected cases.
Effects of endotracheally administered distilled water and normal saline on the arterial blood gases of dogs.
The effects of endotracheally (ET) administered distilled water (DW) and normal saline solution (NSS) on the arterial blood gases of dogs were compared. When distilled water was administered endotracheally, arterial pH was depressed to 99.36% of baseline values within 5 minutes. When compared to pH changes following ET administration of NSS the depression of pH following DW administration was significant (P less than .05). Following ET injection of DW, arterial PO2 was depressed to 61% of baseline values and remained significantly depressed throughout the experiment. In comparison, following ET NSS administration, PO2 was depressed substantially less, and remained at significantly higher levels for the entire experiment. In dogs, administration of NSS by the ET route produces less detrimental effects on arterial blood gases than does the ET administration of DW. This may have implications for the choice of diluent for human drug administration using the ET route.
Endotracheal administration of atropine sulfate.
Atropine sulfate was successfully administered endotracheally to a 74-year-old patient suffering profound bradycardic cardiovascular collapse. Ninety seconds following endotracheal atropine administration, normal blood pressure and pulse were established. Therapeutic blood levels of atropine were documented following endotracheal administration. The endotracheal route for atropine administration appears to provide an effective alternative route of administration when intravenous access is difficult or impossible to establish rapidly.
Use of endotracheally administered epinephrine in a pediatric patient.
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Emergency transthoracic pacemaker.
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Where is the real priority in trauma?
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Endotracheal naloxone reversal of morphine-induced respiratory depression in rabbits.
In an emergency, intravenous access may be difficult to obtain rapidly. Alternate routes of administration for drugs are, therefore, desirable. Our study was performed to determine if naloxone could be efficacious in reversing morphine-induced respiratory depression in rabbits when administered using the endotracheal route. Our results indicate that naloxone administered in this fashion is effective in reversing morphine-induced respiratory depression in the rabbit. Mean minute ventilation was depressed to greater than half of resting baseline levels using morphine sulfate. Endotracheally administered naloxone reversed this respiratory depression and resulted in a greater than five-fold increase in mean minute ventilation above baseline levels. We concluded that endotracheal naloxone is efficacious in reversing morphine-induced respiratory depression in the rabbit. The endotracheal route may be an effective alternative for naloxone administration in man when rapid intravenous access is not obtainable.
Spontaneous hemothorax.
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