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Biomedical subjects

Matthew R Lewin

Publications and source records attributed to Matthew R Lewin.

14 recordsLinked to original sources
PubMed2006

An unusual case of subterfuge in the emergency department: covert administration of antipsychotic and anxiolytic medications to control an agitated patient.

Pediatric, nursing home, and institutionalized psychiatric patients frequently receive medications covertly or against their will. Surreptitious medicating of emergency department (ED) psychiatric patients may occur but has not been reported. We discuss competing ethical, therapeutic, and legal issues in potential conflict during the treatment of an acutely psychotic patient who had homicidal and suicidal ideation and presented to a busy, urban ED. The practice of covertly medicating may not be uncommon in EDs, but fear of professional censure probably inhibits open discussion and documentation of such events. No specific statutory, ethical, or case law in the United States seems to control this type of situation.

Administration, Oral↗
PubMed2006

Improvised cricothyrotomy provides reliable airway access in an unembalmed human cadaver model.

OBJECTIVE: Patients with injuries requiring surgical airway management occurring far from medical care might benefit from the availability of a simple, reliable, improvisational method of cricothyrotomy with materials available in a wilderness or prehospital setting. We evaluated an improvised cricothyrotomy device in an experimental, unembalmed human cadaver model. METHODS: A high-flow intravenous spike and drip chamber was cut through the drip chamber and used as the sole apparatus for performing cricothyrotomy on unembalmed cadavers whose anterior neck surfaces and deep tissues were warmed to or near body temperature. Correct placement in the trachea and damage to the posterior wall of the trachea were assessed by either fiberoptic bronchoscopy or neck dissection. Video recordings were used to time each procedure. Each operator was responsible for both device insertion and bag valve mask attachment and ventilation, modeling as the sole care provider for the patient. RESULTS: One physician and 3 emergency medicine residents, all without previous, specific instruction, performed 10 procedures on 5 female and 5 male unembalmed cadavers weighing a mean of 65 kg (range 45-110 kg). All 10 attempts at placement of the intravenous tubing spike through the cricothyroid membrane were successful. On 2 attempts, the initial placement of the device was incorrect, but the error was immediately identified on attempt to ventilate the patient. Repositioning of the device resulted in appropriate cannulation of the trachea in both attempts. The median time span from manual identification of the cricothyroid membrane to percutaneous access and connection of the bag valve mask with successful ventilation was 27.3 seconds. Violation of the posterior tracheal wall was not seen on any of the 5 procedures in which fiberoptic visualization was available or in the 5 procedures evaluated by neck dissection. CONCLUSIONS: Cricothyrotomy is the quickest and most effective method for obtaining airway access when nonsurgical methods of securing the airway are contraindicated or fail. Although frequently described, no improvised airway devices of this type have been tested in a systematic manner. We tested the reliability and utility of cricothyrotomy with a high-flow intravenous spike and drip chamber. Our results suggest that the spike and drip chamber is a plausible means of temporarily establishing airway access in patients with acute airway obstruction in a wilderness or prehospital environment.

Adult↗
PubMed2005

Emergency medical services in Japan: an opportunity for the rational development of pre-hospital care and research.

Japan is at a crossroads in the development of its Emergency Medical Services (EMS). At present, Japan has an essentially pure scoop-and-run, defibrillation system. However, there is a strong movement toward expanding the scope of paramedic practice to include more complex, Advanced Life Support (ALS) and trauma protocols to its nationally standardized pre-hospital protocols. The implications of introducing complex pre-hospital protocols guided by the use of existing scientific evidence to support such action is discussed in the context of Japan's unique opportunity to test many fundamental questions in pre-hospital medical care and the public's understanding and acceptance of these practices. Japan, a technologically advanced country that is not encumbered by entrenched "standards of care," has the opportunity to develop an efficient and rational EMS system.

Ambulances↗
PubMed2004

Nonsyndromic genetic predisposition to aortic dissection: a newly recognized, diagnosable, and preventable occurrence in families.

The major diseases affecting the aorta are aortic aneurysms and dissections, with patients with acute dissections often presenting in the emergency department (ED). Recent studies demonstrate a strong genetic predisposition to thoracic aortic aneurysms and dissections, independent of syndromes traditionally considered to predispose to aortic disease (such as Marfan syndrome). Nonsyndromic familial thoracic aortic aneurysms and dissections are inherited in families as an autosomal dominant disorder and a variable age of onset of the aortic disease. The case reported here illustrates the critical importance of obtaining a family history of thoracic aortic aneurysms and dissections, along with unexplained sudden death, when assessing an individual with chest pain in the ED, regardless of age and in the absence of a known genetic syndrome.

Adult↗
PubMed2003

Rickettsia sibirica infection in members of scientific expeditions to northern Asia.

The risk of acquiring North Asian tick typhus (infection by Rickettsia sibirica) during travel to regions of Asia where this disease is endemic is unknown. We investigated prospectively 13 paleontologists on expedition to Mongolia. Four paleontologists had acute illness characterised by fever, rash, headache, and lymphadenopathy. All had IgM and IgG antibodies to R sibirica. Paleontologists with no illness and people who went on expeditions in other parts of the world did not have antibodies to R sibirica. Only two of the four infected persons were aware of tick bites. Travellers to regions endemic for R sibirica are at risk of contracting North Asian tick typhus even in the absence of recognised tick-bites.

Aldehyde Oxidoreductases↗
PubMedDate not supplied

Seal finger.

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Adult↗