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Biomedical subjects

P J Mariani

Publications and source records attributed to P J Mariani.

18 recordsLinked to original sources
PubMed1993

Gastrointestinal tract perforation with charcoal peritoneum complicating orogastric intubation and lavage.

A rare complication of gastric decontamination occurred in a young woman undergoing treatment for tricyclic ingestion. After orogastric intubation and lavage, she developed an acute abdomen and underwent laparotomy. Charcoal was discovered throughout the peritoneum, but concurrent and subsequent efforts failed to localize a specific perforation site. Her hospital course was protracted and complicated by tenacious peritoneal charcoal deposition, persistent peritonitis, and adhesion and abscess formation. She underwent both percutaneous and open abscess drainage, oophorectomy, and small-bowel resection. She required total parenteral nutrition in addition to feeding jejunostomy. This present case constitutes the first report of the clinical consequences of charcoal peritoneum. Outright viscus perforation should be considered among potential complications of orogastric intubation and lavage in the poisoned patient. Methods to minimize risks of its occurrence are suggested.

Abscess↗
PubMed1992

Plasma cocaine and tetracaine levels following application of topical anesthesia in children.

STUDY OBJECTIVES: To measure plasma cocaine and tetracaine levels in children after standardized application of a solution of tetracaine 0.5%, epinephrine 0.05%, and cocaine 11.8% (TAC) to lacerations requiring suture repair. DESIGN: Nonrandomized, controlled trial over a five-month period. SETTING: University hospital emergency department. TYPE OF PARTICIPANTS: Stable children less than 16 years of age with uncomplicated lacerations. MEASUREMENTS AND MAIN RESULTS: Blood was obtained at either 15 or 20 minutes (early; 32) or 45 or 60 minutes (late; 45) for measurement of plasma cocaine and tetracaine levels. Analysis for cocaine and tetracaine concentrations was performed using gas chromatography-mass spectroscopy with a limit of detection for both assays of 0.5 ng/mL. Serum cocaine levels were low but measurable at both times in 75% of children. No tetracaine was measurable. Median cocaine levels were 1 ng/mL (range, 0 to 112 ng/mL) for the early group and 2 ng/mL (range, 0 to 274 ng/mL) for the late group (P = NS). Only two children had levels of more than 100 ng/mL. No significant correlation between patient or laceration characteristics and cocaine levels was detected. No significant change in heart rate or blood pressure was detected. Children who required additional local anesthesia had nonfacial lacerations and lower cocaine levels than children with facial lacerations. CONCLUSION: Application of 3 mL of standard TAC solution for 15 minutes results in low but measurable plasma cocaine levels in 75% of children.

Anesthetics, Local↗
PubMed1991

Plasma cocaine and tetracaine levels following application of topical anesthesia in a swine laceration model.

Standard TAC (0.5% tetracaine, 0.05% epinephrine, and 11.8% cocaine) solution is finding increased use as a topical anesthetic for lacerations. The extent of systemic absorption of TAC components and their resultant physiologic effects are unclear. Absorption of cocaine or tetracaine may result in serious toxicity. The investigators hypothesized that there are no measurable plasma cocaine or tetracaine levels after application of TAC in a swine laceration model. After an overnight fast 10 domestic swine underwent tracheostomy, mechanical ventilation, femoral venous, and arterial cannulation. Maintenance anesthesia with intermittent thiopental and pancuronium was provided to maintain stage III anesthesia. Heart rate (HR), arterial pressure (BP), plasma cocaine, and tetracaine levels were measured at intervals for 180 minutes. Five milliliters of TAC was applied for 15 minutes to a standardized facial laceration in experimental swine (n = 5). Randomly labeled plasma samples were placed in vials containing 2% sodium fluoride and 1% potassium oxalate, immediately refrigerated, and analyzed for cocaine and tetracaine using gas chromatography and mass spectroscopy. Significant changes in HR and mean BP, compared with baseline values, were analyzed using Dunnett's multiple range test. Plasma cocaine levels were measurable in all experimental swine after 10 minutes, while no tetracaine was detectable. No significant differences in HR or BP changes were observed between experimental and control subjects. Application of standard TAC solution results in measurable plasma cocaine levels, but not tetracaine. Further studies into anesthetic formulation, as well as timing and technique of application, are required before consensus on optimal emergency departmental use of topical anesthesia can be achieved.

Administration, Topical↗
PubMed1990

Occipital condyle fracture presenting as retropharyngeal hematoma.

Reported is the case of a 30-year-old male motorcycle accident victim who was found on plain cervical-spine radiography to have prevertebral soft-tissue swelling. Although subsequent computed tomography demonstrated no cervical-spine fracture, it did reveal a fracture of one occipital condyle. The mechanism, diagnosis, and treatment of occipital condyle fractures are reviewed, as is the ligamentous and fascial anatomy of the cervicocranium. Dissection of fracture hematoma inferiorly along vertically oriented tissue planes is hypothesized as the pathogenesis of our patient's retropharyngeal hematoma. In addition to being a sign of potential cervical-spine injury, post-traumatic prevertebral soft-tissue swelling may also indicate occipital condyle fracture. To avoid overlooking such fractures, computed tomography undertaken to investigate upper cervical-spine prevertebral soft-tissue swelling should always include slices up to the level of the basal skull so as to visualize the condyles.

Adult↗
PubMed1986

Pseudoephedrine-induced hypertensive emergency: treatment with labetalol.

The case of a young man in hypertensive emergency following the ingestion of 840 mg of pseudoephedrine is reported. The hypertension, which peaked at 200/160 mm Hg and was associated with severe headache and diaphoresis, responded expeditiously to two initial intravenous doses of labetalol. No rebound was observed following the administration of an additional dose in the intensive care unit, after which an uneventful one-day hospitalization ensued. The toxicity of pseudoephedrine is briefly reviewed along with the pharmacology and use of labetalol. On the basis of previous experimental studies and the present report, labetalol is suggested as a promising agent in the treatment of hyperadrenergic-induced hypertensive emergencies.

Adult↗
PubMed1986

Foley catheter extraction of blunt esophageal foreign bodies.

The case is reported of a successful Foley catheter extraction of two superimposed coins from the esophagus of an 8-year-old girl. The presence of the second coin was suspected only on review of the lateral cervical radiograph. In a previous report, failure to initially diagnose the presence of an additional coin resulted in an endoscopic failure to clear the esophagus. The technical aspects of Foley extraction are reviewed along with the controversy surrounding the procedure. Series totaling 294 cases document a cumulative success rate of 85% without significant complications. The technique, when performed by airway experts, is concluded to be a viable alternative to endoscopic removal. Lateral films, fluoroscopic extraction, and barium studies in select cases are recommended as safeguards against missing nonobvious foreign bodies of the esophagus.

Catheterization↗
PubMed1986

Topical cocaine prior to treatment of penile tourniquet syndrome.

A case of the penile tourniquet syndrome is reported in a 5-year-old boy. Release of the constricting strands of hair was possible only after topical cocaine achieved adequate local anesthesia. The syndrome is briefly reviewed and emergency care recommendations are made.

Anesthesia, Local↗
PubMedDate not supplied

Iatrogenic tension pneumothorax complicating outpatient Heimlich valve chest drainage.

Use of new technology makes possible the outpatient management of conditions previously requiring inpatient treatment. With increased use of such modalities comes a greater chance that the emergency physician will encounter patients with device-related complications. We report a case of such a complication, a tension pneumothorax presenting to the emergency department following misguided manipulation of a modified Heimlich chest drainage system. It is recommended that physicians opting to utilize such out-patient technology refrain from improvised modifications that may be unfamiliar to subsequent providers.

Adult↗