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Biomedical subjects

R A Barish

Publications and source records attributed to R A Barish.

At least 19 recordsLinked to original sources
PubMed1999

Trauma resuscitation/critical care fellowship for emergency physicians: a necessary step for the future of academic emergency medicine.

Emergency physicians (EPs) have long been de-facto providers of trauma resuscitation and critical care in academic and community hospital settings, and are significantly involved in out-of-hospital trauma care and trauma research. A one-year fellowship has been developed and implemented to provide advanced training in trauma resuscitation and critical care to EPs with a special interest in the field. This fellowship provides additional depth and breadth of training to prepare graduates for leadership roles in academic and specialized trauma centers. This is the first fellowship of its kind for EPs, and may serve as a model for fellowships at other institutions.

Baltimore↗
PubMed1997

Confirmation of the pulse oximetry gap in carbon monoxide poisoning.

STUDY OBJECTIVES: To demonstrate the degree to which pulse oximetry overestimates actual oxyhemoglobin (O2Hb) saturation in patients with carbon monoxide (CO) poisoning. This phenomenon has been reported in fewer than 20 humans in the English medical literature. METHODS: A retrospective chart review of 191 patients evaluated for CO poisoning at a regional hyperbaric center identified 124 patients 10 years of age and older who had had both arterial blood gas and pulse oximetry measurements and who had received either high-flow oxygen through a nonrebreather mask or 100% inspired oxygen through an endotracheal tube. Blood gas measurements, including direct spectrophotometric determination of O2Hb and carboxyhemoglobin (COHb) saturation values, were compared with finger-probe pulse oximetry readings. RESULTS: Measured O2Hb saturation (mean +/- SD, 88.7 +/- 10.2%; range, 51.4% to 99.0%) decreased linearly and predictably with rising COHb levels (10.7 +/- 10.4%; range, .2% to 46.4%). Pulse oximetry saturation (99.2% +/- 1.3%; range, 92% to 100%) remained elevated across the range of COHb levels and failed to detect decreased O2Hb saturation. The pulse oximetry gap, defined as the difference between pulse oximetry saturation and actual O2Hb saturation (10.5% +/- 9.7%; range, 0% to 40.6%), approximated the COHb level. CONCLUSION: There is a linear decline in O2Hb saturation as COHb saturation increases. This decline is not detected by pulse oximetry, which therefore overestimates O2Hb saturation in patients with increased COHb levels. The pulse oximetry gap increases with higher levels of COHb and approximates the COHb level. In patients with possible CO poisoning, pulse oximetry must be considered unreliable and interpreted with caution until the COHb level has been measured.

Adolescent↗
PubMed1995

Ophthalmologic therapeutics.

For the treatment of ocular disorders, the emergency physician has access to a variety of medications and delivery systems. This article focuses on topically applied ophthalmic medications: ointments and solutions, which are placed in the inferior conjunctival cul-de-sac, and hyperosmotic agents, which are administered parenterally. The indications, contraindications, potential side effects, mechanism of action, and dosage schedules for eight categories of ophthalmic agents are described. For most patients requiring ophthalmologic treatment in the emergency department, topical agents are highly efficacious, easy to administer, associated with few side effects, and inexpensive.

Emergencies↗
PubMed1994

Use of new and established antidotes.

Antidotes to poisonings commonly encountered by the emergency physician are emphasized in this article. Indications for use, expected therapeutic actions, side effect, and limitations are discussed. New and controversial antidotal treatments are also considered.

Adult↗
PubMed1993

The efficacy and safety of a continuous albuterol protocol for the treatment of acute adult asthma attacks.

We performed a prospective study over a 6-month period to test the efficacy and safety of a continuous nebulized albuterol protocol for the treatment of acute adult asthma attacks. All patients 18 years or older presenting to the emergency department with acute asthma attacks were begun by the triage nurse on the protocol of three continuous albuterol (2.5 mg) nebulizer treatments. Pretreatment and posttreatment peak flow, respiratory rate, pulse, and blood pressure were documented and patients gave a pretreatment and posttreatment rating of the clinical severity of their attack using a (1 to 10) visual analog scale. In addition, all adverse effects were noted. Seventy-six patients were entered in the study. The average age was 44 years (range, 20 to 82 years). Pretreatment and posttreatment peak flow, respiratory rate, pulse, blood pressure, and clinical severity were compared using the paired t test. Patients showed statistically significant increases in peak flow (128 to 292; P < .0001) and statistically significant decreases in respiratory rate (27 to 20; P < .0001); pulse, 103 to 94 (P < .0001); clinical severity, 7.8/10 to 1.8/10 (P < .0001); and blood pressure, 141/82 to 132/77 (P < .001). Adverse effects were minimal. Two patients (2.6%) felt flushed, three patients (4%) felt jittery, and one patient (1.3%) had a sensation of palpitations. We conclude that a continuous nebulized albuterol protocol is both extremely efficacious and safe for the treatment of acute adult asthma attacks.

Acute Disease↗
PubMed1993

Baseball bat assault injuries.

The baseball bat, according to Baltimore City police crime statistics, is a commonly used weapon. To assess the severity of injuries inflicted by this modern-day club, we retrospectively reviewed 75 charts of patients treated at the University of Maryland Medical Systems Hospital for baseball bat injuries from January 1990 through July 1991. Multisystem trauma was documented, with craniocerebral injury being the most frequent and the most frequent cause of death. Of the victims struck on the head, 26% sustained an intracranial hemorrhage. In our series, the history of loss of consciousness and the Glasgow Coma Scale score failed to reliably identify the patients with serious injuries. Seventeen percent of our patients with intracranial hemorrhages had both a negative or uncertain history of loss of consciousness and a normal Glasgow Coma Scale score on arrival.

Adolescent↗
PubMed1992

Unsuspected heterotopic pregnancy in a woman without risk factors.

A 27-year-old woman presented to the emergency department with abdominal pain. One week prior to this she had had an ultrasound which revealed an intrauterine pregnancy (IUP). A second ultrasound performed at our institution revealed an intrauterine pregnancy along with a concomitant ectopic pregnancy which had ruptured. This case emphasizes that coincident pregnancies may occur in women who are without risk of ectopic pregnancy or multiple gestations. In addition, ultrasound must be evaluated fully for heterotopic pregnancy in all women.

Adult↗
PubMed1992

Venomous snakebites. Current concepts in diagnosis, treatment, and management.

It is essential that all emergency physicians become familiar with the recognition and treatment of venomous snakebites. Techniques such as the use of tourniquets and incision and suction should no longer be performed routinely. The mainstay of treatment for poisonous bites is the intravenous administration of the appropriate antivenin to neutralize the effects of the venom.

Animals↗
PubMed1991

Acute traumatic cervical epidural hematoma from a stab wound.

Cervical spinal epidural hematoma is an infrequent entity that usually requires emergency decompressive therapy because of rapid neurologic dysfunction. We present the case of a 34-year-old man who presented to the emergency department with minimal symptomatology after a stab wound to the neck. A computed tomography myelogram of the cervical spine revealed a cervical spinal epidural hematoma. This case illustrates an unusual presentation as well as etiology of cervical spinal epidural hematoma.

Adult↗
PubMed1987

Late postpartum eclampsia.

A case of new-onset seizures occurring 12 days postpartum is described. The patient presented with headache, hypertension, and proteinuria. Postpartum eclampsia was diagnosed and IV magnesium sulfate was administered. The patient had no further seizures and did not require long-term anticonvulsants. Medical and neurologic evaluations failed to reveal any other etiology for the seizures.

Adult↗
PubMed1986

Esophageal spasm following propranolol overdose relieved by glucagon.

A case of propranolol overdose complicated by esophageal spasm preventing extrication of an orogastric lavage tube and relieved by intravenous glucagon is presented. Esophageal spasm is an infrequent complication of beta-adrenergic over-dose. Possible mechanisms of esophageal spasm and its relief with glucagon are discussed.

Esophageal Diseases↗
PubMedDate not supplied

The electrocardiographic manifestations of pulmonary embolism.

The electrocardiographic manifestations of pulmonary embolism include rhythm and condition disturbances and changes in the P wave, QRS complex, or T wave. Since these abnormalities are highly variable and frequently transient, they lack the sensitivity necessary to establish the diagnosis of pulmonary embolism. The electrocardiogram may rise the suspicion of pulmonary embolism, but other diagnostic tests are necessary to confirm the diagnosis.

Blood Pressure↗
PubMedDate not supplied

The electrocardiographic features of hypothermia.

Hypothermia results in the development of several characteristic electrocardiographic changes. As the core body temperature decreases, several changes in cardiac rhythm occur. Prolongation of the PR, QRS, and QT intervals are also seen. Muscle tremor artifact may be present, even in the absence of clinical shivering. A characteristic secondary deflection on the terminal portion of the QRS complex (Osborn wave) is usually found. All of these features are reversible with rewarming.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Use of a mildly restrictive administrative protocol to reduce orders for manual blood film examination from the emergency department.

In order to conserve laboratory resources, we instituted a mildly restrictive administrative protocol requiring a telephone request by emergency physicians or their designees in order to obtain a manual blood film examination (BFE). This test includes a manual differential leukocyte count (DLC), examination of red cell morphology, and platelet estimate. The protocol resulted in a marked reduction of the number of BFE's performed on emergency department patients from the previous level of one for every complete blood count (CBC). Retrospective chart review of a sample of patients not receiving manual BFEs indicated no apparent adverse effect on patient care. We speculate that the availability of an electronic partial differential count, providing enumeration of lymphocytes and neutrophils along with the CBC, facilitated in part the reduced ordering of manual BFEs.

Baltimore↗
PubMedDate not supplied

Arterial injury from a high pressure water jet: case report.

We report the case of a patient who sustained a high-pressure water jet injury to the thigh while cleaning industrial piping. The patient presented with a puncture wound to the anterior thigh and a pulseless foot. Emergency arteriography was performed that revealed complete disruption of the superficial femoral artery. The patient underwent surgical exploration and debridement, and a successful repair of the disrupted artery was performed with a prosthetic arterial graft. A discussion of high-pressure water jet injuries and their management is presented.

Accidents, Occupational↗