Biomedical subjects

R A Barish

Publications and source records attributed to R A Barish.

28 records · Page 2Linked to original sources

PubMedDate not supplied

Deep venous thrombosis of the upper extremity: diagnosis and treatment.

Deep vein thrombosis of the upper extremity was long thought to be a benign disease, rarely complicated by pulmonary embolism and associated with minimal long-term morbidity. More recent observations have demonstrated however, that a significant number of patients will continue to have disabling symptoms after treatment with conservative measures and standard anticoagulation therapy, and that pulmonary embolism can occur in the course of the disease. Because of its significant morbidity and increasing incidence, an aggressive emergency department approach to diagnosis and early consideration of fibrinolytic therapy are recommended.

Adult↗

PubMedDate not supplied

Delayed presentation of unstable cervical spine injury with minimal symptoms.

Emergency physicians are less likely to suspect the presence of a severe or unstable cervical spine injury in patients who have been ambulatory since the traumatic episode. We present the case of a man with multiple cervical fractures and a 75% anterior subluxation of C6 and C7 who did not seek medical care for six weeks after falling from a height. Previous reports of delayed or occult cervical spine injuries are reviewed. Physicians must aggressively search for injuries whenever a history of neck pain is present or a strong mechanism of injury exists, even if the patient has been ambulatory for days or weeks following the injury.

Accidental Falls↗

PubMedDate not supplied

The importance of an annual report.

An annual report, by summarizing the emergency department's accomplishments, is an effective means of highlighting the vital role of the emergency department within the hospital system and the community. The report should begin with an Executive Summary and proceed to detail the clinical, educational, research, administrative, financial, and other essential aspects of the status and development of the department.

Annual Reports as Topic↗

PubMedDate not supplied

Accidental hypothermia with cardiac arrest: recovery following rewarming by cardiopulmonary bypass.

A 22-year-old man eventually had a good neurologic recovery following prolonged coma after extracorporeal rewarming from profound hypothermia (24 degrees C) due to exposure. The patient was in full arrest for 60 minutes prior to institution of cardiopulmonary bypass (CPB). Total bypass time was 50 minutes. Cardiopulmonary bypass is the current rewarming method of choice for severe hypothermia associated with a persistent nonperfusing cardiac rhythm. CPB provides the most rapid core rewarming with the additional benefit of circulatory support during the period of cardiac instability.

Adult↗

PubMedDate not supplied

Magnesium: clinical considerations.

Magnesium is gaining recognition as a clinically important electrolyte. Hypomagnesemia has been associated with a variety of disorders including seizures, malignant ventricular dysrhythmias, and sudden death. The emergency department patients who are most likely to be magnesium deficient include alcoholics, patients who take diuretics, and those in diabetic ketoacidosis. Hypokalemia and hypocalcemia may represent unrecognized hypomagnesemia. Clinical trials and case reports also document increasing interest in magnesium as an effective therapeutic agent for potentially life-threatening problems such as torsade de pointes, digitalis toxicity, bronchospasm, and alcohol withdrawal. We present an overview of hypomagnesemia, review the current literature, and focus on the role of magnesium in the acute care setting and the implications for the emergency physician.

Acute Disease↗

PubMedDate not supplied

Isolated uvular angioedema associated with ACE inhibitor use.

Angioedema is a well-known complication of medical therapy with angiotensin-converting enzyme (ACE) inhibitors. Isolated uvular angioedema, a rare presentation of angioedema, in a patient taking lisinopril (Zestril) is described in this case report. Management of uvular edema is also reviewed.

Adult↗

PubMedDate not supplied

The potential impact of health care reform on emergency department utilization.

How will emergency department utilization and costs be affected by universal coverage provisions? Proponents of health care reform predict that the number of ED visits will decline when currently uninsured Americans become eligible for primary physicians' care. However, economic concepts indicate the contrary: that ED volume and costs will actually escalate upon implementation of health care reform initiatives. These basic concepts include: 1) the insulation of most consumers from the true cost of health care, fostering higher demands for that care; 2) the financial benefits afforded physicians and health maintenance organizations by ED's ability, and legal responsibility, to assess and treat any patient at any time; and 3) access to ED personnel and material by individuals with urgent and nonurgent conditions, which generates fixed costs, regardless of patient volume. These effects of health care reform on EDs must be anticipated by hospital administrators to avoid compromise of patient care quality and consumer satisfaction.

Emergency Medical Services↗

PubMedDate not supplied

Pneumomediastinum presenting as acute airway obstruction.

Pneumomediastinum is an entity with diverse underlying etiologies and variable clinical presentations. We present a case of pneumomediastinum that on initial presentation appeared to be an upper airway emergency most consistent with adult epiglottitis. The pathophysiology of pneumomediastinum involves extravasation of air through perivascular interstitial tissues. Once air has gained access into the soft tissues, it may dissect upward into the neck and distend upper airway structures. This may cause patients with pneumomediastinum to have symptoms such as a sore throat or dysphagia. The patient we describe had such dramatic upper airway symptomatology that adult epiglottitis was the initial suspected diagnosis, and acute airway intervention was required. The various etiologies, presentations, and pathophysiology of pneumomediastinum are discussed.

Acute Disease↗

PubMedDate not supplied

Prescription noncompliance: contribution to emergency department visits and cost.

We randomly surveyed 100 patients in the acute care section of a large urban university hospital Emergency Department (ED) on 6 days with regard to the existence of and reasons for prescription noncompliance. Noncompliance was considered a major factor contributing to the ED visit if: (1) no medications had been taken for at least 48 h before the ED visit; (2) the medications, when previously taken, had routinely controlled the condition for which the patient was presenting to the ED; and (3) no other significant cause or illness was believed to have precipitated the ED visit. ED, admissions, and yearly medication costs were calculated for all patients. Noncompliance was found to be a contributing factor in the cases of 22 patients (22%). The most common medications involved were phenytoin and albuterol. Cost was the most common reason for noncompliance (11 [50%]). The average ED charge per noncompliant patient discharged was $576.61. Six noncompliant patients were admitted at an average cost of $4,834.62. The average cost of a year's medication was $520.72. Noncompliance with drug prescriptions is a significant contributor to ED visits and health care costs.

Adult↗

PubMedDate not supplied

Reengineering the emergency evaluation of chest pain.

This article presents strategies for enhancing the emergency department care delivered to patients with chest pain and suspected acute myocardial infarction. It also describes the planning and implementation of an emergency department reengineering project at a university medical center. The establishment of chest pain evaluation centers within emergency departments has been associated with improved clinical outcomes and cost control. Creating such a center requires careful revamping of diagnostic and treatment algorithms, a process that must be based on information from all departments affected by the changes.

Baltimore↗