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Biomedical subjects

R A Lowe

Publications and source records attributed to R A Lowe.

52 records · Page 3Linked to original sources
PubMed1991

Rational ordering of electrolytes in the emergency department.

STUDY OBJECTIVE: To validate the predictive abilities of a retrospectively developed set of clinical criteria for detecting clinically significant electrolyte abnormalities, using a different patient population. DESIGN: Cross-sectional study. SETTING: The emergency department of a busy public hospital. TYPE OF PARTICIPANTS: Nine hundred eighty-two patients on whom the emergency physician ordered serum electrolytes. INTERVENTIONS: The predictive properties of ten clinical criteria were evaluated; these included poor oral intake, vomiting, chronic hypertension, taking a diuretic, recent seizure, muscle weakness, age of 65 years or more, alcoholism, abnormal mental status, and recent history of electrolyte abnormality. MEASUREMENTS AND MAIN RESULTS: Seven hundred thirty patients (74.3%) had one or more electrolytes outside of the laboratory normal range, but only 143 (14.6%) had clinically significant electrolyte abnormalities. The clinical criteria predicted 135 of the clinically significant electrolyte abnormalities (sensitivity, 94.4%). When the eight "false-negative" cases were reviewed, none of the electrolyte abnormalities affected patient outcome. Implementation of the criteria would have avoided unnecessary testing in 233 patients (23.7%). CONCLUSION: Although no set of clinical criteria can eliminate the need for clinical judgment, use of a set of clinical criteria could substantially decrease electrolyte ordering without compromising patient care.

Cross-Sectional Studies↗
PubMed1989

Perimortem cesarean section.

Perimortem cesarean section probably represents an underemphasized procedure on the skills list of the emergency physician. Although fraught with emotional and medicolegal overtones, the procedure can yield viable infants in at least 15% of cases and occasionally alters maternal hemodynamics so as to restore the pulse in a clinically dead woman. This article reviews the physiology and hemodynamics of the maternal-fetal unit and discusses prognostic factors for the survival of healthy mother and infant, leading to recommendations for when to perform a perimortem cesarean section. The article then describes the technical aspects of the procedure.

Cesarean Section↗
PubMed1987

Rational ordering of serum electrolytes: development of clinical criteria.

The purpose of this study was to determine the frequency of electrolyte abnormalities in emergency department patients, to assess the proportion of these abnormalities affecting patient outcome, and to develop a set of clinical criteria to allow selective ordering of serum electrolytes. The ordering physicians completed questionnaires describing the clinical presentations of 1,031 patients on whom electrolytes were requested. For every patient with abnormal electrolyte values, the chart was reviewed to ascertain whether this was a clinically significant electrolyte abnormality (CSEA). The clinicians' responses to the questionnaires were used to construct a clinical criteria set predictive of CSEAs. Five hundred forty-five patients (52.9%) had one or more abnormal electrolytes, but only 161 patients (15.6%) had CSEAs. A set of ten clinical criteria detected 159 of 161 CSEAs (98.8% sensitivity) and would have avoided the ordering of electrolytes in 262 cases (29.9% specificity). At a cost to the patient of $20 per set of electrolytes ordered, detection of 159 CSEAs using the clinical criteria would cost $96.73 per CSEA detected. Detection of the additional two CSEAs by ordering electrolytes on all patients in the series would cost an additional $5,240. If the accuracy of these clinical criteria is confirmed in other settings, they may be useful guidelines for reducing laboratory charges without compromising patient care.

Adolescent↗
PubMed1987

Approach to acute pharyngitis.

The evaluation of the patient with a "sore throat" is deceptively complex. The clinician must first assess the potential for airway compromise. Specific risk factors, reviewed in this article, should be considered, including the presence of a pharyngeal membrane, immunocompromise, potential gonococcal exposure, and prior rheumatic fever.

Acute Disease↗
PubMed1986

Streptococcal pharyngitis in the emergency department: analysis of therapeutic strategies.

Potential streptococcal pharyngitis represents a common presenting complaint of patients in emergency departments. Studies have shown that therapy within the first 48 hours of presentation hastens the resolution of the infection. A prior analysis of the cost of treatment for potential streptococcal pharyngitis in an outpatient practice suggested that when the likelihood of a positive throat culture is high, therapy is more cost effective without a throat culture. The current analysis evaluates the effects of emergency department charges, incomplete follow-up, and several common screening tests (Gram stain, clinical scoring) upon the cost of treatment and the risk for rheumatic fever. The results of the current analysis support the use of common screening tests to permit immediate oral or parenteral penicillin treatment of selected patients without a throat culture and the use of a throat culture to detect false-negative screen results.

Ambulatory Care↗
PubMed1986

Penetrating neck trauma: consensus and controversies.

Proper emergency evaluation and treatment of the victim of penetrating neck trauma requires a thorough knowledge of cervical anatomy and of the injuries that are likely to occur. Nonoperative studies supplement the physical examination in the evaluation of these patients, and may either assist in the operative approach or allow for safe observation of the patient. The debate concerning exploration and observation of penetrating neck wounds continues.

Blood Vessels↗
PubMed1986

Sore throat: to culture or not to culture.

The traditional use of the throat culture to guide treatment of potential streptococcal pharyngitis recently has been questioned because of the following facts: antibiotic therapy within the first 48 hours of illness reduces the severity and symptoms of streptococcal pharyngitis; more rapid treatment of streptococcal pharyngitis may be more effective in prevention of rheumatic fever; clinical and Gram stain criteria can identify individuals with a high probability of a positive throat culture; new latex agglutination tests can identify within minutes individuals with a high probability of a positive throat culture; the throat culture may be falsely negative in individuals with partially treated pharyngitis, an inadequately swabbed or plated specimen, or an improperly read culture plate; and incomplete patient followup increases the true societal cost of traditional therapy based on throat culture results. These issues suggest that a sufficiently accurate screening test for guiding antibiotic therapy at the initial visit may be more clinically beneficial and cost effective than recalling all positive throat culture patients for antibiotic therapy. Nonetheless, a throat culture remains important when a screening test of a patient with suspected streptococcal pharyngitis is negative. Indications for culturing pharyngitis for other potential pathogens also are discussed.

Adult↗