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Biomedical subjects

R H Strauss

Publications and source records attributed to R H Strauss.

At least 19 recordsLinked to original sources
PubMed1997

Accidental strangulation by a motor vehicle window.

OBJECTIVE: To describe a child who was asphyxiated by a motor vehicle window and to review the relevant literature. DESIGN: Case report. SETTING: A 402-bed tertiary care medical center in La Crosse, WI. PATIENT: Four-year-old girl. INTERVENTIONS: Supportive pediatric critical care. MAIN OUTCOME MEASURES: None. RESULTS: The patient did not survive. CONCLUSIONS: Parents must assume responsibility for restraining their children in motor vehicles. Parents must not leave children alone in motor vehicles. Parents must become "more injury literate."

Accident Prevention↗
PubMed1993

Dietary carbohydrate, muscle glycogen, and exercise performance during 7 d of training.

The effects of moderate- or high-carbohydrate diets on muscle glycogen and performance in runners and cyclists over 7 consecutive days of training were determined. Muscle biopsies were performed on 4 separate days before exercise for 1 h at 75% peak oxygen consumption (VO2) followed by five, 1-min sprints. After the training session on day 7, subjects ran or cycled to exhaustion at 80% peak VO2. Muscle glycogen for cyclists and runners was maintained with the high-carbohydrate diet but was reduced 30-36% (P < 0.05) with the moderate-carbohydrate diet. All subjects completed all training sessions, and there were no differences in times to exhaustion on day 7. For cyclists and runners, consuming a moderate-carbohydrate diet over 7 d of intense training reduces muscle glycogen but has no apparent deleterious effect on training capability or high-intensity exercise performance. A high-carbohydrate diet maintains muscle glycogen, but this has no apparent benefit on training capability or high-intensity exercise performance.

Adult↗
PubMed1993

Critical care pediatrician-led aeromedical transports: physician interventions and predictiveness of outcome.

This article reviews the one-year experience (March 28, 1987 to March 27, 1988) of the pediatric transport service of the University of Wisconsin Hospital and Clinics (UWHC). The UWHC pediatric transport team consisted of a critical care flight nurse and a pediatric critical care attending physician or fellow. The aims of the study were to: 1) determine the types and number of interventions performed by the physicians to gauge the need for physician presence on transport; and 2) determine which variables (severity of illness scores, age, gender, distance from hospital) recorded at the time of the referral telephone call best predicted outcome of the patient. There were 109 children transported by helicopter during the one-year study period. Thirty percent of the patients (43% of trauma patients and 22% of medical patients) had no interventions at all, 18% of medical patients and 10% of trauma patients were intubated, and 9% of medical patients and no trauma patients had central venous catheters inserted. Multivariate modeling determined that among medical patients, outcome could be accurately predicted only 38% of the time if telephone PRISM (Pediatric Risk of Mortality) scores were determined. Among trauma patients, if gender, age, distance from UWHC, and telephone PRISM scores were known, outcome could be predicted 74% of the time. Unless studies show the benefit of pediatrician-accompanied transport, transports could probably be done without critical care pediatricians. Severity of illness scoring at this time is probably not sufficiently accurate to warrant its use for deciding the appropriateness of transport of pediatric patients.

Air Ambulances↗
PubMed1992

Aeromedical transport services accepting pediatric patients and their abidance by published guidelines.

The number of aeromedical transport services accepting pediatric patients (ATSP) in the United States has increased greatly over the past decade. Most aeromedical transport services are primarily designed for adults but will also transport children. Suggested guidelines for ATSP were published by the American Academy of Pediatrics (AAP) in 1986. This survey of 65 ATSP and their abidance by the major AAP guidelines showed that two thirds of the ATSP were based at facilities with pediatric tertiary care capabilities; most ATSP were not directed by pediatric critical care (PCC) or pediatric emergency care (PEC) specialists; most transport team personnel were not trained in PCC or PEC; most ATSP had specific protocols for different clinical situations; most ATSP had separate equipment appropriate for pediatric patients; and there was little variation in transport team composition based on different clinical situations. In summary, all ATS surveyed transported children, but few were aware of the AAP guidelines, and only one in 65 was in complete abidance with the recommendations.

Adult↗
PubMed1991

Endocrine effects in female weight lifters who self-administer testosterone and anabolic steroids.

It appears that the self-administration of testosterone and anabolic steroids is increasingly practiced by women in sports where strength and endurance are important. We recently evaluated endocrine parameters in nine female weight lifters using steroids and seven not using these agents. Of the nine anabolic steroid users, seven took multiple anabolic steroids simultaneously. Thirty-fold elevations of serum testosterone were noted in the women injecting testosterone. In three of these women serum testosterone levels exceeded the upper limits for normal male testosterone concentrations. A significant compensatory decrease in sex hormone-binding globulin and a decrease in thyroid-binding proteins were noted in the women steroid users. Also, a 39% decrease in high-density lipoprotein cholesterol was noted in the steroid-using weight lifters. Most of the subjects in this study used anabolic steroids continuously, which raises concern about premature atherosclerosis and other disease processes developing in these women.

Adult↗
PubMed1991

Anabolic steroids in the athlete.

Anabolic-androgenic steroid hormones can enhance muscular strength and size in athletes. However, deleterious side effects include transient sterility, gynecomastia, acne, balding, psychological changes, and possibly increased risks of heart disease and liver tumors. These drugs are banned by most sports organizations.

Adolescent↗
PubMed1990

Injury and disability in matched men's and women's intercollegiate sports.

Eight matched men's and women's intercollegiate varsity teams were studied prospectively for one academic year to determine the incidence of athletic injury and resulting disability. Sports in which both men and women participated in a comparable manner were chosen: basketball, fencing, gymnastics, swimming, tennis, indoor track, outdoor track, and volleyball. Men (232) and women (150) were injured at comparable rates, 42 percent versus 39 percent. When adjusted for exposure time, seven of the eight sports continued to show similar injury rates. Women gymnasts, however, experienced .82 injuries per 100 person-hours of exposure as compared to .21 injuries for the men (p = .0001). Disability was greater in women gymnasts, 7.44 days per 100 person-hours versus 1.15 days for men (p = .0004). Percent of season lost to injury was also greater for women gymnasts. Types and sites of injury were similar for men and women, with sprains and strains accounting for over half of all injuries. We found no evidence for gender differences in matched sports except for gymnastics, in which technically diverse events may have accounted for the differences observed.

Athletic Injuries↗
PubMed1989

A technique to treat wrestlers' auricular hematoma without interrupting training or competition.

Auricular hematoma is a common injury occurring among high school and collegiate wrestlers. Conventional pressure dressings applied over the auricle make it impossible for the athlete to continue to train and to compete, resulting in a high degree of noncompliance. We describe a technique that permits treatment of the hematoma while the athlete continues to train. It involves an incision and drainage followed by the immediate application of a pressure dressing sutured to the auricle. This approach was used to treat 24 auricular hematomas in 19 wrestlers. The analysis demonstrates a low complication rate and documents a rapid return to competition.

Adolescent↗
PubMed1989

Auricular injury and the use of headgear in wrestlers.

Questionnaires designed to assess attitudes and use of headgear were completed by 537 Division I collegiate wrestlers. Only 35.2% of the wrestlers wore headgear all of the time during practice as opposed to 92.4% during competition, which was a statistically significant difference. The most common reason for not wearing headgear was discomfort (35%). There were 482 participating in nonschool team events, and 203 (42%) described headgear use as "seldom or never." However, there was a statistically significant difference of developing auricular hematoma while wearing headgear (26%) vs not wearing headgear (52%). There were 208 (39%) who reported a permanent auricular deformity resulting from an injury that occurred with (10.6%) or without (26.6%) headgear. These results suggest that headgear provides only partial protection and that nonuse is widespread, causing a surprisingly high frequency of permanent auricular deformities.

Adolescent↗
PubMed1989

History and current application of intravenous therapy in children.

More than 36,000,000 individuals in the United States were hospitalized in 1985, and, on the average, 25% of hospitalized patients have insertion of an intravenous catheter (IVC). Considering those 9,000,000 IVC placements in 1985, it may be surprising to learn that "modern" intravenous (IV) therapy has a lifetime that is barely 40 years old. For the pediatrician, IV access holds particular importance, since its acquisition is often the rate-limiting step in initiation of a therapeutic plan, particularly in the setting of cardiopulmonary resuscitation. This article is a review of the nearly 500-year history of IV therapy and an overview of the IV techniques and products currently available for use in pediatric patients.

Blood Transfusion↗
PubMed1988

Use of flexible fiberoptic endoscopy for determination of endotracheal tube position in the pediatric patient.

Flexible fiberoptic endoscopy (FFE) was utilized in a series of 24 critically ill pediatric patients to determine the position of the endotracheal tube (ETT) tip relative to the carina. Training on a model system revealed no significant differences in predicting ETT-to-carina distance (ETT-C) with respect to operator, ETT size, or absolute ETT-C as measured directly. No significant differences in ETT-C could be determined between traditional bedside chest x-ray (CXR) or FFE when FFE was performed on intubated pediatric ICU patients. A correlation coefficient comparing the two methods was 0.767. Neither ETT size nor FFE operator affected this correlation. Although used as the gold standard, CXR failed to demonstrate the carina clearly in 15 patients. FFE delineated the carina clearly in 22 patients. Ability to visualize ETT placement within the trachea was essentially identical for FFE (22/24) compared to CXR (23/24). However, the time required to obtain this information was significantly different: 30.6 min (range 13 to 57) for CXR; 40 sec (range 16 to 94) for FFE. No clinically significant changes in patient pulse oximetry, heart rate, or physical exam were observed during FFE. Only copious secretions impaired the utility of FFE. We concluded that FFE is a safe, fast, easily learned method to determine relative ETT position or precise ETT-C in the mechanically ventilated pediatric patient.

Child↗
PubMed1988

Exercise-induced anaphylaxis related to food intake.

On one occasion, a healthy, male college athlete ate shrimp three and one-half hours before his usual, strenuous exercise. Several minutes after exercise, generalized anaphylaxis occurred which required emergency medical management. Physicians who work at sites where individuals exercise should be prepared for immediate treatment of this rare but important syndrome in order to avoid possible morbidity and mortality.

Adult↗
PubMed1987

Predictability of mitral regurgitation detected by Doppler echocardiography in patients referred for cardiac transplantation.

Mitral regurgitation (MR) is common in patients with congestive heart failure (CHF), but the frequency in relation to the origin of ventricular dilatation has not been established. In 50 patients referred for cardiac transplantation, MR was assessed by Doppler echocardiography and the findings were compared with clinical information. Dilatation of the left ventricle, left atrium and mitral anulus was analyzed in 25 patients with respect to cause of CHF. All 50 patients had MR of at least moderate severity, regardless of cause (idiopathic dilated cardiomyopathy in 36, coronary artery disease in 14), length of symptoms (20 +/- 19 months, less than 6 months in 13 patients) or presence of murmurs (absent in 13 patients). Comparison of patients with nonischemic cardiomyopathy to those with ischemic heart disease revealed larger left ventricular volumes (215 +/- 81 vs 131 +/- 60 ml in systole, p less than 0.05) and left atrial volumes (124 +/- 70 vs 70 +/- 35 ml, p less than 0.05). Mitral anular dilatation was present only in patients with idiopathic cardiomyopathy (diameters 3.6 +/- 0.4 vs 3.1 +/- 0.2 cm, p less than 0.05). The frequency of significant MR in these patients with CHF suggests that it may have a major role in decompensation and in the therapeutic response.

Adolescent↗
PubMed1986

Pediatric emergency intravenous access. Evaluation of a protocol.

Effectiveness of a protocol for intravenous (IV) access during pediatric resuscitation was prospectively evaluated to determine whether utilization of a specified sequence of measures would reduce IV access time compared with resuscitations deviating from the protocol. The protocol involved rapid sequential attempts at percutaneous femoral vein catheterization, saphenous vein cutdown, and intraosseous infusions if initial percutaneous peripheral IV insertion failed. While no single technique provided completely reliable and rapid IV access, utilization of all techniques per protocol significantly improved IV access time. When initial percutaneous peripheral IV attempts failed, resuscitations in compliance with the protocol achieved IV access more rapidly (median, 4.5 minutes) than those deviating from the protocol (median, 10.0 minutes). Even with incomplete compliance, 66% of resuscitations achieved IV access within the first five minutes. Our experience indicates that IV access during pediatric resuscitation should rarely be delayed beyond the fifth minute if all available IV techniques are used.

Adolescent↗
PubMed1986

Central venous catheter insertion by femoral vein: safety and effectiveness for the pediatric patient.

Prospective observations made during surveillance of routine central venous catheterizations for hemodynamic monitoring were evaluated to determine the safety and effectiveness of femoral insertion of central venous catheters and to demonstrate the feasibility of teaching pediatric residents to perform this procedure. During a 19-month period of observation, 29 pediatric patients requiring a central venous catheter underwent attempted percutaneous femoral vein catheterization. Femoral catheterization was successful in 86% of patients attempted, and insertions by pediatric residents were successful in 68% of patients attempted. Arterial puncture was the only significant complication of insertion, occurring in 14%, and was not associated with adverse sequelae. During 33 months of observations, complications of indwelling femoral central venous catheters did not significantly exceed the frequency for internal and external jugular, subclavian, and antecubital central venous catheters. During more than 4 years of observation, the significant complications associated with indwelling femoral central venous catheters were swelling of the leg or documented thrombosis in 11% of 74 critically ill patients. These observations indicate safety and effectiveness of femoral central venous catheters which compares favorably to central venous catheter insertion by other routes. In contrast to previous reports of central venous catheter insertion via subclavian and internal jugular veins, we observed no cardiorespiratory compromise as a result of femoral central venous catheter complications. Skill in this technique is a feasible educational goal for pediatric residents.

Accident Prevention↗