Biomedical subjects
R R Simon
Publications and source records attributed to R R Simon.
Position and diaphoresis in acute asthma.
Presence of pulsus paradoxus, PCO2, sternocleidomastoid retraction, and flow rates have been used at the bedside to assess the severity of acute asthma. In our study of 49 adult patients, pulse rate, respiratory rate and pulsus paradoxus were shown to be significantly higher in patients assuming the upright position on admission to the emergency center; arterial pH, PO2, and peak expiratory flow rate were significantly lower in the upright patients. All upright patients had sternocleidomastoid retraction. Peak expiratory flow rate was 73.3 +/- 5 liters per minute in diaphoretic patients, 134 +/- 21 liters per minute in non-diaphoretic, upright patients, and 225 +/- 7.5 liters per minute in recumbent patients (p less than 0.02). No recumbent patient had a peak expiratory flow rate of less than 150 liters per minute or a PCO2 of greater than 44 mm Hg. The index of Fischl, signifying a need for admission to the hospital if greater than 4, was 4 or higher in 70 percent of upright patients and in 88 percent of diaphoretic patients. Only 7 percent of recumbent patients had Fischi indexes of greater than 4.
Entrepreneurism in emergency medicine.
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Cystitis and pyelonephritis.
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Emergency cricothyroidotomy in the patient with massive neck swelling: Part 1: Anatomical aspects.
A method for localizing the hyoid bone in normal adult and children subjects is presented. The reliability of this calculated value in permitting localization of the hyoid was examined in 200 adult subjects in relationship to age, sex, neck size, and ethnic origin. The same method was utilized in 198 children with similar results. It was found to be a constant and remarkably predictable dimension which was unaffected by any of these variables. Because the hyoid serves as a frame from which the respiratory passage is suspended, it can be easily located and used to stabilize and retract superiorly and anteriorly the larynx and trachea, allowing easier access to these structures by a tracheotomy or cricothyroidotomy in the patient with massive neck swelling where emergency tracheotomy or cricothyroidotomy are difficult.
Emergency cricothyroidotomy in the patient with massive neck swelling. Part 2: Clinical aspects.
A technique has been described for emergency tracheotomy in a patient with massive neck swelling which utilizes the hyoid bone to permit localization of the midline of the neck and manual surgical traction of the larynx. The method for localizing the hyoid bone in a patient with massive neck swelling requires only one measurement to be taken: from the angle of the mandible to the mental protuberance. From this measurement, one can locate the hyoid bone with ease. This procedure has been performed in 5 cadavers and 7 patients with excellent results, providing rapid access to the airway within less than 2 min. The authors believe that the procedure permits rapid access to the airway in patients with massive neck swelling in whom emergency tracheotomy or cricothyroidotomy is difficult and time consuming.
Efficacy of cervical spine immobilization methods.
Cervical spine immobilization devices are widely used to stabilize the cervical spine and prevent neurologic deficits associated with unstable fractures. In order to quantitate their efficacy we measured controlled cervical spine motion in three axes, using six different immobilization methods in 25 volunteers instructed to actively move their necks as much as possible in the directions of flexion, extension, rotation, and lateral bending while lying supine. Control measurements were made with no device and measurements were repeated following immobilization with: soft collar (SC), hard collar (HC), extrication collar (EC), Philadelphia collar (PC), bilateral sandbags joined with 3-inch cloth tape across the forehead (ST), and the combination of sandbags, tape, and the Philadelphia collar (ST/PC). Neck movements were reported in degrees recorded on a hand-held goniometer. There were no significant differences between control and SC measurements except in rotary movement. PC was not significantly better than the other two types of hard collars, except in limiting extension. ST immobilization was significantly better than any of the other four methods used alone, for all four movements. The addition of PC to ST was significantly more effective in reducing extension only.
A new technique for securing a chest tube.
Most techniques described for securing a chest tube in position do not discuss closing the orifice in the chest wall after removal of the tube. An air tight closure of the chest wall and good approximation of the wound edges after removal of the chest tube must be done to prevent complications and obtain a cosmetically good scar. A technique for securing a chest tube is described that permits excellent approximation of the wound edges upon removal.
Necrotizing fasciitis.
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Management of salicylate intoxication.
Salicylate intoxication is common. It results in impaired generation of adenosine triphosphate and produces a primary respiratory alkalosis. In adults the clinical manifestations may closely simulate a cerebrovascular event or alcoholic ketoacidosis. Central nervous system dysfunction, fever, glycosuria, ketonuria, respiratory alkalosis with an elevated anion gap, tinnitus, dehydration, hypokalaemia and haemostatic defects are common. The diagnosis may be made rapidly by the ferric chloride test or Phenistix test. Standard therapy includes gastric emptying, activated charcoal and alkalinisation of the urine. Osmotic diuresis is a controversial measure. Haemodialysis is indicated for patients with serum salicylate levels more than 100 mg/100ml, severe acid-base disturbance, or deterioration despite optimum therapy.
A new technique for subclavian puncture.
A new technique for performing and teaching subclavian punctures based on the finding of a new landmark--a small tubercle on the medial aspect of the deltopectoral groove, is presented. This tubercle has been found to be easily palpable on 92% of individuals examined. With this new landmark and the technique described the novice can quickly master this procedure with very little difficulty. The author found that both clinicians inexperienced in subclavian puncture and nursing personnel performed the procedure successfully after the first or second trial.