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Biomedical subjects

R W Derlet

Publications and source records attributed to R W Derlet.

66 records · Page 4Linked to original sources
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Evaluating anatomical factors affecting endotracheal intubation.

Critically ill patients often require endotracheal intubation in the emergency department. Sometimes immediate attempts at endotracheal intubation are indicated. In other situations, a momentary delay to assess the anatomic factors that might make intubation difficult is advantageous. This examination should include assessment of nose and oral cavity patency, mobility and posterior depth of the mandible, and mobility and length of the neck.

Humans↗
PubMedDate not supplied

The effect of haloperidol in cocaine and amphetamine intoxication.

The effectiveness of haloperidol pretreatment in preventing the toxic effects of high doses of amphetamine and cocaine was studied in rats. In this model, toxic effects were induced by intraperitoneal (i.p.) injection of amphetamine 75 mg/kg (100% death rate) or cocaine 70 mg/kg (82% death rate). Haloperidol failed to prevent amphetamine-induced seizures, but did lower the mortality rate at most doses tested. Haloperidol decreased the incidence of cocaine-induced seizures at the two highest doses, but the lowering of the mortality rate did not reach statistical significance at any dose. These data suggest a protective role for the central dopamine blocker haloperidol against death from high-dose amphetamine exposure without reducing the incidence of seizures. In contrast, haloperidol demonstrated an ability to reduce cocaine-induced seizures without significantly reducing mortality.

Amphetamines↗
PubMedDate not supplied

Amphetamine toxicity: experience with 127 cases.

We present a retrospective study of 127 cases of amphetamine toxicity in an emergency department (ED). The most common presenting symptoms seen were agitation, hallucinations, suicidal behavior, and chest pain. Toxicologic analysis showed amphetamines are generally not mixed with other stimulants. The vast majority of patients did not require pharmacologic treatment in the ED. Thirteen patients (10%) required admission to the hospital. Toxic medical effects of amphetamine-related compounds seen in our patients are discussed.

Amphetamine↗
PubMedDate not supplied

Pedestrian accidents: adult and pediatric injuries.

An epidemologic review of 217 pedestrian injuries treated at a level one trauma center during a one-year period is presented. Injuries that occurred in pediatric age group patients were reviewed separately from adults. In both categories approximately 60% were admitted to the hospital. Hospital length of stay and severity of injuries was found to be much worse in adults. Seven percent of adults and 3% of children died after arrival at the hospital. The most common areas of injury in both groups were the head and the distal extremities. Nearly 25% of adults sustained tibia-fibular fractures. This study shows that the incidence of critical injuries in pedestrians is high, and adults sustain more severe injuries than children. We clarify types of injuries commonly seen in pedestrian trauma.

Accidents, Traffic↗
PubMedDate not supplied

Cocaine toxicity and the calcium channel blockers nifedipine and nimodipine in rats.

Two dihydropyridine type calcium channel blockers (CCBs) were studied for any protective or therapeutic effect upon cocaine-induced toxicity and death in rats. To test for the protective effects, rats were pretreated with vehicle (control), nifedipine or nimodipine, intraperitoneally (IP) 30 minutes prior to an LD85 of cocaine, or intravenously (IV) 10 minutes prior to cocaine administration. Animals receiving IP control vehicle developed seizures in 5.6 +/- 1.0 minutes and respiratory arrest in 9.8 +/- 1.4 minutes. Animals pretreated IP with nifedipine or nimodipine developed seizures and respiratory arrest significantly sooner than the controls, although the overall incidences of seizures and respiratory arrest were not significantly different. Pretreatment with IV CCBs resulted in similar findings. To test the therapeutic effect of CCBs given following cocaine overdose, rats were administered cocaine IP and then treated with IV nifedipine or nimodipine once seizures occurred. In these animals, there was no significant difference in the incidence or time to respiratory arrest compared to vehicle controls. This study demonstrates that neither pretreatment nor posttreatment with the CCBs nifedipine or nimodipine reduces cocaine toxicity in this rodent model.

Animals↗
PubMedDate not supplied

Utilizing clinical factors to reduce head CT scan ordering for minor head trauma patients.

Our study objective was to determine whether simple clinical criteria can be used to safely reduce the number of patients who require cranial computed tomography (CT) scan after sustaining minor head trauma. Awake patients (Glascow Coma Scale = 15) who presented to the emergency department with acute head injury associated with a loss of consciousness were evaluated for clinical predictors of head injury prior to CT scan. The studied risk factors included severe headache, nausea, vomiting, and depressed skull fracture on physical examination. Patients with no risk factors present were compared with patients with one or more risk factors with respect to abnormal CT rate and rate of operative intervention for head injury. Of the 2143 patients entered into the study, 1302 (61%) had no risk factor for head injury, whereas 841 (39%) had one or more risk factors present. A total of 138 (6.4%) of those studied had an abnormal CT scan. This number included 3.7% of those patients with no risk factors vs. 11% in patients with one or more risk factors. The CT scan abnormalities in the no-risk-factor group were not clinically significant. All 5 patients who required operative intervention had at least one of the risk factors present. The use of four simple clinical criteria in minor head trauma patients would allow a 61% reduction in the number of head CT scans performed and still identify all patients who require neurosurgical intervention and the majority of patients with an abnormal CT scan. This method could lead to a large savings in patient charges nationwide. Further studies may be helpful in confirming these findings.

Adult↗
PubMedDate not supplied

Chemical restraint for the agitated patient in the emergency department: lorazepam versus droperidol.

Patients presenting to the emergency department with acute agitation frequently require physical and chemical restraint. To determine the efficacy of lorazepam vs. droperidol, we conducted a prospective, randomized study of violently agitated patients requiring chemical restraint. Patients were randomized to receive either lorazepam or droperidol i.v. A six-point sedation scale was used. Sedation scores were recorded at time 0, 5, 10, 15, 30, and 60 min. Vital signs were compared at time 0 and at 60 min. Repeat dosages of each drug could be given at 30 min. Toxicology screen, ethanol and creatinine phosphokinase levels were obtained. A total of 202 patients were evaluated. One hundred patients received lorazepam and 102 patients received droperidol. Agitation was attributed to methamphetamine toxicity in 146 patients (72%), cocaine toxicity in 28 (14%), psychiatric illness in 20 (10%), and ethanol withdrawal in 8 (4%). Ethanol intoxication was present in 98 patients (49%). Both drugs had similar sedation profiles at 5 min. Patients receiving droperidol had significantly lower sedation scores at times 10, 15, 30, and 60 than lorazepam. More repeat doses of lorazepam were given (40) than droperidol (8) at 30 min. We conclude that droperidol produces a more rapid and better sedation than lorazepam at the doses used in this study in agitated patients requiring chemical restraint. Lorazepam is more likely to require repeat dosing than droperidol. Methamphetamine toxicity was present in the majority of patients in this study.

Adult↗
PubMedDate not supplied

How do prudent laypeople define an emergency medical condition?

To determine the public's perception as to the general definition of an emergency medical condition (EMC), and to compare opinions between the general public and healthcare workers (HCW) on which specific medical conditions require emergency department (ED) care, a survey of people at 12 supermarkets and shopping malls in Northern California was conducted over a 6-month period in 1997. Individuals over age 18 were asked in person to complete a survey sheet. It asked participants to choose one of four definitions of "emergency medical condition." In addition, people were asked to determine which of 30 chief complaints they thought needed care in the ED. Demographic information was also collected. A second set of surveys asking the same questions was conducted among nonemergency healthcare providers at hospitals. Healthcare worker was defined as an MD, RN, LVN, or PA. A total of 1,018 members of the public and 126 healthcare workers completed the survey. EMC definitions selected by the public were: 1) an abbreviated federal EMTALA definition: a condition that may result in death, permanent disability, or severe pain (48.7%); 2) the federal definition plus other conditions preventing work (3.0%); 3) the federal definition plus any other conditions outside business hours (16.5%); and 4) any condition at any time as determined by the patient (31.6%). HCWs selected the following: definition 1 (71%); definitions 2 and 3 (0%); and definition 4 (27%). Definitions 1 and 3 were statistically different when comparisons were made between the public and HCWs. On the question of which of the 30 chief complaints needed care in an ED, agreement was seen between the public and HCWs for severe abdominal pain (94% vs. 99%, respectively) and severe chest pain (96% vs. 99%, respectively). However, the two disagreed on the need for ED care for severe headache (58% vs. 91%, respectively); mild chest pain (51% vs. 79%, respectively); and difficulty breathing (77% vs. 98%, respectively). No significant difference in opinions on the need for ED care was seen for some minor conditions: mild headache, sore throat, cough, flu symptoms, minor foot problems. No significant differences in answers occurred when age groups, occupations, or locations were compared. In conclusion, the public has split views concerning the general definition of an emergency medical condition. Approximately half uses a conservative federal definition, and half uses patient self-determined need as the definition. Data on which specific conditions need ED care provide additional insight on agreement between the public and HCWs on most problems. Both groups agree that many perceived minor medical complaints do not require ED care.

Adult↗