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T E Terndrup

Publications and source records attributed to T E Terndrup.

54 records · Page 3Linked to original sources
PubMed1991

Comparison of pulmonary artery, rectal, and tympanic membrane temperatures in adult intensive care unit patients.

Tympanic thermometry using infrared thermography technology offers a noninvasive, rapid temperature measurement tool which may be useful for selected intensive care unit (ICU) patients. Multiple comparisons of pulmonary artery catheter (PAC), rectal (R), and tympanic membrane (TM) temperatures were performed in nine adult ICU patients using PAC temperatures as the gold standard. The correlation between R (r = 0.93) and PAC was significantly better than TM (r = 0.74) temperatures. However, PAC (37.2 +/- 0.06 degrees C; mean +/- SEM) and TM (37.1 +/- 0.08 degrees C) temperatures were not significantly different, whereas R (37.6 +/- 0.07 degrees C) was significantly warmer than both (P less than .05). Differences between either R (+0.4 degrees C) or TM (-0.1 degrees C) and PAC temperatures were consistent over selected ranges between 35 degrees C and 40 degrees C. The performance of TM and R was similar in the ability to predict PAC temperatures.

Adult↗
PubMed1991

The performance of two tympanic thermometers in a pediatric emergency department.

In a prospective, unblinded, controlled study, 303 children underwent comparison of rectal (RT) and right-sided tympanic membrane (TMT) temperatures. Digital electronic thermometers were used for RT, while two different infrared detection devices assessed TMT. The performance of TMT devices were compared using correlation with RT, fever detection, and ease of use. Correlation between RT and the two devices was good, r = 0.70 and r = 0.69, with little influence of patient age on performance. Using receiver operating characteristics curves to assess fever screening. Thermoscan performed somewhat better than First Temp. Staff rated the Thermoscan as significantly easier to use.

Age Factors↗
PubMed1991

The impact of moderate ambient temperature variance on the relationship between oral, rectal, and tympanic membrane temperatures.

We examined the effect of moderate ambient temperature variance on the relationship between oral (OT), rectal (RT), and tympanic membrane (TMT) temperature in 21 healthy adults. Calibrated digital electronic thermometers were used to assess OT and RT, while TMT was measured using an infrared detection device and microprocessor. Recordings were made at baseline and after 15 and 20 minutes of exposure to either warm (35 degrees C) or cool (18.3 degrees C) environmental temperatures. Differences were examined for the three temperature sites and times using repeat measures analysis of variance. No significant differences in RT (37.7 degrees +/- 0.3 degrees C; mean +/- SD) were observed at any time. Both OT (+0.5 degrees C) and TMT (+0.7 degrees C) were significantly changed during warm, but not cool exposure, compared to baseline conditions. We conclude that OT and TMT have a predictable relationship to RT at normal ambient temperature. However, in warm examination areas, spuriously elevated OT and TMTs may occur.

Adult↗
PubMed1989

A comparison of oral, rectal, and tympanic membrane-derived temperature changes after ingestion of liquids and smoking.

Ambulatory patients frequently ingest liquids or smoke just before temperature measurement. The change in body temperature measurements over time following ingestion of ice water, hot water, and smoking were investigated. Twenty-two healthy, afebrile study subjects sequentially ingested temperature-controlled water and smoked a cigarette. Simultaneous oral and auditory canal temperatures were measured over 15 minutes following ingestion. Auditory canal temperatures were obtained with an infrared detection probe; we designated this process a tympanic membrane-derived (TMD) temperature. To determine the correlation between rectal and TMD temperatures, 100 patients had simultaneous measurements at both sites. Mean initial temperatures were rectal, 37.1 +/- 0.5 degrees C (mean +/- S.D.); oral, 36.4 +/- 0.4 degrees C; and TMD, 37.4 +/- 0.4 degrees C. Maximal mean oral temperature change was greatest at 1.5 minutes after hot, +0.9 +/- 0.1 degrees C, and cold, -1.2 +/- 0.2 degrees C, water. This change was statistically significant for seven minutes at the 95% confidence level (analysis of variance test with Dunnett's multiple range test for significance). There was no significant change in the TMD temperature with any ingestion. The Pearson correlation coefficient for 107 pairs of rectal and TMD temperatures, r = 0.90 (P less than .001), was excellent. It was concluded that hot and cold liquids significantly influence oral temperature measurement for seven to nine minutes following ingestion. TMD temperature is unaffected by liquid ingestion and may allow accurate measurement of body temperature. Further studies are needed to determine the accuracy of TMD temperature over a wide range of body temperature in diverse clinical settings.

Adolescent↗
PubMed1989

A comparison of infant ventilation methods performed by prehospital personnel.

By comparing mouth-to-mouth ventilation to other methods, we tested whether there are significant differences among infant mannequin ventilation methods performed by emergency medical technicians-paramedics (EMT-Ps). Fifty-nine participants were evaluated in the performance of six ventilation methods; methods studied were mouth-to-mouth; two mouth-to-mask devices; and infant, pediatric, and adult bag-valve-mask devices. By measuring each breath, the percentage of acceptable ventilations in predetermined ranges, 5 to 25 mL/kg or 10 to 20 mL/kg, was calculated. Methods were compared using repeat measures ANOVA testing. Correlation between ventilation performance and the experience of personnel was expressed as the Pearson correlation coefficient. There were no significant differences in performance between methods, except for inadequate ventilation with the Laerdal Pocket Mask (P less than .05) from poor mask fit. The correlation between years of prehospital experience and the number of resuscitations versus ventilation performance was poor. Single rescuer, EMT-Ps can successfully ventilate an infant mannequin with various size resuscitation bags. The Laerdal Pocket Mask is an ineffective device for infant mannequin ventilation and should not be recommended for infant resuscitation.

Adult↗
PubMed1989

Intramuscular meperidine, promethazine, and chlorpromazine: analysis of use and complications in 487 pediatric emergency department patients.

Despite widespread use of a parenterally administered mixture of meperidine, promethazine, and chlorpromazine (Demerol, Phenergan, and Thorazine, DPT), there has been no systematic evaluation of its efficacy and complications in emergency department patients. We reviewed the medical records of all patients less than 16 years old who received DPT in our ED during the 24-month period ending December 31, 1987. Of 487 patients who received DPT, the maximum dose was 50/25/25 mg, respectively. Wound repair (69%) and fracture reduction (12%) were the two most common indications. Lacerations most commonly involved the face (65%) or digits (20%). Efficacy was not directly reported, but only eight patients received repeat sedation. Head injuries and a lower mean initial meperidine dosage were more prevalent in patients requiring repeat sedation (P less than .05). Three patients (0.6%) experienced significant complications. All had respiratory depression and received IV naloxone. An abnormal initial mental status examination or an underlying neurologic abnormality was significantly associated with complications (P less than .05). DPT appears to be a safe and relatively effective sedative for selected pediatric ED patients when administered as a ratio of 2:1:1 mg/kg, respectively. Complications are increased in patients with acute or underlying neurologic abnormalities.

Analgesia↗
PubMed1989

Correlation of nonlinear mathematical transformation of the normal electrocardiogram with the severity of coronary artery disease.

Signal processing was applied to normal ECGs to study whether the results could predict coronary artery disease (CAD) on angiography. ECGs determined to be normal by conventional criteria for 116 white males and 84 white females were subjected to signal processing. The technique applied nonlinear mathematical transformation to a segment of seven ECG leads which were photographically imaged, automatically digitized, normalized for time, and had topographical coordinate transformation using an IBM-XT microcomputer. The resulting curvilinear display on the computer monitor was termed a biopotential coordinate transformation (BCT). Successive superimposition of BCTs from normal ECGs of patients with normal angiograms developed boundaries of a normal template for each lead. Study BCTs were then compared to the normal templates to predict the presence or absence of CAD. Correlation of the BCT results with the severity of CAD for the males resulted in average sensitivities of 80%, 84.4%, and 91.7% for single, double, and triple-vessel CAD, respectively. Similarly, for the females average sensitivities were 59.1%, 73.9%, and 88.9%, respectively. In past studies on the same population, the BCT process detected CAD with average sensitivity of 85.1% and specificity of 81.8% for white males and average sensitivity of 73% and specificity 81% for white females. As such, computerized signal processing of ECGs may provide a noninvasive method for detection of CAD in patients with seemingly normal resting ECGs. The results of this study indicate that the sensitivity of the process increases in direct proportion to the severity of CAD. Further investigation is warranted for process refinement and verification.

Coronary Angiography↗
PubMed1989

The impact of a didactic session on the success of feline endotracheal intubation by paramedics.

Clinical reports of endotracheal (ET) intubation of infants by paramedics suggest suboptimal success rates. Methods to improve the performance of paramedics in ET intubation should be explored. The small, anesthetized cat may be utilized to evaluate infant ET intubation performance. By determining success rates and complications of ET intubation in the cat model, analysis of the current skills and the impact of a short didactic session is described. Unprepared paramedics (n = 36) were randomized to an educational (experimental) or control group. Supervisory personnel evaluated ET tube placement and complications. There was no significant difference in the percent of successfully intubated cats, 67% and 57%, respectively, between experimental and control groups. Fifteen percent of successful ET intubations exceeded 30 seconds of intubation time. The experimental group chose appropriate equipment more frequently. Serious complications occurred in 50% of attempted intubations. There was a poor correlation between performance and measures of paramedic experience. Development of educational methods is required to improve infant ET intubation success and reduce complications.

Allied Health Personnel↗
PubMed1989

Influence of topical anesthesia on the sedation of pediatric emergency department patients with lacerations.

Local anesthetic infiltration of wounds causes pain which distresses children. A painless topical anesthetic solution containing tetracaine, adrenaline, and cocaine (TAC) may reduce this distress. We hypothesized that the use of TAC for anesthesia may reduce the utilization of sedation for laceration repair. We performed a retrospective review of all pediatric emergency department (PED) patients receiving parenteral meperidine, promethazine, and chlorpromazine (DPT) during the period after TAC became routinely available. For comparison, data from a recent retrospective study of DPT (preTAC) use in the same PED were used. There was a reduction in the percent of total PED patients receiving DPT, from 1.7% preTAC to 1.2% during the TAC period (P less than 0.05). During the TAC period, there were no significant changes in patient volume or case-mix indicators. Of the major indications for DPT, there was no significant change in the percent receiving DPT for fractures, abscesses, burns, foreign body removal, or head injuries. However, there was a significant reduction in the percent of patients with lacerations receiving DPT during the experimental period, from 12% to 7.6% (P less than 0.05). There were no significant differences in laceration frequency (119/mo and 116/mo), length (2.7 and 2.7 cm), location (85% and 93% total for face and digits), or complexity (64% and 63%) for preTAC and TAC periods, respectively. We conclude that TAC used for local anesthesia may reduce the need for sedation in PED patients with lacerations that require suturing.

Administration, Topical↗
PubMed1988

Simultaneous dorsal dislocation of the proximal and distal interphalangeal joints in one digit.

Dorsal dislocation of a proximal and distal interphalangeal joint is a common clinical problem. However, simultaneous dorsal dislocation of both interphalangeal joints in a single digit is rare. We describe the first case of an open, simultaneous proximal and distal interphalangeal dislocation. Patient outcome following vigorous wound care, closed reduction, and four weeks of immobilization was excellent. Review of reported cases revealed that these injuries occur most commonly in men, on the dominant hand, and in association with sporting injuries or falls, and typically have a good outcome following closed reduction and splinting.

Aged↗
PubMedDate not supplied

Spontaneous pneumothorax complicating pregnancy--case report and review of the literature.

Patients with a spontaneous pneumothorax frequently present for care in the emergency department. The occurrence of spontaneous pneumothorax during parturition occurs rarely. We describe a case of spontaneous pneumothorax during the first trimester of pregnancy, which resolved with tube thoracostomy. The patient delivered vaginally a healthy 4.3 kg male at term under epidural anesthesia. We discuss spontaneous pneumothorax and review reported cases during pregnancy.

Adult↗
PubMedDate not supplied

Comparison of ventilation performance: standard resuscitation bag and the resuscitation bag controller.

Clinical evaluation of ventilation performance during resuscitation is largely subjective. A mechanical device, the resuscitation bag controller (RC), which encircles the bag and allows controlled compression may improve the precision and accuracy of ventilation with manual resuscitation bags (MRB). We hypothesize that more precise, controlled pressure ventilation can be delivered with the RC, compared to the MRB. Prehospital (N = 13) and hospital personnel (N = 12) who routinely perform manual ventilation were randomized to either method of ventilation. Operators were instructed to ventilate an intubated adult mannequin. The percent of breaths delivered within a specified range, 800 to 1200 mL, was compared using simple regression analysis. The precision of tidal volume (TV) and peak airway pressure (PAP) was compared between methods and groups using the coefficient of variation. Comparison for significant differences between methods and groups in the number of breaths with a TV less than 800 mL and those with pressures greater than 30 cm H20 was performed using chi square or Fisher's exact test. There were no significant differences in the percent of acceptable breaths or mean TV delivered between methods or groups. The precision (i.e., reproducibility of the same value) of TV for both methods was best for hospital personnel. PAPS were less than or equal to 30 cm H2O for 93% of all breaths. Hospital personnel delivered a significantly greater percent of inadequate (less than 0.8 L) breaths, 19 versus 7.4%, and excessive pressure breaths, 9.2 versus 4.2%, when compared to prehospital personnel. We conclude that the resuscitation bag controller offers little advantage over standard bag resuscitation for adult resuscitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Sudden death associated with undiagnosed Graves' disease.

Hyperthyroidism may result in multiple symptoms attributable to an excess of thyroid hormone. We report a case of Graves' disease in association with sudden death in a previously healthy, undiagnosed young female. This case illustrates an unusual initial presentation of Graves' disease.

Adult↗
PubMedDate not supplied

The influence of diazepam or lorazepam on the frequency of endotracheal intubation in childhood status epilepticus.

Anticonvulsant management of status epilepticus (SE) may result in respiratory depression, often requiring endotracheal intubation (ETI). By examining rates of ETI in childhood SE after intravenous diazepam or lorazepam, when administered alone or in combination with phenytoin, the influence of anticonvulsants on the frequency of ETI during SE was determined. The medical records of 142 consecutive children younger than 16 years of age admitted from a university hospital ED with seizures during a 28-month period were retrospectively reviewed. SE was identified in 38 (27%) of cases. Records of children with SE were reviewed for demographic, seizure severity, and management variables. Twelve patients were excluded, ten of whom received concomitant phenobarbital. Patients receiving lorazepam had ETI rate of 27% (4/15), compared to 73% (8/11) in the diazepam group (P = 0.026, Fisher's exact). The groups were not significantly different in age, weight, sex, seizure type, seizure duration, and appropriate anticonvulsant dosage. A prospective, randomized trial comparing lorazepam and diazepam is warranted to confirm the apparent advantage of lorazepam in reducing respiratory depression.

Child↗
PubMedDate not supplied

Impact of operator technique and device on infrared emission detection tympanic thermometry.

Preliminary data on the use of infrared emission detection (IRED) tympanic thermometers suggest that operator technique may be important in IRED readings. No systematic investigation of specific technique and available IRED devices has previously been performed. In a prospective, blinded trial, 40 healthy adult subjects using six IRED thermometers with two techniques were examined in random sequence. Differences between IRED tympanic, oral, and rectal temperatures were compared using ANOVA. Significant differences were observed between all temperatures, the IRED devices, and the method of probe insertion. Differences between oral or rectal temperatures and IRED tympanic readings were reduced by an ear tug (as for routine otoscopy) for all but one device. An "ear tug" results in increased IRED readings that may improve accuracy of tympanic thermometers using IRED.

Adult↗
PubMedDate not supplied

Sedative-analgesic agent administration in children: analysis of use and complications in the emergency department.

The frequency of, indications for, and complications from non-acetaminophen sedative-analgesic agents (SAAs) administered to children less than 16 years of age in the emergency department (ED) were determined by a retrospective review. All 21,353 charts from a single university hospital ED over a 16-month period were included. Few children (N = 759; 3.5%) received SAAs. Of 919 total doses, 13% of children received a second and 4.5% received a third SAA. The group was 59% male. Most children were < or = 10 years of age. Sixty-two percent of SAAs were either sedatives or opioids. Sedatives given included chloral hydrate, diazepam, lorazepam, midazolam, and phenobarbital. Opioids given included morphine, codeine, and meperidine. Indications for SAAs included painful procedures, analgesia, radiographic imaging, and seizure activity. Complications (N = 51; 6.7%) included inadequate sedation, vomiting, and respiratory depression or oxygen desaturation. Respiratory depression or oxygen desaturation occurred only after intravenous administration of SAAs for seizures. In children, non-acetaminophen SAAs are used most commonly in younger patients requiring sedation for painful procedures or for radiologic imaging. Respiratory depression was observed only after intravenous administration of anticonvulsants.

Analgesics↗
PubMedDate not supplied

Infant ventilation and oxygenation by basic life support providers: comparison of methods.

INTRODUCTION: Little information is available in the performance of infant ventilation by basic life support (BLS) personnel. HYPOTHESIS: There are no significant differences between mouth-to-mouth (M-M), mouth-to-mask (M-Ma), pediatric bag-mask (PBM), and adult bag-mask (ABM) devices in the percent of acceptable breaths delivered by BLS providers. METHODS: Fifty certified BLS providers performed five ventilation methods in random sequences for 60 seconds each on a 5kg infant mannequin following standardized instructions. Supplemental oxygen, 10 l/min, was supplied with one M-Ma trial and PBM methods. Airway patency, peak airway pressure (PAP), ventilatory rate (VR), tidal volume, and delivered oxygen concentration (FiO 2) were recorded. The percent of breaths with excessive PAP (i.e., greater than 30 mmHg), percent of acceptable breaths using loose (i.e., 25-125ml) and strict (i.e., 50-100ml) criteria, and FiO 2 at 15, 30, 45, and 60 seconds were compared between ventilation methods using ANOVA. RESULTS: For all subjects and those with a patent airway (n=36), there were no significant differences in the percentage of acceptable breaths produced by PBM (56+/-6) (mean+/-SEM; all subjects) and ABM (41+/-6.2) was significantly greater than M-Ma, with and without a patent airway. Although RR and the percentage of excessive breaths were not significantly different, the percentage of acceptable breaths and FiO 2 delivered with each ventilation method was significantly better in the patent airway group.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗