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Biomedical subjects

T J Abramo

Publications and source records attributed to T J Abramo.

18 recordsLinked to original sources
PubMed1999

Abdominal distention and shock in an infant.

Acute abdominal distention in the pediatric patient may be attributable to extraperitoneal fluid, masses, organomegaly, air, an ileus, a functional or mechanical bowel obstruction, or injury and blood secondary to trauma. An infant who presents to the emergency department with acute abdominal distention and shock is a true emergency for which the differential diagnosis is extensive. An unusual case of abdominal distention, ascites, hematochezia, and shock in an infant, subsequently found to have spontaneous perforation of the common bile duct is reported. This uncommon cause of abdominal distention and shock in an infant is many times left out of the differential diagnosis of an acute abdomen. The presentation may be as an uncommon acute form or a classis subacute type. This patient had hematochezia, which had not been previously reported in association with this entity. Failure to recognize and treat an acute abdomen can result in high mortality.

Abdomen, Acute↗
PubMed1997

Subcutaneous emphysema as an uncommon presentation of child abuse.

A case of subcutaneous emphysema and pneumomediastinum as a result of child abuse is presented to add to the spectrum of findings associated with child maltreatment. This case is a reminder that although most cases of subcutaneous emphysema resolve uneventfully, there still needs to be an aggressive search for a cause. In addition, in the pediatric age group, the history given should be carefully verified as being plausible because of the possibility that child abuse may be the true etiology.

Child Abuse↗
PubMed1997

Noninvasive capnometry monitoring for respiratory status during pediatric seizures.

OBJECTIVE: To determine the reliability and clinical value of end-tidal CO2 by oral/nasal capnometry for monitoring pediatric patients presenting post ictal or with active seizures. DESIGN: Clinical, prospective, observational study. SETTING: University affiliated children's hospital. INTERVENTIONS: One hundred sixty-six patients (105 patients with active seizures, 61 post ictal patients) had end-tidal CO2 obtained by oral/nasal sidestream capnometry, and respiratory rates, oxygen saturation, and pulse rates recorded every 5 mins until 60 mins had elapsed. End-tidal CO2 values were compared with a capillary PCO2 and clinical observation. MEASUREMENTS AND MAIN RESULTS: The mean end-tidal CO2 reading was 43.0 +/- 11.8 torr [5.7 +/- 1.6 kPa] and the mean capillary PCO2 reading was 43.4 +/- 11.7 torr [5.7 +/- 1.6 kPa]. The correlation between end-tidal CO2 and capillary PCO2 was significant (r2 = .97; p < .0001). A relative average bias of 0.33 torr (0.04 kPa) with end-tidal CO2 lower than capillary PCO2 was established with 95% limits of agreement +/-4.2 torr (+/-0.6 kPa). Variability of difference scores was not related to range of mean scores (r2 = .00003), age (r2 = .0004), or respiratory rates (r2 = .0009). End-tidal CO2 (r2 = .22; p < .001) correlated better with respiratory rate changes when compared with oxygen saturation (r2 = .02; p = .01). CONCLUSIONS: Dependable end-tidal CO2 values can be obtained in pediatric seizure patients using an oral/nasal cannula capnometry circuit. Continuous end-tidal CO2 monitoring provides the clinician with a reliable assessment of pulmonary status that can assist with decisions to provide ventilatory support.

Adolescent↗
PubMed1997

Adolescent female patient with shock unresponsive to usual resuscitative therapy.

Thyroid storm (thyroid crisis) is a rare and serious complication of thyrotoxicosis with a significant mortality rate if left untreated. Early recognition of the syndrome with a thorough history and physical examination is therefore essential. The exact mechanism for this decompensation is unknown; however, many physiologic stressors can precipitate the crisis. This report describes an unusual case of a previously unrecognized thyrotoxicosis developing into a storm in a pediatric patient manifesting as refractory shock.

Adolescent↗
PubMed1996

Upper airway obstruction caused by brown recluse spider envenomization of the neck.

A 7-year-old boy presented to the emergency department with progressive cervical soft tissue swelling and airway compromise due to envenomization by a brown recluse spider. This life-threatening complication is an extremely unusual presentation of brown recluse spider envenomization. Previous published reports have centered on the disfiguring localized tissue necrosis or life-threatening systemic reactions that occur secondary to the spider's venom.

Airway Obstruction↗
PubMed1996

Noninvasive capnometry in a pediatric population with respiratory emergencies.

OBJECTIVE: This study was designed to investigate the reliability, safety, and efficacy of measuring end tidal CO2 (ETCO2) in nonintubated pediatric patients presenting to an emergency department (ED) with respiratory emergencies. DESIGN/SETTING/PATIENTS: Eighty-five children were enrolled in a clinical, prospective, observational study at a university-affiliated children's hospital. Children age four weeks to 15.3 years with upper and lower respiratory diseases were enrolled by convenience sampling over a five-month period. INTERVENTIONS: ETCO2 measurements were obtained on each patient by oral/nasal side-stream capnometry. When a consistent waveform was obtained, the value was compared with a capillary arterial partial pressure of CO2 (CapCO2), oxygen saturation (O2Sat), and clinical observations. RESULTS: Study patients had a mean ETCO2 reading of 33 mmHg with a standard deviation (SD) of 4.6 mmHg and CapCO2 reading of 36 mmHg with a SD of 4.5 mmHg. Pulmonary findings, final diagnosis, and age did not significantly alter the relationship between CapCO2 and ETCO2. The relationship between CapCO2 and ETCO2 was significant (t = 14.9, P < 0.0001, r = 0.87), with a 95% confidence interval for prediction of +/-5 mmHg. CONCLUSION: Dependable ETCO2 values can be obtained using an oral/nasal capnometry circuit, and they consistently correlate with CapCO2 in a pediatric population with upper and lower respiratory diseases. Noninvasive ETCO2 analysis is safe and reliable within the limitations of this study group. Further exploration is necessary to determine the value of this technology in assisting with clinical decisions in the patient with impending respiratory failure.

Adolescent↗
PubMed1995

Comparison of pediatric end-tidal CO2 measured with nasal/oral cannula circuit and capillary PCO2.

This study was designed to determine whether end-tidal carbon dioxide (ETCO2) values obtained by noninvasive oral/nasal cannula circuit with side-stream capnometry correlate reliably with capillary PCO2 (CapCO2) in a pediatric population without cardiopulmonary problems. Each patient was monitored until a reliable 5-minute ETCO2 waveform was obtained. A capillary blood gas sample was drawn while, simultaneously, ETCO2 was recorded. The difference between CapCO2 and ETCO2 levels was tested with a paired t-test at P < .001. The limits of agreement were established with a 95% confidence level. The stability of the measured difference across the range of mean scores (CapCO2 + ETCO2/2), age, and respiratory rate was tested using simple linear regression. Fifty-eight children (23 girls and 35 boys) had mean ETCO2 readings of 33.96 mm Hg (SD 4.26), and mean CapCO2 readings of 35.93 (SD 4.04). A relative average bias of 1.96 with ETCO2 lower than CapCO2 was established with 95% limits of agreement of +/- 5.2 mm Hg (t = 5.71). Variability of difference scores was not related to range of mean scores (r = .08), age (r = .09), or respiratory rate (r = .25). End-tidal CO2 measured by an oral/nasal cannula capnometry circuit is a noninvasive method of assessing indirect measurements of PCO2 in a normal pediatric population.

Adolescent↗
PubMed1995

A 7-month-old with bilious vomiting.

We present the case of a 7-month-old boy who presented with a history of bilious vomiting, abdominal distention with a mass, anorexia, and no urinary or stool output for 2 days. Air enema demonstrated a mass effect on the rectosigmoid area, with urinary contrast revealing a large Hutch diverticulum with a narrow neck of the urinary bladder. This patient illustrates a rare case of an infant with bilious vomiting.

Bile↗
PubMed1995

Dog bites.

Explore the source record for details and available documents.

Animals↗
PubMed1994

Serious group A beta-hemolytic streptococcal infections complicating varicella.

STUDY OBJECTIVE: To alert practicing emergency physicians to an important and possibly increasing relationship between life-threatening group A beta-hemolytic streptococcal (GABHS) infections and children recovering from varicella. DESIGN: A case series of six patients managed from January through March 1993. SETTING: A university-affiliated pediatric specialty emergency department. TYPE OF PARTICIPANTS: Six previously healthy immunocompetent children between 1 and 5 years of age seen in our ED over a nine-week period. RESULTS: Six children had onset of varicella two days to two weeks before developing a serious life-threatening GABHS infection. Children presented with clinical symptoms of invasive GABHS infection with bacteremia (one patient); streptococcal toxic shock syndrome with negative blood culture (two), pneumonia with pleural effusion and streptococcal toxic shock syndrome (one), pneumonia with pleural effusion (one), and pyomyositis of the thigh (one). Four of six patients required intensive care admissions and aggressive support of vital signs. All six survived. CONCLUSION: Emergency physicians should be aware of the association between varicella and serious GABHS infections and be prepared to recognize and aggressively manage serious complications should they occur.

Cellulitis↗
PubMed1988

Occult blood in stools and necrotizing enterocolitis. Is there a relationship?

A prospective study was undertaken to determine the incidence of occult hematochezia in enterally fed low-birth-weight neonates (less than 1800 g at birth). The relationship of this occult hematochezia to the development of necrotizing enterocolitis (NEC) was then analyzed. Daily stool specimens from 95 neonates were tested for occult blood during the first six weeks of life. Fifty-four (58%) of the 95 neonates had one or more blood-positive stools. Six neonates (6.3%) developed NEC. Necrotizing enterocolitis occurred in only two of the 54 neonates with one or more blood-positive stools vs four of the 41 neonates with blood-negative stools only. Presence of occult blood in the stools did not correlate with development of NEC.

Enteral Nutrition↗