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Biomedical subjects

W T Zempsky

Publications and source records attributed to W T Zempsky.

12 recordsLinked to original sources
PubMed1998

Lidocaine iontophoresis for topical anesthesia before intravenous line placement in children.

In a double-blind randomized trial including 42 children aged 7 to 18 years, less pain occurred with intravenous placement after iontophoresis of 2% lidocaine with epinephrine, as reported by patients (p = 0.005), parents (p = 0.001), intravenous personnel (p = 0.009), and investigators (p = 0.0002) compared with placebo therapy. Lidocaine iontophoresis provides rapid and effective topical anesthesia for intravenous access in children.

Adolescent↗
PubMed1998

Paramedics as allied health care providers in the pediatric emergency department.

OBJECTIVE: To determine the frequency of use and scope of practice of paramedics in the pediatric emergency department (PED). DESIGN: Thirty-eight question mailed survey. PARTICIPANTS: One hundred eighty directors of pediatric emergency medicine departments. MAIN RESULTS: One hundred twelve (62%) pediatric emergency medicine directors completed the survey of which 87 (74%) had a physically distinct PED. The PEDs saw an mean volume of 29,563 patients per year. Twenty-one percent of the PEDs surveyed had paramedics who were employed as allied health personnel. Paramedic responsibilities in the PEDs included patient transport, 89%; laboratory transport, 67 %; IV access, 78%; medication administration, 22 %; suturing, 11%; assisting, 94%; intubation, 6%; and narcotic administration, 11%. Paramedic mean starting salary was $9.55 (SD+/-1.90)/h) versus nurse mean starting salary of $15.03 (SD+/-3.58)/h (P < 0.001). PED directors who employed paramedics rated the success of their paramedic program as 7.9 (SD+/-1.7) on a scale from 1 (not at all successful) to 10 (very successful). CONCLUSIONS: Paramedics can function successfully as members of the PED patient care team. In a resource-scarce health care environment the use of paramedics may be a cost-effective adjunct to nursing support.

Child↗
PubMed1997

EMLA versus TAC for topical anesthesia of extremity wounds in children.

STUDY OBJECTIVE: To compare the anesthetic efficacy of EMLA (eutectic mixture of local anesthetics) cream with that of TAC (tetracaine, adrenaline, and cocaine) solution for suturing uncomplicated extremity wounds. METHODS: We conducted a prospective, single-blind, randomized trial in a convenience sample of 32 children, ages 5 to 18 years, who required repair of an extremity laceration. Eligible wounds were less than 5 cm long and less than 12 hours old. Lacerations involving digits, deep tissues, or musculature were excluded. Patients receiving medications that predisposed them to methemoglobinemia were also excluded. Lacerations were treated with TAC .1 mL/kg (maximum, 3.0 mL) or EMLA .15 g/kg (maximum, 5.0 g). Anesthesia was assessed every 10 minutes. TAC and EMLA were allowed to remain on the wounds for a maximum of 30 and 60 minutes, respectively. Anesthesia was deemed successful if no supplemental lidocaine was required, as judged by a suturing caregiver who was blinded to the anesthetic used. RESULTS: The two groups were similar with regard to age, sex, wound length and depth, and wound age. EMLA-treated wounds were repaired without supplemental anesthesia more often than TAC-treated wounds: 13 of 16 (85%) versus 7 of 16 (45%, P= .03). More time was required for EMLA to cause anesthesia (55 versus 29 minutes, P<.01). Dehiscence occurred in one wound in each group; no wound infections were observed. CONCLUSION: EMLA appears to be superior to TAC for anesthesia of simple extremity lacerations in that those wounds treated with EMLA required supplemental anesthesia less often. EMLA required approximately 1 hour to cause optimal anesthesia in open wounds. Protocols should be developed to allow efficient use of EMLA for anesthesia of extremity lacerations in the ED.

Adolescent↗
PubMed1997

Long-term appearance of lacerations repaired using a tissue adhesive.

BACKGROUND: Histoacryl Blue (HAB), a tissue adhesive, has been shown to decrease laceration repair time, cause less pain to the child, eliminate the need for suture removal, and result in a similar short-term cosmetic outcome compared with conventional suturing. Reports suggest that poor correlation can exist between the short-term and long-term cosmetic outcomes for lacerations repaired by conventional suturing. Therefore, this study compares the long-term cosmetic outcome of HAB to conventional suturing for laceration repair in children. DESIGN: Prospective, randomized clinical trial. PARTICIPANTS: Children presenting an urban pediatric emergency department for laceration repair between October 1994 and February 1995 were eligible. Patients less than 1 or more than 18 years old, those with lacerations more than 5 cm in length, or in areas of high tension or mobility were excluded. INTERVENTIONS: After routine wound management, including subcutaneous closure when deemed necessary, patients were randomized to receive skin sutures or HAB for cutaneous closure. Photographs taken at the 2-month and 1-year follow-up visits were evaluated for cosmetic appearance by two plastic surgeons blinded to the method of repair. RESULTS: Sixty-one children were enrolled: HAB (N = 30), suture (N = 31). Thirty HAB and 25 sutured patients were assessed at 2 months, while 17 HAB and 15 sutured patients were reevaluated at 1 year. Patients that followed-up at 2 months and 1 year were comparable to those with no follow-up in: treatment group (HAB vs suture), demographics, wound characteristics, and initial parental satisfaction. The two plastic surgeons graded the cosmetic appearance of the wounds repaired by HAB to be comparable to those repaired by conventional suturing at both the 2-month and 1-year follow-up. CONCLUSIONS: The use of HAB is an ideal alternative to conventional suturing for the cutaneous closure of low tension lacerations in children with a long-term cosmetic outcome comparable to conventional suturing.

Adolescent↗
PubMed1996

Child restraint device use in patients leaving a children's hospital.

OBJECTIVE: To determine the frequency of and factors associated with the use of child restraint devices (CRDs) in patients leaving an urban children's hospital. DESIGN: Verbally administered survey, followed by observation of CRD use. SETTING: Main parking area at an urban children's hospital with mandated use of parking attendants. PARTICIPANTS: A convenience sample of 295 parents or guardians who were leaving the hospital and were accompanied by at least 1 child younger than 48 months. RESULTS: Eighty percent of the respondents were female; 77% of the respondents were white and 22% were African American. Two hundred thirty-five (80%) used CRDs. Subjects who were at risk of CRD noncompliance included nonwhite individuals (adjusted odds ratio [OR], 6.6; 95% confidence interval [CI], 3.0-14.5), those whose primary source of medical care was from a public clinic (OR, 2.4; 95% CI, 1.1-5.3) or from a specialty clinic (OR, 2.4; 95% CI, 0.8-6.6), and those who were older than 24 months (OR, 8.7; 95% CI, 3.5-21.9). Parental education and income level were not important predictors of CRD compliance controlling for race, primary medical care source, and age. Study participants were observed for incorrect CRD use; 30% (30/ 99 of infants younger than 12 months were incorrectly placed in the forward-facing position, and 23% (54/ 235 of all CRD users did not use its harness. CONCLUSIONS: Patients who use public clinics or pediatric subspecialists as their primary source of medical care, especially those who are African Americans, are at risk of CRD noncompliance. Children's hospitals should take an active role in improving CRD use in these patients.

Child, Preschool↗
PubMed1995

Ear temperatures.

Explore the source record for details and available documents.

Body Temperature↗
PubMed1989

Effect of pancreatic enzyme supplements on iron absorption.

Iron deficiency has been reported in one third of patients with cystic fibrosis. There are data that suggest that iron absorption is increased with exocrine pancreatic deficiency and that administration of pancreatic enzymes may impair oral iron absorption. We compared oral iron absorption over a 3-hour period in the presence and absence of exogenous pancreatic enzymes in 13 stable young-adult patients with cystic fibrosis and 9 age-matched control patients. Although none of the patients with cystic fibrosis had a hemoglobin level less than 119 g/L, serum ferritin levels were less than 25 micrograms/L in 5 of the 13 patients, and the mean corpuscular volume was significantly lower in the patient group (86.1 +/- 2.7 vs 90.9 +/- 5 fL). Baseline mean serum iron levels were higher in controls (18.9 +/- 5.9 mumol/L) than in patients (11.9 +/- 6.3 mumol/L). There was no difference in iron absorption in the absence of exogenous pancreatic enzymes. Significant impairment of iron absorption was detected in both patients with cystic fibrosis and controls after administration of a preparation of pancreatic enzymes. There was an inverse relationship between iron stores, as measured by serum ferritin, and iron absorption. These findings suggest that long-term consumption of pancreatic enzymes by patients with cystic fibrosis may contribute to iron deficiency.

Adolescent↗
PubMed1988

The cause of rectal prolapse in children.

Fifty-four pediatric patients with rectal prolapse (RP) were identified by review of medical records from 1977 to 1987. Rectal prolapse was attributed to chronic constipation (15 patients), acute diarrheal disease (11 patients), cystic fibrosis (CF) (six patients), and neurologic/anatomic abnormalities (13 patients). In nine patients, no underlying cause was identified. The patients with CF did not differ from the other groups in terms of age at time of onset of prolapse, growth measurements, or number of episodes of prolapse. All patients with CF had a history of abnormalities or presented with signs and symptoms consistent with this diagnosis; none had a history of constipation. Although physicians can be reassured that CF is not a likely diagnosis in patients with RP and acute diarrheal disease or a clear history of constipation, a sweat test is indicated in all such cases as well as in those in which there is no apparent underlying cause. A sweat test is not usually indicated in patients with RP in association with underlying anatomic abnormalities.

Child↗
PubMedDate not supplied

Lacerations against Langer's lines: to glue or suture?

This study evaluated the effects of initial wound orientation on the cosmetic outcome of facial lacerations repaired with histoacryl blue (HAB), a tissue adhesive, vs. conventional suturing. This was a retrospective analysis of patients from a prospective randomized clinical trial on the use of HAB. Children in the initial cohort who had facial lacerations and were also evaluated for cosmetic appearance at a 2-month follow-up appointment were eligible. Orientation along Langer's Lines, which define the functional anatomy of the underlying structures to the skin, was determined by two investigators blinded to the initial method of repair. Photographs of the wounds were reviewed and the wounds were categorized as being: Langer (+) (<20 degrees deviated from Langer's Lines) or Langer (-) (> or =20 degrees deviated from Langer's Lines). Photographic appearance at follow-up was evaluated using a 100-mm visual analog scale (0=best, 100=worst) by two plastic surgeons blinded to the method of repair. Sixty-one patients were enrolled in the initial cohort, with 55 (90%) evaluated at the 2-month follow-up. Forty-eight of the 55 (87%) had facial lacerations, therefore meeting present study criteria: [HAB (n=26), Suturing (n=22), Langer (+) (n=27), Langer (-) (n=21)]. Langer (+) patients were comparable to Langer (-) for demographics, wound characteristics, and method of repair. There was no difference in overall cosmetic appearance of facial wounds closed with HAB vs. conventional suturing. Follow-up appearance was significantly worse for sutured Langer (-) vs. Langer (+) wounds. In contrast, cosmetic appearance of lacerations closed by HAB were comparable between Langer (-) and Langer (+) wounds. In conclusion, initial wound orientation had a greater impact on the cosmetic appearance for lacerations closed by suturing compared to HAB. HAB may be the preferred method of cutaneous closure for facial lacerations oriented against Langer's Lines.

Child, Preschool↗