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Biomedical subjects

A B Wolfson

Publications and source records attributed to A B Wolfson.

17 recordsLinked to original sources
PubMed1992

Perceptions of emergency care by the elderly: results of multicenter focus group interviews.

STUDY OBJECTIVE: To determine the elderly's perception of emergency care and to identify specific problems and solutions. DESIGN: Focus group interviews. SETTING AND TYPE OF PARTICIPANTS: Community senior citizen centers in Boston; Los Angeles; Pittsburgh; Youngstown, Ohio; and Norwalk, Connecticut. Senior citizens who had had emergency care in the past year participated. MEASUREMENT AND RESULTS: Participants were satisfied with their overall medical care. Long waits were a hardship for patients and their families. The elderly are not familiar with the process of emergency care. They were frightened by their injury or illness. Their anxiety was not allayed until they were informed of the nature of their illness and what their treatment and disposition was to be. The emergency department environment frequently made them uncomfortable. There was considerable confusion caused by the billing process. CONCLUSIONS: The elderly would benefit from prior or concurrent education regarding emergency care. Staff should be more sensitive to the anxiety felt by the elderly, should explain the reasons for delays in care, and what to expect. Patients should be informed of the nature and seriousness of their illness as soon as possible. Family and friends may be encouraged to stay with patients. The billing process needs to be clarified and simplified.

Aged↗
PubMed1992

Ethical conflicts in the prehospital setting.

STUDY OBJECTIVE: To assess the range of ethical conflicts that confront prehospital care providers. DESIGN: Convenience sample, from October 1989 to January 1990. SETTING: An urban advanced life support emergency medical service that transports approximately 3,000 patients per month. METHODS: Six hundred seven paramedic responses were analyzed by a single observer. An ethical conflict was identified when the paramedic faced a dilemma about what "ought to be done" and the paramedic's values conflicted or potentially conflicted with the patient's. Cases with potential ethical consequence were brought to experts in medical ethics and epidemiology for further analysis and classification. RESULTS: Ethical conflicts arose in 14.4% of paramedic responses (88 of 607 cases). Twenty-seven percent of the conflicts involved issues of informed consent, such as refusal of treatment or transport, conflicts of hospital destination, treatment of minors, and consent for research. Difficulties regarding the duty of the paramedics, usually under threatening circumstances, accounted for 19% of the dilemmas encountered. Requests for limitation of resuscitation accounted for 14%. Other circumstances that presented ethical conflicts involved questions of patient competence (17%), resource allocation (10%), confidentiality (8%), truth telling (3%), and training (1%). CONCLUSION: The data demonstrate a range of ethical conflicts in the prehospital setting and point to areas in which policy needs to be developed. The data also can be used in a prehospital ethics curriculum for paramedics and physicians. Because case sampling was not strictly random, absolute conclusions should not be drawn regarding the frequency of the dilemmas.

Beneficence↗
PubMed1991

Oral indomethacin for acute renal colic.

A number of studies have suggested that nonsteroidal antiinflammatory agents can relieve renal colic by a mechanism of action different from that of narcotics, offering the potential advantage of avoiding narcotic side-effects such as alteration of mental status. The authors prospectively administered oral indomethacin, 50 mg, to 25 nonvomiting patients with acute renal colic due to a documented stone. Eleven patients group (I) received the drug in an unblinded, nonrandomized fashion after failure of oral or parenteral narcotics to provide satisfactory pain relief, either at home or in the emergency department. In 14 additional patients group (II) indomethacin was given as the only initial treatment. Pain intensity before and after treatment was reported using a 1-to-10 scale. In group I, pain decreased from 5.8 +/- 2.7 to 3.6 +/- 3.8 (P less than .02). Six of the 11 patients reported a decrease in pain intensity of 50% or more, which occurred within 25 +/- 11 minutes, and in 5 of these 6, pain decreased to a 0 or 1 level. In group II, pain decreased from 7.6 +/- 1.5 to 4.6 +/- 4.0 (P less than .008). Eight of the 14 patients reported a decrease in pain intensity of 50% or more, which occurred within 40 +/- 14 minutes, and in 5 of these 8 pain decreased to a 0 or 1 level. Among all 25 patients who received indomethacin, pain relief was not significantly associated with the duration of pain before treatment or with patient age or sex. There was a trend for pretreatment pain intensity to be higher among nonresponders (P = .07).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

Emphysematous cystitis: a complication of urinary tract infection occurring predominantly in diabetic women.

The case of a patient with emphysematous cystitis who presented with complaints of lower abdominal pain, dysuria, and pneumaturia is presented. The presenting symptoms, differential diagnosis, and radiographic and cystoscopic appearances of emphysematous cystitis, a rare complication of lower urinary tract infection occurring almost exclusively in diabetics, are reviewed. Treatment consists of urinary drainage, prompt initiation of antibiotic therapy, and strict glucose control. The prognosis usually is excellent.

Combined Modality Therapy↗
PubMed1990

Ethical issues in geriatric emergency medicine.

The emergence of ethics, geriatrics, and emergency medicine as areas of specialized interest has proceeded rapidly over the past two decades. Each of these fields continues to grow in response to patient needs, but it is clear that scientific knowledge alone cannot provide the physician with all the guidance necessary to ensure the provision of optimal care. Patient care cannot consist only of making diagnoses, prescribing medications, and performing technical procedures. Particularly in the care of the elderly, the emergency physician must be able to recognize ethical issues and to respond to them in the manner that will provide the greatest benefit to the patient. With the application of such skills, the emergency treatment of the elderly promises more benefit for elderly patients and their families and less doubt and anguish for emergency practitioners.

Aged↗
PubMed1990

Pancreatitis.

Pancreatitis is a common but rather poorly understood entity most often associated with alcohol abuse or biliary tract disease. Despite the availability of a variety of diagnostic tests and imaging techniques, the diagnosis of pancreatitis continues to be primarily a clinical one. Of major concern to the emergency physician is distinguishing pancreatitis from other, potentially lethal, causes of abdominal pain, and identifying those patients with severe pancreatitis who are at risk for a complicated course secondary to the remote systemic effects of the disease.

Clinical Protocols↗
PubMed1989

A survey of observation units in the United States.

Observation units have been proposed as a tool in lowering over-all health care costs and increasing the quality of care in outpatient facilities. Emergency department (ED) use of these units has been evaluated at single facilities but never at a national level. A survey of 250 facilities across the United States was performed to gather information about the observation unit phenomenon. Of the 250 hospitals in the survey group, 27% had operational observation or holding units and another 16% planned units within 1 year. A statistically significant increase in the use of these units was noted in nonteaching facilities when compared with their teaching counterparts. A trend toward higher use of observation units in suburban/urban settings was noted when compared with rural locations, although the difference was not statistically significant. Of the units in existence, 93% were located within the ED, staffed by emergency physicians, and administrated by the ED director. Most are staffed by ED nurses and ancillary help. No hospital had both an ED unit and a non-ED unit, and many units functioned as both holding and observation areas. The units are perceived to be beneficial in patient care and in lowering health care casts, although objective documentation to validate these beliefs is lacking. Further prospective research is needed to evaluate these units scientifically before broad recommendations can be made.

Data Collection↗
PubMed1989

Metabolic acidosis.

This article reviews acid-base homeostasis and discusses the approach to the acidotic patient, with special reference to problems commonly encountered in emergency practice. General principles of therapy are presented, and their application to specific types of life-threatening metabolic acidosis addressed. By extension, recommendations are made concerning the treatment of the acidosis associated with cardiac arrest. Finally, preliminary information is presented on promising new approaches to the treatment of metabolic acidosis that are currently under investigation.

Acid-Base Equilibrium↗
PubMed1989

Respiratory physiology.

A basic review is presented of the anatomy and physiology of the airways and the alveolar - capillary interface. Lung volumes are defined, as are terms used in pulmonary function testing, and alveolar ventilation is discussed. Five common mechanisms of arterial hypoxemia are explored and some common examples are presented, and the value and limitations of arterial blood gas determinations and pulse oximetry in the Emergency Department setting are discussed.

Humans↗
PubMed1989

Hypoglycemia.

Hypoglycemia is a common and easily treatable condition in the pre-hospital and Emergency Department settings. Recognition of the varied faces of clinical hypoglycemia, coupled with determination of blood glucose levels and expeditious glucose replacement, can prevent serious morbidity. A directed history, careful physical examination, and appropriate laboratory studies during the Emergency Department visit can uncover the etiology of hypoglycemia in most cases, and in the rest will contribute to any further diagnostic evaluation that may prove necessary.

Glucose↗
PubMed1985

Gonococcal peritonitis in a patient treated with continuous ambulatory peritoneal dialysis (CAPD).

We report a case of gonococcal peritonitis in a sexually active female on continuous ambulatory peritoneal dialysis. The presumed route of entry into the peritoneal cavity was via the Fallopian tube. The episode responded rapidly to a standard antibiotic treatment protocol. Some episodes of culture-negative peritonitis may be caused by genital tract organisms which are not cultured by routine methods.

Adolescent↗
PubMedDate not supplied

Hemodialysis-related emergencies--Part 1.

Hemodialysis patients are seen in the emergency department much more frequently than their relatively small number would suggest. Many pitfalls attend the management of these patients, in whom there is a high potential for serious morbidity and mortality. This article outlines the principles of emergency department management of hemodialysis patients and describes the approach to the diagnosis and treatment of their most common presenting problems. Many of these are related to the hemodialysis procedure itself or to underlying chronic renal failure. Special attention is given to the problems of the vascular access, the hemodialysis patient's lifeline. The indications for emergent dialysis are discussed, as well as the temporizing measures available to the emergency physician while awaiting institution of dialysis.

Emergencies↗
PubMedDate not supplied

Hemodialysis-related emergencies--Part II.

The management of medical emergencies in hemodialysis patients is not simple and is best carried out in consultation with experienced nephrologists. However, emergency staff who are likely to encounter such emergencies must be familiar with the principles of their diagnosis and treatment and have practical management strategies at their disposal.

Blood Pressure↗