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Biomedical subjects

Andrew D Perron

Publications and source records attributed to Andrew D Perron.

At least 19 recordsLinked to original sources
PubMed2006

The athlete's electrocardiogram.

The electrocardiogram performed in the competitive athlete may manifest abnormal electrocardiographic findings; these findings may indicate either normal variant syndromes as well as true cardiac pathology. The normal variant syndromes include ST-segment and T-wave abnormalities, rhythm disturbances, and intraventricular conduction delay--it must be stressed that these electrocardiographic findings are, in fact, normal variants, not indicative of underlying pathology. Other presentations in these same competitive athletes describe significant cardiac pathology, including syndromes predisposing the patient to sudden cardiac death and other potentially dangerous dysrhythmias and diagnostic of acute coronary syndrome. This article reviews the various findings in this group of patients.

Adolescent↗
PubMed2005

Orthopedic pitfalls in the ED: tibial plafond fractures.

Fractures of the tibial plafond, or distal tibial articular surface, are usually associated with a high-force mechanism, which frequently can involve associated injuries and prolonged disability. Because of distracting injury and variations in clinical findings, tibial plafond fractures may be initially missed or misdiagnosed. This review examines the clinical presentation, diagnostic techniques, and management of tibial plafond fractures applicable to the emergency practitioner.

Adult↗
PubMed2005

Orthopedic pitfalls: cauda equina syndrome.

Low back pain is an extremely common complaint encountered by emergency and primary care physicians. Although the majority of patients have uncomplicated benign presentations, there is a small subset who has a much more severe disease process called cauda equina syndrome, which entails acute compression of the nerve roots of the cauda equina. These patients usually present posttraumatically with the triad of saddle anesthesia, bowel or bladder dysfunction, and lower extremity weakness. Significant morbidity can result from delayed diagnosis and treatment; therefore, the emergency physician should remain aware of this potential orthopedic pitfall. This case report discusses the clinical presentation, diagnosis, and relevant treatment of cauda equina syndrome in the ED.

Abdominal Pain↗
PubMed2005

Electrocardiographic ST-segment elevation in the trauma patient: acute myocardial infarction vs myocardial contusion.

The diagnosis of myocardial contusion in the setting of blunt trauma engenders much discussion and controversy-partly because of the lack of a gold standard for its identification other than histologic findings at autopsy. Furthermore, blunt cardiac trauma represents a spectrum of disorders ranging from transient electrocardiographic change to sudden death from myocardial rupture; hence, no single terminology exists to define such a wide range of scenarios. Here, we present 2 cases of electrocardiographic ST-segment elevation after high-speed motor vehicle crashes resulting in numerous injuries, including blunt chest trauma. Both patients demonstrated electrocardiographic ST-segment elevation, resulting from myocardial contusion and acute myocardial infarction.

Arrhythmias, Cardiac↗
PubMed2005

Sudden cardiac death in athletes: a guide for emergency physicians.

A conditioned athlete is usually regarded as a member of the healthiest segment of society, and exercise itself is looked upon as a means to improve health. Although extremely uncommon, sudden cardiac death (SCD) in young athletes is a devastating medical event to all involved (patient, family, community, team, and caregivers). Most etiologies of SCD in athletes result in the same final common denominator (cardiac arrest) on presentation to an emergency physician. There are, however, certain historic, physical examination, and electrocardiographic features of many of these disease processes that emergency physicians should have a working knowledge of to try to identify them before they result in SCD. This review examines the clinical presentation, diagnostic techniques, and management options applicable to emergency practitioners.

Adolescent↗
PubMed2005

Closed reduction of prosthetic hip dislocation by emergency physicians.

OBJECTIVE: The purpose of this study was to determine the frequency of successful closed reduction (CR) of dislocated prosthetic hips performed by emergency physicians (EPs) as well as the incidence of acute complications. METHODS: The study design was an explicit chart review set at an academic ED with an annual census of 55,000. The study was performed on March 1, 1999 to February 28, 2004. Patients were identified using coded ED diagnoses, and data were obtained by a trained abstractor. RESULTS: One hundred twelve dislocations in 66 patients had attempted CR in the ED. Eighty-one had CR attempted solely by an EP with 91% success. Twenty-eight of the remaining 31 (90%) had successful CR performed by either an orthopedic surgeon or both an EP and an orthopedic surgeon. Overall, 10 patients (9%) failed ED CR. No postreduction complications were identified in any patient. CONCLUSIONS: EPs can safely and successfully perform CR on patients with dislocated total hip arthroplasties.

Adult↗
PubMed2005

Wide-complex tachycardia: beyond the traditional differential diagnosis of ventricular tachycardia vs supraventricular tachycardia with aberrant conduction.

Wide-complex tachycardia (WCT) is defined as a rhythm disturbance with a rate greater than 100 beats/min and a QRS complex duration of 0.12 seconds or more in the adult patient; in the pediatric patient, both rate and QRS complex width are age related. In evaluating this type of tachycardia, there are 2 broad categories usually discussed in the medical literature: ventricular and supraventricular with aberrant intraventricular conduction. There are several other important causes of a WCT encountered in clinical practice, which are less often discussed; these tachycardias often require specific therapies differing from the standard approach to WCT. These tachycardias are diverse; as such, the pathophysiology behind each form of WCT includes toxic, metabolic, and conduction system dysfunction mechanisms.

Adult↗
PubMed2005

Arrhythmic complications of acute coronary syndromes.

Cardiac arrhythmias routinely manifest during or following an acute coronary syndrome (ACS). Although the incidence of arrhythmia is directly related to the type of ACS the patient is experiencing, the clinician needs to be cautious with all patients in these categories. As an example, nearly 90% of patients who experience acute myocardial infarction (AMI) develop some cardiac rhythm abnormality and 25% have a cardiac conduction disturbance within 24 hours of infarct onset. In this patient population, the incidence of serious arrhythmias, such as ventricular fibrillation (4.5%) ,is greatest in the first hour of an AMI and declines rapidly thereafter. This article addresses the identification and treatment of arrhythmias and conduction disturbances that complicate the course of patients who have ACS, particularly AMI and thrombolysis. Emphasis is placed on mechanisms and therapeutic strategies.

Acute Disease↗
PubMed2004

Disagreement in the interpretation of electrocardiographic ST segment elevation: a source of error for emergency physicians?

Evaluation of the electrocardiogram (ECG) is a complex, subjective process with the potential for interobserver disagreement. The objective of this study was to determine the ECG patterns with discrepant interpretations, the rates of disagreement in the determination of both the presence of ST segment elevation (STE) and morphology. ECGs were reviewed in a retrospective fashion by attending EPs for STE and waveform morphology. Those ECGs that were interpreted in a discrepant fashion were then analyzed to detect patterns of disagreement. ECGs from 599 patients were reviewed. Two hundred eleven patients (35.2% of the total patient population surveyed) had STE as determined by at least one attending EP; 40 (19% of the STE population) patients had STE determined by 1 EP, 21 (10% of the STE population) patients by 2 EPs, and 150 (71% of the STE population) patients by 3 EPs. The STE of 61 (28.9%) ECGs were interpreted in a discrepant fashion. The average STE was 1.31 mm per lead for ECGs with disagreement and 2.93 mm per lead for ECGs with agreement (P<.05). ECGs with reciprocal ST depression were more likely to have agreement with regard to the STE (P<.05). Fourteen ECGs (8.2% of 171 ECGs with STE determined by at least 2 EPs) had ST segment morphology interpreted in a discrepant fashion. Disagreement in the determination of electrocardiographic ST segment elevation by EPs occurs frequently and is related to the amount of STE present on the ECG. Electrocardiographic patterns responsible for this interpretive disagreement of ST segment elevation can represent an unfortunate but potentially predictable source of error in emergency medical care.

Adult↗
PubMed2004

Orthopedic pitfalls in the ED: Achilles tendon rupture.

Achilles tendon rupture is a relatively uncommon occurrence in a general ED population. The history can be subtle, and physical findings may not be clear-cut. Prompt diagnosis and treatment of these injuries, however, is important to improved clinical outcome. The emergency physician needs to remain vigilant for this diagnosis to avoid this orthopedic pitfall. This review article examines the clinical presentation, diagnostic technique, and management options applicable to the emergency physician in the treatment of Achilles tendon rupture.

Achilles Tendon↗
PubMed2004

Orthopedic pitfalls in the ED: calcaneal fractures.

Fractures of the calcaneus are usually associated with a high-force mechanism, which frequently can involve associated injuries and prolonged disability. Due to distracting injury and variations in clinical findings, calcaneal fractures may be initially missed or misdiagnosed. This review article examines the clinical presentation, diagnostic techniques, and management of calcaneal fractures applicable to the emergency practitioner.

Accidents, Occupational↗
PubMed2004

Myocarditis: emergency department recognition and management.

Myocarditis is an acute inflammatory syndrome involving the heart and related structures. In many instances, the presentation is obvious, and appropriate treatment and disposition follow accordingly. In other situations, patients present with viral illness of the respiratory or gastrointestinal tracts (or both) or nonspecific symptoms such as fatigue and weakness,leading the clinician astray. Management is largely supportive, including aggressive cardiorespiratory support.

Acute Disease↗
PubMed2003

Additional electrocardiographic leads in the ED chest pain patient: right ventricular and posterior leads.

In the evaluation of the patient with chest pain, the 12-lead electro cardiogram is a less-than-(ECG) perfect indicator of acute myocardial infarction (AMI), particularly when used early in the course of the acute ischemic event; this relative insensitivity for AMI results from many different issues, including a less-than-optimal imaging of certain areas of the heart. It has been suggested that the sensitivity of the 12-lead ECG can be improved if 3 additional body surface leads are used in selected individuals. Acute posterior (PMI) and right ventricular myocardial infarctions are likely to be underdiagnosed, because the standard lead placement of the 12-lead ECG does not allow these areas to be assessed directly. Additional leads frequently used include leads V(8) and V(9), which image the posterior wall of the left ventricle, and lead V(4R), which reflects the status of the right ventricle. The standard ECG coupled with these additional leads constitutes the 15-lead ECG, the most frequently used additional lead ECG in clinical practice. The use of the additional leads might not only confirm the presence of AMI, but also provide a more accurate reflection of the true extent of myocardial damage.

Aged↗
PubMed2003

Chest pain in athletes.

The symptom of chest pain in the athlete can represent anything from a nonspecific musculoskeletal strain to a life-threatening condition such as tension pneumothorax. For the physician charged with evaluating this patient population, a thorough knowledge of the possible etiologies, their usual diagnostic algorithms, available imaging modalities, and potential therapeutic options is essential. Although the vast majority of patients with traumatic chest pain will not harbor significant pathology, the clinician must be prepared for those few who do have such conditions, and be prepared to intervene in an appropriate, time-sensitive fashion.

Athletic Injuries↗
PubMed2003

Evaluation and management of the high-risk orthopedic emergency.

Orthopedic injuries are frequently seen in the ED. Whereas the diagnosis and management of most of these injuries is straightforward, there are distinct pitfalls to avoid. The common theme among the high-risk "pitfall" injuries discussed in this article, besides a thorough patient history and careful physical examination with appropriate radiographs, is a high suspicion for the presence of these injuries. When the EP is knowledgeable about these orthopedic pitfalls, these injuries are much less likely to slip by in clinical practice.

Adult↗
PubMed2003

Acute complications associated with shoulder dislocation at an academic Emergency Department.

Shoulder dislocation is the most frequent dislocation treated in the Emergency Department (ED). Orthopedic literature cites up to a 55% incidence of fracture, vascular or neurologic injury associated with this injury, but these studies suffer from referral bias. No large ED series has been reported. This retrospective chart review was conducted in an academic ED for patients with shoulder dislocation presenting July 1, 1995-June 30, 2000. There were 263 charts identified; 73 were miscoded and 5 were lost, leaving 190 for analysis. Mean age was 34.3 years. Fifty-five patients had at least one fracture (29%), 48 of which (76%) were of the Hill-Sachs type. Despite presence of a fracture, all shoulders underwent successful ED reduction. Sensory nerve deficits were found in 24 (12.6%), which persisted after reduction in 25% of these patients. No vascular injuries were identified. The finding of fracture in 33% of patients with shoulder dislocation is in the range of rates reported in the orthopedic literature (15-55%). The finding that, despite the presence of a fracture, all underwent successful closed reduction is important, as one-third of these patients will have this condition. Neurologic deficits in 12% is significantly lower than the 21-65% reported in the orthopedic literature. Although complications associated with shoulder dislocation were relatively common, they did not significantly affect ED management.

Academic Medical Centers↗
PubMed2003

The prehospital 12-lead electrocardiogram: impact on management of the out-of-hospital acute coronary syndrome patient.

The electrocardiogram (ECG), when applied in the prehospital setting, has a significant effect on the patient with chest pain. The potential effect on the patient includes both diagnostic and therapeutic issues, including the diagnosis of acute myocardial infarction (AMI) and the indication for thrombolysis. The prehospital ECG may also detect an ischemic change that has resolved with treatment delivered by emergency medical services (EMS) prior to the patient's arrival in the emergency department (ED). Perhaps the most significant issue in the management of chest-pain patients involves the effect of the out-of-hospital ECG on the ED-based delivery of reperfusion therapy, such as thrombolysis. In AMI patients with ST-segment elevations, it has been conclusively demonstrated that information obtained from the prehospital ECG reduces the time to hospital-based reperfusion treatment. Importantly, these benefits are encountered with little increase in EMS resource use or on-scene time.

Aged↗