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Biomedical subjects

C M Slovis

Publications and source records attributed to C M Slovis.

At least 55 records · Page 3Linked to original sources
PubMed1990

Endocarditis in intravenous drug abusers.

IE due to parenteral drug use is an ever-increasing problem for physicians working in the ED. IE may present with a multitude of signs and symptoms of variable severity. Patients may complain of only vague symptoms consistent with a viral syndrome, or they may present with a neurologic or cardiovascular catastrophe. ED physicians must have a high degree of suspicion for IE whenever they evaluate a patient who could possibly be abusing drugs.

Ambulatory Care↗
PubMed1990

Neurologic complications of alcoholism.

Neurologic and myopathic complications of alcoholism are multiple and diverse, affecting both the central and peripheral nervous systems. In the ED, initial concern is for diagnosing readily reversible causes and ruling out possible life- or limb-threatening etiologies. A rapid assessment of the ABCs, a fingerstick blood glucose determination, and, in cases of AMS, the administration of intravenous naloxone is indicated. In almost every instance of a potential neurologic complication, intravenous thiamine replacement is indicated initially, along with the parenteral administration of folic acid and the other B vitamins, including nicotinic acid and pyridoxine. Metabolic screening with electrolytes, glucose, blood urea nitrogen, creatinine, calcium, magnesium, liver enzymes (AST, alkaline phosphatase), bilirubin, arterial blood gases with carboxyhemoglobin determination, and a complete blood count are often warranted. Special tests such as CT scan, CK, ammonia, or toxicologic screens are indicated in specific instances. In terms of physical examination, attention to the presence of focal neurologic findings is paramount because of the possibility of a subdural or epidural hematoma. It is important not to miss meningitis and a low threshold for treatment or lumbar puncture should be maintained. Specialized consultation and referral are needed only after stabilization and appropriate tests are performed. If an organized approach to the evaluation of an alcoholic with neurologic symptoms is undertaken, occult disease will not be missed and outcomes will be improved.

Alcoholism↗
PubMed1989

A toxicity study of parenteral thiamine hydrochloride.

Thiamine deficiency is not uncommon in certain populations and clinical disease states such as Wernicke's encephalopathy or beriberi. Rapid parenteral repletion may be required, yet questions about the safety of IV thiamine have been raised because of reports of anaphylaxis. Our study was a prospective evaluation of the safety of thiamine hydrochloride given as a 100-mg IV bolus in 989 consecutive patients (1,070 doses). A total of 12 adverse reactions (1.1%) were reported. Minor reactions consisting of transient local irritation were seen in 11 patients (1.02%), and there was only one major reaction (0.093%) consisting of generalized pruritus. Thiamine hydrochloride may be administered intravenously without undue concern. Intradermal test doses before administration are not warranted unless patients have had previous allergic reactions.

Adolescent↗
PubMed1989

Bedside cerebrospinal fluid glucose analysis.

We studied the reliability and accuracy of a two-minute reagent strip (Chemstrip bG) and hand-held autoanalyzer (Accu-Chek IIR) for determining cerebrospinal fluid glucose. We found that both bedside methods were highly reliable (r = 0.93, Chemstrip bG: r = 0.95, Accu-Chek II) and were very accurate (89.7% and 96.6% accurate at +/- 15 and 20 mg/dL, respectively, for the Chemstrip bG: 91.7% and 95.8% accurate at +/- 15 and 20 mg/dL, respectively, for the Accu-Chek II) over a wide range of glucose values in 237 determinations. There was no significant difference between the two bedside methods. We conclude that these two methods of bedside glucose estimation are both highly reliable and accurate and could be used to quickly determine patients' cerebrospinal fluid glucose values.

Autoanalysis↗
PubMed1989

Severe alcohol intoxication: a study of 204 consecutive patients.

We report a five month retrospective analysis of 204 consecutive patients seen in an adult medical emergency department with blood alcohol concentrations (BAC) in excess of 400 mg/dl. The average BAC was 467 mg/dl with a range of 400-719 mg/dl. In 153 patients (75%) the BAC was 400-500 mg/dl, in 47 patients (23%) the BAC was 500-600 mg/dl and in 4 patients (2%) the BAC was greater than 600 mg/dl. Eighty-eight percent of the patients were oriented to person, place, and time upon questioning, 12% were disoriented or unresponsive to noxious stimuli. None of the four patients whose BAC was greater than 600 mg/dl were initially alert and oriented and only eight of the unresponsive patients had a BAC below 500 mg/dl (p less than .001). Sixteen patients (8%) were admitted. Three of the admissions were for continued unresponsiveness presumed due to ethanol, the other thirteen were for coexistent medical conditions. There were no significant associations between BAC and vital sign abnormalities.

Adult↗
PubMed1988

Severe metabolic alkalosis in the emergency department.

A case of severe metabolic alkalosis (MA) resulting from ingestion of baking soda (sodium bicarbonate) is presented. On admission to the emergency department, the patient was alert and stable with an initial examination that was remarkable only for carpopedal spasm. Shortly thereafter, the patient had a sudden, unexpected cardiopulmonary arrest. Following resuscitation, without administration of sodium bicarbonate, the arterial blood gas revealed a pH of 7.73, pO2 of 51 mm Hg, and pCO2 of 52 mm Hg. After admission to the intensive care unit, the patient's MA was corrected using IV 0.25 N hydrochloric acid. The patient remained comatose as a result of severe anoxic encephalopathy and died two weeks after admission. We believe this is the first reported case of severe MA resulting in sudden cardiopulmonary arrest in a previously ambulatory patient.

Acute Disease↗
PubMed1987

Diabetic ketoacidosis and infection: leukocyte count and differential as early predictors of serious infection.

The records of 153 patients who presented to an emergency department with diabetic ketoacidosis were reviewed to determine whether any admission evaluation laboratory data could serve as a predictor of occult or coexisting infection. Ten patients with admission radiographs already demonstrating active infection (pneumonia or tuberculosis) and two patients with wet gangrene of an extremity were not included in subsequent statistical analysis, as their infections were diagnosed on initial evaluation. Analysis of readily available admission variables revealed that when age, sex, temperature, glucose, serum bicarbonate, pH, total leukocyte count, and differential are subjected to univariate and multivariate discriminant analysis, only an elevation in band neutrophils reliably predicted infection. Approximately half of our patients with elevated band counts (10 or greater) had a coexisting occult infection. An elevated band count was predictive of an occult coexisting major infection with a sensitivity of 100% (19/19) and a specificity of 80% (98/122).

Adult↗
PubMed1987

Hepatic vein bullet embolus as a complication of left thoracic gunshot injury.

The case of a patient with a hepatic vein bullet embolus complicating a left ventricular gunshot injury is described. The patient presented hypotensive with a left midaxillary entrance wound. Initial radiographs showed a bullet fragment below the right hemidiaphragm. Emergency open thoracotomy was performed with release of a tense pericardial effusion and repair of a left ventricular penetrating wound. Surgical exploration failed to reveal direct penetrating injury to the diaphragm or abdominal viscera. After a hepatic venogram localized the bullet fragment in a branch of the right lobe hepatic vein, a periscopically directed catheter extraction of the fragment was successfully performed. A discussion of missile embolization, its pathology, clinical presentation, diagnosis, and management is presented.

Adult↗
PubMed1987

Intravenous use of glycopyrrolate in acute respiratory distress due to bronchospastic pulmonary disease.

A patient with acute respiratory distress secondary to emphysema and reactive airway disease had inadequate tidal volumes with and without endotracheal intubation. Because of the patient's failure to respond to maximal standard bronchodilator therapy and the physical inability to ventilate the patient by manual positive pressure, he received IV glycopyrrolate (0.2 mg) approximately 50 minutes after admission to the ED. The patient's condition immediately improved, as evidenced by the ability to manually ventilate the patient; he developed increased tidal volumes; and he began responding to inhalation therapy. This is the first reported case of IV glycopyrrolate administration for chronic obstructive pulmonary disease or asthma in the literature and demonstrates an instance in which inhalation therapy was ineffective due to low tidal volumes.

Acute Disease↗
PubMed1986

Non relationship of climatologic factors and painful sickle cell anemia crisis.

Conflicting results have arisen from studies concerning the correlation (if any) between climatological changes and the frequency of painful episodes in the sickle cell population. During a 13 month period records of 71 patients with hemoglobin genotypes SS or SC were reviewed. Data analysis failed to reveal an association between the frequency of painful sickle cell crisis and a number of weather and environmental variables. We were unable to demonstrate relationships between the climatologic factors of temperature, humidity, carbon monoxide level and precipitation in the frequency of 362 pain crises in 71 sickle cell patients during a 13 month period.

Adolescent↗
PubMed1985

Tight-fitting garments as counterpressure devices.

A case of traumatic splenic rupture in a hemodynamically stable elderly woman is presented. The patient decompensated almost immediately following the removal of a tight-fitting girdle. The implications of recognizing garments as potential counterpressure devices in emergency management are discussed. Emergency physicians are cautioned to carefully explore and reevaluate patients after the removal of tight-fitting garments.

Aged↗
PubMed1985

A priority dispatch system for emergency medical services.

A decision tree priority dispatch system for emergency medical services (EMS) was developed and implemented in Atlanta and Fulton County, Georgia. The dispatch system shortened the average response time from 14.2 minutes to 10.4 minutes for the 30% of patients deemed most urgent (P less than or equal to .05); resulted in a significant increase in the use of advanced life support units for this group (P less than or equal to .02); decreased the number of calls that required a backup ambulance service; and significantly increased conformity to national EMS response time standards for critically ill and injured patients (P less than or equal to .0009). Due to dispatch error, 0.3% of calls were dispatched as least severe but subsequently were found to be most urgent.

Emergency Medical Service Communication Systems↗
PubMed1983

Spontaneous drainage of cardiac tamponade.

The case of a 23-year-old man with life-threatening pericardial tamponade resulting from a cardiac stab wound is presented. After initial attempts at stabilization failed to reverse the progressively worsening status of the patient, he was prepared for surgery. Just prior to induction of anesthesia, blood began to flow from the patient's chest tube, resulting in a return to a near normal hemodynamic status. This was believed to be the result of spontaneous drainage of cardiac tamponade prior to cardiorrhaphy. The patient was discharged ten days post admission in excellent health and was doing well at a one-month follow-up visit. The discussion includes what comprises definitive care for cardiac tamponade, and the controversy in the timing and appropriateness of pericardiocentesis.

Adult↗
PubMed1982

Massive foreign object ingestion.

Although foreign object ingestion is usually a benign event, it may result in serious complications. Presented is the case of a 41-year-old man admitted secondary to the ingestion of 71 metallic objects, including a wrench, wire springs, and a razor blade. The patient was observed in hospital for eight days, during which time there was no evidence of passage of any objects. On the eighth hospital day the patient underwent a gastrostomy for removal of the foreign objects. Post-operative recovery was uneventful. Guidelines for both the diagnosis and therapy of foreign body ingestions are discussed, with particular attention to indication for medical versus surgical intervention.

Adult↗
PubMed1982

Survival in a heat stroke victim with a core temperature in excess of 46.5 C.

Presented is a case report of a 52-year-old male heat stroke victim. The patient presented in deep coma with a temperature above 42 C. Following rapid assessment, the patient was intubated, rehydration was begun, and he was externally cooled with ice bags and internally cooled with ice water gastric lavage. After 25 minutes the patient's core temperature was measured at 46.5 C (115.7 F). Multiple organ system failure developed over the ensuing days. With aggressive care, the patient improved dramatically and was discharged at prior baseline status on the 24th day of hospitalization. This case now represents the highest human body temperature elevation reported without permanent residua.

Body Temperature↗
PubMed1982

Preventing severe heat injury in runners: suggestions from the 1979 Peachtree Road Race experience.

Of an estimated 17632 participants of the 1979 Peachtree Road Race, a 10-km race held at 0800 on 4 July in Atlanta, Georgia, 29 had severe heat injury (collapse with altered mental status and rectal temperature of 39.7 degrees C or greater); all 29 recovered promptly. The temperature was 24.0 degrees C; the relative humidity, 83%; and the wet bulb-globe index, 23.0 degrees C. Compared with unaffected participants matched by age, sex, and predicted finishing time, case-runners were taller, had slower best recent 1.6-km and 10-km times, had run less in June, were more likely to achieve 89% of estimated maximum aerobic capacity during the race, less often splashed with water, were more likely to have underestimated their predicted finishing times based on their best recent 10-km times, and were more likely to live in Georgia. Height, sprinkler use, and underestimating predicted finishing times were each significant in the presence of the others. These observations suggest that participants of similar races, particularly those taller than 179.2 cm, should splash with water at least twice and base their predicted finishing times on their best recent 10-km times; adherence to these recommendations by runners at risk should reduce their severe heat injury risk at least 8.1 times.

Athletic Injuries↗