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Biomedical subjects

C V Pollack

Publications and source records attributed to C V Pollack.

At least 19 recordsLinked to original sources
PubMed1997

Incision and drainage of cutaneous abscesses is not associated with bacteremia in afebrile adults.

STUDY OBJECTIVE: To determine the prevalence of bacteremia associated with incision and drainage (I&D) of cutaneous abscesses in afebrile adult emergency department patients. Such information has implications for the ED management of immunocompromised patients, patients with history of endocarditis, and patients with prosthetic appliances such as heart valves and artificial joints. METHODS: We conducted a prospective clinical study in the adult ED of an urban tertiary care teaching hospital. Our subjects were afebrile patients aged 18 to 65 years with localized, nondraining, purulent cutaneous abscesses requiring outpatient surgical management. Before I&D, blood for aerobic and anaerobic blood culture was drawn under sterile conditions. The wound was opened and samples for aerobic wound culture were obtained. Two and 10 minutes after I&D, blood was again drawn, from separate venipunctures. All patients were discharged home with ED follow-up scheduled 48 hours later. RESULTS: From the 50 patients who completed the study, 150 blood samples (50 before and 100 after I&D) and 50 wound samples were obtained. No blood culture was positive, but 30 wound cultures (64%) were positive; the most commonly isolated organism was Staphylococcus aureus. CONCLUSION: I&D of localized cutaneous abscesses in afebrile adults is unlikely to result in transient bacteremia. Larger studies are needed to determine whether routine antibiotic prophylaxis is necessary for afebrile patients undergoing I&D.

Abscess↗
PubMed1997

Respiratory pearls, pitfalls, and updates.

The scope of respiratory and ventilatory support offered in the emergency department (ED) has expanded substantially in the last 10 years. Emergency physicians are now much more aggressive and sophisticated in their management of bronchospasm, pulmonary edema, and acute respiratory failure. New medications and new technologies that have been tested in intensive care units should also be considered appropriate for use in the ED; indeed, from a respiratory support standpoint, the ED should be viewed as an intensive care unit. In this article, the authors outline these new concepts and treatments that allow initiation of "intensive care" in the ED.

Algorithms↗
PubMed1995

Outpatient management of acute urticaria: the role of prednisone.

STUDY OBJECTIVE: To evaluate the efficacy of a 4-day "burst" course of prednisone added to standard treatment with H1 antihistamines for the management of acute urticaria in outpatients. DESIGN: Prospective, randomized, double-blinded, clinical trial. SETTING: Emergency department of an urban tertiary care teaching hospital. PARTICIPANTS: Adult patients with urticarial rash of no more than 24 hours' duration, regardless of cause. Patients were excluded if they manifested wheezing, stridor, or angioedema or if they had taken antihistamines or glucocorticoids within 5 days of arrival at the ED. Patients also were excluded if there was a history of diabetes or active peptic ulcer disease. INTERVENTIONS: All patients were asked to evaluate the severity of pruritus ("itch score") on a 10-cm visual analog scale. Patients were then given diphenhydramine, 50 mg intramuscularly, and discharged home on a regimen of hydroxyzine, 25 mg orally, every 4 to 8 hours for pruritus, plus either prednisone, 20 mg, or placebo orally every 12 hours for 4 days. Patients' conditions were reassessed clinically, with itch score calculated again 2 days later, and again at 5 days by telephone. RESULTS: Forty-three patients were enrolled; 24 received prednisone and 19 received placebo. The two groups had similar itch scores at enrollment (prednisone, 8.1 +/- 1.7; placebo, 7.4 +/- 2.1, P = .25 [ANOVA]), but at 2- and 5-day follow-up the prednisone group had significantly lower itch scores (1.3 +/- 1.3 and .0 +/- .0 versus 4.4 +/- 2.2 and 1.6 +/- 1.0, respectively; P < .0001 [ANCOVA] at each interval) and greater clinical improvement in rash. Response did not correlate with age, sex, or identification of an allergen. No adverse effects were noted in either group. CONCLUSION: The addition of a prednisone burst improves the symptomatic and clinical response of acute urticaria to antihistamines. Patients' conditions improved more quickly and more completely when prednisone was administered, without any apparent adverse effects.

Acute Disease↗
PubMed1995

Treatment of acute bronchospasm with beta-adrenergic agonist aerosols delivered by a nasal bilevel positive airway pressure circuit.

STUDY OBJECTIVE: To determine whether beta-adrenergic agonist aerosols are more effective in treating acute bronchospasm if delivered by nasal bilevel positive airway pressure (BiPAP) than by a small-volume nebulizer (SVN). We hypothesized that BiPAP would reduce the work of breathing in asthmatic patients and thereby hasten improvement of bronchospasm from beta-agonist therapy. Previous trials with aerosols given by intermittent positive-pressure breathing were unrewarding, but BiPAP is unique in that inspiratory (IPAP) and expiratory (EPAP) support pressures may be set separately. DESIGN: Convenience-randomized prospective clinical study. SETTING: Emergency department of an urban tertiary care teaching hospital. PARTICIPANTS: Afebrile, wheezing patients between 18 and 40 years of age. INTERVENTIONS: Patients were randomly assigned to receive two doses of aerosolized albuterol (2.5 mg in 3 mL normal saline solution), 20 minutes apart, delivered by either SVN (n = 40) or BiPAP (n = 60) by nosemask or facemask (IPAP, 10 cm H2O; EPAP, 5 cm H2O). RESULTS: Peak expiratory flow rate (PEFR), arterial blood oxygen saturation (by pulse oximetry), and pulse and respiratory rates were measured at baseline and after each treatment. The two treatment groups had similar values for pulse oximetry, pulse rate, respiratory rate, and percent of predicted peak expiratory flow rate (%PPEFR) at entry, and all patients experienced similar changes in the first three of these variables through the course of treatment. BiPAP patients had a significantly greater increase in %PPEFR after each treatment (P = .0011) and from baseline to completion (P = .0013). Increase in absolute PEFR was greater in the BiPAP group (from 211 +/- 89 [mean +/- SD] to 357 +/- 108 L/minute for BiPAP, from 183 +/- 60 to 280 +/- 87 L/minute for SVN; P = .0001). CONCLUSION: In this population, response to initial ED management of bronchospasm, as measured by PEFR, was better with aerosols delivered by BiPAP than with those delivered by SVN.

Acute Disease↗
PubMed1994

Suprapubic bladder aspiration versus urethral catheterization in ill infants: success, efficiency and complication rates.

STUDY OBJECTIVE: To compare success rates, complications, and efficiency of suprapubic bladder aspiration with urethral catheterization in ill infants. DESIGN: Prospective, randomized clinical study. SETTING: The pediatric emergency department at the University of Mississippi Medical Center in Jackson. PARTICIPANTS: Convenience sample of infants under 6 months of age requiring an uncontaminated urine specimen for the evaluation of febrile illness, suspected urinary tract infection, or sepsis. Infants with wet diapers were excluded. INTERVENTIONS: Patients were randomized to undergo timed suprapubic bladder aspiration (performed by a physician and a nurse) or urethral catheterization (performed by two nurses). If suprapubic bladder aspiration was unsuccessful, urethral catheterization was performed immediately and the bladder was drained; emptying volume was recorded. All patients had a next-void "bag" urinalysis performed for post-procedure hematuria. RESULTS: Fifty patients underwent primary suprapubic bladder aspiration. The success rate (defined by obtaining at least 2 mL of urine) was 46%. Mean +/- SD time per successful suprapubic bladder aspiration was 16.73 +/- 7.73 seconds. Fifty patients underwent primary urethral catheterization. The success rate was 100%; the mean time required was 80.70 +/- 46.52 seconds. After failed suprapubic bladder aspiration, urethral catheterization was 100% successful, with a mean draining volume of 2.95 +/- 2.38 mL. No immediate problems were identified among any instrumented patients; later complications (next-void hematuria after either procedure, other visceral injury with suprapubic bladder aspiration) were not detected. CONCLUSION: Both suprapubic bladder aspiration and urethral catheterization afford the emergency physician low-risk access to uncontaminated urine in ill infants. Suprapubic bladder aspiration is less efficient in that it requires physician participation and failure rates are higher. These data suggest that successful suprapubic bladder aspiration is primarily dependent on the volume of urine in the bladder; thus, in the ill or febrile ED infant who may be dehydrated, the likelihood of success decreases. The authors recommend that ED nursing and physician staff become comfortable with performing urethral catheterization on infants.

Drainage↗
PubMed1994

Gluteal compartment syndrome.

Gluteal compartment syndrome is a rare disorder that most often occurs in conjunction with prolonged immobility after a sedative overdose but also may result from direct trauma. Patients present with localized tenderness, induration, and pain with passive flexion of the gluteal muscles. Signs of sciatic nerve compression occur frequently, and rhabdomyolysis may be associated with the syndrome. If the diagnosis of gluteal compartment syndrome is suspected, intracompartmental pressures should be measured. If pressures are high or if sufficient clinical suspicion remains, the patient should undergo prompt fasciotomy.

Adult↗
PubMed1994

Incidence of subclinical methemoglobinemia in infants with diarrhea.

STUDY HYPOTHESIS: Infants with diarrhea are at a greater-than-recognized risk of developing methemoglobinemia. DESIGN: Prospective clinical study. SETTING: A university hospital pediatric emergency department. PARTICIPANTS: Consecutive infants under 6 months of age with a history of diarrhea of more than 24 hours' duration not associated with vomiting. INTERVENTIONS: Blood samples were obtained for methemoglobin (MHgb) assay (normal, 0.4% to 1.5%) and electrolytes. Treatment interventions were performed as clinically indicated. Patients with elevated MHgb levels subsequently underwent hemoglobin electrophoresis to exclude congenital methemoglobinemia. RESULTS: Forty-three patients were studied; 27 (64%) had elevated MHgb levels and 13 were cyanotic. Five patients received infusions of methylene blue for methemoglobinemia. All patients recovered without sequelae. There was a strong correlation between weight at or below the tenth percentile for age and the development of methemoglobinemia. Contrary to previous studies, there was no correlation between incidence or severity of methemoglobinemia and acidosis, hyperchloremia, or positive microbiologic studies. CONCLUSION: In ill infants with diarrhea, particularly those who are small for age, consideration should be given to screening for methemoglobinemia.

Blood Protein Electrophoresis↗
PubMed1993

Simultaneous asymmetric bilateral traumatic hip dislocation.

A 25-year-old man presented to the emergency department with simultaneous right anterior and left posterior hip dislocations resulting from a motor vehicle accident. Simultaneous bilateral traumatic hip dislocation is an uncommon occurrence. More rare is asymmetric simultaneous bilateral hip dislocation, with only ten cases documented in the English-language literature. The importance of an anteroposterior pelvic radiograph after significant major trauma is emphasized. Several serious complications can be associated with this condition, so expeditious management in the ED is warranted.

Accidents, Traffic↗
PubMed1993

Prehospital fluid resuscitation of the trauma patient. An update on the controversies.

The most efficacious means of prehospital volume resuscitation of the trauma patient has been debated for many years; more recent discussion has questioned the indications for any prehospital resuscitation. This article reviews the various viewpoints active in each of these areas, summarizes the current status of the disputed issues, and offers suggested directions for further research.

Blood Grouping and Crossmatching↗
PubMed1993

Emergencies in sickle cell disease.

Sickle cell disease in its heterozygous and homozygous forms exhibits diverse, debilitating pathologic manifestations. No organ system is spared from the effects of chronic hypoxia and poor rheology. The emergency physician should be familiar with the typical complications of SCA, because in large part these problems can either be managed in the ED or require emergent, focused evaluation and referral.

Anemia, Sickle Cell↗
PubMed1992

Long-term local effects of intraosseous infusion on tibial bone marrow in the weanling pig model.

The weanling pig model was used to determine the long-term local effects, if any, on tibial bone marrow after intraosseous (IO) infusion of resuscitation fluid and drugs at standard dosages. One of six IO treatments (two normal saline boluses [20 mL/kg]; bolus sodium bicarbonate [1 mEq/kg]; 10% sodium bicarbonate infusion at a maintenance rate for 1 hour; bolus 1:10,000 epinephrine [0.01 mg/kg]; 1:10,000 epinephrine solution infusion, 1 microgram/kg/min for 1 hour; or dopamine infusion, 10 micrograms/kg/min for 1 hour) was randomly administered via the left tibia to 18 pigs at 4 weeks of age. The animals were subsequently followed for 3 months, after which marrow from the same space and peripheral blood were examined. Marrow from the right tibia of each animal served as control; untreated historic controls were also used for comparison. Examination of the marrow revealed normal cell differentials in all limbs in all groups. Overall cellularity was somewhat decreased in the experimental limbs of the normal saline bolus group when compared with same-animal control limbs, perhaps due to the pressure effect from rapid injection. Peripheral blood counts and differentials in these and all other animals were normal. The authors conclude that IO administration of commonly used resuscitative medications does not result in significant adverse effects in the tibial bone marrow in this model.

Animals↗
PubMed1992

Sickle cell vaso-occlusive pain crisis in adults: alternative strategies for management in the emergency department.

The gene for sickle cell disease is carried by 8% of the African-American population in the United States. The primary care physician is often called upon to recognize and treat one of the major sequelae of sickle cell disease--vaso-occlusive pain crisis. An injectable nonsteroidal anti-inflammatory drug has recently become available and may offer some improvement in outcome of vaso-occlusive pain crises. We present five case reports reviewing various current therapeutic options, including newer pharmacologic agents, and comment on alternatives to impatient management of pain crises. The use of the emergency department short-term observation unit as an alternative to hospitalization is discussed.

Acetaminophen↗