Biomedical subjects
Publications and source records attributed to D B McMicken.
The alcohol-dependent patient who presents with a seizure is perhaps the most perplexing and difficult challenge for the emergency physician. This review discusses the pathophysiology and presents our recommendations as to the evaluation, treatment, and criteria for admission for ARS.
Alcohol usage is an integral causal factor in all types of trauma. Additionally, both the acute and to a much greater extent chronic usage of alcohol impair the body's normal physiologic responses to injury. Emergency physicians are painfully aware of the relationship between alcohol and trauma. However, we occasionally fail to appreciate the body's altered response and physical state due to alcohol. We frequently fail to use this opportunity to confront patients with the fact that they have a problem and refer them appropriately to rehabilitation programs.
Current studies have begun to elucidate the pathophysiology of alcoholism and its withdrawal syndrome. Newer benzodiazepines, beta-blockers, alpha-agonists, butyrophenones and calcium channel blocking agents, alone and in combination, have been studied recently in alcohol withdrawal. This article discusses evaluation and therapy for delirium tremens, major alcohol withdrawal, mild alcohol withdrawal, adjunct therapy, and admission criteria.
Head trauma and suspected subarachnoid hematoma are encountered frequently by the emergency physician. There are few data to indicate which patients need immediate computerized tomography (CT) and what is the role of lumbar puncture in subarachnoid hemorrhage. Reviewed are the classification of head trauma and subarachnoid hemorrhage, indications for immediate CT, persons needing contrast enhancement, and the use of CT in comparison to skull films, digital subtraction angiography, and magnetic resonance.
A young woman returned to the emergency department two hours after discharge because of persistent vomiting and chest pain. Six hours earlier she had received syrup of ipecac to induce emesis following a drug overdose. Radiologic examination in the emergency department revealed pneumomediastinum and retropneumoperitoneum. A nasogastric tube was inserted in the emergency department. The patient was admitted to the ICU and placed on prophylactic antibiotics. Barium and gastrograffin esophagrams revealed no evidence of extravasation. Gastrointestinal endoscopy showed distal esophagitis. Gastroscopy and duodenoscopy were unremarkable. The patient did well following discharge.
Alcoholism may be society's most devastating problem short of war and malnutrition. Perhaps the most complex and perplexing medical complication of alcoholism is alcohol-related seizures. This article is a collective review designed to provide emergency physicians with an overview of the topic that is pertinent to their clinical practice. Part 1 addresses the pathophysiology, differential diagnosis, and evaluation of alcohol-related seizures. Part 2 will concentrate on the clinical presentation, management, and disposition. In addition, a classification of alcohol-related seizures will be proposed.
Alcoholism may be society's most devastating problem short of war and malnutrition. Perhaps the most complex and preplexing medical complication of alcoholism is alcohol-related seizures. This article is a collective review designed to provide emergency physicians with an overview of the topic that is pertinent to their clinical practice. Part 1 addressed the pathophysiology, differential diagnosis, and evaluation of alcohol-related seizures. Part 2 focuses on the clinical presentation, management, and disposition. In addition, a classification of alcohol-related seizures is proposed.