Biomedical subjects
Publications and source records attributed to D G Klein.
ARDS continues to be associated with high mortality rates despite numerous advances in critical care. Improvements in oxygenation can be achieved by placing patients with ARDS prone. The Vollman Prone Positioner offers an easy, safe, and inexpensive method to turn patients prone (for more information: www.vollman.com).
Severe head injury is a major cause of disability, death, and economic cost. Significant reductions in mortality and morbidity can be achieved in patients with severe head injury through the use of evidence-based protocols and guidelines. Although no set standard is available for the management of patients with severe head injury, improved outcomes following severe head injury are seen with complete and rapid physiologic resuscitation and specific strategies that decrease ICP.
Explore the source record for details and available documents.
Long-term infusions of neuromuscular blocking agents are being used with increasing frequency in critical care areas to paralyze patients for optimal ventilatory support or to reduce patient energy demands. Prolonged weakness with no sensory disturbance has been reported in some patients. The complex nature of the critically ill patient makes the pharmacokinetics of neuromuscular blocking agents unpredictable. Monitoring neuromuscular blockade with a peripheral nerve stimulator and administering the appropriate dose may minimize the complications of its use. The CNS can be the change agent to assist the nursing staff in incorporating recent technological innovations and research findings in nursing clinical practice. The rational model of change serves as a guide when little resistance is anticipated or when change is perceived as rational.
Wounds that result from trauma and burn injuries may lead to the development of infection from the mechanism of injury, bacterial contamination, exogenous and endogenous sources, and impaired host defenses. Knowledge of these factors, combined with thorough wound assessment, differentiation between contaminated and infected wounds, the appropriate use of wound cultures and antibiotics, and the appropriate selection of wound-management techniques, is important in the optimization of wound healing.
Ludwig's angina is a cellulitis frequently occurring as a result of infections of the second and third lower molar. Despite a decrease in mortality from 50% to less than 10% since the introduction of antibiotics, it remains a rare but life-threatening illness. The potential for rapid respiratory obstruction is the greatest concern. Familiarity with the anatomy of the neck and recognition of symptoms are essential for effective treatment. Treatment focuses on maintenance of an airway, antibiotic therapy, and surgery. Asphyxia, aspiration, mediastinitis, pneumonia, empyema, and septicemia are possible complications.
It was proposed that effectiveness of a religious response to personal crisis is related to type and amount of self-discrepancy. Fifty subjects were administered a questionnaire to assess the following two types of self-discrepancies: (1) discrepancy between perceived actual self and perceived ideal self and (2) discrepancy between perceived actual self and perceived ought-to-be self. Subjects also were asked to choose types of religious responses to a personal crisis. Religious responses were behaviorally, cognitively, and affectively loaded. Subjects with an actual/ought discrepancy chose behavioral and affective religious responses more frequently than did those without this discrepancy. No effects were found for the actual/ideal discrepancy. Implications of these results for revision and extension of the model are discussed.
Traumatic injury results in major physiologic alterations that begin at the time of injury and persist until recovery is complete. The response of the body is divided into two phases--the acute phase and the flow phase. The acute phase is characterized by shock with changes in hormone concentration. These hormones, either alone or in combination, result in lipolysis, amino acid release, gluconeogenesis,, and glycolysis. The flow phase of injury is a catabolic process that is characterized by an increased protein metabolism. Hypermetabolism and increased nitrogen losses are seen. The magnitude of these alterations is directly related to the severity of injury. Tissues with the highest oxygen consumption are more susceptible to injury and death. Cellular function does not depend on oxygen alone but also on the ability of the cells to use available oxygen. If the body is unable to compensate through biochemical, hormonal, and metabolic activities, an irreversible state results unless appropriate interventions are instituted promptly.
Explore the source record for details and available documents.
Many products capable of producing chemical burns are now available. The prognosis of a patient injured by chemicals is dependent on the rapidity of treatment. There are many types of chemical agents each with its own specific properties. The local reactions and systemic effects of these chemicals vary as does their counteragents. Knowledge of the chemicals, the types of injuries they produce, and appropriate treatment for each is essential to ensure appropriate assessment, treatment, and safety.
Explore the source record for details and available documents.
OBJECTIVE: To compare tympanic membrane temperature with pulmonary artery (PA) and rectal temperature (calibrated glass mercury) to determine consistency among measures. DESIGN: Convenience, within-subject, quasi-experimental. SETTING: Midwestern university-affiliated tertiary medical center. PATIENTS: 128 adult (18 years or older) patients admitted to the surgical intensive care unit with an age range of 18 to 90 years (mean 57 years). OUTCOME MEASURES: Tympanic, PA, and rectal temperature. INTERVENTION: Rectal and tympanic membrane temperatures were measured in 60 patients. PA and tympanic membrane temperatures were measured in 68 patients. RESULTS: Rectal and tympanic membrane temperatures were moderately correlated (r = 0.525). Mean rectal was slightly higher than mean tympanic membrane temperature (mean difference 0.19 degrees C). PA and tympanic membrane temperatures were highly correlated (r = 0.909). Mean tympanic membrane temperature was slightly higher than mean PA temperature (mean difference 0.42 degrees C). For PA temperatures, 57 (84%) of the differences were between 0 and +1 degree Celsius, whereas for rectal temperature, 23 (37%) were between 0 and +1 degree Celsius and 28 (47%) were between 0 and -1 degree Celsius. CONCLUSIONS: Tympanic temperature measurements would be an appropriate substitute for PA temperature if the PA catheter has been removed or the PA thermistor is nonfunctional. In addition, this study suggests that to effectively track temperature in a particular patient, the site for temperature measurement must be consistent.