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Biomedical subjects

D J Vukich

Publications and source records attributed to D J Vukich.

6 recordsLinked to original sources
PubMed1992

A field comparison of the pharyngeotracheal lumen airway and the endotracheal tube.

A prospective, sequential study compared ease of use and bag-valve ventilation delivered by an endotracheal tube (ET) with that of the pharyngeotracheal lumen airway (PtL) for 111 victims of cardiac arrest in the pre-hospital setting. The PtL airway was found to be significantly easier to use as measured by the time required to intubate the patient and the number of attempts to place the device. Arterial blood gas determinations were made on arrival at the hospital and repeated 15 minutes later. No statistical significance could be found between the two airway devices for either the first or second blood gas determination. During PtL ventilation, the first arterial blood gas values were PaCO2, 58 +/- 32 mm Hg; PaO2, 163 +/- 180 mm Hg; pH, 7.15 +/- 0.22. During ET ventilation the first arterial blood gas values were PaCO2, 53 +/- 29 mm Hg; PaO2, 156 +/- 178 mm Hg; pH, 7.16 +/- 0.23. No adverse effects were reported. We conclude that the ability of the PtL to deliver effective ventilation is comparable with that of the ET as measured by arterial PCO2. When the ET method of airway control cannot be achieved, the PtL airway offers an effective alternative.

Adult↗
PubMed1991

An analysis of emergency physicians' cumulative career risk of HIV infection.

STUDY OBJECTIVE: To determine point and range estimates of the cumulative career risk of occupationally acquired human immunodeficiency virus (HIV) infection by emergency physicians as well as to determine if the efficacy of universal precautions was seriously diminished by prolonged risk over time. DESIGN: Monte Carlo estimation of a mathematical model of cumulative risk. Eight scenarios were estimated for high versus low prevalence of HIV, no precautions versus universal precautions, and prevalence increasing to a steady state versus peaking and then declining. MEASUREMENTS AND MAIN RESULTS: For high-prevalence areas, not using universal precautions, and assuming HIV seroprevalence increases to a steady-state level, the median estimate of cumulative risk of HIV infection over a 30-year career was 1.4% (90% of tolerance range, 0.2% to 14.0%); for low-prevalence emergency departments, the median was 0.1% (0.001% to 3.6%). Universal precautions with a presumed effectiveness of approximately 40% resulted in an approximate 30% decrease in risk. CONCLUSIONS: Although the per-exposure risk is small, the cumulative risk of HIV infection may be disproportionately large. The efficacy of universal precautions does not appear to be substantially diminished over time.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Use of the infectious disease laboratory in emergency medicine.

Until relatively recent advances in the identification of infectious agents, the emergency physician found only limited usefulness of the infectious disease laboratory. There are some tests that can provide information rapidly enough for the Emergency Department setting and new technologies that hold even greater promise for the future. The tests described in this article are currently available in most moderately sized Emergency Departments.

Bacterial Infections↗
PubMed1989

How many myocardial infarctions should we rule out?

We used computer simulation to estimate the consequences of four admitting strategies (coronary care unit, intermediate care unit, routine ward care, or outpatient follow-up) on cost, outcome, admission threshold probabilities, and false-positive admission rates for patients with acute myocardial infarction. At virtually any probability of acute myocardial infarction, replacing more intensive by less intensive strategies saved money but increased mortality and decreased life expectancy. Therefore, choices among strategies may be made by using the most effective strategy for progressively lower and lower risk patients until the additional cost per additional life saved reaches a cutoff value; then, a less expensive strategy is selected. With sample cutoff values of $1 and $2 million per life saved, the marginal threshold admission probabilities were: (table; see text) These results imply that the acceptable proportion of false-positive admissions may be as high as 70% to 80%; lower rates could indicate excessively restrictive admitting policies. Clinicians may be operating closer to the optimal decision point than has previously been asserted.

Coronary Care Units↗
PubMed1989

Diseases of the pleural space.

Pneumothorax in the ED most often will be primary and spontaneous in a young person who may be treated with either chest tube, mini-chest tube, or aspiration of pneumothorax according to local preference. The other large group of pneumothoraces will be spontaneous but secondary to a disease process, procedure, or drug abuse. The treatment of these must be individualized because conservative measures may not work and the underlying process may require attention as well. Although gaining in popularity, the use of devices or procedures other than formal chest tubes is still not general practice. The major complication of pneumothorax is tension pneumothorax, which is rapidly fatal and must be excluded immediately in all patients regardless of the etiology. Treatment of this complication must be carried out without delay for further diagnostic studies by venting the chest. The significance of pleural effusion depends on its volume and composition. If the cause is not known with certainty or if the patient is dyspneic, thoracentesis should be performed. The fluid is sent for numerous tests including specific gravity, pH, glucose, LDH, and protein. On this basis it is determined as either transudate, which tends to be associated with more benign disorders, or exudate, which is seen with infection, malignancy, and numerous other processes. In all cases the underlying disease requires therapy but only certain exudates require aggressive treatment primarily. Many parapneumonic effusions and all empyemas are exudates that require tube thoracostomy.

Humans↗