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Biomedical subjects

D Jehle

Publications and source records attributed to D Jehle.

34 records · Page 2Linked to original sources
PubMed1989

Elevated Toxoplasma IgG antibody in patients tested for infectious mononucleosis in an urban emergency department.

There are many infectious causes of fatigue, sore throat, and fever, including mononucleosis and toxoplasmosis. Toxoplasma antibody testing is rarely performed in most emergency departments; as a result, toxoplasmosis is diagnosed infrequently. We obtained Toxoplasma IgG IFA titers on ED patients who had mononucleosis testing performed to determine the frequency of toxoplasmosis in this population. Two hundred sixty patients were included in our study. Eleven (4.2%) had a positive mononucleosis test, and 14 (5.4%) had a positive Toxoplasma titer. In the detection of toxoplasmosis, Toxoplasma IgG titers of 1:1,024 or greater have been shown to be a sensitive means of detecting infection in the first six months. Further testing with IgM titers is needed to establish a positive diagnosis when necessary. We found more patients with elevated Toxoplasma IgG titers than with positive heterophil antibody titers in an ED population tested for mononucleosis over a two-year period. We conclude that toxoplasmosis may be as common as mononucleosis in our ED and that clinicians should consider this pathogen when working up patients with appropriate symptoms.

Adolescent↗
PubMed1989

Acoustic otoscopy in the diagnosis of otitis media.

Acoustic otoscopy detects middle ear pathology by measuring the ability of the tympanic membrane to reflect sound. Fluid or thickening of the tympanic membrane increases sound reflection. We conducted a study to compare acoustic otoscopy with pneumatic otoscopy in identifying middle ear pathology in 80 children (160 ears) presenting to the emergency department with ear or upper respiratory complaints. We then evaluated the use of acoustic otoscopy in 34 adults (68 ears) with and without ear complaints. Using a reflectivity of 5 or more units to signify acute pathology in children, the sensitivity was 82%, and the specificity was 100%. Using a reflectivity of 6 or more units to indicate acute suppurative pathology in adults, the sensitivity was 83%, and the specificity was 95%. We found acoustic otoscopy to be objective, practical, and reproducible. We conclude that acoustic otoscopy is a valuable adjunct in the diagnosis of otitis media in children and adults.

Acoustic Stimulation↗
PubMed1988

Effect of alcohol consumption on outcome of pedestrian victims.

The influence of alcohol consumption on the severity of pedestrian injuries has not been studied extensively. In this retrospective study, we reviewed the cases of 143 pedestrian accident victims admitted to our trauma center during 1982 and 1983. Alcohol consumption was present in 30% of patients; 74% of them had blood alcohol levels of more than 100 mg/dL. There was a significant difference in age distribution (P less than .001); the alcohol-related accidents peaked in the 25- to 34-year-old age group, and the nonalcohol-related accidents peaked in the less than 18- and more than 55-year-old groups. Mean Injury Severity Score (25.0 vs 17.8, P less than .01) and mean length of stay (30.9 vs 17.2 days, P less than .005) were significantly greater in the patients who had consumed alcohol. Those patients with ethanol in their blood had significantly more frequent injuries to the spine (25.6% vs 10%, P less than .05) and the chest (32.6% vs 13%, P = .01). Overall mortality (11.6% vs 20%, P = .23) and mortality excluding emergency department deaths (11.6% vs 11.1%, P = .93) were not significantly different between the drinking and nondrinking groups. However, the ED mortality was higher in the nonalcohol group (0% vs 10%, P = .03). We conclude that pedestrian victims are commonly intoxicated and that chest and spine injuries are more common in this population.

Accidents, Traffic↗
PubMed1986

Transconjunctival oxygen monitoring as a predictor of hypoxemia during helicopter transport.

As the use of helicopters for air transport of critically ill patients increases, the availability of monitoring devices for physiological parameters during flight becomes important. It has long been known that arterial PO2 (PaO2) decreases during unsupplemented, non-pressurized flight. In this study, the authors examined the use of the transconjunctival oxygen (cjO2) monitor for assessing the adequacy of arterial oxygenation during helicopter flight in four healthy volunteers. Arterial PaO2 as measured by conventional blood gas analysis was compared with cjO2 at ground level, 5,000 feet, and 10,000 feet altitude. Mean PaO2 dropped significantly from 93.5 to 81.5 to 58.5 mm Hg, respectively (P less than 0.001, analysis of variance with repeated measures). Mean cjO2 also decreased significantly from 63.8 to 52.0 to 34.8 mm Hg, respectively (P less than 0.001, analysis of variance with repeated measures). Within individual subjects, cjO2 was an accurate predictor of PaO2 (P less than 0.001, multiple regression analysis). The relationship between cjO2 and PaO2 was linear with a regression coefficient of 1.147. The authors conclude that the transconjunctival O2 monitor may be useful for monitoring the adequacy of arterial oxygenation during helicopter flight in hemodynamically stable patients. The results of study also support the use of supplemental oxygen in all patients subjected to helicopter transport.

Adult↗
PubMed1986

Bicarbonate.

Bicarbonate is a laboratory value of considerable importance in emergency medicine. It is essential in the diagnosis of acid-base disorders, but must be interpreted in the context of a number of other parameters, including electrolytes, arterial blood gases, and renal function. As most laboratory evaluations, its prime importance is confirmation of impressions drawn from the history and physical examination. Still, in the emergency department, it is frequently found as an unsuspected component of a variety of pathologic processes. Except in extreme deviations from the normal range, the clinician is encouraged to seek an understanding of primary and compensatory processes before the initiation of therapy.

Acid-Base Equilibrium↗
PubMed1984

[Transformation reactions of special metals in organisms and in the environment. 2. Abiotic methylation reactions of mercury, especially by methyltin compounds and humic and fulvic acids].

Following a literature survey concerning abiological methylation reactions including transmethylation of mercury we present the results of transmethylation experiments. Model experiments in aqueous solution show an instantaneous methylation of mercuric chloride by mono-, di-, and trimethyltin chloride, the dimethyl compound having the highest rate of formation. The same is valid for similar experiments with soils, in which influences of the kind of soil also play a certain role. The methylation experiments of HgCl2 with humic and fulvic acids isolated from soil yielded positive results only in some few of the extracts and only with humic acid fractions.

Benzopyrans↗
PubMed1979

[Effect of tin on rats. 1. Inverse voltammetric determination of tin in the presence of lead in biological material after extraction].

By means of inverse polarography, the authors determined tin selectively after double extraction with diethylammonium diethyl dithiocarbamate (DADDTC) in perchloric solution. The recovery rates were: in potatoes, 91.7 +/- 5.8%; in beef kidney, 85.0 +/- 22.7%; in beef liver 79.9 +/- 13.8%; and in milk, 69.8 +/- 11.4%. Possible interferences from other elements with the tin determination are discussed.

Animals↗
PubMed1976

[Lead and cadmium content of baby food and their nutritional hygienic-toxicological significance].

Little is known of the amounts of lead and cadmium which the infantile organism takes up from the total diet. The author's analyses of more than 150 jars or packs of ready-to-use baby food produced in the German Democratic Republic (trade mark: Für's Kind) revealed lead contents of less than 100 mug/kg and cadmium contents of less than 10 mug/kg. Only spinach showed higher lead values. In liver -containing ready-to-use foods the cadmium contents were higher than 10 mug/kg (25-50 mug/kg). Like liquid milk, powdered milk-base foods contained no cadmium. From these values it was calculated that the daily lead and cadmium intake of an infant during his first year of life amounts to 42-47 mug of lead and to 6,4-11,5 mug of cadmium, respectively. A conversion to mg/kg of body weight shows that, in both cases, the load on an infant equals that on an adult or is even greater. Literature data lead intake are in good agreement with these results. Corresponding studies for cadmium are not known.

Adult↗
PubMedDate not supplied

Emergency department echocardiography in the diagnosis and therapy of cardiac tamponade.

A 44-year-old male presented to the emergency department in shock with jugular venous distension and upper chest cyanosis. Superior vena cava syndrome was ruled out by computed tomography (CT scan). However, a large pericardial effusion was found on CT scan and confirmed by sonography. Pericardial tamponade was diagnosed by emergency physicians and sonography-guided pericardiocentesis was performed with marked improvement in symptomatology.

Adult↗
PubMedDate not supplied

The impact of a major televised sporting event on emergency department census.

This study examines the effect of a major televised sporting event, the Super Bowl, on emergency department (ED) census. Daily patient census figures for the month of January 1988-1992 were obtained. Individual shift census was divided by monthly mean census to compare relative volume. Census figures for 4 of the 5 Super Bowl days were significantly lower than the remaining 143 days studied. The day of the Super Bowl was the month's slowest shift for 3 of the 5 days. When the local team was a playoff participant, a stronger association was noted. The results demonstrate a significant decrease in ED utilization coinciding with the Super Bowl broadcast. Major televised events can significantly decrease ED volume, especially when local interest is present. Staffing changes may then be made accordingly.

Emergency Service, Hospital↗
PubMedDate not supplied

Blood loss estimation by out-of-hospital emergency care providers.

OBJECTIVES: To evaluate emergency medical technicians' (EMTs') ability to estimate spilled blood volume and to determine whether limited training improves estimate accuracy and whether there is a difference in improvement comparing two different training methods. METHODS: The study design was a single-blinded, clinical model, utilizing EMTs (basic, intermediate, and advanced) from a local commercial ambulance service. Participants estimated the volume of randomly selected volumes of packed red blood cells reconstituted to a normal hematocrit and poured onto three absorbent (carpet) and three nonabsorbent (vinyl) surfaces. Participants were then randomly assigned to one of two teaching groups. The SITEGRP (n = 17) returned to the six testing sites and were told the actual blood volumes. The SLIDE-GRP (n = 16) were taught with slides of six similar blood spill sites. Both groups were provided with suggestions for making volume estimates. The same participants were then retested one month later using the same type of sites and six new blood volumes. RESULTS: Thirty-three participants with an average of 7.5 years of prehospital care experience completed testing on both dates. Mean percent error {[(estimated volume - actual volume)/actual volume] x 100} for all participants decreased from 65%+/-33% initially to 52%+/-20% after retesting (p < 0.05). Mean percent error was 74%+/-41% and 59%+/-20% for the SITEGRP (p < 0.15) initially and after retesting, respectively. Mean percent error was 56%+/-17% and 45%+/-17% for the SLIDEGRP (p < 0.05) initially and after retesting, respectively. CONCLUSION: Prehospital care providers are not accurate at estimating spilled blood volumes. This ability can be improved with limited education. Slides appear to be as effective as viewing actual spill sites.

Clinical Competence↗
PubMedDate not supplied

Positive-outcome bias: comparison of emergency medicine and general medicine literatures.

OBJECTIVE: The existence of positive-outcome bias in the medical literature is well established. Positive-outcome bias in two emergency medicine journals was compared with that found in two general medicine journals. METHODS: Published original contributions from Annals of Emergency Medicine, American Journal of Emergency Medicine, JAMA, and New England Journal of Medicine were reviewed. Articles were categorized as demonstrating a positive or negative outcome or showing no difference using new criteria. Descriptive articles were excluded. RESULTS: Of 700 articles reviewed, 177 emergency medicine and 211 general medicine articles met the study criteria. The emergency medicine journals had 142 articles (80%) with positive outcomes, 27 (15%) with negative outcomes, and 8 (5%) with no difference. The general medicine journals had 169 articles (80%) with positive outcomes, 33 (16%) with negative outcomes, and 9 (4%) with no difference. There was no significant difference between journal groups (chi-square; p = 0.99). The power of the study was 0.80 to detect a difference of 15% between groups with alpha set at 0.05. CONCLUSION: There was no significant difference in the proportions of positive-outcome studies published in this sample of the emergency medicine literature compared with the general medicine literature. The potential impact of positive-outcome bias and methods of dealing with the problem are reviewed.

Emergency Medicine↗