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Biomedical subjects

D W Munter

Publications and source records attributed to D W Munter.

14 recordsLinked to original sources
PubMed1999

Emergency department evaluation and treatment of wrist injuries.

This article provides the emergency physician a thorough understanding of the basic and surface anatomy required to accurately diagnose wrist injuries in the emergency department. Functional and neurologic examinations are discussed in detail as they increase precision in diagnosis. Special radiographic studies, guided by exam findings, are often crucial in adequately visualizing an otherwise occult injury. Radiographic evidence of injury is not present at time of initial evaluation in a small but noteworthy percentage of significant injuries. For these reasons, the appropriate use of radiographic studies is included. Finally, a rationale for performing conservative mobilization and promptly referring a suspected occult fracture is provided.

Carpal Bones↗
PubMed1998

Metoclopramide toxicity in an infant.

Metoclopramide (4-amino-5-chloro-N-2-methoxybenzamide) is a central and peripheral acting dopamine antagonist. It also stimulates motility in the upper gastrointestinal tract and increases lower esophageal sphincter pressure. In the pediatric population, it is used extensively as an antiemetic and in the treatment of gastroesophageal reflux disease. The case of a six-month-old infant who was accidentally overdosed with 24 mg (3 mg/kg) of metoclopramide within a nine-hour period is presented. The patient demonstrated toxic extrapyramidal effects. There have been multiple early reports in the European literature of acute extrapyramidal reactions in the pediatric population, but no reports of toxicity exist in the current emergency medicine literature.

Antiemetics↗
PubMed1997

Correlation of patient entry rates and physician documentation errors in dictated and handwritten emergency treatment records.

This study was designed to examine the relationship between patient entry rates (a measure of physician work load) and documentation errors/omissions in both handwritten and dictated emergency treatment records. The study was carried out in two phases. Phase I examined handwritten records and Phase II examined dictated and transcribed records. A total of 838 charts for three common chief complaints (chest pain, abdominal pain, asthma/chronic obstructive pulmonary disease) were retrospectively reviewed and scored for the presence or absence of 11 predetermined criteria. Patient entry rates were determined by reviewing the emergency department patient registration logs. The data were analyzed using simple correlation and linear regression analysis. A positive correlation was found between patient entry rates and documentation errors in handwritten charts. No such correlation was found in the dictated charts. We conclude that work load may negatively affect documentation accuracy when charts are handwritten. However, the use of dictation services may minimize or eliminate this effect.

Documentation↗
PubMed1996

Foreign bodies in the gastrointestinal tract.

Management of foreign bodies of the gastrointestinal tract is not standardized among the various specialties and subspecialties of physicians who care for these patients. This article gives a true emergency department approach to the patient with an ingested or inserted gastrointestinal foreign body. Evaluation and management of the foreign body by location are presented. Controversial issues such as Foley catheter removal of esophageal foreign bodies, management of sharp objects in the stomach, and management of body packers and body stuffers are discussed. Examples of foreign bodies encountered by the typical emergency physician are demonstrated.

Catheterization↗
PubMed1996

Esophageal emergencies.

Esophageal disorders are commonly seen in the emergency department. Dysphagia (difficulty swallowing) should always be taken seriously and should never be considered a functional complaint, whereas odynophagia (painful swallowing) is usually caused by an inflammatory process. This article addresses dysphagia/odynophagia, as well as esophagitis, neoplasms, gastroesophageal reflux disease, esophageal trauma, and the often difficult differentiation of chest pain of esophageal origin.

Deglutition Disorders↗
PubMed1995

Intravenous bretylium overdose.

An 81.5-mg/kg intravenous overdose of bretylium tosylate was administered to a 74-year-old patient after resuscitation from inferior wall myocardial infarction and cardiac arrest. The patient exhibited prolonged neurological depression with eventual neurological recovery. This case demonstrates the central nervous system depression that can occur with bretylium overdose. The emergency physician should be aware of this effect and avoid ending lifesaving measures because of apparent brain death in patients with bretylium overdose.

Aged↗
PubMed1994

Automatic implantable cardioverter-defibrillators.

The AICD represents a major technologic advance for patients with life-threatening ventricular tachyarrhythmias in whom drug or surgical therapy is unsuccessful. A significant reduction in mortality in these patients is seen with AICD use. As the device becomes more widely available and more centers in the country become adept in its implantation and use, a rapidly expanding patient population with AICDs will exist. These patients, who typically have severe underlying cardiac disease and are at high risk for sudden cardiac death, will present in increasing numbers to EDs with complaints related to the device. Emergency physicians must be prepared to evaluate and treat AICD patients and must be aware of the complications and problems associated with AICDs. This preparation will ensure that the AICD patient will receive prompt and appropriately directed treatment in the ED.

Biomechanical Phenomena↗
PubMed1989

Ventricular fibrillation during rectal examination.

The case of a 74-year-old man who developed ventricular fibrillation during a digital rectal examination is presented. The patient was subsequently resuscitated and developed cardiac enzyme elevation without ECG changes, indicating a nontransmural myocardial infarction. Although controlled studies have not shown any ill effects of rectal examination in patients with acute myocardial infarction, there have been multiple case reports of bradycardia, ectopy, and ventricular arrhythmias resulting from rectal examination. The postulated etiology of the ectopy is twofold; increased vagal tone from rectal parasympathetic innervation or increased sympathetic tone from anxiety-stimulated catecholamine release. Rectal examination is definitely indicated in a subset of patients including those with gastrointestinal or genitourinary complaints, unexplained hypotension or anemia, trauma, and neurological deficits, and those who will receive anticoagulation or thrombolytic therapy. In the remaining patients, the decision must be made on a case-by-case basis. Awareness of and precautions for possible ill effects of the examination are prudent.

Aged↗
PubMed1989

Blunt scrotal trauma: emergency department evaluation and management.

Blunt scrotal trauma may result in a variety of injuries, including testicular rupture, torsion, dislocation, hematoma, or contusion, as well as epididymal, scrotal, and urethral injuries. Testicular rupture occurs in 50% of patients with traumatic hematocele, and is probably frequently misdiagnosed. If not aggressively diagnosed and surgically repaired, testicular rupture may lead to testicular atrophy and loss. Traumatic testicular torsion must also be diagnosed early to preclude testicular loss. Testicular scan, when rapidly available, is indicated in any case of suspected traumatic torsion. If testicular scanning is unavailable or equivocal, surgical exploration is indicated. Once torsion is ruled out, ultrasound is a useful diagnostic technique in acute scrotal trauma to differentiate those scrotal and testicular injuries requiring surgical intervention.

Child↗
PubMedDate not supplied

Isotretinoin ingestion in a pediatric patient.

Isotretinoin (13-cis-retinoic acid) is an oral synthetic vitamin A derivative used for control of acne and a variety of other dermatologic conditions. The case of a 21 month old child who accidentally ingested an estimated 1120 mg (63.3 mg/kg) of isotretinoin is presented. The patient demonstrated only minor immediate effects, consisting of facial flushing, and mild tachycardia, tachypnea, and hypertension, all of which resolved over 24 hours. The patient had no subsequent adverse long-term effects from the ingestion. This is the first reported ingestion of isotretinoin in a child. Short term sequelae have not been reported; long-term administration of isotretinoin may cause multiple and potentially severe reactions.

Female↗
PubMedDate not supplied

Wolff-Parkinson-White syndrome: illustrative case and brief review.

The Wolff-Parkinson-White syndrome (WPWS) is a pre-excitation syndrome manifested on the 12-lead ECG by a short PR interval (less than .12 sec), a prolonged QRS interval (greater than .10 sec), and an initial slurring of the QRS complex called a delta wave. The anatomical etiology is the presence of accessory atrioventricular conduction fibers called the Kent bundle. Patients with the WPWS may present to the emergency department with a wide spectrum of symptoms, ranging from mild palpitations, to unstable tachydysrhythmias and sudden cardiac death. WPWS should be suspected in any patient presenting with a tachydysrhythmia with a rate exceeding 200/minute. Cardioversion is indicated in the unstable patient. It is impossible to predict the effect of any particular drug without prior electrophysiologic studies in a patient with WPWS. Procainamide is the safest drug for the stable WPWS patient with a tachydysrhythmia, including wide-complex and irregular rhythms. Verapamil is a useful drug in narrow-complex, regular rhythms, although complications have been reported. Atrial fibrillation may be difficult to diagnose in a very rapid tachycardia, and the use of verapamil in WPWS with atrial fibrillation is contraindicated. Electrophysiologic studies are indicated in the WPWS patient to maximize prophylactic therapy. An illustrative case as well as pathophysiology and management of WPWS are discussed.

Adult↗