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Biomedical subjects

E Hardin

Publications and source records attributed to E Hardin.

14 recordsLinked to original sources
PubMed2000

Can clinical parameters predict fractures in acute pediatric wrist injuries?

OBJECTIVE: Fractures around the wrist are common in pediatric patients presenting to the emergency department (ED). This pilot study was aimed at identifying clinical variables that are most likely to be associated with a fracture. METHODS: This was a prospective blinded case series of patients 3-18 years of age presenting with an acute (<3 days) wrist injury, without obvious deformity. A team of five investigators blinded to the eventual radiographic findings evaluated patients. Physical examination variables included range of motion (ROM), site of maximal tenderness, and functional deficit. The latter was determined objectively, by recording any difference in grip strength between the injured and noninjured hands. Diagnostic radiographs were obtained for all patients. Univariate analysis using Wilks' log likelihood ratio test was performed to identify clinical variables associated with confirmed wrist fractures. Sample size was determined based on the ability to detect a difference of 15 degrees in the ROM variables, 20% point differences in grip strength, and 30% proportion differences in categorical variables using a power of 0.8 and a two-tailed of 0.05. RESULTS: The ROMs were not significantly different between the fracture (Fx) and nonfracture (NFx) group. There was significant change in the grip strength between the Fx and NFx groups (t = 3.3, p = 0.0019). Tenderness over the distal radius was also associated with a greater likelihood of a fracture (G(2) = 5.0, p = 0.02). Sensitivity of clinical prediction was found to be 79%, and specificity was 63%. The false-negative rate was 0.21 and the false-positive rate was 0.37, while the positive predictive value was found to be 0.68 and negative predictive value 0.75. CONCLUSIONS: Distal radius point tenderness and a 20% or more decrease in grip strength were predictive of fractures.

Acute Disease↗
PubMed1996

Emergency medicine and the laboratory.

The laboratory is an extremely important and necessary resource for the emergency department. This article discusses the uniqueness of the relationship and discusses various principles and procedures crucial to the successful operation of an emergency department in a large inner-city hospital. Special consideration is given to the requirements for a stat laboratory, which provides mandatory service for any large general hospital emergency department. A major problem experienced by teaching hospitals relates to the inappropriate use of the laboratory, and this issue is discussed as well as the dynamics that leads to laboratory overuse by emergency department housestaff.

Emergency Service, Hospital↗
PubMed1993

Urban violence in Los Angeles in the aftermath of the riots. A perspective from health care professionals, with implications for social reconstruction.

Beginning April 29, 1992, Los Angeles, Calif, was engulfed in a 3-day insurrection reflecting the residents' responses to a legal ruling. Unlike the media-painted picture, this article argues that the enormous outburst of violence and consequential property destruction was not the exclusive domain of the citizens of South-Central Los Angeles and that available data will not support the maintenance of the prevailing uneven distribution of civic and state resources in health care, educational programs, and economic opportunities. What it does support is the proposal for a more equitable allocation of resources among institutions, groups, and peoples, complemented by community empowerment, a more civic-oriented police operation, and a more rational approach to social reconstruction in which all elements of the society are full participants. Finally, the article suggests that augmentation of the present "law and order" approach and the paramilitary police already have proven economically ineffective. Given the dominant role of the medical profession in social and civic life, it is now appropriate for the medical profession to enter the debate on policies of health improvement, violence deterrence, and the general field of social reconstruction.

Health Occupations↗
PubMed1993

Unreliability of blood pressure and heart rate to evaluate cardiac output in emergency resuscitation and critical illness.

OBJECTIVE: To evaluate the reliability of the vital signs to evaluate circulatory stability as reflected by cardiac index. DESIGN: Descriptive analysis based on data gathered prospectively, using a predetermined protocol. SETTING: University-run county hospital, with a large trauma service. PATIENTS: Sixty-one high-risk trauma patients with accidental injury who were studied immediately after admission to the Emergency Department, and subsequently, 163 critically ill postoperative ICU patients. INTERVENTIONS: Standard fluid therapy, usually crystalloids, but occasionally packed red cell transfusions and colloids, as indicated by clinical criteria. MEASUREMENTS AND RESULTS: Arterial BP was measured by pressure transducer and arterial catheter; heart rate (HR) was measured by electrocardiograph signal, and cardiac output was measured by thermodilution. In sudden severe hypovolemic hypotension, the mean arterial pressure (MAP) nadir (lowest) roughly correlated (r2 = .25) with flow, but there was poor correlation (r2 = .0001) when all pressure and flow values were evaluated. The pressure and flow values were obtained throughout the course of the hypotensive episodes during the initial resuscitation in ICU patients and during terminal illnesses. CONCLUSIONS: Observations at the time of acute severe hypotensive crises that show rough correlation of MAP and cardiac index should not be extrapolated throughout the entire hypotensive period or to other less extreme clinical situations. The stress response to hypovolemia, with endogenous catecholamines and neural mechanisms, tends to maintain arterial pressure in the face of decreasing flow for a variable period of time. However, when these mechanisms are overwhelmed by prolonged hypovolemia, the pressure decreases precipitously, but not synchronously, with flow. We conclude that blood flow cannot reliably be inferred from arterial pressure and heart rate measurements until extreme hypotension occurs.

Blood Pressure↗
PubMed1992

Perforated ulcers related to smoking "crack" cocaine.

This article describes four patients with perforated gastroduodenal ulcers related to smoking "crack" cocaine. All patients came to the hospital with acute abdominal pain; only one patient had a history of ulcer disease. Only one patient had an elevated white blood cell count, and two patients had depressed white blood cell counts. In three patients, the x ray showed that pneumoperitoneum was present. Upon surgical exploration of the abdomen, all patients were found to have extensive peritoneal contamination. Operative repair consisted of omental patching with or without primary closure of the perforation. A history of cocaine smoking should be sought in patients with unexplained abdominal pain or pneumoperitoneum. In patients with acute abdominal pain and a history of smoking cocaine, a perforated gastroduodenal ulcer may be present, despite normal or low white blood cell counts and the lack of pneumoperitoneum on x-ray examination.

Adult↗
PubMed1979

The use of "clear" enzyme control materials.

Low turbidity, "clear" enzyme controls commercially produced in three concentrations and conventional human lyophilized control sera, which are more turbid, were evaluated to determine which was superior for quality control purposes. Criteria used to evaluate the controls were: 1) turbidity measurement, 2) daily assays for 30 days to estimate day-to-day precision, and 3) stability of the enzyme assay value for these controls when they were reconstituted and frozen for 0 to 30 days and 0 to 10 days with three aliquots separately prepared and frozen for 0 to 10 days for a total of 30 days. The controls were analyzed for lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, creatine kinase, and alkaline phosphatase activities with the Perkin-Elmer KA 150 enzyme analyzer.

Alanine Transaminase↗
PubMed1976

Clinical laboratory evaluation of the Perkin-Elmer KA-150 Enzyme Analyzer.

We evaluated the Perkin-Elmer KA-150 Enzyme Analyzer in a clinical laboratory situation according to a rigid evaluation protocol. The factors evaluated for five commonly assayed enzymes were as follows: (a) rate of analysis of patient samples, (b) analytical linearity, (c) overall precision (within-run and between-day), (d) carry-over from a sample with activity near 1000 U/liter, (e) error detection at low and high concentrations, (f) correlation of values with those obtained by methods used in our laboratory and (g) normal-value ranges. We find the KA-150 to be an effective and rapid enzyme analyzer.

Alanine Transaminase↗