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Biomedical subjects

F M Fesmire

Publications and source records attributed to F M Fesmire.

31 records · Page 2Linked to original sources
PubMed1989

The utility of the presence or absence of chest pain in patients with suspected acute myocardial infarction.

In 422 patients admitted from the emergency department (ED) for suspected acute myocardial infarction, the hypothesis that chest pain that persists on arrival in the ED or recurs during the initial ED evaluation is a useful predictor of acute myocardial infarction (AMI) and complications of coronary ischemia was tested. Compared with patients whose chest pain spontaneously ceased before arrival in the ED, patients whose chest pain persisted or recurred during the initial ED evaluation had a 2.3 times greater risk of interventions (P less than .001), a 1.7 times greater risk of complications (P = .045), a 3.8 times greater risk of life-threatening complications (P = .04), and a 2.4 times greater risk of AMI (P = .005). A third group of patients with suspected AMI never experienced chest pain. This group of patients who never experienced chest pain had a three times higher risk of death (P = .02) compared with patients whose chest pain persisted or recurred in the ED, and a 2.1 times greater risk of intervention (P = .01), a 5.2 times greater risk of life-threatening complication (P = .015), and a 7.9 times greater risk of death (P = .025) compared with patients whose chest pain resolved before arrival in the ED. It was concluded that patients with chest pain that resolves spontaneously before arrival to the ED have a better in-hospital prognosis than any other group.

Chest Pain↗
PubMed1989

Tracheal obstruction presenting as new-onset wheezing.

Two cases of recent-onset dyspnea and wheezing initially treated with bronchodilator therapy for presumed reactive airway disease are presented. Plain-film chest radiographs subsequently demonstrated mediastinal masses causing extrinsic tracheal compression. The first patient had inoperable poorly differentiated squamous cell carcinoma resistant to radiotherapy. The second patient underwent resection of a substernal multinodular goiter with complete resolution of symptoms. The physician should always entertain the diagnosis of upper airway obstruction in all adult patients with new-onset wheezing. New-onset adult wheezing of uncertain etiology should prompt the physician to refer the patient for pulmonary function testing with flow-volume loops.

Aged↗
PubMed1989

Initial ECG in Q wave and non-Q wave myocardial infarction.

The initial ECGs in 440 patients admitted for suspected acute myocardial infarction were retrospectively analyzed to determine predictive values of these ECGs for acute myocardial infarction and to determine differences in the initial ECG for Q wave and non-Q wave myocardial infarction. One hundred (23%) of the study patients were diagnosed as having an acute myocardial infarction. Acute injury was seen in 47% of these patients (positive predictive value [PPV], 84%; 95% confidence interval [CI], 72% to 92%), ischemia in 15% (PPV, 39%; 95% CI, 24% to 57%), and left ventricular hypertrophy with strain in 11% (PPV, 19%; 95% CI, 4% to 29%). Forty-three patients were diagnosed as having a Q wave infarction and 50 patients as having a non-Q wave infarction. Seventy-two percent of the patients with a Q wave infarction had acute injury as the initial ECG interpretation compared with 38% in the non-Q wave infarction group (P less than .001). In contrast, only 17% of patients with Q wave infarction had an initial ECG interpretation of ischemia or strain as compared with 36% of patients with non-Q wave infarction (P = .03). Because of the relatively high incidence of acute myocardial infarction in patients admitted with an initial ECG interpretation of ischemia or left ventricular hypertrophy with strain, prospective studies must be performed to determine if selective patients with acute ST segment depression or ischemic T wave inversion in the setting of suspected acute myocardial infarction may benefit from early thrombolytic therapy.

Electrocardiography↗
PubMed1989

Risk stratification according to the initial electrocardiogram in patients with suspected acute myocardial infarction.

Previously developed initial electrocardiogram (ECG) prediction rules were modified to stratify 426 patients with suspected acute myocardial infarction into low-, intermediate-, and high-risk groups (normal, abnormal, and positive ECG categories) for development of acute myocardial infarction and complications of coronary ischemia. Compared with patients with normal ECGs, patients with positive ECGs had a 2.9 times greater risk of interventions, a greater risk of life-threatening complications, and a 14.2 times greater risk of acute myocardial infarction. Compared with patients with abnormal ECGs, patients with positive ECGs had a 1.7 times greater risk of interventions, a 2.6 times greater risk of life-threatening complications, and a 4.9 times greater risk of acute myocardial infarction. This prediction scheme was further improved by assigning "high" risk to any patient requiring an acute intervention during the initial evaluation in the emergency department. Otherwise, risk was assigned according to the ECG category, with normal, abnormal, and positive ECGs corresponding to "low," "intermediate," and high risk, respectively. Hospitals with limited intensive care beds may be able to use these prediction rules as an aid in determining in-hospital disposition of patients with suspected acute myocardial infarction.

Electrocardiography↗
PubMed1988

Survival following massive arsenic ingestion.

A case of a 30-year-old man who ingested a massive quantity of arsenic (approximately 2,150 mg) in an apparent suicide attempt is presented. Aggressive initial therapy, including fluid resuscitation, chelation therapy, and hemodialysis, resulted in the patient's survival. The successful management of arsenic intoxication requires both prompt recognition and the initiation of specific and aggressive therapeutic modalities.

Adult↗
PubMedDate not supplied

The ECG in acute myocardial infarction.

The initial ECG is the most rapid and readily available tool in the emergency department for the evaluation of patients presenting with suspected myocardial infarction. However, studies have shown that the initial ECG is diagnostic of acute myocardial infarction in only a minority of patients. This paper discusses the importance of the initial ECG and other information in aiding the disposition of patients with suspected myocardial infarction. Classic electrocardiographic descriptions are discussed as well as the newer terminology of Q wave versus non-Q wave infarction and ST segment versus T wave infarction. A brief review is made of the electrophysiology of the ECG changes seen in myocardial infarction. Finally, clinical studies are presented that establish a definite role for the use of the initial ECG.

Electrocardiography↗
PubMedDate not supplied

An intern's kiss.

Explore the source record for details and available documents.

Attitude to Death↗
PubMedDate not supplied

The pediatric cervical spine: developmental anatomy and clinical aspects.

The radiographic interpretation of the pediatric cervical spine can be a perplexing problem for the emergency physician. Given the wide range of variances in the ossification centers, the unfused synchondroses, and the relative hypermobility of the pediatric cervical spine, radiographs may be easily misread if one is not thoroughly familiar with the developmental anatomy and variants. This paper discusses those developmental aspects of the pediatric cervical spine that impact on emergency radiographic interpretation. Frequently encountered pediatric cervical spine fracture/dislocations are reviewed with an analysis of age-related distributions. Finally, the syndrome of Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) is discussed.

Adolescent↗