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Biomedical subjects

G L Sternbach

Publications and source records attributed to G L Sternbach.

At least 19 recordsLinked to original sources
PubMed1992

Carbon monoxide poisoning. An occult epidemic.

Carbon monoxide poisoning is a significant health threat in the United States. Smoke inhalation from fires is the most common source. History of carbon monoxide exposure and elevated carboxyhemoglobin levels should alert physicians to the diagnosis of acute poisoning. When there is no history of exposure, carbon monoxide poisoning must be considered when two or more patients are similarly or simultaneously sick. The diagnosis must be excluded by a directed history and physical examination. If suspicion remains, carboxyhemoglobin levels should be determined and oxygen therapy should be started empirically while laboratory results are pending. Prompt administration of hyperbaric oxygen may reduce the risk of death. If carbon monoxide poisoning is confirmed, the source must be identified and recommendations for correction or avoidance should be made.

Carbon Monoxide Poisoning↗
PubMed1992

Severe hyperphosphatemia associated with hemorrhagic shock.

Hyperphosphatemia is an electrolyte abnormality that most frequently results from renal insufficiency and the attendant inability to excrete phosphorus (PO4) efficiently. A case is presented in which a young man with hemorrhagic shock developed severe hyperphosphatemia in the absence of renal failure. This is the first such case documented to the authors' knowledge. The prompt correction of the primary cause (ie, hypoperfusion and acidosis) resulted in a rapid return of PO4 levels to normal. This was probably related to the intracellular shift of PO4. Physicians should be aware of this electrolyte disturbance because it is not a well-recognized complication and because, in most cases, proper treatment of shock will also correct the elevated PO4.

Adult↗
PubMed1992

Emergency department presentation and care of heart and heart/lung transplant recipients.

STUDY OBJECTIVE: Heart and heart/lung transplants are accepted forms of therapy for patients with end-stage cardiac or pulmonary disease. These patients are likely to present postoperatively to the emergency department. To our knowledge, there have been no previous reports in the medical literature of the ED presentation of these patients. DESIGN: We conducted a retrospective review of the records of all patients who had received a heart or a heart/lung transplant at Stanford University Medical Center from 1988 through 1990 and who had at least one ED visit. MEASUREMENTS AND RESULTS: Between the time of operation and April 1, 1991, 131 ED visits were recorded. Fever was the single most common presenting complaint, for 48 (37%) of the visits. Difficulty in breathing (13%); gastrointestinal symptoms of nausea, vomiting, or diarrhea (10%); and chest pain (9%) were other common reasons for presentation. CONCLUSION: The transplant patient, by virtue of requiring chronic immunosuppression, is susceptible to infection with a spectrum of opportunistic organisms. When fever or other symptoms suggest infection, appropriate cultures and aggressive diagnostic procedures (eg, lumbar puncture, bronchoscopy) should be performed.

Adolescent↗
PubMed1992

'Designer drugs'. Recognizing and managing their toxic effects.

"Adam," "Eve," "ecstasy," "China white." Illicit street drugs such as these are called designer drugs because they are designed to elicit certain effects and to bypass legal classification. Unfortunately, use and abuse of such substances can lead to serious medical problems and even death. Drs Sternbach and Varon describe the best-known compounds and discuss clinical characteristics and management of designer drug intoxication.

Amphetamines↗
PubMed1992

Hypothermia. Saving patients from the big chill.

Although hypothermia is a serious and sometimes fatal condition, prompt recognition and institution of appropriate rewarming techniques may save even profoundly affected persons. The diagnosis of hypothermia should be considered when patients present with alterations of cerebral function without apparent explanation, especially in the presence of underlying predisposing illnesses and conditions. When hypothermia is suspected, an accurate core temperature must be obtained. Application of rewarming techniques appropriate to the degree of hypothermia may be lifesaving. Conservative use of pharmacotherapy is warranted.

Age Factors↗
PubMed1991

Resuscitation attitudes among medical personnel: how much do we really want to be done?

Cardiopulmonary resuscitation (CPR) is attempted every day. Whereas medical professionals and personnel perform these resuscitation attempts, no previous studies have reported the attitudes of medical personnel towards resuscitation for themselves. We have attempted to assess the prevalent attitudes among various physicians at various levels in training and nurses. An eleven item questionnaire was sent to medical students, house officers, attending physicians and registered nurses at university medical centers. Each questionnaire consisted of respondent's sociodemographic information, their attitudes about CPR for themselves and their beliefs about outcome after CPR with particular disease states. The results were analyzed using chi-square analysis. Four hundred questionnaires were mailed and 240 were returned (60% response rate). All groups favored resuscitation in a university hospital over other sites (P less than 0.05). More nurses requested to be 'no code' compared with other professionals (P less than 0.005). Attending physicians requested that CPR attempts be terminated after less time than any other group (P less than 0.005). Medical students requested resuscitation significantly more than any other group in the presence of terminal conditions such as metastatic cancer, acquired immunodeficiency syndrome and severe chronic obstructive pulmonary disease (P less than 0.005). Medical personnel's beliefs about CPR may be influenced by their experiences with particular patients and events. As trainees acquire more experience they appear less inclined to desire resuscitation efforts for themselves.

Attitude of Health Personnel↗
PubMed1991

Recurrent pneumoperitoneum following vaginal insufflation.

The authors report a case of a 24-year-old nulligravida woman who presented to the hospital with complaints of severe abdominal pain and radiographic evidence of pneumoperitoneum. She had two prior nondiagnostic laparotomies for similar complaints and radiographic findings. After a careful sexual history was taken the patient revealed that she had sexual intercourse preceding every similar episode including this one, during which her partner forcefully blew air into her vagina. Pneumoperitoneum associated with vaginal insufflation has been previously reported in two multigravida patients with and without anatomic abnormalities. When pneumoperitoneum is present in the absence of gastrointestinal symptoms or trauma, a meticulous sexual history should be made to avoid unnecessary laparotomies.

Adult↗
PubMed1991

Hangman's fracture in a 7-week-old infant.

The "hangman's fracture" in infancy and childhood is a bilateral avulsion of the pedicles or their synchondroses from the C-2 vertebral body, frequently with anterior dislocation of C-2 or C-3. We present the case of the youngest infant in the medical literature with a hangman's fracture and discuss anatomy, kinematics of injury, radiographic diagnosis, and treatment.

Accidents, Traffic↗
PubMed1990

Infections in alcoholic patients.

Alcoholic patients have an increased susceptibility to certain bacterial infections. Among the more important of these infections are pneumonia, tuberculosis, spontaneous peritonitis, and bacteremia. This susceptibility is caused by alteration of immune function and mechanical defenses and are the sequel of chronic alcoholism, most notably cirrhosis. In many infections, morbidity is increased in alcoholics, with the course of the illness being more severe and complications more frequent. Assessment of the alcoholic patient with suspected infection should, therefore, be thorough and treatment prompt.

Alcoholism↗
PubMed1989

The adult respiratory distress syndrome.

ARDS is a pulmonary injury syndrome associated with a variety of clinical disorders. The pathophysiology of ARDS has been clarified substantially in the past several years. Neutrophils are probably the chief mediators of pulmonary injury, serving as the focus for release of several toxic substances that cause capillary endothelial and alveolar epithelial damage. The mortality rate in ARDS remains high despite advances in elucidating of pathogenesis. Newer approaches to management stress earlier identification of patients and specific therapy aimed at interfering with the damage produced by toxic mediators of pulmonary injury.

Combined Modality Therapy↗
PubMed1988

Pericarditis.

Pericarditis is a common but frequently subclinical entity. There are a number of causes, including infection, systemic illness, cardiac disease, trauma, and neoplasm. Iatrogenic causes include surgery, cardiac instrumentation, irradiation, and medications. The clinical presentation varies, depending on the cause. Chest pain and dyspnea are characteristic complaints. A typical progression of ECG changes occurs during the course of acute pericarditis. These changes occasionally require differentiation from those of acute myocardial infarction or normal variant ST segment elevation. Echocardiography is the most sensitive technique for detecting the presence of pericardial effusion. In addition, a number of echocardiographic findings are characteristic of larger effusions and cardiac tamponade. Any form of pericarditis may lead to the development of cardiac tamponade. Malignant effusion is probably the most common single cause.

Humans↗
PubMed1988

Thyrotoxic periodic paralysis.

We present the case of a 21-year-old man who presented to the emergency department with an episode of profound weakness due to thyrotoxic periodic paralysis, a syndrome of muscular weakness occurring in patients with hyperthyroidism. Prior to the diagnosis, the patient was treated with a parenteral tranquilizer. When hypokalemia was discovered, potassium was administered, resulting in the development of hyperkalemia. Episodes of thyrotoxic periodic paralysis are usually self limited, and recovery of motor strength is complete. However, potassium is frequently administered to hasten recovery and prevent cardiac arrhythmias and respiratory arrest. Serum potassium must, therefore, be monitored carefully in these patients during treatment.

Adult↗
PubMed1986

Intravenous diltiazem for the treatment of supraventricular tachycardia.

To determine the effects of diltiazem hydrochloride on patients with paroxysmal supraventricular tachycardia, we administered intravenous diltiazem, 0.25 mg/kg to patients who presented to the Stanford Medical Center Emergency Department with this rhythm. Blood pressure was recorded prior to administration, and monitored for 20 min thereafter. Six of the ten patients converted to sinus rhythm a mean of 7.75 min (+/- 4.4) after drug administration. The remaining four experienced slowing of heart rates from a mean of 177 to 166 beats/min. Systolic blood pressure fell a mean of 12.4 mmHg during treatment, but returned to pretreatment level or higher within 20 min following diltiazem administration. This mean degree of blood pressure reduction compares favorably with effects produced by intravenous verapamil under comparable circumstances. Intravenous diltiazem appears to be a safe and effective drug for the conversion of paroxysmal supraventricular tachycardia.

Adult↗
PubMed1986

Evaluation of the knee.

The knee is frequently injured and affected by a variety of diseases. A precise history of injury or onset of symptoms is essential. The joint is ideally examined as soon after injury as possible. Examination should include observation of swelling, palpation of bony prominences, determination of the presence of effusion, recording of range of motion and evaluation of joint stability. Although x-ray studies constitute an important part of overall assessment, they only augment and not supplant thorough physical examination. Aspiration of joint effusion should be performed for diagnostic purposes, or to relieve pain. Arthrocentesis is indicated when effusion of uncertain etiology is present.

Arthritis↗