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Biomedical subjects

G R Braen

Publications and source records attributed to G R Braen.

15 recordsLinked to original sources
PubMed1998

The Jehovah's Witness blood refusal card: ethical and medicolegal considerations for emergency physicians.

Jehovah's Witnesses are members of a Christian group that does not allow blood transfusion. It is a general practice for adult Witnesses to carry on their person a wallet-sized advance directive card refusing blood. The blood refusal card directs that no blood is to be given to the owner under any circumstance, even if physicians believe transfusion will be lifesaving. Although the card claims to refuse blood on a religious basis, it also states that there are various dangers associated with blood. The possibility that in an emergency the dangers of blood may be relatively small, as compared with the likelihood of death due to exsanguination without blood, is not noted on the card. Emergency physicians should look for evidence of an informed refusal when evaluating these documents. Advance directives regarding life and death decisions should be subject to scrutiny and not be automatically accepted at face value. A goodfaith decision to transfuse the unconscious adult Jehovah's Witness, in emergent need of blood, is justified if the patient does not have a blood refusal advance directive that is informed and otherwise survives a high level of scrutiny. The ethical and medicolegal considerations upon which this thesis is based are discussed.

Adult↗
PubMed1994

Ectopic pregnancy.

The incidence of ectopic pregnancies has increased dramatically over the past 20 years, resulting in significant maternal morbidity and mortality. This article reviews the epidemiology, pathogenesis, clinical manifestations, diagnostic testing, differential diagnosis, treatment, prognosis, and medico-legal considerations in the evaluation of the patient with a suspected or confirmed pregnancy.

Diagnosis, Differential↗
PubMed1992

Failure of gastric emptying and charcoal administration in fatal sustained-release theophylline overdose: pharmacobezoar formation.

We report the case of a fatal theophylline overdose from a sustained-release preparation in a 54-year-old woman. Initial serum theophylline concentration was 31.3 mg/L. Manifestations of mild toxicity cleared in the emergency department after treatment with gastric lavage, charcoal, and a cathartic. A life-threatening overdose was not suspected, and the patient arrested eight hours after discharge from the ED. At autopsy, her serum theophylline concentration was 190.1 mg/L. A white, waxy mass weighing 318.8 g and containing 29 g theophylline, representing the residue of many sustained-release tablets, was found in her stomach. This case reinforces the importance of obtaining repeat serum theophylline levels in patients with sustained-release theophylline overdose. Gastric pharmacobezoar formation should be considered in cases of sustained-release theophylline overdose with rising theophylline levels and patient deterioration, despite adequate gut decontamination.

Bezoars↗
PubMed1982

Les torsades des pointes.

A 17-year-old woman had two admissions within five months for recurrent episodes of ventricular tachycardia in conjunction with a prolonged QT interval. On both occasions these were refractory to intravenous lidocaine and bretylium. During her first admission her dysrhythmia was controlled by repeated doses of intravenous propranolol; however, she required temporary overdrive transvenous pacing on her second admission. On both occasions when the low normal serum potassium was replaced and therapeutic levels of diphenylhydantoin and phenobarbital were obtained, the episodes of ventricular tachycardia subsided. This case illustrates the complexities inherent in making the diagnosis and in treating this syndrome, and should assist the emergency physician in treating this difficult and potentially fatal dysrhythmia.

Adolescent↗