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Biomedical subjects

G R Schwartz

Publications and source records attributed to G R Schwartz.

At least 19 recordsLinked to original sources
PubMed1997

Pediatric cervical spine injury sustained in falls from low heights.

STUDY OBJECTIVE: To determine whether history and clinical examination findings can identify young children who have sustained cervical injury after falling short distances. METHODS: We conducted a retrospective review of the medical records of children younger than 6 years old with the diagnosis of cervical vertebral fracture or cervical spinal cord injury after a fall of less than 5 feet. Data from medical records over an average time span of 11 years at four large children's hospitals were compiled. RESULTS: We identified eight children who sustained cervical spine injury after a fall of less than 5 feet. These children ranged in age from 9 to 68 months. Three had rotary subluxation of C1, and three had subluxation of C1-C2. One of the children in the latter group also had an odontoid fracture. Two children had a fracture of C2. All the children had limited range of motion of the neck or neck pain. CONCLUSION: All children in this study with the diagnosis of cervical spine injury had clinical evidence of that injury on history or physical examination. Clinicians treating asymptomatic young children who sustain short falls may not need to perform radiographic evaluation of the cervical spine.

Accidental Falls↗
PubMed1996

Changing bacteriology of periorbital cellulitis.

STUDY OBJECTIVE: Bacteremic periorbital cellulitis has traditionally been associated with Haemophilus influenzae infection, and the recommended diagnostic evaluation in young children includes blood culture and cerebrospinal fluid (CSF) analysis. The objectives of this study were to examine in pediatric patients with periorbital cellulitis (1) the prevalence of H influenzae bacteremia in the era of vaccination for H influenzae type B (HIB) and (2) the yield of routine CSF analysis. METHODS: This was a retrospective case series of children aged 2 months to 17 years with a final discharge diagnosis of periorbital cellulitis who were treated from 1986 through 1994 at an urban university referral hospital. The prevalence of bacteremia and meningitis was obtained from chart review. RESULTS: Forty-nine children were enrolled, of whom 3 were treated as outpatients. The mean age was 36 months (median, 19 months). A blood culture was obtained for 92% of the patients. Five patients (10%; 95% confidence interval, 3% to 22%) had a positive blood culture (four streptococcal species, one H influenzae). The patient with H influenzae bacteremia was treated in 1987 and had not had the HIB vaccine. CSF was analyzed for 41% of the patients, and none had an abnormal cell count or a positive culture. Sinusitis was diagnosed radiographically in 19% of the subjects. CONCLUSION: Streptococcal organisms are the most common cause of bacteremia associated with periorbital cellulitis in the post-HIB vaccination era. H influenzae bacteremia is now a rare occurrence. Meningitis is uncommon, and lumbar puncture may not be mandatory in well-appearing children. Sinusitis is common and was probably underdiagnosed in our series because most children were not evaluated radiographically. Outpatient management may be indicated in selected children.

Adolescent↗
PubMed1994

Job satisfaction.

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Emergency Medicine↗
PubMed1993

The adult patient in the pediatric emergency department.

STUDY OBJECTIVE: To establish the frequency of use of pediatric emergency departments by adult patients and the spectrum of disease with which they present. DESIGN: Prospective, descriptive study and unblinded survey. SETTING: Children's Hospital pediatric ED. TYPE OF PARTICIPANTS: Seventy-two adult patients presenting to a pediatric ED during a two-year period and 31 pediatric emergency medicine fellowship directors. INTERVENTIONS: For each patient, we recorded demographic information, chief complaint, interventions by physicians, diagnosis, condition, and disposition after initial care. Pediatric emergency medicine fellowship training program directors were surveyed by telephone regarding their experiences with adult patients and the extent of adult emergency medicine training within their programs. MAIN RESULTS: Of the 72 adult patients evaluated, one third (22) were treated for trauma and the remaining 50 for medical illness. More than 40 different diagnoses were encountered, including stroke and myocardial infarction. Twenty patients (27.8%) required hospitalization, four (5.6%) in intensive care settings. Of the 31 fellowship directors surveyed, 27 (87.1%) indicated that adult patients had been managed in their EDs during the previous year. All but one reported that their fellowship programs incorporated between one and four months of adult emergency medicine in their curricula. CONCLUSION: Adults frequently present to pediatric EDs for both minor and serious illnesses. Training in adult emergency medicine should be a part of all pediatric emergency medicine fellowship programs.

Adult↗
PubMed1992

Interfacing with police in the pediatric emergency department.

In summary, ED staff and local police departments should make a concerted effort to work together. The ED director should develop management protocols in conjunction with local police chiefs to plan strategies in advance. It is helpful to provide "orientation sessions," so that each group of professionals knows what to expect of the other. It may also be helpful to arrange tours of the ED so that police know where to go when they are called to the ED. All of these efforts should foster better care of children in the ED and will reduce tensions between the dedicated groups who work with such children.

Adolescent↗
PubMed1976

Xylocaine viscous as an aid in the differential diagnosis of chest pain.

Sixty patients with chest pain, chest and epigastric pain, or predominantly epigastric pain, not explained by electrocardiographic (EKG) changes or pulmonary findings, were given 20 cc of Xylocaine Viscous orally. Thirty-seven out of 60 experienced complete or almost complete relief within 10 to 15 minutes. Of this group, none were found to have suffered a myocardial infarction. Of the 23 patients who did not experience pain relief, six had a myocardial infarction and seven were diagnosed as having cardiac angina. Determination of serum lidocaine levels after oral ingestion of 20 cc of Xylocaine Viscous in patients with normal gastric function demonstrated a maximum level of 0.55 mu/ml--a serum level unlikely to result in adverse side effects.

Administration, Oral↗