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Biomedical subjects

H A Muller

Publications and source records attributed to H A Muller.

At least 19 recordsLinked to original sources
PubMed1995

Attending supervision of nonemergency medicine residents in a university hospital ED.

There have been a limited number of studies assessing the impact of attending physician supervision of residents in the emergency department (ED). The objective of this study is to describe the changes in patient care when attending emergency physicians (AEPs) supervise nonemergency medicine residents in a university hospital ED. This was a prospective study including 1,000 patients, 32 second- and third-year nonemergency medicine residents and eight AEPs. The AEPs classified changes in care for each case as major, minor, or none, according to a 40-item data sheet list. There were 153 major changes and 353 minor changes by the AEP. The most common major changes were ordering laboratory or x-ray tests that showed a clinically significant abnormality, and eliciting important physical exam findings. Potentially limb- or life-threatening errors were averted by the AEP in 17 patients. Supervision of nonemergency medicine residents in the ED resulted in frequent and clinically important changes in patient care.

Diagnostic Errors↗
PubMed1990

Control of epidemic methicillin-resistant Staphylococcus aureus.

We controlled the spread of epidemic methicillin-resistant Staphylococcus aureus (MRSA) infection in an 884-bed veterans' facility by cohorting known active MRSA carriers and MRSA-infected patients on one nursing unit. Simultaneously, all previously-institutionalized transfers into the veterans' facility were screened with swab cultures for MRSA at the time of admission. All MRSA patients were maintained on contact (gown and glove) or strict isolation and treated aggressively with topical and enteral antibiotics with the assistance of the infectious disease consultant. The monthly incidence of new MRSA patients dropped from a maximum of 16 per month to three or less per month within six months of instituting these infection control measures. There were no further MRSA bacteremias after the establishment of the MRSA cohort in a single unit. Aggressive cohort management of known MRSA patients and screening of previously-institutionalized patients on admission for MRSA controlled epidemic MRSA in this large institution.

Aged↗
PubMed1981

Flow rate variance of commonly used IV infusion techniques.

Fluid resuscitation of the acutely hypovolemic shock state may involve the infusion of crystalloid, colloid, or blood components at various flow rates, depending on the clinical status of the patient. A study was designed in which these fluids were infused via gravity, blood pump, pressure infusion cuff, or being pushed in manually by way of a 50-cc syringe. Flow rate for each fluid and corresponding method of administration were established and compared. The flow rates for each fluid were most rapid with the pressure infusion cuff, followed by the blood pump and the 50-cc syringe. Gravity was the slowest method of infusion. These data may help in the choice of an appropriate method of fluid administration in resuscitation of the hypovolemic shock state.

Blood Flow Velocity↗
PubMed1979

Posttraumatic aneurysms of the hand.

Aneurysms should be suspected in patients with a mass in the hand following either open or closed trauma. Posttraumatic aneurysms are classified as true or false. False aneurysms usually result from penetrating trauma and can occur in any disrupted vessel. In contrast, true aneurysms usually occur in either the thenar or hypothenar eminence a few weeks following closed hand injuries. Pulsations may be evident. Symptoms are coolness or paresthesia of the digits and dull pain aggravated by exercise. A positive Allen's test is a helpful confirmatory sign in diagnosis. Treatment is surgical with resection of the aneurysm and primary anastomosis or vein graft when possible.

Adult↗
PubMed1978

Methemoglobinemia: nitrobenzene ingestion.

In an unusually severe case of multiple toxin ingestion, a 48-year-old man ingested approximately 300 cc of Hoppe's Gunpower Solvent #9, which contains kerosene, denatured ethyl alcohol, oil and nitrobenzene. The major manifestation was nitrobenzene-induced methemoglobinemia of rapid onset. Treatment involves the judicious use of 1% methylene blue plus, in severe cases, hemodynamic and ventilatory support. The patient recovered after 48 hours and was transferred to the psychiatric service with continued follow-up for a mild poison-induced hemolytic anemia.

Anemia, Hemolytic↗
PubMed1978

Emergency, emergentology, emergentologist.

No word exists that identifies the branch of knowledge of emergency medicine. The potpourri of names applied to those specializing in emergency medicine creates an aura of amorphism. Emergentology and emergentologist, derived from the Latin emergent, are recommended primarily because they are easily pronounced, appropriately descriptive single words that are obviously related to emergency medicine's foundation word--emergency.

Emergency Medicine↗
PubMed1976

Clinical use of the "G-suit".

The "G-suit," a device for combating hypovolemic shock with external pneumatic counterpressure, represents an application of an old idea to a relatively common medical problem. Its simplicity of use and quick therapeutic effect buys time for the patient with hypovolemic shock, whether the suit is applied in the prehospital or emergency department setting.

Emergency Medical Services↗