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Biomedical subjects

H W Meislin

Publications and source records attributed to H W Meislin.

At least 55 records · Page 3Linked to original sources
PubMed1985

Liquid crystal thermometry for continuous temperature measurement in emergency department patients.

A single temperature measurement recorded on admission to the emergency department provides no information about temperature alterations occurring during the course of evaluation. Continuous monitoring of patients' temperatures in the ED, however, may alter management and decrease morbidity. Our study evaluated the reliability of liquid crystal thermometers (LCTs) and the clinical benefit of continuous temperature monitoring in the ED. Commercially available LCTs (corrected 4 degrees F to reflect core temperature) were applied to the foreheads of randomly selected patients. Serial oral electronic thermometer readings were compared to those obtained by LCT. Fever was defined as a temperature higher than 99.5 F orally or 100 F by LCT. One hundred two patients underwent simultaneous LCT and oral temperature measurements, with a correlation coefficient of 0.661. Hypothermia was not encountered. Eighty-four patients were afebrile, and 18 were febrile by oral measurement on admission. Of the afebrile patients, 13 (15.5%) became febrile while in the ED. The temperature course was identified correctly by LCT in 83.3% of cases. The LCT correctly identified all patients who were febrile on admission, as well as 92.3% of those who developed fever while in the ED. The latter fevers would have been missed by routine single-temperature determination on ED admission. Detection of fever stimulated more aggressive clinical evaluation of these patients. Eight of nine patients who defervesced in response to antipyretic therapy were identified correctly by LCT.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

MAST suit update.

In recent years, the use of the MAST suit has become commonplace. While no controlled human studies have shown the device's efficacy, extensive clinical experience suggests that it is practical and useful in combating shock, stabilizing fractures, and promoting hemostasis. Studies indicate that the antishock trousers elevate blood pressure primarily by increasing peripheral vascular resistance. Proper application and removal of the device are crucial. A number of potential complications exist, but are infrequent and rarely should preclude MAST suit use. Further studies are necessary to prove the efficacy of the device and clearly define its role in patient management.

Altitude↗
PubMed1984

Diabetes insipidus: occurrence after minor head trauma.

Post-traumatic diabetes insipidus is a rare entity, usually associated with severe head trauma, often with skull fracture and cranial nerve dysfunction. A 24-year-old male presented to a medical clinic 2 weeks after a minor head injury with presenting symptoms of polyuria with nocturia and intense polydipsia. A diagnosis of post-traumatic diabetes insipidus was made. Although other causes of polyuria syndromes must be ruled out, plotting urine versus plasma osmolalities can provide rapid preliminary diagnostic help when considering diabetes insipidus. First-line treatment should include a trial of chlorpropamide and hydrochlorothiazide. Caution should be exercised in not overlooking associated anterior pituitary damage, which may develop several years post-trauma.

Adult↗
PubMed1984

Acute post-traumatic diabetes insipidus: treatment with continuous intravenous vasopressin.

A young male presented within hours after closed head injury with hypotension, tachycardia, and polyuria. A diagnosis of post-traumatic diabetes insipidus was made. Although a rare entity, the rapid diagnosis of diabetes insipidus and early treatment with vasopressin may have been life-saving in this case. A detailed approach for treatment with continuous intravenous vasopressin may be the most accurate and efficient method of managing acute onset diabetes insipidus, especially in the hemodynamically compromised patient. This will allow for a controlled fluid management in order to achieve hemodynamic stability and prevent aggravation of cerebral edema.

Acute Disease↗
PubMed1983

Alterations in MAST suit pressure with changes in ambient temperature.

A study was undertaken to test the hypothesis that change in ambient air temperature has an effect on MAST suit pressure according to the ideal gas law. Two different MAST suits were tested on Resusci-Annie dummies. The MAST suits were applied in a cold room at 4.4 degrees C and warmed to 44 degrees C. Positive linear correlations were found in nine trials, but the two suits differed in their rate of increase in pressure. Three trials using humans were conducted showing increased pressure with temperature but at a lesser rate than with dummies. A correlation of 0.5 to 1.0 mm Hg increase in MAST suit pressure for each 1.0 degrees C increase in ambient temperature was found. Implications are discussed for the use of the MAST suit in environmental conditions where the temperature changes.

Gravity Suits↗
PubMed1983

Effect of altitude change on MAST suit pressure.

Transport of patients involving changes in altitude has become commonplace in the treatment of trauma patients. Often these patients are treated with medical antishock trouser (MAST) suits initially and during transport. The effects of altitude changes on the pressures generated in MAST suits were systematically investigated. Jobst Standard Antishock Air Pants were applied to the lower half of a Resusci-Anne dummy and inflated to 30 mm Hg of pressure. In a simulation of patient transport, the inflated MAST suit and dummy were placed in a helicopter and ascended from 2,500 feet to 9,500 feet. Pressures increased to 84, 87, and 87 mm Hg in three separate trials. Intermittent MAST suit pressure readings at 1,000-foot increments in altitude showed a positive linear relationship. Three descending trials, in which the MAST suit was inflated to 60 mm Hg at 9,500 feet and the helicopter descended to 2,500 feet, were also done. Pressures dropped to 7, 8.5, and 8 mm Hg in the three trials. A positive second order relationship between MAST suit pressure and altitude was noted for the descending trials. It was concluded that MAST suit pressure is a function of altitude. Emergency medicine personnel should be aware of this, and should monitor patients accordingly when transporting through changes in altitude.

Altitude↗
PubMed1983

Human rabies.

A 40-year-old man who farmed in Mexico and raised dogs as a hobby presented with dysphagia, hydrophobia, insomnia, anorexia, malaise, fever, and decreased strength and sensation in his dominant arm. After a repetitive three-hour history and physical examination, a tentative diagnosis of rabies was made in an atmosphere of patient denial followed by reluctance of hospital personnel to accept such a rare diagnosis. Upon confirmation of the diagnosis by the Center for Disease Control, Atlanta, the patient underwent aggressive therapy, including maximum respiratory support, anticonvulsants, steroids, pressors, hemodialysis and interferon treatment, but died on the 16th day following admission. This case is presented because of its rarity and to review the disease, clinical history, current therapy, and recent literature regarding emergency department differential diagnosis.

Adult↗
PubMed1983

Airway trauma.

The mechanism of injury, diagnosis, and treatment of maxillofacial, laryngeal, tracheal, and bronchial trauma are considered. Also discussed is pulmonary barotrauma.

Airway Obstruction↗
PubMed1980

The esophageal obturator airway: a study of respiratory effectiveness.

The respiratory effectiveness of esophageal obturator airway (EOA) ventilation versus endotracheal tube (ET) ventilation was compared in 22 patients experiencing cardiopulmonary arrest in a prehospital setting. Arterial blood gas analyses were performed on each patient after initial ventilation with the EOA and again after ET insertion and ventilation. For the entire study population, there was no significant difference (P greater than .05) in PO2 or pH measurements. There was a significant difference (P less than .01) in mean PCO2s. Patients admitted to the coronary care unit demonstrated no difference in any parameter of blood gas measurements. In patients declared dead in the emergency department, there was a statistically significant difference in PCO2 levels, which were lower with ET ventilation. All other parameters showed no significant difference. In general, when blood gas analyses were good or bad with the EOA, they were similarly good or bad with ET ventilation, whether the patient lived of died. Fifty-five percent of patients showed a decrease in PO, after ET intubation and 73% demonstrated a decrease in PCO2 after ET intubation. Patients who left the emergency department alive had shorter apnea to EOA insertion times than did those declared dead in the emergency area. Although the EOA does not replace ET ventilation, this study demonstrates that esophageal airway ventilation is as effective as endotracheal intubation in the emergency department setting.

Aged↗
PubMed1978

Management and microbiology of cutaneous abscesses.

Cutaneous abscesses in the perineal region contain primarily anaerobes commonly found in stool. Non-perineal abscesses contain mixed microflora indigenous to the skin. Bacteroides fragilis, the only anaerobe resistant to penicillin, is found predominantly in the perineal area. Staphylococcus aureus, although the most common aerobe found, is seen less frequently than expected and is almost always resistant to penicillin. Escherichia coli and Neisseria gonorrhoeae are rarely found. Incision and drainage is the primary mode of treatment. Fever is rare, though tachycardia is common in patients with normal host defenses. Patients with altered host defenses may require initial culture and Gram-stained smear to determine appropriate antibiotic therapy. The Gram-stained smear reliably indicates sterile and mixed abscesses, as well as those containing pure S aureus. Incision and drainage alone is the only therapy required in the usual patient. Since in these patients antibiotics are not required, initial culture and Gram-stained smear are unnecessary.

Abscess↗
PubMed1977

Cutaneous abscesses. Anaerobic and aerobic bacteriology and outpatient management.

Specimens from 135 cutaneous abscesses in outpatients were cultured anaerobically and aerobically. Of these, 4% were sterile and 29% yielded pure cultures, predominantly of Staphylococcus aureus. Aerobic species were isolated from all anatomic areas. Anaerobes were found with a frequency comparable to aerobes in all nonperineal areas except the hand. In contrast, abscesses in the perineal region contained a greater variety and frequency of anaerobes. Only two patients were febrile. All abscesses were treated with incision and drainage, and all healed without complication, including those 74% that were treated without adjunctive antibiotics. Primary management of cutaneous abscesses should be incision and drainage. In general, routine culture and antibiotic therapy are not indicated for localized abscesses in patients with presumably normal host defenses.

Abscess↗
PubMed1976

Extratemporal facial nerve injury.

Isolated traumatic facial nerve injury, frequently seen in wartime combat, may also be encountered among civilians. The clinical picture occurring as a result of such injury may be confusing because partial, or incomplete, damage to the peripheral nerve may mimic impairment of the central facial motor mechanism. In treating the patient with facial injury, life-threatening aspects of the injury must be assessed and stabilized first. Then, attention may be focused on the injured facial nerve, for which prompt surgical repair is the treatment of choice. Prior to surgery, the assessment of taste and hearing, as well as mastoid and skull x-ray films and electrodiagnostic tests are helpful in localizing the facial nerve injury.

Electrodiagnosis↗
PubMed1976

Life-support system: emergency medical care for conventions.

The life-support system described provides on-site emergency medical care for a designated group of people. It consists of a fixed subunit, a back-up emergency department; a temporary subunit, a life support station, and a mobile subunit, an ambulance and mobile medical personnel. A proposal for a life-support system for indoor conventions is presented with specifications of personnel, communications, supplies, registrant education and life-support team function. Results, critique, and discussion of a life-support station at the 1974 Annual ACEP/EDNA Scientific Assembly are presented.

Adult↗
PubMed1976

Jarisch-Herxheimer reaction. Case report.

The Jarisch-Herxheimer reaction is a response to the treatment of syphilis. The most common findings are fever, malaise, headache, and exacerbation of cutaneous lesions. The reaction is thought to be due to the effects of treponema breakdown products, and it should not be confused with an allergic reaction to the antibiotic employed. Thus, further therapy must not be withheld. Treatment is symptomatic.

Adult↗