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Biomedical subjects

J C Ruthman

Publications and source records attributed to J C Ruthman.

8 recordsLinked to original sources
PubMed1989

Accuracy of interpretations of emergency department radiographs: effect of confidence levels.

We conducted a prospective study to assess the relationship between the interpretive agreement rate for emergency department radiographs and the degree of interpretive confidence. We hoped to identify a subset of ED radiographs that did not require mandatory review by a radiologist. For each of the 1,872 plain radiographs studied, emergency physicians assigned a confidence level to the interpretation before comparing it with the radiologist's dictated report. A second radiologist was consulted to resolve disagreements. The overall rate of interpretive agreement was 94.6%. Agreement varied significantly (P less than .001) as a function of confidence level and by type of radiograph, but not by training level. Agreement varied significantly (P less than .001) as a function of confidence level for some types of radiographs (eg, chest, extremities) and for some types of radiographic findings (acute positive). No subset of radiographs had 100% agreement. Treatment was potentially altered in 38 patients as a result of the interpretive disagreement that occurred in 2% of studied radiographs. We conclude that the interpretive agreement rate increases in relation to interpretive confidence but that confidence levels cannot safely exclude certain radiographs from mandatory review by a radiologist.

Emergency Medicine↗
PubMed1989

Pituitary apoplexy presenting as monocular blindness.

The case of a 56-year-old man with sudden onset of retrobulbar headache and progressive loss of vision in his left eye is described. The anatomical position of the chiasm noted during surgical resection of a necrotic pituitary adenoma accounted for this patient's presentation of monocular blindness. We discuss the typical features of pituitary apoplexy and provide a pathophysiological explanation of these signs and symptoms. A differential diagnosis is given and appropriate treatment is described.

Adenoma↗
PubMed1988

Isolated plantar midtarsal dislocation.

A case of isolated plantar midtarsal dislocation resulting from blunt trauma is presented. Review of the English-language literature reveals this to be an extremely rare injury. Strategies for emergency department management of this injury are discussed.

Accidents, Occupational↗
PubMed1988

Elevated serum zinc levels in metal fume fever.

Metal fume fever is not an uncommon syndrome among welders following exposure to oxidized metal fumes (usually zinc). The relationship of serum zinc level to the acute phase of this illness is not known. Two cases of metal fume fever, associated with elevated serum zinc levels, are presented. Further studies are necessary to determine the diagnostic usefulness of serum zinc levels in metal fume fever.

Adult↗
PubMed1988

A comparison of epinephrine and methoxamine for resuscitation from electromechanical dissociation in human beings.

Electromechanical dissociation (EMD) is an organized electrical depolarization of the heart without synchronous myocardial fiber shortening and, therefore, without cardiac output. Patients in EMD have a poor prognosis for resuscitation and long-term survival. The beneficial effect in resuscitation of epinephrine, the adrenergic agent currently recommended, has been shown to depend on stimulation of alpha-adrenergic vasoconstriction. The beta-adrenergic inotropic and chronotropic effects of epinephrine are theoretically detrimental by increasing myocardial oxygen consumption and subendocardial ischemia. The purpose of our study was to determine whether the pure alpha agonist methoxamine was superior to epinephrine in human beings in EMD as determined by survival at one hour. These two agents were compared in a prospective, randomized, and double-blinded study involving 80 patients with EMD of various causes seen in the emergency department and internal medicine inpatient service. The advanced cardiac life support (ACLS) algorithm (current at the time of our study) for resuscitation from EMD was used, with the blinded study drug (epinephrine 1 mg or methoxamine 10 mg) administered where the algorithm calls for epinephrine. Calcium and isoproterenol also were used in the majority of cases according to ACLS standards but never prior to the use of methoxamine or epinephrine. Survival data are summarized as: survival less than one hour, 22 patients receiving methoxamine, 22 receiving epinephrine; one to six hours, 15 patients receiving methoxamine, 13 patients receiving epinephrine; six to 12 hours, one patient receiving epinephrine; more than 24 hours but not surviving to discharge, three patients receiving methoxamine, two patients receiving epinephrine; and survival to discharge, one patient receiving epinephrine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Emergency department presentation of type A botulism.

In October 1983, 28 people became ill with type A botulism in a common-source, food-borne outbreak. Thirteen of these patients presented to an emergency department for initial medical evaluation. The records of these thirteen patients were examined retrospectively in an attempt to characterize the initial presenting symptoms. All patients complained of at least three of four symptoms (generalized weakness, diplopia, dry mouth, and difficulty speaking). Emergency physicians can play a pivotal role in limiting the extent of common-source botulism outbreaks by early recognition of the disease and immediate mobilization of community public health resources.

Botulism↗
PubMedDate not supplied

Lunacy.

Explore the source record for details and available documents.

Emergency Service, Hospital↗