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Biomedical subjects

J F Waeckerle

Publications and source records attributed to J F Waeckerle.

48 records · Page 3Linked to original sources
PubMed1988

Emergency treatment of burn injury.

Emergency physicians often encounter patients who have suffered burn injuries. Most are minor in nature but approximately 100,000 a year are true emergencies. Regardless of severity, the emergency physician and staff must possess the evaluative skills and knowledge of current treatment regimens to appropriately treat these patients. Burn injuries are classified according to extent of body surface involved and depth of skin injury. This classification, together with an understanding of the pathophysiology based on the source of injury, will allow categorization and thereby determine initial therapy and definitive management. The treatment of minor burns focuses on three primary objectives: relief of pain, prevention of infection and additional trauma, and minimizing of scarring and contracture. With major burns the first hours after injury are characterized by life-threatening problems. Airway injuries, trauma other than the burn injury, treatment of shock, and pain relief are of the highest priority, overriding the management of the burn wound itself. The care that the minor burn victim receives is critical to ultimate outcome; the care that the major burn victim receives is critical to both immediate survival and ultimate outcome. The emergency physician must provide optimal care to ensure optimal results.

Burns↗
PubMed1988

Inhalation injuries.

Inhalation injuries occur in approximately one-third of all major burns and account for a significant number of deaths in those burn patients each year. Victims die as a result of carbon monoxide poisoning, hypoxia, and smoke inhalation. These deaths can occur without thermal wounds as well as with burn injuries. There are three distinct problems with inhalation injuries: thermal burns of the upper airway, carbon monoxide poisoning, and smoke inhalation. Each has different symptoms and signs, different treatment, and different prognosis. Thermal burns occurring in the upper airway are usually manifested within 48 hours of injury. Diagnosis is made by direct visualization of the upper airway, looking for signs of thermal injury. Admission for observation with humidified oxygen, attentive pulmonary toilet, bronchodilators as needed, and prophylactic endotracheal intubation as indicated are the mainstays of treatment. Resolution of the injury usually occurs within days. Carbon monoxide poisoning, the most common cause of death in inhalation injury, is a result of combustion. Symptoms and signs correlate with blood levels, but arterial blood gases are used to determine the degree of carbon monoxide intoxication. Treatment is based on the principle that carbon monoxide dissociation occurs much faster if the patient is placed on 100% oxygen. Occasionally the patient's symptoms may persist or get worse despite adequate treatment. Smoke inhalation significantly damages normal respiratory physiology, resulting in injury progressing from acute pulmonary insufficiency to pulmonary edema to bronchopneumonia, depending on the severity of exposure. Diagnosis is based on history, but clinical findings, arterial blood gases, and fiberoptic bronchoscopy are helpful. Treatment is supportive with careful attention paid to fluid resuscitation in the patient with burns.(ABSTRACT TRUNCATED AT 250 WORDS)

Burns, Inhalation↗
PubMed1987

A prospective study identifying the sensitivity of radiographic findings and the efficacy of clinical findings in carpal navicular fractures.

Carpal navicular fracture is the most common wrist bone fracture. Improper diagnosis and inadequate treatment result in potentially serious complications, including delayed fracture union, pseudoarthrosis, avascular necrosis, and wrist instability ultimately leading to deformity and osteoarthritis. Initial radiographs do not always demonstrate a discernible fracture line. To better define the frequency of initially negative radiographs of the navicular associated with true navicular fractures, and to test the efficacy of the three clinical signs (snuffbox tenderness, pain with supination against resistance, and pain with longitudinal compression of the thumb toward the navicular), a prospective study of 85 patients who presented to the emergency department during a four-year period with a mechanism of injury suggesting possible navicular injury was conducted. Forty-five patients had no demonstrable fracture or instability on initial examination or during the follow-up period. Forty patients ultimately were shown to have navicular fractures. Patients with negative radiographs and positive clinical findings were reevaluated after ten to 14 days of immobilization. Thirty-two patients had fracture lines visible on initial radiographic examination, and eight had lucent fracture lines demonstrated after ten to 14 days of immobilization. Snuffbox tenderness had a sensitivity of 100% and a specificity of 98% for fracture; supination against resistance had a sensitivity of 100% and a specificity of 98%; and longitudinal compression of the thumb had a sensitivity of 98% and a specificity of 98%. Chi-square analysis revealed a P value less than .001 for each of the three clinical maneuvers. This study reports a 20% occurrence of initially false-negative radiographs, which is higher than previously reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1980

First time major motor seizures in an emergency department.

A five-year retrospective study was conducted to review 91 emergency patients with first time major motor seizures who were hospitalized. Patients were reviewed with regard to etiology of seizures, evaluation, and hospital course. Our objectives were to compare admission and discharge diagnoses, to establish a screening survey which might determine the need for immediate admission, and to evaluate the sensitivity of tests used in diagnostic evaluation. The emergency department diagnosis was in agreement with the discharge diagnosis in 89% of cases. A screening system included a history, physical examination, urinalysis, complete blood cell count, electrolytes, blood urea nitrogen, glucose, electrocardiogram, and arterial blood gases more than one hour post-seizure. When applied to the cases, it distinguished need for admission in 90 of 91 patients. Skull radiographs, electroencephalograms, CAT scans, brain scans, and lumbar punctures were helpful in making a specific diagnosis, but not in determining the need for immediate admission.

Adolescent↗
PubMed1980

Antishock garments.

Explore the source record for details and available documents.

Emergency Medical Services↗
PubMed1979

Intracranial abscesses with behavioral changes.

Intracranial abscesses represent one of the most serious complications of ear and paranasal sinus infections. The infection may spread by bone erosion, preformed pathways, or septic thrombosis via the Haversian canals. This may result in subdural abscesses, meningitis, or intracerebral abscesses. These intracranial complications are associated with a high morbidity. The purpose of this communication is to emphasize that behavioral changes after ear or paranasal sinus infections may be a manifestation of an intracranial abscess.

Adult↗
PubMed1977

The clinical pharmacist in emergency medicine.

The function of a pharmacist in emergency medicine, encompasing clinical practice, education and research, are described, and an evaluation of physicians' and nurses' attitudes toward pharmacist involvement in these areas is presented. In July 1974, a pharmacist joined the staff of a department of emergency health services in a medical center. In June 1976, a 14-item questionnaire was administered to physicians and nurses associated with the department. Seventy-two percent of the questionnaires were completed and returned. All respondents felt the pharmacist was an important component of the department and a benefit to its patient care and educational programs. Eighty-seven percent of the physicians stated that the pharmacist is capable of offering primary care to certain patients once the diagnosis has been made by a physician; 95% felt the role of the pharmacist is transferrable to other emergency room facilities and 83% were willing to have their patients charged for his services.

Attitude of Health Personnel↗
PubMed1976

Hereditary angioneurotic edema treated by partial uvulectomy.

Hereditary angioneurotic edema (HANE) is a rare familial disease of C1 esterase inhibitor deficiency that produces recurring attacks of acute, circumscribed, noninflammatory edema. The technique of partial uvulectomy to treat HANE can reduce the mortality from this condition due to asphyxiation. Three cases in which partial uvulectomy was the successful mode of treatment are described.

Adult↗