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Biomedical subjects

J M Wightman

Publications and source records attributed to J M Wightman.

13 recordsLinked to original sources
PubMed2001

Explosions and blast injuries.

Powerful explosions have the potential to inflict many different types of injuries on victims, some of which may be initially occult. Flying debris and high winds commonly cause conventional blunt and penetrating trauma. Injuries caused by blast pressures alone result from complex interactions on living tissues. Interfaces between tissues of different densities or those between tissues and trapped air result in unique patterns of organ damage. These challenge out-of-hospital personnel, emergency physicians, and trauma surgeons to specifically seek evidence of these internal injuries in individuals with multiple trauma, adjust management considerations to avoid exacerbation of life-threatening problems caused by the blast wave itself, and ensure appropriate disposition of these patients in possible mass-casualty situations. Knowledge of the potential mechanisms of injury, early signs and symptoms, and natural courses of these problems will greatly aid the management of blast-injured patients.

Biomechanical Phenomena↗
PubMed2000

Etomidate-facilitated hip reduction in the emergency department.

Joint dislocations are common presenting complaints in emergency departments (EDs). Dislocations of major joints, such as the shoulder, elbow, and hip, are often difficult to gently reduce because of the challenge in obtaining sufficient relaxation of large muscle groups. This is the first reported use of etomidate to assist in the reduction of a major joint in an outpatient setting. We discuss the case of an elderly woman with total hip arthroplasty who experienced four spontaneous posterior hip dislocations in a 5-month period. Narcotics and benzodiazepines failed to facilitate reduction at every encounter, whereas etomidate made the procedure easy the two times it was used in the ED. This article reviews the administration of etomidate for conscious sedation and discusses potential complications.

Aged↗
PubMed1999

A standardized letter of recommendation for residency application.

Emergency medicine (EM) program directors have expressed a desire for more evaluative data to be included in application materials. This is consistent with frustrations expressed by program directors of multiple specialties, but mostly by those in specialties with more competitive matches. Some of the concerns about traditional narrative letters of recommendation included lack of uniform information, lack of relative value given for interval grading, and a perception of ambiguity with regard to terminology. The Council of Emergency Medicine Residency Directors established a task force in 1995 that created a standardized letter of recommendation form. This form, to be completed by EM faculty, requests that objective, comparative, and narrative information be reported regarding the residency applicant.

Correspondence as Topic↗
PubMed1987

Decreased vascular resistance after intra-arterial injection of [met]enkephalin in the hindquarters of conscious rabbits.

The hemodynamic effects of i.a. [met]enkephalin were studied in the hindquarter vasculature of chronically prepared, conscious rabbits. A new method allowed i.a. injection while simultaneously measuring blood pressure and blood flow to this vascular bed. [Met]enkephalin produced a dose-dependent (3-300 micrograms/kg) decrease in hindquarter vascular resistance (18-42% change from base line). The duration of the response ranged from 28 sec to over 2 min. Heart rate decreased 16 to 45% over the same dose range but returned to preinjection levels in 5 sec. Only the bradycardia was abolished by pretreatment with atropine methyl nitrate. All hemodynamic changes were eliminated or significantly reduced after pretreatment with the ganglionic blocking agent, chlorisondamine hydrochloride. The opioid antagonist, naloxone hydrochloride, abolished the hemodynamic effects of [met]enkephalin. Resistance decreases in the mesenteric vasculature were coincident with those in the hindquarters. The time to onset of the response was delayed when [met]enkephalin was injected i.v. These data indicate activation of a reflex originating in the hindquarters that resulted in opioid-dependent increased efferent parasympathetic activity to the heart and decreased sympathetic tone to at least two vascular beds.

Animals↗
PubMedDate not supplied

Acute management of glycogen storage disease type Ia.

Rapid metabolic deterioration may occur in patients with some glycogen storage diseases (GSDs) regardless of presenting complaint. Hepatic, renal, and hemostatic abnormalities may also complicate diagnosis and treatment of trauma victims. We report the case of a man presenting with an epidural hematoma and a history of GSD type Ia.

Adult↗
PubMedDate not supplied

Objectives to direct the training of emergency medicine residents on off-service rotations: traumatology, Part 1.

This is the 30th article in a continuing series of objectives to direct emergency medicine resident experiences on off-service rotations. Because injuries account for tremendous morbidity and mortality, management of trauma is an essential part of training in emergency medicine. Instruction in traumatology during off-service rotations may be conducted at the bedside in difficult and demanding clinical settings. Therefore, it is essential for residents to have specific goals and objectives to guide their acquisition of knowledge required to make rapid, accurate decisions for patients with major trauma.

Emergency Medicine↗
PubMedDate not supplied

Objectives to direct the training of emergency medicine residents on off-service rotations: traumatology, Part 2.

This is the 31st article in a continuing series of objectives to direct emergency medicine resident experiences on off-service rotations. Neck and torso trauma accounts for a large portion of injuries, and its management is an essential part of training in emergency medicine. Due to the often life-threatening presentations of trauma victims, resident instruction may be conducted at the bedside in difficult and demanding situations. Therefore, it is essential for residents to have specific goals and objectives to guide their acquisition of knowledge required to make critical decisions for patients with major trauma.

Curriculum↗
PubMedDate not supplied

Objectives to direct the training of emergency medicine residents on off-service rotations: traumatology, Part 3.

This is the thirty-second article in a continuing series of objectives to direct emergency medicine resident experiences on off-service rotations. Instruction during rotations in traumatology may be conducted at the bedside in difficult and demanding clinical settings. Yet, residents must not only obtain an essential fund of knowledge, but also become comfortable with a variety of life-saving and diagnostic procedures. It is essential for residents to have specific goals and objectives to guide their acquisition of knowledge and skills required to manage major trauma effectively.

Curriculum↗
PubMedDate not supplied

Objectives to direct the training of emergency medicine residents on off-service rotations: surgery, Part 1.

This is the 34th article in a continuing series of objectives to direct emergency medicine resident experiences on off-service rotations. Abdominal and gastrointestinal complaints are common problems in the emergency department and often lead to consultation with a surgeon. Because an understanding of the principles of surgical diagnosis and treatment is an essential component of the practice of emergency medicine, residents rotating on surgical services require specific goals and objectives to emphasize early patient assessment, identification of the possible need for surgery, and a basic understanding of definitive management.

Curriculum↗
PubMedDate not supplied

Objectives to direct the training of emergency medicine residents on off-service rotations: Surgery, part 2.

This is the 35th article in a continuing series of objectives to direct emergency medicine resident experiences on off-service rotations. Vascular and urological complaints are common problems in the emergency department and often lead to consultation with a surgeon. Because an understanding of the principles of surgical diagnosis and treatment is an essential component of the practice of emergency medicine, emergency medicine residents rotating on surgical services require specific goals and objectives to emphasize early patient assessment, identification of the possible need for surgery, and a basic understanding of definitive management. Unique aspects of pediatric surgery are also addressed in this segment.

Clinical Competence↗
PubMedDate not supplied

Objectives to direct the training of emergency medicine residents on off-service rotations: surgery, Part 3.

This is the 36th and final article in a series of objectives to direct emergency medicine resident experiences on off-service rotations. An understanding of the principles of surgical diagnosis and treatment is an essential component of the practice of emergency medicine. Emergency medicine residents rotating on surgical services require specific objectives to maximize their learning potential, emphasize early patient assessment, identify the possible need for surgery, and gain a basic understanding of definitive management. This article approaches surgical problems from the presenting complaint. It concludes with procedures not covered in the goals and objectives for traumatology.

Curriculum↗
PubMedDate not supplied

Military assistance in complex emergencies: what have we learned since the Kurdish relief effort?

After the success of relief efforts to the displaced Kurdish population in northern Iraq following the Gulf War, many in the US military and the international relief community saw military forces as critical partners in the response to future complex emergencies (CEs). However, successes in subsequent military involvement in Somalia, Rwanda, the former Yugoslavia, and other CEs proved more elusive and raised many difficult issues. A review of these operations reinforces some basic lessons that must be heeded if the use of military forces in humanitarian relief is to be successful. Each CE is unique, thus, each military mission must be clearly defined and articulated. Armed forces struggle to provide both security and humanitarian relief, particularly when aggressive peace enforcement is required. Significant political and public support is necessary for military involvement and success. Military forces cannot execute humanitarian assistance missions on an ad hoc basis, but must continue to develop doctrine, policy and procedures in this area and adequately train, supply, and equip the units that will be involved in humanitarian relief. Militaries not only must cooperate and coordinate extensively with each other, but also with the governmental and non-governmental humanitarian relief organizations that will be engaged for the long term.

Africa, Central↗