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Biomedical subjects

J P Gillen

Publications and source records attributed to J P Gillen.

5 recordsLinked to original sources

Unrecognized traumatic atlanto-occipital dislocation.

This report describes the case of a 67-year-old male victim of an auto-pedestrian accident who was alert and neurologically intact on initial presentation. The patient denied head or neck pain and was without evidence of craniocervical injury. A lateral c-spine radiograph did not show any abnormal findings. The patient deteriorated during his trauma evaluation and was refractory to resuscitation. At autopsy, he was found to have an atlanto-occipital dislocation (AOD). The case is discussed and the anatomic, clinical, and radiographic features of atlanto-occipital dislocation are reviewed.

Accidents, Traffic↗

The tolerability of lactated Ringer's solution and BSS plus for ocular irrigation with and without the Morgan therapeutic lens.

OBJECTIVE: To evaluate two solutions, lactated Ringer's (LR) and a balanced salt solution (BSS Plus, Alcon Laboratories, Ft. Worth, TX), compared with normal saline solution (NSS), for ocular irrigation in healthy adult volunteers with and without the Morgan therapeutic lens (MTL). METHODS: This was a prospective, double-blind, randomized study of healthy volunteers who were at least 18 years of age. Exclusion criteria included the use of analgesics within four hours of the study. A complete ophthalmologic examination was performed at baseline and at the completion of the study. Following randomization and prior to any intervention, baseline discomfort scores were obtained by means of a verbally administered, horizontal, 100-mm, unnumbered analog discomfort scale. Both eyes of each volunteer were irrigated simultaneously for 15 minutes, with additional discomfort scores being recorded every 5 minutes using the same 100-mm, unnumbered analog discomfort scale. A global evaluation to assess the method of irrigation and the solutions used for irrigation was completed by both the physician blinded to the treatment groups and the volunteers. The volunteers were continuously monitored for any adverse effects resulting from the irrigation solutions or MTL. RESULTS: Sixty-three volunteers were recruited into the study, with 61 entered in the final analysis. Age and gender were balanced within each group. There was no significant difference in discomfort scores between the two groups; however, all discomfort scores decreased over time (p = 0.008). A lens-solution interaction was identified, with LR being the most tolerated when administered with the MTL. A statistically higher ocular pH difference was seen between the pre- and postirrigation readings for the control eye in volunteers irrigated with MTL (p = 0.046). Analysis of the global evaluations for each group revealed no difference in the distributions of physician and volunteer scores. No adverse event was reported in either group. CONCLUSION: There does not appear to be any difference in discomfort scores between the ocular irrigation fluids when used without the MTL. Overall, the use of the MTL appears well tolerated by healthy, adult volunteers. However, there does appear to be a significant lens-solution effect on volunteers' discomfort scores, with LR having significantly lower discomfort scores when used for ocular irrigation with the MTL. The authors conclude that the use of the MTL for ocular irrigation is well tolerated and recommend using LR as the irrigation solution for maximal patient comfort.

Acetates↗

Structured emergency medicine board review and resident in-service examination scores.

OBJECTIVE: To determine whether the institution of a structured board review program is associated with improved in-service examination scores by residents at an emergency medicine (EM) residency program. METHODS: A retrospective, historical control analysis of the association of a board review program and in-service examination scores at one EM residency program was performed. A structured board review consisting of monthly reading assignments in "classic" EM textbooks followed by a graded multiple-choice written examination was instituted in 1987. Percentile scores on the American Board of Emergency Medicine (ABEM) in-service examination before (1985-1986) and after (1987-1994) initiation of the board review process were compared by resident level (EM-1, 2, or 3). RESULTS: The EM-1 mean percentile score before review was 50.7 and rose to 68.9 after the institution of the board review program (p = 0.039). Mean EM-2 scores (66.8 vs 65.4) and EM-3 scores (74.4 vs 67.4) decreased slightly; these decreases were not statistically significant. Due to the large increase in EM-1 scores, the mean scores for the total program increased slightly (63.4 vs 67.4; p = NS). CONCLUSION: In this study, EM-1 in-service scores improved in association with the institution of a structured board review program. This formalized didactic program may increase the knowledge base and test performance of EM-1 residents. A favorable effect on EM-2 and EM-3 resident scores was not seen.

Certification↗

Ventricular fibrillation during orotracheal intubation of hypothermic dogs.

Physical manipulation of the hypothermic patient is well known to cause ventricular fibrillation. Careful review of the literature fails to demonstrate a true temporal relationship between orotracheal intubation and ventricular fibrillation (VF) when acceptable temperature-corrected arterial blood gases have been obtained. Eleven mongrel dogs were anesthetized and cooled, with orotracheal intubation and extubation performed every two degrees centrigrade, starting at 27 C. Ventilator setting were adjusted to maintain normal pH according to arterial blood gases drawn every two degrees and corrected for temperature. There was only one episode of VF during 42 intubations performed at temperatures less than 28 C (2.38%). There were eight separate episodes of spontaneous VF unrelated to intubation in five dogs. Four of these five with spontaneous VF were resuscitated with countershock only, further cooled, and reintubated an additional 11 times without a single episode of VF during intubation. Our data suggest that the incidence of VF during intubation in the hypothermic patient is much less than previously described, provided that normal pH is maintained and hypoxemia is corrected.

Animals↗