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Biomedical subjects

J Wasserberger

Publications and source records attributed to J Wasserberger.

At least 19 recordsLinked to original sources
PubMed1989

Violence in a community emergency room.

Violence in both community and county hospitals in the USA is increasing. It caused significant physical, emotional and economic hardship to many emergency department employees. We describe an incident that caused significant injury to an innocent bystander in a quiet upper-class community emergency department and outline procedures that hospitals and emergency department employees can take to combat this violence. Policy, procedures, planning and methods must be available for appropriately trained and equipped police officers to respond to such incidents. The effects of such violent episodes on the emergency department staff are discussed. Methods to prevent such incidents are presented.

Adult↗
PubMed1989

Emergency department thoracotomy.

The best candidates for a community hospital emergency room thoracotomy are those victims who have decompensated following small-caliber gunshot wounds or stab wounds to the chest or abdomen who initially had signs of life in transport to the hospital or in the Emergency Department. Some of these patients can be successfully resuscitated by an emergency physician using the techniques described in this article.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Phenytoin toxicity: predictors of clinical course.

The records of 46 patients who were admitted to a general hospital with the diagnosis of phenytoin toxicity were retrospectively studied to identify factors present at the time of admission which correlated with severity of illness and which would therefore be of prognostic value. Length of hospital stay was used as a measure of severity of illness. Correlations were made between the length of hospital stay and 18 variables studied at the time of admission, including severity of symptoms, use of other drugs (sedative hypnotics, anticonvulsants and phenothiazines), history (seizures, cardiac arrhythmias, and alcohol abuse), laboratory evidence of liver disease or renal disease, electrolyte abnormalities, coagulopathies, prior suicide attempts, glucose levels, and white blood cell counts. Significant correlations related the length of hospital stay with the severity of symptoms, concurrent phenothiazine usage, and the presence of abnormal liver function tests on admission, but not with other factors studied. Admission phenytoin serum levels following an overdose were not a useful predictor of length of hospital stay in this series of patients.

Hospitals, General↗
PubMed1989

Phenytoin toxicity: a review of 94 cases.

Records of all patients admitted to an urban teaching hospital from 1977-1987 with a diagnosis of phenytoin toxicity were reviewed in order to determine indications for admission and discharge, and to assess the need for therapeutic intervention and monitoring. Of 94 patients identified, 57 were male and 37 were female. Ages ranged from 19 mo to 84 yr. Serum phenytoin levels ranged from 21.4-90 micrograms/ml, with a mean level 44.4 +/- 12.5 micrograms/ml. Ataxia was observed in 59/94 patients (63%), and of these 18 patients had fallen; 9 had suffered injury from falling sufficient to require medical care. No other factors were associated with morbidity. No hemodynamic instability was seen in any of the cases. Electrocardiographic records were available for 71/94 cases (76%). There were no abnormalities due to phenytoin. Symptoms of toxicity resolved with supportive care. There were no deaths in this series. Phenytoin is a relatively safe medication even in the toxic range as determined by baseline phenytoin levels. Hospital admission is indicated in symptomatic cases until a declining serum phenytoin level is observed and ataxia resolves. The data in this series do not support routine electrocardiographic monitoring in cases of phenytoin toxicity.

Adolescent↗
PubMed1988

Gunshot wounds in children under 10 years of age. A new epidemic.

Before 1980 we had not treated any children with gunshot wounds who were younger than 10 years of age, but the number has increased dramatically each year since then. Thirty-four children younger than 10 years of age were treated for gunshot wounds from 1980 to 1987. Sociologic and epidemiologic data were assessed by a child-abuse team and police. Other studies have concluded that gunshot wounds in young children were usually caused by unintentional injury, child abuse, or neglect. From our present study we add a further, and very disturbing, category, that of attempted or intentional pediatric homicide. The children in this category were shot in retaliation for gang activities of their older siblings. This study demonstrates that the majority of our patients' childhood gunshot wounds were related to gang violence and retaliation, the availability of handguns in the home, and child neglect. The prevalence of childhood gunshot wounds in the inner city is increasing dramatically.

California↗
PubMed1988

Shotgun wound ballistics.

Shotguns are popular world wide and more of these weapons exist than the rifled types. With an increasing incidence and prevalence of gunshot wounds it is important for traumatologists to be familiar with shotgun wound ballistics. Shotgun wounds differ from those of other missiles because the spectrum of wound severity is large owing to the fact that the pellets scatter as they travel. Close-range shotgun wounds can be as destructive as those from a high-velocity rifle, but longer weapon-victim ranges may produce only minimal injury. The type of shot (size and weight of pellets) used also determines the type of injury, with more serious injuries produced by the larger type of buckshot (greater than 0.14 inches in diameter). The severity of injury from birdshot depends mainly on the "effective" weapon-victim range which can be calculated from the shot size and shot pattern either clinically or from X-ray. Wounds may then be classified according to severity, yielding information on prognosis and extent of investigation and treatment required. We propose a four-level severity scale based upon birdshot pellet scatter patterns which correlate well with morbidity and mortality rates.

Firearms↗
PubMed1987

Intravenous prochlorperazine for the rapid control of nausea and vomiting in acute myocardial infarction: a clinical observation.

Sixteen patients with acute myocardial infarctions who were either vomiting or nauseated were given an intravenous injection of prochlorperazine. All patients obtained relief with exception of one patient who was in acute renal failure. No patient developed symptomatic hypotension. Intravenous prochlorperazine in the dose of 2.5 mg is a rapid, effective, and safe method to relieve vomiting and nausea in patients who have sustained an acute myocardial infarction.

Aged↗
PubMed1987

Serum digoxin levels and mortality in 5,100 patients.

A retrospective study of 5,100 patients on digoxin, with a four-week follow up after digoxin levels were measured, was done to determine the mortality rate. A significant increase in mortality was correlated with an increasing serum digoxin level, up to 50% at a level of 6.0 ng/mL and more. Clinical toxicity was suspected in only 0.25% of all patients on digoxin, although almost 10% had levels above the therapeutic range. Deliberate digoxin overdoses were fatal in 50% of cases. This study shows a correlation between increasing digoxin levels and increasing mortality rates. We recommend the use of serum digoxin measurements to identify those asymptomatic patients with elevated levels. The physician should seriously consider the indications for initiating or continuing digoxin treatment in any patient because of an increased mortality in patients with levels of more than 1.0 ng/mL.

Adult↗
PubMed1987

Electronic gun (Taser) injuries.

The Taser is an electrical weapon used for immobilization. Two hundred eighteen patients who were shot by police with a Taser for violent or criminal behavior were compared to 22 similar patients shot by police with .38 Specials. The long-term morbidity rate was significantly different for "tasered" victims (0%) and for those with bullet wounds (50%) (P less than .05). The mortality rate was also significantly different between "tasered" victims (1.4%), and gunshot wound victims (50%) (P less than .05). Possible complications associated with Taser wounds included contusions, abrasions, and lacerations (38%); mild rhabdomyolysis (1%); and testicular torsion (0.5%). Although 48% of "tasered" patients required hospitalization, all but one was for a preexisting injury or toxic or psychiatric problem. We conclude that Tasers are relatively safe when compared to shooting with more conventional weapons.

Adolescent↗
PubMed1987

Base station prehospital care: judgement errors and deviations from protocol.

During a three-year period 5,944 paramedic runs were reviewed at the King/Drew Medical Center for deviations from prehospital management protocols established by the Los Angeles Paramedic Training Institute, and from standard medical practice. An overall compliance to the prehospital management protocols of 94% was found. Compliance to standard medical care was 97%. The most common deviations were failure to administer prophylactic lidocaine to patients having chest pain suggestive of myocardial ischemia and failure to apply cervical spine precautions in patients with suspected head trauma. Fifty percent of the radio operators who deviated from algorithms also were found to be making errors in judgment in standard medical care.

Algorithms↗
PubMed1987

Homemade guns.

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Adolescent↗