Biomedical subjects
Publications and source records attributed to K Sturmann.
The essentials of the neurological examination are reviewed from the perspective of the emergency medicine practitioner. Important historical information to be obtained, as well as indications and techniques for individual components of the physical examination, are covered. Appropriate and concise methods for documenting the results of the neurological examination in the patient record are also discussed.
We report the case of a 32-year-old male who presented to the emergency department with left-sided chest pain associated with burning epigastric discomfort and radiation to the back. Similar symptoms had prompted his visit to another emergency department 1 week earlier. He was discharged from that institution after a negative upper gastrointestinal series. In our emergency department a transoesophageal echocardiograph raised suspicion of a dissection of the thoracic aorta, which was later confirmed by a contrast chest computed tomography scan. The patient was admitted to the intensive care unit but refused surgical intervention at the time of admission. A detailed history failed to uncover any known risk factors for this disease entity. Aortic dissection is rarely seen in young, healthy individuals. Atypical clinical representations are reviewed. The emergency department work-up of aortic dissection is discussed.
OBJECTIVE: To determine if iodine tincture is a more effective skin antiseptic for blood culture collection than povidone-iodine, an iodophor. DESIGN: Pairwise comparisons across phases. In phases 1 and 3, blood culture skin preparation was performed with the iodophor; in phases 2 and 4, skin preparation was performed with iodine tincture. SETTING: Emergency department of a large urban teaching hospital. PATIENTS: All adult patients seen in the emergency department who had blood cultures collected because a systemic bacterial infection was suspected. MAIN OUTCOME MEASURE: The blood culture contamination rate for the iodophor and iodine tincture skin preparations. RESULTS: A total of 8467 blood cultures were collected during the study, and 421 (4.97%) were classified as contaminated. The contamination rate for the blood cultures collected using the iodophor was 6.25%, and the contamination rate for the cultures using iodine tincture was 3.74%; this difference is statistically significant (P < .00001). CONCLUSIONS: The effectiveness of the skin antiseptic may be an important factor in determining contamination rate in blood culturing. If these results are confirmed by others, then institutions that have a high blood culture contamination rate when using an iodophor for skin preparation should consider changing to iodine tincture.
A blood culture study comparing the performance of the new high-volume Bactec resin media to hypertonic medium was conducted in adult patients seen in the emergency department. Twenty milliliters of blood was divided equally among three media: hypertonic (NR8A), aerobic high-volume resin (HV26), and anaerobic high-volume resin (HV27). During a 5.5-month period, 2,724 blood cultures were collected; there were 417 (15.3%) positive cultures, of which 233 (8.6%) yielded pathogens and 184 (6.8%) contaminants. For the 257 isolates recovered from 233 cultures yielding pathogens, the isolation rates were: NR8A-194 (75.5%), HV26-204 (79.4%), and HV27-189 (73.5%). We conclude that in this emergency department patient population, the rate and speed of recovery of pathogenic microorganisms is comparable in high-volume resin media and the hypertonic medium but that the high-volume resin media still has a definite advantage over standard nonradiometric media in adults because high-volume blood cultures (20 mL) can be performed using a two-bottle collection set rather than a three-bottle set.
Methylene chloride is a chlorinated hydrocarbon used widely in home and industry. Its intentional abuse has not been reported previously. We describe the case of a 14-year-old boy who presented with lethargy, nausea, and chills six hours after the intentional inhalation of a household product containing methylene chloride. The patient's elevated carboxyhemoglobin level responded well to 100% oxygen therapy. The pathophysiology and treatment of methylene chloride are discussed.
Analgesics in patients with acute abdominal pain are often withheld for fear that they may change physical examination findings and thus may be unsafe. We conducted a randomized, prospective, placebo-controlled trial to investigate changes in physical examination following the administration of placebo, 5 mg, or 10 mg of morphine to 49 patients with acute abdominal pain. One patient was withdrawn secondary to inadequate documentation. Of the 48 patients who completed the trial, a statistically significant change in physical examination was noted in both groups receiving analgesics, but not in the placebo group. No adverse events or delays in diagnosis were attributed to the administration of analgesics. We conclude that physical examination does change after the administration of analgesics in patients with acute abdominal pain and that a larger study is needed to evaluate analgesic safety in this subpopulation of emergency department patients.