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Biomedical subjects

Mark E Ralston

Publications and source records attributed to Mark E Ralston.

5 recordsLinked to original sources
PubMed2005

Comparison of levalbuterol and racemic albuterol combined with ipratropium bromide in acute pediatric asthma: a randomized controlled trial.

Our study compared levalbuterol (LEV) to the combination of racemic albuterol (RAC) and ipratropium bromide (IB) in 140 patients aged 6-18 years presenting to a tertiary hospital Emergency Department with acute asthma and a peak expired flow rate (PEF)<80% predicted. Patients were randomized to: LEV (<or=6 nebs LEV 1.25 mg); or RAC/IB (<or=3 nebs RAC 5.0 mg+IB 0.25 mg followed as needed by <or=3 nebs RAC 5.0 mg). No difference was noted in the study population (mean age 11.6 years and initial mean predicted PEF 49.5%) between LEV (n=72) and RAC/IB (n=68) for study outcomes except for measures of heart rate (HR). Median % HR increase for RAC/IB (26%) exceeded LEV (9%) (p<0.001). In a sample of children with acute asthma and initial mean PEF<50% predicted, LEV was associated with less tachycardia but had no other advantage over RAC combined with IB.

Acute Disease↗
PubMed2005

This issue: Managing emergencies part 2.

Pediatric toxicologic exposures are common, and the primary care pediatric practitioner must be prepared to handle emergencies related to poisoning and overdose in children and adolescents. Fortunately, many poisonings in children are unintentional, preventable, and benign. For both simple and complex cases, help is available to medical professionals 24/7 from multiple sources, including an improved toxic exposure database, new research, the network of Certified Specialists in Poison Information at our nation's regional poison control centers, and backup medical and clinical toxicologists. The US system of AAPCC-certified poison control centers has been appropriately labeled "a national safety net" serving the public and medical practitioners in the management of pediatric toxicologic exposures. Increased funding to this system will be critical to update its services for the future, including preparation to detect the increasing threat of new public health emergencies such as chemical and biological terrorist attacks.

Child↗
PubMed2004

Physiologic anterior subluxation: case report of occurrence at C5 to C6 and C6 to C7 spinal levels.

Physiologic anterior subluxation is a phenomenon that is common to the upper pediatric cervical spine and characterized by the normal forward displacement of one cervical vertebra relative to the subjacent one. Physiologic anterior subluxation can be seen in children in the setting of trauma, when it must be distinguished from pathologic subluxation. Physiologic anterior subluxation has not been reported at lower cervical spinal levels (C 5 to C 6 or C 6 to C 7 ). This is a report of physiologic anterior subluxation at C 5 to C 6 and C 6 to C 7 spinal levels distinguished from pathologic subluxation in a 9-year-old child evaluated in the acute setting after cervical spine injury.

Accidents, Traffic↗
PubMed2003

Role of oblique radiographs in blunt pediatric cervical spine injury.

OBJECTIVE: To determine the usefulness of oblique cervical spine radiography (OCSR) in the management of children who have sustained blunt cervical spine injury, particularly if OCSR is abnormal when no acute abnormalities are shown on standard cervical spine radiography (SCSR). METHODS: We carried out a blinded radiographic review of 109 patients younger than 16 years evaluated at an academic pediatric trauma center and a community hospital between July 1990 and December 1997. All patients had SCSR (anteroposterior/lateral views) and OCSR performed for a trauma-related event within 7 days of injury. RESULTS: In 105 patients (96.3%), radiographic impression after review of SCSR and OCSR did not differ from that after SCSR review alone (95% confidence interval 90.9%, 99.0%). Radiographic impression was revised after OCSR review in 4 patients, all with equivocal findings on SCSR, to normal in three patients and abnormal in one patient (subluxation). Of 78 patients without acute abnormalities on SCSR, no patient had acute abnormalities on OCSR (95% CI, 0-3.8%). CONCLUSIONS: In our series of 109 children who underwent acute radiographic evaluation of blunt cervical spine trauma, oblique views were unlikely to be abnormal if no acute abnormalities were evident on standard anteroposterior and lateral radiographs. Although few patients are likely to benefit from the addition of these views on a routine basis, a useful role for oblique cervical spine radiographs in detecting cervical spine injury in children cannot be excluded based on the results of this study.

Adolescent↗