PubMed Health⌕ Search

Biomedical subjects

R A Barish

Publications and source records attributed to R A Barish.

16 recordsLinked to original sources
PubMed1992

Unsuspected heterotopic pregnancy in a woman without risk factors.

A 27-year-old woman presented to the emergency department with abdominal pain. One week prior to this she had had an ultrasound which revealed an intrauterine pregnancy (IUP). A second ultrasound performed at our institution revealed an intrauterine pregnancy along with a concomitant ectopic pregnancy which had ruptured. This case emphasizes that coincident pregnancies may occur in women who are without risk of ectopic pregnancy or multiple gestations. In addition, ultrasound must be evaluated fully for heterotopic pregnancy in all women.

Adult↗
PubMed1992

Venomous snakebites. Current concepts in diagnosis, treatment, and management.

It is essential that all emergency physicians become familiar with the recognition and treatment of venomous snakebites. Techniques such as the use of tourniquets and incision and suction should no longer be performed routinely. The mainstay of treatment for poisonous bites is the intravenous administration of the appropriate antivenin to neutralize the effects of the venom.

Animals↗
PubMed1991

Acute traumatic cervical epidural hematoma from a stab wound.

Cervical spinal epidural hematoma is an infrequent entity that usually requires emergency decompressive therapy because of rapid neurologic dysfunction. We present the case of a 34-year-old man who presented to the emergency department with minimal symptomatology after a stab wound to the neck. A computed tomography myelogram of the cervical spine revealed a cervical spinal epidural hematoma. This case illustrates an unusual presentation as well as etiology of cervical spinal epidural hematoma.

Adult↗
PubMed1987

Late postpartum eclampsia.

A case of new-onset seizures occurring 12 days postpartum is described. The patient presented with headache, hypertension, and proteinuria. Postpartum eclampsia was diagnosed and IV magnesium sulfate was administered. The patient had no further seizures and did not require long-term anticonvulsants. Medical and neurologic evaluations failed to reveal any other etiology for the seizures.

Adult↗
PubMed1986

Esophageal spasm following propranolol overdose relieved by glucagon.

A case of propranolol overdose complicated by esophageal spasm preventing extrication of an orogastric lavage tube and relieved by intravenous glucagon is presented. Esophageal spasm is an infrequent complication of beta-adrenergic over-dose. Possible mechanisms of esophageal spasm and its relief with glucagon are discussed.

Esophageal Diseases↗
PubMedDate not supplied

The electrocardiographic manifestations of pulmonary embolism.

The electrocardiographic manifestations of pulmonary embolism include rhythm and condition disturbances and changes in the P wave, QRS complex, or T wave. Since these abnormalities are highly variable and frequently transient, they lack the sensitivity necessary to establish the diagnosis of pulmonary embolism. The electrocardiogram may rise the suspicion of pulmonary embolism, but other diagnostic tests are necessary to confirm the diagnosis.

Blood Pressure↗
PubMedDate not supplied

The electrocardiographic features of hypothermia.

Hypothermia results in the development of several characteristic electrocardiographic changes. As the core body temperature decreases, several changes in cardiac rhythm occur. Prolongation of the PR, QRS, and QT intervals are also seen. Muscle tremor artifact may be present, even in the absence of clinical shivering. A characteristic secondary deflection on the terminal portion of the QRS complex (Osborn wave) is usually found. All of these features are reversible with rewarming.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Use of a mildly restrictive administrative protocol to reduce orders for manual blood film examination from the emergency department.

In order to conserve laboratory resources, we instituted a mildly restrictive administrative protocol requiring a telephone request by emergency physicians or their designees in order to obtain a manual blood film examination (BFE). This test includes a manual differential leukocyte count (DLC), examination of red cell morphology, and platelet estimate. The protocol resulted in a marked reduction of the number of BFE's performed on emergency department patients from the previous level of one for every complete blood count (CBC). Retrospective chart review of a sample of patients not receiving manual BFEs indicated no apparent adverse effect on patient care. We speculate that the availability of an electronic partial differential count, providing enumeration of lymphocytes and neutrophils along with the CBC, facilitated in part the reduced ordering of manual BFEs.

Baltimore↗
PubMedDate not supplied

Arterial injury from a high pressure water jet: case report.

We report the case of a patient who sustained a high-pressure water jet injury to the thigh while cleaning industrial piping. The patient presented with a puncture wound to the anterior thigh and a pulseless foot. Emergency arteriography was performed that revealed complete disruption of the superficial femoral artery. The patient underwent surgical exploration and debridement, and a successful repair of the disrupted artery was performed with a prosthetic arterial graft. A discussion of high-pressure water jet injuries and their management is presented.

Accidents, Occupational↗
PubMedDate not supplied

Deep venous thrombosis of the upper extremity: diagnosis and treatment.

Deep vein thrombosis of the upper extremity was long thought to be a benign disease, rarely complicated by pulmonary embolism and associated with minimal long-term morbidity. More recent observations have demonstrated however, that a significant number of patients will continue to have disabling symptoms after treatment with conservative measures and standard anticoagulation therapy, and that pulmonary embolism can occur in the course of the disease. Because of its significant morbidity and increasing incidence, an aggressive emergency department approach to diagnosis and early consideration of fibrinolytic therapy are recommended.

Adult↗
PubMedDate not supplied

Delayed presentation of unstable cervical spine injury with minimal symptoms.

Emergency physicians are less likely to suspect the presence of a severe or unstable cervical spine injury in patients who have been ambulatory since the traumatic episode. We present the case of a man with multiple cervical fractures and a 75% anterior subluxation of C6 and C7 who did not seek medical care for six weeks after falling from a height. Previous reports of delayed or occult cervical spine injuries are reviewed. Physicians must aggressively search for injuries whenever a history of neck pain is present or a strong mechanism of injury exists, even if the patient has been ambulatory for days or weeks following the injury.

Accidental Falls↗
PubMedDate not supplied

The importance of an annual report.

An annual report, by summarizing the emergency department's accomplishments, is an effective means of highlighting the vital role of the emergency department within the hospital system and the community. The report should begin with an Executive Summary and proceed to detail the clinical, educational, research, administrative, financial, and other essential aspects of the status and development of the department.

Annual Reports as Topic↗
PubMedDate not supplied

Accidental hypothermia with cardiac arrest: recovery following rewarming by cardiopulmonary bypass.

A 22-year-old man eventually had a good neurologic recovery following prolonged coma after extracorporeal rewarming from profound hypothermia (24 degrees C) due to exposure. The patient was in full arrest for 60 minutes prior to institution of cardiopulmonary bypass (CPB). Total bypass time was 50 minutes. Cardiopulmonary bypass is the current rewarming method of choice for severe hypothermia associated with a persistent nonperfusing cardiac rhythm. CPB provides the most rapid core rewarming with the additional benefit of circulatory support during the period of cardiac instability.

Adult↗
PubMedDate not supplied

Magnesium: clinical considerations.

Magnesium is gaining recognition as a clinically important electrolyte. Hypomagnesemia has been associated with a variety of disorders including seizures, malignant ventricular dysrhythmias, and sudden death. The emergency department patients who are most likely to be magnesium deficient include alcoholics, patients who take diuretics, and those in diabetic ketoacidosis. Hypokalemia and hypocalcemia may represent unrecognized hypomagnesemia. Clinical trials and case reports also document increasing interest in magnesium as an effective therapeutic agent for potentially life-threatening problems such as torsade de pointes, digitalis toxicity, bronchospasm, and alcohol withdrawal. We present an overview of hypomagnesemia, review the current literature, and focus on the role of magnesium in the acute care setting and the implications for the emergency physician.

Acute Disease↗