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Biomedical subjects

R B Leonard

Publications and source records attributed to R B Leonard.

85 records · Page 5Linked to original sources
PubMedDate not supplied

Blunt carotid artery trauma: a case report.

Blunt carotid artery trauma represents only 3% of all carotid artery injuries, but 42% of reported cases have been associated with severe neurologic deficits. We present a case of blunt injury to the right internal carotid artery with subsequent thrombosis and neurologic deficit. Computed tomography (CT) of the head without contrast was normal, a finding that emphasizes the importance of obtaining carotid arteriograms in any patient with a focal neurologic deficit but a normal CT of the head. We review the incidence, mechanism, presentation, and treatment of blunt carotid injuries. We also stress the importance of observing for blunt carotid injuries in the patient with blunt cervical trauma in order to allow earlier intervention, since patient outcome is dependent on that early recognition and intervention.

Accidents, Traffic↗
PubMedDate not supplied

Axillosubclavian vein thrombosis: case report.

Deep-vein thrombosis of the upper extremity, that is, axillosubclavian vein thrombosis, is a relatively rare and potentially overlooked diagnosis in the emergency department (ED). It can be the cause of significant morbidity and it may be life-threatening. Reported here is the case of a 23-year-old man who presented to the ED with left upper extremity pain and swelling. Venography confirmed the diagnosis of axillosubclavian vein thrombosis. Hospitalization and treatment with intravenous heparin led to a satisfactory recovery. The clinical presentation, predisposing factors, diagnosis, treatment, and complications of this rare entity are discussed.

Adult↗
PubMedDate not supplied

Peripartum cardiomyopathy: a case report.

Peripartum cardiomyopathy (PPCM) is a relatively rare form of acute heart failure. Onset is from the last trimester of pregnancy to 5 months postpartum. Diagnosis is made by excluding other causes of acute heart failure, such as infections or toxins, and by determining that the patient does not have an underlying cardiac problem that has been unmasked by pregnancy. Diagnosis in the last trimester is complicated by the fact that the early symptoms of this disorder may mimic the symptoms of normal pregnancy. PPCM must be considered in any patient who presents with new onset peripheral edema, dyspnea on exertion, or paroxysmal nocturnal dyspnea during late pregnancy or up to 5 months postpartum. Limited studies suggest that early and aggressive therapy is associated with a better outcome. Therapy is directed toward decreasing preload and improving cardiac function. Return of cardiac size to normal is associated with a better prognosis than continued cardiomegaly.

Acute Disease↗
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Posterior sternoclavicular dislocation: a case report.

Posterior sternoclavicular dislocation is a relatively rare form of trauma, but one that must be recognized by the emergency physician. Such a case is presented here. Due to the proximity of the clavicle to critical thoracic outlet structures, serious complications can arise from a posterior dislocation: impingement on and possible trauma to the trachea, pneumothorax, laceration of underlying great vessels, brachial plexus injury, esophageal trauma, and laryngeal trauma that may cause permanent vocal cord changes. Many of these potential complications are life-threatening, and it is important that this injury not be triaged in the emergency department as a minor injury, thereby leading to its improper or delayed treatment.

Adolescent↗
PubMedDate not supplied

SARA three years later. Emergency physician's knowledge, beliefs, and actions.

OBJECTIVE: Investigate Emergency Physicians' knowledge about the Superfund Amendments and Reauthorization Act (SARA) Title III legislation, passed by the United States Congress in 1986, and to determine the factors contributing to their level of preparedness in dealing with patients exposed to toxic chemicals. METHODS: A 115-item questionnaire was mailed to the medical directors of all emergency departments (EDs) in the State of New York. The results of the cross-sectional survey were analyzed using standard statistical methods. RESULTS: One hundred and eighty-seven (72%) of the directors of EDs in New York State responded to the survey. Three years after SARA was enacted, only 33% of the directors had heard about this legislation. Only 18% had been invited to attend the meetings of the Local Emergency Planning Committees (LEPC). Sixty percent of the directors knew whether or not the LEPC had devised plans that defined a role for their EDs in responding to environmental emergencies. This knowledge about community planning mainly had an effect on preparedness of the EDs. Preparedness also was predicted by how recently the EDs had treated patients exposed to toxic chemicals, the perception that emergency physicians had a legitimate role in planning for and responding to chemical emergencies, and how often emergency physicians had attended continuing education courses about hazardous materials. CONCLUSION: Despite the finding that some emergency physicians are involved in community preparations, two main problems persist in planning a medical response to environmental emergencies. First, the ED directors generally are unaware of the legislation that mandates these preparations and are not interacting with community planners. Second, there is not full involvement by the local EDs in the LEPC planning efforts. RECOMMENDATIONS: A procedure is needed to disseminate information about legislation which affects emergency physicians, such as SARA, and about regional planning for environmental emergencies. Dissemination should include education about the professions' role in planning for and providing care for patients exposed to toxic chemicals.

Diffusion of Innovation↗
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Patient-data collection system used during medical operations after the 1994 San Fernando Valley-Northridge earthquake.

INTRODUCTION: In large disasters, such as earthquakes and hurricanes, rapid, adequate, and documented medical care and distribution of patients are essential. METHODS: After a major (magnitude 6.7 Richter scale) earthquake occurred in Southern California, nine disaster medical assistance teams and two Veterans Administration (VA) buses with VA personnel responded to staff four medical stations, 19 disaster-assistance centers, and two mobile vans. All were under the supervision of the medical support unit (MSU) and its supervising officer. This article describes the patient-data collection system used. All facilities used the same patient-encounter forms, log sheets, and medical treatment forms. Copies of these records accompanied the patients during every transfer. Centers for Disease Control and Prevention data classifications were used routinely. The MSU collected these forms twice each day so that all facilities had access to updated patient flow information. RESULTS: Through the use of these methods, more than 11,000 victims were treated, transferred, and their cases tracked during a 12-day period. CONCLUSIONS: Use of this system by all federal responders to a major disaster area led to organized care for a large number of victims. Factors enhancing this care were the simplicity of the forms, the use of the forms by all federal responders, a central data collection point, and accessibility of the data at a known site available to all agencies every 12 hours.

California↗
PubMedDate not supplied

Medical outreach after hurricane Marilyn.

INTRODUCTION: Many geographical areas are subject to devastating disasters that leave the citizens not only without homes, but also without their local medical systems. Now medical-aid stations consisting of personnel, supplies, and equipment quickly can be deployed when needed to such areas under the aegis of the National Disaster Medical System (NDMS). Such teams can provide emergent medical care as well as daily medical care. However, these aid stations are of no help for the home-bound or nursing home patients too infirm to reach them. Thus, these citizens only can obtain medical care if medical teams make planned outreach excursions to reach them. OBJECTIVE: To describe a planned outreach program that was implemented for such patients on St. Thomas Island after it was devastated by Hurricane Marilyn in 1995. RESULTS: Over a five-day period, the outreach team provided medical care for 67 patients ranging in age from 11 days to 90 years. Play and art therapy was provided for non-injured children. The most common needs in the elderly were anti-hypertensive medications and insulin-loaded syringes. CONCLUSIONS: For outreach efforts of this nature, membership of the team should include a registered nurse, a paramedic, a respiratory therapist, a public health specialist, and a local authority familiar both with the area and its inhabitants. A physician does not need to be assigned to the team, but should be available by radio.

Adolescent↗