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Biomedical subjects

R C Jorden

Publications and source records attributed to R C Jorden.

At least 19 recordsLinked to original sources
PubMed1993

Penetrating chest trauma.

Penetrating chest trauma causes a broad spectrum of injury that requires a variety of diagnostic and resuscitative skills. Prompt resuscitation and decisive action are mandatory for patients who present in extremis, whereas a thorough diagnostic evaluation and appropriate observation are indicated in less compelling circumstances. Clinical skill and judgment along with plain radiographs provide the basis for treatment in most cases. More sophisticated imaging techniques, with the exception of angiography, are of limited value. A systematic approach based on wound location, be it central, peripheral, or proximate to the diaphragm, should result in timely resuscitation and sound diagnostic evaluation.

Blood Transfusion, Autologous↗
PubMed1992

Grossly positive peritoneal lavage and nontherapeutic laparotomy after abdominal stab wound.

Diagnostic peritoneal lavage is often employed in the evaluation of stab wounds of the anterior abdomen and lower chest. This technique is perhaps too sensitive, however, in detecting self-limited solid visceral and abdominal wall injuries. We report five cases of nontherapeutic laparotomies in abdominal stab wound victims who had a grossly positive peritoneal lavage prior to surgery. Previous retrospective data indicate that such "false positive" lavages most commonly result from blood entering the abdominal cavity from the wound, although nonoperative injuries to solid viscera and iatrogenic trauma are sometimes implicated. We review these studies and suggest caution in relying too much on lavage results in determining the need for exploration after abdominal stab wounds. Rather, they must be considered alongside other findings in assessing each individual case.

Abdominal Injuries↗
PubMed1991

Benign cystic mesothelioma presenting as acute abdominal pain in a young woman.

Benign cystic mesothelioma is a rare tumor that, due to compressive effects, presents with abdominal pain and distention and other mass symptoms such as early satiety. Although diagnostic modalities such as plain radiography, ultrasonography, and computed tomography (CT) scan can suggest the diagnosis, confirmation can be accomplished only at surgery. The differential diagnosis includes any benign or malignant cystic abdominal or pelvic tumor. Management consists of surgical excision, which unfortunately is not always curative, since there is a recurrence rate of 50%. The clinical features, work-up, and course of a 15-year-old female with benign cystic mesothelioma are presented, followed by a brief review of the literature.

Abdominal Pain↗
PubMed1991

Treatment of pyelonephritis in an observation unit.

STUDY OBJECTIVE: To determine the feasibility of managing patients with acute pyelonephritis as outpatients after initial treatment with IV antibiotics in an emergency department observation unit. DESIGN: Prospective and uncontrolled. SETTING: ED observation unit. TYPE OF PARTICIPANTS: Nonpregnant female patients 14 years old or older without immunocompromise or serious underlying disease and no evidence of septic shock. INTERVENTIONS: All patients received two IV doses of trimethoprim/sulfamethoxazole at a 12-hour dosing interval and promethazine and acetaminophen as needed for nausea and fever, respectively. Baseline laboratory data, urinalysis, and urine and blood cultures were obtained. MEASUREMENTS AND MAIN RESULTS: Patients were observed for signs of septic shock, nausea, vomiting, and the ability to tolerate an oral intake. At the end of the observation period, 43 of 44 patients were discharged on oral trimethoprim/sulfamethoxazole. One additional patient who was doing well clinically was recalled and admitted because of a positive blood culture. CONCLUSION: Patients with acute pyelonephritis, despite significant fever or nausea and vomiting, can be treated effectively as outpatients after a brief period of observation and IV antibiotics.

Adolescent↗
PubMed1991

Usefulness of empiric chest radiography and urinalysis testing in adults with acute sickle cell pain crisis.

STUDY OBJECTIVE: To determine the usefulness of obtaining routine chest radiographs and urinalyses on adults presenting to the emergency department in acute sickle cell pain crisis. The hypothesis tested is that in some adult sickle cell patients, sickle cell pain crises are precipitated or accompanied by acute infection that may be clinically occult and that routine screening for pulmonary or urinary tract infection would identify some of these precipitating illnesses. DESIGN: Prospective clinical study. SETTING: A university hospital ED. PATIENTS: All patients more than 14 years old with S-S, S-C, or S-beta-thalassemia sickle hemoglobinopathies who presented to the ED with acute nontraumatic painful complaints during a six-month period. INTERVENTIONS: All patients underwent posteroanterior and lateral chest radiography, routine urinalysis, and CBC count with reticulocyte count. A standard questionnaire for localizing symptoms of systemic, pulmonary, and urinary tract infection was completed for each patient. Urine cultures were ordered on all patients with voiding symptoms, flank pain, and/or more than 5 WBCs or RBCs per high-power field on urinalysis. Physical examination for evidence of pulmonary and urinary tract infection was carefully performed and recorded for subsequent analysis. RESULTS: Seventy-one patients with 134 ED presentations were studied over a six-month period. Eight diagnoses of acute pneumonia were made. Four of these patients complained of chest pain (50% vs 48% overall) and three had shortness of breath (38% vs 21%). None of these patients complained of fever or symptoms of upper respiratory illness. Ten diagnoses of urinary tract infection were made. Four of these patients complained of dysuria and frequency; three complained of flank pain. Eleven of the 18 infections (61.1%) did not have a typical history for or suggestive physical or laboratory findings of bacterial infection. CONCLUSION: In sickle cell disease patients with pain crisis, routine chest radiography and urinalysis may be clinically useful and cost effective in the early diagnosis of crisis-related infection.

Acute Disease↗
PubMed1989

Substance abuse education in residency training programs in emergency medicine. NIAAA Task Force of the American College of Emergency Physicians.

The emergency department is the focal point for many social ills, not the least of which is substance abuse. We conducted a study to determine to what degree substance abuse education is taught in emergency medicine residency training programs. A set of educational objectives was developed by a task force composed of representatives of the American College of Emergency Physicians, the Society of Teachers of Emergency Medicine, and the University Association for Emergency Medicine. A questionnaire then was sent to the directors of all emergency medicine residency programs accredited by the Accreditation Council for Graduate Medical Education to determine the degree to which those objectives are covered in residency training. A 62% response rate was achieved. The data revealed that such topics as narcotic prescription law, patterns of risk, and issues pertaining to substance abuse by physicians were covered by fewer than half of the programs responding. Respondents were generally satisfied with the adequacy of training of residents and faculty in the area of substance abuse; however, they were dissatisfied with the adequacy of available training materials. Recommendations for changes in graduate curriculum as well as avenues for further research are provided.

Attitude of Health Personnel↗
PubMed1989

Acute carbon monoxide poisoning: emergency management and hyperbaric oxygen therapy.

An ice storm in February 1989 resulted in numerous incidences of carbon monoxide poisoning in central Mississippi secondary to exposure to open fires in unventilated living spaces. Sixteen cases were treated during this period at the University of Mississippi Medical Center and 6 received Hyperbaric Oxygen therapy. These 6 cases and the mechanisms of CO poisoning are discussed and recommendations for emergency management are reviewed.

Acute Disease↗
PubMed1988

Airway management.

In this article the author discusses standard oral, nasal, and surgical approaches to airway management, including some modifications of these routine techniques. Several specific clinical settings then are presented, and airway management options and recommendations for each condition are discussed. The clinical circumstances covered include blunt trauma, conditions causing elevated intracranial pressure, anterior neck trauma, problems of pediatric patients, and foreign body aspiration. A number of novel, unorthodox approaches to airway management also are presented.

Airway Obstruction↗
PubMed1988

Percutaneous transtracheal ventilation.

PTV is an adjunct to airway management that can prove helpful in selected cases. Its speed and ease of performance are offset by the need for specialized equipment to accomplish it. This difficulty, combined with infrequent indications, makes PTV a rarely performed procedure. Nevertheless, it remains a viable airway management alternative whose applications may be broadened in the future.

Animals↗
PubMed1985

Limitations of computed tomography in the evaluation of acute abdominal trauma: a prospective comparison with diagnostic peritoneal lavage.

There has been recent enthusiasm for computed tomography (CT) to supplant diagnostic peritoneal lavage (DPL) in the detection of abdominal injuries. We prospectively compared CT to DPL following acute blunt trauma or stab wound to the abdomen. Patients with hemodynamic instability or overt signs of intraperitoneal pathology underwent urgent laparotomy and were excluded from study. Those with indications for DPL had lavage catheter insertion via open technique and attempted aspiration for gross blood. This was followed by contrast CT of the abdomen with a Technicare 2010 scanner. Lavage fluid, when required, was then instilled, recovered, and analyzed. CT interpretations were made in a blind fashion by a single staff radiologist. Decision for laparotomy was based on clinical, DPL, and CT data. In blunt trauma (N = 65), DPL detected 5/5 (100%) injuries discovered at laparotomy and CT 2/5 (40%). Following stab wounds (N = 35), DPL was true positive in 7/7 (100%) and CT in 1/7 (14.3%), with one false positive CT leading to negative laparotomy and one false positive DPL which prompted unnecessary celiotomy. Overall, the sensitivity of DPL was 100% versus 25% for CT and specificity 98.9% for both DPL and CT. In particular, CT missed seven solid visceral (five liver, two spleen), five hollow visceral, one major vascular, and three diaphragmatic lesions requiring operative intervention. In our experience, CT demonstrated an alarming incidence of false-negative studies. Given the widespread variability of CT equipment and personnel we would argue strongly against the use of CT alone in the evaluation of acute abdominal trauma and continue to support DPL as the most accurate and reliable instrument of detection.

Abdominal Injuries↗
PubMed1985

A comparison of PTV and endotracheal ventilation in an acute trauma model.

Percutaneous transtracheal ventilation (PTV) is an active airway management technique that may be an alternative to cricothyroidotomy in critically injured patients. A canine trauma model was devised to compare the ventilatory capacity and hemodynamic effects of PTV to endotracheal intubation. Mongrel dogs (25-37 kg), splenectomized 14 days previously, were anesthetized with pentobarbital and bled to a mean arterial pressure (MAP) of 20 mm Hg. Animals were maintained at this MAP for 1 hour, then resuscitated with simultaneous: a) aortic crossclamping via left thoracotomy, b) Ringer's lactate infusion, and c) active airway support. Control animals (N = 5), intubated with a cuffed endotracheal tube, were ventilated at a rate of 12 per minute, a tidal volume of 500 cc and an FIO2 of 60%. In study animals (N = 5), PTV, for a duration of 1 second, was instituted at the same rate and FIO2. There was no statistically significant difference between the two groups with regard to pO2, pCO2, pH, and hemodynamic parameters. PTV was also performed in the emergency department on four patients unresponsive to resuscitative thoracotomy for postinjury cardiac arrest. PTV rate was 12/minute; duration, 1 second; and FIO2, 100%. Mean values (+/- SEM) for pH, pO2, and pCO2 obtained after 15 minutes of PTV were 7.14 +/- 0.03, 322 +/- 49.5 torr, and 21.5 +/- 4.7 torr, respectively. PTV is comparable to endotracheal intubation with respect to oxygenation, ventilation and hemodynamic response (p greater than 0.05). Our preliminary clinical study corroborates its efficacy in the acute trauma setting and supports further clinical investigation.

Animals↗
PubMed1984

Case report: common femoral artery occlusion following blunt trauma in a child.

Vascular injury from blunt trauma is infrequently seen in children unless associated with major trauma. This case report is an example of a significant vascular injury in the setting of minor trauma. The consequences of missing such an injury as well as some of the difficulties encountered in establishing the diagnosis are discussed.

Child, Preschool↗
PubMed1984

Percutaneous transtracheal ventilation in a canine shock model with an open thorax.

This study evaluates the effectiveness of percutaneous transtracheal ventilation (PTV) in a canine shock model. Five mongrel dogs (25 to 35 kg), splenectomized two weeks prior to study, were anesthetized (pentobarbital, 22 mg/kg) and bled to and sustained at a mean arterial pressure (MAP) of 20 mm Hg for 60 minutes. Ringer's lactate was infused and the descending thoracic aorta was cross-clamped. Simultaneously, PTV was begun with 60% O2 through the cricothyroid membrane. Hemodynamic measurements and arterial blood gases were obtained at 0, 5, 15, and 30 minutes following the initiation of PTV. Orotracheal ventilation was then instituted in place of PTV and continued for 30 minutes, and measurements were repeated. Auto-transfusion was also begun at this time. During PTV, PO2 and PCO2 were adequate in all dogs at each interval. We conclude that PTV provides effective oxygenation and ventilation in dogs subjected to profound shock, thoractomy, and thoracic aortic cross-clamp.

Animals↗
PubMedDate not supplied

Gastric emptying in the acutely inebriated patient.

Fifty inebriated emergency department (ED) patients underwent evacuation of gastric contents via a nasogastric tube, in order to determine if a significant amount of ingested ethanol can be removed prior to absorption. Such a result could potentially reduce additional intoxicating effect. The gastric contents were assayed for total ethanol concentration, and a potential (postabsorption) additive blood alcohol level (PABAL) was projected and compared to the actual BAL on arrival. The type of beverage ingested and the time since last drink were recorded. BAL ranged from 108 to 637 mg/dL (mean +/- SD, 290 +/- 104.7). Gastric aspirate volume ranged from 50 to 700 mL (190 +/- 134), and contained alcohol in a range of 87 to 2271 mg/dL (475 +/- 479). Based on the distribution volume for alcohol calculated according to the patient's weight, this corresponded to a PABAL of 3 to 167 mg/dL (mean, 24.3 +/- 29.3). There was no significant correlation between the volume or concentration of gastric aspirate and the patient's stated drinking history. The authors conclude that a significant amount of ingested alcohol may occasionally be removed from absorption by the routine evacuation of gastric contents in intoxicated patients. These patients cannot be identified upon presentation, however, and these data cannot support routine use of gastric emptying in the detoxification of inebriated patients.

Adolescent↗
PubMedDate not supplied

Acute abdominal aortic occlusion.

Acute occlusion of the infrarenal abdominal aorta is a catastrophic event requiring early recognition and intervention if permanent disability is to be decreased or avoided. While traditional causes of occlusion (saddle embolus and thrombosis) are the most frequent, vasculitis and hypercoagulable states have recently been suggested as etiologies. This article presents three cases of acute abdominal aortic occlusion from different mechanisms and reviews the literature concerning presentation and management.

Acute Disease↗