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Biomedical subjects

R C Luten

Publications and source records attributed to R C Luten.

10 recordsLinked to original sources
PubMed1994

Neonatal resuscitation.

All emergency departments should be adequately equipped and well prepared to handle a newborn delivery and resuscitation. It is important to remember that most neonates will respond to drying, warming, positioning, suctioning, and tactile stimulation and that overzealous and invasive resuscitation is not only unwarranted in most cases, but substantially increases the risk of iatrogenic complications. After the initial management, further therapy is based on assessment of respirations, heart rate, and skin and mucous membrane color. An algorithm outlining neonatal resuscitation is presented in Figure 6.

Asphyxia Neonatorum↗
PubMed1992

Length-based endotracheal tube and emergency equipment in pediatrics.

HYPOTHESIS: Pediatric endotracheal (ET) tubes can be accurately selected based on body length using a specialized emergency tape. POPULATION: Derivation set: Two hundred five children undergoing elective surgery. Validation set: Two hundred thirteen children undergoing elective surgery. Each child served as his or her own control. METHODS: Derivation phase: Two hundred twenty-one children undergoing ET intubation for elective surgery had their body length and leak pressures measured. The 205 children who had leak pressures between 10 and 40 cm H2O constituted the derivation set. The body length for a given ET tube size was derived from the interquartile range of patient lengths in this derivation set. Sizes for other resuscitative equipment items were chosen by a panel of experts using a modified Delphi technique. This information was placed by length on a color-coded tape. Validation phase: The tape was validated by using it to select ET tube size in another group of 203 children undergoing elective surgery. Criteria for acceptable fit in this group included leak pressure as above and the anesthesiologists' decision to accept the tube size or to retintubate. In the validation phase, length-based ET tube selections were compared with age-based rules: (age + 16)/4, and (age + 18)/4. RESULTS: The tape selected the appropriate ET tube size by leak pressure criterion in 77% of the cases and was within +/- 0.5 mm of the "correct" size 99% of the time. This was significantly better (P less than .005) than two widely used age-based rules, which gave the correct initial size in only 47% and 9% of these cases, and were within +/- 0.5 mm for 86% and 59%. The anesthesiologists chose to continue with the tape-sized tube rather than to reintubate in 89% of cases. CONCLUSION: A system for length-based selection of emergency equipment represents a significant adjunct to emergency physicians and paramedics who must deal with critically ill children. Length-based ET tube selection is clearly superior to age-based rules, which are difficult to remember and require accurate estimation of a patient's age.

Body Height↗
PubMed1989

How many myocardial infarctions should we rule out?

We used computer simulation to estimate the consequences of four admitting strategies (coronary care unit, intermediate care unit, routine ward care, or outpatient follow-up) on cost, outcome, admission threshold probabilities, and false-positive admission rates for patients with acute myocardial infarction. At virtually any probability of acute myocardial infarction, replacing more intensive by less intensive strategies saved money but increased mortality and decreased life expectancy. Therefore, choices among strategies may be made by using the most effective strategy for progressively lower and lower risk patients until the additional cost per additional life saved reaches a cutoff value; then, a less expensive strategy is selected. With sample cutoff values of $1 and $2 million per life saved, the marginal threshold admission probabilities were: (table; see text) These results imply that the acceptable proportion of false-positive admissions may be as high as 70% to 80%; lower rates could indicate excessively restrictive admitting policies. Clinicians may be operating closer to the optimal decision point than has previously been asserted.

Coronary Care Units↗
PubMed1989

The child in the EMS system.

Preventable accidents and injuries are the major threat to the health care of children. The solution to this problem is a functioning emergency medical services system with the prevention aspect being unquestionably the most important. The first step to the enhanced function of the EMS system is to make the medical community and the lay public aware of its roles in this system and, secondly, to foster cooperation among all participants. The intent of the "Year of the Child in EMS" campaign is to contribute to this effort.

Adolescent↗
PubMed1988

A rapid method for estimating weight and resuscitation drug dosages from length in the pediatric age group.

Drug dosages used during pediatric emergencies and resuscitation are often based on estimated body weight. The Broselow Tape, a tape measure that estimates weight and drug dosages for pediatric patients from their length, has been developed to facilitate proper dosing during emergencies. In our study, 937 children of known weight were measured with this tape. Weight estimates generated by the tape were found to be within 15% error for 79% of the children. The tape was found to be extremely accurate for children from 3.5 to 10 kg, and from 10 to 25 kg. Regression lines of estimated compared with actual weight for these children have slopes of 0.98 and 0.96, respectively, not significantly different from the ideal slope of 1.00 (P = 28 and .13). Accuracy was significantly decreased for measured children who weighed more than 25 kg. In a separate group of children (n = 53), the tape was shown to be more accurate than weight estimates made by residents and pediatric nurses (P less than .0001). Use of the Broselow Tape is a simple, accurate method of estimating pediatric weights and drug doses and eliminates the need for memorization and calculation.

Body Height↗
PubMed1986

Which laboratory tests should be performed on children with apparent febrile convulsions? An analysis and review of the literature.

There exist wide variations among clinicians as to management of the child who presents with the first febrile convulsion. In 1980, the American Academy of Pediatrics issued a consensus statement on febrile convulsions which included recommendations for initial management. Multiple studies have also addressed this topic. From these studies, guidelines for management have been drawn. Review of these studies reveals little scientific support for current management strategies. The decision to perform lumbar puncture is analyzed as an example of the practical limits of clinical investigations. Reliance upon consensus clinical opinion is therefore recommended.

Child↗
PubMedDate not supplied

The pediatric cervical spine: developmental anatomy and clinical aspects.

The radiographic interpretation of the pediatric cervical spine can be a perplexing problem for the emergency physician. Given the wide range of variances in the ossification centers, the unfused synchondroses, and the relative hypermobility of the pediatric cervical spine, radiographs may be easily misread if one is not thoroughly familiar with the developmental anatomy and variants. This paper discusses those developmental aspects of the pediatric cervical spine that impact on emergency radiographic interpretation. Frequently encountered pediatric cervical spine fracture/dislocations are reviewed with an analysis of age-related distributions. Finally, the syndrome of Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) is discussed.

Adolescent↗