Biomedical subjects

R J Dachs

Publications and source records attributed to R J Dachs.

3 recordsLinked to original sources

PubMed1997

Intravenous ketamine sedation of pediatric patients in the emergency department.

STUDY OBJECTIVE: To determine efficacy, safety, recovery times, and parental satisfaction with i.v. ketamine sedation in pediatric patients requiring brief, painful procedures in the emergency department. METHODS: Pediatric ED patients whom we found to require brief (< 10 minutes), painful procedures were considered candidates for ketamine sedation. Each subject received 1.0 to 2.0 mg/kg i.v. ketamine, after which the necessary procedure was performed. RESULT: Thirty patients, ranging in age from 18 months to 8 years, were enrolled in the study. With the exception of one patients in whom ketamine was inadvertently given subcutaneously, all subjects given i.v. ketamine exhibited sedation adequate for the planned painful procedure within 2 minutes of ketamine administration. An initial bolus of 1.0 mg/kg required supplemental administration of ketamine in 50% of the patients (6 of 12), whereas an initial bolus of 1.5 mg/kg reliably produced adequate sedation in 94% (17 of 18). The median time elapsed before the criteria for discharge after injection were fulfilled was 25 minutes. No deleterious cardiopulmonary effects were noted. Vomiting and mild agitation after the procedure were observed in two and four cases, respectively. At follow-up all parents reported satisfaction with ketamine sedation. CONCLUSION: I.v. ketamine is a consistently effective method of producing a rapid, brief period of profound sedation and analgesia in children in the ED. Although no serious complications were noted in our series, larger studies are needed to establish this drug's safety profile in the ED. Vomiting, ataxia, and agitation were noted in a few cases.

Anesthetics, Dissociative↗

PubMed1992

Aortoenteric fistula.

Aortoenteric fistula is a rare but deadly medical emergency. Primary fistulas occur between the native aorta and the intestinal tract. Secondary fistulas occur between an aortic graft and the gastrointestinal tract. Patients often present with a "herald bleed," followed by massive gastrointestinal hemorrhage. Sepsis and abdominal pain in a patient who has had an aortic graft may also indicate the formation of a fistula. Prompt intervention is imperative; the mortality rate is 100 percent if the condition is left untreated. In clinically stable patients with a herald bleed, evaluation usually consists of endoscopy in an operating room. Computed tomographic scanning is useful for patients with signs of sepsis; scans showing an aortic graft surrounded by inflammation and abscess formation may indicate fistula formation. Clinically unstable patients require immediate laparotomy. Even in surgically treated patients, the mortality rate is approximately 60 percent.

Aortic Diseases↗

PubMed1989

Male college students' compliance with testicular self-examination.

The role of the physician and written educational material were assessed for effectiveness in increasing the regular performance of monthly testicular self-examination (TSE) by male college students. Of 633 students from three New England colleges, 4.7% (n = 30) performed monthly TSE. These respondents then received written material or written material plus a physician's lecture on testicular cancer and TSE. In follow-up, 18% of the students that received written material alone (n = 24 of 130) reported performing monthly TSE. Of the students that also received a physician's lecture, 36% (n = 58 of 163) reported performing monthly TSE, a statistically significant increase in performance. Still the majority of the students followed did NOT adopt the practice of monthly TSE. Although the physician appears to be able to make a significant difference in the group's performance of TSE, a search for more effective methods to increase this population's practice of TSE should be sought.

Adult↗