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Biomedical subjects

R L Krome

Publications and source records attributed to R L Krome.

At least 19 recordsLinked to original sources

The incidence of post minor traumatic brain injury syndrome: a retrospective survey of treating physicians.

There is a relative lack of information in the literature regarding the epidemiology, functional significance, and clinical resolution of the consequences of minor traumatic brain injury (MTBI). Most retrospective studies to date have been elicited by direct patient interview. Because it was supposed that a minor, but significant, traumatic brain injury would require continuing medical intervention beyond the emergency room contact, a survey was conducted of primary care physicians who were believed to be providing continuing medical care. Had their patients required reevaluations for symptoms of the post-MTBI syndrome? Two hundred fifty-six patients with traumatic brain injury initially seen in the emergency room of two community hospitals were reviewed. One hundred ninety-two (75%) had MTBIs (Glasgow coma scale more than 12 and a negative head CAT scan). One hundred twenty-two physicians were surveyed by mail; 67 (55%) responded. Twenty-one percent of their patients were experiencing symptoms of the post-MTBI syndrome from two to six months after their injuries. Studies relying on patient interviews have also estimated the post-MTBI syndrome at 20%. This correlation implies that "suggestion" does not bias patient interview style research in evaluating the post-MTBI syndrome.

Adult

Emergency department revisits.

We reviewed the charts of patients returning within 72 hours to our emergency department to determine whether monitoring revisits is a useful quality assurance indicator. Patient visits for June and December 1987 were selected to eliminate a potential seasonal difference. Of the 13,261 visits during these two months, 455 (3.4%) were revisits within 72 hours. Charts were available on 444 patients, of whom 407 (91.7%) represented cases in which the return and the initial visits were clearly related. Charts were reviewed for deficiencies in medical management, appropriate prescribed follow-up, patient education, and patient compliance. Suspected medical management problems were discussed by the three senior authors, and a consensus decision was made. Return visits were considered avoidable if a deficiency was noted in at least one of the areas listed above. There were 297 unscheduled related return visits, 96 (32.3%) of which were avoidable. Of these avoidable visits, 38 (39.6%) had medical management deficiencies, 14 (14.6%) had inappropriate prescribed follow-up, 20 (20.8%) had not been given proper education, and 35 (36.5%) were due to patient noncompliance. Of the 110 scheduled return visits, there was one (0.9%) deficiency in medical management and none in the other categories. Of the unscheduled return visits, 146 (49.2%) returned within 24 hours; 89 (30.0%) between 24 and 48 hours; and 62 (20.8%) between 48 and 72 hours. Of the avoidable visits, 85% returned within 48 hours, as did 92% of those with medical management deficiencies.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergency Service, Hospital

Emergency thoracotomy.

Emergency thoracotomy is a valuable therapeutic modality for the moribund patient when trauma is the cause of the shock state. It is a procedure that requires an understanding of the technique and indications and should be instituted based on the indications listed above. There is probably no reason to do this procedure in the patient who is in extremis as a result of blunt trauma, because results have been universally dismal in these patients. In the patient with a rapidly expanding abdomen resulting from trauma and who is moribund, opening the chest and cross-clamping the aorta may be beneficial. Emergency thoracotomy does not take the place of volume replacement and definitive surgical care for the trauma patient.

Emergencies

Thoracostomy.

Tube thoracostomy in the Emergency Department is an integral part of trauma and care and treatment of nontraumatic intrapleural collections. An understanding of pleuropulmonary anatomy, physiology, and pathophysiology forms the basis for appropriate and safe application of this procedure. Rapid diagnosis and treatment of intrapleural collections in the trauma patient is essential when one considers the grave prognosis of untreated tension pneumothorax or massive hemothorax. Prior knowledge of possible procedural complications with particular attention to thoracostomy site, sterile technique, and careful blunt dissection makes chest tube placement straightforward and safe. Most post-procedural complications can be avoided through a thorough understanding of the collection system and careful monitoring of the patient.

Drainage