Biomedical subjects

S A Colucciello

Publications and source records attributed to S A Colucciello.

4 recordsLinked to original sources

PubMed2000

New diagnostic tests for pulmonary embolism.

In 1990, the multicenter Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED), sponsored by the National Institutes of Health, compared the diagnostic value of the radioisotopic ventilation-perfusion lung scan (V/Q scan) with that of pulmonary angiography for the diagnosis of pulmonary embolism (PE). Despite the endurance of the radioisotopic V/Q scan as the most widely used test for evaluation of pulmonary embolism (PE), a better screening tool is clearly needed for use in the emergency department. During the past decade, several new modalities have emerged for evaluation of patients with suspected PE. We evaluate the diagnostic utility of the D-dimer test and the alveolar dead space determination as potential screening tests and of spiral computed tomography, magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography as potential confirmatory tests for PE. For comparison, recent data on the diagnostic utility of the alveolar-arterial oxygen gradient and the V/Q scan are included. The potential application of these new tests to a hypothetical ED population is described.

Angiography↗

PubMed1993

Successful resuscitation from cardiac arrest using sublingual injection for medication delivery.

A 7-month-old child suffered a cardiopulmonary arrest. After eight minutes of basic CPR by the parents, paramedics arrived and found the child in asystole. Endotracheal intubation and peripheral venous access were unsuccessful, and intraosseous equipment was unavailable in the field. The patient then received 1.5 mg epinephrine and 0.15 mg atropine injected sublingually with prompt return of a sinus rhythm and a palpable pulse. One hour after arrival in the emergency department, the patient again arrested, this time fatally. This case may represent the first report of successful resuscitation from cardiac arrest using sublingually injected medications.

Administration, Sublingual↗

PubMed1993

Blunt abdominal trauma.

The management of the patient with blunt abdominal trauma remains in continuous flux. The emergency physician cannot place undue reliance on physical examination, and plain radiography of the abdomen rarely adds to patient care. Laboratory tests, particularly elevated liver function tests or a large base deficit, may increase our suspicion for intraabdominal trauma. However, normal blood tests should never prevent further investigation as warranted by mechanism of injury or clinical picture. Ultrasound and laparoscopy are two diagnostic interventions that have been more extensively studied abroad than in the United States. With the advent of large clinical trials in our own country they should play a growing role in the diagnosis and management of abdominal trauma in the coming decade. DPL revolutionized the diagnosis of intraabdominal injury. It has an astoundingly impressive track record of 97% accuracy that is rivaled by few other tests in medicine. It has been criticized at times for being overly sensitive to trivial injuries, leading to nontherapeutic laparotomies. CT has the advantage of being relatively noninvasive and theoretically has the potential for decreasing nontherapeutic laparotomies, but is very reader-dependent and in many studies not as sensitive as peritoneal lavage. Both CT and DPL may miss critical intraabdominal injuries, but this is much less likely with lavage. Perhaps the greatest risk of CT is the delay it adds to performing a needed laparotomy. CT provides an excellent modality to screen for abdominal injury in the stable patient. However, the more critically injured a patient is, the greater the danger of delays introduced by CT. In these patients, greater emphasis should be placed on immediate DPL or direct transport to the operating room. The challenge in the 1990s will be to refine the diagnosis of intraabdominal trauma to allow for swift recognition of those injuries that require surgical intervention.

Abdominal Injuries↗

PubMedDate not supplied

Misdiagnosis of appendicitis in nonpregnant women of childbearing age.

A retrospective case series was conducted at a teaching hospital with an emergency department (ED) census of 100,000 patients per year to identify the incidence of, and factors associated with, the misdiagnosis of appendicitis in nonpregnant women aged 15 to 45 years. There were 174 nonpregnant women identified with a pathologic diagnosis of appendicitis. Clinical features were then compared between patients misdiagnosed (seen in prior 10 days and given an incorrect diagnosis) and those who were initially diagnosed correctly. The results showed that 33% of the women with appendicitis were initially misdiagnosed. The most common misdiagnoses included pelvic inflammatory disease, gastroenteritis, and urinary infections. Misdiagnosed women more frequently exhibited diffuse and bilateral lower abdominal pain and tenderness, cervical motion, and right adnexal tenderness. Misdiagnosed women also had a lower incidence of right lower quadrant pain and tenderness, and peritoneal signs. In addition, misdiagnosis was associated with an increased incidence of perforation, abscess formation, and an increase in the total length of hospitalization. In conclusion, the incidence of misdiagnosis of appendicitis in women of childbearing age is high. Women who are misdiagnosed have less typical symptoms and physical findings and more frequent abnormal pelvic findings than those who are diagnosed correctly. Emergency physicians should be aware that atypical signs and symptoms are associated with misdiagnosed appendicitis in nonpregnant women of childbearing age.

Adolescent↗