Biomedical subjects

S S Polsky

Publications and source records attributed to S S Polsky.

5 recordsLinked to original sources

PubMed1990

Quality assurance in emergency medical service systems.

EMS quality assurance programs can help guarantee that the provision of prehospital care is medically accountable. The establishment and management of such a program, although time consuming, are critically important. It is essential that the medical director or a designee responsible for quality assurance activities be allotted the necessary time to carry them out properly. Incident reports, critique sessions, audits, education (training) sessions, observation or debriefing in the emergency department, as well as on-line medical control all play a role in inputting data into the system. The quality assurance program forms a continuous action loop starting and ending with protocols and education. Documentation of variance or compliance with protocols forms the basis for analysis of the quality of care delivered. Any intervention must be based on carefully documented information and should include praise for good work, as well as education when needed, and restriction of function when necessary.

Emergency Medical Services↗

PubMed1988

Sitting oral-tracheal intubation.

Sitting oral-tracheal intubation is a useful technique for rapid airway control in the patient for whom maintenance of the upright posture is desirable. The technique consists of introducing the endotracheal tube with the patient in the sitting or semi-sitting position. Specific positioning of both patient and operator is required.

Emergencies↗

PubMed1986

Rapid warming and infusion of packed red blood cells.

A four-part experiment was undertaken to determine the feasibility of adding normal saline warmed to 45 C to units of packed red blood cells (PRBCs) to warm them and increase blood flow in transfusions. In Part One, the flows of fresh and outdated PRBCs through a modified infusion system were compared. The results showed that there was no significant difference in flow rates and between fresh (11.5 gm/min +/- 0.98 SD) and outdated (10.08 gm/min +/- 1.45 SD) PRBCs using the Student t test for uneven groups. This allowed outdated PRBCs to be used in place of fresh for a good portion of the experiment. In Part Two, PRBCs were run through a Travenol blood warmer coil (Travenol Laboratories, Deerfield, Illinois), and flow rate was 5.17 gm/min (+/- 0.61 SD) with delivery temperature of 29 C (+/- 1.58 SD). In Part Three normal saline warmed to 45 C was added to units of PRBCs, and flow rate was 57.72 gm/min (+/- 0.61 SD) with delivery temperature of 26 C (+/- 1.49 SD). In Part Four normal saline warmed to 45 C was added to units of PRBCs as in Part Three and then run through the blood warmer. The flow rate was 18.23 gm/min (+/- 3.44 SD) with delivery temperature of 35.3 C (+/- 1.45 SD). Plasma hemoglobins also were determined on fresh PRBCs before and after addition of warmed normal saline and passage through the blood warmer. There was no evidence of significant hemolysis of the blood due to this technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Preservation↗

PubMed1983

Abdominal trauma during pregnancy.

In summary, trauma occurs relatively frequently among pregnant patients. Various anatomic and physiologic changes of pregnancy may alter the type of injury experienced by pregnant women. These changes may also alter the manifestations of given injuries and the treatment required to reestablish maternal-fetal hemostasis. Fortunately, most trauma experienced by pregnant individuals is minor and is associated with good prognosis for both the mother and her fetus. Blunt trauma as a result of automobile collision is the most frequent form of serious injury involving pregnant women. However, several cases of penetrating abdominal wounds have also been reported. Both blunt and penetrating trauma may frequently injure the uterus. Fetal intracranial injury and fracture, as well as abruption, often occur as a result of blunt trauma. Multiple direct fetal, placental, and cord injuries have been reported as a result of penetrating trauma. Both blunt and penetrating trauma frequently cause injury to other intraabdominal organs, and blunt trauma is associated with an especially high incidence of pelvic fracture and retroperitoneal hemorrhage. Laparotomy is often required to treat such injuries. At the time of the laparotomy, difficult decisions are required in determining whether the fetus is best delivered or left in utero. Recent technologic advances for assessing fetal status may be helpful in these decisions. Rarely, a mother may expire with her living fetus undelivered, and a rapid postmortem cesarean section may save the fetal life. During the last several years, the prognosis for both trauma victims and gravid women with complicated pregnancies and their fetuses has improved markedly. Hopefully, during the next several years, the knowledge and therapeutic modalities developed to treat each group will be combined to provide optimal care for the pregnant trauma victim and her fetus.

Abdominal Injuries↗

PubMedDate not supplied

Adult epiglottitis.

Adult epiglottitis (or "supraglottitis") is an uncommon but increasingly recognized entity. Though prior studies emphasized the fulminant nature of the disease, recent evidence suggests that epiglottitis in adults may follow a relatively less severe clinical course, especially if Hemophilus influenza is not isolated. The records of 28 patients with adult epiglottitis were retrospectively analyzed to characterize the presenting features and clinical course of the disease. The diagnosis was established by laryngoscopy, lateral cervical radiographs, or both. Laryngoscopy did not precipitate airway obstruction in any patient. The majority of patients experienced a relatively benign clinical course and improved with medical management that consisted of ICU admission, intravenous antibiotics, hydration, inhaled mist, and corticosteroids. Only two patients (7%) required airway support with orotracheal intubation because of respiratory difficulty. There were no instances of respiratory arrest or airway obstruction. No tracheostomies were performed, and there were no deaths. It was concluded that adult epiglottitis can follow a less severe course than classically described.

Adolescent↗