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Biomedical subjects

T C Frewen

Publications and source records attributed to T C Frewen.

30 records · Page 2Linked to original sources

The child requiring transport: lessons and implications for the pediatric emergency physician.

A retrospective review of the charts of all patients transported by our emergency transport team was done to determine the following characteristics: age, presenting problem, and outcome of patients and utilization of transport team personnel. Eighty-five percent of patients were under six years of age; central nervous system pathology accounted for 53% of patients transported, followed by respiratory problems (30%), cardiac problems (4.2%), and major trauma (2.7%). Sixty patients survived with normal neurologic examination at discharge. A statistically significant difference in retrospectively assigned PSI score (17.0 +/- 6.02 in nonsurvivors versus 5.8 +/- 6.02 in survivors) was observed. Utilization of the transport team was deemed appropriate. Comparison of our data with other available sources, as well as suggestions for emergency physicians and continuing medical education programs, is outlined.

Adolescent↗

The effect of cephalothin prophylaxis on postoperative ventriculoperitoneal shunt infections.

Postoperative infection is an important complication after insertion of a ventriculoperitoneal (VP) shunt in children with hydrocephalus. A randomized double-blind placebo-controlled study was performed to determine the efficacy of cephalothin in preventing postoperative shunt infection. Sixty-three children who presented for elective VP shunt insertion between January 1982 and December 1985 and who did not have a history of shunt infections were randomly assigned to receive four doses of prophylactic cephalothin, 25 mg/kg (32 patients), or of a multivitamin placebo (31 patients). Postoperative infection developed in 6% of the treatment group, compared with 10% of the placebo group, a difference that was not statistically significant, although a clinical significance may have been masked by the small sample size. A large multicentre trial is needed to determine the efficacy of antibiotic prophylaxis in reducing the incidence of postoperative VP shunt infections.

Bacterial Infections↗

Adult respiratory distress syndrome in a child with acute epiglottitis.

Intubation of a 23-month-old child suffering epiglottitis was complicated by pulmonary edema progressing to the adult respiratory distress syndrome. Increased pulmonary shunt and pulmonary hypertension required high levels of positive end-expiratory pressure and prolonged mechanical ventilation to correct hypoxemia. A possible role for a cuffed endotracheal tube in epiglottitis is discussed.

Acute Disease↗

Cerebral blood flow, metabolic rate, and cross-brain oxygen consumption in brain injury.

In six deeply comatose children, the relationships of intracranial pressure, cerebral perfusion pressure, cerebral blood flow, cross-brain oxygen consumption, and metabolic rate to outcome were studied sequentially during therapy. Intracranial pressure, cross-brain oxygen consumption, and metabolic rate values were significantly different in the three children who survived compared with those in the three who died. The differences in cross-brain oxygen consumption and metabolic rate occurred in the presence of clinically acceptable values for intracranial and cerebral perfusion pressures. Cross-brain oxygen consumption and metabolic rate may be important indicators of degree of neuronal injury, and of outcome.

Adolescent↗

Resistance of the auditory brain stem response to high barbiturate levels.

In the comatose patient the auditory brain stem response may be one of the few indices of CNS function available. Because barbiturates may be administered to control intracranial pressure and its sequelae, demonstration of the effect of barbiturates on the brain stem response is desirable. In cats preloaded with 63 mg/kg of pentobarbital, intravenous injection of an additional 60 mg/kg reduced, but did not abolish, the later waves of the response. One cat that survived a cumulative dose of 183 mg/kg continued to show a well-defined brain stem response. Even doses of barbiturate nearly incompatible with survival do not abolish this response.

Animals↗

Bilateral lower extremity compartment syndromes secondary to intraosseous fluid resuscitation.

Intraosseous infusions are reserved for use in life-threatening hypovolemic or cardiogenic shock when intravenous (i.v.) access cannot be readily established. Although minor fluid extravasation is a common problem with this technique, a fully established compartment syndrome has never been reported. We describe a child with severe compartment syndromes of both lower extremities complicating the use of intraosseous fluid resuscitation.

Bone and Bones↗