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Biomedical subjects

W J Zehner

Publications and source records attributed to W J Zehner.

5 recordsLinked to original sources
PubMed1995

Terbutaline vs albuterol for out-of-hospital respiratory distress: randomized, double-blind trial.

OBJECTIVE: To determine the efficacy and safety of single doses of subcutaneous terbutaline (TERB) or nebulized albuterol (ALB) during out-of-hospital treatment for respiratory distress from asthma or chronic obstructive pulmonary disease. METHODS: Patients aged > 18 years who had respiratory distress were enrolled in a double-placebo, double-blind, randomized trial. Paramedics measured respiratory severity using an empiric score [respiratory rate, wheezing, speech, and peak expiratory flow rate (PEFR)], and the patients rated their own respiratory distress using a visual analog scale (VAS). The patients received O2 plus ALB (2.5 mg) and saline injection (n = 40) or TERB (0.25 mg) and saline aerosol (n = 43). RESULTS: The groups were similar with respect to age, gender, initial empiric scores (median score 9 for both groups), PEFRs (89 +/- 84 L/min, mean +/- SD, for ALB vs 97 +/- 84 L/min for TERB), and respiratory distress VAS scores. Both groups showed significant improvement in their respiratory distress VAS scores by the time of ED arrival. The ALB group had a greater improvement in respiratory distress VAS score than did the TERB group (p < 0.05). Empiric scores, PEFR scores, and hospital admission frequencies were not significantly different. No complication was observed. CONCLUSION: The out-of-hospital administration of either aerosolized ALB or subcutaneous TERB reduced respiratory severity. Albuterol provided greater subjective improvement in respiratory distress.

Administration, Inhalation↗
PubMed1992

The effect of ambient temperature extremes on tympanic and oral temperatures.

Exposure to ambient temperature extremes immediately preceding emergency department triage may affect tympanic membrane temperatures taken with infrared emission detection thermometers. In a prospective, unblinded study, 20 healthy subjects, on 2 separate days, underwent 15-minute exposures to hot (43.5 degrees C) and cold (-5 degrees C) temperature extremes in an environmental control room (ECR). Tympanic and oral temperatures were taken at baseline and at 2-minute intervals for 20 minutes after exiting the ECR. Rectal temperatures remained stable during the exposures. Oral temperatures rose significantly after hot exposure (P less than .05; max 0.4 degrees C) and briefly decreased after cold exposure (max 0.5 degrees C). Tympanic temperatures were elevated for 20 minutes after hot exposure (max 0.8 degrees C) and decreased briefly only in male subjects after cold exposure (max 0.7 degrees C). Individuals demonstrated wide variability in their temperature responses. Tympanic and oral temperatures taken within the first 20 minutes after exposure to outdoor temperature extremes may fail to accurately reflect the patient's true temperature.

Adult↗
PubMed1991

The impact of moderate ambient temperature variance on the relationship between oral, rectal, and tympanic membrane temperatures.

We examined the effect of moderate ambient temperature variance on the relationship between oral (OT), rectal (RT), and tympanic membrane (TMT) temperature in 21 healthy adults. Calibrated digital electronic thermometers were used to assess OT and RT, while TMT was measured using an infrared detection device and microprocessor. Recordings were made at baseline and after 15 and 20 minutes of exposure to either warm (35 degrees C) or cool (18.3 degrees C) environmental temperatures. Differences were examined for the three temperature sites and times using repeat measures analysis of variance. No significant differences in RT (37.7 degrees +/- 0.3 degrees C; mean +/- SD) were observed at any time. Both OT (+0.5 degrees C) and TMT (+0.7 degrees C) were significantly changed during warm, but not cool exposure, compared to baseline conditions. We conclude that OT and TMT have a predictable relationship to RT at normal ambient temperature. However, in warm examination areas, spuriously elevated OT and TMTs may occur.

Adult↗
PubMedDate not supplied

Paramedic documentation of indicators for cervical spine injury.

INTRODUCTION: Current paramedic training mandates complete immobilization of all patients, symptomatic or not, whose mechanism of injury typically is viewed as conducive to spinal trauma. It is common to observe confrontations between paramedics and walking, asymptomatic accident victims who fail to understand why they should "wear that collar and be strapped to that board." Immobilized, frustrated patients then may wait for hours in a busy emergency department until a physician declares them to be without spinal injury. Patients frequently refuse treatment and transport. HYPOTHESIS: Algorithms exist for physicians to "clear" the cervical spine (C-spine) without radiography. It was hypothesized that paramedics routinely assess and document these indicators in their patient evaluations. METHODS: A retrospective chart review was conducted on 161 patients (Group 1) admitted to a regional medical center with a diagnosis of C-spine injury over a 52-month period. The charts of 225 motor vehicle accident (MVA) victims (Group 2) transported by ambulance to the emergency department over a five-month period then were studied. Indicators for C-spine injury documented by emergency medical service (EMS) personnel were abstracted. RESULTS: All patients underwent mental status assessment and full spinal immobilization (neck and back) by EMS crews prior to transport to the hospital. Two or more indicators of possible C-spine injury were documented on each prehospital care report (PCR). CONCLUSION: Paramedics already assess most, if not all, of the criteria standard to C-spine clearance algorithms, but are inconsistent in their documentation of the presence or absence of all of the relevant findings.

Algorithms↗