ABSTRACT
Pediatric, cardiopulmonary arrest is a rare event outside intensive care units in children's hospitals. Medical-surgical RNs rarely are involved in code situations and are often uncomfortable in performing necessary tasks. We implemented a multi-disciplinary educational plan, coupled with in-situ high-fidelity simulation, aimed at improving medical-surgical, RN comfort levels during codes. 260 medical surgical RNs on 10 separate hospital units parficipated. Pre and post intervention surveys were collected and compared. Results revealed a significant increase in the proportion of RNs responding "very comfortable" in all categories. Education, coupled with in-situ high-fidelity simulation, is an effective tool to increase RN comfortable levels during codes.
Subject(s)
Cardiopulmonary Resuscitation/education , Education, Nursing/methods , High Fidelity Simulation Training , Medical-Surgical Nursing/education , HumansABSTRACT
A simple method of reconstructing a previously removed posterior ear canal with an autogenous, bilaminar membrane is described. The resulting air-filled mastoid cavity is an anatomic extension of the middle ear cleft and is separated from the ear canal by a functional barrier that is continuous with the tympanic membrane. The acoustic characteristics of an associated tympanoplasty are not significantly altered, and many of the problems that are associated with an exteriorized cavity are avoided. In contradistinction to other methods of mastoid obliteration or reconstruction, the semitransparent nature of the soft canal wall allows inspection of the underlying cavity for residual or recurrent disease. The technique can be used to repair either a newly created cavity or a previous radical (or modified radical) mastoidectomy defect. The functional results of thirty ears reconstructed in this fashion are detailed. A variable amount of soft-wall retraction was noted postoperatively in 47% of the ears; however, the long-term functional results in these cases remain satisfactory.
Subject(s)
Connective Tissue/transplantation , Ear Canal/surgery , Ear Diseases/surgery , Mastoid/surgery , Tympanoplasty , Ear Diseases/physiopathology , Ear, Middle/surgery , Hearing , Humans , Transplantation, AutologousABSTRACT
Twenty subjects with no vestibular complaints and normal otoscopic exams were stimulated with 44 degrees C water for 5 minutes in one ear and their nystagmus was recorded by vertical and horizontal electro-oculography. Changes in vertical eye position and nystagmus inhibition were correlated during periods of mental tasking, relaxation, and voluntary eye elevation. The results showed an average of 42 degree eye depression with mental tasking during irrigation. In addition, mental arithmetic had a "releasing" effect on horizontal nystagmus. Elevation of the eyes on command, however, produced marked irregularity in the horizontal tracings, simulating inhibition. Almost every subject had an apparent vertical deflection on ENG with eye closure. These findings suggest a mechanical component to the phenomenon of inhibition as well as an active central mechanism.
Subject(s)
Eye Movements , Mental Processes , Nystagmus, Physiologic , Adolescent , Adult , Electronystagmography , Humans , Middle Aged , Physical Stimulation , Therapeutic Irrigation , Vestibule, Labyrinth/physiologyABSTRACT
A series of 15 intramembranous (IMTC) and mesotympanic (MTC) cholesteatomas associated with intact tympanic membranes in children is presented. Clinical observations, audiometric and radiographic data, and surgical findings are correlated. A history of recurrent otitis media was obtained in 85% (13/15) of the cases, differentiating them from the usual congenital cholesteatomas. The possibility that many of these are indeed "acquired" lesions is emphasized. Hypothetical pathogenetic mechanisms are discussed. The basal cell papillary proliferation theory is considered the most attractive explanation of the development of both IMTCs and MTCs. The need for careful, prolonged, follow-up otoscopic examination of children with recurrent otitis media is stressed, if more of these lesions are to be recognized early.
Subject(s)
Cholesteatoma/pathology , Tympanic Membrane/pathology , Audiometry , Child , Child, Preschool , Cholesteatoma/diagnosis , Cholesteatoma/etiology , Female , Humans , Infant , Male , Metaplasia , Otitis Media/complicationsABSTRACT
The effect of diaphoresis on patients with Meniere's disease (labyrinthine hydrops) previously has not been reported. With the use of two distinct activities to produce diaphoresis, we were able to document substantial transient improvements in pure-tone threshold, speech-reception threshold, and speech discrimination concurrent with a decrease in tinnitus and fullness in two patients with unilateral Meniere's disease that had been diagnosed previously by the glycerin test. The two diaphoretic activities were (1) strenuous exercise, including periodic visits to the sauna, and (2) passive activity consisting of repetitive visits to the sauna. Glycerin, an osmotic diuretic, produces similar temporary beneficial effects primarily in patients in the fluctuant hearing stage of Meniere's disease. The glycerin test is being used in several clinics as an adjunct for the diagnosis of endolymphatic hydrops.
Subject(s)
Auditory Threshold , Meniere Disease/physiopathology , Sweating , Adult , Glycerol/therapeutic use , Humans , Male , Meniere Disease/diagnosis , Meniere Disease/drug therapy , Meniere Disease/therapy , Osmosis , Physical Exertion , Steam BathABSTRACT
Voluntary or passive head movements in normal and awake individuals with or without visual clues other than prior visual fixation, produce an occular movement in the same direction as the head movement rather than the expected counter gaze movement.
Subject(s)
Head/physiology , Adult , Electronystagmography , Eye Movements , Humans , MovementABSTRACT
The records of 47 patients with Ménière's syndrome were analyzed in a retrospective computerized study to determine the effect of different medical regimens on the long term course of hearing loss. Four treatment groups, including histamine (subcutaneous), other vasodilators (oral), vitamins, and untreated controls were examined. Results suggest that there was no statistically significant difference among the four groups in the rates or absolute level of hearing loss or SRT despite different therapeutic regimens. The ability of these agents to conserve hearing in patients with Ménière's syndrome remains unproven on the basis of clinical and laboratory evidence.
Subject(s)
Hearing Disorders/prevention & control , Meniere Disease/drug therapy , Adult , Aged , Clinical Trials as Topic , Drug Evaluation , Female , Hearing , Hearing Disorders/epidemiology , Histamine/therapeutic use , Humans , Male , Meniere Disease/complications , Meniere Disease/diagnosis , Middle Aged , Retrospective Studies , Thiamine/therapeutic use , Vasodilator Agents/therapeutic use , Vitamin B 12/therapeutic useABSTRACT
The glycerol test for endolymphatic hydrops was administered to 17 patients exhibiting classical symptoms of Meniere's disease. A complete battery of audiometric tests including the SISI, TTD (Rosenberg variation). ABLB, Sweep Frequency Bekesy, two tests of speech discrimination (Rush Hughes and Northwestern), and air and bone conduction thresholds were administered pre and post-glycerol ingestion in order to determine the effect of osmotic diuresis. Improvement in pure-tone sensitivity and speech discrimination scores were most often observed. Among the special audiometric tests only the SISI scores exhibited changes, however, these could be related to the threshold changes. There were no significant differences observed in the threshold tone decay tests nor in the ABLB. The sweep frequency Bekesy test revealed only the changes which were observed in pure-tone sensitivity.
Subject(s)
Audiometry/methods , Edema/diagnosis , Glycerol , Labyrinth Diseases/diagnosis , Acoustic Stimulation , Administration, Oral , Adult , Aged , Auditory Perception/drug effects , Auditory Threshold/drug effects , Discrimination, Psychological , Female , Glycerol/pharmacology , Humans , Male , Meniere Disease/diagnosis , Middle Aged , Recruitment, Neurophysiological/drug effects , SpeechABSTRACT
In certain cerebellar lesions, optokinetic tracking is deficient, especially on tracking or following to the ipsilateral side. However, in many cases optokinetic nystagmus can occur, and apparently in better degree than would be expected from a study of pendulum tracking. This may be due to the patient leading into the stimulus and picking it up as soon as it is presented in far lateral gaze (in the direction of the fast component) and allowing the drift caused by the tone deficit to assist the tracking. An added vestibular tone can eliminate such a pseudo reflex. Induced vestibular nystagmus is enhanced and assumes a more dominant role so that optokinetic nystagmus is overcome, not only on gaze to the side of the tracking, but also on straight ahead gaze and even on some deviation of the eyes in the opposite direction.
Subject(s)
Cerebellar Diseases/physiopathology , Caloric Tests , Electronystagmography , HumansABSTRACT
Studies of ocular motor function in monkeys undergoing either total or hemicerebellectomies has revealed the following abnormalities which can be attributed to cerebellar dysfunction: 1. Loss of smooth pursuit movements 2. Gaze-fixation nystagmus 3. Loss of inhibitory input on the vestibular apparatus reflected in a decreased latency and prolonged response to caloric stimuli. It is intimated that the role of the hemicerebellum deals with ipsilateral tone and its effect on eye movements.
Subject(s)
Cerebellum/physiology , Eye Movements , Oculomotor Muscles/physiology , Animals , Caloric Tests , Eye/physiopathology , Follow-Up Studies , Haplorhini , Macaca mulatta , Nystagmus, Pathologic/etiology , Oculomotor Muscles/physiopathologyABSTRACT
Vestibular involvement in the acute phase of idiopathic facial paralysis (Bell's palsy) was observed in 22 percent and 14 patients. These patients were evaluated by history, physical examination and caloric tests with electronystagmography (ENG) employing the Cawthorne-Hallpike technique. Bell's palsy has been considered a mononeuropathy limited to the facial nerve. Evidence of occasional involvement of other cranial nerves (Vth and/or VIIIth) suggests a polyneuropathy. Several theories have been advanced to explain the involvement of the vestibular nerve.