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1.
Clin Toxicol (Phila) ; : 1-3, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31566030

RESUMO

Introduction: Limitations of urine drug-screening (UDS) by immunoassay include false-positive results. Pantoprazole, a proton-pump inhibitor (PPI), is reported to cause false-positive results for THC on UDS. The objective of this study was to determine if oral PPIs cause false-positive THC results using the THC One Step Marijuana Test Strip®. Methods: Eligible healthy volunteers completed a 5-day course of a PPI followed by urine testing using the THC One Step Marijuana Test Strip®. Phase one included 3 subjects taking pantoprazole 40 mg once daily for 5 days. On day 5, urine specimens underwent THC screening. Phase two included 9 subjects randomized to 5-day supply of once-daily oral esomeprazole 20 mg, lansoprazole 15 mg, or omeprazole 20 mg. All study methods and testing mirrored those in phase one. Results: All 12 subjects completed the study protocol. All urine samples collected on day 5 were negative for THC in all subjects. Discussion: Our results demonstrate that oral PPIs did not cause a false-positive THC using the THC One Step Marijuana Test Strip®. Limitations include small sample size, use of a single commercial immunoassay, and inability to confirm medication compliance. Further, large-scale research using other commercial urine immunoassays is warranted.

2.
Undersea Hyperb Med ; 46(4): 437-445, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509900

RESUMO

Introduction: To determine if hyperbaric oxygen (HBO2) therapy has an effect on diabetic blood glucose levels (BGL) and, if so, the extent of this effect. Also, to examine factors that exacerbate any observed effect. Methods: This was a retrospective review of prospectively collected quality data on diabetics undergoing HBO2. Pre- and post-treatment BGL were recorded. Pre-treatment BGL ⟨120 mg/dL received glucose supplementation. Hypoglycemia was defined as BGL ⟨70 mg/dL. BGL ⟨90 mg/dL was included as an elevated hypoglycemia threshold. Results: 77 patients representing 1,825 treatments were included for analysis. No patient had deleterious side effects or required emergency care. BGL decreased in 75.4% of treatments in this group, with a median decrease of 25 mg/dL (IQR=54 mg/dL; range of decreased 374 mg/dL to increased 240 mg/dL). A statistically significant greater percentage of treatments of patients with type 2 diabetes resulted in a decrease in BGL (1598 or 77.5%) compared to treatments of patients with type 1 diabetes (169 or 51.5%) (χ2(1, N=1767) =55.37, p⟨0.001). 1.1% of treatments had post-HBO2 serum glucose ⟨90 mg/dL, and 0.2% of treatments had post-HBO2 serum glucose ⟨70 mg/dL. The majority (70%) of patients with post-HBO2 BGL ⟨90 mg/dL were maintained on insulin alone (χ2(2, N=20) =12.4, p=0.002). Well-controlled diabetics (i.e., those with all BGLs within 50 mg/dL over all pre-HBO2 treatments) had no post-HBO2 BGL ⟨70 mg/dL or ⟨90 mg/dL. Conclusion: Our results suggest that HBO2 does not cause a clinically significant decrease in diabetic patient BGL. No patient in our study had deleterious side effects or required emergency care. We found that glucose level of ⟨90 mg/dL occurred more often in those who use insulin. Hyperbaric patients who exhibit consistent BGL values may represent a group who could be managed similarly to the non-diabetic population.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Oxigenação Hiperbárica , Idoso , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Oxigenação Hiperbárica/efeitos adversos , Oxigenação Hiperbárica/estatística & dados numéricos , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Estudos Retrospectivos , Esteroides/efeitos adversos
3.
Undersea Hyperb Med ; 45(4): 389-394, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30241117

RESUMO

Introduction: Hyperbaric oxygen (HBO2) therapy is used to promote healing in select problem wounds. Transcutaneous oxygen measurement (TCOM) can be used to predict the response of these wounds to HBO2, with in-chamber TCOM values shown to be the most predictive. We evaluated the use of in-chamber TCOM values to determine optimal treatment pressure. Methods: A retrospective review was completed of patients undergoing HBO2 therapy for a lower-extremity wound and who had in-chamber TCOM. Data collected included TCOM values, treatment profile, and patient outcome. Results: A total of 142 patients were identified. The overall results demonstrated healing in 59%, minor amputation (below ankle) in 11.3%, and major amputation (above ankle) in 16.2% of patients. 79.3% of patients at 2 atmospheres absolute (ATA) and 86.6% of patients at 2.4 ATA had transcutaneous oxygen pressure (TcPO2) values ≥250 mmHg. Among those with TcPO2 ⟨250 mmHg at 2 ATA, 41% attained TcPO2 ⟩250 mmHg at 2.4 ATA. Among those treated at 2 ATA the healing rate was 70.6% if TcPO2 ⟩250 mmHg, and 11.8% if TcPO2 ⟨250 mmHg (P⟨0.001). Among those treated at 2.4 ATA the healing rate was 33.3% if TcPO2 ⟩250 mmHg and 14.3% if TcPO2 ⟨250 mmHg (P⟨0.001). Discussion: Determining optimal therapeutic pressure for patients undergoing HBO2 is important to maximize benefit and minimize risk. This study indicates that in-chamber TCOM can be used to select an individualized optimal treatment pressure in patients undergoing HBO2 for lower-extremity wounds, including diabetic foot ulcers. This may result in better utilization of HBO2 and better outcomes.


Assuntos
Amputação , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Oxigenação Hiperbárica/métodos , Cicatrização/fisiologia , Amputação/métodos , Amputação/estatística & dados numéricos , Pressão Atmosférica , Feminino , Humanos , Falência Renal Crônica/complicações , Úlcera da Perna/terapia , Masculino , Pessoa de Meia-Idade , Pressão Parcial , Estudos Retrospectivos
4.
Undersea Hyperb Med ; 44(2): 93-99, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28777899

RESUMO

INTRODUCTION: Hyperbaric oxygen (HBO2) therapy is generally safe and well tolerated. However, known side effects do exist. Elevation in the blood pressure of patients undergoing HBO2 therapy is a less defined potential side effect. We sought to better quantify effects of HBO2 on blood pressure (BP) in patients undergoing HBO2. METHODS: A retrospective chart review was performed on quality assurance data captured on all patients undergoing HBO2 between March 2012 and October 2015 at a large tertiary referral university hospital hyperbaric center. RESULTS: We identified 155 patients who received 3,147 hyperbaric oxygen treatments. For all treatments there was an overall increase in the median systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) following treatment. No statistically significant difference was found when comparing patients with and without hypertension. Calcium channel blockers (CCB) and beta-blockers (BB) were found to have an agonizing effect while ACE inhibitors (ACEI) were found to have a protective effect. The change in SBP was less with each additional treatment in patients undergoing more than one treatment. DISCUSSION: The current study demonstrates that absolute rises in blood pressure do occur as a result of HBO2 therapy. However, the extent of this effect is not large. BB and CCB had agonizing effects while ACEI had a protective effect. Finally, there was a protective effect with more treatments.


Assuntos
Pressão Sanguínea , Oxigenação Hiperbárica/efeitos adversos , Hipertensão/etiologia , Antagonistas Adrenérgicos beta/farmacologia , Idoso , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Pressão Arterial/fisiologia , Pressão Sanguínea/efeitos dos fármacos , Bloqueadores dos Canais de Cálcio/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária
5.
J Correct Health Care ; 23(2): 157-161, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28421890

RESUMO

The United States has the highest rate of incarceration in the world. Many correctional facilities have outsourced the medical care for this population that often presents with complex health issues. This study evaluates the reasons that inmates present to an emergency department (ED) and compares them to the general population ED visits. The most common presenting complaints were trauma (16.8%), abdominal pain (13.5%), chest pain (9.0%), and self-injury (8.7%). These presenting complaints differed significantly from those of the general population (abdominal pain [8.1%] and chest pain [5.2%]). Inmate-patients seen in the ED presented with a significantly higher frequency of trauma, 16.8% versus approximately 1.5%.


Assuntos
Serviço Hospitalar de Emergência , Prisioneiros , Adulto , Feminino , Humanos , Masculino , Auditoria Médica , New York/epidemiologia , Estudos Retrospectivos , Ferimentos e Lesões/epidemiologia
7.
J Med Toxicol ; 12(4): 391-395, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27295188

RESUMO

INTRODUCTION: Whole bowel irrigation (WBI) is a management option for overdose of medications poorly adsorbed to activated charcoal, with modified release properties, or for body packers. Polyethylene glycol (PEG) is a mixture of ethylene oxide polymers of varying molecular weight. PEG with an average molecular weight of 3350 g/mol is used for WBI. PEG electrolyte lavage solution has been shown in vitro to hasten the dissolution of acetaminophen. The impact of PEG on the pharmacokinetics of extended release pharmaceuticals is unknown. Lower average molecular weight PEG mixtures are used as solvents and excipients. We sought to investigate the impact of PEG on the release of morphine from several extended release morphine formulations. METHODS: An in vitro gastric model was developed. To test the validity of our model, we first investigated the previously described interaction of ethanol and Avinza®. Once demonstrated, we then investigated the effect of PEG with several extended release morphine formulations. RESULTS: In the validation portion of our study, we confirmed an ethanol Avinza® interaction. Subsequently, we did not observe accelerated release of morphine from Avinza® or generic extended release morphine in the presence of PEG. CONCLUSION: The use of PEG for gastric decontamination following ingestion of these extended release morphine formulations is unlikely to accelerate morphine release and aggravate intoxication.


Assuntos
Liberação Controlada de Fármacos , Overdose de Drogas/terapia , Dependência de Morfina/terapia , Morfina/farmacocinética , Polietilenoglicóis/uso terapêutico , Cromatografia Gasosa , Preparações de Ação Retardada , Humanos , Concentração de Íons de Hidrogênio , Espectrometria de Massas , Morfina/administração & dosagem , Soluções Farmacêuticas/uso terapêutico , Irrigação Terapêutica
9.
West J Emerg Med ; 16(3): 442-6, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25987926

RESUMO

INTRODUCTION: Electroencephalography (EEG) is indicated for diagnosing nonconvulsive status epilepticus (NCSE) in a patient who has altered level of consciousness after a motor seizure. A study in a neonatal population found 94% sensitivity and 78% specificity for detection of seizure using a single-lead device. This study aims to show that a reduced montage EEG would detect 90% of seizures detected on standard EEG. METHODS: A portable Brainmaster EEG device was available in the emergency department (ED) at all times. Patients presenting to the ED with altered mental status and known history of seizure or a witnessed seizure having a standard EEG were eligible for this study. The emergency physician obtained informed consent from the legally authorized representative (LAR), while an ED technician attached the electrodes to the patient, and a research associate attached the electrodes to the wiring routing to the portable EEG module. A board-certified epileptologist interpreted the tracings via the Internet. Simultaneously, the emergency physician ordered a standard 23-lead EEG, which would be interpreted by the neurologist on call to read EEGs. We compared the epileptologist's interpretation of the reduced montage EEG to the results of the 23-lead EEG, which was considered the gold standard for detecting seizures. RESULTS: Twelve of 12 patients or 100% had the same findings on reduced-montage EEG as standard EEG. One of 12 patients or 8% had nonconvulsive seizure activity. CONCLUSION: The results are consistent with prior studies which have shown that 8-48% of patients who have had a motor seizure continue to have nonconvulsive seizure activity on EEG. This study suggests that a bedside reduced-montage EEG can be used to make the diagnosis of NCSE in the ED. Further study will be conducted to see if this technology can be applied to the inpatient neurological intensive care unit setting.


Assuntos
Eletroencefalografia , Serviço Hospitalar de Emergência , Unidades de Terapia Intensiva , Monitorização Fisiológica/instrumentação , Sistemas Automatizados de Assistência Junto ao Leito , Estado Epiléptico/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletroencefalografia/instrumentação , Eletroencefalografia/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estado Epiléptico/fisiopatologia
10.
J Am Coll Clin Wound Spec ; 7(1-3): 8-12, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28053862

RESUMO

Calcific uremic arteriolopathy, also known as calciphylaxis, is a rare syndrome of small vessel calcification of unknown etiology causing painful, violaceous skin lesions that progress to form chronic non-healing ulcers and gangrene. Hyperbaric oxygen therapy (HBOT) can be used as adjunctive therapy in the treatment of these ulcers. However, due to paucity of cases, there is limited data on the clinical benefit of HBOT and identifying factors associated with healing. The purpose of this study was to determine patient outcomes and factors associated with healing in patients with calciphylaxis undergoing HBOT. A retrospective chart review was completed on patients who were diagnosed with calciphylaxis and had hyperbaric medicine consultation between May 2012 and January 2016. Clinical outcomes, demographics, risk factors, laboratory values, wound distribution, and HBOT profiles were collected and analyzed. We identified 8 patients. Out of 8 patients consulted for calciphylaxis, five were consented and underwent HBOT (2 males and 3 females). All had coexisting ESRD and Diabetes. All males were able to tolerate being in the chamber and received therapeutic treatments (at least 20 HBOT) with complete resolution of ulcers. HBOT was discontinued in one female due to an inconsistent biopsy report and two others due to death secondary to septic shock or respiratory arrest and severe uremia. Calciphylaxis is a devastating disease with a high mortality rate. Our results demonstrated a positive response to HBOT especially when receiving at least 20 treatments. A majority of calciphylaxis cases are females and indeed female gender has been cited as a risk factor for this disease. However, current literature has not conferred a relationship between gender nor the number of HBOT received and outcomes. Our results showed that males had a more favorable outcome provided they received at least twenty HBOT. Further prospective studies are needed to elucidate these outcomes.

11.
Pharm Pract (Granada) ; 12(3): 416, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25243028

RESUMO

OBJECTIVE: Because free sample of prescription medications have been shown to influence prescribing habits of physicians, we sought to discern if promotional efforts of a retail pharmacy influenced prescriptions filled in our county after a free antibiotic program was initiated. METHODS: Retrospective analysis of prescription antibiotics filled throughout the county was performed. Prescriptions filled during the first 6 months of the year before the program was initiated were compared to prescriptions filled during the first 6 months of the year immediately following initiation of the promotion. RESULTS: A total of 436,372 antibiotic prescriptions were dispensed during that time. The number of antibiotics filled that were included in the promotion increased by 13.4% while the number of antibiotics filled that were excluded from the promotion decreased by 20.4%. CONCLUSION: These data suggest that the promotional pricing of the antibiotics had a significant impact on the number of prescriptions filled in each category. Because a prescription written does not always equate to a prescription filled, further investigation is needed to confirm the relationship between these promotions and actual prescriber habits.

12.
West J Emerg Med ; 15(4): 459-64, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25035752

RESUMO

INTRODUCTION: Traumatic brain injury (TBI) is a significant health concern. While 70-90% of TBI cases are considered mild, decision-making regarding imaging can be difficult. This survey aimed to assess whether clinicians' decision-making was consistent with the most recent American College of Emergency Physicians (ACEP) clinical recommendations regarding indications for a non-contrast head computed tomography (CT) in patients with mild TBI. METHODS: We surveyed 2 academic emergency medicine departments. Six realistic clinical vignettes were created. The survey software randomly varied 2 factors: age (30, 59, or 61 years old) and presence or absence of visible trauma above the clavicles. A single important question was asked: "Would you perform a non-contrast head CT on this patient?" RESULTS: Physician decision-making was consistent with the guidelines in only 62.8% of total vignettes. By age group (30, 59, and 61), decision-making was consistent with the guidelines in 66.7%, 47.4%, and 72.7% of cases, respectively. This was a statistically-significant difference when comparing the 59- and 61-year-old age groups. In the setting of presence/absence of trauma above the clavicles, respondents were consistent with the guidelines in 57.1% of cases. Decision-making consistent with the guidelines was significantly better in the absence of trauma above the clavicles. CONCLUSION: Respondents poorly differentiated the "older" patients from one another, suggesting that respondents either inappropriately apply the guidelines or are unaware of the recommendations in this setting. No particular cause for inconsistency could be determined, and respondents similarly under-scanned and over-scanned in incorrect vignettes. Improved dissemination of the ACEP clinical policy and recommendations is a potential solution to this problem.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Serviço Hospitalar de Emergência/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Tomografia Computadorizada por Raios X/normas , Adulto , Tomada de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos
13.
Wound Repair Regen ; 22(3): 351-5, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24844334

RESUMO

There is limited data regarding hyperbaric oxygen's effectiveness in the treatment of nonhealing arterial insufficiency ulcers. This study was designed to analyze healing rates and amputation rates in patients who underwent adjunctive hyperbaric oxygen for a nonhealing arterial insufficiency ulcer. A retrospective chart review was completed on patients who underwent hyperbaric oxygen for arterial insufficiency ulcers that failed to heal despite standard treatment. Information collected included complete ulcer healing, amputation, and patient characteristics. There were 82 patients identified. A majority did not have diabetes (84.1%). The overall rate of healing was 43.9%. The overall major amputation rate was 17.1%. The amputation rate among those who healed was 0% compared to 42.4% among those not healed (p < 0.0001). Dialysis was predictive of major amputation (p = 0.03). Our findings suggest hyperbaric oxygen can play a role in management of arterial insufficiency ulcers that have failed standard treatment. The overwhelming majority of these patients did not have diabetes, which allows this study to be translated to patients with a primary arterial insufficiency ulcer. These results support the use of hyperbaric oxygen for select nonhealing arterial insufficiency ulcers that have failed standard therapy and the need for a prospective pilot study.


Assuntos
Oxigenação Hiperbárica , Úlcera da Perna/terapia , Salvamento de Membro/métodos , Lesão por Pressão/terapia , Úlcera Varicosa/terapia , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Feminino , Humanos , Úlcera da Perna/fisiopatologia , Masculino , Lesão por Pressão/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Úlcera Varicosa/fisiopatologia
14.
Brain Inj ; 28(4): 422-30, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24564636

RESUMO

OBJECTIVE: To identify factors that can predict which emergency department (ED) patients with mTBI are likely to develop persistent post-concussion symptoms (PPCS). DESIGN: A matched case-control study was conducted at a Level 1 trauma centre between June 2006 and July 2009. Patients diagnosed with mTBI in the ED and diagnosed at a concussion management programme with at least one PPCS (85 cases) were compared to patients diagnosed with mTBI in the ED (340 controls) to determine if factors assessed at the time of ED presentation could predict patients likely to develop persistent symptoms. RESULTS: Multivariable hierarchical logistic regression with variables indicating increased risk for PPCS (prior mTBI, history of depression, history of anxiety, multiple injury, forgetfulness/poor memory, noise sensitivity, or light sensitivity) resulted in a final predictive model including prior mTBI, history of anxiety, forgetfulness/poor memory and light sensitivity. The final model had a specificity of 87.9% and a sensitivity of 69.9%. CONCLUSIONS: A strong prediction model to identify those ED patients with mTBI at risk for PPCS was developed and could be easily implemented in the ED; therefore, helping to target those patients who would potentially benefit from close follow-up.


Assuntos
Ansiedade/diagnóstico , Concussão Encefálica/complicações , Transtornos Cognitivos/diagnóstico , Serviço Hospitalar de Emergência , Fotofobia/diagnóstico , Síndrome Pós-Concussão/diagnóstico , Adulto , Ansiedade/fisiopatologia , Concussão Encefálica/fisiopatologia , Estudos de Casos e Controles , Transtornos Cognitivos/fisiopatologia , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Fotofobia/fisiopatologia , Síndrome Pós-Concussão/fisiopatologia , Encaminhamento e Consulta , Fatores de Tempo , Centros de Traumatologia , Índices de Gravidade do Trauma
15.
Clin J Sport Med ; 24(3): 245-50, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24284951

RESUMO

OBJECTIVE: To determine the feasibility of using weight change and Borg score as tools for monitoring runner health and safety during a multistage, remote ultramarathon. DESIGN: Observational cohort study of feasibility on nonblinded event participants. SETTING: Six-day, multistage, remote ultramarathon in Utah. PARTICIPANTS: Twenty-seven athletes in the 2012 Desert R.A.T.S. (Race Across the Sand) ultramarathon. ASSESSMENT OF RISK FACTORS: Participant weight, health conditions that limited race participation, such as fatigue or exhaustion, and Borg score were reviewed. MAIN OUTCOME MEASURES: Inability to complete a stage of the race (Did Not Finish status) or development of a clinically significant health condition during the race. Potential prognostic risk factors, such as a high Borg score and weight loss, were analyzed. RESULTS: An overall decrease in weight was observed over the course of the event. Median percent weight changes were losses of 2.96% (day 1), 7.42% (day 2), 2.21% (day 4), and 3.35% (day 6). There was no statistically significant difference in percent weight change between the 14 runners who finished the race and the 13 runners who did not finish the race (U = 73; z = 0.189; P = 0.85). Runners' ability to complete the race was related to the development of adverse health conditions (P = 0.004). Median Borg scores reported were 15 (day 1), 17 (day 2), 13 (day 3), 16 (day 4), and 15 (day 6). Only 2 racers who finished the entire event without adverse events ever gave a Borg score of ≥ 18. CONCLUSIONS: The feasibility of weight change as a tool for monitoring runner health and safety in this setting is limited, but the Borg rating of perceived exertion warrants further study as a potential field expedient tool for monitoring runner health and safety during a multiday, remote ultramarathon.


Assuntos
Nível de Saúde , Esforço Físico , Corrida/fisiologia , Perda de Peso/fisiologia , Adolescente , Adulto , Área Sob a Curva , Desempenho Atlético/fisiologia , Estudos de Coortes , Fadiga/fisiopatologia , Fadiga/psicologia , Estudos de Viabilidade , Humanos , Pessoa de Meia-Idade , Curva ROC , Adulto Jovem
16.
Undersea Hyperb Med ; 41(5): 379-85, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25558546

RESUMO

INTRODUCTION: Hyperbaric oxygen (HBO2) therapy uses different maximum treatment pressures. A side effect of HBO2 is oxygen toxicity seizure. The purpose of this study was to determine the overall incidence of oxygen toxicity seizure and assess risk at different treatment pressures. METHOD: A retrospective chart review was performed on patients who underwent HBO2 at a university hospital and at an outpatient center. Statistical analysis was performed to determine overall incidence of seizure and identify risk factors including maximum treatment pressure. RESULTS: A total of 931 patients were identified representing a total of 23,328 treatments. The overall incidence of seizure was one in 2,121 treatments (five per 10,000). There were zero per 10,000 at 2.0 atmospheres absolute/atm abs (0/16,430), 15 per 10,000 at 2.4/2.5 atm abs (1/669) and 51 per 10,000 at 2.8 atm abs (1/197). There was a statistically significant difference for seizure between the different pressures (χ2 (2, 23,540) = 31.38, p < .001). DISCUSSION: The overall incidence of oxygen toxicity seizure in this study is consistent with recent reports. This study demonstrated a statistically significant increased risk of seizure with increasing treatment pressure. Treatment at higher pressure should be chosen based on demonstrable benefit with a clear understanding of increased risk with higher pressure.


Assuntos
Pressão Atmosférica , Oxigenação Hiperbárica/efeitos adversos , Oxigênio/envenenamento , Convulsões/epidemiologia , Adulto , Idoso , Ar , Intoxicação por Monóxido de Carbono/terapia , Feminino , Humanos , Oxigenação Hiperbárica/estatística & dados numéricos , Incidência , Masculino , Pessoa de Meia-Idade , Pressão/efeitos adversos , Estudos Retrospectivos , Convulsões/etiologia , Fatores de Tempo
17.
Undersea Hyperb Med ; 41(5): 393-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25558548

RESUMO

INTRODUCTION: Middle ear barotrauma (MEB) is a common complication of hyperbaric oxygen (HBO2) therapy. The purpose of this study was to determine the overall incidence of MEB and evaluate for differences in the incidence of MEB at different rates of compression (ROC). The study also sought to identify other potential risk factors for MEB. METHODS: A retrospective chart review was performed on patients undergoing HBO2 at an academic regional level 1 trauma center. The MEB overall incidence as well as incidence at different ROC were determined. RESULTS: 236 patients representing 4,981 treatments were analyzed. The overall incidence of MEB was 43.2%. There was no statistically significant difference in the incidence of MEB at different ROC. There was a statistically significant higher incidence of TEED 4 MEB in intubated patients (p < 0.0001). The vast majority of MEB was minor when considering severity based on overall lower TEED scores of 1 or 2 (84%). DISCUSSION: The overall incidence of MEB in this study is consistent with those previously reported. It is important to note that a vast majority of MEB was minor. This supports HBO2 as a safe treatment modality with minimal overall risk. The current study supports standardization of most treatment protocols to a ROC of 2 psi/minute.


Assuntos
Pressão Atmosférica , Barotrauma/epidemiologia , Orelha Média/lesões , Oxigenação Hiperbárica/efeitos adversos , Barotrauma/etiologia , Sedação Consciente , Estado de Consciência , Feminino , Humanos , Oxigenação Hiperbárica/estatística & dados numéricos , Incidência , Intubação/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pressão/efeitos adversos , Estudos Retrospectivos , Fatores de Risco
19.
Pediatr Emerg Care ; 29(8): 884-7, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23903674

RESUMO

OBJECTIVES: Pediatric head trauma is a common occurrence. There is mounting evidence that even patients with minor head injury require limits on school activities and/or removal from sports and play to help speed recovery and limit morbidity. The objective of this study was to determine whether discharge instructions given to children who had sustained head injuries included information regarding activity restrictions, activity time constraints, and/or specifics of follow-up care. METHODS: This was a retrospective chart review of patients aged 2 to 18 years evaluated and treated for head injury during a 4-month period at a level I trauma center (volume ∼23,000 pediatric patients per year). Included were those children seen, evaluated, and diagnosed with any of the following: mild head injury, concussion, minor head trauma, or mild traumatic brain injury (mTBI). Subjects were excluded if there was a positive acute head injury computed tomography finding (other than findings of a simple linear skull fracture) or if the subject required admission. RESULTS: Among the 204 patients meeting eligibility, 95.1% received instruction to follow up with a physician, 82.8% received anticipatory guidance regarding expected symptoms, 15.2% received specific restriction time from sports, and 21.5% were removed from sports. Of these patients, 113 patients were determined "likely" to have sustained an mTBI. Patients with sports-related mTBI received return-to-sports restrictions (χ2 = 11.225, P < 0.008) and to remove the child from play (χ2 = 9.781, P < 0.004) as discharge instructions significantly more than did patients with motor vehicle accident or other mechanisms of injury. CONCLUSIONS: Children sustaining head injury were inadequately instructed to restrict athletic activities upon discharge. This is particularly true for patients who sustain an mTBI from non-sports-related activity.


Assuntos
Traumatismos Craniocerebrais , Medicina de Emergência , Sumários de Alta do Paciente Hospitalar , Esportes , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos , Centros de Traumatologia
20.
J Neurotrauma ; 30(20): 1747-54, 2013 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-23758329

RESUMO

The objective of the current study was to determine the classification accuracy of serum S100B and apolipoprotein (apoA-I) for mild traumatic brain injury (mTBI) and abnormal initial head computed tomography (CT) scan, and to identify ethnic, racial, age, and sex variation in classification accuracy. We performed a prospective, multi-centered study of 787 patients with mTBI who presented to the emergency department within 6 h of injury and 467 controls who presented to the outpatient laboratory for routine blood work. Serum was analyzed for S100B and apoA-I. The outcomes were disease status (mTBI or control) and initial head CT scan. At cutoff values defined by 90% of controls, the specificity for mTBI using S100B (0.899 [95% confidence interval (CI): 0.78-0.92]) was similar to that using apoA-I (0.902 [0.87-0.93]), and the sensitivity using S100B (0.252 [0.22-0.28]) was similar to that using apoA-I (0.249 [0.22-0.28]). The area under the receiver operating characteristic curve (AUC) for the combination of S100B and apoA-I (0.738, 95% CI: 0.71, 0.77), however, was significantly higher than the AUC for S100B alone (0.709, 95% CI: 0.68, 0.74, p=0.001) and higher than the AUC for apoA-I alone (0.645, 95% CI: 0.61, 0.68, p<0.0001). The AUC for prediction of abnormal initial head CT scan using S100B was 0.694 (95%CI: 0.62, 0.77) and not significant for apoA-I. At a S100B cutoff of <0.060 µg/L, the sensitivity for abnormal head CT was 98%, and 22.9% of CT scans could have been avoided. There was significant age and race-related variation in the accuracy of S100B for the diagnosis of mTBI. The combined use of serum S100B and apoA-I maximizes classification accuracy for mTBI, but only S100B is needed to classify abnormal head CT scan. Because of significant subgroup variation in classification accuracy, age and race need to be considered when using S100B to classify subjects for mTBI.


Assuntos
Apolipoproteína A-I/sangue , Lesões Encefálicas/diagnóstico , Encéfalo/diagnóstico por imagem , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Adolescente , Adulto , Fatores Etários , Idoso , Lesões Encefálicas/sangue , Lesões Encefálicas/radioterapia , Criança , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Radiografia , Sensibilidade e Especificidade
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