ABSTRACT
Pediatric telephone advice is sought frequently by members of the community. This study was undertaken to evaluate the quality and accuracy of pediatric telephone advice given by free-standing urgent care centers. One hundred such facilities were telephoned and advice was requested by a research assistant. A case was presented that could have represented a pediatric medical emergency. Overall only 17 centers gave adequate advice. The data suggest that under some circumstances free-standing urgent care center pediatric telephone advice may be inaccurate and inappropriate. Workable policies and protocols for pediatric telephone advice should be instituted by these facilities.
Subject(s)
Community Health Centers/standards , Emergency Medical Services/standards , Hotlines , Algorithms , Emergencies/nursing , Home Nursing , Humans , Infant , MaleABSTRACT
This study was undertaken to determine the detectability of drugs in tablet or capsule form by plain radiography. A total of 459 drugs in tablet or capsule form were radiographed in water with parameters commonly used in routine upper abdominal films. Detectability was judged subjectively by radiologist's readings and objectively by the use of a densitometer. Of the total, 6.3% were as radiopaque as a ferrous sulfate control tablet, 29.6% were moderately radiopaque, but less than control values, and 64% were essentially nondetectable. Potential benefits of this information in the clinical setting are discussed.
Subject(s)
Capsules , Poisoning/diagnostic imaging , Tablets , Humans , RadiographyABSTRACT
Closed, indirect fractures and dislocations of the lower cervical spine occur in families or groups within which there is a spectrum of anatomic damage to a cervical motion segment. This study of 165 cases demonstrates the various spectra of injury, called phylogenies, and develops a classification based on the mechanism of injury. The common groups are compressive flexion, vertical compression, distractive flexion, compressive extension, distractive extension, and lateral flexion. The probability of an associated neurologic lesion relates directly to the type and severity of cervical spine injury. With use of the classification, it is possible to formulate a rational treatment plan for injuries to the cervical spine.
Subject(s)
Cervical Vertebrae/injuries , Fractures, Bone/classification , Fractures, Closed/classification , Joint Dislocations/classification , Adolescent , Adult , Aged , Biomechanical Phenomena , Female , Fractures, Closed/diagnostic imaging , Humans , Joint Dislocations/diagnostic imaging , Male , Middle Aged , RadiographyABSTRACT
Venous air embolism can usually be detected by the use of a precordial Doppler ultrasound monitor at an air infusion rate as low as 0.015 ml/kg/min, and consistently at a rate of 0.021 ml/kg/min. This is in contrast to previously reported thresholds wherein the first physiological change, a gasp, occurs at 0.36 ml/kg/min, electrocardiographic changes first take place at 0.60 ml/kg/min, drop in blood pressure at 0.69 ml/kg/min, increased central venous pressure at 0.40 ml/kg/min, and end-tidal CO2 decreases at 0.42 ml/kg/min. The first change in heart sounds monitored through an esophageal stethoscope is not detectable until an air infusion rate of 1.70 ml/kg/min, and the classical mill-wheel murmur does not occur until 1.96 ml/kg/min. This demonstrates that Doppler ultrasound can detect venous air embolism before the earliest physiological changes, in contrast to most other methods which do not detect venous air embolism until after cardiopulmonary changes have become well established.
