Evaluation of warmed intravenous fluids in the prehospital setting.

INTRODUCTION: This study was designed to determine if warmed intravenous fluid (IVF) in the prehospital setting improves core body temperature and patient comfort. METHODS: Data were collected in a controlled, nonblinded, prospective study during the winter months of 2 consecutive years. Prehospital adult patients qualified if they received a bolus of 250 mL of fluid (20 mL/kg for pediatrics). Patient and IVF temperatures were measured on arrival at the ED. If the patient's condition allowed, a visual analog survey was completed. RESULTS: Twenty adult patients were enrolled. The warmed IVUF demonstrated an average temperature of 32.5 degrees C (90.1 degrees F) versus 23.5 degrees C (74.3 degrees F) for nonwarmed fluids. The patients with warmed IVF demonstrated a higher core body temperature than the nonwarmed-36.8 degrees C (98.2 degrees F) versus 35.5 degrees C (95.9 degrees F). Overall, patient surveys showed increased comfort with warmed IVF. CONCLUSION: Prehospital IVF can be warmed in the field and should help prevent the adverse effects of hypothermia. Although this study shows a trend in favor of warmed IVF, the population is too small to justify any broad statements. This matter warrants further investigation with a larger group of patients.

A population-based case-control study of risk factors for breech presentation.

OBJECTIVE: We evaluated relationships between breech presentation and infant, maternal, and pregnancy characteristics of singleton births. STUDY DESIGN: A population-based case-control study (3588 breech cases, 8183 controls) was conducted with data from the 1987 to 1988 Washington State birth certificate. RESULTS: Low birth weight, short gestational age, primiparity, and older maternal age were associated with increased risk of breech birth, and after we controlled for these factors, the following were also associated with breech birth: hydrocephalus, established maternal diabetes, congenital malformation of the infant, smoking during pregnancy, and late or no prenatal care. In addition, black and Filipino women had decreased risk of breech presentation compared with white women. CONCLUSION: Several different maternal and infant characteristics appear to increase risk of breech birth, suggesting that there may be several different biologic mechanisms leading to breech presentation.

Preclinical training in bronchoscopic diagnosis of cancer.

This study evaluated educational effectiveness of preclinical training of residents in diagnostic bronchoscopic techniques which used videotaped programs. Sixty-five residents in eleven medical centers were randomized. Experimental subjects viewed five videotaped programs dealing with bronchoscopic anatomy and pathology. Following their tenth clinical experience in bronchoscopic diagnosis, performance of both experimental and control subjects was objectively evaluated using a Visual Discrimination Test (VDT) that contained six videotaped sequences in suspected cancer patients. Clinical performance was subjectively evaluated by teachers who used a list of Minimum Competency Requirements (MCRs). Experimental subjects provided a significantly greater number of correct answers in the VDT and achieved higher scores for the MCRs that were specifically related to recognition of bronchoscopic anatomy and pathology. This study demonstrated that preclinical training using videotaped programs could improve visual perception and discrimination skills of residents in their bronchoscopic examination of patients with suspected cases of cancer.

Functional diseases of the esophagus: role of endoscopy.

The use of endoscopic procedures in the evaluation of primary motor disorders, or functional diseases, of the esophagus is filled with both risks and benefits. Since both flexible and open-tube esophagoscopy carry a significant risk factor, it is necessary to have a clear concept of the indications and value of endoscopy in the management of functional diseases of the esophagus. A review of the literature reveals very little documentation on the value of endoscopy in diagnosing esophageal functional diseases other than Zenker's diverticulum and achalasia. Based on the current literature and the experience of the authors, observations and recommendations concerning the role of endoscopy in functional diseases of the esophagus are presented. These are: 1) In Phase I or upper esophageal sphincter dysfunctions, endoscopy contributes little to their understanding, is difficult to perform, and may be hazardous. In this group, esophagoscopy should be reserved for indications beyond the dysfunction itself. If endoscopy has to be performed, open-tube esophagoscopy should be performed by an experienced endoscopist. 2) In functional diseases of the esophageal body or Phase II dysfunction, endoscopy is frequently valuable. In spastic disorders, it helps to differentiate between primary spasm of neuromuscular origin and spasm secondary to esophagitis or an obstructive process. In scleroderma and pulsion diverticulum, endoscopy helps to identify such unsuspected complications as esophagitis, hiatal hernia, and carcinoma. 3) In Phase III or however esophageal sphincter dysfunctions, endoscopic examination is essential both to rule out organic lesions that stimulate functional disorders, and to determine the presence and extent of esophagitis.

Educational training in endoscopy.

An educational training need has developed as a result of the recent rapidly increasing acquisition of endoscopes. This acquisition has been occurring at a rate faster than training programs can acquaint physicians with their use. A Veterans Administration (VA) feasibility study has determined that color television-endoscopy can provide the type of instructional materials that could be used to assist a larger number of physicians in acquiring skills in endoscopy. Since the budget requirements for television-endoscopy are substantial, it seemed expedient for the VA to establish a Center for Endoscopic Programs (VACEP). The purpose of this Center is to prepare instructional materials that will enhance educational training in endoscopy. We believe that the provision of self-instructional and teaching supplement types of audiovisual materials are essential to the accomplishment of VACEP's educational objectives. Our society today is video oriented, and we believe very strongly in the value of the television medium as an educational adjunct in teaching endoscopy.