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Mekaeil V, Wiener D, Silverman M, Miller I, Dittus E, Eskin B, Allegra J. 39 Emergency Department Visits for Serious and Painful Conditions Markedly Decreased after the Arrival of COVID-19. Ann Emerg Med 2020. [PMCID: PMC7598895 DOI: 10.1016/j.annemergmed.2020.09.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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2
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Johnson D, Wiener D. Severe Hyperkalemia, a Case Report. J Educ Teach Emerg Med 2020; 5:V1-V3. [PMID: 37465225 PMCID: PMC10332545 DOI: 10.21980/j8kh1d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/02/2020] [Indexed: 07/20/2023]
Abstract
This case highlights the classic electrocardiogram (ECG) finding of a severely widened QRS complex with a sinusoidal pattern indicative of severe hyperkalemia. It also emphasizes the importance of the ECG in screening for electrolyte abnormalities and the ability to begin therapy before laboratory confirmation in the correct clinical setting. A 78-year-old male with history of end stage renal disease presented with chest pain. Findings on initial ECG allowed for rapid diagnosis and treatment before serum potassium levels were confirmed. His treatment consisted of cardiac stabilization with calcium, followed by efforts to shift potassium intracellularly with insulin and beta-agonists. Ultimately the patient was confirmed to have a severely elevated potassium level of eight mmol/L. Unfortunately, during aggressive initial management, the patient suffered a pulseless electrical activity cardiac arrest, and in accordance with his wishes no resuscitative efforts were performed. While the outcome was unfortunate, it also highlights the temporal relationship between the presented ECG findings and fatal arrhythmias. After reviewing the case, one should recognize the importance of the ECG for screening and prompt treatment of electrolyte derangements, understand the acute management of hyperkalemia, and appreciate the possibility for rapid deterioration. Topics Hyperkalemia, electrocardiography, electrolytes.
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Affiliation(s)
- Daniel Johnson
- Morristown Medical Center, Department of Emergency Medicine, Morristown, NJ
| | - Dan Wiener
- Morristown Medical Center, Department of Emergency Medicine, Morristown, NJ
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Hammes K, Vannini I, Nitzl D, Veiga I, Wiener D, Wenger-Riggenbach B. Canine sterile neutrophilic dermatosis (resembling Sweet's syndrome) with severe extracutaneous manifestations. SCHWEIZ ARCH TIERH 2019; 161:231-238. [PMID: 30942190 DOI: 10.17236/sat00203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Sterile neutrophilic dermatosis is a rare disease in dogs, similar to Sweet's syndrome in humans. This case report describes the treatment of a 2-year old Bearded Collie that was presented with a 3-week history of fever, hind-limb weakness, peripheral lymphadenomegaly and leucocytosis. Blood tests revealed severe leukocytosis, renal azotaemia, elevated liver enzymes and bilirubinaemia. Skin lesions started to appear in week four. Histology revealed a sterile neutrophilic dermatitis resembling Sweet's syndrome. The dog displayed extracutaneous manifestations, including fever, polyarthritis, a severe leukemoid reaction, anaemia, hepatopathy and nephropathy. Issues regarding the use of criteria for the diagnosis of Sweet's syndrome in humans that are used for dogs with sterile neutrophilic dermatosis, are discussed in this case report. The condition resolved with dexamethasone and mycophenolate mofetil as a novel steroid-sparing therapy. Three months later the dog relapsed, which rapidly responded to short-term dexamethasone treatment and temporarily increased mycophenolate mofetil dosage.
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Affiliation(s)
- K Hammes
- Bessy's Kleintierklinik AG, Watt/Regensdorf, Switzerland
| | - I Vannini
- Bessy's Kleintierklinik AG, Watt/Regensdorf, Switzerland
| | - D Nitzl
- Bessy's Kleintierklinik AG, Watt/Regensdorf, Switzerland
| | - I Veiga
- Institute of Animal Pathology, Vetsuisse Faculty, University of Bern
| | - D Wiener
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Texas A&M University, USA
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Lewiss RE, Cook J, Sauler A, Avitabile N, Kaban NL, Rabrich J, Saul T, Siadecki SD, Wiener D. A workflow task force affects emergency physician compliance for point-of-care ultrasound documentation and billing. Crit Ultrasound J 2016; 8:5. [PMID: 27207087 PMCID: PMC4875042 DOI: 10.1186/s13089-016-0041-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 05/09/2016] [Indexed: 01/09/2023] Open
Abstract
Background Emergency point-of-care ultrasound (POC u/s) is an example of a health information technology that improves patient care and time to correct diagnosis. POC u/s examinations should be documented, as they comprise an integral component of physician decision making. Incomplete documentation prevents coding, billing and physician group compensation for ultrasound-guided procedures and patient care. We aimed to assess the effect of directed education and personal feedback through a task force driven initiative to increase the number of POC u/s examinations documented and transferred to medical coders by emergency medicine physicians. Methods Three months before a chosen go-live date, departmental leadership, the ultrasound division, and residents formed a task force. Barriers to documentation were identified through brain storming and email solicitation. The total number and application-specific POC u/s examinations performed and transferred to the healthcare record and medical coders were compared for the pre- and post-task force intervention periods. Chi square analysis was used to determine the difference between the number of POC u/s examinations reported before and after the intervention. Results A total of 1652 POC u/s examinations were reported during the study period. Successful reporting to the patient care chart and medical coders increased from 41 % pre-task force intervention to 63 % post-intervention (p value 0.000). The number of scans performed during the 3-month periods (pre-intervetion, post-intervention 0–3 months, post-intervention 3–6 months) was similar (521, 594 and 537). When analyzed by specific application, the majority showed a statistically significant increase in the percentage of examinations reported, including those most critical for patient care decision making: (EFAST (41 vs. 64 %), vascular access (26 vs. 61 %), and cardiac (43 vs. 72 %); and those most commonly performed: biliary (44 vs. 61 %) and pelvic (60 vs. 66 %). Of the POC u/s studies coded and reported for reimbursement, 15.9 % were billed before intervention and 32 % were billed after intervention (p value: 0.000). Conclusions The formation of a workflow solution task force positively affected emergency physician compliance with POC u/s documentation for coding and billing over a 6-month period. Further investigation should assess the long-term effect of the intervention and whether this translates into increased revenue to the department.
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Affiliation(s)
- Resa E Lewiss
- Department of emergency medicine, Department of Radiology, University of Colorado Hospital, Aurora, CO, USA.
| | - Jessica Cook
- Department of emergency medicine, Yale-New Haven Hospital, New Haven, CT, USA
| | - Allison Sauler
- Department of emergency medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY, USA
| | | | - Nicole L Kaban
- Department of emergency medicine, Mount Sinai Beth Israel Hospital , New York, NY, USA
| | - Jeffrey Rabrich
- Department of emergency medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY, USA
| | - Turandot Saul
- Department of emergency medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY, USA
| | - Sebastian D Siadecki
- Department of emergency medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY, USA
| | - Dan Wiener
- Bronx-Lebanon Hospital Center, Bronx, NY, USA
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Quaas J, Derrick B, Mitrani L, Baarbe S, Yarusi B, Wiener D, Newman D. Survey of patient and physician influences and decision-making regarding CT utilization for minor head injury. Injury 2014; 45:1503-8. [PMID: 24929778 DOI: 10.1016/j.injury.2014.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 05/06/2014] [Accepted: 05/11/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Assess factors that influence both the patient and the physician in the setting of minor head injury in adults and the decision-making process around CT utilization. METHODS This is a convenience sample survey study of adult minor head injury patients (GCS 15) and their physicians regarding factors influencing the decision to use CT to evaluate for intra-cranial haemorrhage. Once a head CT was ordered and before the results were known, both the patient and physician were given a one-page survey asking questions about their concern for injury and rationale for CT use. CT results and surveys were then recorded in a centralized database and analyzed. RESULTS 584 subjects were enrolled over the 27-month study period. The rate of any intra-cranial haemorrhage was 3.3%. Both the physicians (6% pre-test estimate) and the patients (22% pre-test estimate) over-estimated risk for haemorrhage. Clinical decision rules were not met in 46% of cases where CT was used. Physicians listed an average of 5 factors from a list of 9 that influenced their decision to order CT. Patients listed an average of 1.7 factors influencing their decision to present to the Emergency Department for evaluation. Many patients felt cost (45%) and low risk stratification (34%) should weigh heavily in the decision to use CT. If asked to limit CT utilization, physicians were able to identify a group with less than 2% risk of injury. CONCLUSIONS Patients with low risk of intra-cranial injury continue to be evaluated by CT. Physician decision-making around the use of CT to evaluate minor head injury is multi-factorial. Shared decision-making between the patient and the physician in a low risk minor head injury encounter shows promise as a method to reduce CT utilization in this low risk cohort.
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Affiliation(s)
- Joshua Quaas
- Department of Emergency Medicine, St. Luke's-Roosevelt Hospital, New York, NY, United States.
| | - Bruce Derrick
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
| | - Lindsey Mitrani
- Department of Emergency Medicine, St. Luke's-Roosevelt Hospital, New York, NY, United States
| | - Simon Baarbe
- Department of Emergency Medicine, St. Luke's-Roosevelt Hospital, New York, NY, United States
| | - Brett Yarusi
- Department of Emergency Medicine, St. Luke's-Roosevelt Hospital, New York, NY, United States
| | - Dan Wiener
- Department of Emergency Medicine, St. Luke's-Roosevelt Hospital, New York, NY, United States
| | - David Newman
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, United States
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Kirschner J, Shah K, Runde D, Newman D, Godbout B, Wiener D, Lee J. Patterns in computed tomography utilization among emergency physicians in an urban, academic emergency department. Emerg Radiol 2014; 21:577-81. [DOI: 10.1007/s10140-014-1237-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
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Rolston D, Runde D, Kathuria N, Drake A, Lee J, Raja A, Shah K, Wiener D, Quaas J. Changes in the Clot Burden of Pulmonary Embolism as Diagnosed by Computed Tomography Angiography over a 10-Year Period. Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.07.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Walker GA, Runde D, Rolston DM, Wiener D, Lee J. Emergency department rectal temperatures in over 10 years: A retrospective observational study. World J Emerg Med 2013; 4:107-12. [PMID: 25215102 PMCID: PMC4129836 DOI: 10.5847/wjem.j.issn.1920-8642.2013.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 04/05/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fever in patients can provide an important clue to the etiology of a patient's symptoms. Non-invasive temperature sites (oral, axillary, temporal) may be insensitive due to a variety of factors. This has not been well studied in adult emergency department patients. To determine whether emergency department triage temperatures detected fever adequately when compared to a rectal temperature. METHODS A retrospective chart review was made of 27 130 adult patients in a high volume, urban emergency department over an eight-year period who received first a non-rectal triage temperature and then a subsequent rectal temperature. RESULTS The mean difference in temperatures between the initial temperature and the rectal temperature was 1.3 °F (P<0.001), with 25.9% of the patients having higher rectal temperatures ≥2 °F, and 5.0% having higher rectal temperatures ≥4 °F. The mean difference among the patients who received oral, axillary, and temporal temperatures was 1.2 °F (P<0.001), 1.8 °F (P<0.001), and 1.2 °F (P<0.001) respectively. About 18.1% of the patients were initially afebrile and found to be febrile by rectal temperature, with an average difference of 2.5 °F (P<0.001). These patients had a higher rate of admission (61.4%, P<0.005), and were more likely to be admitted to the hospital for a higher level of care, such as an intensive care unit, when compared with the full cohort (12.5% vs. 5.8%, P<0.005). CONCLUSIONS There are significant differences between rectal temperatures and non-invasive triage temperatures in this emergency department cohort. In almost one in five patients, fever was missed by triage temperature.
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Affiliation(s)
- Graham A Walker
- Department of Emergency Medicine, Kaiser Permanente, San Francisco, USA
| | - Daniel Runde
- Department of Emergency Medicine, University of California, Los Angeles, USA
| | - Daniel M Rolston
- Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, USA
| | - Dan Wiener
- Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, USA
| | - Jarone Lee
- Massachusetts General Hospital, Harvard Medical School, South Boston, MA 02127, USA
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Lee J, Evans CS, Singh N, Kirschner J, Runde D, Newman D, Wiener D, Quaas J, Shah K. Head computed tomography utilization and intracranial hemorrhage rates. Emerg Radiol 2012; 20:219-23. [PMID: 23250570 DOI: 10.1007/s10140-012-1098-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
Utilization of computed tomography scans (CTs) has increased dramatically in emergency departments in the USA. This study aimed to retrospectively determine the yield of CTs among all patients that received a CT of the head from 2001 to 2007, which is adjusted for patient volume. For secondary endpoints, we examined the yield of CT of the head for the following hemorrhages: (1) intracerebral, (2) subarachnoid, (3) subdural, and (4) epidural. In 2001, 3.3 head CTs were performed per 100 patients seen. This increased by 60 % to 5.2 per 100 in 2007 (p = 0.005, R (2) = 0.82). This correlated with a nonsignificant decrease in the rate of intracranial hemorrhage found by CT from 3.6 per 100 CTs in 2001 (95 % confidence interval (CI) = 2.7-4.5) to 3.0 per 100 in 2007 (95 % CI = 2.5-3.6). There were no significant differences in "positive" rates for each subgroup of intracranial hemorrhage. Our study found that the utilization of head CTs increased dramatically, but there was a corresponding increase in the number of positive findings so that the overall yield of head CTs from 2001 to 2007 remained relatively constant.
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Affiliation(s)
- Jarone Lee
- Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St, Suite 810, Boston, MA 02114, USA.
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Nguyen N, Egan D, Wiener D. 333 Emergency Department Utilization and Hospital Admissions After a New Diagnosis of Human Immunodeficiency Virus. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.06.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rolston D, Katz E, Runde D, Patel V, Quaas J, Wiener D. 238 Predicting Pseudohyperkalemia on Hemolyzed Potassium Specimens. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.06.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Runde D, Godbout B, Shah K, Newman D, Lee J, Wiener D. 86 Radiation Exposure Among Highest CT Scan Utilizers. Ann Emerg Med 2011. [DOI: 10.1016/j.annemergmed.2011.06.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Herzog E, Shapiro J, Aziz EF, Hong MK, Wiener D, Mittal S. A NOVEL PATHWAY TO PROVIDE THERAPEUTIC HYPOTHERMIA TO SURVIVORS OF OUT-OF-HOSPITAL CARDIAC ARREST LEADS TO A REMARKABLE 43% SURVIVAL WITH AN EXCELLENT NEUROLOGIC OUTCOME IN VT/VF BUT FAILS TO IMPROVE OUTCOME FOR IN-HOSPITAL CARDIAC ARREST OR ASYSTOLE /PEA ARREST. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shah KH, Kwong BM, Hazan A, Newman DH, Wiener D. Success of the Gum Elastic Bougie as a Rescue Airway in the Emergency Department. J Emerg Med 2011; 40:1-6. [DOI: 10.1016/j.jemermed.2008.04.045] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 03/11/2008] [Accepted: 04/14/2008] [Indexed: 11/26/2022]
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Nakao J, Egan D, Newman D, Sharp V, He X, Tsao D, Skalak T, Lord A, Nollen C, Wiener D. 131: Falling Through the Cracks? Missed Opportunities for Earlier Diagnosis of HIV Infection. Ann Emerg Med 2010. [DOI: 10.1016/j.annemergmed.2010.06.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shah K, Teng J, Shah H, Choe A, Darvish A, Newman D, Wiener D. Can bedside ultrasound assist in determining whether serum creatinine is elevated in cases of acute urinary retention? J Emerg Med 2010; 39:198-203. [PMID: 19327933 DOI: 10.1016/j.jemermed.2009.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 12/12/2008] [Accepted: 02/06/2009] [Indexed: 05/27/2023]
Abstract
BACKGROUND There are no guidelines to determine which patients with acute urinary retention (AUR) require blood testing (i.e., serum creatinine) to assess for renal failure. OBJECTIVE To determine if hydronephrosis on bedside ultrasound correlates with an abnormal serum creatinine (Cr) level in cases of AUR. METHODS This was a prospective, observational study of subjects clinically diagnosed with AUR at two associated urban academic centers from October 2004 through August 2006. Emergency physicians completed a data form and performed a bedside ultrasound to determine the presence or absence of hydronephrosis. The data collected included suspected cause of AUR, amount of urinary output after Foley insertion, and blood test results. Follow-up was obtained by telephone and electronic medical record for 1 month. Standard statistics were employed. RESULTS Among 96 enrolled subjects with AUR, 43 had a serum Cr level obtained on the initial visit, and 10 (23%; 95% confidence interval [CI] 11-36) of these had an elevated Cr (10% [95% CI 4-16] of the study cohort). The test characteristics of hydronephrosis on bedside ultrasound to detect elevation in Cr were a sensitivity, specificity, positive predictive value, and negative predictive value of 70%, 67%, 39%, and 88%, respectively. CONCLUSION In cases of AUR, the prevalence of elevated creatinine is high, and hydronephrosis based on bedside ultrasonography does not correlate with elevation in creatinine.
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Affiliation(s)
- Kaushal Shah
- Department of Emergency Medicine, St. Luke's-Roosevelt Hospital, New York, New York 10025, USA
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Shah KH, Kwong B, Hazan A, Batista R, Newman DH, Wiener D. Difficulties with gum elastic bougie intubation in an academic emergency department. J Emerg Med 2010; 41:429-34. [PMID: 20580514 DOI: 10.1016/j.jemermed.2010.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Revised: 02/05/2010] [Accepted: 05/02/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND The difficulties with gum elastic bougie (GEB) use in the emergency department (ED) have never been studied prospectively. OBJECTIVES To determine the most common difficulties associated with endotracheal intubation using a GEB in the ED. METHODS We conducted a prospective, observational study of GEB practices in our two affiliated urban EDs with a 3-year residency training program and an annual census of 150,000 patients. Laryngoscopists performing a GEB-assisted intubation completed a structured data form after laryngoscopy, recording patient characteristics, grade of laryngeal view (using the modified Cormack-Lehane classification), reason for GEB use, and problems encountered. Data were analyzed using standard statistical methods and 95% confidence intervals. RESULTS A GEB was used for 88 patients. The overall success rate was 70/88 (79.6%; 95% confidence interval [CI] 71.1-88.0%). The GEB failure rate of the first laryngoscopist was 25/88 (28.4%; 95% CI 21.0-40.3%), with the two most common reasons being: inability to insert the bougie past the hypopharynx in 13 (52%; 95% CI 32.4-71.6%) and inability to pass the endotracheal tube over the bougie in six (24%; 95% CI 7.3-40.7). CONCLUSIONS The GEB is a helpful rescue airway device, but emergency care providers should be aware that failure rates are relatively high at a teaching institution.
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Affiliation(s)
- Kaushal H Shah
- Columbia University College of Physicians and Surgeons, New York, New York, USA
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Abstract
Pollakisuria in adult goats can be caused by diseases of the urinary tract and by distension of parts of the genital tract leading to irritation of the bladder. Hydrometra is the most common cause of uterine distension in goats and usually can be resolved by prostaglandin injections. But other pathologies of the uterus can generate a similar syndrome. A dwarf goat was presented at the clinic with a history of chronic pollakisuria and tenesm. An initial ultrasonographic examination of the abdomen led to the suspicion of hydrometra, but treatment with injections of prostaglandin were not successful. Blood samples revealed low progesterone and high oestrogen values. A laparotomy was performed and an enlarged uterus with 1.5 L of mucous content and cystic ovaries were found and partially removed. A single solid leiomyoma was diagnosed histologically in the uterine wall. Two months later the goat's condition had deteriorated and therefore she was euthanized. Necropsy and pathohistological examination revealed the presence of a metastasized adenocarcinoma of the uterus. In this case, the pollakisuria provoqued by distension of the uterus was not caused by hydrometra, but by neoplasia. The syndrome and the pathogenesis of the adenocarcinoma in consideration of the hormonal status of the patient is discussed.
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Affiliation(s)
- P Pfister
- Clinic for Ruminants, Vetsuisse-Faculty of Bern, University of Bern, Switzerland.
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Fiorini M, Drumheller B, Killian B, Newman D, Krausher M, Ward M, D’Amore J, Slesinger T, Sama A, Wiener D. 245: Can Clinical Parameters Differentiate Severity of Diverticular Disease in Emergency Department Patients? Ann Emerg Med 2007. [DOI: 10.1016/j.annemergmed.2007.06.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shah K, Hazan A, Lipsky A, Newman D, Wiener D. 18. Ann Emerg Med 2006. [DOI: 10.1016/j.annemergmed.2006.07.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kafy S, Huang J, Wiener D, Tulandi T. Audit of Morbidity and Mortality Outcomes of 1792 Hysterectomies by Laparoscopy, Vaginal and Abdominal Approach. Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
OBJECTIVE Pregnancy may confer a number of conditions related to the head and neck. The objective of this study was to evaluate the clinical manifestations of sinonasal pathology that occur during pregnancy. METHODS Thirty-three pregnant patients were evaluated for the occurrence of rhinorrhea, congestion, epistaxis, or acute sinusitis during the first trimester of pregnancy, controlling with 28 women of child-bearing age. A visual analogue scale was used to grade the severity of each symptom. Statistical analysis was carried out to assess for significant differences in the prevalence and severity of symptomatology between cases and controls. RESULTS Compared to the control group, there was no statistically significant difference in the prevalence of congestion, epistaxis, rhinorrhea, or acute sinusitis. There was no statistically significant difference in the severity of any presenting symptom between pregnant and control group patients. CONCLUSION Pregnancy is not associated with an increased prevalence or severity of nasal symptomatology during early pregnancy. The influence of hormonal changes on nasal physiology during pregnancy is discussed with a view toward safe management.
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Affiliation(s)
- S E Sobol
- Department of Otolaryngology, McGill University, Montreal, Quebec
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Abstract
Very low birth weight neonates have low tissue concentrations of vitamin A, which may contribute to the development of lung disease. These infants, however, may not receive vitamin A supplementation for several days after birth. We determined if the relatively permeable skin of a newborn could be used to administer vitamin A. 25 control rat pups were killed and lungs and livers were collected. 20 microl (1,000 IU) of retinyl palmitate were applied to the skin surface of an additional 50 two-day-old pups. At 2.5 and 5 h after application, 25 pups were killed, and lungs and livers were collected. Concentrations of retinyl palmitate and retinol were significantly higher in the lungs of pups 5 h after administration of vitamin A compared with controls. There were no differences in concentrations of retinyl palmitate or retinol in livers. We conclude that transcutaneous administration may be an effective means of delivering vitamin A to the lungs of newborn rats.
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Affiliation(s)
- T L Ashmeade
- Division of Neonatology, Department of Pediatrics, University of South Florida College of Medicine, Tampa, Fla., USA.
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Pitchenik AE, O'Connell M, Wiener D. Tobacco awareness curricula in medical schools. Ann Intern Med 2000; 133:314. [PMID: 10929188 DOI: 10.7326/0003-4819-133-4-200008150-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rayon JI, Carver JD, Wyble LE, Wiener D, Dickey SS, Benford VJ, Chen LT, Lim DV. The fatty acid composition of maternal diet affects lung prostaglandin E2 levels and survival from group B streptococcal sepsis in neonatal rat pups. J Nutr 1997; 127:1989-92. [PMID: 9311955 DOI: 10.1093/jn/127.10.1889] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Dietary fatty acid effects upon the immune system may be mediated in part by effects upon the synthesis of proinflammatory mediators. The effects of maternal dietary fatty acid composition upon lung prostaglandin (PG) E2 levels and survival from group B streptococcal (GBS) infection were investigated in neonatal rat pups. Beginning on d 2 of gestation and throughout lactation, pregnant dams were fed a purified diet whose fat source (22% of energy) was either corn oil or menhaden fish oil. On postnatal d 3, pups were randomly cross-fostered to dams of the same diet group to minimize litter effects; litters were then culled to 10 pups per dam. On postnatal d 7, pups were either injected with 1 x 10(7.5) GBS organisms or were killed for determination of lung tissue levels of PGE2 and lung and erythrocyte fatty acid composition. Arachidonic acid and PGE2 levels were significantly higher in the lungs of pups in the corn oil group compared with the fish oil group. Forty-nine percent of pups in the corn oil group survived the GBS challenge compared with 79% of pups in the fish oil group (P = 0.0005). These data suggest that the fatty acid composition of pre- and/or postnatal diet affects the neonatal response to immune challenge, which may be due in part to effects upon the synthesis of pro-inflammatory mediators.
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Affiliation(s)
- J I Rayon
- Department of Pediatrics, Division of Neonatology, University of South Florida College of Medicine, Tampa FL 33606, USA
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Heinz R, Wiener D, Friedman H, Tien R. Detection of cerebrospinal fluid metastasis: CT myelography or MR? AJNR Am J Neuroradiol 1995; 16:1147-51. [PMID: 7639142 PMCID: PMC8337797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To determine the sensitivity of contrast MR versus myelography followed by CT in the detection of cerebrospinal fluid metastases in children with primary central nervous system tumors. METHODS Thirty-three patients who had primary central nervous system malignancies had spinal MR with gadolinium within 2 weeks of a myelogram followed by CT. MR technique included T1-weighted image sequences of the entire spine with and without gadolinium. CT scans were routinely performed at T-12 to L-2, L-4 to S-1, and foramen magnum to C-2. All studies were reviewed blindly; the number, character, and location of all metastases was recorded and the results of the two studies compared. Cerebrospinal fluid cytologic findings were recorded for each patient, and compared with the results of the imaging studies. RESULTS Seven of the 33 patients had metastases detected; metastases were seen on both MR and myelography followed by CT. However, MR showed 24 lesions and myelography followed by CT showed only 15. When a lesion was seen on both MR and myelography followed by CT, the MR was usually more convincing. Superficial lesions seen on MR sometimes would be missed on myelography followed by CT. Both MR and myelography followed by CT were quite sensitive in the detection of small lesions (2 to 3 mm) when present on spinal nerve roots. Whereas MR showed multiple lesions not seen on myelography followed by CT, CT failed to show any metastases not seen on MR. Imaging studies showed metastases in 3 patients who had normal cytologic findings. CONCLUSIONS MR shows significantly more cerebrospinal fluid metastases than myelography followed by CT.
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Affiliation(s)
- R Heinz
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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Loube DI, Johnson JE, Wiener D, Anders GT, Blanton HM, Hayes JA. The effect of forceps size on the adequacy of specimens obtained by transbronchial biopsy. Am Rev Respir Dis 1993; 148:1411-3. [PMID: 8239184 DOI: 10.1164/ajrccm/148.5.1411] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study prospectively compared the diagnostic yield of transbronchial biopsies using large and small forceps (cup sizes, 3 x 2 x 0.9 versus 2 x 1.5 x 0.6 mm, respectively). Diagnostic yield was compared by a pathologist, blinded to the size of forceps used on the basis of the relative amount of tissue obtained, alveolar tissue obtained, and ability to ascertain a histopathologic diagnosis. Large forceps obtained significantly more tissue than did small forceps (20 of 27 patients [74%] versus five of 27 patients [19%], p < 0.005, with similar amounts obtained in two patients). Also, large forceps obtained significantly more alveolar tissue than did small forceps (16 of 22 patients [73%] versus six of 22 patients [27%], p < 0.05, with no alveolar tissue obtained in five patients). In 18 of the 27 patients, biopsies performed resulted in nonspecific diagnoses, including fibrosis or chronic inflammation. All nine of the patients with a specific diagnosis were ultimately proved to have sarcoidosis. There was a trend toward more of these patients having noncaseating granulomas obtained with the large forceps than with the small forceps (seven of nine patients versus four of nine patients). No difference was observed in the amount of postbiopsy bleeding with either forceps. We conclude that large forceps used for transbronchial biopsy yield more tissue and more alveolar tissue than do small forceps. These findings may have an impact on the diagnostic yield in some diseases such as sarcoidosis.
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Affiliation(s)
- D I Loube
- Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6200
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Corso S, Vukelja SJ, Wiener D, Baker WJ. Diffuse alveolar hemorrhage following autologous bone marrow infusion. Bone Marrow Transplant 1993; 12:301-3. [PMID: 8241990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Autologous BMT performed in a 57-year-old woman with relapsed large cell lymphoma was complicated by two consecutive episodes of diffuse alveolar hemorrhage (DAH). The second episode occurred immediately after infusion of autologous BM. DAH is an increasingly recognized complication of autologous BMT and carries a high mortality. It is characterized by dyspnea, cough, bilateral pulmonary infiltrates and progressively bloodier aliquots of bronchoalveolar lavage fluid. The pathogenesis is probably multifactorial involving an initial insult to lung endothelium with inflammatory cells serving as the mediators of subsequent injury. The rapid development of DAH following marrow infusion strongly implicates DMSO as a potential cause in our patient.
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Affiliation(s)
- S Corso
- Department of Hematology-Oncology, Brooke Army Medical Center, San Antonio, TX 78234-6200
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Wiener D, Shah S, Malone J, Lowell N, Lowitt S, Rowlands DT. Multiparametric analysis of peripheral blood in the normal pediatric population by flow cytometry. J Clin Lab Anal 1990; 4:175-9. [PMID: 2352053 DOI: 10.1002/jcla.1860040305] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Lymphocyte subset analysis was performed on 114 healthy children and 84 healthy adults. Samples were prepared by a whole blood lysis technique and analyzed by flow cytometry. The percentage and total number of CD3+, CD4+, CD8+, and CD19+ lymphocytes were calculated for each of six age groups. A direct correlation with age was seen in the percentages of CD3+, CD4+, and CD8+ lymphocytes. The absolute number and percentage of total lymphocytes, the percentage and absolute number of CD19+ lymphocytes, and the absolute number of CD3+ lymphocytes decreased with age. No significant correlation with age was observed for white blood cells, the absolute number of CD4+ and CD8+ lymphocytes, and the CD4+/CD8+ ratio.
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Affiliation(s)
- D Wiener
- Department of Pathology, University of South Florida College of Medicine, Tampa
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Abstract
We report a case of hysterical, intractable paroxysmal sneezing in an adolescent girl. The patient had been observed by two pediatricians, an allergist, an emergency room physician, and a chiropractor. She had been treated with antihistamines, epinephrine, corticosteroid nasal spray, and a 1-week course of an oral corticosteroid without improvement. She was referred for evaluation of an allergic etiology before continuing her workup with a computed tomographic head scan. The patient had been sneezing almost daily for 3 mo up to 2000 times a day. The patient did not sneeze at night. She had nasal congestion but no rhinorrhea or eye symptoms. She did not sneeze during the interview. The results of a physical examination were normal except for mild obesity. No organic cause was found. Most cases of intractable paroxysmal sneezing reported in the literature occur in adolescents and appear to have a psychogenic etiology. The problem was discussed with the child and parents, and psychologic therapy was recommended. Considerable decrease in sneezing subsequently occurred, but the parents credited this is further chiropractic therapy.
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Gonzalez FJ, Garrett CT, Wiener D, Caine MD. The use of potassium iodide equilibrium density gradient centrifugation in the purification of RNA for hybridization with nonreiterated DNA sequences. Anal Biochem 1978; 85:146-56. [PMID: 204222 DOI: 10.1016/0003-2697(78)90285-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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