Jeffrey G. Neal

Magnetic Resonance Imaging in the Early Diagnosis of Group A β Streptococcal Necrotizing Fasciitis: A Case Report

Early diagnosis of invasive group A beta streptococcal (GABS) infection has been achieved in a patient using magnetic resonance imaging (MRI) complemented by needle aspiration. Life-saving treatments of GABS infection that include immediate surgical debridement along with the administration of i.v. antibiotics, gamma globulin, and hyperbaric oxygen were then implemented successfully to prevent the development of streptococcal toxic shock syndrome. While MRI is valuable in making early diagnosis of GABS, it should not delay surgical intervention.

Ease of donning commercially available powder-free surgical gloves

There are a wide variety of powder-free gloves that can now be used by surgeons. The purpose of this study was to quantify the forces required to don these powder-free surgical gloves. The lowest donning forces for wet hands was encountered with powder-free gloves coated with a hydrogel polymer. In addition, the hydrogel coated gloves exhibited the least increase in donning forces from dry hands to wet hands. While greater forces were encountered with the other commercially available powder-free gloves than the hydrogel coated gloves, they all could be safely donned on dry hands without tearing.

Integrity of powder-free examination gloves to bacteriophage penetration.

The purpose of this study was to compare the resistance to viral penetration of powder-free synthetic examination gloves with powder-free latex examination gloves commonly used in hospitals. Because these gloves had no holes, this study examined viral penetration through a membrane. Using a standard bacteriophage penetration model, no bacteriophage penetration was detected through the membrane for any of the gloves tested. The new powder-free nitrile and polyvinyl chloride synthetic examination gloves provided comparable resistance to viral penetration as did the powder-free latex examination gloves.

Influence of irrigation solutions on oscillating bone saw blade performance.

The influence of irrigation on bone cutting was determined by measuring the biomechanical performance of a bone cutting saw during irrigation with various solutions. Solutions of 0.9% saline and 10, 20, and 30% poloxamer-188 were used as the irrigant. A 10% solution of poloxamer-188 was judged to be the superior irrigant because it successfully maintained bone temperature at a controlled level without interfering with the rate of bone removal.

Biomechanical performance of orthopedic gloves

The purpose of this study was to compare the biomechanical performance of commercially available orthopedic gloves to that of a single surgical glove, as well as a double glove system. The orthopedic gloves were found to be thicker than the single surgical glove. This increased thickness of the orthopedic glove was associated with a greater resistance to glove puncture. The thickest orthopedic gloves also had reduced tactile sensitivity when compared to the single surgical glove. In addition, the glove donning forces and glove hydration rates varied considerably. These latter biomechanical performance parameters were not significantly related to glove thickness. The double glove systems tested in this study had similar performance characteristics in regard to many of the orthopedic gloves. The glove donning forces for the double glove systems were the lowest of the gloves tested. In addition, the double glove systems displayed the greatest resistance to glove hydration of the gloves tested. Their performance in the glove hydration tests and the force required to don the double glove systems were much more desirable than any of the orthopedic gloves. The results of this study indicate that the double glove systems may provide a desirable alternative to the use of the single orthopedic gloves.

Inadequate Standard for Glove Puncture Resistance: Allows Production of Gloves with Limited Puncture Resistance

The National Fire Protection Association has developed standards for glove puncture resistance using a metal puncture probe. Biomechanical performance studies have demonstrated that glove puncture resistance to the probe is significantly greater than that of the hypodermic needle, suggesting that these standards have no clinical relevance. These standards give a false sense of security to health care personnel and sanction the production and use of gloves that give inadequate protection. The result is potentially harmful for medical personnel.

Biomechanical performance of examination gloves.

The purpose of this study was to compare the biomechanical performance of new powder-free commercially available synthetic examination gloves to that of commercially available powder-free latex examination gloves. The synthetic gloves were significantly thinner than the latex gloves. Despite the decreased thickness, all three nitrile gloves, as well as the polyvinyl chloride glove, exhibited a greater resistance to glove puncture. The glove donning forces varied considerably among all gloves, and wet donning forces were greater than dry donning forces. Under dry conditions, the donning forces for the synthetic gloves were less than or equal to the forces for the latex gloves. Because of their increased puncture resistance and similar donning forces, synthetic gloves are a safe alternative to latex examination gloves.

BALCONY COLLAPSE AT THE UNIVERSITY OF VIRGINIA GRADUATION: WHAT HATH JEFFERSON WROUGHT?

The purpose of this report is to describe the emergency medical response to a disaster caused by the collapse of a balcony in Pavilion I on the Lawn of the University of Virginia during graduation. The emergency medical response to rescue of the injured was hindered by five major factors: (1) a metal linked chain blocked access of rescue vehicles, (2) inability to identify an emergency medical command officer, (3) failure to transfer injured patients with stable vital signs and secured to backboards to a triage area away from the scene of the accident, (4) ineffective crowd control, and (5) the failure to delay procession until completion of patient transport from the disaster site. Sixteen people were injured in the accident and one patient died. The cause of the accident was the absence of a redundant architectural support system for the balcony.

Failure of glove hole detection device for synthetic gloves.

Holes in latex gloves can be reliably detected by commercially available electronic devices. The purpose of this study was to compare the performance of an electronic glove hole detection device using latex gloves to that of neoprene, vinyl, and nitrile latex-free gloves. The electronic hole detection device accurately detected holes in the latex gloves during the 2-h study. In contrast, the latex-free gloves were immediately conductive of electricity in the absence of holes. Consequently, electronic glove hole detection devices cannot be reliably used with latex-free gloves.

Ease of donning commercially available latex examination gloves

There are a wide variety of latex examination gloves now available for use by health care providers. A prospective randomized trial was completed to quantify the forces required to don a sample of seven cornstarch-lubricated gloves and 13 powder-free latex examination gloves. The data collected was analyzed by a 20 x 2 general factorial ANOVA, as well as two 1-way ANOVAs using a least significance difference post hoc test. Some powder-free gloves can be easily donned with dry or wet hands without tearing with forces comparable to those encountered with powdered gloves. With the advent of these powder-free examination gloves, powdered gloves can now be abandoned, protecting health professionals and patients from the dangers of absorbable dusting powders. Despite the dangers of the absorbable dusting powders and the Food and Drug Administrations requirement for labeling examination glove boxes, some manufacturers of powdered examination gloves do not appropriately label their boxes with a warning to the health professional and patient of the presence of powder.