Larry D. Weiss

Pulmonary embolism with ST segment elevation in leads V1 to V4: case report and review of the literature regarding electrocardiographic changes in acute pulmonary embolism.

A 62-year-old man presented to the Emergency Department (ED) after having three short syncopal episodes earlier that day soon after experiencing acute onset of shortness of breath. He had no significant past medical history and was a nonsmoker. Initially in the Emergency Department he was without any complaints, but then became acutely short of breath and hemodynamically unstable and died despite resuscitative efforts. His electrocardiogram showed ST segment elevations in leads V1 to V4, which is consistent with an anteroseptal myocardial infarction. Autopsy revealed that this patient did not have a myocardial infarction, but rather died of a pulmonary embolism (PE). This case demonstrates how a PE can mimic an anteroseptal myocardial infarction on electrocardiogram. This patients lack of risk factors for PE also makes this case unusual.

Hyperbaric oxygen and wound healing

Abstract Hyperbaric oxygen therapy (HBOT) involves the administrtion of oxygen in an environment where the ambient pressure has been increased. The ensuing hyperoxia and elevated pressure have a number of beneficial clinical effects, including the promotion of wound healing. When HBOT is used repetitively, it can become an expensive treatment modality. Therefore, in wound patients it can be cost effective only in extraordinary circumstances. In the acute wound, it can be a useful adjunct in the treatment of some life- or limb-threatening situations. In treating a chronic wound, it can be useful in specific settings in which a wound has been truly refractory to appropriate local medical and surgical care. This article is not a comprehensive review of hyperbaric medicine. Outstanding reviews of diving medicine 1–4 and clinical hyperbaric medicine 5–8 have already been written. This review examines the relevance of HBOT to wound management. It is necessary, however, to preface this review with a brief discussion of the background, basic physics, and physiology of HBOT.

The Politics of Essential Drugs. The Makings of a Successful Health Strategy: Lessons From Bangladesh

The global drug situation reform attempts Bangladesh national drug policy 1982 a storm unleashed achievements and limitations WHOs role - ambiguity and contradictions not the end of the story.

Methemoglobin levels following intravenous lidocaine administration

Methemoglobin levels were obtained before and after administration of IV lidocaine in 40 cardiac patients. Patients were given a 1-mg/kg bolus of IV lidocaine hydrochloride, started on a maintenance infusion at 2.0 mg/min, and given a second bolus of lidocaine of 0.5 mg/kg 15 minutes after the initial bolus. The maintenance infusion was adjusted from 1 to 4 mg/min according to clinical needs. Methemoglobin levels were drawn at zero, one, and six hours, and lidocaine levels were drawn at one and six hours after the initial bolus. Elevation of methemoglobin levels after lidocaine administration was statistically significant (P less than .05), but not clinically significant. The highest methemoglobin level obtained was 1.2%. Only one other patient had a level above 1%. No patient developed either signs of lidocaine toxicity or toxic levels of methemoglobin. Routine determination of methemoglobin levels is not clinically indicated following routine lidocaine administration. It may have some as-yet-undetermined value in lidocaine-toxic patients.

The applications of hyperbaric oxygen therapy in emergency medicine

Hyperbaric oxygen therapy involves the administration of oxygen in an environment where the ambient pressure has been increased. The ensuing hyperoxia and the elevated pressure have a number of beneficial clinical effects. Many of the clinical indications for hyperbaric oxygen therapy (HBOT) involve emergent conditions. It is therefore important for emergency physicians to be familiar with the applications of HBOT. Emergency physicians have become well represented in hyperbaric medicine. Currently, emergency physicians comprise approximately 15% of the membership of the Undersea and Hyperbaric Medical Society (UHMS). Along with internal medicine and anesthesiology/critical care medicine, emergency medicine is among the most heavily represented specialities in the UHMS (UHMS personal communication, February 1991). This is not surprising, considering the variety of emergent conditions that can be treated with HBOT. and the general attributes of an emergency physician: a broad general background, the ability to resuscitate unstable patients, and 24-hour in-house availability. The UHMS recognized the important association between Emergency Medicine and Hyperbaric Medicine when they convened a symposium entitled “Hyperbaric Oxygen in Emergency Medical Care” in 1983.’ This will not be a comprehensive review of hyperbaric medicine. Outstanding reviews of diving medicine and clinical hyperbaric medicine6-9 already have been written. This review will examine the relevance of HBO therapy to emergency medicine. It is necessary, however, to preface this review with a brief discussion of the background, the basic physics, and the physiology of HBOT.

Polyarticular symmetric tophaceous joint inflammation as the initial presentation of gout

A 76-year-old woman suffered from bilateral distal index finger pain and swelling. The patient had been initially treated with antibiotics for herpetic whitlow complicated by a secondary bacterial infection. Gout was diagnosed through clinical history, physical examination and identification of monosodium urate crystals in the joint aspirate. Gout appearing as polyarticular, symmetric tophi involving the periungual region and distal interphalangeal joint has not been previously described.

Varying presentations of methemoglobinemia: two cases.

The cases of two patients with methemoglobin levels approaching 30% are presented. No history of exposure to an oxidant was ever determined for the first case; the second patient had taken amyl nitrate orally along with alcohol as well as a self-injected narcotic and antihistamine. Due to their symptomatology, both patients were treated with methylene blue with good results; however, the patient described in case one had a brief episode of symptoms and pulse oximetry changes, not previously emphasized, consistent with the administration of methylene blue. The pathophysiology of methemoglobinemia, the utility of bedside diagnostic techniques, and the use of pulse oximetry are discussed.

Central embolization of needle fragments: A complication of intravenous drug abuse

Central embolization is a known complication of catheter and needle fragments that enter the intravenous space. These events are associated with a number of complications including sepsis, thrombus formation with embolization, arrhythmia, and sudden death. This report reviews the case of a drug abuser who sought medical attention in the emergency department after breaking a needle in her left supraclavicular area. Initial efforts to explore the region were delayed. The delay resulted in embolization of the needle fragment to the lung periphery. This case illustrates the complications of central drug abuse and prompts a review of existing techniques to remove intravascular foreign bodies nonsurgically.

Methemoglobin levels following sublingual nitroglycerin in human volunteers

Sublingual nitroglycerin 0.8 mg every five minutes for a total of 4.8 mg was administered to 11 healthy volunteers. One volunteer had to withdraw due to a hypotensive bradycardic reaction after 2.4 mg. In the remaining subjects, methemoglobinemia over the next hour never significantly increased from baseline levels, reaching a peak of only 0.71%. We conclude that commonly used doses of sublingual nitroglycerin do not induce significant methemoglobinemia and that nitroglycerin would not be useful in the treatment of cyanide poisoning.

Social Security and Medicare: A Policy Primer

Foreword by Arthur S. Flemming Social Security and Medicare as Policy Problems--Recurrent Themes The Social Insurance Approach The History of Social Security and Medicare The Modern Social Security and Medicare Programs Does Social Security Protect Todays and Tomorrows Old? Is Social Security Financially Stable? Is Social Security Fair? Disability as a Policy Problem Meeting and Financing the Health Care Needs of Older Americans Conclusion--An Invitation to Shape the Future Selected Bibliography Index