Michael F. Tenholder
Georgia Regents University
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Featured researches published by Michael F. Tenholder.
The American Journal of Medicine | 1993
Carolyn A. Hofer; James K. Smith; Michael F. Tenholder
Calcium channel antagonists can be quite toxic. In the management of poisoning, early recognition is critical. Calcium channel antagonists are frequently prescribed, and the potential for serious morbidity and mortality with overdosage is significant. Ingestion of these agents should be suspected in any patient who presents in an overdose situation with unexplained hypotension and conduction abnormalities. The potential for toxicity should be noted in patients with underlying hepatic or renal dysfunction who are receiving therapeutic doses. Because there is no specific antidote, decontamination of the gastrointestinal tract is crucial. Intravenous calcium should be administered to symptomatic patients because it is relatively innocuous and may be beneficial. Volume expansion should be the initial approach to hypotension unrelated to bradycardia. Patients who have had a verapamil overdose should be observed in intensive care units where Swan-Ganz catheterization and ventricular pacing are routinely available. The choice of sympathomimetic agents for treatment remains controversial. According to the published literature, isoproterenol, epinephrine, and norepinephrine may be more effective in improving bradycardia and the resultant hypotension than dopamine. However, none of these agents is universally effective. A more logical approach may be to improve cardiac output with agents like amrinone. Bay K 8644 and 4-aminopyridine show promise as potential antidotes but at present are still experimental.
American Journal of Infection Control | 1993
Eunice H. Steimke; Michael F. Tenholder; Malkanthie I. Mccormick; J. Peter Rissing
Mycobacterium tuberculosis has reemerged as a significant public health problem. Elderly persons, especially those in long-term care facilities, are among those at high risk for infection with M. tuberculosis. Frequently, their symptoms are not clearly indicative of M. tuberculosis, and the diagnosis may thus be missed. We discuss the investigation of a cluster of skin test conversions on one locked unit in our long-term care facility. During the epidemiologic investigation, four of 25 patients who had previously had negative results of purified protein derivative testing (16%) and eight of 95 employees (11%) had skin test conversions. Despite a comprehensive, costly evaluation, the index case was not found. We identified weaknesses in our employee and patient M. tuberculosis surveillance programs. Employee baseline purified protein derivative testing data were inadequate. Annual skin tests for employees with previously negative results were not mandatory. There was no mechanism in place to encourage compliance. We developed a plan to educate personnel about the reemergence of M. tuberculosis, signs and symptoms in elderly patients, and the placement and interpretation of purified protein derivative skin tests. Documentation of purified protein derivative surveillance of both patients and employees was computerized. The number of inpatient and outpatient negative-pressure rooms was increased. Appropriate personal protective equipment was made available for use in high-risk situations.
Chest | 1992
Erich A. Kimmerling; Joseph A. Fedrick; Michael F. Tenholder
Chest | 1992
Michael F. Tenholder; Martin J. Bryson; Warren L. Whitlock
Chest | 1993
Michael F. Tenholder; Harold D. Jackson
Chest | 1994
Frank W. Ewald; Michael F. Tenholder; Rita F. Waller
Chest | 1994
Harold D. Jackson; Kenneth J. Carney; Mark A. Knautz; Michael F. Tenholder
Chest | 1992
Michael F. Tenholder; Frank W. Ewald; Nayereh K. Khankhanian; John H. Crosby
Chest | 1993
Michael F. Tenholder
Archive | 2015
Michael F. Tenholder; William A. Erwin; Heidi S. Nelson