Paul Pearigen - Academia.edu (original) (raw)

Papers by Paul Pearigen

Emergency Medicine Clinics of North America, Aug 1, 1996

Common and uncommon GI and other intraperitoneal illnesses may present in unusual ways. In additi... more Common and uncommon GI and other intraperitoneal illnesses may present in unusual ways. In addition, many systemic or extraperitoneal disease processes frequently include abdominal pain as a clinical manifestation. The clinician should suspect an unusual cause of abdominal symptoms in patients with repeated visits to the ED without a diagnosis, those who appear ill or complain of severe abdominal pain with disproportionately negative abdominal physical examination findings, those with constitutional or extraperitoneal symptoms or signs, and the elderly or immunocompromised. After initial resuscitation and stabilization have taken place, early evaluation of the need for urgent surgical evaluation and operative management is crucial in the patient with abdominal pain, even when the cause of the symptoms is unclear. A thorough history and careful and complete abdominal and nonabdominal physical examination, paired with appropriate but judicious diagnostic testing, are essential to detecting these unusual causes of abdominal pain and to preventing needless morbidity and mortality.

Brain Research, Jul 1, 1996

To separately analyze the hypoxic component of hypoxic-ischemic encephalopathy, rats were prepare... more To separately analyze the hypoxic component of hypoxic-ischemic encephalopathy, rats were prepared such that their paO2 was maintained at 20 mmHg while maintaining systemic arterial pressures. During the 20-rain experiment, brain oxygen concentration and extracellular amino acid concentrations were monitored. At sacrifice, the brains were studied for morphologic evidence of injury by immunocytochemical staining for the non-constituitive stress protein HSP-72 or neuronal death by acid fuchsin staining. Oxygenated rats subjected to global ischemia were prepared for comparison. In these experiments, hypoxia resulted in no increase in extracellular glutamate concentration, and no morphologic injury was detected. Thus, hypoxia without ischemia is well tolerated by brain.

Drug Safety, 1991

Contents 409 410 4lJ 411 411 414 414 415 416 416 416 417 417 417 417 417 418 418 419 419 419 419 ... more Contents 409 410 4lJ 411 411 414 414 415 416 416 416 417 417 417 417 417 418 418 419 419 419 419 419 4/9 419 420 420 420 420 420 420 422 422 423 Summary I. Mechanisms of Toxicity 2. Clinical Features of Toxicity Poisoning Due to Calcium Antagonists 409 423 423 423 425 425 425 426 426 426

The Journal of emergency medicine, Sep 1, 1995

Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pulmonary edema... more Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pulmonary edema, chemical hepatitis, seizures, and mental status alteration, but myocardial depression has not been reported following aspirin overdose in cbitdren. In addition to these more typical features, the 13-month-old boy reported bere developed clinical, radiographic, and ecbocardiograpbic evidence of myocardial impairment with pulmonary edema and moderately severe global left ventricular dysfunction (estimated shorten& fraction of 23%). Complete resolution of the myocardial dysfunction was demonstrated on follow-up ecbocardiograpby as the child recovered from the aspirin intoxication. This case suggests that myocardial dysfunction can occur as a result of toxic aspirin ingestion, and that it may contribute to salkylate-induced pulmonary edema.

Emergency Medicine Clinics of North America, Nov 1, 1998

Common and uncommon GI and other intraperitoneal illnesses may present in unusual ways. In additi... more Common and uncommon GI and other intraperitoneal illnesses may present in unusual ways. In addition, many systemic or extraperitoneal disease processes frequently include abdominal pain as a clinical manifestation. The clinician should suspect an unusual cause of abdominal symptoms in patients with repeated visits to the ED without a diagnosis, those who appear ill or complain of severe abdominal pain with disproportionately negative abdominal physical examination findings, those with constitutional or extraperitoneal symptoms or signs, and the elderly or immunocompromised. After initial resuscitation and stabilization have taken place, early evaluation of the need for urgent surgical evaluation and operative management is crucial in the patient with abdominal pain, even when the cause of the symptoms is unclear. A thorough history and careful and complete abdominal and nonabdominal physical examination, paired with appropriate but judicious diagnostic testing, are essential to detecting these unusual causes of abdominal pain and to preventing needless morbidity and mortality.

The Journal of Emergency Medicine, Oct 31, 1995

U Abstract -Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pul... more U Abstract -Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pulmonary edema, chemical hepatitis, seizures, and mental status alteration, but myocardial depression has not been reported following aspirin overdose in cbitdren. In addition to these more typical features, the 13-month-old boy reported bere developed clinical, radiographic, and ecbocardiograpbic evidence of myocardial impairment with pulmonary edema and moderately severe global left ventricular dysfunction (estimated shorten& fraction of 23%). Complete resolution of the myocardial dysfunction was demonstrated on follow-up ecbocardiograpby as the child recovered from the aspirin intoxication. This case suggests that myocardial dysfunction can occur as a result of toxic aspirin ingestion, and that it may contribute to salkylate-induced pulmonary edema.

Annals of Emergency Medicine, Jan 6, 1998

To evaluate the impact of a medical toxicology consulting service (MTCS) on resource use and effi... more To evaluate the impact of a medical toxicology consulting service (MTCS) on resource use and efficiency of care in patients hospitalized with a diagnosis of tricyclic antidepressant (TCA) poisoning.

Emergency medicine clinics of North America, 1998

The crying infant is a common presenting complaint and a difficult diagnostic dilemma that may re... more The crying infant is a common presenting complaint and a difficult diagnostic dilemma that may represent the primary manifestation of a serious or even life-threatening condition. Although many children experience an exacerbation of the normal crying tendencies or minor ailments typical of the early months of life, a significant number of infants have underlying pathologic conditions requiring immediate intervention. This article briefly reviews current and past research on this phenomenon and presents differential diagnoses and recommendations for the evaluation and management of the acute crying episode.

The Journal of Emergency Medicine, 1995

U Abstract -Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pul... more U Abstract -Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pulmonary edema, chemical hepatitis, seizures, and mental status alteration, but myocardial depression has not been reported following aspirin overdose in cbitdren. In addition to these more typical features, the 13-month-old boy reported bere developed clinical, radiographic, and ecbocardiograpbic evidence of myocardial impairment with pulmonary edema and moderately severe global left ventricular dysfunction (estimated shorten& fraction of 23%). Complete resolution of the myocardial dysfunction was demonstrated on follow-up ecbocardiograpby as the child recovered from the aspirin intoxication. This case suggests that myocardial dysfunction can occur as a result of toxic aspirin ingestion, and that it may contribute to salkylate-induced pulmonary edema.

The Journal of Emergency Medicine, 2000

e Abstract-Nifedipine is a prototypical dihydropyridine calcium channel "blocker" that can cause ... more e Abstract-Nifedipine is a prototypical dihydropyridine calcium channel "blocker" that can cause hypotension and cardiac conduction abnormalities. When compared to other calcium channel antagonists, overdoses have been reported to be relatively benign with treatment consisting mainly of supportive care. We report two pediatric cases of death secondary to accidental ingestion of long acting nifedipine (Adalat). Both cases did not respond to aggressive supportive care that included calcium, atropine, epinephrine, glucagon, sodium bicarbonate, and transthoracic pacing.

Annals of Emergency Medicine, 1998

To evaluate the impact of a medical toxicology consulting service (MTCS) on resource use and effi... more To evaluate the impact of a medical toxicology consulting service (MTCS) on resource use and efficiency of care in patients hospitalized with a diagnosis of tricyclic antidepressant (TCA) poisoning.

Brain Research, 1996

To separately analyze the hypoxic component of hypoxic-ischemic encephalopathy, rats were prepare... more To separately analyze the hypoxic component of hypoxic-ischemic encephalopathy, rats were prepared such that their paO2 was maintained at 20 mmHg while maintaining systemic arterial pressures. During the 20-rain experiment, brain oxygen concentration and extracellular amino acid concentrations were monitored. At sacrifice, the brains were studied for morphologic evidence of injury by immunocytochemical staining for the non-constituitive stress protein HSP-72 or neuronal death by acid fuchsin staining. Oxygenated rats subjected to global ischemia were prepared for comparison. In these experiments, hypoxia resulted in no increase in extracellular glutamate concentration, and no morphologic injury was detected. Thus, hypoxia without ischemia is well tolerated by brain.

Emergency Medicine Clinics of North America, Aug 1, 1996

Common and uncommon GI and other intraperitoneal illnesses may present in unusual ways. In additi... more Common and uncommon GI and other intraperitoneal illnesses may present in unusual ways. In addition, many systemic or extraperitoneal disease processes frequently include abdominal pain as a clinical manifestation. The clinician should suspect an unusual cause of abdominal symptoms in patients with repeated visits to the ED without a diagnosis, those who appear ill or complain of severe abdominal pain with disproportionately negative abdominal physical examination findings, those with constitutional or extraperitoneal symptoms or signs, and the elderly or immunocompromised. After initial resuscitation and stabilization have taken place, early evaluation of the need for urgent surgical evaluation and operative management is crucial in the patient with abdominal pain, even when the cause of the symptoms is unclear. A thorough history and careful and complete abdominal and nonabdominal physical examination, paired with appropriate but judicious diagnostic testing, are essential to detecting these unusual causes of abdominal pain and to preventing needless morbidity and mortality.

Brain Research, Jul 1, 1996

To separately analyze the hypoxic component of hypoxic-ischemic encephalopathy, rats were prepare... more To separately analyze the hypoxic component of hypoxic-ischemic encephalopathy, rats were prepared such that their paO2 was maintained at 20 mmHg while maintaining systemic arterial pressures. During the 20-rain experiment, brain oxygen concentration and extracellular amino acid concentrations were monitored. At sacrifice, the brains were studied for morphologic evidence of injury by immunocytochemical staining for the non-constituitive stress protein HSP-72 or neuronal death by acid fuchsin staining. Oxygenated rats subjected to global ischemia were prepared for comparison. In these experiments, hypoxia resulted in no increase in extracellular glutamate concentration, and no morphologic injury was detected. Thus, hypoxia without ischemia is well tolerated by brain.

Drug Safety, 1991

Contents 409 410 4lJ 411 411 414 414 415 416 416 416 417 417 417 417 417 418 418 419 419 419 419 ... more Contents 409 410 4lJ 411 411 414 414 415 416 416 416 417 417 417 417 417 418 418 419 419 419 419 419 4/9 419 420 420 420 420 420 420 422 422 423 Summary I. Mechanisms of Toxicity 2. Clinical Features of Toxicity Poisoning Due to Calcium Antagonists 409 423 423 423 425 425 425 426 426 426

The Journal of emergency medicine, Sep 1, 1995

Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pulmonary edema... more Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pulmonary edema, chemical hepatitis, seizures, and mental status alteration, but myocardial depression has not been reported following aspirin overdose in cbitdren. In addition to these more typical features, the 13-month-old boy reported bere developed clinical, radiographic, and ecbocardiograpbic evidence of myocardial impairment with pulmonary edema and moderately severe global left ventricular dysfunction (estimated shorten& fraction of 23%). Complete resolution of the myocardial dysfunction was demonstrated on follow-up ecbocardiograpby as the child recovered from the aspirin intoxication. This case suggests that myocardial dysfunction can occur as a result of toxic aspirin ingestion, and that it may contribute to salkylate-induced pulmonary edema.

Emergency Medicine Clinics of North America, Nov 1, 1998

Common and uncommon GI and other intraperitoneal illnesses may present in unusual ways. In additi... more Common and uncommon GI and other intraperitoneal illnesses may present in unusual ways. In addition, many systemic or extraperitoneal disease processes frequently include abdominal pain as a clinical manifestation. The clinician should suspect an unusual cause of abdominal symptoms in patients with repeated visits to the ED without a diagnosis, those who appear ill or complain of severe abdominal pain with disproportionately negative abdominal physical examination findings, those with constitutional or extraperitoneal symptoms or signs, and the elderly or immunocompromised. After initial resuscitation and stabilization have taken place, early evaluation of the need for urgent surgical evaluation and operative management is crucial in the patient with abdominal pain, even when the cause of the symptoms is unclear. A thorough history and careful and complete abdominal and nonabdominal physical examination, paired with appropriate but judicious diagnostic testing, are essential to detecting these unusual causes of abdominal pain and to preventing needless morbidity and mortality.

The Journal of Emergency Medicine, Oct 31, 1995

U Abstract -Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pul... more U Abstract -Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pulmonary edema, chemical hepatitis, seizures, and mental status alteration, but myocardial depression has not been reported following aspirin overdose in cbitdren. In addition to these more typical features, the 13-month-old boy reported bere developed clinical, radiographic, and ecbocardiograpbic evidence of myocardial impairment with pulmonary edema and moderately severe global left ventricular dysfunction (estimated shorten& fraction of 23%). Complete resolution of the myocardial dysfunction was demonstrated on follow-up ecbocardiograpby as the child recovered from the aspirin intoxication. This case suggests that myocardial dysfunction can occur as a result of toxic aspirin ingestion, and that it may contribute to salkylate-induced pulmonary edema.

Annals of Emergency Medicine, Jan 6, 1998

To evaluate the impact of a medical toxicology consulting service (MTCS) on resource use and effi... more To evaluate the impact of a medical toxicology consulting service (MTCS) on resource use and efficiency of care in patients hospitalized with a diagnosis of tricyclic antidepressant (TCA) poisoning.

Emergency medicine clinics of North America, 1998

The crying infant is a common presenting complaint and a difficult diagnostic dilemma that may re... more The crying infant is a common presenting complaint and a difficult diagnostic dilemma that may represent the primary manifestation of a serious or even life-threatening condition. Although many children experience an exacerbation of the normal crying tendencies or minor ailments typical of the early months of life, a significant number of infants have underlying pathologic conditions requiring immediate intervention. This article briefly reviews current and past research on this phenomenon and presents differential diagnoses and recommendations for the evaluation and management of the acute crying episode.

The Journal of Emergency Medicine, 1995

U Abstract -Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pul... more U Abstract -Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pulmonary edema, chemical hepatitis, seizures, and mental status alteration, but myocardial depression has not been reported following aspirin overdose in cbitdren. In addition to these more typical features, the 13-month-old boy reported bere developed clinical, radiographic, and ecbocardiograpbic evidence of myocardial impairment with pulmonary edema and moderately severe global left ventricular dysfunction (estimated shorten& fraction of 23%). Complete resolution of the myocardial dysfunction was demonstrated on follow-up ecbocardiograpby as the child recovered from the aspirin intoxication. This case suggests that myocardial dysfunction can occur as a result of toxic aspirin ingestion, and that it may contribute to salkylate-induced pulmonary edema.

The Journal of Emergency Medicine, 2000

e Abstract-Nifedipine is a prototypical dihydropyridine calcium channel "blocker" that can cause ... more e Abstract-Nifedipine is a prototypical dihydropyridine calcium channel "blocker" that can cause hypotension and cardiac conduction abnormalities. When compared to other calcium channel antagonists, overdoses have been reported to be relatively benign with treatment consisting mainly of supportive care. We report two pediatric cases of death secondary to accidental ingestion of long acting nifedipine (Adalat). Both cases did not respond to aggressive supportive care that included calcium, atropine, epinephrine, glucagon, sodium bicarbonate, and transthoracic pacing.

Annals of Emergency Medicine, 1998

To evaluate the impact of a medical toxicology consulting service (MTCS) on resource use and effi... more To evaluate the impact of a medical toxicology consulting service (MTCS) on resource use and efficiency of care in patients hospitalized with a diagnosis of tricyclic antidepressant (TCA) poisoning.

Brain Research, 1996

To separately analyze the hypoxic component of hypoxic-ischemic encephalopathy, rats were prepare... more To separately analyze the hypoxic component of hypoxic-ischemic encephalopathy, rats were prepared such that their paO2 was maintained at 20 mmHg while maintaining systemic arterial pressures. During the 20-rain experiment, brain oxygen concentration and extracellular amino acid concentrations were monitored. At sacrifice, the brains were studied for morphologic evidence of injury by immunocytochemical staining for the non-constituitive stress protein HSP-72 or neuronal death by acid fuchsin staining. Oxygenated rats subjected to global ischemia were prepared for comparison. In these experiments, hypoxia resulted in no increase in extracellular glutamate concentration, and no morphologic injury was detected. Thus, hypoxia without ischemia is well tolerated by brain.