Dan Tandberg

• MD
• Professor Emeritus at Dan Tandberg, MD

Background: Evaluation of distal extensor mechanism alignment continues to evolve in children with patella instability. Prior studies support the use of the tibial tubercle to trochlear groove (TT-TG) distance but limitations exist for this measurement including: changes in the TT-TG distance with knee flexion, difficulty with finding the deepest...

The tibial tubercle-trochlear groove (TT-TG) distance is a useful tool in guiding surgical management for patients with recurrent lateral patellar instability. Current recommendations for tibial tubercle transfer are based on TT-TG distance thresholds derived from adult populations. Recurrent patellar instability, however, frequently affects childr...

Pediatric osteoporosis is uncommon but can result in painful and debilitating insufficiency fractures. Treatment options for osteoporosis in children are few. Bisphosphonate therapy for children has not been approved by the Food and Drug Administration (FDA) in the United States, but its use in that population has been increasing. Randomized contro...

Case controlled study. To explore the relative effects of body mass index (BMI) and the presence or absence of adolescent idiopathic scoliosis (AIS) on bone mineral density (BMD) as evidenced by Z-scores in adolescents. Prior studies have identified adolescents with idiopathic scoliosis as having "osteoporosis" or "osteopenia," when only a small pe...

Post hoc analysis of a large US population-based study of melanoma was carried out to test Whiteman’s divergent pathway model that suggests different etiologic pathways for melanoma based on (1) pattern of sun exposure, as characterized by anatomic site, and (2) host factors such as propensity for melanocyte proliferation, as characterized by nevus...

The prehospital electrocardiogram (ECG) is becoming the standard of care of suspected cardiac chest pain. We evaluated the evidence regarding the prehospital ECG and sought to quantify the reduction in time to reperfusion therapy attributable to the prehospital ECG. We conducted a systematic review and analyzed studies that were conducted in emerge...

The purpose of this study was to determine whether patient outcomes were adversely affected as healthcare referral values increased for two common poisonings: acute, unintentional acetaminophen (APAP) poisonings and acute, unintentional iron (Fe) poisonings. We hypothesized that symptom rates would increase with high referral values. Qualifying 199...

Recent studies suggest that women with acute urethral syndrome or abdominal pain, presenting to emergency departments (EDs), have a high prevalence of Chlamydia trachomatis. To estimate the prevalence of C. trachomatis in women presenting to an ED and to see whether those with dysuria or abdominal pain have a higher prevalence of C. trachomatis. Th...

The prehospital 12-lead electrocardiogram (ECG) has become a standard of care. For the prehospital 12-lead ECG to be useful clinically, however, cardiologists and emergency physicians (EP) must view the test as useful. This study measured physician attitudes about the prehospital 12-lead ECG. This study tested the hypothesis that physicians had "no...

Sexual assault survivors with post-traumatic stress disorder (PTSD) were assessed for frequency of nightmares, measured retrospectively on the Nightmare Frequency Questionnaire (NFQ) and prospectively on nightmare dream logs (NLOG). Retrospective frequency was extremely high, averaging occurrences every other night and an estimated number of nightm...

Sleep quality and posttraumatic stress disorder (PTSD) were examined in 151 sexual assault survivors, 77% of whom had previously reported symptoms of sleep-disordered breathing (SDB) or sleep movement disorders (SMD) or both. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Posttraumatic Stress Scale (PSS). High PSQI scores...

Chronic nightmares occur frequently in patients with posttraumatic stress disorder (PTSD) but are not usually a primary target of treatment. To determine if treating chronic nightmares with imagery rehearsal therapy (IRT) reduces the frequency of disturbing dreams, improves sleep quality, and decreases PTSD symptom severity. Randomized controlled t...

To evaluate imagery rehearsal therapy for the treatment of chronic nightmares in a sample of adolescent girls. Adolescent girls ranging in age from 13 to 18 years were recruited from the Wyoming Girls School in Sheridan, Wyoming (treatment group, n = 9; control group, n = 10). These girls had previously suffered a high prevalence of unwanted sexual...

The purpose of this study was to determine the extent to which poison center triage guidelines influence healthcare facility referral rates for acute, unintentional acetaminophen-only poisoning and acute, unintentional adult formulation iron poisoning. Managers of US poison centers were interviewed by telephone to determine their center's triage th...

To assess the impact of treatment for co-morbid sleep-disordered breathing (SDB) on patients with nightmares and post-traumatic stress. Twenty-three chronic nightmare sufferers (15 with post-traumatic stress disorder, PTSD) who also suffered co-morbid SDB (obstructive sleep apnea, OSA, n=16; upper airway resistance syndrome, UARS, n=7) completed a...

We developed a statistical model that would identify and quantify the relative contributions of different factors hypothesized to impact the frequency of emergency center (EC) patients who leave without being seen (LWBS). We performed an analysis of the daily counts of patients that registered in our EC during a 21-month period who then LWBS. Candi...

Imagery-rehearsal therapy for chronic nightmares was assessed in a randomized, controlled study of sexual assault survivors with posttraumatic stress disorder (PTSD). Nightmares, sleep quality, and PTSD were assessed at baseline for 169 women, who were randomized into two groups: treatment (n = 87) and wait-list control (n = 82). Treatment consiste...

A descriptive, hypothesis-generating study was performed with 156 female sexual-assault survivors who suffered from insomnia, nightmares, and posttraumatic stress disorder (PTSD). They completed 2 self-report sleep questionnaires to assess the potential presence of intrinsic sleep disorders. Seventy-seven percent of the sample (120 of 156) endorsed...

In this article we try to determine if the examiner's gender affects women's perceived pain and embarrassment during emergency department pelvic examination, using a prospective comparative study in a university teaching hospital. Test subjects were taken from a convenience sample of female emergency department (ED) patients undergoing pelvic exami...

ST-segment elevation is used to make early decisions about using thrombolytic therapy in patients with suspected myocardial infarction. This study was performed to assess interobserver and intraobserver variation in subjects' measurements of ST-segment elevation in isolated ECG complexes. We performed a masked, paired-sample experiment. Emergency p...

Crack cocaine is commonly smoked in a pipe with a metallic filter made from a steel wool scouring pad. We report an unusual complication of smoking crack cocaine: the aspiration and ingestion of a Brillo pad filter. A 34-year-old female presented 7 h after drinking beer and smoking crack. She was concerned that she might have inhaled the "screen" f...

To test the hypothesis that time series analysis can provide accurate predictions of future ambulance service run volume, a prospective stochastic time series modeling study was conducted at a community-based regional ambulance service. For all requests for ambulance transport during two sequential years, the time and date, total run time, and acui...

Three chronic conditions were examined--acute alcohol intoxication, seizure disorder, and respiratory illness--to quantify the extent of repetitive emergency medical services (EMS) use in a defined population. Urban EMS system ambulance data from 1992 to 1994 were analyzed for the three designated conditions with respect to transports by condition...

To examine the effect of emergency immobilization on neurologic outcome of patients who have blunt traumatic spinal injuries. A 5-year retrospective chart review was carried out at 2 university hospitals. All patients with acute blunt traumatic spinal or spinal cord injuries transported directly from the injury site to the hospital were entered. No...

Crack cocaine is commonly smoked in a pipe with a metallic filter made from a steel wool scouring pad. We report an unusual complication of smoking crack cocaine: the aspiration and ingestion of a Brillo® pad filter. A 34-year-old female presented 7 h after drinking beer and smoking crack. She was concerned that she might have inhaled the “screen”...

The reduction of quantitative diagnostic test scores to the dichotomous case is a wasteful and unnecessary simplification in the era of high-speed computing. Physicians could make better use of the information embedded in quantitative test results if modern generalized curve estimation techniques were applied to the likelihood functions of Bayes' t...

A study was done to prospectively compare the pain and distress of urethral mini-catheterization (MC) with the pain and distress of intravenous (IV) catheterization in women. Ten-centimeter visual analog scales were used on which the left end represented "no pain" or "no distress" and the right "the worst pain imaginable" or "extreme distress." Dis...

For many years, multiple linear regression models have been used at a residency program to generate preliminary rank lists of residency applicants. These lists are then used by the admissions committee as an aid in developing a final ranking to submit to the National Residency Match Program (NRMP). A study was undertaken to compare predictions made...

It is uncertain how much diagnostic peritoneal lavage (DPL) fluid must be recovered from abdominal trauma patients to avoid falsely low red blood cell (RBC) counts. A study was carried out to investigate this controversy. A convenience sample of adult abdominal trauma patients in a Level 1 university trauma center who were undergoing DPL with 1 L c...

A prospective comparative trial was conducted to determine the effect of a physician's visual assessment of emergency patients on triage categorization and ability at triage to predict admission. The setting was a university, county, referral center and residency training site. Participants were a consecutive sample of emergency department patients...

To compare the initial emergency medical services (EMS) prehospital assessment of medical and traumatic cardiopulmonary arrest in the pediatric patient with that of the Office of the Medical Investigator (OMI) and assess differences and implications for EMS training and prevention. Retrospective review of ambulance run forms with the OMI autopsy co...

Purpose : Among pediatric patients, cardiopulmonary arrests account for a small, but important, percentage of responses by emergency medical services (EMS). EMS prehospital assessment of medical and traumatic arrests in the pediatric patient were compared with that of the Office of Medical Investigator (OMI) autopsy reports to assess differences an...

Objective: To determine whether hospital employee biological hazardous exposure rates varied with time of day or increased with time interval'into shift. Methods: This was a retrospective occurrence report review conducted at a university hospital with an emergency medicine residency program. Health care worker biological hazardous exposure data ov...

Little is known about the accuracy and reliability of current triage methods. We examined agreement among observers with regard to the need for ED care and the ability to predict at triage the need for admission to the hospital and compared these findings with admission rates after medical evaluation and management. We used a crossover design in wh...

A nonconcurrent prospective cohort study was conducted to evaluate if National Resident Matching Program (NRMP) rank developed using multivariate regression followed by consensus group activity is associated with perceived general performance during emergency medicine residency. All residents graduating from a university hospital-based residency pr...

A cross-sectional study was performed to retrospectively assess self-rated sleep complaints in three groups of subjects: controls without nightmares (N = 77), acute nightmares sufferers (< 6 months duration, N = 36), and chronic nightmare sufferers (> 6 months duration, N = 128). Four specific complaints of sleep disturbance were categorically meas...

The objective of this study was to determine the degree of association of self-estimated scholastic standing (self-rank) with an independent evaluation of the dean's letter (dean's letter score). Applicants to our emergency medicine residency program were asked to estimate their scholastic standing on the application form. A blinded independent rev...

To assess the hydration status of women presenting to an ED with hyperemesis gravidarum and to determine whether clinically relevant changes in orthostatic vital signs occur. A convenience sample of 23 pregnant women who had hyperemesis gravidarum, with each patient serving as her own control. The study took place in the ED observation unit of an u...

Hypothesized that victims of rape would report more nightmares and more disturbed sleep. A retrospective study was conducted on the charts of 598 women presenting to a rape crisis center. The review assessed nightmare frequency and the association between nightmares and disturbed sleep. Of the 598 women, 488 were rape victims and 110 women were vic...

To examine the effect that cerumen occlusion of the ear canal has on infrared tympanic membrane temperature measurement. A prospective, randomized, single-blind human study was carried out in a university hospital observation unit. The subjects were a convenience sample of human volunteers ages 18 years or older who did not have cerumen occlusion o...

We tested the hypothesis that time series analysis can provide accurate predictions of future poison center telephone call volume by a prospective stochastic time series modeling of calls to a university-based regional poison center. All callers evaluated and managed during two sequential years had the time and date of the call recorded in a comput...

An academic emergency group was surveyed to determine if scheduling night shifts in blocks (“floats”) improved attitudes and functioning. Seven physicians worked most of their nights as floats. Another four chose only isolated nights. Float physicians were surveyed for isolated and block nights. Faculty in the float group had poorer attitudes compa...

Time series analysis can provide accurate predictions of emergency department volume, length of stay, and acuity. Prospective stochastic time series modeling. A university teaching hospital. All patients seen during two sequential years had time of arrival, discharge, and acuity recorded in a computer database. Time series variables were formed for...

The hypothesis that the use of an observation unit (OU) in the emergency department (ED) results in monetary savings by lowering the hospital admission rate for asthma was studied in a retrospective comparative cohort at an urban university county hospital. All acute asthmatic patients seen in the ED during a 22-month period were included. Preobser...

The treatment of live insects in patients' ears is controversial. To determine which chemical agent is most effective for immobilizing and killing intra-aural cockroaches, we carried out the following investigation. An in vitro blinded comparative study. A model was developed in which live cockroaches were submerged in microscope immersion oil, 2%...

To explore the relationship between social conditions and fire mortality rates among children. Retrospective analysis of fire fatalities in children 0 to 14 years old in New Mexico. State Office of the Medical Investigator. All 57 New Mexico children 0 to 14 years old who died from fire-related injuries from 1981 through 1991. Medical investigator...

A 22-month-old child had a generalized tonic-clonic seizure during attempted orotracheal intubation and broke the laryngoscope bulb with his teeth. The glass was swallowed but passed uneventfully through the gastrointestinal tract. The possibility of this unusual complication should be considered when patients at risk for seizures are intubated by...

To investigate the role of cranial magnetic resonance (MR) imaging in evaluating patients discharged from the emergency department after minor head injury. A prospective blinded cohort study. University hospital ED. Fifty-eight patients with minor head injury who were discharged from the ED with written head injury instructions. Patients admitted t...

The objective of this study was to determine which airway maneuvers cause the least cervical spine movement. A controlled laboratory investigation was performed in a radiologic suite, using eight human traumatic arrest victims who were studied within 40 minutes of death. All subjects were ventilated by mask and intubated orally, over a lighted oral...

Allergic reactions have been described as an occupational hazard among nurses and pharmaceutical workers who handle psyllium-containing laxatives. This study reports the case of a 38-year-old female nurse who ingested a bowl of psyllium-containing Heartwise Cereal (Kelloggs, Battle Creek, MI) and 25 minutes later developed severe systemic anaphylax...

The authors propose that pH buffering of bupivicaine with sodium bicarbonate reduces the pain associated with its local subcutaneous infiltration. In a double-blind, prospective study, 62 healthy adult volunteers received a 0.5 mL subcutaneous infiltration of 0.5% buffered bupivicaine into the dorsum of a randomly chosen hand. The pH was adjusted t...

There is considerable under-reporting of contaminated occupational needlestick and other sharp object injuries among emergency health care workers. A convenience sample of emergency physicians, emergency nurses, and emergency medical technicians (EMTs). A survey instrument eliciting demographic and work-related factors was developed and administere...

That visual colorimetry can be used to rapidly and precisely estimate the erythrocyte count of 1:5 dilutions of simulated peritoneal lavage fluid. Fifty-four normal adult human subjects. The automated or chamber RBC count is often used on fluid obtained by peritoneal lavage in patients with abdominal trauma to help determine the need for surgery. U...

We compared the effect of topical 0.5% tetracaine, 1:2,000 epinephrine, and 11.8% cocaine (TAC) with 1% lidocaine infiltration on bacterial proliferation in experimental lacerations. Forty-eight lacerations were made on the backs of Hampshire pigs, inoculated by injection with infectious doses of Staphylococcus aureus and randomly anesthetized with...

A 20-year-old woman was struck by lightning while seeking shelter under a tree. The discharge entered at the site of the victim's behind-the-ear type hearing aid, destroying it. She suffered cardiorespiratory arrest, burns, left ventricular failure, and myoglobinuria, yet recovered fully. It is widely known that carrying a metallic object such as a...

Previous studies have shown that acidic pH and several ingestible substances can cause misleading guaiac tests of gastric aspirates. In this in vitro study, over 100 foods, beverages, and drugs were diluted to concentrations potentially present in the stomachs of outpatients being evaluated for gastrointestinal bleeding. These were mixed with known...

Previous studies have shown that ipecac-induced emesis, even if instituted very early, removes only a mean of 28% to 45% of an ingested tracer. Because vomiting is an ancient reflex that occurs in mammals, reptiles, and other animals, we speculated that, in humans, maintaining a sitting rather than a horizontal posture during induced emesis might d...

It has been widely held that gastric lavage is more unpleasant than ipecac-induced emesis. In fact, patients are occasionally threatened with large rubber tubes in order to persuade them to drink ipecac. To confirm that this assumption exists, we asked 41 emergency physicians and nurses who had never personally undergone either procedure to estimat...

A 48-year-old man with Wolff-Parkinson-White syndrome presented with paroxysmal supraventricular tachycardia. Prior episodes had required inpatient drug therapy or cardioversion. Attempts at conversion to normal sinus rhythm with vagal maneuvers were unsuccessful. Inflation of military antishock trousers resulted in rapid termination of the arrhyth...

In New Mexico, chile peppers (Capsicum annum) are prepared by roasting and manually removing the skin from the fruit. Peeling is often done barehanded and may cause prolonged burning pain, irritation, and erythema but not vesication. In a survey of elderly Hispanic women, treatment with oils or cool tap water were frequently used home remedies. Twe...

Ipecac-induced emesis and gastric lavage are the two procedures most widely used to evacuate the stomachs of patients who have ingested poisons. To resolve a long-standing controversy over the relative efficacy of these two methods, the authors carried out a controlled study in which they administered 25 100-micrograms tablets of cyanocobalamin (vi...

A comparison of several maneuvers that are believed to increase vagal tone was made by measuring the carotid sinus with an ultrasound device. For 20 healthy volunteers the mean carotid sinus diameter was 5.7 mm supine, 6.1 mm in the Trendelenberg position, 6.5 mm after supine medical antishock trousers (MAST) inflation, 7.0 mm after MAST inflation...

A 20-year-old man developed sinoatrial Wenckebach after moderate blunt chest and cardiac trauma from a motor vehicle accident. This unusual dysrhythmia is manifested by grouped beating, a constant PR interval, progressive shortening of the cycle length, and repetitive pauses. Sinoatrial Wenckebach has not previously been described in association wi...

We have noted that inflation of the military antishock trousers (MAST) successfully converted five of six patients with paroxysmal supraventricular tachycardia to normal sinus rhythm. In all patients the usual "vagal" maneuvers were tried first and were unsuccessful. MAST inflation may be a safe and useful addition to the traditional vagal maneuver...

A 21-year-old man with an innocent-appearing, self-inflicted stab wound to the left upper anterior chest developed pneumoperitoneum and pneumomediastinum seven hours after the injury. At laparotomy he had lacerations of the left hemidiaphragm and anterior wall of the stomach, which were surgically repaired. He recovered without complications. Altho...

Hermann BOERHAAVE introduced clinical thermometry into the practice of medicine in 1709, and since that time a measurement of body temperature has been included in the early evaluation of most sick patients.1 This is because useful clues about the nature and severity of a patient's illness can often be derived from the pattern and magnitude of the...

Roentgenograms of 66 different kinds of glass fragments embedded in chicken legs were taken to evaluate the roentgenographic detectability of glass in an animal tissue similar in size and structure to the human hand or foot. All 66 specimens were easily seen. The presence of lead or other heavy elements was not required for visualization. Fragments...

Roentgenograms of 66 different kinds of glass fragments embedded in chicken legs were taken to evaluate the roentgenographic detectability of glass in an animal tissue similar in size and structure to the human hand or foot. All 66 specimens were easily seen. The presence of lead or other heavy elements was not required for visualization. Fragments...

A 24-year-old man with respiratory failure, severe bradycardia, and coma following heroin overdose was successfully resuscitated using endotracheally administered naloxone hydrochloride (Narcan). Post-treatment naloxone assays demonstrated the presence of large amounts of naloxone in the patient's blood and urine. Serial serum naloxone levels over...

A young presented to the emergency department after ingesting multiple drugs. Upper gastrointestinal bleeding developed after emesis was induced with syrup of ipecac. A small Mallory-Weiss tear of the cardioesophageal junction was found at endoscopy. This case is presented to alert physicians to this uncommon complication of ipecac-induced emesis.

The temperature-dependent dissociation of neutral salt-soluble collagen into its component chains was measured in 0.6–1.6 M urea solutions at pH 7.3. The temperature-dependent association of the same radiocactively labeled collagen into fibers was measured in 0–0.4 M urea solutions, pH 7.3. The effect of urea on the temperature, Tm(G), for half dis...