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Biomedical subjects

A B Sanders

Publications and source records attributed to A B Sanders.

At least 91 records · Page 5Linked to original sources
PubMed1987

Long-term survival with open-chest cardiac massage after ineffective closed-chest compression in a canine preparation.

The ultimate goal of cardiopulmonary resuscitation (CPR) is long-term, neurologically intact survival. This study examined whether open-chest cardiac massage could improve 7 day survival and neurologic function when instituted after the failure of standard closed-chest compression CPR. Twenty-nine mongrel dogs were anesthetized and then instrumented with catheters to monitor right atrial and ascending aortic pressures. Ventricular fibrillation was induced and after 3 min standard CPR was begun. Standard CPR was performed with a Thumper programmed for 2 inch chest compressions at 60/min with a 50% duty cycle. External defibrillation was attempted twice after 15 min of ventricular fibrillation. Unsuccessfully defibrillated animals were randomly assigned to either an additional 2 min of continued closed-chest compressions, or 2 min of open-chest cardiac massage. All animals underwent a period of advanced cardiac life support and were followed until they were resuscitated or died. Follow-up care, including scoring of neurologic deficit, was performed for 7 days. In dogs receiving open-chest cardiac massage there was significantly more immediate resuscitation success (14/14 vs 5/14; p less than .005), 24 hr survival (12/14 vs 4/14; p less than .005), and 7 day survival (11/14 vs 4/14; p less than .02) than in those receiving continued closed-chest compression. Open-chest cardiac massage significantly improved long-term outcome when instituted after 15 min of ineffective closed-chest compression.

Animals↗
PubMed1986

Neurologic outcome following successful cardiopulmonary resuscitation in dogs.

Successful cardiopulmonary resuscitation necessitates that both myocardial and central nervous system function be restored with minimal long-term damage. Recent resuscitation research has emphasized minimizing neurologic damage during and after cardiopulmonary resuscitation. However, whether neurologic damage is a major cause of death or morbidity following successful cardiopulmonary resuscitation is unknown. This study examined the role of neurologic injury as a cause for morbidity and mortality following cardiopulmonary resuscitation, and if parameters used successfully during resuscitation for assessing the potential for myocardial salvage, could also be used to predict neurologic outcome. Eighty-eight mongrel dogs underwent 3 min of untreated ventricular fibrillation and either 15 or 17 min of cardiopulmonary resuscitation. Twenty-four hour survivors were evaluated with a neurologic deficit scoring system. Thirty-one percent of these animals were never resuscitated. Twenty-eight percent were resuscitated, but expired prior to 24 h. Approximately half of those who expired after resuscitation died from apparent neurologic sequellae. Forty-one percent of the 88 animals survived for 24 h. Two-thirds of these survivors were completely neurologically normal, while one-third were neurologically impaired. Hemodynamic parameters useful in assessing cardiovascular prognosis were not helpful in predicting neurologic outcome. Hence, although the majority of resuscitated animals did not suffer neurologic damage, up to one-third did exhibit neurologic impairment following resuscitation. Neurologic injury is also a major contributor to early death following successful resuscitation. Hemodynamic parameters of cardiovascular recovery do not predict neurologic outcome after prolonged cardiopulmonary resuscitation.

Animals↗
PubMed1986

Survey of undergraduate emergency medical education in the United States.

To determine the status of undergraduate education in emergency medicine, questionnaires were sent to 141 medical schools. Of the 135 schools responding, 15.2% require emergency medicine courses in the fourth year (mean, 164 hours); 11.9% require these courses (average, 84 hours) in the third year. Emergency medicine is offered in 21.8% of second-year and 37.9% of first-year curriculums. Training in cardiopulmonary resuscitation is offered in 96% of the schools responding, and certification is required in 53%. Training in advanced cardiac life support is offered in 73% of schools, with 23% requiring it for graduation. Training in advanced trauma life support is offered in 17.2% of schools. Osteopathic schools require more time for emergency medicine in the clinical years but less time in formal lectures. Schools with a residency program in emergency medicine more frequently offer emergency medicine in the preclinical years. This survey provides some basic data on the status of undergraduate emergency medicine education in medical school curriculums, and it encourages medical educators to review the undergraduate curriculum to ensure that students receive adequate exposure to the essentials of emergency medicine.

Curriculum↗
PubMed1986

Core content survey of undergraduate education in emergency medicine.

One hundred forty-one medical schools were surveyed to determine the emergency medicine core content topics and skills being taught in the curricula. Responses were obtained from 96 schools through two mailings and a telephone followup. Most topics surveyed were offered in the vast majority of medical schools (greater than 92%) with the exception of emergency medical services (offered in 79% of schools). Emergency medicine topics were a required part of the curriculum in a much smaller percentage of schools. No subtopics in toxicology, ophthalmologic emergencies, or emergency medical services were required in more than 30% of schools. The survey showed a similar pattern of these skills being offered in most schools, but required in a smaller number. For example, while C-spine immobilization is taught in 90% of schools, it is required in only 46%. Educators must consider a coherent, interdisciplinary knowledge base and skills list for their medical school curricula.

Clinical Competence↗
PubMed1986

An analysis of Part II of the National Board of Medical Examiners Test with regard to questions in emergency medicine.

We conducted a study to determine the number of items and successful response rate to questions specific to emergency medicine on the National Board of Medical Examiners Test, Part II (NBME-II). The 1979 and 1983 NBME-II examinations were reviewed by a subcommittee of the Society of Teachers of Emergency Medicine. Items pertaining directly to the core content knowledge base were selected and classified by core content topic and NBME subspecialty. Overall, 14.7% of the 892 items on the 1983 examination pertained to emergency medicine. The successful response rate was 73.3% for the emergency medicine questions. When looked at by sub-specialty categories, the percentage of items pertaining to emergency medicine varied from 1.3% in obstetrics/gynecology to 27.2% of the items in surgery. On the 1979 examination, 13.8% of the questions pertained to emergency medicine, with a successful response rate of 67.1%. Analysis of the data by core content topic showed that some areas (orientation to emergency medicine, ophthalmologic diseases, environmental emergencies, and behavioral emergencies) had two items or fewer on both examinations. Other topics, such as trauma, showed a consistent pattern of questions on both examinations. Our study emphasizes the difficulty of attempting to test competency in the clinical knowledge base of medicine within the artificiality of knowledge base departmental boundaries.

Certification↗
PubMed1986

An analysis of medical care at mass gatherings.

Emergency medical care at public gatherings is haphazard at best and dangerous at worst. The Arizona chapter of the American College of Emergency Physicians, through the Chapter Grant Program, studied the level of medical care provided at public gatherings in order to develop guidelines for emergency medical care at mass gatherings. The study consisted of a survey of medical care at 15 facilities providing events for the public. The results of these surveys showed a wide variation of medical care provided at mass events. Of the 490 medical encounters reviewed, 52.2% were within the realm of care of paramedics, but not basic emergency medical technicians. The most common injuries/illnesses were lacerations, sprains, headaches, and syncope. Problems noted included poor documentation and record keeping of medical encounters, a tendency for prehospital care personnel to make medical evaluations without transport or medical control, and variability of care provided. Based on this survey and a literature review, guidelines for medical care at mass gatherings in Arizona were determined using an objective-oriented approach. It is our position that event organizers have the responsibility of ensuring the availability of emergency medical services for spectators and participants. We recommend that state chapters or National ACEP evaluate the role of emergency medical care at mass gatherings.

Arizona↗
PubMed1985

Coronary perfusion pressure during cardiopulmonary resuscitation.

Currently, there is no way to measure the effectiveness of cardiopulmonary resuscitation in humans. The literature suggests that minimum aortic diastolic and estimated coronary perfusion pressures during cardiopulmonary resuscitation (CPR) in the animal model correlate with higher resuscitation rates. Six patients were studied during CPR to determine the arterial diastolic and estimated coronary perfusion pressures (arterial minus right atrial diastolic pressures). Mean arterial pressures were 27/11 mm Hg, central venous pressures were 32/10 mm Hg, and the mean estimated coronary perfusion pressure was only 1 mm Hg. None of the six patients survived. This study demonstrates that the techniques of measuring hemodynamic values during CPR is practical. Poor estimated coronary perfusion pressures were obtained from the six patients studied. This study should be extended to include a large number of patients to determine whether these hemodynamic parameters can be used as prognostic indicators of successful resuscitation in humans.

Adult↗
PubMed1985

Expired PCO2 as an index of coronary perfusion pressure.

Presently, there is no reliable noninvasive method of assessing the adequacy of cardiopulmonary resuscitation (CPR). Studies of animals have shown that during prolonged arrest the coronary perfusion pressure (CPP) is correlated with successful resuscitation. During previous studies it appeared that expired PCO2 correlated with CPP. To investigate this relationship, eight mongrel dogs (mean weight, 22.7 +/- 5.8 kg) were anesthetized with pentobarbital. Catheters were placed in the thoracic aorta and right atrium of each dog. Each animal was electrically fibrillated, and CPR was started using mechanical resuscitator. The PCO2 was determined at end expiration using a Hewlett Packard 47210A Capnometer with the electrode attached to the endotracheal tube. After 10, 15, 20, or 25 minutes of ventricular fibrillation and closed-chest massage, a thoracotomy was performed, and internal massage was begun. Coronary perfusion pressure was calculated at least each minute and correlated with the PCO2 values. A correlation coefficient of 0.78 was calculated based on 368 data points for eight dogs (P less than 0.01). The results of this study indicate that expired PCO2 is positively correlated with CPP in the canine model of CPR. Inasmuch as CPP correlates with survival in prolonged CPR, the noninvasive measurement of PCO2 may be a useful method of assessing the adequacy of CPR.

Animals↗
PubMed1985

Emergency department management of the sexual assault victim.

The optimal management of the sexual assault victim involves a multidisciplinary effort on the part of all legal, police, medical, and support personnel who interface in the emergency department. History, general physical examination, and pelvic examination are performed methodically, keeping in mind that the primary goal is to tend to the patient's medical needs. The gathering of evidence proceeds simultaneously with the physical examination. Evidence to be obtained and techniques are reviewed. Treatment entails attention to physical injuries, potential venereal disease and pregnancy, and psychiatric intervention. Management of the male rape victim or child victim of sexual abuse requires special attention to the peculiarities of those problems.

Adolescent↗
PubMed1985

Expired PCO2 as a prognostic indicator of successful resuscitation from cardiac arrest.

We performed a study to determine if the measurement of expired PCO2 during CPR for cardiac arrest could be used as a prognostic indicator of successful resuscitation. Twelve mongrel dogs were fibrillated electrically, and external chest massage and assisted ventilation were applied for 15 minutes. Expired PCO2 and aortic and right atrial pressures were monitored each minute of arrest. Coronary perfusion pressure (CPP) was calculated by subtracting the right atrial from the aortic diastolic pressure. Half the dogs received high-force chest compression (80 lb) and half received low-force chest compression (40 lb). The six dogs that received high-force compression were resuscitated successfully. The expired PCO2 was significantly higher in the successfully resuscitated dogs (expired PCO2 = 9.6 +/- 3.2 mm Hg) when compared to those dogs that died (expired PCO2 = 3.2 +/- 1.1 mm Hg, P less than .01). Expired PCO2 was highly correlated (r = 0.91, P less than .01) with the CPPs. The measurement of expired PCO2 during attempted CPR may be useful as a noninvasive indicator of CPP and adequate technique. Further studies on the use of this technique as an assessment criterion are warranted.

Animals↗
PubMed1985

Importance of the duration of inadequate coronary perfusion pressure on resuscitation from cardiac arrest.

The effect of the duration of inadequate coronary perfusion pressure on resuscitation from cardiac arrest was examined in 32 mongrel dogs with a mean weight of 22 +/- 5 kg. In all dogs, the heart was electrically fibrillated and closed chest compression with assisted ventilation was performed for 15 minutes. At this time, all dogs had an inadequate coronary perfusion pressure (mean 7 +/- 9 mm Hg) and were randomized to a control group (group 1) with continued closed chest compression or to one of the three groups with open chest cardiac massage. These three groups differed only in the duration of continued closed chest compression before initiation of open chest massage (15, 20 and 25 minutes, respectively, in groups 2, 3 and 4). The control group (group 1) had no significant increase in coronary perfusion pressure, and only one of the eight dogs could be resuscitated. The three groups with open chest cardiac massage had a significant increase in coronary perfusion pressure (from 5 +/- 9 to 51 +/- 26 mm Hg, p less than 0.05), but the rate of successful resuscitation depended on the duration of inadequate coronary perfusion pressure before cardiac open chest massage. In group 2, six of eight dogs were resuscitated (p less than 0.05 compared with the control group); in group 3, three of eight dogs were resuscitated and in group 4 none of the eight dogs was resuscitated. The resuscitation rate was significantly (p less than 0.05) greater in group 2 than in group 4. These findings indicate that techniques that improve coronary perfusion pressure during cardiopulmonary resuscitation must be applied before extensive myocardial cellular dysfunction occurs if the probability of successful resuscitation is to be improved.

Animals↗
PubMed1985

Difficult intubations: aids and alternatives.

Physicians who are likely to encounter emergency situations should know how to secure an airway with techniques other than the standard methods of oral and nasal intubation. The approach and the equipment used depend on the clinician's abilities and experience. Aids and alternative techniques include use of the fiberoptic laryngoscope, guided retrograde transcricoid intubation, esophageal devices, cricothyrotomy, tracheotomy and transtracheal jet ventilation.

Cricoid Cartilage↗
PubMed1984

MAST suit update.

In recent years, the use of the MAST suit has become commonplace. While no controlled human studies have shown the device's efficacy, extensive clinical experience suggests that it is practical and useful in combating shock, stabilizing fractures, and promoting hemostasis. Studies indicate that the antishock trousers elevate blood pressure primarily by increasing peripheral vascular resistance. Proper application and removal of the device are crucial. A number of potential complications exist, but are infrequent and rarely should preclude MAST suit use. Further studies are necessary to prove the efficacy of the device and clearly define its role in patient management.

Altitude↗