Search PubMed⌕ Search

Biomedical subjects

A N Laggner

Publications and source records attributed to A N Laggner.

At least 91 records · Page 5Linked to original sources
PubMed1997

The emergency department in a 2000-bed teaching hospital: saving open ward and intensive care facilities.

Providing emergency medicine at the entrance to the hospital proves to be a sufficient link between pre- and inhospital medical care. The aim of our study is to investigate how many open ward and intensive care facilities can be saved within the hospital by the emergency department. Therefore, the data of our emergency department within a 2000-bed teaching hospital are retrospectively analysed. Unstable life-threatening emergencies for acute care, stable for immediate care and non-life-threatening emergencies are defined. Patients were discharged, admitted to an open ward, intensive care unit, the operation theatre or died. According to the level of care needed in the emergency department the continuing medical management is investigated. Over a 2-year period, 102,411 patients entered our emergency department. Overall 1498 (1%) needed acute care, 3652 (4%) immediate care and 97,261 (95%) delayed care. Of the acute care patients, 29 (2%) were discharged, 573 (38%) were admitted to an open ward, 551 (37%) to an intensive care unit, 67 (4%) needed surgery and 278 (19%) died. Of the immediate care patients, 1611 (44%) were discharged, 1755 (48%) were admitted to an open ward, 551 (37%) to an intensive care unit, and 286 (8%) needed surgery. Of the delayed care patients, 93061 (96%) were discharged and 4200 (4%) were admitted to an open ward. Of 5150 patients with life-threatening diseases, 551 (11%) needed an intensive care unit and 2328 (45%) an open ward. Providing acute and immediate care in our emergency department saves both intensive care and open ward facilities of the hospital.

Adult↗
PubMed1997

Early defibrillation.

Explore the source record for details and available documents.

Cardiopulmonary Resuscitation↗
PubMed1996

Creatine kinase-mb fraction and cardiac troponin T to diagnose acute myocardial infarction after cardiopulmonary resuscitation.

OBJECTIVES: This study sought to evaluate the diagnostic value of the biochemical markers creatine kinase (CK), creatine kinase-MB fraction (CK-MB) and cardiac troponin T (cTNT) to diagnose acute myocardial infarction (AMI) after cardiopulmonary resuscitation (CPR). BACKGROUND: Elevations of CK and CK-MB after CPR are a frequent finding and might be associated with ischemic myocardial injury, as well as physical trauma to the chest. METHODS: Patients who had cardiac arrest and primary successful resuscitation were included in the study. The diagnosis of AMI was confirmed or ruled out by means of typical electrocardiographic findings, thallium-201 myocardial scintigraphy or autopsy, if death occurred during the hospital period, in 39 primary survivors of sudden cardiac death. In 24 patients (62%) the diagnosis of AMI was established. Serum cTNT, CK and CK-MB were measured, and the CK-MB/CK ratio was calculated on admission and after 12 h. RESULTS: On admission all markers of myocardial injury proved to be weak methods for the diagnosis of AMI. After 12 h cTNT as well as CK-MB exhibited a similar diagnostic performance; CK and the CK-MB/CK ratio proved to be worthless. Sensitivity and specificity for a cTNT cutoff value of 0.6 ng/ml, 12 h after cardiac arrest, were 96% and 80%, respectively. For a CK-MB cutoff value of 26 U/liter, sensitivity was 96% and specificity was 73%. CONCLUSIONS: Cardiac TNT and CK-MB are valuable tools in detecting AMI as the cause of sudden cardiac death. However, there is a considerable lack of sensitivity and specificity. Cardiac injury is probably caused not only by AMI, but also by myocardial damage related to CPR efforts.

Animals↗
PubMed1996

Creatine kinase and creatine kinase-MB release after nontraumatic cardiac arrest.

The aim of the study was to describe the course of serum creatine kinase (CK) and its MB fraction (CK-MB) in patients surviving cardiac arrest, and to identify factors influencing CK and CK-MB release. The study was set in the community of Vienna, Austria. Data concerning cardiopulmonary resuscitation, collected within a period of 33 months, were evaluated retrospectively and compared with laboratory blood investigations collected prospectively (on admission and after 6, 12, and 24 hours) in 107 adult patients surviving a witnessed cardiac arrest for 24 hours. CK and CK-MB were elevated in >75% of the patients within 24 hours. Release of CK and CK-MB was mainly associated with electrocardiographic evidence of acute myocardial infarction (AMI) cumulative energy administered during defibrillation, and duration of chest trauma by compression. The CK-MB/CK ratio was elevated in 32% of the patients. Of patients with electrocardiographic evidence of AMI, only 49% had an elevated CK-MB/CK ratio. In conclusion, the elevation in serum CK and CK-MB fraction in patients after nontraumatic cardiac arrest is a frequent finding, and is associated with ischemic myocardial injury, as well as physical trauma to the chest. This should be considered when interpreting the course of CK and CK-MB fraction for the diagnosis of AMI.

Adult↗
PubMed1996

Hemodynamic effects of active compression-decompression after prolonged CPR.

BACKGROUND: This study was designed to test the effects of active compression-decompression (ACD) versus standard (STD) cardiopulmonary resuscitation (CPR) on hemodynamics after prolonged cardiac arrest (CA). METHODS AND RESULTS: After nontraumatic prehospital CA, 21 patients were resuscitated in a prospective nonblinded setting sequentially with STD and ACD CPR at the emergency department, if it had not been possible to achieve restoration of spontaneous circulation (ROSC) before admission. The compression rate was 80/min with a 50% duty cycle, and 1 mg epinephrine was given every 5th min. Invasive arterial, central venous pressure and end tidal CO2 (ETCO2) were monitored. Comparing coronary perfusion pressure (CoPP) and ETCO2, no significant differences between STD and ACD CPR were found. In 3 cases ROSC could be achieved for a short time. CONCLUSIONS: In our study, a comparison of STD and ACD CPR revealed no significant differences in coronary perfusion pressures and ETCO2. We conclude that after prolonged CA, ACD CPR does not provide an apparent hemodynamic advantage over STD CPR.

Aged↗
PubMed1996

Analysing calls by lay persons reporting cardiac arrest.

Prior to establishing a protocol for pre-arrival instructions for cardio-pulmonary resuscitation in the Vienna emergency medical system dispatch centre, a study was performed to determine whether any problems exist which may compromise guidance for basic life-support on the telephone. To evaluate the feasibility of prearrival instructions, a retrospective analysis of cardiac arrest calls was performed. We reviewed the Vienna emergency medical services dispatch centre tape recordings, ambulance run sheets and the hospital charts of 114 patients suffering from atraumatic cardiac arrest. Analysis showed that in 59 cases the arrest occurred in the victim's home. The telephone and the patient were either in the same or in adjoining rooms in 55% of the calls. We did not experience any technical or language difficulties. The caller and victim were related in 51 cases. The callers were completely calm in 77% and fairly calm in an additional 15%. Not one caller was distraught. Our data show that most objections to the feasibility of pre-arrival instructions can be refuted. We conclude that in Vienna the setting and location of arrest will impose few problems on the performance of bystander-cardio-pulmonary resuscitation using pre-arrival instructions given by dispatchers.

Austria↗
PubMed1996

Usefulness of a new rapid bedside troponin T assay in patients with chest pain.

We evaluated the usefulness of a rapid, qualitative, bedside immunoassay for cardiac-specific troponin T in patients with chest pain. A concordant result between quantitative troponin T and qualitative troponin T assay was observed in 183 (96%) tests. The sensitivity of the rapid troponin T assay for detecting acute myocardial infarction increased significantly according to the number of hours elapsed after onset of chest pain from 17% for patients presenting within 4 h to 71% for patients presenting in the time interval of greater than 8 h from onset of chest pain (P < 0.001). Specificity ranged from 83 to 93% in the three time intervals evaluated. A concordant result between CK-MB-measurement and rapid troponin T assay was observed in 159 (83%) tests. In 14/191 tests a positive rapid troponin T and a negative CK-MB assay was observed. In 9/14 (64%) cases this result was true positive for the rapid troponin T assay and in 5/14 (36%) cases false negative. As sensitivity and specificity of the rapid troponin T assay are comparable with CK-MB measurements, rapid troponin T assay is a simple and useful laboratory tool for the bedside triage in patients with chest pain.

Adult↗
PubMed1996

Prehospital opiate emergencies in Vienna.

To establish baseline data on prehospital emergencies caused by opiates during a 4-month period, a retrospective analysis of run records of the Emergency Medical System in Vienna, the capital of Austria, was conducted. During the study period, there were 308 opioid emergencies involving 240 persons, an average of 2.5 overdoses per day. Severely compromised patients were treated in 67.8% of the 308 emergencies, and 79.3% of emergencies were transported to hospital; 52.5% of the involved persons were younger than 22 years of age. Sex distribution and periodicity and frequency of emergencies differed among age groups. A subgroup of individuals involved repeatedly in emergencies was identified, partly showing temporal clustering of fatal and nonfatal overdoses. Persons involved in opiate emergencies belong to heterogenous subgroups. At a local level, research should be initiated to clarify the pattern and impact of these emergencies on overall drug abuse prevention.

Adult↗
PubMed1996

After antagonization of acute opiate overdose: a survey at hospitals in Vienna.

This study describes the clinical management and characteristics of people who, following acute opioid overdose, are taken to hospital after efficient antagonization by the pre-hospital emergency service. In addition, it defines areas of interest for further research. Over a 4-month period (September-December 1993) we collected data by a structured protocol sheet on patients' characteristics, anamnestic data on abuse and emergencies, clinical presentation, treatment by specific antidote and routine laboratory investigations. Outcome was verified by retrospective review of prehospital and forensic data. We studied 77 subjects, predominantly young males, who were involved in 83 emergencies, mostly occurring at weekends. In more than 60% of cases a single administration of specific antidote sufficed to stabilize the patients; 64% of patients left hospital against medical advice after an average stay of less than 6 hours; 46% denied daily opioid abuse and half the subjects, especially younger drug-users, seemed interested in counselling. This hospital-based study did not provide reliable data on the epidemiology of opioid overdose. Clinical management is determined by experience, pragmatism and beliefs. Efforts towards secondary prevention of drug problems at emergency departments might be warranted, and further research on pattern and management of opioid overdose is needed.

Adolescent↗
PubMed1996

Assessment of myocardial injury by serum tumour necrosis factor alpha measurements in acute myocardial infarction.

Clinical and experimental data have shown that after acute myocardial infarction there is a significant release of tumour necrosis factor alpha. Therefore, an attempt was made to correlate changes in serum tumour necrosis factor alpha concentrations with indices of infarct extent in patients with acute myocardial infarction. In 50 patients with acute myocardial infarction, blood samples for evaluation of tumour necrosis factor alpha and alpha-hydroxybutyrate-dehydrogenase were collected every 6 h until 120 h after admission. Infarct extent was estimated by clinical parameters such as the occurrence of heart failure and rhythm disturbances, by enzymatic methods such as cumulative release of alpha-hydroxybutyrate-dehydrogenase and imaging techniques, by late resting single photon emission tomography--201 thallium scintigraphy--using an extent score and by echocardiography using a wall motion index. The maximum change in serum tumour necrosis factor alpha after infarction (delta TNF) was calculated by subtracting tumour necrosis factor alpha concentration on admission from peak tumour necrosis factor alpha concentration. The average peak tumour necrosis factor alpha level was observed 84 h after admission (median: 12 pg.ml-1). Between the 72nd and the 96th h no significant changes in tumour necrosis factor alpha values were observed. Analysis of the data showed that larger delta (TNF) values were found to be associated significantly with signs of heart failure (P = 0.003), the presence of rhythm disturbances (P = 0.001), increased enzymatic infarct extent indicated by cumulative release of alpha-hydroxybutyrate-dehydrogenase (r = 0.74; P < 0.001), large myocardial perfusion defects measured with 201 thallium scintigraphy (r = 0.80; P < 0.001), and a considerable number of left ventricular wall motion abnormalities (r = 0.57; P < 0.001). In conclusion, delta (TNF) is a reliable method of assessing damage severity in the myocardium after acute myocardial infarction. As only two blood samples are necessary within 84 h, the method may be one of the more convenient for the assessment of infarct size in clinical practice.

Adult↗
PubMed1996

Accuracy and reliability of noninvasive continuous finger blood pressure measurement in critically ill patients.

OBJECTIVE: To evaluate the accuracy and reliability of noninvasive continuous finger blood pressure measurement in critically ill patients. DESIGN: Prospective data collection. SETTING: Emergency department in a 2,000-bed hospital. PATIENTS: Thirty-nine patients admitted to the emergency department requiring invasive arterial blood pressure monitoring were enrolled to the study protocol. INTERVENTIONS: Continuous noninvasive blood pressure measurement was performed on the middle phalanx of the second and third finger, using a test instrument which provides continuous arterial waveform display with the use of a finger cuff. Invasive mean arterial blood pressure measurement was done by cannulation of the radial artery and direct transduction of the systemic arterial pressure waveform. MEASUREMENTS AND MAIN RESULTS: Three thousand one hundred eighteen pairs of simultaneous finger cuff and intra-arterial blood pressure measurements were collected in 1-min intervals from 39 patients over a total of 51.8 hrs. The overall discrepancy between both measurements was 0.10 mm Hg. The standard deviation of the differences was +/- 5.02 mm Hg. The mean bias in patients treated with catecholamines was 0.01 mm Hg and was not different from the bias observed in patients without catecholamines (mean bias: 0.23 mm Hg; p > .22). Whereas 95% of all comparisons between finger cuff and intra-arterial measurement had a discrepancy < or = +/- 10 mm Hg, 4.7% had a discrepancy between +/- 10.1 to 15 mm Hg and 0.3% exhibited a discrepancy > +/- 15 mm Hg. In 29 (74%) patients, the duration of errors > 10 mm Hg was < or = 1 min. In seven (18%) patients, the duration of errors > 10 mm Hg was between 2 to 3 mins and in three (8%) patients, the errors lasted for > 3 mins. CONCLUSIONS: Our data provide a guide to the accuracy and reliability of noninvasive finger blood pressure measurements in critically ill patients. Although most test instrument measurements were reliable, in 8% of all patients large discrepancies (> 10 mm Hg) between both measurements with a duration of > 3 mins were noted. Concerning the considerable risk for arterial cannulation, our preliminary data demonstrate that the test instrument (PORTAPRES, TNO Biomedical Instrumentation Research Unit; The Netherlands) is an advance in noninvasive monitoring of critically ill patients and may be useful in most emergency clinical settings.

Adult↗
PubMed1996

Systemic and cerebral oxygen extraction after human cardiac arrest.

The aim of this study was to observe cerebral and systemic oxygen extraction after human cardiac arrest with return of spontaneous circulation. Eight adult patients after non-traumatic, cardiac arrest were included. Cerebral and systemic oxygen extraction ratios were measured together with haemodynamic variables beginning 2 hours after cardiac arrest and every 4 hours thereafter until 24 hours. Between 2 and 12 hours after cardiac arrest cerebral oxygen extraction values ranged from very low over normal to very high. In the further course these values were reduced until 24 hours in six patients. Two patients who were still alive after 6 months, both severely mentally disabled, had a higher cerebral oxygen extraction ratios in comparison with non-survivors. Systemic oxygen extraction seemed to vary more than the cerebral oxygen extraction. The two long-term survivors had normal to supranormal values from 8 to 24 hours. In conclusion cerebral oxygen extraction was higher in long-term cardiac arrest survivors than in non-survivors between 12 and 24 hours after the event. Further, a better quality of neurological recovery was associated with higher cerebral oxygen extraction. Systemic oxygen extraction was also impaired, but to a lesser extent, especially in long-term survivors.

Aged↗
PubMed1996

Arterial blood pressure after human cardiac arrest and neurological recovery.

BACKGROUND AND PURPOSE: In animal cardiac arrest studies, outcome has been improved by inducing arterial hypertension early after return of spontaneous circulation. The aim of our study was to evaluate whether arterial blood pressure within the first minutes and hours after return of spontaneous circulation influences neurological recovery in human cardiac arrest survivors. METHODS: Of 136 retrospectively evaluated patients after sudden cardiac death, two groups were defined: group 1, mean arterial blood pressure (MABP) within 5 minutes after return of spontaneous circulation above 100 mm Hg; group 2, MABP of 100 mm Hg or less. Thereafter MABP was measured every 5 minutes until 2 hours after return of spontaneous circulation. The groups were compared in regard to age, sex, in/out of hospital, witnessed/not witnessed, first electrocardiographic rhythm, time from cardiac arrest to beginning of life support and to return of spontaneous circulation, cumulative epinephrine dose administered, and best neurological outcome within 6 months. RESULTS: In group 1 (n = 54) good neurological recovery was observed in 63% and in group 2 (n = 82) in 55% (chi 2 = 0.87, P = NS). Both groups exhibited comparable baseline values except that time intervals from beginning of life support to return of spontaneous circulation were shorter in group 1. After we controlled for this difference with Spearman's partial rank correlation (rs), there was no association between MABP measured within the first 5 minutes and outcome (rs = -.023; P = NS). Good neurological recovery was independently and directly related to MABP measured during 2 hours after return of spontaneous circulation (rs = .26; P < .01). CONCLUSIONS: In human cardiac arrest survivors, good functional neurological recovery was independently and positively associated with arterial blood pressure during the first 2 hours after human cardiac arrest but not with hypertensive reperfusion within the first minutes after return of spontaneous circulation.

Aged↗
PubMed1996

How can acute mountain sickness be quantified at moderate altitude?

Reports of acute mountain sickness (AMS) at moderate altitude show a wide variability, possibly because of different investigation methods. The aim of our study was to investigate the impact of investigation methods on AMS incidence. Hackett's established AMS score (a structured interview and physical examination), the new Lake Louise AMS score (a self-reported questionnaire) and oxygen saturation were determined in 99 alpinists after ascent to 2.94 km altitude. AMS incidence was 8% in Hackett's AMS score and 25% in the Lake Louise AMS score. Oxygen saturation correlated inversely with Hackett's AMS score with no significant correlation with the Lake Louise AMS score. At moderate altitude, the new Lake Louise AMS score overestimates AMS incidence considerably. Hackett's AMS score remains the gold standard for evaluating AMS incidence.

Acute Disease↗