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Biomedical subjects

A Skulberg

Publications and source records attributed to A Skulberg.

At least 19 recordsLinked to original sources
PubMed1991

[Criteria of death and time of death--do Norwegian physicians follow laws and regulations?].

In Norway, death is defined as total and irreversible damage of the whole central nervous system. This means that the time of death is some minutes after circulatory arrest. The time lapse may vary from about five minutes up to 45 minutes, depending on the temperature in the brain when the circulation ceased. Five cases of spontaneous circulation after cessation of resuscitation are described. All the patients had asystoly, diagnosed on ECG by anaesthesiologists. The resuscitation had lasted for 30 minutes when the crew of the ambulance, which included a doctor, gave up. Two of the patients left the hospital alive, three died after some hours. One of the patients had no cerebral sequelae, the other developed dementia. Circulation may also start spontaneously after the doctor has diagnosed circulatory arrest in patients suffering from suffocation and exsanguination.

Aged↗
PubMed1991

[Cardiopulmonary resuscitation attempts at Ullevål hospital during January 1989-July 1990].

During the period January 1989 to July 1990, 68 in-hospital cardiopulmonary resuscitations were attempted in 65 patients at Ullevål Hospital. The total number of deaths during the same period was 2,166. 21 patients survived initially (32%). Nine patients died later, and 12 patients (18%) were discharged from hospital without major cerebral disability. Six patients were alive at follow-up 13-25 months after cardiopulmonary resuscitation. No differences in survival were found between males and females, or between patients under and over 70 years of age.

Adult↗
PubMed1991

[Accidental hypothermia. Risk factors in 29 patients with body temperature of 30 degrees C and below].

29 patients with a body temperature below 30 degrees C (mean 26.4 degrees C) were treated during the period 1982-88, both years inclusive. Eight patients were severely hypotensive (systolic blood pressure less than 60 mm Hg) and two had ventricular fibrillation on admission. Bradycardia (less than 60 beats per minute) was noted in ten patients. 12 patients were rewarmed by surface warming, 17 by extracorporeal circulation with femoral cannulation. 22 patients (76%) were discharged alive. Age, sex, body temperature, method and rate of rewarming, serum electrolytes, acidosis and the use of blood components did not influence the outcome. Renal failure was the only complication associated with a fatal outcome. Severe hypotension on admission tended to increase mortality, but logistic regression analysis identified the mode of cooling as the only independent risk factor for death. A patient cooled indoors had an odd risk of 10.6 of hospital mortality compared to one found outdoors. For the sake of convenience, in hospitals with the available resources rewarming by extracorporeal circulation may be used in patients with circulatory arrest, since this is the easiest way to control and support failing circulation. In all other cases carefully monitored surface rewarming should be used as this necessitates less use of hospital resources and produces equally good results.

Accidents↗
PubMed1990

[Acute pulmonary dysfunction in adults. Adult respiratory distress syndrome--ARDS].

During a 3-year period 0.1% of all patients undergoing surgery and 0.3% of the patients submitted for trauma developed ARDS. The diagnosis was based on strict criteria. Mortality among the 42 patients was 45.2%. Abdominal sepsis was associated with high mortality, trauma with a much better prognosis. Swan-Ganz catheters were used in 81% of the patients. The measurements were characterized by high pulmonary vascular resistance and increased intrapulmonary shunting. However, the initial recordings showed only small differences between survivors and fatal cases as regards haemodynamics and blood gas parameters. Mortality was associated with low diuresis, heart failure, need of inotropic support and on age of over 50 years. The significance of invasive central monitoring is discussed.

Adult↗
PubMed1990

[Blood transfusion in heart surgery].

We have studied the effect of blood-saving measures in open heart surgery. Such measures were introduced in 1987. All fluids administered on the day of operation and on the first postoperative day were registered in all cardiac patients operated during one month in 1986, 1987, 1988. In 1986 the patients were exposed to a median of 21 donors while in 1988 they were exposed to a median of 2 donors. The reduction in transfusions was achieved by substituting plasma by polygeline, by giving thrombocytes only when there was a low thrombocyte count and by accepting a hemoglobin value of 9 g/100 ml before transfusion of erythrocytes. In 1988 most postoperatively drained blood was retransfused using a Sorensen retransfusion set. The reduction in transfusions has reduced the cost of each open heart operation by NOK 11,662.

Blood Donors↗
PubMed1989

[Surgical treatment of necrotizing fasciitis].

We present nine patients with necrotizing fasciitis. Two of them had Fourniers gangrene. Predisposing factors included diabetes mellitus, alcohol and drug abuse. Local signs were redness, swelling and pain rapidly followed by fever and deterioration in the patient's general condition. Soft tissue-gas was observed in all patients. It was found either clinically, on roentgenograms or by CT. Bacteria were found in blood cultures and/or necrotic tissues in all patients. The dominating treatment was radical surgical excision and early reexplorations. Antibiotics, intensive care support and early parenteral nutrition were given. Four patients were given hyperbaric oxygen treatment. The overall mortality rate was 11%. Amputation of one lower extremity became necessary in three patients. In these cases 4-8 days had elapsed between the onset and the first surgical excision. We find it important to underline early diagnosis and radical surgical excision in patients with necrotizing fasciitis.

Adult↗
PubMed1989

[Drowning].

Explore the source record for details and available documents.

Drowning↗
PubMed1989

[Pulmonary edema following airway obstruction].

This case report describes an adult patient who developed post extubation laryngeal spasm and later pulmonary edema following relief of the laryngeal spasm. The mechanism that causes pulmonary edema following upper airway obstruction is very probably due to a modified Müller maneuver (inspiration against a closed glottis), which will increase negative intrapleural pressure, and thereby cause increased pulmonary capillary permeability.

Adult↗
PubMed1989

Plasma endotoxin as a predictor of multiple organ failure and death in systemic meningococcal disease.

We studied prospectively the quantitative relation of circulating endotoxin (lipooligosaccharides [LOSs]) and the development of multiple organ failure and death in 45 consecutively admitted patients with bacteriologically verified systemic meningococcal disease (SMD). A plasma LOS level of greater than 700 ng/L correlated with development of severe septic shock (P less than .0001), adult respiratory distress syndrome (P = .0035), a pathologically elevated serum creatinine level (P less than .0001), or death as a consequence of multiple organ failure (P = .0002). Initial plasma LOS levels of less than 25, 25-700, 700-10,000, and greater than 10,000 ng/L were associated with 0%, 14%, 27%, and 86% fatality, respectively. The LOS half-life after initiation of antibiotic therapy was 1-3 h. Increasing plasma LOS levels were never seen. These observations suggest that LOS quantitation using the limulus amebocyte lysate assay with a chromogenic substrate gives important progsnotic information and may provide new insight concerning pathophysiological aspects of SMD.

Adolescent↗
PubMed1989

Effects of nimodipine on cerebral blood flow and cerebrospinal fluid pressure after cardiac arrest: correlation with neurologic outcome.

Fifty-one patients were included in a blind randomized study to evaluate whether the Ca-blocker nimodipine could influence cerebral blood flow (CBF) or cerebrospinal fluid pressure (CSFP) during the cerebral hypoperfusion period that follows resuscitation from cardiac arrest and to determine whether changes in CBF correlate with neurologic outcome. CBF measured 1 to 4 hours after arrest with the use of 133Xe intravenous was significantly greater with nimodipine than with placebo (27 +/- 3 versus 13 +/- 1 ml.100 g-1.min-1 at 3 hours), but with no significant difference at 24 hours. There was no clinical evidence of seriously increased CSFP in any patient in either group the first 48 hours. Mean arterial pressure was significantly lower (86 +/- 4 versus 101 +/- 4 mm Hg at 3 hours), and antiarrhythmic drugs were used significantly less frequently in the nimodipine group than in the placebo group. Twelve patients in each group eventually regained consciousness. There was no significant difference in neurologic status between the two groups at any point, and no positive correlation between CBF in the hypoperfusion period and neurologic outcome.

Aged↗
PubMed1987

Alterations in T-helper and T-suppressor lymphocyte populations after multiple injuries.

Fifteen patients with multiple injuries and an Injury Severity Score (ISS) ranging from 2 to 57 (median 25) were studied for variations in lymphocyte populations on the day of injury and the three following days. Nine of the patients had an ISS above 16. In all patients the total number of lymphocytes fell during the first 24 hours after the injury (P less than 0.01), mainly due to a reduction in the number of circulating T-lymphocytes from a median of 1.8 to 0.6 x 10(9) cells/l (P less than 0.01). No reduction in the T-helper/T-suppressor cell ratio could be demonstrated for the group as a whole, but in the 9 patients with an Injury Severity Score (ISS) of more than 16 a significant reduction in ratio from median 1.5 to 0.8 was found. Due to clinical observations patients with an ISS of more than 16 are considered severely injured and at risk of developing complications such as infection and septicaemia. The fall in T-helper/T-suppressor ratio indicates impaired immunity in these patients.

Adolescent↗
PubMed1976

Cardiopulmonary resuscitation by lay people.

The survival-rate in 75 of 631 patients with cardiac arrest in whom resuscitation was started outside hospital by lay people was 36%. Only 8% survived when attempts at resuscitation were delayed until the arrival of an ambulance team which included an anaesthetist and a specially trained nurse. These data show the importance of anoxia-time (time from cessation of circulation to initiation of resuscitation) to the chances of survival after resuscitation) to the chances of survival after resuscitation, and support the idea that lay people should be taught and encourage to perform cardiopulmonary resuscitation.

Blood Circulation↗