Search PubMed⌕ Search

Biomedical subjects

B J Zink

Publications and source records attributed to B J Zink.

26 records · Page 2Linked to original sources
PubMed1991

The efficacy and safety of methohexital in the emergency department.

STUDY OBJECTIVE: To determine the efficacy and safety of methohexital sodium (MTX) in emergency department patients. DESIGN: A consecutive case series; all ED patients who received MTX from July 1989 through July 1990 were studied in a prospective manner. SETTING: A university hospital ED. PARTICIPANTS: All 102 adult and pediatric patients who received MTX. INTERVENTIONS: Emergency physicians trained in the use of MTX administered the drug. A study form was completed that provided data on dosage and response, indications for use, final diagnosis, hemodynamic and respiratory parameters, and an efficacy survey. RESULTS: Average cumulative dose of MTX was 1.6 +/- 1.3 mg/kg. The average duration of action per dose was 7.6 +/- 5.0 minutes. Leading indications for use were orthopedic procedures (54), endotracheal intubation (18), head computed tomography scan (ten), and wound care (eight). Hemodynamic changes were minimal; the average change in systolic blood pressure five minutes after MTX was -1.8 +/- 20 mm Hg. Average heart rate change was 3.0 +/- 20 beats. Percent respiratory depression was 17 +/- 24%. There was no correlation between MTX dose and the degree of respiratory depression. Narcotics and/or benzodiazepines were given with MTX in 92 cases, with no significant increase in respiratory depression. No major complications attributable to MTX were identified. CONCLUSION: MTX, when used by trained personnel who adhere to an established protocol, appears to be a safe and effective drug in selected ED patients.

Adolescent↗
PubMed1989

Intravenous fluid therapy in the prehospital management of hemorrhagic shock: improved outcome with hypertonic saline/6% Dextran 70 in a swine model.

The small quantities of 7.5% hypertonic saline (HTS) in 6% Dextran 70 (DEX 70; Travenol Laboratories, Deerfield, IL) required to produce marked improvement in tissue perfusion may make it an ideal solution for the prehospital management of hypotensive trauma patients. This study shows that the initial treatment of porcine hemorrhagic shock with 7.5% HTS/6% DEX 70 results in significantly improved hemodynamics and higher survival rates than those seen in animals treated with normal saline. These results are very encouraging and dictate the need for evaluation in human trials.

Animals↗
PubMed1989

Early versus late fluid resuscitation: lack of effect in porcine hemorrhagic shock.

The benefit of IV fluid therapy in the prehospital management of hemorrhagic shock is unproven. We used a reproducible, lightly anesthetized model of porcine continuous hemorrhage to evaluate the usefulness of pre-hospital IV fluid therapy. Incorporated into the model were time delays associated with ambulance request and dispatch, patient evaluation and treatment, and transport to the hospital in the average urban prehospital care system. Treatment occurred concurrently with hemorrhage. Twenty-eight immature swine (15 to 20 kg) were bled at a rate of 1.25 mL/kg/min. Animals in the prehospital IV group (n = 14) received fluid resuscitation at 1 mL/kg/min beginning 20 minutes after initiation of hemorrhage; those in the in-hospital IV group (n = 14) received fluid at a rate of 3 mL/kg/min beginning 35 minutes after hemorrhage. Both groups received blood and saline at 3 mL/kg/min 45 minutes after hemorrhage began, and both groups had hemorrhage controlled 25 minutes after simulated hospital arrival. Survival was 57% in both groups, and there were no statistically significant differences seen in measured hemodynamic or biochemical parameters. We conclude that early administration of IV normal saline has no effect on hemodynamics or survival in this porcine hemorrhagic shock model simulating an urban prehospital care system.

Animals↗
PubMed1989

A four-year program to train residents in emergency medical services.

There is general agreement that residents in the field of emergency medicine require extensive training in emergency medical services (EMS). This paper outlines a comprehensive four-year training program in EMS that has been integrated into the emergency medicine residency curriculum of the University of Cincinnati since 1985. The EMS program is comprehensive and makes it possible for the level and type of EMS activities that are provided to match the evolving expertise of the resident. The program provides a significant amount of practical training in ground and aeromedical transport, in disaster work, in telemetry communications, and in other areas. Evaluation of the program is at an early stage but informal reports are strongly positive.

Curriculum↗
PubMed1988

The effect of ethanol on survival time in hemorrhagic shock in an unanesthetized swine model.

Controversy exists as to whether ethanol intoxication causes exaggerated hypotension or increased mortality during hemorrhagic shock. Previous studies have used anesthetized animals. This limits data interpretation as anesthetic agents, particularly pentobarbital, have well-documented effects on hemodynamics and the response to hemorrhage. We studied the effects of moderate ethanol intoxication on blood pressure and survival time during fatal hemorrhagic shock in unanesthetized swine. Immature female swine weighing 15 to 20 kg were splenectomized and instrumented with chronic indwelling aortic catheters, right atrial catheters, and gastrostomy tubes. Four to seven days later the unanesthetized animals underwent hemorrhagic shock. Thirty minutes prior to the start of hemorrhage, the experimental group (n = 8) received 3 mL/kg of 100% ethanol mixed as a 1:3 solution with water through a gastrostomy tube. The control group (n = 8) received an equal amount of water. The distal aortic catheter was connected to a roller pump and blood was removed at a rate of 1 mL/kg/min until the animal died. Arterial pressure, heart rate, lactate ethanol and glucose levels, hematocrit, and arterial blood gases were measured in both groups at baseline and every 15 minutes thereafter. A mean ethanol level of 1,500 to 1,700 micrograms/mL was produced in the experimental group from baseline through 60 minutes. Data were analyzed using Student's two-tailed t test, and analysis of variance for repeated measures. There was no significant difference in survival time between the control (63.1 +/- 2.8 min) and ethanol (59.9 +/- 5.9 min) groups. Systolic blood pressure was significantly lower in the ethanol group after 15 minutes of hemorrhage (81 +/- 22 to 59 +/- 14 mm Hg, P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Hemodynamic and metabolic effects of ethanol in canine hemorrhagic shock.

Ethanol has been reported to cause myocardial suppression, exaggerated hypotension, and increased mortality in various animal models of hemorrhagic shock. Previous studies have not used a fixed-volume graded hemorrhage model and have not monitored cardiac output or metabolic parameters such as serum glucose and lactate levels. We studied hemodynamic and metabolic changes after administration of ethanol in a 50% graded hemorrhage model in conditioned, anesthetized beagles after orogastric ethanol loading. The hemorrhage was done over a 60-min period followed by a 90-min stabilization period. The ethanol group (n = 6) had significantly higher heart rates during the stabilization period. Mean arterial pressures (MAP) were lower in the ethanol group during the stabilization period. The change from baseline MAP 30 min after hemorrhage was -31% in the control group and -53% in the ethanol group (P less than .05 using Wilcoxon ranked sum test). Serum glucose and lactate levels were higher in the ethanol group. These results indicate that ethanol impairs hemodynamics and alters glucose and lactate metabolism in dogs in the fixed-volume graded hemorrhage model. The effect of these changes on morbidity and mortality remains to be determined.

Animals↗
PubMed1987

Effects of dichloroacetate administration during fatal hemorrhagic shock in immature swine.

During hemorrhagic shock, decreased perfusion and poor tissue oxygenation lead to increased lactate production. Previous animal studies have suggested that sodium dichloroacetate (DCA), an agent that decreases lactate production, can improve hemodynamics and survival when administered after severe hemorrhage. We used an unanesthetized porcine hemorrhagic shock model to assess the effect of DCA on survival time when administered during fatal hemorrhage. Immature female swine weighing 14 to 20 kg were splenectomized and instrumented with chronic indwelling aortic and right atrial catheters one week prior to hemorrhage. On the day of the experiment, the unanesthetized animals' aortic catheter was connected to a roller pump and blood was removed at a rate of 1.0 mL/kg/min until death occurred. Experimental animals (n = 8) received sodium dichloroacetate (25 mg/mL distilled water) 100 mg/kg IV bolus beginning 15 minutes after the start of hemorrhage followed by a 3 mg/kg/min constant IV infusion. Control animals (n = 8) received an equal volume of normal saline. Arterial pressure, heart rate, blood gases, serum lactate, and serum glucose were measured at baseline and every 15 minutes during hemorrhage. There were no significant differences in survival time (controls, 63 +/- 2.8 min; DCA-treated, 60 +/- 3.7 min), lactate levels, or blood pressures between the two groups. These results suggest that DCA does not decrease serum lactate or improve survival time when administered during ongoing severe hemorrhagic shock. Further study should be directed at the effects of DCA as an adjunctive treatment after hemorrhage has been controlled and tissue perfusion restored.

Acetates↗