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Biomedical subjects

Baruch Krauss

Publications and source records attributed to Baruch Krauss.

25 records · Page 2Linked to original sources
PubMed2003

Can the bispectral index monitor quantify altered level of consciousness in emergency department patients?

OBJECTIVES: A daily part of emergency medicine practice includes assessing patients with altered levels of consciousness (ALOC). The authors hypothesized that a bispectral index monitor (BIS), a processed electroencephalographic monitor traditionally used to monitor patients under anesthesia, would represent an objective quantification of impairment of consciousness. They compared the BIS score with the Glasgow Coma Scale score (GCS) in emergency department (ED) patients with ALOC. METHODS: The authors performed a convenience sampling of ED adults presenting with ALOC (GCS <or= 14). Patients with abnormal baseline mental status were excluded, as were those who were unable to tolerate the forehead BIS leads. The blinded BIS value was recorded after the treating physician assigned a GCS to the patient. The BIS and GCS measurements were then correlated. RESULTS: Data were obtained for 38 patients (20 male, 18 female). The median age was 42 years (range 14 to 93 years). Despite being statistically significant (p = 0.0165), the correlation between the GCS and the BIS score was only moderate (Spearman's rho = 0.387) and displayed wide variability. For example, when the GCS was between 3 and 5, the corresponding BIS scores ranged from 47 to 98. When the GCS was between 12 and 14, the corresponding BIS scores ranged from 56 to 98. Receiver operating characteristic curves for BIS at each GCS threshold demonstrated low discriminatory power (areas under the curve range 0.61 to 0.73). CONCLUSIONS: BIS monitoring does not reliably correlate with GCS in ED patients with ALOC, and does not appear to have potential to accurately quantify impairment of consciousness in this setting.

Adolescent↗
PubMed2003

Ventilatory response during dissociative sedation in children-a pilot study.

OBJECTIVES: It is unclear whether ketamine induces subclinical respiratory depression when administered in dissociative doses intravenously (IV). The authors report a pilot study of capnography in emergency department (ED) pediatric patients receiving ketamine alone for procedural sedation, and describe serial measures of ventilatory response [end-tidal carbon dioxide (EtCO(2)), respiratory rate, pulse oximetry]. METHODS: The authors performed continuous capnography on a convenience sample of 20 ED pediatric patients who received ketamine 1.5 mg/kg IV for procedural sedation. RESULTS: Continuous EtCO(2) and pulse oximetry remained essentially unchanged following ketamine injection, and no EtCO(2) levels > 47 mm Hg were noted at any point throughout sedation. CONCLUSIONS: No hypoventilation was observed in 20 ED pediatric patients receiving ketamine 1.5 mg/kg administered IV over 1 minute. The authors found no evidence of respiratory depressant properties for this dissociative agent.

Anesthetics, Dissociative↗
PubMed2002

Carbon dioxide monitoring in emergency medicine training programs.

OBJECTIVES: Although the measurement of carbon dioxide (CO2) in breath is the standard of care for verification of endotracheal tube placement in all anesthesia practice and in the prehospital setting, there is currently no uniform consensus on the status of CO2 monitoring in emergency medicine. We conducted this survey to delineate practice patterns of CO2 monitoring in academic emergency medicine training programs and to describe the preference for type of CO2 monitoring device. METHODS: We surveyed the availability, presence, and types of CO2 monitoring in all general emergency medicine (GEM) residency programs and all pediatric emergency medicine (PEM) fellowship programs. A two-question survey was used, and data were collected from March 1998 to June 1998. The clinicians surveyed were asked whether their emergency department (ED) used CO2 monitoring for detection of endotracheal tube placement and, if so, what type of CO2 monitoring devices was used. Types of CO2 monitoring devices were categorized as colorimetric, capnometric, capnographic, or combinations of these. RESULTS: Of the 168 programs surveyed, all GEM and PEM programs responded, and the survey results showed that 136 of 168 (81%) used some form of CO2 monitoring, and 32 of 168 (19%) did not use CO2 monitoring. The majority of programs (115/168, 68%) used a single device. Colorimetric devices were used most frequently (76/168, 45%), and capnometry was used the least (9/168, 5%). PEM programs had a significant preference for quantitative CO2 monitoring, whereas GEM programs had a significant preference for qualitative CO2 monitoring. CONCLUSIONS: Although the majority of academic emergency medicine training programs used CO2 monitoring, 19% did not. Colorimetric devices were the most frequently used CO2 monitoring technology.

Carbon Dioxide↗
PubMed2002

Pulmonary aspiration risk during emergency department procedural sedation--an examination of the role of fasting and sedation depth.

The assessment of pre-procedure fasting and control of sedation depth are prominent elements of widely disseminated procedural sedation guidelines and of the Joint Commission on Accreditation of Healthcare Organizations' standards. Both exist primarily to minimize the risk of pulmonary aspiration of gastric contents. This paper critically examines the literature on pre-procedure fasting and controlling sedation depth in association with pulmonary aspiration, and interprets this evidence in the context of modern emergency medicine practice. The article reviews the pathophysiology of aspiration and changing concepts regarding aspiration risk over the last decade. After reviewing studies on aspiration risk during general anesthesia, the paper reviews the risk of aspiration during labor and delivery as a more appropriate comparison group for aspiration risk during emergency department procedural sedation and analgesia (ED PSA). It is noted that aspiration during ED PSA has not been reported in the medical literature and that aspiration during general anesthesia and labor and delivery is uncommon. The literature provides no compelling evidence to support specific fasting periods for either liquids or solids prior to PSA, and existing guidelines for elective patients are of necessity arbitrary and based upon consensus opinion. The article discusses the implications in the areas of training and preparedness, monitoring, and research for the emergency physician practicing PSA.

Anesthesia, General↗
PubMedDate not supplied

Accuracy of a new low-flow sidestream capnography technology in newborns: a pilot study.

OBJECTIVE: To evaluate the accuracy of a new low-flow sidestream capnography technology and analyze components of the capnogram in mechanically ventilated newborns with and without pulmonary disease. METHODS: Twenty patients were prospectively identified. Eligible infants were mechanically ventilated and had an indwelling arterial catheter. Two groups were identified: newborns who were receiving mechanical ventilation for pulmonary diseases, and newborns who were receiving postoperative mechanical ventilation for nonpulmonary conditions. End-tidal CO(2) (PetCO(2)) was measured for 1-minute pre- and post-arterial blood sampling, and PetCO(2) and PaCO(2) were compared for each patient. Eight quantitative waveform parameters were also measured on all patients. RESULTS: Newborns in the pulmonary group (n=13) (persistent pulmonary hypertension of the newborn/meconium aspiration syndrome, respiratory distress syndrome, pneumonia) and newborns in the control group (n=7) were matched for birth weight, gestational age, and postnatal age. PetCO(2)-PaCO2 Gradient values were higher in the pulmonary group (7.4+/-3.3 mm Hg) than controls (3.4+/-2.4 mm Hg). Four waveform parameters (ascending slope, alveolar angle, alpha angle, descending angle) were identified, which independently differentiated patients with pulmonary disease from controls. CONCLUSIONS: Low-flow capnography with Microstream technology accurately measured alveolar CO(2) in newborns without pulmonary disease, as demonstrated by normal PetCO(2)-PaCO(2) gradients. The measured PetCO(2)-PaCO(2) gradient, as expected, was significantly higher in newborns with pulmonary disease. We also identified four quantitative waveform parameters that may be useful in differentiating between mechanically ventilated newborn patients with and without lung disease.

Capnography↗