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Biomedical subjects

C E Robertson

Publications and source records attributed to C E Robertson.

At least 37 records · Page 2Linked to original sources
PubMed1995

Evaluation of outcome following cardiac arrest in patients presenting to two Scottish emergency departments.

OBJECTIVES: To compare and contrast outcomes following cardiac arrest managed in two Accident and Emergency departments, and to identify factors which might account for such differences. DESIGN: Prospective 1-year evaluation of patients sustaining an out-of-hospital cardiac arrest. SETTING: The Accident and Emergency departments of the Edinburgh (ERI) and Glasgow (GRI) Royal Infirmaries which serve two large urban municipalities. PATIENTS: All patients sustaining a prehospital cardiac arrest and brought to ERI or GRI were included. Children (< 13 years), those declared dead on arrival at the scene, and events related to poisoning, near drowning, trauma and pregnancy were excluded. MEASUREMENTS AND MAIN RESULTS: There were 297 prehospital arrests from ERI, and 158 from GRI. Eighty-two (27.6%) were admitted as 'in-patients' to ERI and 23 (14.6%) to GRI (P < 0.01). Thirty-nine (13.1%) survived to hospital discharge from ERI; 13 (8.2%) survived to discharge from GRI (NS). The proportion of VF/VT:Asystole observed was significantly different between the two centres--162:98 from ERI, 54:73 from GRI (P < 0.001). Significantly more prehospital arrests were witnessed and received bystander CPR in those brought to ERI (P < 0.02). For the combined VF/VT/Asystole groups the ERI ambulance response times were significantly shorter (P < 0.01). However, there was no significant difference in the collapse to EMS arrival at the scene times between ERI and GRI. Two survivors from ERI had asystole as their initial observed rhythm. From GRI, one survivor had asystole, one had electromechanical dissociation and in another the initial rhythm was unknown. No survivor to discharge had severe neurological disability. CONCLUSIONS: Patients suffering out-of-hospital cardiac arrests in Edinburgh have a significantly better chance of being admitted to a ward. There is a trend favouring better survival to discharge in Edinburgh, but with the numbers investigated this does not achieve statistical significance. Amongst those factors which contribute to survival there are fewer witnessed arrests, less bystander CPR and slower ambulance response times in those brought to GRI. There is a need to investigate the environment in which patients collapse, to train the public in CPR, and to review the efficiency and resourcing of the ambulance service.

Adolescent↗
PubMed1995

Active decompression improves the haemodynamic state during cardiopulmonary resuscitation.

OBJECTIVE: To examine whether use of the active compression-decompression device improves the haemodynamics of cardiopulmonary resuscitation compared with those of conventional cardiopulmonary resuscitation. DESIGN: Prospective crossover study. SETTING: The accident and emergency department of a university teaching hospital. PATIENTS: 36 adult patients with non-traumatic, normothermic, out of hospital cardiac arrest. INTERVENTIONS: Cardiopulmonary resuscitation was performed during resuscitation in alternating 3 min cycles of conventional and active compression-decompression cardiopulmonary resuscitation. MAIN OUTCOME MEASURES: The end tidal carbon dioxide (ETCO2), femoral arterial pressure, and acid-base analysis of central venous blood measured during the last 30 s of each 3 minute cardiopulmonary resuscitation cycle. RESULTS: ETCO2 was monitored in 36 patients during conventional and active compression-decompression cardiopulmonary resuscitation. Active compression-decompression cardiopulmonary resuscitation caused a significant increase in ETCO2 (P < 0.0002), indicating improved cardiac output. Arterial pressure measurement was carried out in 10 patients. Systolic pressure was significantly greater with active compression-decompression than conventional cardiopulmonary resuscitation (P < 0.007). Central venous blood was taken for acid-base analysis in 11 patients. There was a significant increase in the central venous hydrogen ion concentration (P = 0.025) with rises in the partial pressures of carbon dioxide and oxygen, suggesting improved venous return. CONCLUSIONS: This study confirms that active compression-decompression cardiopulmonary resuscitation is associated with better haemodynamic status than conventional resuscitation.

Acid-Base Equilibrium↗
PubMed1995

Plasma elastase levels and the development of the adult respiratory distress syndrome.

Inflammatory cells, particularly neutrophil granulocytes, have been implicated in the pathogenesis of the adult respiratory distress syndrome (ARDS). In this study, we investigated whether a relationship exists between neutrophil elastase in the plasma of multiple-trauma patients on initial hospital presentation and the subsequent development of lung injury and ARDS. Sixty-one multiple-trauma patients were enrolled prospectively. Neutrophil elastase was measured by a specific radioimmunoassay, and analysis was performed by nonparametric statistical methods. A highly significantly elevated plasma elastase level was found in patients who progressed to ARDS (median 217 ng/ml, range 127 to 480) (n = 8) compared with those who did not (median 117 ng/ml, range 21.4 to 685) (n = 53) (p = 0.009). Significant correlation was found between initial elastase values and subsequent requirement for mechanical ventilation (p = 0.01), lowest arterial oxygen saturation/oxygen supplementation recorded (p = 0.003), and organ failure score (p = 0.006). This study shows that within minutes of the initiating trauma event, there is evidence of enhanced neutrophil degranulation as manifested by elevated levels of immunoreactive neutrophil elastase in the peripheral blood. The level of this enzyme correlates with the degree of subsequent lung injury and ARDS. These findings reinforce the importance of neutrophils and their secretory products in early ARDS disease pathogenesis.

Adolescent↗
PubMed1994

Role of selectins in development of adult respiratory distress syndrome.

The acute lung injury of adult respiratory distress syndrome (ARDS) is characterised by inflammatory cell accumulation and activation in the lung. Selectins are a family of adhesion molecules implicated in leucocyte-endothelial adhesion, whose receptors can exist in a cleaved, soluble form. We investigated whether circulating soluble selectin adhesion molecules, obtained from ARDS at-risk patients, were associated with subsequent ARDS development. 82 patients, at risk of ARDS, were enrolled from three well-defined groups (multiple trauma, pancreatitis, perforated bowel). Plasma samples were obtained on hospital presentation and soluble L, E, and P, selectins were quantified with a sandwich enzyme-linked immunosorbent assay (ELISA). 14 patients subsequently developed ARDS. Initial plasma soluble L-selectin (sL-selectin) levels were significantly lower in patients who progressed to ARDS compared to those who did not (p = 0.0001; 95% Cl for mean in ARDS patients as percent of that in non-ARDS patients, 27-61%). Moreover concentrations were lower than in 62 normal volunteers (range 0.37-6.55, median 1.83 micrograms/mL, n = 62), suggesting that a selective reduction of sL-selectin correlates with susceptibility. In addition, a significant correlation was found between low values of sL-selectin and indices of subsequent lung injury including requirement for ventilation (p = 0.0001) and degree of respiratory failure (p = 0.0001). A significant correlation was also found between low values of sL-selectin and patient mortality (p = 0.002). These results elucidate the inflammatory cell endothelial interactions in the early stages of ARDS and may be of prognostic value.

Acute Disease↗
PubMed1994

Plasma endothelin following cardiac arrest: differences between survivors and non-survivors.

Cardiac arrest is associated with major metabolic disturbances, including severe hypoxia and large increases in circulating catecholamines, both of which are known to stimulate generation of the potent endothelium-derived vasoconstrictor peptide endothelin-1. We have, therefore, examined plasma immunoreactive endothelin concentrations following cardiac arrest. Blood was sampled at 10-min intervals from a central venous catheter inserted at onset of resuscitation in 38 patients (13 female; mean age, 67 years) presenting with cardiac arrest to the Accident and Emergency Department at the Royal Infirmary of Edinburgh. Plasma immunoreactive endothelin concentrations (mean +/- S.D.) in patients following cardiac arrest (5.4 +/- 2.3 pg/ml) were no different from those in healthy subjects (5.1 +/- 1.2 pg/ml). There was no significant difference between endothelin concentrations at presentation in survivors and non-survivors of cardiac arrest. However, non-survivors had a significant fall in endothelin concentrations with time from onset of resuscitation from 5.4 +/- 2.2 pg/ml to 3.5 +/- 1.8 pg/ml (P = 0.002), while survivors had a non-significant increase in concentrations. On multiple regression analysis there was a significant association between higher plasma endothelin concentration and survival (r = 0.37; P = 0.009). The failure of plasma endothelin to increase after cardiac arrest is unexpected. Although the fall in plasma endothelin with time in non-survivors may reflect the adverse physiological milieu that occurs during cardiac arrest, it is also possible that low endothelin concentrations contribute to the poor prognosis in this condition.

Aged↗
PubMed1994

Assessment of the active compression-decompression device (ACD) in cardiopulmonary resuscitation using transoesophageal echocardiography.

Transoesophageal echocardiography was used to investigate the haemodynamic profile achieved during active compression-decompression cardiopulmonary resuscitation in humans. The mechanism of antegrade blood flow achieved by ACD-CPR is consistent with the cardiac pump theory. Improved right heart compression, antegrade blood flow patterns and left ventricular filling were observed in some patients during ACD-CPR.

Aged↗
PubMed1994

Out of hospital needlestick injuries.

Retrospective analysis showed that 67 children had presented in Edinburgh with needlestick injuries on 70 occasions over five years. Worryingly, 10 children sustained injuries pretending to be intravenous drug abusers. Despite risks of hepatitis B and HIV infection, protection and follow up were inadequate. Publicity about discarded needles and a treatment plan for use in accident and emergency departments are recommended.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Management of minor head injuries in the accident and emergency department: the effect of an observation ward.

The management of 483 patients presenting with minor head injury to the accident and emergency (A&E) departments of two Scottish hospitals was studied prospectively. Such patients comprised 5.7 and 3.9% of the total attendances to each department. Of the 277 patients assessed in the former department, 83 (30%) fulfilled at least one of the currently accepted criteria for recommending admission to hospital and 49 (17.7%) patients were actually admitted. Patients in whom head injury was not the principal reason for admission were excluded from the study. In the same time period the second department dealt with 206 patients with minor head injury, 49 (24%) of whom had criteria for admission. However, significantly fewer, 10 (4.9%) patients, were actually admitted. The major relevant factor when comparing the two departments was the existence in the former of an observation ward. These results support the view that easy access to hospital beds is a major determinant of management in patients presenting with minor head injury to the A&E department and may be more influential than clinical findings.

Adolescent↗
PubMed1993

Survival from cardiac arrest in an accident and emergency department: the impact of out of hospital advisory defibrillation.

A prospective 1-year audit of cardiac arrests treated in the Accident and Emergency department of the Royal Infirmary, Edinburgh is presented. During the period January 1st, 1991 to December 31st, 1991, 325 patients with cardiac arrest were treated. Two-hundred ninety-seven of these were 'out-of-hospital' and 28 were 'in-department' arrests. Of patients with 'out-of-hospital' ventricular fibrillation/pulseless ventricular tachycardia 22.8% were discharged. Survival rates for patients with asystole or electromechanical dissociation were very poor. The impact of semiautomatic out-of-hospital defibrillation upon the survival and number of patients presenting to the department is discussed.

Aged↗
PubMed1992

Effect of "fast track" admission for acute myocardial infarction on delay to thrombolysis.

OBJECTIVE: To evaluate the impact of a fast track triage system for patients with acute myocardial infarction. DESIGN: Comparison of delays in admission to hospital and in receiving thrombolytic treatment before and after introducing fast track system with delays recorded in 1987-8. Patients fulfilling clinical and electrocardiographic criteria for myocardial infarction were selected for rapid access to the cardiac care team, bypassing evaluation by the medical registrar. SETTING: Major accident and emergency, cardiac and trauma centre. SUBJECTS: 359 patients admitted to the cardiac care unit during 1 February to 31 July 1990 with suspected acute infarction. MAIN OUTCOME MEASURES: Accuracy of diagnosis and delay from arrival at hospital to thrombolytic treatment. RESULTS: 248 of the 359 patients had myocardial infarction confirmed, of whom 127 received thrombolytic treatment. The fast track system correctly identified 79 out of 127 (62%) patients who subsequently required thrombolytic treatment. 95% (79/83) of patients treated with thrombolysis after fast track admission had the diagnosis confirmed by electrocardiography and enzyme analysis. The median delay from hospital admission to thrombolytic treatment fell from 93 minutes in 1987-8 to 49 minutes in fast track patients (p less than 0.001). Delay in admission to the cardiac care unit was reduced by 47% for fast tract patients (median 60 minutes in 1987-8 v 32 minutes in 1990, p less than 0.001) and by 25% for all patients (60 minutes v 45 minutes, p less than 0.001). CONCLUSION: This fast track system requires no additional staff or equipment, and it halves inhospital delay to thrombolytic treatment without affecting the accuracy of diagnosis among patients requiring thrombolysis.

Aged↗
PubMed1992

Plasma catecholamine responses in acute severe asthma.

Twenty patients presenting to an A&E department with acute severe asthma were studied. Despite clinically severe airway obstruction few had raised catecholamine levels. However several patients with impending respiratory arrest had markedly elevated catecholamine levels, and relationships are demonstrated between these levels and other measures of disease severity.

Acute Disease↗
PubMed1992

Acid base changes in arterial and central venous blood during cardiopulmonary resuscitation.

Twenty-seven patients in cardiopulmonary arrest had simultaneous measurements of arterial and central venous blood gases during cardiopulmonary resuscitation (CPR) with a pneumatic chest comparison and ventilation device. Mean central venous and arterial hydrogen ion concentrations, PCO2 and calculated bicarbonate concentrations were significantly different (P less than 0.01) at all sampling times (0, 10 and 20 min). Central venous blood samples predominantly showed a respiratory acidosis in contrast to a mixed disturbance in arterial samples inclined towards a metabolic acidosis. The mean difference between central venous PCO2 (pcv CO2) and arterial PCO2 (pa CO2) ranged from 5.18 to 5.83 kPa reflecting the low blood flow in patients undergoing CPR. Measurement of arterial Po2 indicated adequate oxygenation using the pneumatic device. Arterial blood gas analysis alone does not reflect tissue acid base status. Bicarbonate administration during CPR may have adverse effects and any decision as to its use should be based on central venous blood gas estimations.

Acid-Base Imbalance↗
PubMed1992

Flying squad response to out-of-hospital cardiac arrest--a decade of experience.

The Flying Squad (MEDIC I) based at the Royal Infirmary, Edinburgh, commenced operation in 1980. The MEDIC I response to out of hospital non-traumatic cardiac arrest over the past decade is reported. On-scene resuscitation was attempted in 384 patients. A total of 149 (39%) patients were successfully resuscitated and transferred to hospital. Thirty-six (9.4%) patients survived to discharge from hospital. Patients receiving basic life support prior to the arrival of MEDIC I and in ventricular fibrillation had a survival rate of 14.5% (25/174). During 1988-89, 21 patients were initially attended by ambulance crews equipped with semi-automatic external defibrillators and eight (38%) of these patients survived. The response of a hospital-based flying squad to support trained ambulance crews, especially when equipped with a defibrillator may provide an economically and operationally feasible alternative to training all first responders in the full range of paramedic skills.

Adolescent↗
PubMed1991

The value of helicopter transportation for trauma patients.

Helicopters have been used for the evaluation of civilian casualties since the 1960s. This trend has been increasing and a number of helicopter emergency services have now commenced in the UK. Despite these developments, little attention has been paid to their exact role, and the potential benefits to patients. In addition, the costs of such services are high, and the risks to patients and staff from air accidents are considerable. Similar or improved results may be obtained through the use of more cost-effective ground-based units. Judicious placement of both helicopter emergency services and land-based 'flying squads' in an integrated accident service may contribute usefully to better care of patients. However, enthusiasm for helicopters should not lead to a waste of resources and should be accompanied by careful consideration, planning and audit of their use.

Aircraft↗
PubMed1990

Measurement of end-tidal carbon dioxide concentration during cardiopulmonary resuscitation.

End-tidal carbon dioxide concentrations were measured prospectively in 12 cardiac arrest patients undergoing cardiopulmonary resuscitation (CPR) in an accident and emergency department. The end-tidal carbon dioxide (CO2) concentration decreased from a mean (+/- SD) of 4.55 +/- 0.88% 1 min after chest compression and ventilation was established, to values ranging from 2.29 +/- 0.84% at 2 min to 1.56 +/- 0.66% following 8 min of CPR. Spontaneous circulation was restored in five patients. This was accompanied by a rapid rise in end-tidal CO2 which peaked at 2 min (3.7 +/- 1.08%). Changes in end-tidal CO2 values were often the first indication of return of spontaneous cardiac output. There was a significant difference in the end-tidal CO2 in patients undergoing CPR before return of spontaneous circulation (2.63 +/- 0.32%) and patients who failed to develop spontaneous output (1.64 +/- 0.89%) (p < 0.001). We conclude that measurement of end-tidal CO2 concentration provides a simple and non-invasive method of measuring blood flow during CPR and can indicate return of spontaneous circulation.

Adult↗
PubMed1990

Non-traumatic chest pain in young adults: a medical audit.

Four hundred consecutive young patients who attended an accident and emergency department with non-traumatic chest pain as their primary complaint were reviewed. They represented 0.7% of total new attendances. Most were self-referrals, but ambulance transport was requested for over 25%. The majority of investigations (mainly chest radiography and electrocardiography) performed in this group of patients were normal; however, almost one in six investigations was judged to be abnormal. Although this group of patients is at low risk for serious cardiorespiratory disease, a small but significant number of underlying (mainly non-cardiac) disorders was found and 22.5% (90) required in-patient admission. In contrast, almost one-fifth of patients received no specific diagnosis, while almost 40% were deemed to require no follow-up.

Adolescent↗