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Biomedical subjects

D Crippen

Publications and source records attributed to D Crippen.

At least 19 recordsLinked to original sources
PubMed2001

The World Trade Center attack. Similarities to the 1988 earthquake in Armenia: time to teach the public life-supporting first aid?

On 7 December 1988, a severe earthquake hit in Armenia, a former republic of the Soviet Union (USSR); on 11 September 2001, a manmade attack of similar impact hit New York City. These events share similar implications for the role of the uninjured survivor. With basic training, the uninjured survivors could save lives without tools or resuscitation equipment. This article makes the case for teaching life-supporting first aid to the public in the hope that one day, should another such incident occur, they would be able to preserve injured victims until formal rescue occurs.

Aircraft↗
PubMed2001

'Round-table' ethical debate: is a suicide note an authoritative 'living will'?

Living wills are often considered by physicians who are faced with a dying patient. Although popular with the general public, they remain problems of authenticity and authority. It is difficult for the examining physician to know whether the patient understood the terms of the advance directive when they signed it, and whether they still consider it authoritative at the time that it is produced. Also, there is little consensus on what spectrum of instruments constitutes a binding advance directive in real life. Does a 'suicide note' constitute an authentic and authoritative 'living will'? Our panel of authorities considers this problem in a round-table discussion.

Critical Care↗
PubMed2000

Debate: what constitutes 'terminality' and how does it relate to a living will?

A moribund and debilitated patient arrives in an emergency department and is placed on life support systems. Subsequently it is determined that she has a 'living will' proscribing aggressive measures should her condition be judged 'terminal' by her physicians. But, as our round table of authorities reveal, the concept of 'terminal' means different things to different people. The patient's surrogates are unable to agree on whether she would desire continuation of mechanical ventilation if there was a real chance of improvement or if she would want to have her living will enforced as soon it's terms were revealed. The problem of the potential ambiguity of a living will is explored.

Aged↗
PubMed2000

Life-threatening brain failure and agitation in the intensive care unit.

The modern intensive care unit (ICU) has evolved into an area where mortality and morbidity can be reduced by identification of unexpected hemodynamic and ventilatory decompensations before long-term problems result. Because intensive care physicians are caring for an increasingly heterogeneous population of patients, the indications for aggressive monitoring and close titration of care have expanded. Agitated patients are proving difficult to deal with in nonmonitored environments because of the unpredictable consequences of the agitated state on organ systems. The severe agitation state that is associated with ethanol withdrawal and delirium tremens (DT) is examined as a model for evaluating the efficacy of the ICU environment to ensure consistent stabilization of potentially life-threatening agitation and delirium.

Alcohol Withdrawal Delirium↗
PubMed1999

Critical care and the Internet. A clinician's perspective.

The Internet holds great promise for clinicians because of its ability to access and consolidate large amounts of knowledge quickly and easily. As a result, information overload is occurring and physician users are finding it necessary to use creative and selective methods to digest this data. Physician users will have to discover new skills to determine authenticity and substance of data as they sift through mountains of coal looking for diamonds. Users will become an integral part of the evolution process, guiding the Internet towards merit and magnitude.

Attitude of Health Personnel↗
PubMed1997

Role of bedside electroencephalography in the adult intensive care unit during therapeutic neuromuscular blockade.

BACKGROUND: Size, weight and technical difficulties limit the use of ponderous strip chart electroencephalographs (EEGs) for real time evaluation of brain wave function in modern intensive care units (ICUs). Portable, computer processed, bedside EEGs provide real time brain wave appraisal for some brain functions during therapeutic neuromuscular blockade when the visual clues of the cerebral function disappear. RESULTS: Critically ill ICU patients are frequently placed in suspended animation by neuromuscular blockade to improve hemodynamics in severe organ system failure. Using the portable bedside EEG monitor, several cerebral functions were monitored continuously during sedation of selected patients in our ICU. CONCLUSIONS: The processed EEG is able to continuously monitor the end result of some therapeutics at the neuronal level when natural artifacts are suppressed or eliminated by neuromuscular blockade. Computer processed EEG monitoring may be the only objective method of assessing and controlling sedation during therapeutic musculoskeletal paralysis.

Journal Article↗