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D Scheidegger

Publications and source records attributed to D Scheidegger.

At least 19 recordsLinked to original sources
PubMed1992

[Development of the helicopter-rescue concept in the Basel region].

1927 medical helicopter transports were performed in Basle between 1986 and 1989. Of the total flights, 173 transports without patients and 186 incubator transports were excluded from the study. Treatment and transportation were provided for 1085 victims of trauma (70.2%) and 461 medical-surgical patients (29.8%), mostly with life-threatening conditions. 589 trauma patients were treated at the scene of accident and later transported by helicopter to a nearby medical center (54.3%). The 4.3% rate of negative emergency flights is low. Since introduction of the helicopter rescue system at Basle in 1975, scene flights have increased from 29% in 1984 to 46% in 1989. 47.4% of all patients were categorized as seriously ill or severely injured. 36.4% of all patients required intubation and assisted ventilation. Of the trauma patients, 54.3% involved scene-flights requiring in-field intensive therapy. Helicopter transport provides not only a rapid source of transportation, but also vital medical assistance at the scene of emergency. Transport generally occurs only after stabilization of vital functions. These factors contribute to the low mortality before return flights (3%) as well as during transport (0.3%). We conclude that early aggressive in-field intensive therapy can help to decrease both morbidity and mortality in emergency-care patients.

Aircraft↗
PubMed1992

Survival in major burn injuries treated by one bathing in cerium nitrate.

Sixty-four patients aged 16-74 years with total body surface area burns (TBSA) ranging from 30 to 90 per cent, were given one bathing in 0.04 M cerium nitrate within 4 h of admission to hospital. Of 21 patients aged 16-30 years, one died (aged 28 with 90 per cent TBSA), and of those aged 31-74 years, two died, one (aged 50 years with 55 per cent TBSA) had multiple internal injuries, the other (aged 51 years with 55 per cent TBSA) had a pulmonary embolism at day 19. Two risk scores, developed from data on 11,200 burn patients treated by standard methods (Roi et al. 1983), were applied to the analysis of risk for 59 patients for whom both total burn surface (TB) and full thickness (FT) areas had been recorded. About 20 patients bore risk of 0.8 or greater on the FT scale and 1.0 on the TB scale, yet instead of 80 per cent deaths among these, only two died. No FT assessment had been made on the multiple injury death whose TB risk score was 0.66. Such survival results in high-risk patients should encourage the use of cerium nitrate for treating serious burn injury.

Adolescent↗
PubMed1992

Perioperative myocardial ischemia in patients undergoing elective hip arthroplasty during lumbar regional anesthesia.

Perioperative myocardial ischemia predicts unfavorable outcomes and occurs in as many as 41% of patients with coronary artery disease or cardiac risk factors undergoing noncardiac surgery. To determine the prevalence of myocardial ischemia, we studied 52 consecutive unselected patients undergoing elective hip arthroplasty during lumbar regional anesthesia. Patients were continuously monitored for 6 days using a three-channel Holter monitor. Ninety-nine episodes of myocardial ischemia occurred in 16 patients (31%), six of whom were considered preoperatively to be at low risk for coronary artery disease. Forty-four percent of the ischemic episodes were preceded or accompanied by a heart rate greater than or equal to 100/min and 56% by a heart rate greater than or equal to 90 beats/min. Ninety-six percent of the ischemic episodes were clinically silent, and 82% were not related to patient care events. Thirteen episodes of myocardial ischemia occurred preoperatively, 1 intraoperatively, and 85 postoperatively. The incidence of postoperative ischemic episodes showed a circadian variation: 44% occurred between 6 AM and noon, 33% between noon and 6 PM, 17% between 6 PM and midnight, and 6% between midnight and 6 AM. Six adverse cardiac events occurred during hospitalization (three of the six among patients with perioperative ischemia) and an additional four events during a follow-up period of 12 months (all four events occurred among patients with perioperative ischemia). Patients with perioperative myocardial ischemia had a relative risk of 2.6 (95% confidence interval 1.3-5.2) to develop an adverse cardiac event postoperatively.

Aged↗
PubMed1992

Adenosine during cardiac arrest and cardiopulmonary resuscitation: a placebo-controlled, randomized trial.

UNLABELLED: BACKGROUND AND HYPOTHESIS TESTED: The effects of adenosine (100 micrograms/kg/min; n = 7) were examined during rodent cardiopulmonary resuscitation (CPR). Change in coronary artery perfusion pressure, end-tidal PCO2, and arterial acid-base status of anesthetized, male, Sprague-Dawley rats were compared with CPR controls (0.9% sodium chloride; n = 7) and with sham controls (n = 9). Sustained ventricular fibrillation was induced and precordial chest compression was followed by defibrillation. RESULTS: After 6 mins of cardiac arrest, six (86%) of seven adenosine-treated animals were resuscitated after adenosine infusion and four (57%) of seven control animals were resuscitated after sodium chloride infusion. During chest compression, coronary artery perfusion pressure was 7 +/- 2 mm Hg after adenosine, but was 22 +/- 3 mm Hg in the controls (p less than .01). Parallel decreases were observed in mean aortic pressure. Arterial and end-tidal PCO2 significantly (p less than .01) decreased after adenosine. These changes contrasted with a second control group of nine identically prepared animals which, in the absence of ventricular fibrillation and subsequent chest compression, demonstrated no changes in hemodynamic, respiratory, or blood gas variables. CONCLUSIONS: Adenosine decreased coronary artery perfusion pressure. However, despite marked reductions in coronary artery perfusion pressure, survival was not compromised after adenosine infusion in this rodent model of CPR.

Acid-Base Equilibrium↗
PubMed1992

Does on-scene resuscitation affect in-hospital "do not resuscitate" decisions and mortality in patients with severe head injuries?

To evaluate the effect of on-scene versus in-hospital resuscitation of patients with severe head injuries with regard to "do not resuscitate" (DNR) decisions and in-hospital mortality, 561 patients were prospectively studied. Patients were grouped according to whether resuscitation initially occurred at the scene of the injury (group 1), in a regional hospital before transfer (group 2), or after direct admission to our neurosurgical center (group 3). The DNR and mortality rates within the first 48 hours (13%, 10%, 10%, respectively) as well as for the entire stay in the surgical intensive care unit (SICU) were comparable for the three groups. It has been pointed out that efficient resuscitation at the scene of the injury may, instead of improving overall outcome, increase morbidity and mortality rates because more severely injured patients now reach the hospital alive. We conclude, however, that primary aggressive treatment at the scene of the injury did not increase DNR and in-hospital mortality rates within the 48-hour follow-up period, nor for the total stay in the SICU. Investigation of long-term outcome will be important to further establish the efficacy of this approach.

Adult↗
PubMed1991

[Severe craniocerebral injuries: northwestern Switzerland 1984-1989].

Data from 561 severely head-injured patients treated in a Surgical Intensive Care Unit between 1984 and 1989 are analyzed. Age and sex distribution of the patients was comparable to findings in other studies. More than half of the patients were injured in road accidents, accidents involving cars representing the greatest risk. In 90% of all patients, severe head injury was the primary diagnosis. 60% of the patients were intubated within 30 minutes at the scene of the accident, as opposed to 17% of patients intubated in the emergency room within the same time interval. Patients resuscitated at the scene of the accident and admitted directly by helicopter arrived at the emergency room on average one hour after the accident; for those transported directly by ambulance, without intubation prior to admission, the average time interval was half an hour. Since the time interval between accident and onset of resuscitation is crucial, this difference in transportation times is not considered to be of major importance. Half of the patients who died in the Surgical Intensive Care Unit died within the first 48 hours, usually from primary severe brain damage. In 50% of the 446 patients from the first 4 years of this study the recoveries ranged from good to complete and 28% died. Only 3 (less than 1%) out of 446 patients were alive in a vegetative state, and 8% severely handicapped one year after the accident. Aggressive primary treatment did not increase the number of patients surviving in a vegetative or severely handicapped state.

Adolescent↗
PubMed1991

Propofol-fentanyl anesthesia for pheochromocytoma resection.

Numerous anesthetic techniques and agents have been used for anesthetizing pheochromocytoma patients. However, a comparison based on literature reports is difficult, since most describe only isolated cases. We discuss current anesthetic techniques and a case report of a patient who successfully received a combined propofol-fentanyl anesthesia for pheochromocytoma resection.

Adrenal Gland Neoplasms↗
PubMed1991

[Outcome prognosis in severe craniocerebral trauma: important predictors in the early phase].

An early prognosis may influence the management of severely head-injured patients. Clinical aspects (age, Glasgow Coma Score, pupil reaction) and neuroradiological findings (basal cysternes, midline shift) are the most important facts for prognosis; evoked potentials, stress parameters and the quality of resuscitation also correlate with definitive outcome. Despite a clear correlation between these single factors and outcome, prognosis during the first 48 hours remains too uncertain to justify an influence on initial management.

Aged↗
PubMed1991

[Helicopter and emergency physician at the accident site. Medical comparison between altitude and flat land emergency care].

In-field intensive care reduces lethality and morbidity in severe trauma. We analyze and compare 400 medical helicopter rescue flights in the region of Basel and 325 medical air-rescues in the mountains of Interlaken. The presence of a physician in the helicopter is based on an interventional concept, with clinical diagnosis, monitoring and early intensive in-field care. Compared to the mountains, we find a predominance of road accidents (44%) in the region of Basel, with more head injuries (47.3%) and more polytrauma (19.4%) and thoraxtrauma (20.5%). In the mountains, with a majority of sport accidents (65.5%), pelvis and extremity injuries (73.4%) prevailed. As a consequence of inaccessible accident sites in the mountains, 23% of the rescues had to be performed by winch. An endotracheal intubation was performed in 35.5% of the patients in the Basel region, and in 11.6% in the mountains. Fixation of fractures and hemostasis was performed in both regions in 22% and 12% of the cases. In spite of high rates of severe conditions in both regions (57% in Basel, 17% in the mountains), the low mortality prior to and during air transport (2.5% in the Basel and 2.7% in the Interlaken region) confirms the necessity of the concept of early in-field intensive therapy. This concept allows good analgesia, is save and comfortable for the patients. The presence of a physician in the air rescue team has to be recommended not only for rescues in the plain, but also in the mountains.

Aircraft↗
PubMed1990

[Cardiopulmonary resuscitation in Switzerland: time to act!].

Cardiovascular related deaths still represent about 50% of all demises despite their decreasing incidence in the United States and in Switzerland. About two thirds of these deaths are due to ischemic heart disease in which half of the patients die outside hospital, the majority of them two hours after the first symptoms. Moreover, sudden death is the first symptom of coronary artery disease in 25% of cases. In this country few of these persons receive adequate basic life support (BLS) at the scene because a coordinated plan to teach BLS to the citizen does not yet exist in Switzerland. With the aid of specialized medical societies, the Swiss Red Cross and affiliated organizations, it is proposed to elaborate a plan to teach BLS to the general public in Switzerland on the basis of the future European guidelines for BLS.

Death, Sudden↗
PubMed1990

[Transesophageal echocardiography].

Transesophageal echocardiography is a new, semi-invasive technique for the examination of the heart and the aorta. Within 10-15 minutes it is possible to obtain good pictures of the anatomy and function of the heart. Diagnostic indications are native and prosthetic valvular heart disease; the method is particularly suitable for visualization of endocarditic vegetations, evaluation of embolic events or congenital heart disease and assessment of aortic dissection. In the intensive care unit transesophageal echocardiography is a new window to the heart, yielding instantaneous information on cardiac status. For the anesthetist it is the first method to provide perioperative beat to beat analysis of ventricular function.

Aortic Dissection↗
PubMed1990

[Pharmacology of cardiopulmonary resuscitation].

Among the adrenergic receptor agonists, epinephrine, at alpha and beta stimulating doses, remains the drug of choice for cardiopulmonary resuscitation. However, alpha adrenergic agonists such as phenylephrine, methoxamine and dopamine (at alpha stimulating doses) result in similar success rates of resuscitation as epinephrine. In the opposite, beta adrenergic agonists, without or with only low alpha stimulating effect, such as isoproterenol or dobutamine are significantly less efficient. There are few data indicating that sodium bicarbonate improves outcome. Moreover it carries the risk of adverse effects. It may be of benefit in case of preexisting metabolic acidosis or during prolonged resuscitation with documented acidosis. Calcium remains indicated in case of hypocalcaemia, hyperkalaemia or calcium channel blocker intoxication. Severe ionized hypocalcaemia can occur after out-of-hospital cardiac arrest.

Adrenergic alpha-Agonists↗
PubMed1990

Prospective endoscopic study of stress erosions and ulcers in critically ill neurosurgical patients: current incidence and effect of acid-reducing prophylaxis.

We studied prospectively 40 critically ill neurosurgical patients who required prolonged mechanical ventilation to determine the current incidence of stress-related gastroduodenal erosions and ulcers, and to assess endoscopically the efficacy of acid-reducing prophylactic treatment. Nineteen patients were randomized to receive ranitidine plus antacids if necessary to maintain gastric pH at greater than or equal to 4. The remaining 21 patients were given no drug prophylaxis. Gastric pH was significantly (p less than .001) higher in the treated group: 78% of pH readings were at greater than or equal to 4 as compared to 32% in the control group. However, after five study days, incidence and severity of stress lesions were similar in the two groups: nine patients in each group had more than five erosions, one treated patient had a gastric ulcer, and one control patient had duodenal ulcerations. No patient experienced clinically relevant upper GI bleeding. The lack of severe stress bleeding and the low ulcer rate contrast with results from earlier reports on similar patient populations. Furthermore, drug prophylaxis had no detectable benefit, as assessed endoscopically. These findings suggest that routine stress lesion prophylaxis may not be necessary in critically ill patients with comparable risk factors.

Adolescent↗
PubMed1990

[Thoracic drainage at the accident site].

The helicopter medical team of the Basel University Hospital treated and evacuated 710 patients in 1987/88. 484 were trauma patients (68.2%) and the intensive medical care began on the accident scene in 56% of the cases. We treated 90 thoracic injuries. 58.9% of these patients needed a chest tube which was directly inserted at the emergency place in 41.4% of the cases. An endotracheal intubation was necessary for 83.8% of the patients with in-field insertion of a chest tube and for 33.9% of other injured persons. No iatrogenic complications were observed. The clinical follow-up showed less complications for infield treated patients. We conclude that in-field insertion of chest tubes, if correctly performed, is a safe procedure contributing to diminish the lethality and the morbidity of trauma patients.

Accidents, Traffic↗
PubMed1990

[Traumatology and emergency medicine: helicopter evacuation in the Basel area].

999 patients were treated and evacuated by medical helicopter in the region of Basel between 1986 and 1988. 687 were trauma patients (70.5%) and among them 53.9% were directly treated on the accident scene. Mortality during the stabilization prior to transport (2.6%) and during transport (0.3%) was low. The presence of a physician in the helicopter allows fast and intensive in-field care. All life-saving procedures like endotracheal tubes (36.3%), closed intercostal drainage (7.4% of trauma patients) and cardiovascular reanimation (1.9), even hemostasis, or fixation of fractures are performed. Early in-field intensive care by medical helicopter decreases lethality and mortality and must be recommended by severe trauma.

Aircraft↗
PubMed1990

[Helicopter emergency medical system in the Basel region].

Between 1986 and 1988, 999 patients were treated on the emergency scene, then transported with the rescue-helicopter in the Basle area. 687 were victims of a trauma (70.5%) and 287 patients were suffering from an acute internal medicine disease. We performed in-field therapy on the accident scene itself in 53.9% of all the cases. According to our scoring system the presence of a physician was absolutely necessary in 56% of all the cases. Air rescue by helicopter allows fast transportation of patients and immediate high quality intensive care. The low mortality rate during treatment before transport (2.6%) and during the transport itself (0.3%) shows that early beginning of medical treatment on the accident scene is connected to better survival chances.

Accidents, Traffic↗