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Biomedical subjects

E L Nagel

Publications and source records attributed to E L Nagel.

13 recordsLinked to original sources
PubMed1976

Prehospital use of the military anti-shock trouser (MAST).

Complications of prehospital use of the military anti-shock trouser (MAST) in treating hypotensive and hypovolemic patients have been few and minor. Undesirable consequences--compromised respiratory excursion or autonomic disturbances such as emesis, urination or defecation--were rare. Forty-seven (88.7%) of 53 patients with conditions classed as potentially lethal or severe survived. Close communications between prehospital and emergency department personnel can assure accurate transmission of circumstances of MAST application and result in optimal responses and improved inhospital patient care. Both "false positives" (supposed initial hypotension or hypovolemia) and "false negatives" (seeming stability in the face of major anatomic derangements) require a carefully structured operational sequence. Further evaluation of the device, particularly in cardiovascular/cardiopulmonary cases, is in progress.

Allied Health Personnel↗
PubMed1976

Spontaneous recovery of the thumb twitch from neuromuscular block by suxamethonium in anaesthetized man.

The neuromuscular blocking effect of repeated bolus administration of suxamethonium 1 mg/kg was observed in 10 healthy surgical patients under enflurane-nitrous oxide-oxygen anaesthesia. Tachyphylaxis and slow recovery of the thumb twitch occurred in close dose-relationships with transition of Phase I block to Phase II, using train-of-four fade as an indicator of the transition. Failure of the thumb twitch to recover to 75% of control, and subsequent step-wise depression from additional doses of suxamethonium had a sudden onset shortly after establishment of marked train-of-four fade.

Adult↗
PubMed1975

Emergency care.

Prehospital ventricular fibrillation can be treated successfully by rescue (paramedic) personnel. By retrospective history, one-half of prehospital sudden death victims experienced no prior warning and collapsed either instantaneously or within one minute of symptoms. The follow-up course was analyzed. Of 301 such subjects, 199 were defibrillated successfully, but only 101 survived long enough to be hospitalized, and only 42 were discharged alive. Predictors for successful outcome were initially rapid post-defibrillation heart rates and atrial fibrillation or sinus tachycardia rhythms. In the hospitalized group, 57% suffered repeat ventricular fibrillation and/or ventricular tachycardia usually during the first 24 hours. Among those discharged from the hospital, mean survival was 13 months with 28% dying suddenly regardless of presence of antiarrhythmic therapy. Intensive antiarrhythmic therapy and monitoring of this survivor population seems indicated.

Allied Health Personnel↗
PubMedDate not supplied

Neuromuscular block by antibiotics: polymyxin B.

Characteristics of neuromuscular block produced by polymyxin B (PXB) were examined in 12 anesthetized cats, using sciatic nervetibialis anticus muscle preparations. The ED50 was 6.7 (+/- 1.4, SD) PXB base/kg body weight. The ED95 was 10.8 (+/- 2.4) mg/kg. Spontaneous recovery from 25 percent of control to 75 percent of control required 72 (+/- 16) minutes. During a 50 percent block, train-of-four twitches elicited at 2 Hz faded with a train-of-four ratio of 0.42 (+/- 0.13), but the tetanus did not fade. Edrophonium Cl, neostigmine methylsulfate, and pyridostigmine Br at sub-clinical dosages weakly antagonized the block but enhanced the block at anti-curare dosages. All 3 cholinesterase inhibitors were short acting, lasting 10 to 15 minutes, and noncumulative on repeated injection. The potency ratio was approximately 20:10:1 in the order of edrophonium, neostigmine, and pyridostigmine on a weight-for-weight basis. Calcium partially antagonized the block. The authors conclude that neuromuscular blocks produced by various antibiotics differ from each other and from that produced by other groups of neuromuscular blocking agents, including curare.

Animals↗
PubMedDate not supplied

Paramedics.

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Allied Health Personnel↗
PubMedDate not supplied

Neuroleptanalgesia for awake pronation of surgical patients.

Pronation of anesthetized patients may result in complications. Neuromuscular block increases the risk. To minimize the risk, the authors devised a technic of "awake pronation," evaluating its feasibility, in 11 consecutive patients in a 1-year period for 12 operations; all attempts were successful and without complicatons. Neuroleptanalgesia is achieved with droperidol and fentanyl, topical anesthesia of the upper airway is induced with lidocaine, awake intubation is performed orotracheally under direct vision, and pronation is accomplished with patient cooperation.

Administration, Topical↗