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Biomedical subjects

H G Garrison

Publications and source records attributed to H G Garrison.

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

Functional outcome of patients with unstable pelvic ring fractures stabilized with open reduction and internal fixation.

An unstable pelvic ring fracture represents a severe injury and is associated with high morbidity and mortality. Little data are available assessing the long-term functional limitations, including disability, in a patient with an unstable pelvic ring fracture. The purpose of this study was to describe the impairment and functional outcome (disability) for patients with unstable pelvic ring fractures managed with open reduction and internal fixation (ORIF). Disability was measured at a minimum of 1 year postinjury using the Sickness Impact Profile (SIP), a measure of the health-related quality of life as perceived by the patient. Of the 230 consecutive patients with a pelvic ring fracture, 54 had unstable fractures requiring ORIF; 48 patients were available at a 1 year follow-up. The follow-up roentgenograms confirmed an osseous union and an anatomic alignment of the pelvis. Thirty-seven (77%) of the patients had mild disability (total SIP < 10); 11 (23%) of the patients had moderate disability (SIP > 10) at 1 year. Of the patients who were employed preinjury, 76% were employed 1 year postinjury; 62% had returned to full time work and 14% had returned with job modification. Of the 7 patients who had been in school, 6 had returned full time and 1 student returned part time. Mean SIP scores for subcategories were: physical health = 6.8 +/- 9.4, psychosocial health = 7.4 +/- 12.7, work = 17.6 +/- 25.5, home management = 8.3 +/- 13.0, ambulation = 10.7 +/- 13.7, and mobility = 5.3 +/- 13.0. Despite the magnitude of the bony injuries, the majority of patients with unstable pelvic ring fractures managed with ORIF had mild disability 1 year postinjury; the majority of the patients had returned to work.

Activities of Daily Living↗
PubMed1992

Unexpected emergency department death: incidence, causes, and relationship to presentation and time in the department.

STUDY OBJECTIVE: To determine the incidence and causes of unexpected death in emergency department patients and its relationship to initial ED presentation. To determine if length of ED stay is directly related to unexpected death. DESIGN: Retrospective chart review of all patients dying in the study ED during a three-year period. Patients receiving CPR on admission or who had "do not resuscitate" orders were classified as expected deaths. Vital signs, level of consciousness, length of time in the ED, and cause of death were recorded for all unexpected deaths. SETTING: Five hundred sixty-six-bed medical center with an ED volume of 45,000 patients per year. PARTICIPANTS: Four hundred eleven patients were pronounced dead from 1987 to 1989, and 403 (98%) charts were available. RESULTS: Fifty-seven (14%) patients met the unexpected death criteria. Abnormal vital signs or altered level of consciousness was observed in 56 (98%) patients on presentation. Medical causes accounted for 42 (74%) of the unexpected deaths. Five (9%) surgical and ten (18%) trauma-related deaths were identified. The yearly incidence of unexpected death was 4.9 (per 10,000 ED visits) in 1987 and 4.1 in both 1988 and 1989. Average length of time in the ED before unexpected death increased during the study period (1987, 91 minutes; 1988, 110 minutes; 1989, 116 minutes). CONCLUSION: Unexpected ED death was uncommon, usually nontraumatic, and occurred in patients with evidence of significant illness. Although average length of stay in the ED increased, there was no increase in the incidence of unexpected ED death. If lengths of ED stay continue to increase, this situation will require further study.

Academic Medical Centers↗
PubMed1991

Acute ethanol intoxication decreases the likelihood of resuscitation from cardiac arrest in rats.

BACKGROUND AND METHODS: Acute ethanol intoxication has been shown to depress myocardial performance in both laboratory and clinical studies. The present study was designed to examine the effect of acute ethanol intoxication on resuscitation of rats subjected to cardiac arrest. Rats were given 1.2 g ("moderately intoxicated") or 2.4 g ("highly intoxicated") of ethanol/kg, or distilled water ("nonintoxicated" rats). Using a standardized technique, we induced cardiac arrest. CPR was then attempted using chest compressions interposed with abdominal compressions. Resuscitation was said to be successful if BP returned spontaneously within 6 mins of institution of chest compressions interposed with abdominal compressions, and if systolic BP was 50% of its prearrest level within 10 mins of discontinuation of chest compressions interposed with abdominal compressions. Mean +/- SD serum ethanol levels were 121.3 +/- 12.9 mg/dL (26.3 +/- 2.8 mmol/L) (moderately intoxicated rats) and 254.4 +/- 34.6 mg/dL (55.2 +/- 7.5 mmol/L) (highly intoxicated rats). RESULTS: Resuscitation was successful in 75% (15/20) of nonintoxicated rats, 46.7% (7/15) of moderately intoxicated rats, and 33.3% (5/15) of highly intoxicated rats. The difference in resuscitation rates was significant for nonintoxicated rats compared with either intoxicated rats as a group (p = .021) or highly intoxicated rats (p = .019), but was not significant for nonintoxicated rats compared with moderately intoxicated rats. CONCLUSION: Acute ethanol intoxication appears to decrease the likelihood of successful resuscitation in a dose-dependent fashion.

Alcoholic Intoxication↗
PubMed1989

Helicopter use by rural emergency departments to transfer trauma victims: a study of time-to-request intervals.

To assess how soon rural emergency departments (EDs) call for helicopters to transport seriously injured patients, the records of all trauma victims (excluding isolated CNS trauma) transported by an emergency helicopter service from referring hospitals to a trauma center over an 18-month period were studied. Admission time to the referring ED was compared with the exact time a call for the helicopter was received and a time-to-request interval (TTR) was calculated. A total of 64 cases were studied. Fifty (78%) of the patients had blunt trauma; 14 (22%) had penetrating trauma. The average TTR for the helicopter was 69.8 minutes, with a range from 17 minutes before arrival at the referring ED to 337 minutes after arrival. Children (aged less than or equal to 16 years) had an average TTR of 34.1 minutes compared with 76.4 minutes for adults (aged greater than 16 years). Of the variables examined, patient age was the only factor significantly associated with TTR. These observations suggest that, except in children, there frequently is a lengthy time interval between the time trauma patients arrive at EDs in rural eastern North Carolina and the time an emergency helicopter service is called to transport them to a trauma center.

Adolescent↗
PubMed1986

Effect of nifedipine on cerebral high-energy phosphates after cardiac arrest and resuscitation in the rat.

We studied the effect of nifedipine, a calcium entry blocker, on the recovery of cerebral adenosine triphosphate (ATP), creatine phosphate (CP), and lactate levels following resuscitation from cardiac arrest. Using the cardiac arrest and resuscitation model of de Garavilla, Babbs, and Tacker with an arrest time of eight minutes, 76% of the animals arrested were resuscitated with an average intermittent abdominal compression-CPR time of 3.3 minutes. Rats were assigned randomly to the following groups: nonischemic; eight minutes of arrest without resuscitation; and postresuscitation treatment with either IV normal saline; 3 micrograms/kg nifedipine; 10 micrograms/kg nifedipine; or 30 micrograms/kg nifedipine. Treated animals were sacrificed at either 20 or 120 minutes thereafter. As expected, after eight minutes of cardiac arrest, the levels of ATP and CP dropped to near 0 and rebounded in all resuscitated animals. By 120 minutes after resuscitation, rats given the 10-micrograms/kg dose of nifedipine had levels of ATP equivalent to nonischemic values. Return of CP values to nonischemic levels was seen only at the 3-micrograms/kg dose and was independent of time of measurement. The ATP and CP levels in these nifedipine-treated groups were significantly better when compared to saline-treated controls. There were no treatment-dependent differences in lactate levels. We conclude that clinically appropriate doses of nifedipine had a beneficial effect on the recovery of cerebral high-energy phosphates after cardiac arrest and resuscitation.

Adenosine Triphosphate↗
PubMed1984

Effect of ethanol on lactic acidosis in experimental hemorrhagic shock.

Many trauma victims who have hemorrhagic shock are also intoxicated. Ethanol could worsen the severity of shock and decrease the amount of blood loss necessary to reach or maintain the shock state, perhaps by increasing lactic acidosis. We examined the effect of ethanol on lactic acidosis in a group of rats that were intoxicated, then put in a state of hemorrhagic shock (MAP = 40 mm Hg). These animals were compared to a control group that were in a similar state of hemorrhagic shock but not intoxicated. The volumes of blood necessary to reach and maintain the predetermined model state of shock for two hours in each group were also measured. The animals were paralyzed and placed on controlled ventilation. The ethanol produced an expected baseline lactic acidosis, and it took significantly less blood volume loss to keep the intoxicated group in shock. However, during shock there was no significant difference in the state of lactic acidosis. These results suggest that acute ethanol intoxication made the animals more sensitive to hemorrhage. This effect was not mediated by an increase in lactic acidosis in our model.

Acidosis↗
PubMed1981

Alteration of aminoglycoside antibiotic ototoxicity by hyper- and hypohydration.

The ototoxicities of tobramycin sulfate and gentamicin sulfate were investigated in guinea pigs under conditions of normal, increased, and decreased hydration. Increased hydration was associated with no decline in the amplitude of the cochlear microphonics, a lesser decline in the eighth nerve action potentials and lesser damage to the organ of Corti. Decreased hydration was associated with an increase in the threshold of the cochlear microphonics and the eighth nerve action potentials, a decline in the amplitude of the cochlear microphonics, a greater decline in the eighth nerve action potentials, and greater damage to the organ of Corti. Tobramycin sulfate was substantially less toxic than gentamicin sulfate with normal, increased and decreased hydration. These findings suggest the preferential use of tobramycin sulfate for patients with normal renal function, and especially patients with renal impairment.

Action Potentials↗
PubMedDate not supplied

Clinical procedures performed by emergency medicine resident physicians: a computer-based model for documentation.

To facilitate documentation and assess the number and types of clinical procedures actually performed by resident physicians, we developed a microcomputer-based recording process. After completing a procedure, including resuscitations, residents recorded in a precoded book issued for each monthly rotation. At the end of each rotation, the books were collected and the information was transferred to a database program by the clerical staff. During 1989, 17 emergency medicine resident physicians at PGY levels 1 through 3 utilized this system. Completed procedure record books were submitted for 124 of 148 clinically active months for a compliance rate of 84%. Of 1,857 procedures recorded, the most frequent were resuscitation (20%), orotrachael intubation (12%), and percutaneous central vein cannulation (12%). Commonly recorded were lumbar puncture (7%), diagnostic peritoneal lavage (5%), nasotrachael intubation (4%), and newborn delivery (4%). The high compliance rate suggests resident physicians acceptance. This system enables residency directors to closely monitor individual and group procedure experiences and to make curriculum changes based on objective findings. It also provides a means of storing and retrieving data for review organizations and credentials committees.

Documentation↗
PubMedDate not supplied

Determination of prehospital blood glucose: a prospective, controlled study.

STUDY OBJECTIVE: To determine if emergency medical personnel can effectively rule out hypoglycemia in the prehospital setting. DESIGN: During a 10-week period, emergency medical personnel determined the fingerstick glucose on all prehospital patients with altered mental status using the Chemstrip bG. Statistical comparisons were made to serum glucose levels performed by hospital laboratory personnel on blood samples obtained prior to glucose administration. A serum glucose level less than 60 mg/dL was considered a positive test for hypoglycemia. PARTICIPANTS: 170 consecutive patients with altered mental status (AMS) ranging in age from 13 to 90 years were enrolled. MEASUREMENTS AND MAIN RESULTS: Of these patients, 158 were normal or hyperglycemic, 12 were hypoglycemic, and one patient was hypoglycemic but had only a borderline negative fingerstick test. Thus, a sensitivity of 91.7% and a negative predictive value of 99.3% were obtained. The specificity was 92.4%, and positive predictive value was 47.8%. CONCLUSION: The Chemstrip bG may be used safely in the prehospital setting to rule out hypoglycemia.

Adolescent↗
PubMedDate not supplied

EMS knowledge and skills in rural North Carolina: a comparison with the National EMS Education and Practice Blueprint.

INTRODUCTION: Many state and local emergency medical services (EMS) systems may wish to modify provider levels and their scope of practice to align their systems with the recommendations of the National Emergency Medical Services Education and Practice Blueprint. To determine any changes that may be needed in a typical EMS system, the knowledge and skills of EMS providers in one rural area of North Carolina were compared with the knowledge and skills recommended in the National Emergency Medical Services Education and Practice Blueprint. METHODS: A survey listing 175 items of patient care-oriented knowledge and skills described in the National Emergency Medical Services Education and Practice Blueprint was developed. EMS providers from five rural eastern North Carolina counties were asked to identify on the survey those items of knowledge and skills they believed they possessed. The skills and knowledge selected by the respondents at the five different North Carolina levels of certification were compared with the knowledge and skills listed for comparable provider levels delineated by the National Emergency Medical Services Education and Practice Blueprint. The proportions of the recommended skills reported to be possessed by the respondents were compared to determine which North Carolina certification levels best correlate with the Blueprint. RESULTS: One hundred forty-five EMS providers completed the survey. The proportion of recommended skills and knowledge reported to be possessed by Emergency Medical Technicians (EMTs) ranked significantly lower than did the skills and knowledge reported to be possessed by respondents at other levels in five of the 10 Blueprint elements. The proportion of recommended skills and knowledge reported to be possessed by EMT-Defibrillator-level personnel ranked lower than did those reported to be possessed by respondents at other levels in seven of the 10 Blueprint elements. The proportion of recommended skills and knowledge reported to be possessed by EMT-Intermediates ranked lower than did those reported to be possessed by respondents at other levels in nine of the 10 Blueprint elements. The proportion of recommended skills and knowledge reported to be possessed by EMT-Advanced Intermediates ranked lower than were the skills and knowledge reported to be possessed by respondents at other levels in two of the 10 Blueprint elements. Finally, the proportion of recommended skills and knowledge reported to be possessed by EMT-Paramedics ranked lower than were those reported to be possessed by respondents at other levels in one of the 10 Blueprint elements. CONCLUSION: In North Carolina, combining the EMT and EMT-Defibrillator levels and eliminating the EMT-Intermediate level would create three levels of certification, which would be more consistent with levels recommended by the Blueprint. The results of this study should be considered in any effort to revise the levels of EMS certification in North Carolina and in planning the training curricula for bridging those levels. Other states may require similar action to align with the National Emergency Medical Services Education and Practice Blueprint.

Certification↗
PubMedDate not supplied

Study design and outcomes in out-of-hospital emergency medicine research: a ten-year analysis.

OBJECTIVE: Lack of rigorous study design and failure to follow diverse patient outcomes have been identified as critical gaps in the medical research literature. This study sought to determine whether similar gaps exist in the literature for out-of-hospital interventions. METHODS: A computerized MEDLINE search was conducted for the ten-year period 1985 through 1994 using the MeSH terms "emergency medical services," "prehospital," and "transportation of patients." Using a standard abstraction form, two investigators independently analyzed articles meeting these inclusion criteria: original research evaluating an out-of-hospital intervention and measuring a patient outcome. Study design was categorized in order of scientific rigor, moving from case series to randomized trial. Measures of outcomes were classified into the six Ds: death, disease, discomfort, disability, dissatisfaction, and debt (cost). RESULTS: Interobserver agreement was high (kappa = 0.80). For the ten-year period, 3,686 titles, 1,454 abstracts, and 373 articles were examined serially; all 285 studies meeting inclusion criteria were analyzed. Case series (44%) was the most frequently used design, while only 15% were randomized trials. The majority of the studies were retrospective (53%). A single outcome was assessed in 45% of the articles; 41% measured two outcomes, 13% three outcomes, and 1% four outcomes. Death and disease were the most common outcomes evaluated. Disability, debt, discomfort, and dissatisfaction were infrequently measured. CONCLUSION: Studies of out-of-hospital emergency medical interventions are limited in the scientific rigor of study design and the diversity of patient outcomes measured. To adequately assess the effectiveness of out-of-hospital care, efforts should be directed toward strengthening study designs and examining the full range of patient outcomes.

Adult↗
PubMedDate not supplied

Quality indicators for out-of-hospital emergency medical services: the paramedics' perspective.

OBJECTIVE: Out-of-hospital emergency medical services (EMS) need relevant and measurable indicators of quality. Those front-line workers who provide service directly to the customer are integral to the process of defining quality. The authors' objective was to obtain from paramedics, the front-line workers in the EMS system, their perspective on quality of care. METHODS: During regularly scheduled education sessions, 102 of the 140 field paramedics from a large municipal EMS system attended a presentation on total quality management. The paramedics were then assigned to focus groups and asked to identify quality indicators and provide recommendations for how they should be measured. RESULTS: Eighteen different quality indicators were identified. In addition, the paramedics suggested 17 ways to measure these proposed quality indicators. CONCLUSIONS: From the perspective of the study participants, indicators of the quality of out-of-hospital care differ from many used in traditional EMS quality assurance programs. Future studies should investigate the applicability of these indicators to the total quality management of EMS systems.

Attitude of Health Personnel↗
PubMedDate not supplied

Ambulance diversion. Standards and Clinical Practices Committee, National Association of EMS Physicians.

Policies regarding ambulance diversion are critical to ensuring that EMS providers are aware of appropriate patient destinations, even before patients enter the system. Field EMS personnel should never be requested to prolong transport time intervals to search for an available hospital at the potential expense of patients' conditions and the immediate availability of out-of-hospital emergency care for the community. The responsibility for providing efficient emergency care to the community rests with all those who contribute to EMS structures and processes. All EMS system participants, including hospitals, EMS providers, local and regional lead agencies, and medical oversight authorities, must work together to create comprehensive ambulance diversion policies that satisfactorily meet each other's needs, while maintaining the highest regard for the needs of EMS patients and the entire community.

Ambulances↗
PubMedDate not supplied

The role of emergency medical services in primary injury prevention. East Carolina Injury Prevention Program.

Injury is a leading cause of death and disability. Preventing injuries from ever occurring is primary injury prevention (PIP). The objective of this statement is to present the consensus of a 16-member panel of leaders from the out-of-hospital emergency medical services (EMS) community on essential and desirable EMS PIP activities. Essential PIP activities for leaders and decision makers of every EMS system include: protecting individual EMS providers from injury; providing education to EMS providers in PIP fundamentals; supporting and promoting the collection and utilization of injury data; obtaining support for PIP activities; networking with other injury prevention organizations; empowering individual EMS providers to conduct PIP activities; interacting with the media to promote injury prevention; and participating in community injury prevention interventions. Essential PIP knowledge areas for EMS providers include: PIP principles; personal injury prevention and role modeling; safe emergency vehicle operation; injury risk identification; documentation of injury data; and one-on-one safety education.

Community-Institutional Relations↗
PubMedDate not supplied

Alteration of aminoglycoside antibiotic ototoxicity: effect of semistarvation.

The effect of semistarvation on the toxicity and ototoxicity of tobramycin sulfate (TO) and gentamicin sulfate (GE) was investigated in guinea pigs by electrophysiological and histopathological methods. The presented data has shown that the toxicity and ototoxicity of aminoglycoside antibiotics is substantially increased when guinea pigs were semistarved. Our results should also warn researchers using semistarvation in their conditioning experiments which investigate the toxicity of different chemicals. Toxicity was greater in GE- than TO-treated animals, which caused the GE-treated animals to die during treatment or shortly after treatment. Thus, TO should be preferentially used because it has been shown to be less toxic and ototoxic in normal and altered nutritional conditions.

Animals↗