Anterior shoulder dislocation: a review of reduction techniques.
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Analgesia↗
Biomedical subjects
J B McCabe
Publications and source records attributed to J B McCabe.
The road to academic respectability.
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Attitude of Health Personnel↗
Unsuspected mitral stenosis.
PURPOSE AND PATIENTS AND METHODS: We observed a series of patients in whom the diagnosis of mitral stenosis was first discovered in the echocardiography laboratory. Because of this experience, we examined the records of 152 patients with echocardiographic evidence of rheumatic mitral stenosis to determine the clinical characteristics and course of patients with unsuspected mitral stenosis as well as those factors that may have obscured the diagnosis. RESULTS: Of these 152 patients, 18 had mitral stenosis that was unsuspected clinically until the echocardiogram. These patients were elderly, with a median age of 72 years. They were all referred for echocardiography because of cardiac symptoms. Eight patients were referred for evaluation of congestive heart failure. Five patients were referred for evaluation of aortic valve disease. Three patients were referred because of cerebrovascular accidents and atrial fibrillation. The Doppler-determined mean diastolic mitral gradient ranged from 4 to 15 mm Hg (mean: 7 mm Hg). Mitral stenosis ranged in severity from trivial to very severe. Eight patients had moderate to severe mitral stenosis with estimated mitral valve areas less than or equal to 1.5 cm2. Seven had mild or trivial mitral stenosis with estimated mitral valve areas greater than 1.5 cm2. After further evaluation, two patients underwent mitral valve surgery with improvement of congestive failure. In three patients, warfarin therapy was begun to prevent emboli. Thus, five of 18 patients had a significant immediate change in therapy because of the discovery of mitral stenosis. CONCLUSION: The diagnosis of mitral stenosis may not be suspected in the presence of advanced age, other serious cardiac and medical conditions, or mechanical factors that complicate the physical examination. In these patients, mitral stenosis may be hemodynamically significant and may cause significant symptoms.
Adult↗
New prospects for shock treatment.
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Humans↗
Influence of emergency medical services systems and prehospital defibrillation on survival of sudden cardiac death victims.
This article reviews the influence of emergency medical systems and prehospital defibrillation on survival of sudden cardiac death. The historical perspective and epidemiologic considerations of prehospital sudden cardiac death are highlighted. Factors predictive of successful resuscitation and impact of community activity on sudden death are discussed. Influences of emergency medical services on outcome of prehospital cardiac arrest are reviewed, with emphasis on the role of dispatchers, emergency medical technicians, and paramedics. The recent emergence of prehospital automatic defibrillation by emergency medical technicians, first responders, and lay persons is discussed in depth, as it has great potential to positively influence outcome of prehospital sudden cardiac death.
Death, Sudden↗
The impact of a didactic session on the success of feline endotracheal intubation by paramedics.
Clinical reports of endotracheal (ET) intubation of infants by paramedics suggest suboptimal success rates. Methods to improve the performance of paramedics in ET intubation should be explored. The small, anesthetized cat may be utilized to evaluate infant ET intubation performance. By determining success rates and complications of ET intubation in the cat model, analysis of the current skills and the impact of a short didactic session is described. Unprepared paramedics (n = 36) were randomized to an educational (experimental) or control group. Supervisory personnel evaluated ET tube placement and complications. There was no significant difference in the percent of successfully intubated cats, 67% and 57%, respectively, between experimental and control groups. Fifteen percent of successful ET intubations exceeded 30 seconds of intubation time. The experimental group chose appropriate equipment more frequently. Serious complications occurred in 50% of attempted intubations. There was a poor correlation between performance and measures of paramedic experience. Development of educational methods is required to improve infant ET intubation success and reduce complications.
Allied Health Personnel↗
Changes in somatosensory evoked potentials in dogs following cardiac arrest and resuscitation.
The effect of cardiac arrest induced global cerebral ischemia on the peripheral, spinal cord, and cortical somatosensory evoked potentials (SSEP) was studied in 7 mongrel dogs. Following the recording of control responses in each animal, ventricular fibrillation was induced and the dogs were allowed to fibrillate for a random time varying between 30 s and 15 min. The animals were then resuscitated using a standardized resuscitation protocol, and evoked potentials were recorded at intervals up to 1 h post resuscitation. A grading scale was devised to categorize the evoked potentials according to degree of abnormality. We found that peripheral SSEPs were well preserved up to 22 min ischemia time. Spinal cord potentials became abnormal with ischemia times greater than 9.5 min. Cortical traces were essentially normal with less than 4 min ischemia time, variable with 4-9.5 min and markedly abnormal with greater than 9.5 min ischemia. Somatosensory evoked potentials may be a useful adjunct in the monitoring of cerebral function following cardiac arrest.
Animals↗
Epiglottitis at the extremes of age.
Epiglottitis may occur at any age. The typical presentation in the young child and young adult is well known, but the presentation in patients at the extremes of age has not been characterized. At our locale, from 1974 to 1984, 19 children 24 months of age or less and, from 1979 to 1984, 9 adults 50 years of age or greater with epiglottitis were seen in the emergency department. In the infantile group, rapidly progressive interference with swallowing, vocalization, and respiration was encountered in less than half the patients. Symptoms were often prolonged before parents sought attention for their child. No preference was shown for maintenance of the upright position while at rest, as recumbency did not promote stridor or initiate respiratory distress. Respiratory complaints were common and included cough, tachypnea, and retractions. Drooling or retention of pharyngeal secretions was uncommon. The adult population had a history of symptoms that spanned several days. Extreme sore throat, pooling of oral secretions, muffled voice, and elevated temperature were uncommon. Dysphagia and mild respiratory complaints were frequent. Upper airway obstruction did occur. At both extremes of age, exceptions to the classic clinical pattern of epiglottitis occurred with significant frequency. Despite this, diagnosis and management in the emergency department were appropriate in most cases.
Adult↗
The effects of antishock trouser inflation during hypothermic cardiovascular depression in the canine model.
The purpose of this study was to investigate the value and to identify any deleterious effects of antishock trouser use during hypothermic cardiovascular depression. Thirteen mongrels were made hypotensive by cooling to a core temperature of approximately 27 degrees C. Eight dogs had antishock trousers inflated for one hour and five dogs served as controls. Metabolic and hemodynamic variables were measured at regular intervals during cooling, during trouser inflation, and after trouser deflation. No study animal experienced ventricular fibrillation. Neither central temperature, pH, or serum potassium nor mean arterial BP or systemic vascular resistance were significantly affected by trouser inflation or deflation. Antishock trouser use during the early phase of hypothermia before rewarming does not appear to result in a central bolus of cold, acidotic, hyperkalemic blood or the precipitation of ventricular fibrillation. There appears to be no significant hemodynamic benefit of antishock trouser use early in the management of hypotension caused by moderate hypothermia.
Animals↗
A comparison of four techniques to establish intraosseous infusion.
This study was designed to determine whether the success rate in establishing intraosseous infusion (IOI) varied with four different types of needles--standard hypodermic, spinal, bone marrow, and Turkel intraosseous infusion needle. Twenty-four second-year residents from various specialties, without prior training or experience in the technique, participated in the study. Each participant attempted to establish an intraosseous infusion in a randomly assigned limb of an anesthetized piglet, using each needle in a randomly assigned order. The overall success rate was 67.7%. Success ratios varied between needles: hypodermic 54%, spinal 75%, bone marrow 75%, and Turkel 67%. Utilizing Cochran's Q-test, there was no statistical difference in success rates between needle types. However, in cases where the resident was successful with all four needles, the average time to successful infusion was significantly less for bone marrow needles.
Animals↗
Metabolism of periplasmic membrane-derived oligosaccharides by the predatory bacterium Bdellovibrio bacteriovorus 109J.
Membrane-derived oligosaccharides (MDO), a class of osmotically active carbohydrates, are the major organic solutes present in the periplasm of Escherichia coli and many other gram-negative bacteria when cells are grown in a medium of low osmolarity. Analyses of growing cells of Bdellovibrio bacteriovorus, a gram-negative predator of other bacteria, have confirmed that they also synthesize a characteristic MDO-like class of oligosaccharides. The natural growth environment of bdellovibrios is the periplasm of other gram-negative bacteria. Because of this location, prey cell MDO constitute a potential source of organic nutrients for growing bdellovibrios. Using cells of E. coli whose MDO were 3H labeled, we examined the extent to which B. bacteriovorus 109J metabolizes these prey cell components. Interestingly, there was neither significant degradation nor incorporation of prey cell MDO by bdellovibrios during the course of their intracellular growth. In fact, bdellovibrios had little capability either to degrade extracellular MDO that was made available to them or to transport glucose, the major monomeric constituent of prey cell MDO. Instead, periplasmic MDO were irreversibly lost to the extracellular environment during the period of bdellovibrio attack and penetration. Thus, although prey cell periplasmic proteins are retained, other important periplasmic components are released early in the bdellovibrio growth cycle. The loss of these MDO may aid in the destabilization of the prey cell plasma membrane, increasing the availability of cytoplasmic constituents to the periplasmic bdellovibrio.
Bdellovibrio↗
Ventilation performance using a self-inflating anesthesia bag: effect of operator characteristics.
Adequate ventilation is required for successful cardiopulmonary resuscitation (CPR). Operator characteristics that influence ventilation performance are not well defined. This study compared ventilation performance and operator characteristics in 74 medical personnel using a self-inflating anesthesia bag. Ventilation device, operator hand size, ventilation technique, average tidal volume, cumulative minute ventilation, and ventilation pressures were recorded during 3 minutes of ventilation. Ventilation volumes and airway pressures were not correlated with hand size or device type. Techniques that used one hand to squeeze the bag resulted in significantly lower average tidal volume than two-handed techniques, with no significant difference in peak or average airway pressure. There was no difference between emergency department and prehospital personnel in average tidal volume delivered. However, prehospital personnel ventilated at significantly higher airway pressures. Emergency department nurses delivered the greatest average tidal volume (923 cc), while emergency department physicians delivered the least (775 cc). Paramedics recorded the highest airway pressures (average, 53 cm H2O; peak, 72 cm H2O), while respiratory therapists recorded the lowest pressures (average, 34 cm H2O; peak, 54 cm H2O). Ventilation during CPR is a complex, learned skill. Large variation exists among different operators. However, appropriate tidal volumes can be delivered using safe airway pressures. Ongoing assessment and retraining of individuals performing ventilation during CPR are essential.
Adult↗
Intravenous fluid flow beneath inflated antishock trousers in a canine hemorrhagic shock model.
A study was performed to determine the percentage of fluid that enters the central circulation following infusion in a peripheral vein beneath an inflated pneumatic antishock garment (PASG) during hemorrhagic shock in a canine model. Seven mongrel dogs were bled acutely to a systolic blood pressure of 50 to 60 mm Hg. The PASG then was inflated. One to two microcuries of Technetium-99-labeled macroaggregated albumin was infused into a peripheral vein in the hind leg, followed by a 10-mL/kg fluid bolus. The albumin particles that reached the central circulation were trapped in the pulmonary capillary bed. Following infusion, a full body scan was performed. The percentage of injected fluid entering the central circulation was calculated by comparing the total body counts to counts localized to the thorax. Average mean arterial pressure was 111 mm Hg prior to bleeding, 47 mm Hg prior to shock trouser inflation, and 66 mm Hg after inflation. The percentage of injected Technetium-99-labeled albumin that reached the central circulation ranged from 80.5% to 99.6%, with a mean of 91.3%. We conclude that a significant percentage of IV fluids infused beneath inflated PASG will reach the central circulation.
Animals↗
Intussusception: a supplement to the mnemonic for coma.
Expected clinical manifestations of intussusception include paroxysmal abdominal pain, vomiting, abdominal mass, and with time, rectal bleeding. We report a case where lethargy and vomiting are the presenting complaints. Diagnostic delay was encountered for this infant who had altered sensorium without accompanying pain, melena, or mass on initial examination. Either plain radiographs, supplemented by ultrasonography of the abdomen, or a barium enema should be performed in infants with unexplained lethargy.
Coma↗
Comparison of the effectiveness of different cervical immobilization collars.
Immobilization of the cervical spine is a common prehospital and emergency department maneuver. The ability of four different cervical collars to immobilize the cervical spine was studied using radiographic measurement in seven normal volunteers. Restriction of motion during flexion, extension, and lateral bending was studied. Differences between collars exist and require further study to identify the optimum device for immobilization of the cervical spine.
Adult↗
Pacemaker-mediated tachycardia: tracking of atrial fibrillation during DDD pacing.
A 68-year-old man with sick sinus syndrome was treated by implantation of a DDD pacemaker. He subsequently developed a rapid heart rate and was found to have a pacemaker-mediated tachycardia due to tracking of atrial fibrillation by the pacemaker. The tachycardia was abolished by reprogramming the pacemaker, and the patient remained asymptomatic.
Aged↗
Successful medical therapy of mitral anular abscess complicating infective endocarditis.
A case of staphylococcal endocarditis with the echocardiographic findings of mitral anular abscess is described. The anular mass resolved after 9 weeks of antibiotic therapy. This case illustrates that perivalvular abscess complicating infective endocarditis may respond to medical therapy.
Abscess↗
An ATP transport system in the intracellular bacterium, Bdellovibrio bacteriovorus 109J.
The intracellularly growing bacterium Bdellovibrio bacteriovorus 109J transports intact ATP by a specific, energy-requiring process. ATP transport does not involve either an ADP-ATP or an AMP-ATP exchange mechanism but, instead, has characteristics of an active transport permease. Kinetically distinct systems for ATP transport are expressed by the two developmental stages of the bdellovibrio life cycle.
Adenosine Triphosphate↗