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Biomedical subjects

J C Darin

Publications and source records attributed to J C Darin.

At least 37 records · Page 2Linked to original sources
PubMed1983

Rapid fluid resuscitation with central venous catheters.

We attempted to determine whether central venous catheters are effective for rapid fluid administration in moderately to severely hypovolemic patients. Comparative maximum flow rates with water and blood products were tabulated for various central and peripheral catheters. The USCI 8 and 9 French introducers (USCI Cardiology and Radiology Division, CR Bard, Inc, Ellerica, MA) had the fastest flow rates of all catheters tested (P less than .05). The best peripheral catheter, IV extension tubing cut to 12-inch length, had slightly less flow than did the introducers (P less than .05). The Deseret Subclavian Jugular Catheter (Deseret Co, Sandy, UT) had by far the slowest measured flow rates. Several parameters were evaluated that alter flow rates regardless of catheter size, including a pressure infusion cuff, packed red blood cells diluted with normal saline, and a Fenwal blood warmer (Fenwal Laboratories, Division of Travenol Laboratories, Inc, Deerfield, IL). Central venous catheters can be effective adjuncts for rapid fluid administration.

Blood Cells↗
PubMed1983

The effect of a paramedic system on mortality of major open intra-abdominal vascular trauma.

In a 12-year period (1970-1981), there were 112 patients operated on with major open intra-abdominal vascular trauma (MOIVT). These were any penetrating injuries to the aorta, inferior vena cava, portal vein, or their primary branches. Sixty-four patients were treated without benefit of paramedics. Only four of 43 patients who had emergency department blood pressures of 60 mm Hg or greater upon entry died (9.3%), whereas 18 of 21 (85.7%) patients with blood pressures of less than 60 mm Hg died (p less than 0.0001). Forty-eight of the 112 patients have been treated by paramedics during the past 4 years. Entry level blood pressures are those first recorded by the paramedics in the field. The mortality in those with blood pressures of 60 mm Hg or greater remained essentially unchanged. However, 11 of 22 patients with blood pressures of less than 60 mm Hg survived compared to three of 21 (p less than 0.025). Over the past 12 years, the community's homicide rate has been stable (71/yr), but the case incidence of MOIVT has risen from an average of 8/yr to 12/yr during the paramedic years. The average annual aggravated assault rate increased from 796 to 1,119. It is believed the improvement in the salvage rate is due to early intervention by trained paramedics functioning within a trauma care system.

Abdominal Injuries↗
PubMed1981

Experimental electrical injury studies.

Voltages from 10 to 14,000 volts demonstrated currents up to 70 amperes with resistances of approximately 200 ohms in studies in hogs. Below 1,000 volts, a current reduction is observed following arcing and skin necrosis. At the higher voltages, this phenomenon was not observed. The energy required for tissue damage was dependent upon the voltage and time of application. The tissue electrode resistance with stainless steel disc was proportional to the diameter. Skin buring commenced at the periphery of the electrodes and moved inwards. For application of currents between the hindlimbs of the hog, the current per tissue cross-section was greatest in artery and nerve, followed by muscle, fat, bone marrow, and bone cortex.

Animals↗
PubMed1978

Prehospital advanced emergency care: a potential pitfall.

Effective prehospital treatment of the severely injured and acutely ill by an Advanced Emergency Care system may change symptoms and signs by the time patients arrive at the hospital. To provide optimal care, physicians must appreciate the capabilities and limitations of the EMT-paramedic. The EMT-paramedic must report verbally and via written record the course of prehospital events. Cardiac rhythms must be documented for review. It should be the responsibility of the medical directors of such Advanced Emergency Care systems to provide supervision, refresher training, critiques, and evaluation, to establish medical responsibility and credibility.

Adult↗
PubMed1977

An effective prehospital emergency system.

An Emergency Medical Services (EMS) system with the capabilities of rapid response, patient extrication, basic life support, advanced life support, radio communication, and transportation provides appropriate care for a wide spectrum of injured and acutely ill patients. The validity of the selective dual response system in demonstrated by: 1) rapid provision of basic life support, 2) appropriate availability of advanced life support, 3) conservation of educational and fiscal resources, and 4) the enchancement of knowledge and manipulative skill expertise of relatively few, but busy, EMT-paramedics who are provided close medical supervision and support.

Allied Health Personnel↗
PubMed1976

Can the well trained EMT-paramedic maintain skills and knowledge?

Reliable criteria exist to assess emergency medical technician (EMT)-paramedic team and individual competence. In addition to written and oral examiniation, reliable individual manipulative skill data, and on-scene observation of emergency care by responsible physicians, EMT-paramedic team competence may be assessed by using tracer conditions that reflect patient outcome converted to a standard base population per unit time. Using standard definitions of "resuscitation" and "save," and the pulseless, nonbreathing patient as tracer, 75 (31%) of 241 patients were resuscitated and 34 (14%) were saved. Team manipulative skill competence may also be determined by an appropriate tracer.

Allied Health Personnel↗
PubMed1976

Which breast to biopsy: an expanding dilemma.

To provide insight into the significance of findings reported from screening asymptomatic women for breast cancer, we reviewed 19,928 mammographic studies with the accompanying physical examination and correlated these findings with 554 breast biopsies. Of 83 breast biopsies with suspicious findings on both physical examination and mammography, 72 demonstrated breast cancer (87%). Of 155 biopsies for suspicious changes on mammography alone, 50 (32%) demonstrated breast cancer. The accuracy of suspicious mammography was independent of findings limited to physical examination, 34 (17%) had breast cancer; 31 were in 152 biopsies of patients with mammography interpreted as normal (20%) and three were in biopsies of 52 patients (6%) in whom a visualized mass was interpreted as benign. One hundred and twelve breast biopsies were performed for changes interpreted as normal or benign. Six malignancies were discovered (5%). No cancer was found in 31 biopsies for nonpalpable benign mammographic abnormalities. Our results emphasize the importance of discriminating between nonvisualization of a mass and mammographic recognition of either a benign or malignant tumor. The reliability of interpretation is considerably greater for a visualized lesion than a nonvisualized one.

Biopsy↗
PubMed1975

Exchange transfusion in hepatic coma: factors affecting results, with long-term follow-up data.

1. Exchange transfusion in our experience has produced a response in 42 per cent of the patients. 2. Complicating factors, primarily sepsis, have been responsible for a 50 per cent mortality in those patients who initially respond, yielding a survival rate of 21 per cent. 3. In a select group of patients with infectious hepatitis under the age of twenty-five years, the survival rate was 37.5 per cent. 4. Excess bilirubin and ammonia rebound after exchange transfusions indicates a grave prognosis. 5. All survivors have normal results on liver function studies.

Adolescent↗