Biomedical subjects
Publications and source records attributed to J Tibballs.
A young pregnant woman, near term, died shortly after being bitten by an immature brown snake (genus Pseudonaja). Analysis of the bitten area suggested that the degree of envenomation was mild, and could not satisfactorily explain her rapid demise. It was concluded that the supine hypotensive syndrome of pregnancy was a contributing factor in her death.
An antivenom to the Sydney Funnel-web Spider, Atrax robustus, developed in rabbits, passed exhaustive quality control studies and was subsequently tested in monkeys. It was shown to reverse the syndrome that follows envenomation in both a conscious unmonitored monkey and in two anaesthetised, monitored monkeys. This paper reports the results of these experiments. An autonomic crisis appears to be the major cause of mortality and morbidity in human victims and monkeys; this aspect of the syndrome is rapidly attenuated by the antivenom. We observed no ill-effects of antivenom.
The effects of the venom of the male Sydney funnel-web spider were studied in closely monitored monkeys, and a number of new features were observed. Excessive catecholamine release was demonstrated and linked to the development of hypertension, arrhythmias, pulmonary oedema, hyperthermia, and metabolic acidosis. Acute intracranial hypertension was found, and may partly explain the central neurological manifestations. It is believed that a neurogenic basis for pulmonary oedema may sometimes exist. Survival after massive envenomation was achieved with the use of aggressive pharmacological denervation of the motor and autonomic nervous systems.
Venom of the male Sydney funnel-web spider was injected subcutaneously into the limbs of monkeys (Macaca fascicularis), and the central movement of venom was delayed by first-aid treatment. This treatment consisted of the application of firm pressure over the site of injection and immobilization of the limb. It was found that quantities of venom as high as 2 mg were inactivated when the first-aid procedures were maintained for 24 hours. Over a six-hour period, 0.5 mg of venom could be inactivated. Since the amount of venom injected by the spider into a human victim is unlikely to exceed 0.2 mg, these findings have immediate application both to the first aid and to actual medical management of human victims.
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The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours following birth and the techniques for providing advanced life support. After careful review of the international resuscitation literature and after discussion of key and controversial issues, consensus was reached on almost all aspects of neonatal resuscitation, and areas of controversy and high priority for additional research were delineated. Consensus on resuscitation for the newly. born infant included the following principles. (i) Personnel trained in the basic skills of resuscitation should be in attendance at every delivery. A minority (fewer than 10%) of newly born infants require active resuscitative interventions to establish a vigorous cry and regular respirations, maintain a heart rate greater than 100 beats per minute (bpm), and maintain good color and tone. (ii) When meconium is present in the amniotic fluid, it should be suctioned from the hypopharynx on delivery of the head. If the meconium-stained newly born infant has absent or depressed respirations, heart rate, or muscle tone, residual meconium should be suctioned from the trachea. (ii) Attention to ventilation should be of primary concern. Assisted ventilation with attention to oxygen delivery, inspiratory time, and effectiveness judged by chest rise should be provided if stimulation does not achieve prompt onset of spontaneous respirations and/or the heart rate is less than 100 bpm. (iv) Chest compressions should be provided if the heart rate is absent or remains less than 60 bpm despite adequate assisted ventilation for 30 s. Chest compressions should be coordinated with ventilations at a ratio of 3:1 and a rate of 120 'events' per minute to achieve approximately 90 compressions and 30 rescue breaths per minute. (v) Epinephrine should be administered intravenously or intratracheally if the heart rate remains less than 60 bpm despite 30 s of effective assisted ventilation and chest compression circulation. Common or controversial medications (epinephrine, volume expansion, naloxone, bicarbonate), special resuscitation circumstances affecting care of the newly born, continuing care of the newly born after resuscitation, and ethical considerations for initiation and discontinuation of resuscitation are discussed. There was agreement that insufficient data exist to recommend changes to current guidelines regarding the use of 21% versus 100% oxygen, neuroprotective interventions such as cerebral hypothermia, use of a laryngeal mask versus endotracheal tube, and use of high-dose epinephrine. Areas of controversy are identified, as is the need for additional research to improve the scientific justification of each component of current and future resuscitation guidelines.