Biomedical subjects
K L Dunn
Publications and source records attributed to K L Dunn.
Autonomic dysreflexia: a nursing challenge in the care of the patient with a spinal cord injury.
Autonomic dysreflexia is an emergency condition resulting in sudden severe hypertension that can occur in spinal cord injury (SCI) patients above the T-5-6 level. This hypertension has its proximate cause in neurologic, not cardiovascular, mechanisms. Knowledge about pathophysiology, possible consequences, and signs and symptoms will assist the nurse in identifying this syndrome, locating and removing causes, controlling symptoms, and preventing morbidity or mortality. A case study is used to illustrate a typical autonomic dysreflexia episode in a hospitalized patient at risk. Prevention of autonomic dysreflexia and patient and professional education are also addressed.
Handicapping language.
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Using reality orientation on behavior problems in an adolescent girl.
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A clinical catheter for continuous blood gas measurement by mass spectrometry.
A new Teflon catheter for continuous in vivo measurement of blood gases by mass spectrometry has an outer diameter of 0.032 in. and can be inserted through percutaneous puncture with an 18-gauge needle. Response time (63% of a total change) is 40 s for oxygen and 65 s for carbon dioxide. When calibrated in analyzed gas at 37 degrees C, the catheter-mass spectrometer system has been shown to analyze tonometered blood with an error of 1.6% for oxygen and 1.9% for carbon dioxide. Temperature dependence is 2.0% per degrees C for oxygen and 1.6% per degrees C for carbon dioxide. The catheter was thrombo-resistant during in vivo use in seven dogs and measurements compared favorably with results of blood sample analyses by standard hospital methods. Compared with previous devices, the new catheter provides size and convenience, advantages that make it more applicable for routine clinical use.
Flumazenil reversal of midazolam sedation in the elderly.
In a randomized, double-blind, placebo-controlled study, the efficacy of flumazenil in reversing the psychomotor, sedative, and amnestic effects of midazolam in elderly patients after surgery under regional anesthesia was examined. Thirty ASA I-III patients older than 63 years undergoing regional anesthesia with midazolam sedation were randomly assigned to receive either intravenous flumazenil (n = 19) or intravenous placebo (n = 11) after surgery. After assessments of sedation immediately postoperatively, 0.1 mg/ml flumazenil or placebo was given in 2-ml increments twice, a minute apart, and titrated in further 2-ml increments until patients were awake or until 10 ml had been given. Efficacy of reversal was determined using patient and observer assessments of sedation and simple psychomotor tests administered preoperatively and at five, 15, 30, 60, 120, and 180 minutes after test drug administration. Reversal of amnesia was tested by assessing recall of pictures shown at five, 15, 30, and 60 minutes after drug administration. Time profiles of digit substitution test and observer assessment of sedation data were significantly different between the flumazenil and placebo groups. For observer's assessment of sleep, significant differences were noted between flumazenil and placebo groups only at five, 15, and 30 minutes after test drug administration. A significant difference was noted between flumazenil and placebo patients in the ability to recall pictures shown five and 15 minutes after drug administration, but not pictures shown at 30 or 60 minutes. Within-group analysis demonstrated that loss of difference over time between flumazenil and placebo groups was the result of decreasing effect of both flumazenil and midazolam.