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Biomedical subjects

L Flint

Publications and source records attributed to L Flint.

35 records · Page 2Linked to original sources
PubMed1993

Citizen response to cardiopulmonary emergencies.

Since 1985, it has become apparent that the key to survival from adult sudden cardiac death is prompt defibrillation. Any delay from the time of collapse to the initial countershock will decrease the likelihood of survival. It also has been determined that CPR performed by lay rescuers is not begun promptly and, once started, often is performed for more than one minute before the emergency medical services (EMS) system is accessed, which significantly delays the time to defibrillation. In adults, therefore, the rescuer should phone first to activate the EMS system before performing CPR. In the pediatric population, respiratory arrests are far more common than cardiac arrests. Therefore, a rescuer should perform one minute of rescue support before activating the EMS system (a concept termed phone fast). It is recognized that this change is dependent upon a national EMS system that is still evolving. It is hoped that this change to phone first and phone fast will provide an impetus for rapid development of the EMS infrastructure.

Cardiopulmonary Resuscitation↗
PubMed1992

Care for victims of urban violence and the education of trauma and critical care surgeons. A troubled partnership?

This article reviews the current status of trauma care education and its relationship to critical care education. The critical linkage of both of these endeavors with urban hospitals oriented to indigent care is stressed. Within the specialty of surgery, the recent progress toward resolution of conflicts that have threatened trauma and critical care education programs is reviewed. The partnership between the trauma programs of urban hospitals will be strengthened by this resolution.

Critical Care↗
PubMed1992

Mesenteric microcirculatory changes in nonlethal hemorrhagic shock: the role of resuscitation with balanced electrolyte or hypertonic saline/dextran.

Class I and II hemorrhage has been routinely treated clinically with 2-2.5 times the volume of shed blood as balanced electrolyte solution. Although this regimen has been shown to adequately restore arterial pressure in trauma patients, it is not clear that it uniformly restores regional perfusion. Since it is becoming apparent that the gut plays a major role in the development of the posttraumatic septic state, we studied the effects of graded doses of balanced electrolyte resuscitation on the mesenteric microcirculation. Regimens consisting of one (1 x LR), two (2 x LR), or three (3 x LR) times the volume of shed blood as lactated Ringer's (LR) solution or 7.5% hypertonic saline and 6% dextran (HSD) equal to one seventh the volume of shed blood were given to groups of anesthetized (urethane-chloralose) male Sprague-Dawley rats after 30 minutes of hemorrhage to 50% of baseline mean arterial blood pressure. The microcirculation of the distal ileum was observed using an in vivo video microscope. Mean arterial pressure and ileal A1 diameters returned to baseline values with HSD within 20 minutes following this moderate hemorrhage. Additionally, A1 diameters returned to baseline in the 2 x LR and 3 x LR groups. A1 vessels remained significantly constricted in the 1 x LR group. Mean arterial pressure remained significantly lower than the baseline value in all of the LR groups. We conclude that in this model, HSD is superior to LR for restoration of blood pressure. In restoring A1 diameters, LR is equivalent to HSD only when volumes of balanced electrolyte two and three times shed blood volume are given.

Animals↗
PubMed1992

Adolescent parental affinity-seeking: age- and gender-mediated strategy use.

The focus of the present study was the use of parental affinity-seeking strategies by adolescents. Both the type of strategies used and the degree to which age and gender factors mediated their use were examined. The results were consistent with Bell and Daly's (1984) constraints dimension of the affinity-seeking process, with adolescents employing a narrower range of strategies with the parent as a familiar target. Additionally, significant differences in the use of strategies were apparent on the basis of adolescent's age and gender and parent's gender.

Adolescent↗
PubMed1991

Achievements, present-day problems, and some solutions for trauma care, surgical critical care, and surgical education.

Trauma care represents a serious challenge to general surgery. Forces favoring fragmentation of surgery will, if left unchecked, act to the detriment of the injured patient. These forces will increase in the future. It is the obligation of the surgeon to ensure that further specialization is linked to and does not fragment the knowledge base of general surgery. In turn, this obligation needs to be acknowledged in surgeons' leadership groups, in every trauma center, and in each surgical education program. Acknowledgement preserves the best trauma care for injured patients, while at the same time protecting the general surgeon as the specialist most suited to provide such care.

Critical Care↗
PubMed1990

Definitive control of mortality from severe pelvic fracture.

Within a group of 271 patients with pelvic fracture, 69 patients met criteria for severe hemorrhage. Sixty consecutive patients were treated by a combined multispecialty musculoskeletal trauma service using a protocol designed to control bleeding, rapidly diagnose and control associated injuries, as well as to prepare the patient for open reduction of the pelvic fracture, if appropriate. The pneumatic antishock garment, external fixation, and angiography were selectively used to control bleeding. Abdominal injuries were diagnosed using clinical examination and diagnostic peritoneal lavage. When lavage aspirate was grossly bloody, patients had no negative explorations. Microscopically positive lavages were associated with a 50% false-negative rate. Using the protocol, the mortality rate was 5%. Overall mortality rate was 10%. The combination of a trauma team approach and a specifically designed protocol reduces the number of deaths from pelvic fracture.

Adult↗
PubMed1990

Persistent arteriolar constriction in microcirculation of the terminal ileum following moderate hemorrhagic hypovolemia and volume restoration.

A stable in vivo preparation of moderate hypovolemia with prompt volume restoration was produced in anesthetized rats. The microcirculation of the terminal ileum was observed in vivo videomicroscopy, and changes in mean arterial pressure (MAP) as well as arteriolar diameters were recorded after a 30-min period in which the MAP was reduced by 50% by bleeding. Volume was restored with shed blood alone (control); dextran 70 alone (dextran); or dextran + hypertonic (7.5%) saline (dextran + HS). A final group of rats was pretreated with allopurinol 5 mg/kg and then treated identically to the control group to assess the role of the xanthine oxidase system in microcirculation changes following hemorrhage. MAP was restored to normal by return of shed blood in control animals, but inflow arterioles (A1) remained significantly constricted. MAP was significantly higher and A1 arteriolar dilation was observed in the dextran + HS group. Responses in allopurinol-pretreated animals were not different from the responses seen in control animals. We conclude that persistent arteriolar constriction is produced by moderate hypovolemia and this effect is ameliorated by volume restoration with dextran + HS.

Allopurinol↗
PubMed1989

Adolescents' compliance-resistance: effects of parents' compliance strategy and gender.

This investigation determined choice of compliance-resisting behaviors on the basis of compliance-gaining strategy, gender of parent, and gender of adolescent. One hundred and eighteen 9th- through 12th-grade students identified resistance strategies they would use when confronted with five compliance-gaining attempts: manipulation, nonnegotiation, emotional appeal, personal rejection, and empathic understanding. Each compliance-gaining attempt was associated with a specific parent and a specific compliance-gaining strategy. The results demonstrate significant differences in resistance strategy selected on the basis of parent's gender, adolescent's gender, and compliance-gaining strategy. When mothers employed personal rejection or empathic understanding, the adolescent was most likely to use nonnegotiation. When the mother used an emotional appeal, adolescents used identity management. Fathers who employed manipulation by using an emotional appeal were resisted with justification. When fathers used nonnegotiation or personal rejection, adolescents used nonnegotiation. The father's use of empathic understanding was countered with identity management. Adolescents are more likely to use identity management with their mothers and justification with their fathers. Female adolescents are more likely to use identity management than are male adolescents, while males are more likely to use nonnegotiation and negotiation than are females. Nonnegotiation occurs most often from son to mother, followed by son to father, daughter to father, and daughter to mother.

Adolescent↗
PubMed1985

Financial analysis of an inner city trauma center: charges vs collections.

The changes in the economy and in tax rules have caused hospitals to assess the financial viability of different areas within their institutions. While emergency departments generally have become recognized as a cost-effective portal of entry for patients, trauma centers, particularly those located in the inner city, usually are seen as areas of large investment and small financial return. This study looks at a large, inner-city trauma service and the charges, collections, and demographics of the trauma population it serves. For patients admitted to the trauma service, total collections were 77% of charges. There was no difference in collections between those patients with blunt injuries and those with penetrating injuries; violent vs nonviolent injuries; patients transferred in vs primary receivals; or patients transferred out after stabilization vs those retained at the trauma center.

Accounting↗
PubMed1983

Continuous electrocardiographic monitoring in patients with sickle-cell anemia during pain crisis.

Electrocardiographic studies in patients with sickle-cell anemia have been performed during the normal resting state with routine twelve-lead ECGs. We studied 30 patients with sickle-cell disease in acute crisis with 24-hour continuous electrocardiographic monitoring. The standard ECG demonstrated a high incidence of abnormalities, but only three patients had arrhythmias. These findings contrasted sharply with the results of continuous monitoring, during which arrhythmias were detected in 24 of 30 patients. They were fairly evenly split between atrial (60%) and ventricular (67%). Nine of the patients had "complex arrhythmias" including two with episodes of ventricular tachycardia. Seventeen patients subsequently underwent equilibrium gated-blood pool scans. Eight patients had abnormal contractility and tended to have more arrhythmias on monitoring than those with normal contractility. Thus, continuous electrocardiographic monitoring of sickle-cell patients during crisis revealed a higher incidence of arrhythmias than previously thought.

Adolescent↗
PubMed1975

Evaluation of ventilatory therapy for acid aspiration.

Aspiration of hydrochloric acid in experimental animals results in severe, progressive hypoxia which is due to intrapulmonary shunting and depressed cardiac output. This preparation is useful therefore in studying the therapy of hypoxia. Mongrel dogs were subjected to acid aspiration and the effects of several ventilatory patterns on intrapulmonary shunt fractions and lung water accumulation observed. The combination of large tidal volumes (30 c.c. per kilogram) with positive end-expiratory pressure was effective in preventing intrapulmonary shunting and other ventilatory patterns were ineffective. Pulmonary edema uniformly followed acid aspiration and was not affected by ventilatory therapy. When ventilatory therapy was delayed for 4 hours, the progression of shunting apparently was limited, but the existing shunt was not reduced.

Animals↗