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Biomedical subjects

M Eckstein

Publications and source records attributed to M Eckstein.

71 records · Page 4Linked to original sources
PubMedDate not supplied

Scene safety in the face of automatic weapons fire: a new dilemma for EMS?

OBJECTIVE: To describe the EMS response to a large-scale shooting incident involving military-style weapons. METHODS: Descriptive review. RESULTS: Twenty ambulances, nine engine companies, and three helicopters responded to this incident. Ten police officers and nine civilians were wounded, all of whom required transport to nearby hospitals. Two gunmen were shot and pronounced dead at the scene. No EMS personnel were injured. CONCLUSION: Incidents involving military-style weapons pose a unique challenge for prehospital care providers who must care for injured civilians and law enforcement personnel while maintaining their own safety. Use of the Incident Command System, establishment of a liaison with law enforcement, and the provision of protective gear for EMS personnel are vital to effectively and safely manage these types of incidents.

Automation↗
PubMedDate not supplied

Needle thoracostomy in the prehospital setting.

OBJECTIVES: To determine the effect of needle thoracostomy (NT) in the prehospital setting, its frequency of use, and its complication rate. METHODS: This was a prospective case series from January 1, 1995, to December 31, 1996. Inclusion criteria were all patients who met trauma center criteria, were transported by paramedics to Los Angeles County/University of Southern California Medical Center (a large, urban, level I trauma center), and had placement of a prehospital NT. RESULTS: Out of 6,241 major trauma patients transported by paramedics over the study period, 108 (1.7%) underwent 114 NTs. Sixty-four patients (59%) sustained gunshot wounds, 32 (30%) sustained stab wounds, eight (7%) were involved in motor vehicle accidents, and the remainder had other types of blunt trauma. The mean injury severity score (ISS) was 22.3, and the overall mortality rate was 28%. Of the patients who received NTs, five (5%) showed objective improvement in field vital signs and seven (7%) had subjective improvement of their dyspnea. Two NTs were found to have not penetrated into the thorax with the catheter tip in the soft tissue. Two patients (2%) received NTs despite the absence of any chest injuries found upon operative intervention, resulting in two iatrogenic pneumothoraxes. No other complications, including vascular injury or infection, were found in any of the patients. CONCLUSION: Prehospital NT is a procedure infrequently performed by paramedics, even in a busy urban area. While there is a risk of the procedure's being done without proper indication, NT may improve outcomes in a small subset of chest-injured patients.

Accidents, Traffic↗
PubMedDate not supplied

Design and retrospective analysis of the Los Angeles Prehospital Stroke Screen (LAPSS).

OBJECTIVES: The therapeutic window for intervention in acute cerebral ischemia is brief. Prehospital identification of acute stroke patients and paramedic administration of neuroprotective agents may soon become critical components of successful acute stroke treatment. This preliminary study sought to demonstrate that a new prehospital screening instrument, the Los Angeles Prehospital Stroke Screen (LAPSS), sensitively identifies acute stroke patients. Further, the study evaluated the potential time savings that could be achieved by paramedic administration of neuroprotective agents in the field. METHODS: The authors designed a simple stroke screening tool for use by prehospital personnel, emphasizing motor deficits. They then tested instrument performance and time savings retrospectively, employing data from patients enrolled within six hours of symptom onset in randomized stroke trials at three university-associated paramedic receiving hospitals. RESULTS: Fifty of 83 patients enrolled in hyperacute stroke trials arrived by ambulance, including 41 with ischemic infarcts and seven with hemorrhages. Of the 41 with acute ischemic stroke, 38 (93%) would have been accurately identified by the LAPSS. For these 38 patients, 1 hour and 50 minutes would have been saved had neuroprotective drug been administered by paramedics at the time of transport vs the actual time of study agent administration in the emergency department. CONCLUSIONS: The LAPSS sensitively identifies ambulance-arriving acute stroke patients, and a substantial time savings will potentially occur if neuroprotective agents are administered by paramedics in the field. The LAPSS is a promising tool that may enable paramedic recognition of stroke with a high degree of sensitivity and simplicity in a short period of time.

Acute Disease↗
PubMedDate not supplied

Synthesis of N-nicotinoyl-tryptamine (tryptamide).

N-Nicotinoyl-tryptamine was synthetized by acylation of tryptamine with mixed nicotinic anhydride. The synthesis of tryptamine via DL-tryptophan decarboxylation in cyclohexanol, in the presence of tetraline oxidation products as the catalyst, was described as well.

Acylation↗
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(RS), (R)(-) and (S)(+) derivatives of 2-N-arylalkylamino-1-butanol having antiarrhythmic properties.

A series of theophyllinyl-7'-ethyl derivatives of (RS), (R)(-) and (S)(+) 2-aminobutanol were synthesized and tested in various models of experimental arrhythmia for their preventive and curative properties; (R)(-) 2-N-theophyllinyl-7'-ethyl amino-1-butanol (1a) and (R)(-) theophyllinyl-7'-ethyl-2-N-methylamino-1-butanol (3a) hydrochlorides showed interesting antiarrhythmic properties. The levorotatory compounds of R configuration showed stronger protective and also therapeutic effect in different experimental arrhythmias.

Amino Alcohols↗
PubMedDate not supplied

New derivatives of amino alcohols with antiarrhythmic activity.

Nine new N-acyl derivatives of 2-amino-1-alcohols and 1-amino-2-alcohols with a potential arrhythmic activity have been obtained. In the preliminary screening 2-[N-(7-theophyllineacetyl)-amino]-2-methyl-1-propanol, 5, was more active in the chloroform-induced arrhythmia than quinidine. Unlike to propranolol and quinidine, compound 5 in doses of 5-30 mg/kg, iv, did not prevent distortions of the cardiac rhythm evoked by adrenaline and strophanthine. When administered at the peak of arrhythmia, it did not abolish disturbances of the cardiac rhythm. Compound 5 had a low toxicity (LD50 = 3000 mg/kg, ip), did not change the control ECG curve, showed no cardiodepressive activity, and had weaker local anesthetic properties than lignocaine.

Amino Alcohols↗
PubMedDate not supplied

Synthesis and some biological properties of 2-xanthonylalkyl-(alkoxy) carboxylic acids.

2-Xanthonylacetic acids 5a-5d and alpha-methyl-2-xanthonyloxyacetic acid 8 were obtained as potential anti-inflammatory compounds. Preliminary evaluation was carried out for anti-inflammatory and analgesic activity of acids 5a, 5c and 5d and for inhibition of blood platelets aggregation by compounds 5a-5d and 8. In the inhibition of carrageenin-induced rat edema the highest activity shown by acids 5a and 5c was similar to that of ketoprofen.

Animals↗
PubMedDate not supplied

The search for new antiarrhythmics in the group of chirally 1,2-aminoalcohols. I. 3',4',5'-trimethoxybenzoic acid esters of optically active N,N'-dimethyl-N,N'-bis-(1-hydroxybutyl-2) ethylenediamines.

Both enantiomeric (2S, 2'S) and (2'R) N, N'-dimethyl-N, N-bis (1-hydroxybutyl-2)-ethylenediamines (Table 1) were obtained by methylation of the corresponding N,N'-ethylene-bis-2-aminobutanols-1. The esterification of the former aminoalcohols with 3, 4, 5-trimethoxybenzoic acid gave the both enantiomeric in title named esters (Table 2). The isomer with S configuration at both chirally center (C2 and C2), has a particularly strong antiarrhythmic properties (about 10-20 greater than quinidine or procaine amide in different experimental arrhythmia models in animals. The 2R,2'R enantiomere is 10-100 times less active one. It seems that the antiarrhythmic activity of this new group of antiarrhythmically active compounds, derivatives of chirally 1, 2-aminoalcohols is connected with spatial configuration.

Amino Alcohols↗
PubMedDate not supplied

The effect of a new antiarrhythmic drug: Craviten (M-71) on the ATP level in heart muscle slices in vitro.

Under anaerobic conditions, in which glucose is the only energy source, the ATP level in heart muscle slices diminishes to about 50% of the control value during 60 min of incubation. The presence of a new antiarrhythmic drug, Craviten (Polfa) (2S, 2'S) N, N'-dimethyl-N, N'-bis-[1(3', 4', 5'-trimethoxybenzoyloxy)-butyl-2]-ethylenediamine dihydrochloride, (M-71), and to some extent also its 2R, 2'R isomer in 10 times greater concentration protects against this spontaneous ATP fall observed anaerobically in the control experiments. Under aerobic conditions, with glucose or palmitate as energy sources, Craviten even raises the ATP level in comparison to the initial control values. This effect is stereospecific, since the 2R, 2'R isomer does not change the aerobic ATP level, Quinidine and procaine amide used for comparison as standard antiarrhythmic drugs do not counteract the anaerobic ATP decrease, and under aerobic conditions they even enhance the ATP fall. Craviten, a new antiarrhythmic drug, exerts some stereospecific effect on energy metabolism and the ATP content in heart muscle slices in vitro.

Adenosine Triphosphate↗
PubMedDate not supplied

The effect of Craviten, a new antiarrhythmic drug, its 2R, 2'R isomer, quinidine and procaine amide on human platelet aggregation.

Among the optical isomers of N, N'-dimethyl-N, N'-bis[1-(3', 4', 5-trimethoxybenzoyloxy)-butyl-2]-ethylenediamine dihydrochloride only the isomer with the (2S, 2'S) configuration (Craviten) in a concentration of 0.2 microgram/ml inhibits the ADP-induced aggregation of human platelets. The (2R, 2'R) isomer and quinidine exert a similar effect but only in a concentration ten times higher. Procaine amide (2 micrograms/ml) has an opposite effect, stimulating human platelet aggregation.

Adenosine Diphosphate↗