Biomedical subjects

M Vorweg

Publications and source records attributed to M Vorweg.

6 recordsLinked to original sources

PubMed2000

Water vapour in a closed anaesthesia circuit reduces degradation/adsorption of halothane by dried soda lime.

Dry lime causes a loss of volatile anaesthetics by degrading and adsorbing them. Degradation produces toxic substances and heat. Rehydration of lime stops degradation. If humidified breathing gases rehydrate lime, closed anaesthesia-circuits may reduce the loss of anaesthetics. To test this hypothesis we ventilated a reservoir bag with PhysioFlex-devices using fresh (F) and dried (D) soda lime both in the presence (+H) and absence (-H) of halothane. We measured halothane delivery, humidity, temperature, and lime weight. Halothane was lost for 13 min in D + H. Humidity increased steeper with fresh lime, whereas absorbent weight increased more with dried lime; halothane increased both variables (F + H: 99%, 8 g; F - H: 93%, 6 g; D + H: 58%, 17 g; D - H: 24%, 15 g). Surprisingly, temperature remained constant, probably because of the high gas flow (70 litres min-1) generated inside the Physioflex. These findings indicate rehydration of dried lime by humid gases and a rapid cessation of the loss of halothane in the PhysioFlex.

Adsorption↗

PubMed1999

[One-lung respiration in a nasally intubated patient using a single-lumen endobronchial tube].

We report the case of a 57-year-old patient who underwent a right-sided thoracotomy. The preoperative examination of the patient already revealed a clear diminution of the mouth opening (Mallampati class 4). Ventilation per mask following the induction of anaesthesia was unproblematic. As oral intubation with a double-lumen tube seemed to be impossible because of the difficult anatomic conditions, nasal intubation was carried out. For this we used a left-sided single-lumen endobronchial tube of Rüsch (size 8.0). The tube was inserted into the left mainstem bronchus using a fiberoptic bronchoscope. Intraoperatively we were able to ventilate exclusively the dependent left lung by inflating the bronchial cuff. The operation itself was performed on the collapsed right lung. At the end of the operation the right lung could be ventilated once again by deflating the bronchial cuff (tracheal cuff inflated). This example demonstrates that one-lung ventilation is possible even under difficult intubation conditions.

Anesthesia, Inhalation↗

PubMed1998

[Heparin-induced coagulation disturbance from mechanical autotransfusion].

UNLABELLED: Disorders in blood coagulation during the use of autotransfusion have been reported in recent literature. We wondered whether or not heparine, remaining in the prepared sample of retransfusion blood might be responsible for these disturbances. METHODS: Therefore we created a setting in which heparine was added to animal blood in order to imitate clinical situations during the use of the CELL SAVER. RESULTS: According to our results the blood shows no irregular heparine load as long as the machine is used following the operating instructions. But if the volume of rinsing liquid is decreased or the pumpflow is increased, the heparine load is increased enormously (Table 1). CONCLUSIONS: If the CELL SAVER is used with reduced volume of rinsing liquid or higher velocity of the pump, the coagulation status of the patient has to be monitored meticously.

Animals↗

PubMed1997

Trauma score systems: Cologne Validation Study.

BACKGROUND: Most standard trauma score systems have been developed and validated in the United States. However, trauma differs between the United States and Germany. This prospective study tested the validity of eight current trauma scoring systems (Glasgow Coma Scale, Trauma Score, Revised Trauma Score, Injury Severity Score, TRISSTS, TRISSRTS, Prehospital Index, Polytraumaschluessel) in 612 patients in Cologne. METHODS: Between January 1, 1987, and December 31, 1987, 2,136 trauma related emergencies were seen by emergency physicians in the field. All trauma patients with a Trauma Score below 16 and a random sample of 10% of patients with a Trauma Score of 16 were included in the study (n = 625). Follow-up was successfully completed for 612 patients (97%). Their hospital outcome was correlated with their individual score result. RESULTS: All trauma score systems under study showed high accuracy rates. TRISSRTS and TRISSTS performed best with values of above 0.97 for the area under the receiver operating characteristics curve. CONCLUSION: We conclude that the standard trauma score systems are valid tools for patient classification and support TRISSRTS as the international reference score system for the assessment of injury severity. This validation will allow comparisons between different trauma care systems.

Adolescent↗

PubMed1994

Prehospital detection of uncontrolled haemorrhage in blunt trauma.

The field strategy for trauma victims is still controversial. The first randomized study in penetrating truncal trauma by Martin et al. (1992) supported experimental findings (Gross et al., 1988, 1989; Kowalenko et al., 1992; Krausz et al., 1992b) that fluid therapy in uncontrolled haemorrhage increases mortality. No controlled data in blunt trauma are available. In this retrospective analysis of blunt trauma victims (n = 353), the parameters systolic blood pressure, capillary refilling time and Traumascore (Champion et al., 1981) were evaluated in the prehospital detection of uncontrolled bleeding. With the CART methodology (Breiman et al., 1984) systolic blood pressure (BP) was the most sensitive parameter. Uncontrolled haemorrhage was found in nearly 50% of patients whose BP was below 90 mmHg and in 66% of those whose BP was below 50 mmHg. An accompanying traumatic brain injury (TBI) impaired the ability of BP to detect uncontrolled bleeding. Future studies evaluating prehospital fluid therapy in severe blunt trauma with a mixture of injuries, should take into account that BP in our study population classified less than 50% patients with uncontrolled haemorrhage.

Adult↗

PubMed1993

Assessment of emergency care in trauma patients.

There are many reasons for evaluation of an emergency care system, such as expenses (1.035 Bio. DM in 1985) and quality control. From January 1, 1987 to December 31, 1987 information on all patients seen by an emergency physician in the field have been recorded prospectively in a standard form by the Cologne emergency medical services. Cologne has 1,000,000 inhabitants and covers an area of 405 km2. The patients' status, diagnosis and therapeutic interventions were recorded. Trauma patients were further assessed as to time of accident, cause of accident, and trauma score. All trauma patients with a trauma score < 16 were followed up to their discharge from the hospital. In 1987, 2,073 trauma patients were treated. Overall mortality at the time of discharge was 9.2%. This result alone, however, is not sufficient for assessment of the trauma system. It is important to provide better information on the patient. The trauma evaluation score already used in the US became also a valid instrument in West-Germany. It shows a high correlation between survival and the patients' physiological status in the field. Standard curves could be established for comparing individual or regional trauma systems.

Brain Damage, Chronic↗