Biomedical subjects

P D Larsen

Publications and source records attributed to P D Larsen.

At least 19 recordsLinked to original sources

PubMed2002

Patterns of external chest compression.

We studied the performance of external chest compression by 20 fourth year medical students on 2 study days, separated by 5-7 weeks, 4-8 months after they had been initially trained in cardiopulmonary resuscitation (CPR). Our hypotheses were (1) that a given individual would perform external chest compressions in the same manner each time CPR was performed and (2) that the pattern of performance of chest compressions would be determined, in part, by the anthropometric characteristics of the rescuer. A Laerdal Skillmeter Resusci-Anne CPR manikin chest compression transducer was interfaced with an analogue-to-digital conversion board in a Macintosh LC III computer. Each subject on each study day performed four cycles of 15 compressions and two ventilations twice, once on a table (which raised the surface of the manikin sternum to 95 cm) and once on the floor. For each individual, on each attempt, we calculated the depth and rate of compressions, duty cycle, peak compression velocity, time to peak compression velocity and time to peak compression depth. In addition, we calculated the regression slope of compression depth versus compression number for each cycle of 15 chest compressions and over four cycles of compressions. Statistically significant correlations were observed between the first and second study days in each of the variables of chest compression measured, indicating that the performance of chest compressions was constant over time for a given individual. We observed that the depth of compression, duty cycle, time to peak compression, time to peak velocity and regression slope of depth of compressions versus compression number were significantly related to the height and weight of the rescuer.

Adult↗

PubMed2001

The protective effect of brachial plexus palsy in purpura fulminans.

Acute infectious purpura fulminans is reported in a 16-month-old male with a history of posttraumatic asplenia and complete left brachial plexus palsy. This patient developed peripheral necrosis of both lower extremities and the right upper extremity, whereas the left upper extremity was completely spared from ischemia and tissue damage. Amputation of four digits on the right hand and debridement of both lower extremities were required. This patient demonstrated the protective effect of a traumatic sympathectomy, which suggests the requirement of an intact sympathetic reflex in the development of purpura fulminans.

Amputation, Surgical↗

PubMed2001

Inspiratory timing during anaesthesia: a model of cardioventilatory coupling.

We describe a simple model of cardioventilatory coupling in which a hypothetical inspiratory pacemaker is stimulated by a signal related to cardiac action. At suitable values for the control variables (cardiac signal magnitude, heart rate, inspiratory pacemaker rate and inspiratory rate variability), the model was found to: (1) replicate all clinically described patterns of coupling; (2) predict variations in these described patterns and new patterns which were subsequently found in clinical time series; (3) simulate variations in clinically observed breathing frequency variations associated with each coupling pattern; (4) simulate the clinically observed distribution of coupling patterns between heart rate and breathing frequency; (5) explain the invariability of coupling below a critical heart rate/breathing frequency ratio; and (6) simulate the changes in breathing frequency and transitions between coupling patterns from the heart rate time series of human subjects. Although cardioventilatory coupling causes complex breathing rate irregularities during anaesthesia, these are readily explained by three variables, heart rate, intrinsic breathing frequency, and the strength of their interaction. This simple model, along with clinical observations of cardioventilatory coupling may provide a useful non-invasive method to study the respiratory central pattern generator.

Anesthesia, General↗

PubMed2001

Cardioventilatory coupling in heart rate variability: the value of standard analytical techniques.

In a group of spontaneously breathing anaesthetized subjects, we examined the ability of simple spectral and non-linear methods to detect the presence of cardioventilatory coupling in heart rate time series. Using the proportional Shannon entropy (H(RI-1)) of the RI(-1) interval (interval between inspiration and the preceding ECG R wave) as a measure of coupling, we found no correlation between H(RI-1) and either the fractal dimension or approximate entropy of the heart rate time series. We also observed no difference in the distribution of heart rate variability (HRV) spectral power in three frequency ranges (high, 0.15-0.45 Hz; low, 0.08-0.15 Hz; very low, 0.02-0.08 Hz) between uncoupled epochs and coupling patterns I, III and IV. Because of its association with low breathing frequencies, pattern II coupling epochs showed exaggerated low-frequency power as the high-frequency 'respiratory' peak fell into the low-frequency range. We conclude that coupling pattern is largely independent of autonomic tone and that these standard methods of HRV analysis are limited in their ability to detect the presence of cardioventilatory coupling in heart rate time series.

Adult↗

PubMed2001

Cardioventilatory coupling in heart rate variability: methods for qualitative and quantitative determination.

In this study we sought to develop quantitative methods for determining the presence of cardioventilatory coupling in raw heart rate time series. The beat-to-beat RR interval time series of 98 anaesthetized, spontaneously breathing subjects were represented graphically as (1) raw RR interval time series, (2) RR consecutive difference time series and (3) a phase portrait of the RR consecutive difference time series. We then examined the relationships between the presence of cardioventilatory coupling in these epochs and the plot appearance and entropy measures derived from these plots. We observed that coupling was significantly associated with the presence of banding in the raw heart rate and RR consecutive difference time series, and with discrete clustering within the RR consecutive difference phase portrait. A significant correlation was found between coupling and the entropy of the RR consecutive difference time series and its phase portrait. We conclude that, with some provisos, these simple graphical and derived quantitative measures provide a basis for the determination of cardioventilatory coupling from heart rate time series.

Adult↗

PubMed2001

Sympathetic nerve and cardiovascular responses to chemical activation of the midbrain defense region.

The changes in mean arterial pressure (MAP), renal (RBF) and femoral (FBF) blood flows, and inferior cardiac (CN) and vertebral nerve (VN) sympathetic nerve discharges (SND) produced by chemical activation (D,L-homocysteic acid) of the midbrain periaqueductal gray (PAG) were compared in baroreceptor-denervated and -innervated cats anesthetized with urethan. Defenselike cardiovascular responses in both states were similar in magnitude and consisted of increased MAP and FBF and decreased RBF; however, the nerve responses differed. In baroreceptor-denervated cats, PAG activation increased CN 10-Hz activity, decreased VN 10-Hz activity, and lengthened the CN-VN phase angle. In baroreceptor-innervated cats in which the rhythm in SND was cardiac related, PAG activation increased CN activity, but VN activity and the CN-VN phase angle were unchanged. These results demonstrate that chemical activation of PAG neurons induces differential patterns of sympathetic outflow generally consistent with accompanying defenselike cardiovascular responses. However, the mechanisms responsible for the changes in 10-Hz and cardiac-related SND appear to be different.

Animals↗

PubMed2001

Long-term correlations in the spike trains of medullary sympathetic neurons.

Fano factor analysis was used to characterize the spike trains of single medullary neurons with sympathetic nerve-related activity in cats that were decerebrate or anesthetized with Dial-urethan or urethan. For this purpose, values (Fano factor) of the variance of the number of extracellularly recorded spikes divided by the mean number of spikes were calculated for window sizes of systematically varied length. For window sizes < or =10 ms, the Fano factor was close to one, as expected for a Bernoulli process with a low probability of success. The Fano factor dipped below one as the window size approached the shortest interspike interval (ISI) and reached its nadir at window sizes near the modal ISI. The extent of the dip reflected the shape (skewness) of the ISI histogram with the dip being smallest for the most asymmetric distributions. Most importantly, for a wide range of window sizes exceeding the modal ISI, the Fano factor curve took the form of a power law function. This was the case independent of the component (cardiac related, 10 Hz, or 2--6 Hz) of inferior cardiac sympathetic nerve discharge to which unit activity was correlated or the medullary region (lateral tegmental field, raphe, caudal and rostral ventrolateral medulla) in which the neuron was located. The power law relationship in the Fano factor curves was eliminated by randomly shuffling the ISIs even though the distribution of the intervals was unchanged. Thus the power law relationship arose from long-term correlations among ISIs that were disrupted by shuffling the data. The presence of long-term correlations across different time scales reflects the property of statistical self-similarity that is characteristic of fractal processes. In most cases, we found that mean ISI and variance for individual spike trains increased as a function of the number of intervals counted. This can be attributed to the clustering of long and short ISIs, which also is an inherent property of fractal time series. We conclude that the spike trains of brain stem sympathetic neurons have fractal properties.

Action Potentials↗

PubMed2000

Coupling of arterial pulse and 10-Hz rhythm in sympathetic nerve discharge.

We used time series analysis to characterize the relationships among the arterial pulse (AP) and the cardiac-related and 10-Hz rhythms in sympathetic nerve discharge (SND) of urethane-anesthetized cats. We found that 10-Hz activity was more tightly coupled to the AP than to the cardiac-related rhythm. These data support the view that the dynamic coupling of AP and the 10-Hz rhythm in SND involves a direct influence of baroreceptor activity on the 10-Hz oscillator.

Animals↗

PubMed2000

Glasgow Coma Scale: variation in mortality among permutations of specific total scores.

OBJECTIVE: The objective of this study was to determine whether different score permutations of the Glasgow Coma Scale (GCS) giving the same GCS total score were associated with significantly different mortality. DESIGN: For each GCS total we compared the mortality associated with each of the different GCS permutations using a Fisher's exact test. The relationship between components of the GCS score and mortality was also examined using uni- and multivariate logistic regression. SETTING: Data were collected from the intensive care unit at Wellington Hospital, a multidisciplinary, tertiary referral unit. PATIENTS: We analysed the GCS and mortality data from all admissions over a 4 year period (January 1994-January 1998). Patients with GCS scores of 3 or 15 were excluded, since these two total scores do not have multiple permutations, leaving 1,390 patients with GCS scores of 4-14 for analysis. RESULTS: The incidence of mortality was significantly different for the different permutations for total GCS scores of 7, 9, 11 and 14. CONCLUSIONS: It is possible for patients to have the same total GCS score, but significantly different risks of mortality due to differences in the GCS profile making up that score. This suggests that GCS scores may be more useful reported in terms of profiles rather than totals. This could also have implications for the use of other scoring systems such as Acute Physiology and Chronic Health Evaluation and Simplified Acute Physiology Score.

Craniocerebral Trauma↗

PubMed2000

Effective pain management in older patients.

Assessing and managing post-operative pain in older adult patients is complex. A baseline preoperative pain assessment provides the necessary data that assist appropriate and effective pain management. Careful monitoring and individualization of patient dosages result in effective older adult patient pain management.

Aged↗

PubMed2000

Differential pattern of spinal sympathetic outflow in response to stimulation of the caudal medullary raphe.

In urethan-anesthetized cats, frequency domain analysis was used to explore the mechanisms of differential responses of inferior cardiac (CN), vertebral (VN), and renal (RN) sympathetic nerves to electrical stimulation of a discrete region of the medullary raphe (0-2 mm caudal to the obex). Raphe stimulation in baroreceptor-denervated cats at frequencies (7-12 Hz) that entrained the 10-Hz rhythm in nerve activity decreased CN and RN activities but increased VN activity. The reductions in CN and RN discharges were associated with decreased low-frequency (</=6 Hz) power and either increased (low stimulus intensity) or decreased (high stimulus intensity) 10-Hz band power. In contrast, VN 10-Hz band power was increased at all stimulus intensities, without changes in low-frequency power. High-frequency (25 Hz) stimulation decreased low-frequency activity of CN and RN discharges in both baroreceptor-denervated and baroreceptor-intact cats, without decreasing VN low-frequency activity. We propose that the differential pattern produced by raphe stimulation involves resonance at the level of the 10-Hz oscillators and differential inhibition of follower circuits that transmit both 10-Hz and low-frequency activity to sympathetic nerves.

Analysis of Variance↗

PubMed2000

Modes of baroreceptor-sympathetic coordination.

We tested the hypothesis that the cardiac-related rhythm in sympathetic nerve discharge (SND) results from the forcing of a central oscillator to the frequency of the heart beat by pulse-synchronous baroreceptor afferent nerve activity. For this purpose, time series analysis was used to examine the phase relations between the brachial arterial pulse (AP) and cardiac-related activity recorded from the postganglionic inferior cardiac sympathetic nerve (CN) in urethan-anesthetized cats. Specifically, we made cycle-by-cycle measurements of peak systolic blood pressure, heart period, CN burst amplitude, and the phase angle (and corresponding interval) between peak systole and the next peak of CN activity. As the steady-state level of systolic blood pressure was raised by increasing the rate of a constant intravenous infusion of phenylephrine, we observed transitions from no phase-locking of CN activity to the AP to either phase-locking of variable strength or phase walk through part of the cardiac-cycle on the time scale of respiration. Phase walk is defined as a progressive and systematic change in the phase lag of cardiac-related CN activity relative to peak systole. Raising blood pressure strengthened phase-locking and either increased or decreased the mean interval between peak systole and the next peak of CN activity even when the change in heart period was small. CN burst amplitude and the interval between peak systole and the next peak of CN activity were inversely related, but the strength of the relationship varied considerably with experimental conditions. The relationship was strongest during phase walk. Step-wise increases in blood pressure induced by abdominal aortic obstruction led to an abrupt increase in the phase lag of CN activity relative to peak systole even when heart rate was not changed. We refer to such changes as sharp phase transitions that are a general property of dynamical nonlinear systems. The results support the view that the cardiac-related rhythm in SND is a forced nonlinear oscillation rather than the consequence of periodic inhibition of randomly generated activity.

Animals↗

PubMed2000

Partial spectral analysis of cardiac-related sympathetic nerve discharge.

We have studied the relationship between pulse synchronous baroreceptor input (represented by the arterial pulse, AP) and the cardiac-related rhythm in sympathetic nerve discharge (SND) of urethan-anesthetized cats by using partial autospectral and partial coherence analysis. Partial autospectral analysis was used to mathematically remove the portion of SND that can be directly attributed to the AP, while partial coherence analysis was used to removed the portion of the relationship between the discharges of sympathetic nerve pairs that can be attributed to linear AP-SND relationships that are common to the nerves. The ordinary autospectrum of SND (AS(SND)) and coherence functions relating the discharges of nerve pairs (Coh(SND-SND)) contained a peak at the frequency of the heart beat. When the predominant mode of coordination between AP and SND was a phase walk, partialization of the autospectra of SND with AP (AS(SND/AP)) left considerable power in the cardiac-related band. In contrast, when the predominant mode of coordination between AP and SND was phase-locking, there was virtually no cardiac-related activity remaining in AS(SND/AP). Partialization of Coh(SND-SND) with AP reduced the peak coherence within the cardiac-related band in both modes of coordination but to a much greater extent during phase-locking. After baroreceptor denervation, Coh(SND-SND) at the cardiac frequency remained significant, although a clear peak above background coherence was no longer apparent. These results are consistent with a model in which the central circuits controlling different sympathetic nerves share baroreceptor inputs and in addition are physically interconnected. The baroreceptor-sympathetic relationship contains both linear and nonlinear components, the former reflected by phase-locking and the latter by phase walk. The residual power in AS(SND/AP) during phase walk can be attributed to the nonlinear relationship, and the residual peak in partialized nerve-to-nerve coherence (Coh(SND-SND/AP)) arises largely from nonlinearities that are common to the two nerves. During both phase walk and phase-locking, in addition to common nonlinear AP-SND relationships, coupling of the central circuits generating the nerve activities may contribute to Coh(SND-SND/AP) because significant Coh(SND-SND) was still observed following baroreceptor denervation.

Animals↗

PubMed2000

Community-based curricula: new issues to address.

Although the issues that may arise when developing and implementing a community-based curriculum may seem overwhelming, such issues should not deter programs from continuing their efforts in that direction. Rarely is a new curriculum perfect. Most come with their inherent problems and issues, and community-based curricula are no exception. Nursing education is being presented with a challenge to design curricula that allows nursing to make a difference in patient outcomes in every setting. As nursing educators we need to welcome that challenge.

Clinical Competence↗

PubMed1999

Cardioventilatory coupling in the anaesthetised rabbit, rat and guinea-pig.

Cardioventilatory coupling is a temporal coherence of respiratory and cardiac rhythms, seen in humans at rest, and during sleep and anaesthesia. In this study we compared the cardioventilatory coupling of anaesthetised rabbits, rats and guinea-pigs. Breathing two successive anaesthetic concentrations (1 or 2% isoflurane) we compared the effect of anaesthetic depth and species on (1) heart rate, (2) heart rate variability, (3) ventilatory rate (f), (4) ventilatory variability, (5) ratio HR/f, (6) degree of coupling (Shannon entropy of the distribution of intervals between inspiration and the preceding electrocardiographic R wave - the RI interval) and (7) coupling pattern, classified into four sub-patterns (I-IV) based upon inspection of the RI interval time series. Rabbits exhibited significantly less ventilatory variability and coupling than rats or guinea-pigs. The sub-pattern of coupling also differed between the three species. Rabbits showed coupling only when HR and f were close to integer ratios whereas other species coupled at non-integer ratios. Ventilatory variability in the rat and guinea-pig differed according to the pattern of coupling observed. Of the three species studied, the rat and guinea-pig demonstrated coupling most similar to that of anaesthetised human subjects. Anaesthetic concentration did not influence the pattern or degree of coupling.

Anesthesia↗

PubMed1999

The determination of cardioventilatory coupling from heart rate and ventilatory time series.

In 35 anaesthetised human subjects, we examined the effect of cardioventilatory coupling on R-R interval and ventilatory period time series. We observed that, in the presence of coupling: (a) ventilatory period fluctuated in a quantal manner, each quantal step corresponding to a multiple (or a little less) of the heart period; (b) heart period fluctuations, associated with respiratory sinus arrythmia, were identical for consecutive ventilatory periods. The regularity of heart period variation lead to geometric patterning of raw R-R time series, R-R consecutive difference time series, the phase portrait (R-R(n) vs R-R(n+1)) and the map of R-R interval variation (DeltaR-R(n) vs DeltaR-R(n+1)). These geometric features may be useful for the determination of cardioventilatory coupling from heart rate time series.

Adult↗

PubMed1999

Polypharmacy and elderly patients.

Medication therapy in elderly patients is difficult to manage and always has the potential of being hazardous. With the age-related changes that affect the pharmacokinetics and pharmacodynamics of a medication, prescribing medications is further complicated. Similarly, assessment of a medication's efficacy is difficult. The situation becomes more complicated when the patient is taking multiple medications. Nurses in the perioperative area need to be cognizant of a patient's preoperative medication regime and the medications that have been prescribed in the perioperative setting. As medication interactions increase substantially with the number of medications taken, the most pertinent nursing intervention is accurate assessment of the patient. Early recognition of potentially harmful medication effects is critical.

Aged↗

PubMed1999

Acidic isoforms of chorionic gonadotrophin in European and Samoan women are associated with hyperemesis gravidarum and may be thyrotrophic.

OBJECTIVE: There is conflicting evidence concerning the role of human chorionic gonadotrophin (hCG) in the aetiology of hyperemesis gravidarum (HG); particular isoforms of hCG may be the critical factor. Ethnic differences in HG prevalence and putative thyrotrophic effects of hCG may also relate to differences in hCG isoform profiles. To address these issues we examined the relationship of hCG isoforms to HG and thyroid function tests in two groups of women from ethnic backgrounds with significantly different HG prevalence rates. PATIENTS AND DESIGN: We enrolled 10 European and 10 Samoan women with HG and an equally sized non-hyperemetic, gestational stage matched control group. MEASUREMENTS: We administered a questionnaire, generated serum hCG charge-isoform profiles by chromatofocusing and measured the serum concentrations of total hCG, oestradiol (E2), thyrotrophin (TSH) and free thyroxine (FT4). RESULTS: The mean serum total hCG levels were highest in the Samoan hyperemetics (176,268 IU/l), and overall higher in hyperemetics compared with controls (159,770 IU/l vs. 86,420 IU/l, P < 0.001). When compared with controls, hyperemetics displayed increased hCG concentrations in the more acidic half (pH < 4) of the chromatofocusing pH range (89,843 IU/l vs. 41,146 IU/l, P < 0.003). Serum E2 levels did not differ between the four groups, but correlated with the hCG concentration between pH 5.2 and 4.01. Mean serum TSH levels were significantly lower in hyperemetics than in controls (0.33 mIU/l vs. 1.19 mIU/l, P < 0.001) and correlated with the hCG concentration between pH 4.6 and 2.8, while serum FT4 correlated with the hCG concentration below pH 4.0. CONCLUSIONS: Acidic isoforms of hCG may play a role in the aetiology of HG and gestational thyrotoxicosis. Minor ethnic differences in hCG isoform profiles were observed, but the relationship of acidic hCG isoforms to HG and serum thyroid hormone levels was largely independent of the patients' ethnicity. The mechanisms by which acidic isoforms might provoke nausea remain uncertain, but do not seem to involve E2, while the longer half-life of acidic hCG isoforms may result in increased in vivo TSH receptor cross-talk with resultant thyrotrophic effects.

Adult↗