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Biomedical subjects

P G Moore

Publications and source records attributed to P G Moore.

At least 37 records · Page 2Linked to original sources
PubMed1985

Factors affecting outcome after chest injury.

From 1978 to 1983 a total of 328 patients was admitted to Royal Newcastle Hospital Intensive Care Unit with chest injuries; 255 had other injuries as well. Of the 328, 171 developed acute respiratory failure, 174 received mechanical ventilation (159 for acute respiratory failure) and 46 died. The commonest causes of death were head injury (19), sepsis (10) and uncontrollable haemorrhage (10). Associated head (131) and/or abdominal (89) injuries tripled mortality. Those without respiratory, cardiac, renal or hepatic failure (155) had a mortality rate of 5.8% while the remainder had mortality rates of 21.6%, 12.5%, 37.5% and 100%, for respiratory (171), cardiac (8), renal (8) and hepatic (5) failures, respectively. Shock was present on admission in 55, of whom 19 died. Sepsis developed in 59 and 14 with this complication died. Sepsis remains a potentially avoidable late cause of death and attention needs to be directed towards limiting invasive techniques of management to those which are necessary, and towards early diagnosis of abdominal injuries with early exploratory surgery. The best chance of survival in the initial phase of injury may lie in the establishment of an integrated regional trauma centre system together with improved pre-hospital and retrieval systems.

Abdominal Injuries↗
PubMed1984

Occult ruptured spleen--two unusual clinical presentations.

Case reports of two patients with occult rupture of the spleen are presented. In one, blunt trauma appeared to involve only the neck and upper chest, resulting in two distinct tracheal injuries and no clinical indication of abdominal injury. On the 5th day after injury this patient strangulated an indirect inguinal hernia. At subsequent surgery, a ruptured spleen was also found. The second patient gave no history of trauma and presented in cardiac and respiratory failure after a 2-month illness characterized by abdominal pain. On clinical and biochemical assessments, he was considered to have pancreatitis complicated by pseudocyst formation. Laparotomy revealed intra-abdominal haemorrhage and a ruptured spleen. The diagnosis and complications of occult ruptured spleen are discussed.

Adult↗
PubMed1983

Incremental evaluation of risky choices.

This paper compares the incremental method of valuation and its possible effects on choices analysed through utility theory with similar zero-base valuations. Analysis shows how biases can arise using incremental valuations in situations with decreasing risk aversion. This could be important in certain circumstances, e.g. delegated decision-making in cases where the total value of an organisation is unknown to the decision-maker or difficult to quantify.

Choice Behavior↗
PubMed1983

Causes of death after blunt chest injury.

During the 10 years from 1968 a total of 1119 patients with chest and associated injuries were admitted to the Royal Newcastle Hospital (RNH); 530 of these needed ICU treatment and fifty-nine died. Common causes of death included irreparable associated injuries to brain and exsanguination due to major vessel injury. However, the commonest cause encountered was refractory respiratory failure due to pulmonary sepsis. This condition was associated with hypovolaemic shock, intra-abdominal injuries, failure of conservative treatment and injuries in the older age groups.

Adolescent↗
PubMed1983

Tracheobronchial and oesophageal ruptures caused by blunt injury.

During the period 1968-1982, six patients with tracheobronchial ruptures following chest injury were treated in the Royal Newcastle Hospital Intensive Care Unit. In one there was associated oesophageal rupture. The management of these patients is described and recommendations regarding management are made.

Adult↗
PubMed1982

Respiratory failure after chest injury: the development of effective treatment.

The development of methods of treatment of severe chest injury over the years is reviewed and the contribution made by the introduction of intensive care units is assessed. A comparative analysis of the results of treatment in large series of patients reported during the period 1946-78 shows that, despite the risk of complications, the addition of artificial ventilation to conservative methods of treatment reduces mortality in patients with respiratory failure associated with chest trauma.

Flail Chest↗
PubMed1981

Tracheostomy in the management of chest injuries: its use and complications.

During the period March 1968 to June 1978 a total of 238 adult patients received long term artificial ventilation for acute respiratory failure following chest and associated injuries. In 180 of these tracheostomy was used as the means of access to the tracheobronchial tree. Our indications for tracheostomy in these patients, details of treatment and the complications which resulted from this aid to management are given. The lack of serious complications suggests that tracheostomy can be used safely and with advantage in the management of acute respiratory failure after injury.

Adult↗
PubMedDate not supplied

Preparation of the intensive care patient for major surgery.

Improved methods for monitoring and treating critically ill patients have increased the number of surgical candidates with multiorgan system impairment. Whereas such patients may have been considered "too sick to undergo surgery" in the past, many such patients linger in the intensive care unit unless definitive therapy is accomplished. Specific attention to review of the patient's preoperative preparation for surgery on a system-by-system basis may improve outcome substantially. The need for possible mechanical ventilation prior to transport to the operating room must receive particular attention. Pneumothorax, if present, must be treated prior to institution of positive-pressure ventilation so progression to tension pneumothorax can be avoided. Deficits in the circulating blood volume must be identified and corrected preoperatively if possible. A need for enhancement of cardiac output or alteration of vascular tone requires pulmonary arterial catheterization and indicates an increased operative risk. Metabolic abnormalities such as disturbances of acid-base balance, sodium or potassium concentration, and endocrinopathies are identified and corrected as much as possible prior to operation. Antibiotics are instituted as appropriate. Replacement of the red blood cell mass is dictated primarily by anticipated or actual blood loss. Factors of coagulation are infused on a replacement basis as necessary. Great care must be taken during transport to the operating room, as maintenance of intravascular monitoring devices, therapeutic infusions, and mechanical ventilation must continue during transport. Precautions must be taken to avoid hypothermia during transport and institution of anesthesia. Critical illness mandates specific considerations of the anesthetic agents to be utilized.

Critical Care↗
PubMedDate not supplied

Role of central nervous system monoamines in cardiopulmonary effects of Althesin in rabbit and man.

The steroid induction agent, Althesin, infused intravenously in light anesthetic doses in otherwise unsedated man (84 micrograms kg-1 min-1) and rabbit (140 micrograms kg-1 min-1) causes similar autonomic and somatic effects. In the rabbit, the rise in heart rate (mainly due to central vagal blockade) and the selective depressant effects on respiratory rate are independent of CNS 5-hydroxytryptamine and noradrenaline. The rise in arterial pressure and the fall in hindlimb conductance is dependent on CNS 5-hydroxytryptamine and noradrenaline synthesizing neurons, which are probably arranged in series. These findings provide a working hypothesis for the mechanisms of action of Althesin on central cardiopulmonary controls in man.

Adult↗
PubMedDate not supplied

Central nervous system opiate and 5-hydroxytryptamine influences on baroreflex control of the coronary circulation.

The effect of intravenous infusion of fentanyl (an opiate receptor agonist, 0.55 microgram kg-1 min-1) on the control of the circumflex coronary circulation was examined in unsedated dogs at rest and during baroreceptor stimulation evoked by acute rises in aortic pressure (balloon inflation in thoracic aorta). Circumflex flow was measured using Doppler flow transducers in dogs with experimental complete heart block and with ventricles paced at a constant rate. Studies were also performed before and one week after intracisternal injection of the neurotoxin 5,7-dihydroxytryptamine (5,7-DHT), to examine the role of CNS 5-hydroxytryptamine (5-HT) in any sympathetic vasoconstrictive effects. Fentanyl infusion caused after a few minutes a progressive rise in resting aortic pressure and a significant fall in circumflex conductance; circumflex flow usually fell. Atrial rate also fell. The gain of the baroreflex control of circumflex conductance was enhanced by fentanyl. One week after intracisternal 5,7-DHT, the gain of the baroreflex in each dog was diminished. When fentanyl was infused into these preparations, no consistent changes in resting atrial rate, aortic pressure and circumflex conductance could be observed, but all dogs showed a recovery of the coronary baroreflex gain towards values observed before intracisternal 5,7-DHT. These data suggest that the gain control of coronary baroreflexes is influenced by CNS opiate and 5-HT dependent mechanisms.

5,7-Dihydroxytryptamine↗