Search PubMed⌕ Search

Biomedical subjects

P J Baskett

Publications and source records attributed to P J Baskett.

At least 19 recordsLinked to original sources
PubMed2001

The respiratory system during resuscitation: a review of the history, risk of infection during assisted ventilation, respiratory mechanics, and ventilation strategies for patients with an unprotected airway.

The fear of acquiring infectious diseases has resulted in reluctance among healthcare professionals and the lay public to perform mouth-to-mouth ventilation. However, the benefit of basic life support for a patient in cardiopulmonary or respiratory arrest greatly outweighs the risk for secondary infection in the rescuer or the patient. The distribution of ventilation volume between lungs and stomach in the unprotected airway depends on patient variables such as lower oesophageal sphincter pressure, airway resistance and respiratory system compliance, and the technique applied while performing basic or advanced airway support, such as head position, inflation flow rate and time, which determine upper airway pressure. The combination of these variables determines gas distribution between the lungs and the oesophagus and subsequently, the stomach. During bag-valve-mask ventilation of patients in respiratory or cardiac arrest with oxygen supplementation (> or = 40% oxygen), a tidal volume of 6-7 ml kg(-1) ( approximately 500 ml) given over 1-2 s until the chest rises is recommended. For bag-valve-mask ventilation with room-air, a tidal volume of 10 ml kg(-1) (700-1000 ml) in an adult given over 2 s until the chest rises clearly is recommended. During mouth-to-mouth ventilation, a breath over 2 s sufficient to make the chest rise clearly (a tidal volume of approximately 10 ml kg(-1) approximately 700-1000 ml in an adult) is recommended.

History, Ancient↗
PubMed2000

"Recommendations for uniform reporting of data following major trauma--the Utstein style" (as of July 17, 1999). An International Trauma Anaesthesia and Critical Care Society (ITACCS).

Basic and advanced care of trauma patients has always been an important aspect of prehospital and immediate in-hospital emergency medicine, involving a broad spectrum of disciplines, specialties and skills delivered through Emergency Medical Services Systems which, however, may differ significantly in structure, resources and operation. This complex background has, at least in part, hindered the development of a uniform pattern or set of criteria and definitions. This in turn has hitherto rendered data incompatible, with the consequence that such differing systems or protocols of care cannot be readily evaluated or compared with acceptable validity. Guided by previous consensus processes evolved by the ERC, the AHA and other International Organizations--represented in ILCOR--on 'Uniform reporting of data following out-of-hospital and in-hospital cardiac arrest--the Utstein style' an international working group of ITACCS has drafted a document, 'Recommendations for uniform reporting of data following major trauma--the Utstein style'. The reporting system is based on the following considerations: A structured reporting system based on an "Utstein style template" which would permit the compilation of data and statistics on major trauma care, facilitating and validating independent or comparative audit of performance and quality of care (and enable groups to challenge performance statistics which did not take account of all relevant information). The recommendations and template should encompass both out-of-hospital and in-hospital trauma care. The recommendations and template should further permit intra- and inter-system evaluation to improve the quality of delivered care and identification of the relative benefits of different systems and innovative initiatives. The template should facilitate studies setting out to improve epidemiological understanding of trauma; for example such studies might focus on the factors that determine survival. The document is structured along the lines of the original Utstein Style Guidelines publication on 'prehospital cardiac arrest'. It includes a glossary of terms used in the prehospital and early hospital phase and definitions, time points and intervals. The document uses an almost identical scheme for illustrating the different process time clocks--one for the patient, one for the dispatch centre, one for the ambulance and, finally, one for the hospital. For clarity, data should be reported as core data (i.e. always obtained) and optional data (obtained under specific circumstances). In contrast to the graphic approach used for the Utstein template for pre- or in-hospital cardiac arrest, respectively, the present template introduces, for the time being, at least, a number of terms and definitions and a semantic rather than a graphic report form. The document includes the following sections: The Section Introduction and background The Section on Trauma Data Structure Development: presents a general outline of the development of structured data using object-orientated modelling (which will be discussed in due course) and includes a set of explanatory illustrations. The Section on Terms and Definitions: outlines terms and definitions in trauma care, describing different types of trauma (blunt, penetrating, long bone, major/combined, multiple/polytrauma and predominant trauma). The Section on Factors relating to the circumstances of the injury describes the following items: cause of injury (e.g. type of injury (blunt or penetrating), burns, cold, crush, laceration, amputation, radiation, multiple, etc. Severity of Injury e.g. prehospital basic abbreviated injury score developed by the working group. The score contains anatomical and physiological disability data, with the anatomical scale ranging ordinally from 1. Head to 9. External; the physiological disability scale ranging ordinally from 0--unsurvivable. Mechanism of injury recording for transportation incidents etc. e.g. the type of impact, po

Data Collection↗
PubMed1999

What are the requirements for medical cover at motor racing circuits?

Motor racing is perceived as a dangerous sport but few data are available on the incidence and nature of injuries sustained. The medical service requirement at one regional motor racing circuit was assessed by determining the incidence of injuries, the medical interventions required and the need for hospital referral and admission over a 5-year period. Five hundred and twenty-one patients, including support staff and spectators, attended the medical centre, of whom 14% were referred to hospital and 4% required admission. Each competitor had a 4% chance of requiring on-circuit medical attention, 0.6% chance of hospital referral and 0.17% chance of admission per race. Most major accidents involved more than two drivers. Twenty sustained major trauma including five pelvic fractures and two intraabdominal haemorrhages. Emergency intervention included intubation and ventilation in five. There were three deaths from a total of 9000 competitors (mortality rate 0.033%). This study shows that despite the nature of the sport, the mortality rate remains low with prompt skilled medical intervention. Medical personnel should include those competent in dealing with minor medical complaints as well as those with advanced airway management and resuscitation skills. Although national motor sport guidelines recommend a minimum of two attending doctors this would have been insufficient for multivehicle accidents.

Athletic Injuries↗
PubMed1998

The incidence of regurgitation during cardiopulmonary resuscitation: a comparison between the bag valve mask and laryngeal mask airway.

The risk of gastric regurgitation and subsequent pulmonary aspiration is a recognised complication of cardiac arrest--a risk which may be further increased by the resuscitative procedure itself. The purpose of this study was to compare the incidence of gastric regurgitation between the bag valve mask (BVM) and laryngeal mask airway (LMA). The resuscitation data collection forms of 996 patients who underwent in-hospital cardiopulmonary resuscitation over a 3.5 year period were reviewed. Of these, 199 patients were excluded from the study because there was no airway management involving a BVM or LMA. The incidence and timing of regurgitation was studied in the remaining 797 patients. Regurgitation was recorded to have occurred at some stage in 180 of these patients (22.6%). However, 84 regurgitated prior to CPR (46.7% of those patients who regurgitated). These patients were excluded from further analysis as regurgitation could not have been affected by any form of ventilation. Of the remaining 713 patients, BVM ventilation was used in 636 cases. In 170 of these the LMA was also used following the BVM. Where the patient was ventilated with the BVM alone or BVM followed by ETT the incidence of regurgitation during CPR was 12.4%. The LMA was used during resuscitation in 256 cases of which 170 had BVM ventilation prior to the LMA. Where the patient was ventilated with the LMA alone or LMA followed by ETT the incidence of regurgitation during CPR was 3.5%. The study confirms experience reported in earlier studies that when an LMA is used as a first line airway device, regurgitation is relatively uncommon.

Cardiopulmonary Resuscitation↗
PubMed1998

The intubating laryngeal mask. Use in failed and difficult intubation.

The use of the intubating laryngeal mask in three patients is described. In two patients for whom tracheal intubation using traditional techniques had failed, the intubating laryngeal mask was used to achieve successful tracheal intubation. The trachea of one of these patients was subsequently re-intubated for a second procedure using the same technique. A third patient with a cervical spine fracture whose trachea was electively intubated using the intubating laryngeal mask is also presented.

Aged↗
PubMed1998

The intubating laryngeal mask. Results of a multicentre trial with experience of 500 cases.

A multicentre trial of the use of the intubating laryngeal mask was carried out at seven centres in the United Kingdom using the same agreed protocol. Lung ventilation followed by blind tracheal intubation through the intubating laryngeal mask was attempted on 500 ASA grade 1 and 2 patients. It was possible to insert the intubating laryngeal mask in all 500 cases. Ventilation via the intubating laryngeal mask was described as satisfactory in 475 (95%) cases, difficult in 20 (4%) cases and unsatisfactory in 5 (1%) cases. Blind tracheal intubation through the intubating laryngeal mask was possible in 481 (96.2%) cases within three attempts. Intubation was successful at the first attempt in 399 (79.8%) cases, at the second attempt in 62 (12.4%) cases and at the third attempt in 20 (4%) cases. The tracheas of 19 (3.8%) patients were not successfully intubated within the three attempts. Ventilation via the intubating laryngeal mask was described as unsatisfactory during two of these cases but oxygenation remained satisfactory in spite of this. Seventeen of the 19 failures occurred during the individual operator's first 20 attempts. The intubating laryngeal mask provides a successful method for blind tracheal intubation in a large proportion of cases and appears to be superior to the standard laryngeal mask airway for this purpose. The intubating laryngeal mask may be of use when tracheal intubation has failed using conventional methods.

Adolescent↗