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Biomedical subjects

P Sefrin

Publications and source records attributed to P Sefrin.

At least 19 recordsLinked to original sources
PubMed1992

[Anesthesiologic problems in the elderly].

Nowadays approximately 20% of all patients operated are older than 60 years of age. So it seems to be interesting to investigate the effect on the increase of systemic disease of these patients, to estimate a proper anaesthesiological management. Anaesthesiological problems occur pre- and postoperatively because of restrictions of the cardiovascular and respiratory system, compromised renal function and defeds of the CNS. Therefore preoperatively registration and therapy of these risks are necessary, however diagnostic evaluation cannot be standardized. There is no typical anaesthesia for the elderly.

Aged↗
PubMed1992

[Current status of preclinical resuscitation. An overview based on recent literature and personal results].

Cardiopulmonary resuscitation is one of the most important topics in modern emergency care medicine. Especially the management of the prehospital cardiac arrest is a region of interest. This article is an attempt to show the current situation of the out-of-hospital resuscitation in the german-speaking area. In an own analysis of 166 resuscitations by emergency physicians and by consideration of results from other groups we found an outcome between four and seventeen percent finally successful resuscitations. The main prognostically favourable factors seem to be the following: non-traumatic cause for the cardiac arrest, ventricular fibrillation as the primarily ECG-statement and begin with CPR within ten minutes.

Adult↗
PubMed1991

[Emergency drugs in respiratory disorders. A choice of commonly used substances].

For the emergency care of respiratory disorders, in addition to clearing of the airways and keeping them open, drug treatment has an important role to play. The bronchodilatory effect of beta-sympathicomimetics brings about a marked decrease in the resistance to flow, but potential cardiovascular side effects must be considered. In the case of theophylline, the solvent, ethylene diamine has its own pharmacodynamic effects that can make it necessary to select different theophylline preparations. The drugs with a primarily cardiac effect, nitroglycerin, dobutamine and dopamine can produce pulmonary relief. Furosemide is specifically indicated for pulmonary edema. In addition to experience in the use of emergency drugs, an appropriate basic knowledge of the pharmacodynamics and pharmacokinetics is indispensable.

Adrenergic beta-Agonists↗
PubMed1991

[The results of resuscitations in an emergency service].

In a prospective study 166 consecutive cases of prehospital resuscitation by emergency doctors were analysed to ascertain those factors which affect the ultimate outcome. Cardiac causes were most frequent (69%): primary ventricular fibrillation was the most common ECG diagnosis (47%). Average time from definite cardiorespiratory arrest until onset of resuscitation procedures by an emergency doctor was 8.2 minutes, to first measures by other resuscitation personnel it was 6.6 minutes. In all cases in which resuscitation procedures were undertaken (in 33 within 10 minutes) this was done by medical personnel who were nearby by chance. 47 patients (28.3%) could be resuscitated and taken to hospital; 16 of them (9.6%) were discharged after "finally successful resuscitation", 13 without any neurological deficit. Favourable factors were: primary ventricular fibrillation and start of resuscitation manoeuvres within 10 minutes. These results highlight the need for training first-aid personnel so that the number of successful resuscitations can be increased.

Electrocardiography↗
PubMed1991

[Endobronchial drug administration in resuscitation].

The endobronchial application of drugs is recommended during pharmacological reanimation in lack of venous punction possibility. To find out the quantity of the area of resorption after deep endobronchial instillation twelve human corpses had been intubated and methylen-blue was applicated through the tube. A special application kit with a single use ampule was used. The results showed a very good distribution of 100% or 90% in the bronchi principals dexter and sinister. The bronchi lobaris of the right and the left bronchial tree were reached by the injection with an incidence of more than 70%. This proved distribution of the applicated indicator liquid in a patient in horizontal position (no circulation) allows the statement that during reanimation a sufficient pulmonal surface area is reached in both lungs to guarantee a resorption of the drug.

Bronchi↗
PubMed1991

[Selective cerebral hypothermia following cardiac arrest in the cat].

The aim of the present study was to introduce a new method of external selective brain cooling in cats. By means of this device, which mainly consisted of a head-sized, closely fitting copper basin, it was possible to reduce brain temperature rapidly. The resultant difference between core and cerebral temperatures amounted to mean values of about 10 degrees C after a 20-min cooling period. Ventricular fibrillation lasting for 15 min was induced in 23 healthy adult cats by internal cardiac electrical overpacing and followed by cardiopulmonary resuscitation (CPR). In several animals (n = 8) CPR efforts failed completely or they died without any indication of sufficient spontaneous circulation. In the initial postischemic period the remaining animals stayed normothermic and served as controls (n = 7) or received external brain cooling (n = 8), which was started simultaneously with CPR and continued for 30 min. During a survival time of 4 h cardiocirculatory function was stabilized pharmacologically and artificial respiration was performed, followed by transcardiac perfusion fixation. After removal from the skull, the brains were processed for histopathological evaluation of ischemic neuronal damage by light microscopy and morphometry. The clinical data obtained indicate that the described method provides a means for efficient heat exchange from within the intracranial space. Rapid, selective brain cooling could be achieved without any critical reduction of the core temperature and therefore, cardiac arrhythmias, a usual consequence of generalized hypothermia, could be avoided. The histopathological evaluation of ischemic neuronal damage showed a significantly higher percentage of unaffected cells in some areas of the cerebral cortex in animals treated with postischemic cerebral hypothermia than in the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

[Venous access in emergencies].

A reliable venous access is necessary for pharmacological treatment in case of emergency. The indication, pharmacology of the drug or the infusion and the expected period of intravascular penetration are decisive for choosing the location for the punction. As a principle all visible veins could be punctured and used for injection; all but varicose or thrombotic veins. Primarily the distal veins of the extremities should be punctured with a venous catheter and only in case of failing one should try more proximal. In case of accidently artery punction the cannula has to be left in place and a pharmacological therapy has to be started immediately. If a peripheral venous punction is impossible the central venous catheter is an alternative even of its remarkable higher rate of complications. Three ways of access to the central veins can bei recommended: the jugular interna vein, the subclavian vein and the basilic vein. Advantages as well as disadvantages are elaborated. As a result the physician in cases of emergency should use the technique of venous punction he is used too in a routine situation.

Bloodletting↗
PubMed1979

[Metabolic changes in the multiply injured. Biochemical studies in multiply injured patients with reference to the severity of the injury].

Leading physical sign of "trauma-disease" in polytraumatized patients is hypovolemic shock. Changes in metabolism have been described previously. At present there are no reports concerning the time at which these changes occur. The early posttraumatic phase is characterized by normosodiemia and initial transient hypopotassemia, which is based on the renin-angiotensin-mechanism. The metabolic acidosis depending on trauma causes decreased oxygen perfusion of tissue, which possibly is found even before alterations of circulation are detected. Already at the site of the accident hyperglycemia and hyperglucagonemia with normal values of insulin were found. The increase of blood glucose was correlated to the values of adrenalin and to the insulin antagonist glucagon. The catabolism of proteins closely related to the degree of trauma continued as long as 5 days after injury. Analysis of the blood clotting system showed that in the early phase after trauma there are changes in hemostatic potential consisting in hemostatic defect. In several essential points the early posttraumatic phase of metabolism is different from that in a later phase. These facts should be kept in mind if planning therapy.

Acidosis↗