Signs of endotracheal intubation in a field setting.
Explore the source record for details and available documents.
Esophagus↗
Biomedical subjects
R D Stewart
Publications and source records attributed to R D Stewart.
A computer-assisted quality assurance system for an emergency medical service.
A busy urban emergency medical service answering more than 50,000 calls each year developed a plan for quality assurance using a computer-assisted model designed to employ a full-time quality assurance officer whose work was supplemented with computer evaluation of EMS field reports. The development of standardized reporting formats, protocols and computer programs enabled a significant improvement in detection of errors of documentation and patient care. Investigated cases rose dramatically in the month following implementation of the system, from five patient care errors per month to 35 (P less than .05), and from 50 documentation errors to 265 per month (P less than .05). Our experience indicates that computer-assisted evaluation of field performance, as judged by prehospital records, is a useful tool to ensure standards in patient care and EMS recordkeeping.
Allied Health Personnel↗
Administering endotracheal medication.
Explore the source record for details and available documents.
Humans↗
Gastrointestinal transit times of cathartics combined with charcoal.
Oral activated charcoal usually is administered in toxic ingestions along with a cathartic. A study was done in volunteers to determine the rapidity of gastrointestinal transit when activated charcoal was administered with various cathartics. A control of activated charcoal was compared to the gastrointestinal transit times of activated charcoal plus the cathartics magnesium citrate, magnesium sulfate, or sorbitol. Activated charcoal alone produced a mean transit time of 23.5 hours; magnesium citrate catharsis occurred in 4.2 hours, magnesium sulfate catharsis occurred in 9.3 hours, and sorbitol catharsis occurred in 0.9 hours. Sorbitol clearly was the most rapidly acting cathartic.
Administration, Oral↗
Nitrous oxide sedation/analgesia in emergency medicine.
Nitrous oxide:oxygen mixtures are safe and effective sedative/analgesic agents for use in emergency medicine. They are suitable for prehospital care because of their safety, rapid onset, and short duration of action. The self-administered form of a 50:50 mixture is the most acceptable system, but other methods of administration should be investigated, particularly in the ED setting. While there are unresolved questions concerning the use of nitrous oxide as an anesthetic and analgesic agent, it is difficult to extrapolate many of the findings to the low-dose, patient-controlled 50:50 mixture used in emergency medicine. Use of the gas mixture in a variety of clinical settings has been associated with no major adverse occurrences, and experience continues to support its safety. Future possibilities for study include the use of the gas mixture in combination with other agents or TENS. No one drug can be considered a panacea for all painful states. Nitrous oxide:oxygen mixtures certainly do not meet all the criteria for the ideal analgesic. Those clinicians who seek a safe and effective sedative/analgesic for mild to moderate pain will be satisfied that we can now offer more to our patients in the early management of their problems.
Analgesia↗
A novel cell type carrying both Th and Tc/s markers in the blood of cyclosporine-treated, allografted rats.
During treatment of heart-grafted rats with cyclosporine, an unusual large lymphocyte appears in the blood. These cells constitute up to 40% of the peripheral blood leukocyte population and carry both the T helper/DTH and T cytotoxic/suppressor differentiation antigens. They require both the allograft and CsA for their generation and are not recently thymus-derived. They gradually disappear after stopping CsA treatment, although the treated rats remain tolerant of the graft.
Animals↗
Effects of acute behavioral stress on plasma and cerebrospinal fluid ACTH and beta-endorphin in rhesus monkeys.
To elucidate the effect of acute behavioral stress on plasma and cerebrospinal fluid (CSF) concentrations of adrenocorticotropic hormone (ACTH) and beta-endorphin, rhesus monkeys were subjected to 30 min of confinement stress. Simultaneous plasma and CSF samples revealed no significant change in CSF ACTH or beta-endorphin up to 120 min after the onset of the stress despite significant elevations in plasma cortisol, ACTH, and beta-endorphin. It is suggested that acute behavioral stress does not alter CSF ACTH or beta-endorphin, and that this information may be clinically useful for future human studies of CSF ACTH and beta-endorphin in neuropsychiatric illnesses.
Acute Disease↗
Pharmacokinetics of intraperitoneal cefotaxime treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis.
The pharmacokinetics of intraperitoneal cefotaxime as the sole therapy in patients on continuous ambulatory peritoneal dialysis with peritonitis have been examined. The mean plasma concentrations achieved following 1 h of peritoneal instillation of 500 mg of cefotaxime were 5.0 +/- 1.6 micrograms ml-1. The average plasma concentration over 24 h was 6.9 +/- 0.4 micrograms ml-1 and was no different from that found following a further 9-11 days of successful treatment of the peritonitis. However, the mean dialysate effluent concentration of cefotaxime was increased following the resolution of the peritonitis, 165 +/- 22.7 mg per cycle on day 10 or 12 compared with 50.4 +/- 7.3 mg per cycle on day 1, suggesting enhanced peritoneal cefotaxime absorption during acute peritonitis. Nevertheless, during both periods, adequate concentrations of cefotaxime were achieved in dialysate to treat local complications, but plasma levels may be inadequate to treat systemic complications due to Staphylococcus albus.
Adult↗
Prehospital use of dexamethasone in pulseless idioventricular rhythm.
We investigated the prehospital use of 100 mg dexamethasone for the treatment of cardiac arrest patients with pulseless idioventricular rhythms (PIVR). In the 86 patients studied in this prospective, randomized, double-blind investigation, four of the 46 patients receiving saline and two of the 37 patients receiving dexamethasone survived long enough to be admitted to the hospital intensive care unit. There were no long-term survivors. No benefit from the field use of 100 mg dexamethasone in PIVR could be identified in this study.
Arrhythmias, Cardiac↗
Effect of varied training techniques on field endotracheal intubation success rates.
A pool of 146 mobile intensive care unit paramedics was divided into four equal groups and trained in the technique of direct laryngoscopic endotracheal intubation of cardiac arrest or deeply comatose patients. Group 1 was selected from supervisors and crew chiefs and trained as preceptors. The remaining paramedics were assigned to three other study groups. Groups 1 and 2 were trained with a didactic presentation followed by manikin practice, an animal laboratory exercise, and operating room experience. Group 3 had no OR experience; Group 4 had only didactic/manikin training. Intubations were observed by preceptors on scene. During the study period of 27 months, 689 of 763 patients (90.3%) were successfully intubated by 122 paramedics. While results suggest variation in skill levels according to training group (Group 1, 92.4%; Group 2, 87.6%, Group 3, 83.3%; Group 4, 76.9%), statistical analysis allowing for the variables of seniority and number of intubations performed by personnel failed to reveal differences in groups attributable to training programs. Complication rates were relatively low for all groups, the most common being prolonged intubation attempts. A significant improvement in the skill was seen as the study progressed when groups are pooled and compared. The findings suggest that endotracheal intubation of deeply comatose or cardiac arrest patients is a field procedure that can be performed safely and skillfully by well-monitored paramedical personnel. Operating room or animal laboratory experience may increase initial success levels, but these factors do not appear to greatly influence eventual performance or incidence of complications of the procedure.
Allied Health Personnel↗
Drug use in pregnancy.
Expected drug effects may be enhanced or lessened in a pregnant woman, and the known side effects may become more likely. Possibly devastating effects on the fetus must be considered. In the care of a pregnant patient and her unborn, medications should be used only when absolutely necessary (Figure 2). Sound advice is the old medical adage, "Primum non nocere"--first do no harm.
Abnormalities, Drug-Induced↗
Out-of-hospital cardiac arrest: factors associated with survival.
One hundred eighty-seven cases of cardiac arrest of presumed cardiac etiology were analyzed to determine factors associated with successful out-of-hospital management by paramedic teams. Field and in-hospital records were reviewed to determine the response time of the advanced life support team, the ECG rhythm on arrival, the presence of paramedics on scene at the time of the arrest, whether bystander CPR had been initiated, and the eventual outcome of the resuscitation attempt. A significant difference in survival-to-leave-hospital was seen in patients in whom ventricular fibrillation or ventricular tachycardia (VF/VT) was present on arrival (15.3%) compared to patients with asystole, idioventricular rhythms, blocks, or electromechanical dissociation (3.4%). Survival rates in patients in whom CPR was being performed by a bystander were 24% in the VF/VT group and zero in the "OTHER" rhythms group. When the advanced life support team arrived in less than four minutes, survival rates in the VF/VT group and "OTHER" rhythms group were 23.1% and 7.7%, respectively. When the field team arrived in less than four minutes and a bystander was performing CPR, the survival rates were 42.9% in the VF/VT group and 15.8% in the "OTHER." These data suggest that efforts to improve survival from out-of-hospital cardiac arrest in a community should be directed toward public education, reduction in response times of paramedic units, and lay CPR training.
Aged↗
Tactile orotracheal intubation.
A previously described method for tactile (digital) endotracheal intubation was refined for use in deeply comatose patients. This technique, consisting of introduction of the endotracheal tube by palpation of the epiglottis, was practiced in cadaver subjects and then applied in both field and emergency department settings. Because the procedure can be carried out without movement of the head and neck and even with an immobilization device in place, it was found particularly suitable in trauma patients who might have suffered injury to the cervical spine. An added advantage is the ease of performance despite secretions or blood in the upper airway. This technique should prove useful to clinicians involved in the early care of critically ill or injured patients.
Adult↗
Emergency care for mass gatherings. Proper planning to improve outcome.
Explore the source record for details and available documents.
Adult↗
Field endotracheal intubation by paramedical personnel. Success rates and complications.
One-hundred thirty mobile intensive care unit paramedics were trained in the technique of direct laryngoscopic endotracheal intubation of cardiac arrest or deeply comatose patients. Three attempts at intubation were permitted. Of the 779 patients studied, 701 (90.0 percent) were successfully intubated: 57.9 percent on the first attempt, 26.1 percent and 5.5 percent on the second and third respectively. Reported and observed complications of the procedure numbered 74 (9.5 percent) of the 779 patients included in the study. There were three unrecognized esophageal intubations. The success rate rose to more than 94 percent toward the end of the study. It is concluded that endotracheal intubation of deeply comatose patients is a field procedure safely and skillfully performed by well-trained and monitored paramedical personnel, with success and complication rates at least comparable to other invasive airway techniques.
Allied Health Personnel↗
Radiological prevalence of Paget's disease in Dunedin, New Zealand.
Explore the source record for details and available documents.
Age Factors↗
Diagnostic value of urinary N-acetyl-beta-D-glucosaminidase, its isoenzymes and the fractional excretion of sodium following renal transplantation.
Daily total urine N-acetyl-beta-D-glucosaminidase activity, isoenzyme profile and fractional excretion of sodium were measured in 13 consecutive renal transplant patients. Rejection episodes were clinically diagnosed in 12 patients, 11 of whom (92%) showed an increased enzymuria either before or during the onset of clinical signs. The ratio of the two major isoenzymes (A/B) fell during 10 episodes (83%) and in six of these (50%) increased levels of the minor isoenzyme forms were observed. Increased fractional excretion of sodium was associated with nine (75%) of the episodes. Increased fractional excretion of sodium with a raised total enzymuria accompanied by a reduced A/B ratio and an increased proportion of the minor isoenzyme forms occurred in eight (67%) of the rejection episodes. The use of these measurements in the diagnosis of episodes of acute rejection in renal transplantation is discussed.
Acetylglucosaminidase↗
Synthetic corticotropin-releasing factor stimulates secretion of immunoreactive beta-endorphin/beta-lipotropin and ACTH by human fetal pituitaries in vitro.
Synthetic ovine CRF, in an amount approximating that found in pituitary portal plasma of the rat, induced a significant increase in the secretion of both ACTH and immunoreactive beta-endorphin/beta-LPH (i beta-END/LPH) by human fetal hemipituitaries in an in vitro superfusion system. This finding suggests that a molecule similar to synthetic ovine CRF may be a physiologic hypothalamic releasing factor in man.
Adrenocorticotropic Hormone↗