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Biomedical subjects

R E Falcone

Publications and source records attributed to R E Falcone.

At least 55 records · Page 3Linked to original sources
PubMed1984

The effect of perioperative adriamycin on skin-graft take and adherence in the rat.

This two-part study was undertaken to evaluate the effect of perioperative Adriamycin on skin-graft take and adherence in an animal model. Thirty-four male Fisher rats were divided into control and experimental groups. The controls received intravenous saline, and the experimental animals received Adriamycin 6 mg/kg (LD 10) 24 hours preoperatively. Each animal was then grafted with an autogenous split-thickness skin graft on a contiguous dermal and fascial bed. Skin-graft take was judged and measured at 7 and 14 days postoperatively. The average skin-graft take for controls was 6.1 cm2 on both the dermal and fascial beds. This was significantly better than the average skin-graft take sustained by the experimental groups of 4.3 and 3.5 cm2 on the dermal and fascial beds, respectively (p less than 0.01). Another 30 animals were divided into three control and three experimental groups. They were treated with saline and Adriamycin as before, and they underwent a similar surgical procedure. Skin-graft adherence, which was measured at 12, 24, and 48 hours postoperatively, was significantly less in the experimental groups compared with the control groups at all times measured. These data suggest that a single supratherapeutic dose of Adriamycin given preoperatively decreases skin graft take in the experimental model studied and that this decrease may be the result of a concomitant decrease in graft adherence.

Adhesiveness↗
PubMed1978

Effect of proteins depletion on the surviving length in experimental skin flaps.

Protein depletion appears to augment, rather than decrease, the length of a skin flap surviving in rats. We were able to document a lowering of serum viscosity in these animals. The augmentation of flap survival produced by protein depletion may even be greater than that produced by the delay phenomenon. A reduction in the total weight of flaps is present in the protein-depleted animals, and this may contribute to the augmentation of flap survival in them.

Animals↗
PubMedDate not supplied

Correlation of metabolic acidosis with outcome following injury and its value as a scoring tool.

This study looked at preresuscitation arterial pH as a predictor of outcome in injury. Seriously injured patients admitted to the Trauma Service over a 5-month period were evaluated prospectively. Data collected included basic patient demographics, initial arterial blood gas determinations (ABGs) including pH, bicarbonate (HCO3), base deficit or excess (BASE), admitting trauma score (TS), discharge injury severity score (ISS), total blood products used for initial resuscitation (TBP), and outcome. There were 191 patients averaging 34.7 years old with average TS 13.6, ISS 19.5, initial pH 7.38 +/- 0.09, HCO3 20.9 +/- 4.0, and BASE -3.3 +/- 4.7. The average TBP was 1309 cc, and overall mortality was 13/191 (6.8%). Comparing survivors to nonsurvivors, the ISS (18.2 vs. 38.3), TS (14.1 vs. 7.8), TBP (976 vs. 5881 cc), HCO3 (21.1 vs. 17.6), and BASE (-3.1 vs. -5.8) data were significantly different; pH (7.38 vs. 7.36) and age (34.4 vs. 38.5) were not. Using multiple regression with TBP as the dependent variable, BASE, age, TS, and to a lesser extent pH and HCO3 correlated (r = 0.536; p < 0.001); using outcome as the dependent variable, only TS and age correlated (r = 0.465; p < 0.0001). Although metabolic acidosis (pH, HCO3, BASE) predicts the TBP used, it does not improve on TS and age for predicting outcome.

Acidosis↗
PubMedDate not supplied

Air medical transport for the trauma patient requiring cardiopulmonary resuscitation: a 10-year experience.

INTRODUCTION: Air medical response and transport for the injured patient in cardiopulmonary arrest remain controversial. This study is a large, single-program experience. METHODS: A retrospective chart review and descriptive study of all injured patients requiring cardiopulmonary resuscitation (CPR) immediately before or during air medical transport. The crew functioned under advanced cardiac life support/advanced trauma life support protocols. SETTING: The patients, when transported, went to a variety of facilities, with the majority of patients transported to a level-I trauma center. The service area was primarily rural. RESULTS: During 1985 to 1994, inclusive, there were 12,518 completed missions. A total of 320 injured patients required CPR (284 with blunt injury and 36 with penetrating injury), six of the 320 patients (1.9%) survived. Survivors and nonsurvivors did not differ significantly in age, mechanism of injury, time from initiation of CPR to arrival in the emergency department (ED), year of injury or initial cardiac rhythm. All survivors did, however, present to the ED in normal sinus rhythm with a palpable blood pressure. CONCLUSION: Air medical transport for the injured patient without signs of life following prehospital intervention appears futile.

Air Ambulances↗
PubMedDate not supplied

Air medical response for illness revisited.

INTRODUCTION: A previous study (1988-1990) suggested that the majority of air medical scene transports for illness in the Columbus, Ohio, service area were inappropriate. The current study followed an aggressive prehospital educational program (1991-1993) that continued during the study. The question asked: Did this educational program make a difference? METHODS: A descriptive, retrospective review of all patients transported from the scene of illness to tertiary care by air. SETTING: A single air medical transport service with a rural service area encompassing most of central and southeastern Ohio. RESULTS: In the 27 months ending September 1993, there were 3,669 completed missions and 1,039 scene missions. Twenty-seven patients transported for illness included 11 males and 16 females, with an average age of 22.3 years. Significant differences between 1988-90 and 1991-93 included: Number--10% vs. 2.6% (2,414 vs. 3,669), diagnosis arrest--29.4% vs. 3.7%, diagnosis seizure--14.7% vs. 48.1%, tertiary care needed--20.6% vs. 70.4%, helicopter needed--0.0% vs. 29.6%. Total mission volume increased (2,414 vs. 3,669) while the percent scene total volume remained constant (28.3%). CONCLUSION: An aggressive educational program led to a significant decrease in inappropriate helicopter use in the service area studied.

Adult↗
PubMedDate not supplied

Flight crew physical fitness: a baseline analysis.

INTRODUCTION: The purpose of this pilot study was to determine whether flight crew personnel are physically fit in comparison to published standards for the average American adult. SETTING: The study group consisted of pilots, paramedics and nurses in two similarly configured and geographically located rotor-wing air medical transport programs. METHODS: A physical fitness assessment of flight crew members was conducted. The results were compared with published standards for average adult males and females (AVG). Percentage of fat in body composition (FM%), aerobic fitness (VO2MAX), muscular endurance (ME), muscular strength (MS) and flexibility (FL) measurements were obtained using accepted testing methods. RESULTS: The study population consisted of 29 male and 21 female individuals. The following were their mean scores. Males averaged: pFAT = 19% (AVG = 20.0%); VO2MAX = 41.0 (AVG = 42.5); ME = 37.0 (AVG = 28.5); MS = 125.0 (AVG = 86.5); FL = 5.2 (AVG = 1.4); Females averaged: pFAT = 28.0% (AVG = 26.5%); VO2MAX (AVG = 34.0); ME = 27.0 (AVG = 21.0); MS = 83.0 (AVG = 76.5); FL = 4.5 (AVG = 3.4). CONCLUSION: These baseline data suggest the study population of air medical flight crew was physically fit compared to the average American adult.

Adult↗
PubMedDate not supplied

Trauma and nontrauma cardiopulmonary arrest: a national survey.

INTRODUCTION: This survey attempts to identify the current standard of care for the air medical transport of the patient in cardiopulmonary arrest. METHOD: An Association of Air Medical Services/National Flight Nurses Association-approved survey by a single mailing with an anonymous response. SETTING: All rotor-craft programs with current memberships in AAMS. RESULTS: Fifty-three of the 178 questionnaires mailed were returned. Program demographics, crew composition and transport volumes were typical of other reported national experiences. The majority of programs (84%) had standing operational protocols for trauma and non-trauma cardiopulmonary arrests. The indications for not initiating or discontinuing CPR, the transport of the patient in cardiopulmonary arrest, triage and financial considerations varied widely between air medical programs. CONCLUSIONS: This study provides some insight on the current air medical management of the patient in cardiopulmonary arrest. National practice guidelines should be developed and tested prospectively in future studies.

Air Ambulances↗
PubMedDate not supplied

Emergency scene endotracheal intubation before and after the introduction of a rapid sequence induction protocol.

INTRODUCTION: A change in airway management protocol provided the opportunity to evaluate scene airway management by air medical crew before and after the introduction of a rapid sequence induction protocol. METHODS: A retrospective chart review and a descriptive study of scene trauma patients whose airway was established primarily by an air medical crew during two study periods: April 1994 through March 1995 (group 1, before rapid sequence induction) and April 1995 through March 1996 (group 2, after rapid sequence induction). Data collected included demographics, type of airway, Glasgow Coma Scale score, scene time, and outcome. The setting included a four helicopter air medical transport program using nurse/paramedic crews with a service area of 25,000 square miles in central, southeastern, and northeastern Ohio. RESULTS: Group 1 patients (n = 148) averaged 31.6 years of age and were primarily male (79.7%) with blunt injuries (92.6%) with an average Glasgow Coma Scale score of 7.7. Group 2 (n = 95) was similar, averaging 31.1 years of age, primarily male (77.9%) with blunt injuries (94.7%) and a Glasgow Coma Scale score of 8.6. Groups 1 and 2 differed in oral endotracheal intubation rate (19/118 versus 36/95 [p = 0.03]) and in scene time (15.7 minutes versus 20.1 minutes [p = 0.0012]). The groups did not differ in rate of successful intubation or the rate of subsequent cricothyrotomy. CONCLUSION: Rapid sequence induction added significantly to ground time without significantly increasing intubation success rate or decreasing cricothyrotomy rate. Its use at the scene of injury may not be appropriate.

Adult↗
PubMedDate not supplied

Helicopter dispatch: a time study.

PURPOSE: To quantitate request to liftoff (R/L) and dispatch to liftoff (D/L) times and reasons for delay in an active air medical transport program. METHOD: This was a prospective observational study blinded to crew and pilots. Data were collected by the communications department during a 4-week period on 197 consecutive missions. RESULTS: The air medical helicopter program services 25,000 square miles with four BK 117 helicopter each staffed by nurse/paramedic crew. During the study period, R/L and D/L averaged 10.9 and 6.8 minutes, respectively. One hundred and twenty-two flights had an R/L of 10 minutes or less for an average R/L of 7.2 minutes and D/L of 5.9 minutes. Seventy-five flights had an R/L greater than 10 minutes, for which reasons included weather check--21; standby by requestor--27; all ships in flight--5; receiving facility delay--4; mechanical problems--4; original ship diverted--2; additional fuel needed--1; airport clearance--1; and no specific reason given--10. CONCLUSION: Most variance occurred in R/L rather than D/L. Evaluating R/L time not only provides a better indication of program activity but also identifies most delays. It appears reasons for delay are limited, which should allow development of a concise plan to overcome them.

Air Ambulances↗
PubMedDate not supplied

Air medical transport of the injured patient: scene versus referring hospital.

INTRODUCTION: In a rural service area, does the outcome of air medical patients transferred from the scene of injury differ from that of patients transferred from a primary receiving hospital? METHODS: Retrospective review of all injured patients transported by air to a single trauma center during calendar year 1996. Data collected include basic patient demographics, time of injury, revised trauma score (RTS), injury severity score (ISS), probability of survival (PS), hospital length of stay (LOS), complications, disposition, and mortality. RESULTS: Concerning trauma admission, 594 of 1461 (40.7%) were transported by air: 363 from the scene (24.9%) and 231 from referring hospitals (15.8%). These two groups were similar in demographics, injury severity, hospital LOS, and crude mortality: RTS, 6.61 versus 6.68 (P > 0.05); ISS, 16.0 versus 16.0 (P > 0.05); LOS = 6.9 days versus 7.3 days (P > 0.05); mortality = 11.8% versus 10.8% (P > 0.05). The groups differed significantly, however, in time from injury to definitive care (34.2 minutes versus 196.2 minutes, P < 0.001), overall complication rate (39.1% versus 57.6%, P = 0.009), and potentially preventable deaths (PS > 0.5, 11.6% versus 44%, P = 0.02). CONCLUSION: Patient groups were similar, suggesting similar triage criteria. Patients transferred from a referring hospital took almost six times longer to reach definitive care and may have suffered an increased morbidity and mortality on this basis.

Adult↗
PubMedDate not supplied

Air medical program merger and stress.

INTRODUCTION: How does the stress of a program merger affect job stress in air medical transport? METHODS: This study was an anonymous survey of 104 transport personnel in a Mid-western critical care transport program with merged air and ground components. Tools included the Social Readjustment Rating Scale (SRRS), which quantitates stressful life events on a weighted scale that allows summation as a score, and the Medical Personnel Stress Survey (MPSS), which quantitates work stress in four categories: organizational stress (OS) related to work environment, frustration/exhaustion (FE) related to patient care, job satisfaction (JS) related to decreased self-worth, and psychosomatic complaints (PC), stress manifested as personal illness. Statistical analysis was performed with a variety of tools. RESULTS: Fifty of 104 personnel responded completely. The average SRRS was low at 130.9; only 20% had scores above 200. No significant differences in MPSS occurred in personnel with high and low SRRS scores. Additionally, the SRRS correlated weakly with OS (r = -0.297, P < 0.05). Within the MPSS, OS correlated with FE and JS (r = 0.493, P = 0.0005; r = -0.593, P < 0.0001) and FE correlated with JS (r = -0.36, P = 0.01). CONCLUSION: The overall personnel stress levels in this air medical program with merged air and ground components were low and appeared to be unrelated to organizational stress. This finding may be a result in part of the careful attention paid to stress and the elimination of stressors during the merger process.

Air Ambulances↗
PubMedDate not supplied

Pediatric pedestrian versus motor vehicle patterns of injury: debunking the myth.

INTRODUCTION: Mechanism of injury has been widely used to enhance the ability of EMS providers to recognize predictable injury patterns. One such pattern, referred to as "Waddell's triad," identifies a triad of injuries associated with pedestrian/motor vehicle collision (MVC), including trauma to the head, abdomen, and lower extremities. We questioned this choice as a common injury pattern for this mechanism. METHODS: A retrospective chart review of 4444 pediatric trauma patients admitted to a regional pediatric trauma center between 1992 and 1996. The source of this information was the medical center's trauma registry. RESULTS: Four-hundred-sixty-five patients suffered a pedestrian/MVC and were included in the study; 231 suffered head injury, and 78 experienced a combination of head and leg injury. Only 11 patients (2.4%) suffered the predicted "triad" of head, leg, and abdominal injury as a result of pedestrian/MVCs. Two of these children suffered minor head injury, and only one patient (0.2%) suffered injury as originally described by Waddell. CONCLUSION: Although the concept of Waddell's triad is logical, and a high index of suspicion should be maintained, the incidence of this predictable injury pattern is low. Educational emphasis should be placed on other aspects of mechanism of pedestrian injury.

Abdominal Injuries↗