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Biomedical subjects

R M Nowak

Publications and source records attributed to R M Nowak.

At least 73 records · Page 4Linked to original sources
PubMed1985

Ionized calcium during CPR in the canine model.

The purpose of our study was to determine ionized calcium levels during cardiopulmonary resuscitation (CPR). Following placement of ascending aortic catheters in 15 adult mongrel dogs, ventricular fibrillation was induced electrically. After five minutes without therapy, mechanical external CPR was instituted. Animals received either standard CPR (S-CPR, n = 8) or simultaneous compression and ventilation CPR (SCV-CPR, n = 7) for 30 minutes. Ionized calcium levels were obtained prior to fibrillation and every five minutes during CPR. Mean ionized calcium levels during CPR (1.27 +/- 0.06 mmol/L) did not differ significantly from prearrest levels (1.27 +/- 0.07 mmol/L) at any point during CPR. This was true when the dogs were analyzed together (P = 0.1293) and when the animals receiving S-CPR (P = 0.4465) and SCV-CPR (P = 0.5470) were analyzed by groups. Defibrillation was attempted in all animals and resulted in electromechanical dissociation in three. None of these dogs was hypocalcemic either prior to arrest or during CPR, and none developed an effective rhythm with the administration of calcium. Furthermore, three of the four animals receiving calcium developed markedly elevated ionized calcium levels. Hypocalcemia apparently does not occur during CPR. The beneficial effect of calcium in reported cases cannot be explained routinely by correction of hypocalcemia. Further studies are needed to define the role of calcium administration, if any, in CPR.

Animals↗
PubMed1984

Verapamil in the treatment of asystolic and pulseless idioventricular rhythm cardiopulmonary arrests: a preliminary report.

A randomized, double-blinded study was conducted to evaluate the effectiveness of the calcium antagonist verapamil in patients in cardiopulmonary arrest with asystole or pulseless idioventricular rhythm (PIVR). Twenty-one such patients presenting to the emergency department received either verapamil (10 mg) or normal saline placebo in an intravenous bolus as initial therapy. They were then treated according to standard American Heart Association guidelines with the exception that calcium was not used. If these rhythms persisted after ten minutes, a second bolus of verapamil or saline was given. Resuscitation was successful in two of ten patients (20%) receiving verapamil and in one of 11 patients (9%) receiving placebo. This similar outcome (P = .462) in this small series suggests that verapamil may not add to successful resuscitation in these patients. Additional studies are needed to define the role of calcium and its antagonists in the treatment of asystole and PIVR.

Aged↗
PubMed1984

Accuracy and usefulness of a breath alcohol analyzer.

We evaluated the accuracy of a hand-held breath alcohol analyzer in the rapid determination of blood alcohol levels in the emergency patient with suspected ethanol intoxication. The Alco -Sensor III breath alcohol analyzer was used to measure alcohol levels in orally and nasally obtained end-expiratory breath samples in 55 patients. These levels were compared to directly measured blood alcohol levels. The patients were categorized into cooperative and uncooperative groups. The mean oral breath alcohol level obtained was 0.187 +/- 0.100 g/dL (range, 0.000 to 0.419) while the mean serum level was 0.217 +/- 0.113 g/dL (range, 0.00 to 400). The overall correlation between these two methods of measuring blood alcohol level was strong (r = .879, P less than .001). In cooperative patients the correlation was even stronger (r = .963, P less than .001), while in uncooperative patients the correlation was less but still significant (r = .723, P = .001). Nasally obtained samples correlated well with blood levels in cooperative patients (r = .874, P less than .001), but the correlation was less strong in uncooperative persons (r = .694, P = .003). Our study indicates that the Alco -Sensor III breath alcohol analyzer is sufficiently accurate to be of use in rapidly assessing blood alcohol levels, even when a patient is unable to cooperate fully.

Alcoholic Intoxication↗
PubMed1984

Endotracheal bretylium tosylate in a canine model.

This study was conducted to determine whether bretylium tosylate (BT) is effectively and safely absorbed through the endotracheal route in the canine model. Eleven adult mongrel dogs were anesthetized with pentobarbital, were orally intubated, and had continuous blood pressure and electrocardiographic monitoring. Four dogs received 5 mg/kg BT, three dogs received 10 mg/kg BT, two dogs received 20 mg/kg BT, and two control dogs were given volumes of normal saline equal to those given the 5- and 10-mg/kg groups. Each dog received the same dose of BT both endotracheally and intravenously, but in a random order and on different dates. Following each drug administration arterial blood was drawn at various intervals over two hours and sent for immediate gas analysis; serum samples were frozen for future determination of BT levels. Regardless of the amounts delivered, the peak levels of BT in the arterial blood following administration by the endotracheal route were consistently low (4.13 micrograms/mL to 14.00 micrograms/mL) when compared to those levels following intravenously administered BT (120 micrograms/mL to 268 micrograms/mL) (all P less than .002 for the 5- and 10-mg/kg groups). No depot effect was observed during a two-hour period. The arterial blood gases did not change significantly following the administration of BT by the endotracheal route in the 5- and 10-mg/kg groups, and sections of these autopsied dog lungs showed no apparent pathologic changes.

Animals↗
PubMed1983

Arterial blood gases and pulmonary function testing in acute bronchial asthma. Predicting patient outcomes.

Pretreatment and posttreatment arterial blood gas and pulmonary function testing measurements were prospectively compared as to their ability to assess asthma severity accurately and, thus, predict the outcome in 102 episodes of acute bronchial asthma initially seen in the emergency department. The Pao2, Paco2, or pH was unable to separate these patients requiring admission from those that could be confidently discharged, while the 1-s forced expiratory volume (FEV1) and peak expiratory flow rate (PEFR) did so both before and after treatment. Furthermore, virtually all patients with hypercarbia (Paco2 greater than 42 mm Hg) and/or severe hypoxemia (Pao2 less than 60 mm Hg) had a PEFR below 200 L/min, or an FEV1 below 1.0 L. Thus, selective use of arterial blood gas analysis should substantially decrease both diagnostic cost and patient discomfort without jeopardizing health care.

Acute Disease↗
PubMed1983

Theophylline concentrations in the emergency treatment of acute bronchial asthma.

Ninety-three patients presenting with acute asthma to the emergency department were studied to determine theophylline levels and their relationship to airway obstruction, history of prior medication use, and side effects of treatment. The mean pretreatment theophylline level was 6.4 micrograms/ml. Patients on long-acting preparations had significantly higher levels than those on short-acting medications (p less than 0.05). The mean post-treatment theophylline level was 16.7 micrograms/ml. Twenty-three patients had toxic levels post-treatment but none of these had a major adverse reaction. Twenty of these patients had been taking long-acting preparations. Fifty percent of the patients with symptoms of gastrointestinal toxicity had theophylline levels below 15 micrograms/ml. There was no correlation between the theophylline level or change in level and the degree of airway obstruction as measured by pulmonary function testing. Clinical findings are not reliable predictors of theophylline levels. Patients taking long-acting theophylline products should receive a lowered loading dose.

Acute Disease↗
PubMed1983

Acute bronchial asthma.

Advances in the understanding of the pathophysiology of acute asthma have been reflected in the changing patterns of present treatment and future research. Monitoring objectively the severity of the airway obstruction and its response to treatment will further make the care of the asthmatic patient a more rational event.

Acute Disease↗
PubMed1982

Hypothermia.

Explore the source record for details and available documents.

Anemia, Macrocytic↗
PubMed1982

Comparison of peak expiratory flow and FEV1 admission criteria for acute bronchial asthma.

One hundred nine episodes of acute bronchial asthma were studied utilizing PEFR and FEV1 measurements to determine objective patient disposition criteria. Of patients with both a pre-treatment PEFR less than 100 L/min, and a post-treatment value less than 300 L/min, 92% required admission or had an unsuccessful OPD course. Of patients with a pre-treatment PEFR less than 100 L/min and an improvement less than 60 L/min after initial terbutaline, 85% were admitted or had problems after discharge. PEFR correlated well with FEV1 at all stages of treatment.

Acute Disease↗
PubMed1981

Bretylium tosylate as initial treatment for cardiopulmonary arrest: randomized comparison with placebo.

To evaluate the therapeutic effectiveness of intravenous bretylium tosylate as a first-line drug for patients in cardiopulmonary arrest, a randomized, double-blind study was conducted, comparing bretylium with a normal saline placebo. Fifty-nine patients presenting to the emergency department with cardiopulmonary arrest due mainly to ventricular fibrillation or asystole initially received either bretylium (10 mg/kg) or placebo in a rapid intravenous bolus and were then otherwise treated according to standard American Heart Association guidelines. If ventricular fibrillation or asystole persisted, a second bolus of bretylium or normal saline was given after 20 minutes. Thirty-five percent of patients presenting with ventricular fibrillation or asystole who received bretylium were successfully resuscitated, whereas 6% of patients who received placebo survived (P less than 0.05). These findings serve to suggest that the early use of bretylium tosylate in cardiopulmonary arrest improves survival.

Anti-Arrhythmia Agents↗
PubMed1979

Spirometric evaluation of acute bronchial asthma.

Spirograms were obtained before and after emergency therapy in 85 episodes of acute bronchial asthma in 82 patients. The clinical status of all patients after emergency treatment was reevaluated 48 hours later. Patients could be divided into three groups: I) admissions; II) patients discharged but with later respiratory problems; and III) patients who were discharged and did well. The mean pre- and posttreatment one second forced expiratory volume (FEV1.0) was significantly different among all three groups. FEV1.0 less than or equal to 0.6 liter before treatment, or an FEV1.0 less than or equal to 1.6 liter after emergency treatment, was associated with an unfavorable course. Eighty-eight percent of Group I patients (admissions) had either an initial FEV1.0 less than or equal to 0.6 liter, or a posttreatment FEV1.0 less than or equal to 1.6 liter. Among all patients whose initail FEV1.0 was less than or equal to 0.6 liter, 80% were either admitted or had subsequent respiratory problems; 75% of all patients whose posttreatment FEV1.0 was less than or equal to 1.6 liter were either admitted or developed subsequent respiratory problems. Moreover, 90% of patients who had both a pretreatment FEV1.0 less than or equal to 0.6 liter and a posttreatment FEV1.0 less than or equal to 1.6 liter were admitted or had subsequent significant airway obstruction. We conclude that spirometry can identify asthmatic patients who require admission or who will have significant airway obstruction within 48 hours after discharge from the emergency department.

Acute Disease↗