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Biomedical subjects

S L Goldman

Publications and source records attributed to S L Goldman.

At least 37 records · Page 2Linked to original sources
PubMed1986

A new evaluation method for instructors of advanced cardiac life support.

This study evaluated the ability of a specific educational program to teach instructors of advanced cardiac life support (ACLS) how to identify errors committed by team leaders of cardiac arrest simulations. The design compared experimental and control groups for differences in identification of critical performance errors, grade assignments and errors specifically emphasized in the educational program. The group receiving the educational program documented more critical performance errors (1.70 vs. 1.10, P = 0.006), made more correct grade assignments (2.35 vs. 2.0, P = 0.026), and identified more errors that were emphasized in the educational program (3.61 vs. 2.25, P = 0.0001) than the control group. The data strongly suggests that the educational program accounted for the observed differences.

Educational Measurement↗
PubMed1985

Assessment of physician performance of cardiopulmonary resuscitation.

Physician performance was assessed in cardiopulmonary resuscitation (CPR) by the number and type of errors committed. In simulated arrests, physicians previously certified in advanced life support made fewer errors (5.6 vs 14.3, P = .007) than those not certified. Senior house staff made fewer errors than junior house staff (5.8 vs 10.9, P = .05). Guidelines for successful completion of these simulations were developed. This study indicates the need for continued physician education in CPR.

Clinical Competence↗
PubMed1982

Jaundice meter: evaluation of new guidelines.

The correlation of transcutaneous bilirubin measurements with serum bilirubin concentrations is not good enough to allow for accurate prediction of the serum values. To impose the jaundice meter's potential clinical usefulness, we evaluated 344 paired jaundice meter-serum bilirubin measurements in 125 infants, using new guidelines from the marketing company which were designed to identify which infants require serum bilirubin determinations rather than to predict the actual bilirubin values. Use of the new guidelines correctly assessed the need for serum determinations in most infants, but false positives and, more importantly, false negatives (missed high serum values) did occur.

Bilirubin↗
PubMed1982

Detection of seizure activity in the paralyzed neonate using continuous monitoring.

In experimental animals neurologic damage may occur during seizure activity whether the seizure is accompanied by motor activity and hypoxemia or whether the animal is paralyzed and normoxemic. These findings suggest that it may be important to detect seizure activity in the paralyzed neonate. Nine infants who were mechanically ventilated and paralyzed with pancuronium had their condition diagnosed as seizure activity. Vital signs were continuously monitored and six infants had either oxygen saturation or transcutaneous oxygen measured during seizure activity. For the group as a whole, rhythmic fluctuations in vital signs, cardiac rhythm, and oxygenation occurred every four minutes (range one to seven minutes) and lasted two minutes (range one to four minutes). In seven patients whose seizures were not accompanied by cardiac arrhythmias the following mean increases were noted: systolic arterial blood pressure, 15 mm Hg (range 7 to 36 mm Hg); heart rate, ten beats per minute (-11 to 30/min); oxygen saturation, 12% (range 4% to 20%); and transcutaneous oxygen, 31 mm Hg (range 14 to 45 mm Hg). Seizures in the two patients with cardiac arrhythmias were accompanied by a decrease in systolic arterial blood pressure of 27 mm Hg (range 15 to 40 mm Hg) and in oxygen saturation of 24% (range 20% to 28%). The presence of rhythmic fluctuation in vital signs and oxygenation should alert the physician to the possibility of seizure activity in the paralyzed neonate.

Anesthesia, General↗
PubMed1981

Hospital based cardiopulmonary resuscitation: it could be better.

The frequency and duration of interruptions of cardiopulmonary resuscitation (CPR) were evaluated in a hospital to determine whether or not CRP was being performed properly according to American Heart Association (AHA) standards. The frequency of interruptions were 0.41 per min. Interruptions of greater than 20 s duration occurred in 17.12% of all interruptions. Eighty percent of these interruptions of greater than 20 s duration were of unjustified duration. CPR education should reflect these unjustified deviations and their reasons in an attempt to limit such interruptions in future patient CPR.

Emergency Service, Hospital↗
PubMed1980

Attenuated response to insulin in very low birthweight infants.

Four hyperglycemia very low birthweight (VLBW) infants were given a constant infusion of insulin with parenteral alimentation in order to improve glucose tolerance. After an initial 45% decrease in serum glucose, intolerance recurred within hours to days despite delivery of as much as 16 units/kg/hour or regular insulin. Resulting serum insulin levels were as high as 72,000 microU/ml. It is suggested that insulin "resistance", instead of insulin deficiency, may be responsible for glucose intolerance in some infants.

Glucose↗
PubMed1979

Hyperglycemic hyperosmolar coma in a 9-month-old child.

Hyperglycemic hyperosmolar coma is a life-threatening emergency with a mortality much higher than that of other forms of hyperosmolarity such as hypernatremia or diabetic ketoacidosis. Despite the differences in the three conditions, present evidence suggests that correction of hyperosmolarity should proceed slowly to avoid the seizures that may occur in all three conditions. This report describes a 9-month-old diabetic child who initially had hyperglycemic hyperosmolar coma and who is one of the youngest survivors of this syndrome in the American literature. This case report points out the limited understanding of the pathophysiology of this syndrome and the consequent problems of therapy.

Diabetic Coma↗
PubMed1979

Increased work of breathing associated with nasal prongs.

To see if continuous distending pressure (CPD) given by nasal prongs increases work of breathing, we measured the mechanics of breathing, minute ventilation, and blood gases in nine infants with both nasal prong and face mask CDP. Minute ventilation was 16% larger (P less than .02), work of breathing was 94% higher (P less than .01), and the mean PaO2 was 8 mm Hg lower (P less than .03) with the nasal prongs. There was no difference in pH or PaCO2. We speculate that CDP given by nasal prongs may increase the risk of respiratory failure in the premature infant already compromised with hyaline membrane disease.

Blood↗
PubMed1978

Apnea, hypoxemia, and aborted sudden infant death syndrome.

To find out whether there is any relationship between the ventilatory response to hypoxia and the sudden infant death syndrome (SIDS), we studied the effects of mild induced hypoxia (PIO2, 120 mm Hg = 17% oxygen) in 16 infants aged 2 weeks to 6 months. Eight had recurrent apneic spells (apnea group) (five had aborted SIDS and three had recurrent apnea in the intensive care nursery) and eight were "well" preterm infants about to fly in a pressurized airplane (PIO2, 120 mm Hg) (control group). Mean birth weights were 2,245 and 1,400 gm and mean gestational ages were 35 and 30 weeks. Postconceptual ages (41.8 and 41.3 weeks) were almost identical. Heart rate was obtained from an ECG, and respiratory rate and pattern were obtained from a pneumogram. In addition, end-tidal PCO2 and PN2 or PO2 were obtained with a nasal catheter and gas analyzers. In the apnea group with inhalation of 17% oxygen, we observed an increase in periodic breathing and an increase in both rate and total duration of respiratory pauses. In the control group there were no significant changes. Heart rate and PCO2 did not change in either group. Our findings suggest that infants prone to apnea may have unique respiratory responses to mild induced hypoxia.

Apnea↗