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Biomedical subjects

W Buylaert

Publications and source records attributed to W Buylaert.

At least 19 recordsLinked to original sources
PubMed1999

Collisions involving mobile intensive care unit vehicles in Flanders, Belgium.

In order to evaluate the risk of collision during emergency responses of mobile intensive care units (MICUs) in Flanders, Belgium, a questionnaire was sent to 37 MICU services. The response rate was 84%. During the study period (1992-96) the incident rates for collision, collision with significant physical harm, and collision leading to a wrecked MICU vehicle were 1 per 52,000 km, 1 per 214,000 km and 1 per 250,000 km, respectively. Most collisions occurred during use of 'lights and siren' (66%), and involved other motor vehicles (72%). About 50% occurred during daylight with clear weather conditions and on dry roadways. Drivers had attended a course for safe and defensive driving in only four services (13%). The use of seat belts was imposed by the hospital authorities in 21 services (72%). Vehicles equipped with airbags and an ABS-braking system were used in eight (28%) and 13 (45%) services, respectively. Our data confirm that the collision rate for MICUs is high and that measures to reduce the risk of collisions and resulting injuries and damage are at present not optimal.

Accidents, Traffic↗
PubMed1998

When an AED meets an ICD... Automated external defibrillator. Implantable cardioverter defibrillator.

The chances of prehospital care providers being confronted with a patient with an implantable cardioverter defibrillator (ICD) are increasing and so care providers must receive proper training. Based on observations made during the resuscitation of a patient with an ICD using an automated external defibrillator (AED) some technical features and possible interactions of ICDs and AEDs are highlighted. Furthermore, we discuss the key points of basic knowledge, safety, and treatment protocols for cardiac arrest and other situations required for practical training in the ICD for prehospital care providers.

Adult↗
PubMed1998

ECG changes and plasma concentrations of propafenone and its metabolites in a case of severe poisoning.

CASE REPORT: Propafenone is a class IC antiarrhythmic agent metabolized into two major metabolites, 5-hydroxypropafenone and N-depropylpropafenone. The potency of 5-hydroxypropafenone to block fast sodium channels is comparable to that of its parent. We report the positive correlation between plasma concentrations and electrocardiographic changes in a patient with severe oral self-poisoning. Serial ECG changes were measured and plasma concentrations were determined by high-performance liquid chromatography. The initial plasma concentrations of propafenone were in the toxic range and correlated with the widening of the QRS-complex. The slow decline in concentration during this first phase might relate to saturation of the isoenzyme CYP2D6. The half-life of propafenone, calculated from the second phase, was approximately 3 hours, defining the patient as a fast metabolizer. The initial concentrations of the metabolite N-depropylpropafenone were surprisingly higher than those of 5-hydroxypropafenone which may also be due to saturation of CYP2D6.

Anti-Arrhythmia Agents↗
PubMed1997

The effect of semi-automatic external defibrillation by emergency medical technicians on survival after out-of-hospital cardiac arrest: an observational study in urban and rural areas in Belgium.

The introduction of semi-automatic external defibrillators (SAEDs) allowed emergency medical technicians (EMTs) to deliver electroshocks in cases of out-of-hospital ventricular fibrillation (VF) or ventricular tachycardia (VT), often many minutes before the arrival of the mobile intensive care unit (MICU) team. In this observational study we report on the results obtained by the EMTs from the fire departments of Gent, Aalter and Brugge. In Gent, an SAED project started in May 1991. By December 1995, the SAED's electrodes had been attached in 367 cardiac arrest patients. The first rhythm detected by the device was asystole or electromechanical dissociation (EMD) in 241 patients (66%): only 5 of these patients survived to hospital discharge (2%). In the remaining 126 VF/VT cases (34%) the survival rate was 21% (26/126). In 14 of these 26 patients the shock(s) delivered by the EMTs restored spontaneous circulation before the arrival of the MICU team, with only venous cannulation and/or intubation being performed by the MICU team. In 4 other VF patients, the shock(s) delivered by EMTs converted the VF, with the MICU team successfully taking care of VF/VT relapses or postcountershock EMD. In the remaining 8 VF/VT cases, only the MICU attempts could resuscitate the patient. The SAED project in Aalter was set up in April 1993. By December 1995, care was taken for only 21 patients. None of the 4 VF/VT patients and the 17 asystole/EMD patients survived. In Brugge, there were 240 cardiac arrest cases treated with SAED between January 1991 and December 1995. Among the 89 VF/VT cases, there were 20 survivors (22%): 8 cases survived thanks to SAED shock(s) delivered by EMTs, in 3 cases survival was due to the combination of SAED shock(s) by EMTs and extensive ALS treatment by the MICU team, and in 9 cases restoration of spontaneous circulation was only obtained after application of ALS techniques by the MICU team. This observational study seems to show a beneficial effect of the introduction of SAED in Gent and Brugge. In Aalter the number of treated cases is tool low to draw conclusions. Anyhow, the global survival rate in the three areas remains low. Therefore, more efforts are needed to strengthen the other links of the chain of survival (early access to the emergency medical services-system, early basic cardiopulmonary resuscitation and early advanced life support.

Adult↗
PubMed1996

Patients with psychiatric emergencies transported by an ambulance in an urban region.

This paper studies the use of an ambulance service in the case of psychiatric emergency referrals. A cross-sectional design was used to compare the patients brought in by an ambulance with all other psychiatric emergency referrals. The sociodemographic and clinical characteristics as well as the referral pattern of both groups of patients are compared. Results show that an important proportion of patients brought in by an ambulance can be described as high risk referrals. However, for another group of referrals the ambulance is used for other reasons. The possibility of using alternative social services in these cases are discussed.

Adult↗
PubMed1996

Hepatotoxicity of N, N-dimethylformamide (DMF) in acute poisoning with the veterinary euthanasia drug T-61.

1. We report on a patient who was resuscitated after a suicide attempt with the veterinary euthanasia product T-61 and treated with N-acetylcysteine (NAC) to prevent hepatotoxicity from N,N-dimethylformamide (DMF), the solvent of T-61. 2. Serum concentrations of DMF were high as compared with values published on occupational exposure. 3. The patient showed only a transient increase in liver enzymes with eventually a full recovery. 4. The hepatoprotective effect of NAC was studied in a rat model using the rise in serum sorbitol dehydrogenase (SDH) as a marker for DMF-induced hepatotoxicity. 5. Four series of randomized, controlled and double-blind experiments were carried out and consistently showed a lower increase in SDH in NAC-treated animals in each series. The difference was statistically significant only when the data of the 4 series were pooled. This is probably due to the large interindividual variations in the effect of DMF. 6. We hypothesize that in the rat NAC may have a protective effect. Whether NAC is also protective in patients, in which it is administered after exposure to DMF, cannot be concluded from the present experiments.

Acetylcysteine↗
PubMed1995

The management of non-compliance with referral to out-patient after-care among attempted suicide patients: a controlled intervention study.

The failure to comply with referral for out-patient after-care is a well-documented problem among attempted suicide patients. The present study aimed at the investigation of an experimental referral procedure by means of a randomized controlled study. Non-compliant patients in the experimental group were visited in their homes by a community nurse in order to assess reasons for non-compliance and to motivate patients to comply with referral. One year after their suicide attempt patients were visited in their homes in order to assess repetition of suicidal behaviour. Uni- and multi-variate analyses showed a significant beneficial effect of the experimental procedure on compliance with referral. A near-significant effect of the experimental procedure on the rate of repetition of suicidal behaviour was found.

Adolescent↗
PubMed1995

How to evaluate an emergency medical dispatch system: a Belgian perspective.

In order to evaluate the local emergency medical dispatch centre, 4601 calls were analysed. Information was obtained from the tape recordings of the dispatch centre and standardized reports from the basic life support (BLS) teams, advanced life support (ALS) teams and the emergency departments of all receiving hospitals in the study area. The need for prehospital ALS care was assessed 'post hoc', based on the clinical findings at the scene and in the emergency department. The accuracy of the medical dispatch was evaluated by comparing the level of care actually sent with the real medical needs of the patient. The 4601 medical problems reported led to 4446 interventions: a BLS team only in 82% (n = 3627), an ALS team and BLS team simultaneously in 14% (n = 623), and a BLS team followed somewhat later by an ALS team in 4% (n = 196). In the 633 cases judged 'post hoc' to require prehospital ALS care, an ALS team was not sent in 260 (41%) or sent with some delay in 112 (18%). Of the 819 interventions of the ALS teams, 446 (54%) dealt with cases not requiring that level of care. With regard to the role of the dispatchers in the mismatches between the medical needs of the patients and the level of care sent, underestimation and overestimation of the severity of the emergency by the dispatchers was found in 31% and 22% cases respectively.

Belgium↗
PubMed1994

Metabolism and hepatotoxicity of N,N-dimethylformamide, N-hydroxymethyl-N-methylformamide, and N-methylformamide in the rat.

The metabolism and hepatotoxicity of N,N-dimethylformamide (DMF) and two of its metabolites, N-hydroxymethyl-N-methylformamide (HMMF) and N-methylformamide (NMF) were evaluated over a 4-day period in rats. DMF toxicity was dose dependent and delayed toxicity after the administration of a high DMF dose (13.7 mmol/kg) in comparison to a lower dose (4.1 mmol/kg) was observed. Treatment of rats with 13.7 mmol/kg DMF, HMMF, or NMF showed i) that DMF is more toxic than HMMF or NMF, and ii) that hepatotoxicity occurs later for DMF than for HMMF or NMF. Analysis of serum and urine samples demonstrated that DMF is first metabolized to HMMF, which is then partially converted to NMF. After HMMF administration, NMF was found both in serum and in urine. The time course of DMF and HMMF toxicity in relation to NMF formation fitted the hypothesis that the hepatotoxicity of DMF and HMMF is mediated via NMF. The degree of hepatotoxicity after HMMF and NMF treatment is similar. However, the degree of DMF hepatotoxicity is much higher than in the case of NMF or HMMF. The role of NMF as an obligatory intermediate in DMF and HMMF hepatotoxicity is discussed.

Animals↗
PubMed1994

The 'early access' link in the chain of survival for cardiac arrest victims in Ghent, Belgium.

Without early access to the emergency medical services (EMS) system, the chances of surviving an out-of-hospital cardiopulmonary arrest (CPA) are poor. The aim of this study was to evaluate this first link in the chain of survival in Ghent. Therefore, we reviewed the data from the registry on all CPA cases treated by our mobile intensive care unit (MICU) and the tape recordings from the local EMS dispatch centre of 100 consecutive non-traumatic CPA cases that occurred after January 1, 1993. Alarm signs before the collapse were recorded in 39 cases. In only 54% (21 out of 39) a pre-arrest call to the EMS system was made. In only four cases (10%) was the MICU at the patient's side when the collapse occurred. The delay between collapse and call in the 79 cases in which no call to the EMS system was made before the collapse was estimated to be 3 min or less for only 49% (39 out of 79). To evaluate the processing of the call in the EMS dispatch centre, we examined all 100 cases with regard to whether or not the first tier (emergency medical technicians) and the second tier (MICU) were dispatched simultaneously upon the first call. We found that in 41 cases the MICU was not sent immediately. The most important reasons were minimal information available for the EMS system (n = 8), underestimation of the emergency of the call by the dispatcher (n = 10) and underestimation of the pre-alarm signs by a general practitioner (n = 7). This analysis shows that all aspects of the first link of the chain of survival need improvement.

Belgium↗
PubMed1993

[Resuscitation in heart arrest due to severe hypothermia].

Two patients were resuscitated after cardiopulmonary arrest due to severe hypothermia. The first patient, a 76-year-old man, had ventricular fibrillation resistant to conventional therapy; he was rapidly rewarmed by means of cardiopulmonary bypass. In the second patient, a 77-year-old woman, classical resuscitation led to restoration of spontaneous circulation. The patient was subsequently rapidly rewarmed with hemodialysis with fluid of 40 degrees C. We conclude that rapid rewarming with cardiopulmonary bypass is the treatment of choice in severely hypothermic patients presenting with cardiac arrest that is resistant to conventional therapy. Hemodialysis seems a suitable technique in patients who remain deeply hypothermic after resuscitation. However, it is difficult to assess its value because of the lack of clinical studies comparing this technique with other procedures.

Aged↗
PubMed1993

A positron emission tomography study of patients with acute carbon monoxide poisoning treated by hyperbaric oxygen.

Seven patients with an acute and severe carbon monoxide intoxication were treated with hyperbaric oxygen and underwent a positron emission tomographic examination 2-5 days after the acute event. Although the final clinical outcome was good in all patients, ischaemic changes were observed. Three patients with temporary sequelae after hyperbaric oxygen treatment showed the most severe changes, mainly in striatum and thalamus. Although positron emission tomographic examination cannot predict the final outcome, it can show the regions at risk for development of late complications following carbon monoxide poisoning.

Adult↗
PubMed1992

Early prediction of non-survival for patients suffering cardiac arrest--a word of caution. The Belgian Cerebral Resuscitation Study Group.

A total of 6178 persons with out-of-hospital (70%) and in hospital (30%) cardiac arrests from the first of January 1982 until the end of 1989 were reviewed retrospectively with respect to 4 variables, contributing to a score for specific prediction of poor prognosis (cut-off point: greater than 3 points). These included age, initial ECG, type of respiratory arrest and bystander resuscitation. Presence of ventricular fibrillation, gasping and bystander resuscitation contributes nothing to the score, while presence of asystole or EMD (electromechanical dissociation), apnoea and absence of bystander resuscitation adds one point to it. Of patients scoring 4 or 5 points 44 were awake 14 days post CPR (Class 3). The positive predictive value of the score was 97% (95% CI 96-98%) for the out-of-hospital group and 92.2% (95% CI 88-95%) for the in-hospital group. The specificity was respectively 92.3% (95% CI 89-95%) and 94.2% (95% CI 91-96%). Although the score can weigh the likelihood of no success against that of success, we cannot recommend it for decision making as far as abandoning or continuing cardiopulmonary resuscitation efforts.

Age Factors↗
PubMed1992

Should semi-automatic defibrillators be used by emergency medical technicians in Belgium? The Belgian Cerebral Resuscitation Study Group.

Early external defibrillation is the single most effective intervention in patients with out-of-hospital cardiac arrest. Literature data indicate that instructing emergency medical technicians (EMTs) to use defibrillators is beneficial, provided the local emergency medical system is well organized. We tried to estimate the potential benefit of early defibrillation in some centres in Belgium by retrospectively analyzing the data from the Belgian Cardio-Pulmonary-Cerebral Resuscitation Registry collected between 1983 and 1987 in Belgian centres with a Mobile Intensive Care Unit (MICU). The data show that 2310 out of 3371 patients (69%) were first attended by the EMTs; on subsequent arrival of the MICU-teams, 584 of these 2310 patients i.e. 17% of the whole study population, presented with ventricular fibrillation. Analysis of estimated time factors in these 2310 patients revealed that the median time interval between collapse and start of resuscitation by EMTs was 8 min; the median time interval between collapse and start of MICU-resuscitation attempts was 16 min. The duration of EMT-resuscitation before MICU-arrival was probably more than 5 min and 10 min in 58% and 23% of the cases respectively. It is concluded that EMTs can be expected to reach a substantial number of ventricular fibrillation victims within a few minutes after the collapse and many minutes before arrival of the MICU. Therefore, training of EMTs in the use of semi-automatic defibrillators seems worthwhile in MICU-served regions in Belgium.

Belgium↗
PubMed1989

Acute cholinesterase inhibitor poisoning mimicking pulmonary oedema.

In patients poisoned with a cholinesterase inhibitor, the diagnosis may initially be missed especially when no history is available from the patient or his relatives. The predominant respiratory symptoms may suggest pulmonary oedema as illustrated by the two case reports presented here. A high degree of suspicion and a careful clinical examination are necessary to make the correct diagnosis, which eventually can be confirmed by measurement of red cell and serum cholinesterase activity.

Aged↗