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At least 487 records · Page 27Linked to original sources
PubMed1986

Controversies in resuscitation.

Many controversies, only a few of which have been discussed here, are now raging in the field of resuscitation. Much is expected to change in the next five to ten years. The American Heart Association is now considering changes for its new advanced cardiac life support course, which should be ready this year. The course will not include some of the possible changes mentioned in this article, because too few studies have been done. Physicians and other rescuers should abide by the guidelines of the American Heart Association as a standard of practice because its recommendations are the result of the best possible consensus. Over the next several years, many exciting changes in resuscitation will occur and may lead to improved survival rates and quality.

Calcium↗
PubMedDate not supplied

Analysis of the operation of the SCD Response intermittent compression system.

The work assessed the performance of the Kendall SCD Response intermittent pneumatic compression system for deep vein thrombosis prophylaxis, which claimed to set its cycle according to the blood flow characteristics of individual patient limbs. A series of tests measured the system response in various situations, including application to the limbs of healthy volunteers, and to false limbs. Practical experimentation and theoretical analysis were used to investigate influences on the system functioning other than blood flow. The system tested did not seem to perform as claimed, being unable to distinguish between real and fake limbs. The intervals between compressions were set to times unrealistic for venous refill, with temperature changes in the cuff the greatest influence on performance. Combining the functions of compression and the measurement of the effects of compression in the same air bladder makes temperature artefacts unavoidable and can cause significant errors in the inter-compression interval.

Artifacts↗
PubMedDate not supplied

Regional blood flow after pneumatic anti-shock garment inflation.

OBJECTIVE: To determine whether fully inflated pneumatic anti-shock garments (PASGs) decrease blood flow to abdominal and retroperitoneal organs. METHODS: An experimental study was conducted using a convenience sample of ten healthy adults. A duplex Doppler ultrasound was used to image and measure blood flow at the aortic root (cardiac output), left carotid artery, left subclavian artery, superior mesenteric artery (SMA), left renal artery, and distal aorta. Each subject was imaged before and after inflation of all three compartments of the garment to 90 mm Hg. Data were analyzed with paired t-tests. RESULTS: PASG inflation did not affect cardiac output (5.45 vs. 5.83 L/min, 95% confidence limit (CL) for mean -0.97 to 0.30, p = 0.26), left carotid artery flow (0.34 vs. 0.35 L/min, 95% CL for mean -0.06 to 0.04, p = 0.70), or left subclavian artery flow (0.12 vs. 0.11 L/min, 95% CL for mean -0.01 to 0.03, p = 0.47). Inflation did cause the aortic flow immediately distal to the renal artery to decrease markedly in all subjects (1.01 vs. 0.11 L/min, 95% CL for mean 0.79 to 1.19, p < 0.001). Flow immediately above this point appeared unaffected. Physical interference with the ultrasound probe by the garment precluded measurement of SMA or renal artery flow in five subjects. In the remaining subjects, these values did not change significantly (SMA 0.40 vs. 0.28 L/min, 95% CL for mean -0.11 to 0.33, p = 0.23; renal artery 0.44 vs. 0.51 L/min, 95% CL for mean -0.09 to 0.08, p = 0.78). CONCLUSION: PASG inflation caused a dramatic decrease in aortic blood flow over a small area immediately distal to the renal arteries but had little or no effect above this point. This provides support for the use of PASG to decrease otherwise uncontrollable hemorrhage from the iliac, pelvic, and leg vessels, but not for injuries above them.

Adult↗
PubMedDate not supplied

Misquotation on PASG.

Explore the source record for details and available documents.

Emergency Medical Services↗
PubMed1998

Effects of a novel pneumatic vest on postoperative pain and lung function after coronary artery bypass grafting.

A prospective study to evaluate the efficacy of a novel inflatable vest in supporting the sternotomy wound during the early period after coronary artery bypass grafting was carried out in 35 patients. The outcome variables were subjective pain score during cough, and peak expiratory flow (PEF) and vital capacity (VC) on postoperative days 2 and 3. The values without pressure in the vest were used as controls in the individual patients. Use of the vest significantly reduced the cough-associated subjective sternotomy pain score on days 2 and 3, when significant reduction of PEF and VC was also observed. The alleviation of pain by the inflatable vest may improve the efficacy of coughing and bronchial clearance in the immediate postoperative period.

Adult↗
PubMed1996

Oxygen consumption and delivery relationship in brain-dead organ donors.

The oxygen delivery (DO2) and consumption (VO2) relationship in brain-dead organ donors is unknown. Therefore, in a prospective study, we determined the DO2/VO2 relationship in 21 consecutive brain-dead patients. Patients were allocated to one of two groups, according to plasma lactate concentration: normal (group NL, n = 11) or high (> 2.5 mmol litre-1) (group HL, n = 10). VO2 was measured independently, using indirect calorimetry, under control conditions, during low DO2 challenge with PEEP administration, and high DO2 challenge with inflation of medical antishock trousers and volume expansion or blood transfusion, as required. Under control conditions, there were no significant differences between groups NL and HL in haemodynamic or oxygenation variables, both groups having a low VO2 (mean 114 (SD 21) ml min-1 m-2). In group HL there was a different DO2/VO2 relationship pattern, with a dependent VO2 only. The mean slope of the DO2/VO2 relationship was significantly higher in group HL than in group NL (0.12 (0.09) vs 0.04 (0.07), P < 0.05). We conclude that brain death was associated with a low VO2, and patients in group HL exhibited DO2/VO2 dependency which was not observed in patients in group NL.

Adolescent↗
PubMed1988

Effect of lower body positive pressure on blood pressure, plasma atrial natriuretic factor concentration, and sodium and water excretion in healthy volunteers and cardiac transplant recipients.

The effect of one hour (40 mmHg) lower body positive pressure on blood pressure, plasma atrial natriuretic factor concentration, and urinary sodium and water excretion was studied in 10 healthy volunteers and seven cardiac transplant recipients. Both groups showed a sustained rise in blood pressure and plasma atrial natriuretic factor concentration. The healthy volunteers had a diuresis during the period of lower body positive pressure and a small natriuresis in the subsequent hour. In contrast, lower body positive pressure had no significant effect on urinary sodium and water excretion in the cardiac transplant group. The data suggest that cardiac innervation is not important as a mediator of the haemodynamic response to lower body positive pressure but is necessary for the renal response. Furthermore, small physiological rises in plasma atrial natriuretic factor concentrations do not cause a brisk natriuresis as has been reported with pharmacological plasma concentrations.

Adult↗
PubMed1989

Central haemodynamic changes during lower body positive pressure in patients with congestive cardiac failure.

Fifteen patients with moderately severe and severe chronic congestive heart failure were studied to determine the central haemodynamic results of short term increases in lower body positive pressure. Central haemodynamic variables were determined by Swan-Ganz thermodilution catheterisation and arterial cannulation. Graded increases in lower body positive pressure were applied to supine patients using Medical Anti-Shock Trousers (MAST). Increasing lower body positive pressure by 25 mm Hg and 55 mm Hg caused increases in mean right atrial pressure (6.0 to 13.2 to 17.9 mm Hg; p less than 0.001 and p less than 0.0001 respectively) and mean pulmonary artery pressure (26.8 to 35.5 to 41.3 mm Hg; p less than 0.05 and p less than 0.01 respectively). No significant changes were seen in left heart filling pressures or in pulmonary vascular resistance. Furthermore, there were no significant increases in indices of cardiac work (cardiac index, left ventricular stroke work index, right ventricular stroke work index or cardiac power output) despite the increased right heart filling pressures. These results show that in patients with longstanding severe congestive heart failure, short term increases in cardiac return may increase right heart pressures but do not appear to cause either beneficial or detrimental changes in left heart haemodynamic indices.

Coronary Disease↗
PubMed1986

Successful treatment of osteomyelitis and soft tissue infections in ischemic diabetic legs by local antibiotic injections and the end-diastolic pneumatic compression boot.

Thirty-four legs at risk of amputation due to peripheral arterial insufficiency associated with ischemic necrosis, soft tissue infections, osteomyelitis, and variable degrees of peripheral neuropathy were reported in 28 diabetic patients. Amputation had been considered in 27 legs for which standard therapies had failed for the current illness and in two legs in which standard therapy had failed for previous illnesses. Local therapy was the initial form of therapy for five legs in which standard therapy appeared likely to fail. Infection was controlled in all patients with the use of local antibiotics and compression boot therapy. Early leg amputation was avoided in all but one patient. Late leg amputation occurred in two patients who were lost to follow-up care. Osteomyelitis, ischemic necrosis, and advanced soft tissue infection were shown not to be clear-cut indications for amputation in the ischemic diabetic foot.

Aged↗
PubMed1987

Effect of optimization of hemodynamics on fibrinolytic activity and antithrombotic efficacy of external pneumatic calf compression.

External pneumatic calf compression is effective but imperfect for antithrombotic prophylaxis in surgical patients. In preliminary studies, sequential filling of multisegmented leggings with graded pressure decreasing from ankle to knee increased venous flow velocity and wall shear stress, decreased residual venous volume, and enhanced postoperative fibrinolysis more than uniform compression. To determine if improved hemodynamics also increased antithrombotic activity, we performed a prospective randomized trial in neurosurgical patients comparing sequential application of graded pressure with uniform pressure applied to either a segmented bladder or to a single bladder. Deep vein thrombosis was diagnosed by leg scanning and impedance plethysmography and confirmed by phlebography. Venous thrombosis developed in 3 of 45 patients with graded-sequential filling, 6 of 50 with uniform compression-multiple compartments, and 3 of 41 with uniform pressure single bladder (differences not significant). These results suggest either that uniform compression offers all that can be expected of external pneumatic calf compression in prevention of venous thrombosis, or that even if a study with greater statistical power showed graded-sequential filling to be superior, the benefit/cost ratio of the more complex latter system is not likely to be large.

Adolescent↗
PubMed1990

Definitive control of mortality from severe pelvic fracture.

Within a group of 271 patients with pelvic fracture, 69 patients met criteria for severe hemorrhage. Sixty consecutive patients were treated by a combined multispecialty musculoskeletal trauma service using a protocol designed to control bleeding, rapidly diagnose and control associated injuries, as well as to prepare the patient for open reduction of the pelvic fracture, if appropriate. The pneumatic antishock garment, external fixation, and angiography were selectively used to control bleeding. Abdominal injuries were diagnosed using clinical examination and diagnostic peritoneal lavage. When lavage aspirate was grossly bloody, patients had no negative explorations. Microscopically positive lavages were associated with a 50% false-negative rate. Using the protocol, the mortality rate was 5%. Overall mortality rate was 10%. The combination of a trauma team approach and a specifically designed protocol reduces the number of deaths from pelvic fracture.

Adult↗