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Biomedical subjects

B E Haynes

Publications and source records attributed to B E Haynes.

At least 19 recordsLinked to original sources
PubMed2001

Paramedics can apply and read Mantoux tuberculosis tests.

Selected paramedics (26) received 2 h of training in the application and interpretation of Mantoux skin tests by a specially trained registered nurse. Instruction included a lecture, a video tape, and practice skin test administration on "induration arms." All students successfully completed written and skills tests. During a follow-up period, registered nurses directly observed skin test application and interpretation by the paramedics when applying the skin test to other departmental fire fighters and compared these to set criteria. Interpretation of skin test results included appropriate referral for positive results. Paramedics administered 319 skin tests during subsequent follow-up and 305/319 (96%) were monitored by a registered nurse. All administration criteria were performed as indicated 100% of the time except for the criterion requiring a 5-10 mm wheal. The application was appropriately repeated in each case. In one application, a paramedic began to use the same needle and syringe to draw up additional solution, but was immediately corrected. Among 227 cases of test interpretation by paramedics, paramedics were monitored by a registered nurse in 169 interpretations (74%). All monitoring criteria were performed as indicated 100% of the time. Nurses concurred with each monitored measurement. Induration results were 0 mm, 216 tests; 1-9 mm, 9 tests; > or =10 mm, 2 tests. Appropriate follow-up was provided to the two individuals with > or =10 mm induration. The results indicate that paramedics can successfully apply and accurately interpret Mantoux skin tests on public safety employees, although the number of positive tests was low, reducing the reliability of the findings.

Allied Health Personnel↗
PubMed2001

Two deaths after prehospital use of adenosine.

Two patients in the prehospital setting died immediately after receiving adenosine for presumed supraventricular tachycardia. Both patients' cardiac rhythms were atrial fibrillation rather than supraventricular tachycardia, and their unstable conditions resulted from underlying diseases-chronic obstructive pulmonary disease and pulmonary embolism-rather than the tachycardia. Misinterpretation of the cause of tachycardia as well as the electrocardiographic findings may be responsible for adverse outcomes.

Adenosine↗
PubMed2000

Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial.

CONTEXT: Endotracheal intubation (ETI) is widely used for airway management of children in the out-of-hospital setting, despite a lack of controlled trials demonstrating a positive effect on survival or neurological outcome. OBJECTIVE: To compare the survival and neurological outcomes of pediatric patients treated with bag-valve-mask ventilation (BVM) with those of patients treated with BVM followed by ETI. DESIGN: Controlled clinical trial, in which patients were assigned to interventions by calendar day from March 15, 1994, through January 1, 1997. SETTING: Two large, urban, rapid-transport emergency medical services (EMS) systems. PARTICIPANTS: A total of 830 consecutive patients aged 12 years or younger or estimated to weigh less than 40 kg who required airway management; 820 were available for follow-up. INTERVENTIONS: Patients were assigned to receive either BVM (odd days; n = 410) or BVM followed by ETI (even days; n = 420). MAIN OUTCOME MEASURES: Survival to hospital discharge and neurological status at discharge from an acute care hospital compared by treatment group. RESULTS: There was no significant difference in survival between the BVM group (123/404 [30%]) and the ETI group (110/416 [26%]) (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.61-1.11) or in the rate of achieving a good neurological outcome (BVM, 92/404 [23%] vs ETI, 85/416 [20%]) (OR, 0.87; 95% CI, 0.62-1.22). CONCLUSION: These results indicate that the addition of out-of-hospital ETI to a paramedic scope of practice that already includes BVM did not improve survival or neurological outcome of pediatric patients treated in an urban EMS system.

Allied Health Personnel↗
PubMed2000

Design and implementation of a controlled trial of pediatric endotracheal intubation in the out-of-hospital setting.

This article describes the design and implementation of the Pediatric Airway Management Project. The project was completed January 1, 1997, and evaluated the effectiveness of endotracheal intubation relative to bag-valve-mask ventilation in improving survival to hospital discharge and neurologic outcome in children, the effect of training on paramedic airway management skills and self-efficacy, the length of time the skills can be retained, and the costs of training and retraining. The main focus of project design was the implementation of a controlled trial comparing methods of airway management for acutely ill and injured pediatric patients in the out-of-hospital setting. To date, this project is the largest prospective, controlled, out-of-hospital study of the care of children ever reported. Barriers to implementation of a study of this size are described.

Airway Obstruction↗
PubMed1995

Belowground carbon allocation in unfertilized and fertilized red pine plantations in northern Wisconsin.

We estimated carbon allocation to belowground processes in unfertilized and fertilized red pine (Pinus resinosa Ait.) plantations in northern Wisconsin to determine how soil fertility affects belowground allocation patterns. We used soil CO(2) efflux and litterfall measurements to estimate total belowground carbon allocation (root production and root respiration) by the carbon balance method, established root-free trenched plots to examine treatment effects on microbial respiration, estimated fine root production by sequential coring, and developed allometric equations to estimate coarse root production. Fine root production ranged from 150 to 284 g m(-2) year(-1) and was significantly lower for fertilized plots than for unfertilized plots. Coarse root production ranged from 60 to 90 g m(-2) year(-1) and was significantly lower for fertilized plots than for unfertilized plots. Annual soil CO(2) fluxes ranged from 331 to 541 g C m(-2) year(-1) and were significantly lower for fertilized plots than for unfertilized plots. Annual foliage litterfall ranged from 110 to 187 g C m(-2) year(-1) and was significantly greater for fertilized plots than for unfertilized plots. Total belowground carbon allocation ranged from 188 to 395 g C m(-2) year(-1) and was significantly lower for fertilized than for unfertilized plots. Annual soil CO(2) flux was lower for trenched plots than for untrenched plots but did not differ between fertilized and unfertilized trenched plots. Collectively, these independent estimates suggest that fertilization decreased the relative allocation of carbon belowground.

Journal Article↗
PubMed1992

Medical response to catastrophic events: California's planning and the Loma Prieta earthquake.

The threat of a great earthquake has compelled California to develop a disaster plan for catastrophic medical events that calls for local response with state-coordinated mutual aid and casualty evacuation, if necessary. During the 1989 Loma Prieta earthquake that killed 63 people and injured 3,700, local emergency medical services systems were busy but not stressed excessively. The medical mutual aid system delivered medical personnel, supplies, and blood. One hospital suffered severe nonstructural damage, but it was able to treat large numbers of casualties. Our system performed admirably in this limited response, but was hampered by difficulties with disaster intelligence, communications, emergency medical services dispatch, patient care records, hospital damage, and inadequate disaster training. We describe our state's mutual aid system, the Loma Prieta response, and lessons and recommendations for the future.

California↗
PubMed1990

Supraventricular tachyarrhythmias and rate-related hypotension: cardiovascular effects and efficacy of intravenous verapamil.

IV verapamil is the preferred drug for the acute management of supraventricular tachyarrhythmias (SVTs) in the absence of contraindications to its use. SVT complicated by hypotension has been considered a relative contraindication for the use of IV verapamil. However, the efficacy of IV verapamil in the management of "rate-related" hypotension has not been specifically addressed. The purpose of this study was to assess the effects of IV verapamil in patients with SVTs and arterial hypotension. A retrospective and prospective study design was used. Inclusion criteria were SVT (QRS duration, less than 120 ms; R-R interval, regular or irregular), QRS rate of 140 or more, systolic blood pressure of 90 mm Hg or less, and normal mental status. We identified 21 episodes of SVT meeting inclusion criteria in 19 patients. SVT was due to atrioventricular node re-entry in 17, atrial fibrillation in three, and atrial flutter in one. There were seven men and 12 women, with a mean age (+/- SD) of 52 +/- 17 years. Systolic blood pressure before verapamil was 70 +/- 28 mm Hg, and QRS rate was 192 +/- 19. IV calcium was not administered before IV verapamil. After IV verapamil administration (mean dose, 6.5 +/- 4.3 mg), a positive response (conversion to sinus rhythm or ventricular rate of less than 120) was noted in 17 of 21 episodes (80%). Post-treatment systolic blood pressure increased to 98 +/- 16 mm Hg (P less than .005 vs pretreatment), and ventricular response rate decreased to 112 +/- 39 (P less than .001 by two-tailed paired t test).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

HMOs and the use of 911.

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Emergency Medical Service Communication Systems↗
PubMed1989

EMT-D regulations.

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Allied Health Personnel↗
PubMed1988

Whiz-Bang or pure O2?

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Emergency Medical Services↗
PubMed1987

Manipulative detorsion: beware the twist that does not turn.

We report 3 cases in which the testicle was untwisted inadequately or torsion recurred soon after manipulative detorsion. While manipulative detorsion can decrease ischemia time an operation should follow as soon as possible to confirm detorsion, assure orchiopexy and prevent repetitive episodes.

Adolescent↗
PubMed1986

Incidence of "secondary drowning" after saltwater submersion.

Most authorities recommend admission of all near-drowning victims out of fear of "secondary drowning." Identifying victims at risk could promote vigorous evaluation and reduce unnecessary hospitalization. We prospectively studied 52 swimmers with symptoms of respiratory distress after submersion. Thirty-one (60%) were released on the beach, and none of 26 followed up by telephone sought medical care or exhibited symptoms of respiratory distress as many as five days later. Twenty-one patients (40%) were transported to a hospital for further evaluation. All who required admission displayed signs of respiratory distress within four hours. No patient developed "secondary drowning" after an asymptomatic interval, indicating that emergency department observation for four to six hours could effectively screen for those patients requiring inpatient therapy. We question the existence of "secondary drowning" as anything other than established, detectable respiratory insufficiency.

Adolescent↗
PubMed1986

A prehospital approach to multiple-victim incidents.

Although most prehospital systems have well-developed protocols for single-victim rescues and mass casualties, multiple-victim incidents falling between the two in scope have not been analyzed in detail. Forty-one audio tapes of incidents with four or more victims were evaluated for techniques and decisions that affected the runs' speed and efficiency. Common problems both in the field and at the base hospital were identified. Recommendations for management in the field and for paramedic and base station transmissions are given.

Disaster Planning↗
PubMed1985

Oleander tea: herbal draught of death.

A woman died after drinking herbal tea prepared from oleander (Nerium oleander) leaves. This case demonstrates the cross-reactivity between the cardiac glycosides in oleander and the digoxin radioimmunoassay. Digoxin-specific Fab antibody fragments have not been used in oleander poisoning, but these might prove to be lifesaving. Treatment of oleander toxicity is aimed at controlling arrhythmias and hyperkalemia; inactivation of the Na-K ATPase pump, however, can make treatment difficult.

Adult↗