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Biomedical subjects

B M Thompson

Publications and source records attributed to B M Thompson.

At least 37 records · Page 2Linked to original sources
PubMed1985

Effects of rapid infusion with high pressure and large-bore i.v. tubing on red blood cell lysis and warming.

A prototype large-bore intravenous tubing was developed and tested. Mean flow rates for blood (Hct 45%) and tap water were determined for several catheters at 600 mm Hg, 300 mm Hg, and gravity flow and were statistically analyzed by calculating the 95% confidence intervals. The degree of hemolysis during high pressure and flow was determined by measuring the plasma free hemoglobin using the spectrophotometric method. To determine if cold banked blood can be adequately warmed at high flow rates, thermocouples were used to measure the blood temperature before and after rapid infusion through a blood warmer. Results included maximum flow rates of 1,764 mL/min for tap water, and 1,714 mL/min for blood (Hct 45%) at 600 mm Hg through the large-bore tubing and an 8.5-F catheter. Flow rates for other pressure and catheter combinations were tabulated. The plasma-free hemoglobin increased slightly compared to controls with high pressure (less than or equal to 600 mm Hg) and flow rates. The increase correlated with less than 1% red blood cell lysis in all trials. When 13 C blood was infused through a warmer, blood temperature increased to 25.3 C at the maximum flow rate of 732 mL/min. Slightly higher heat gain resulted with slower infusion rates. We conclude that the prototype large-bore tubing and up to 600 mm Hg pressure provide rapid flow rates without significant hemolysis. Blood warming may be inadequate at higher flow rates.

Blood↗
PubMed1985

Intraosseous infusion: an alternative route of pediatric intravascular access.

Substantial difficulties can be encountered when establishing rapid intravascular access in critically ill children. The historic technique of tibial intraosseous infusion is presented as an alternate intravenous route in children less than 3 years old. Review of the literature reveals this technique to be a rapid, reliable method with an acceptably low complication rate. Substances absorbed through the marrow, flow rates, technical difficulties, and complications are discussed.

Absorption↗
PubMed1985

Traumatic cardiac arrest: scope of paramedic services.

The challenge of the 1960s to ambulance care provision was the stimulus for the emergence of prehospital advanced life support (ALS) being provided by paramedic personnel. While services for cardiac disease have been accepted, paramedic activities for the trauma victim continue to be a concern for many trauma surgeons. The capability and success rate of treatment, and the time spent at the scene and during transport to the hospital have raised questions about the overall need for paramedic services. Our study period was from January 1, 1981, to December 31, 1982, and it covered 95 clinically dead trauma victims who were first seen and subsequently treated by paramedics working in a medically controlled emergency medical services system. Endotracheal intubation was successful in 81 of the patients (85%). Esophageal obturator airway use was viewed as unsuccessful intubation. Intravenous (IV) access utilizing 16-gauge angiocaths was placed successfully by a peripheral or jugular vein in 70 patients (74%). Thirty-three patients averaged 860 mL volume infusion (30 to 3,000 mL). Average scene time was 22 minutes. Scene time of patients with unsuccessful IV and endotracheal intubation was 14 minutes (P = .07). Fourteen patients (14.7%) were admitted to the operating room or intensive care unit. Only three of the study group (3.2%) survived.

Adolescent↗
PubMed1984

Cardiorespiratory arrest and resuscitation of children.

Ninety-one patients had cardiorespiratory arrest in a children's hospital emergency department over six years. Only five children survived, three with severe neurologic sequelae. The records of 40 other children in the same community resuscitated by paramedics, but taken to other hospitals, were reviewed and there were three survivors. The causes and outcomes of resuscitation of children are clearly different from those of adults. Cardiac disease and ventricular arrhythmias are uncommon. Neurologically intact survival was seen only in those children who received immediate resuscitation and responded promptly. Research in cerebral resuscitation at the cellular level is promising for the future. Prevention of some cardiorespiratory arrests through accident prevention and earlier recognition of serious infections is possible now.

Brain Diseases↗
PubMed1984

The relationship of the level of training and area of medical specialization with registrant performance in an advanced trauma life-support course.

Approved advanced trauma life-support (ATLS) programs were given to 160 residents and practitioners of various specialties, utilizing a standardized 50-item, multiple-choice posttest. Level of training (practitioner v resident) and area of medical specialization with registrant performance on total score and in specific subcontent areas of ATLS were evaluated by subjecting total and subcontent percent scores to a two-way analysis of variance and Newman-Keuls pairwise comparisons. Practitioners outperformed the residents in the subcontent area of abdominal injuries, P less than .05. In specialization, emergency medicine outperformed internal medicine specialists, P less than .05. Pairwise differences among specialists were not statistically significant. In airway problems, surgeons and internists were outperformed by emergency medicine, whereas in burns, emergency medicine and family practitioners significantly outperformed the surgeons. Emergency medicine outperformed internal medicine, P less than .05, in subcontent area of extremity injuries. We conclude that registrants are likely to benefit from an ATLS course, but preliminary evidence would seem to justify some "tailoring" of the ATLS curriculum for different registrant specialty groups.

Curriculum↗
PubMed1984

Bystander CPR in prehospital coarse ventricular fibrillation.

Prehospital bystander cardiopulmonary resuscitation (CPR) was studied to determine if it affected the outcome of defibrillation. Four hundred twenty-one consecutive witnessed cardiopulmonary arrests presenting with the initial rhythm of coarse ventricular fibrillation treated by the Milwaukee County Paramedic System from January 1980 to June 1982 were analyzed. Pediatric, trauma, and poisoning patients and those receiving intravenous or endotracheal medications before defibrillation (58) were excluded. Immediate professional bystander CPR (physician, nurse, EMT) and citizen bystander CPR were compared to a control group receiving no bystander CPR until arrival of EMS personnel. A successful defibrillation occurred if defibrillation prior to administration of medication produced an effective cardiac rhythm with pulses. Eighty-eight of the 363 remaining patients (24%) converted with initial defibrillations. While the group receiving professional bystander CPR had a higher successful defibrillation rate than did the no-CPR group (35% vs 22%, P less than .04), citizen bystander CPR and no-CPR groups had similar successful defibrillation rates (24% vs 22%, no significant difference). One hundred eighty-six of the 363 patients (51%) were transported to a hospital with a rhythm and a pulse (a successful resuscitation). Ninety-seven of the 363 patients (27%) were discharged alive from the hospital (a save). Patients who were converted successfully using initial "quick-look" defibrillations were far more likely to be successfully resuscitated (79/88 [90%] vs 107/275 [39%], P greater than .0001) and to be discharged alive from the hospital (54/88 [61%] vs 43/275 [16%], P greater than .0001) than were those who required further advanced cardiac life support techniques.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

"PALS for life!" A required trauma-oriented pediatric advanced life support course for pediatric and emergency medicine housestaff.

While advanced cardiac life support (ACLS) and advanced trauma life support (ATLS) courses have become accepted standards for physicians who care for the critically ill and injured patient, only recently have pediatric advanced life support (PALS) courses been developed. The American Academy of Pediatrics has shown renewed interest in pediatric cardiopulmonary arrest after impressive gains made in adult resuscitation. The American Heart Association filled a void by including new chapters on Pediatric and Neonatal Resuscitation in the Textbook of Advanced Cardiac Life Support, 1981. A joint committee of AHA and AAP is seeking to unify course objectives and materials for standard curriculum. Because trauma is the most common cause of death and disability in children, pediatric trauma life support measures should be incorporated into any program directed toward emergency physicians and pediatricians who function in an emergency department or rural primary care setting. The Department of Pediatrics and Surgery and its division of Emergency Medicine has developed and implemented a PALS curriculum which is different from most other programs in that emphasis has been placed on pediatric trauma in addition to traditional cardiac (ACLS) resuscitation. This 20-hour program combines a modified ACLS curriculum with specific pediatric trauma lectures and laboratory sessions. It includes a canine surgical procedure lab and modified ATLS skill stations. At the completion of the course, students are eligible for ACLS certification. In the two years in which the course was given, 39 pediatric houseofficers were enrolled in the course.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1984

Experimental cervical spine injury model: evaluation of airway management and splinting techniques.

We evaluated airway management maneuvers and the effects of cervical splinting on a model of an injured spinal column. X-ray films of a fresh cadaver verified a normal cervical spine. C5-C6 instability was created surgically and documented radiologically with flexion and extension maneuvers. Basic and advanced airway techniques were performed and were documented radiologically. The procedures were then repeated using different types of splinting. Chin lift, jaw thrust, esophageal obturator airway (EOA), and endotracheal intubation can cause extension, widening, and/or anterior subluxation. A two-piece, semirigid soft cervical collar may minimize flexion but not extension of the spine. With the Velcro in back, soft collars minimize flexion; with Velcro in front, they minimize extension. Standard nonsurgical airway management techniques appear to aggravate preexisting injuries. The soft collar and semirigid collar do little to prevent movement, and their presence may serve only as a warning to physicians that a neck injury may be present.

Cervical Vertebrae↗
PubMed1984

Effect of circumferential pneumatic compression devices on digital flow.

We reviewed the effects of circumferential pneumatic compression suits (CPCS) when applied to normal and ischemic limbs without prior application of prehospital orthopedic traction devices beneath the garment. The digital arterial toe pressures of 11 normal and six claudicating limbs were measured with the trouser applied and the limbs pressurized to 40, 60, 80, and 100 mm Hg. In addition, normal limbs had the Hare traction device and the Sager splint applied prior to application of the trouser and retesting of the digital arterial flow. We conclude that CPCS prevents flow into the limbs, and this may potentiate the development of compartment syndromes in the previously traumatized or ischemic limbs. Normal limbs with traction devices already applied may be at a higher risk for compartment syndromes, and we suggest that patients with fractured limbs who are in need of CPCS not have the traction device applied.

Blood Pressure↗
PubMed1984

Interposed abdominal compression CPR versus standard CPR in prehospital cardiopulmonary arrest: preliminary results.

Recent studies evaluating interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) have demonstrated a significant increase in cardiac output, mean arterial pressure, and cerebral perfusion compared with standard CPR. A clinical evaluation of IAC-CPR effectiveness on resuscitation outcome has not been reported. A prospective, randomized study comparing IAC-CPR with standard CPR for resuscitation of prehospital cardiopulmonary arrest was developed utilizing the Milwaukee County Paramedic System. When the paramedics arrive, standard CPR is initiated or continued, and countershocks are delivered when appropriate. The patients are randomized into IAC-CPR and standard CPR groups immediately following endotracheal intubation. Abdominal compression force is standardized to 100 mm Hg +/- 20 mm Hg by using a simple airfilled bladder and gauge to monitor each compression. Resuscitations are conducted according to standard advanced cardiac life support guidelines through continuous radio-telemetry contact with a base physician. Since October 1983, 140 patients have qualified for the study group. Seventy patients had standard CPR and 30% (21/70) were admitted to the emergency department with a rhythm and pulse, as were 34% (24/70) of the patients treated with IAC-CPR. The difference between study groups was not significant. To determine if abdominal compression increases regurgitation, the frequency of emesis before and after intubation was analyzed. No significant difference was found between the IAC-CPR and standard CPR groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1984

The precordial thump.

The American Heart Association (AHA) currently recommends the precordial thump as the initial maneuver in treatment of ventricular tachycardia (VT) and monitored ventricular fibrillation (VF). These recommendations are based largely on anecdotal reports of successful "thump-version" of asystole, VF, and VT. The Milwaukee County Paramedic System follows the AHA guidelines in the treatment of VT and VF. The precordial thump is included in the advanced cardiac life support (ACLS) paramedic training program, and has been used in our approach to the pulseless, nonbreathing patient. During an eight-month period, 50 pulseless, nonbreathing patients received precordial thumps during ACLS resuscitative attempts. Twenty-seven patients who developed monitored VT and 23 patients with monitored VF were thumped. Three of 27 patients (11%) with VT were thumped into a supraventricular rhythm, 12 of 27 patients (44%) remained in VT, and 12 of 27 patients were thumped from VT into more malignant rhythms: three, into asystole; eight, into VF; and one, into an idioventricular/electromechanical dissociation rhythm. A total of 23 patients were thumped without effect. Subsequently, using countershock and medications, 12 of these 23 patients were successfully resuscitated. In the prehospital setting the precordial thump is usually not beneficial, and may be detrimental. Thus its use as the initial maneuver in treating the cardiac arrest patient with VT or VF in this setting cannot be supported. The presence of acidosis and hypoxia may explain why prehospital precordial thump responses differ from those seen in the hospital environment.

Adult↗
PubMed1984

A randomized comparison study of bretylium tosylate and lidocaine in resuscitation of patients from out-of-hospital ventricular fibrillation in a paramedic system.

A prospective, randomized study using either bretylium tosylate (BT) or lidocaine (L) as the first-line antiarrhythmic for patients in refractory ventricular fibrillation was conducted using the Milwaukee County Paramedic System. If the patient did not respond to the initial American Heart Association protocol, BT (10 to 30 mg/kg total) or L (2 to 3 mg/kg total) was given randomly as the first antiarrhythmic. If the patient failed to convert, the alternate antiarrhythmic was given. In the L group, 81% (39/48) of the patients obtained an organized electrical rhythm and 56% (27/48) converted to a rhythm with a pulse. The resuscitation rate (admission to an emergency department with pulse) was 23% (11/48), and the save rate was 10.4% (5/48). In the BT group, 74% (32/43) obtained an organized electrical rhythm, 35% (15/43) were converted, 23% (10/43) were resuscitated, and 5% (2/43) were saved. The only significant difference in outcome was that L converted patients better than did BT (P less than .05). Of the 24 patients known to be on digitalis preparations prior to arrest, 41% (5/12) in the L group were resuscitated and 16% (2/12) were resuscitated in the BT group. Data were analyzed for witnessed arrest outcome and for patients given multiple antiarrhythmics.

Aged↗
PubMed1984

Atropine in asystole: human studies.

Current research supporting the use of atropine for asystole is limited. Reported in the literature are the cases of 26 patients who presented with a rhythm of asystole. Of these, only eight were clearly in refractory asystole after epinephrine and sodium bicarbonate, only seven were prehospital patients, and only two were delineated as being intubated. Despite such limited data, atropine has been advocated for asystole, and use of the drug is included in the recommendations of the American Heart Association. We undertook a retrospective review of our prehospital experience with refractory asystole for a four-year period from January 1979 to December 1982. All patients with trauma or poisoning and all pediatric arrests were excluded. All patients who received calcium chloride during resuscitation also were excluded. One hundred seventy patients presented in cardiorespiratory arrest with an initial rhythm of asystole. Of these, 84 remained in refractory asystole after receiving epinephrine and sodium bicarbonate. Forty-three patients in this group received atropine. The successful resuscitation rate in the atropine group was 14% (6/43), while in the control group it was 0% (0/41) (P less than .04). A successful resuscitation was defined as conveyance of a patient with a rhythm and a pulse to an emergency department. Patients were compared for age, sex, witnessing of arrest, cardiac history, and cardiac drugs. No other significant differences were noted between groups. No patient who received atropine for refractory asystole was discharged alive.

Arrhythmias, Cardiac↗
PubMed1984

Calcium chloride: reassessment of use in asystole.

Calcium chloride has been advocated since the 1920s for resuscitation of asystole and ventricular fibrillation. Most reports have been anecdotal, and have failed to substantiate its effectiveness. In two large retrospective series with a collective experience of 181 patients, investigators reviewed the effectiveness of calcium chloride in asystole and did not support its use. A prospective, randomized, double-blind study comparing calcium chloride with saline in the prehospital setting was done. Patients with trauma or pediatric arrests were excluded. During the period from October 1982 to October 1983, a total of 32 patients with witnessed arrests presented with a rhythm of asystole and were refractory to epinephrine, bicarbonate, and atropine. The rate of successful resuscitation in the calcium group was 5.6% (1/18), and there were no successful resuscitations (0/14) in the saline group (P = .37). A successful resuscitation was defined as conveyance of a patient with a rhythm and pulse to an emergency department. Groups were analyzed for sex, age, cardiac history, and cardiac drugs, and there were no statistically significant differences. No patient who was successfully resuscitated in the field was discharged alive from the hospital. Calcium chloride is of no value in resuscitating refractory asystole in the prehospital cardiac arrest setting.

Arrhythmias, Cardiac↗
PubMed1984

Immediate countershock treatment of asystole.

While rapid intervention with basic cardiac life support and prompt delivery of prehospital care using advanced cardiac life support (ACLS) have yielded impressive results in the resuscitation of other arrest rhythms, very little improvement has been shown in the rates of resuscitation from asystole. Anecdotal reports list instances in which patients in asystole have had normal cardiac activity restored after defibrillation. Current ACLS protocols for initial evaluation recommend a single-lead "quick-look" interpretation of cardiac rhythm using portable defibrillator paddles. Under these conditions, ventricular fibrillation could masquerade as, or be misinterpreted as, asystole. We report preliminary field results in a medically controlled paramedic system using "quick-look" interpretation and immediate defibrillation of "asystole" by well-trained paramedics. Following initial countershock, standard ACLS protocols for asystole were used. For an eight-month period 119 patients were entered into the study and compared to system controls of asystolic patients presenting in the previous year. While ten patients (8.4%) showed an immediate rhythm change after initial countershock and six of ten reached the hospital with a rhythm and a pulse, no statistically significant comparison could be made regarding improved resuscitation or survival rates. The finding of no statistically significant deterioration of resuscitation or survival rates, however, justifies the continuation of the study.

Arrhythmias, Cardiac↗
PubMed1984

The effect of tensional load on isolated embryonic chick tendons in organ culture.

Digital flexor tendons isolated from 17-18 day embryonic chickens were cultured intact, either on steel mesh grids, or in an apparatus designed to apply a mechanical load to the tissue. Tendons cultured without an applied load continued to synthesize protein and glycosaminoglycans throughout a 7-day period, but DNA synthesis decreased during this time. Increases in both protein and DNA synthesis were observed in tendons experimentally loaded for 48-72 h. Glycosaminoglycan production by tendons isolated from 17-day embryos was also increased in loaded tendons, sulfated GAG being increased more than hyaluronic acid. The same loading regime applied to tendons from 18-day embryos produced a smaller, yet significant increase in sulfated glycosaminoglycans but hyaluronate production was reduced. These investigations demonstrate that embryonic chicken tendons can be maintained in a viable state in organ culture and may provide a useful model for studies of the effects of mechanical forces on the synthetic capability and structure of connective tissue cells.

Animals↗
PubMed1983

Supradiaphragmatic accessory lobe of the liver in BB Wistar rats.

Supradiaphragmatic accessory livers were observed in two closely related rats in a series of 172 necropsies on BB Wistar rats. The gross and histological appearance of both accessory lobes are described. This abnormality has been reported in only one other inbred strain of rats where it also arose with a very low incidence. As in the previous report, the pattern of occurrence of these accessory lobes suggests a mode of inheritance that is either polygenic or autosomal recessive with low penetrance.

Animals↗