Biomedical subjects

Bruce D Adams

Publications and source records attributed to Bruce D Adams.

7 recordsLinked to original sources

PubMed2005

Cardiac arrest of nonpatients within hospital public areas.

Time to defibrillation is the most important controllable factor for survival. Hospitals also must respond to cardiac arrest in nonpatients (i.e., visitors and staff members) within their public areas. In-hospital cardiac arrest teams may be unaccustomed to resuscitating visitors under what is essentially a prehospital environment. All cardiorespiratory arrests over a 2-year period at the investigators' institution were reviewed. Six of the 749 in-hospital cardiorespiratory arrests (0.8%) occurred in visitors within public areas of the hospital. The average time to defibrillation for the public area cohort was significantly longer than for the in-hospital arrest control group (12.3 vs 2.5 minutes, p <0.0001). Further research is needed to reduce the time to defibrillation and consequently improve survival outcomes for cardiac arrest in hospital public areas.

Electric Countershock↗

PubMed2005

Decreasing the time to defibrillation: a comparative study of defibrillator electrode designs.

INTRODUCTION: Time to defibrillation (T(defib)) is the most important modifiable factor affecting survival from cardiac arrest. Mortality increases by approximately 7--10% for each minute of defibrillation delay. The purpose of this study was to determine whether defibrillator electrode design complexity affects T(defib). METHODS: This was a randomized sequential design study utilizing a standardized ventricular fibrillation cardiac arrest model for CPR mannequins. We evaluated two common types of defibrillator electrode models: a single connector design and a double connector design that requires an adaptor. We compared the time required by cardiac arrest team leaders to apply the two types of defibrillator electrodes to a manikin, connect them to a defibrillator, and then deliver a first defibrillatory shock. The primary outcome was time to defibrillation. The secondary outcome was difficulty of application as perceived by the physician participants on a 10 cm visual analog scale. RESULTS: Thirty-two residents performed a sequential assessment of both electrodes. The average T(defib) for the double connector model was 42.9s longer than that of the single connector model (87.5s versus 44.6s, p<0.001). As evaluated by the study participants, the single connector model was significantly easier to apply then the double connector model (1.3 cm versus 4.4 cm, p<0.001). CONCLUSION: The single connector defibrillator electrode design was associated with a significantly shorter T(defib) than the double connector design. It also was judged to be easier to apply in this model. Ergonomic design of defibrillator electrodes can significantly impact time to defibrillation.

Defibrillators↗

PubMed2005

Emergency medicine residents effectively direct inhospital cardiac arrest teams.

STUDY OBJECTIVE: We compared 2 models of physician leadership for inhospital cardiac arrest teams (CATs): emergency medicine (EM) residents and staff hospitalist physicians. METHODS: A before-after study was conducted on all adult inhospital CAT activations over a 2-year period. The primary outcome was return of spontaneous circulation (ROSC). RESULTS: There were 749 total code blues during the 2-year study period. Ninety-one were excluded by protocol. EM residents directed 288 codes, hospitalists directed 248 codes, and other specialties directed the remaining 62. There was no statistically significant difference in percent ROSC or survival to hospital discharge. EM residents responded first for 59.2% of the codes compared with a first response rate of 28% for hospitalists (P<.05). Time to achieve ROSC was quicker in the EM resident cohort. CONCLUSION: Our findings validate the use of a 24-hour EM resident staffing model for CAT response to inhospital cardiac arrests.

Aged↗

PubMed2004

"Utstein style" spreadsheet and database programs based on Microsoft Excel and Microsoft Access software for CPR data management of in-hospital resuscitation.

In 1997, The American Heart Association in association with representatives of the International Committee on Resuscitation (ILCOR) published recommended guidelines for reviewing, reporting and conducting in-hospital cardiopulmonary resuscitation (CPR) outcomes using the "Utstein style". Using these guidelines, we developed two Microsoft Office based database management programs that may be useful to the resuscitation community. We developed a user-friendly spreadsheet based on MS Office Excel. The user enters patient variables such as name, age, and diagnosis. Then, event resuscitation variables such as time of collapse and CPR team arrival are entered from a "code flow sheet". Finally, outcome variables such as patient condition at different time points are recorded. The program then makes automatic calculations of average response times, survival rates and other important outcome measurements. Also using the Utstein style, we developed a database program based on MS Office Access. To promote free public access to these programs, we established at a website. These programs will help hospitals track, analyze, and present their CPR outcomes data. Clinical CPR researchers might also find the programs useful because they are easily modified and have statistical functions.

Cardiopulmonary Resuscitation↗

PubMed2004

Tenecteplase and return of spontaneous circulation after refractory cardiopulmonary arrest.

Even with the benefit of cardiopulmonary resuscitation, the prognosis of cardiac arrest remains poor. Multiple case series describe survival with the use of thrombolytic therapy for refractory cardiac arrest. Presumably thrombolysis treats that subset of cardiac arrest cases resulting from fulminant pulmonary embolism, or perhaps massive myocardial infarctions. Published reports to date have dealt exclusively with streptokinase, urokinase, reteplase, or recombinant tissue plasminogen activator. The authors report the first case of return of spontaneous circulation with the administration of tenecteplase. Tenecteplase is a recently developed reengineered isomer of tissue plasminogen activator that possesses many properties of the ideal cardiac arrest thrombolytic agent. It is bolus dosed, stable at room temperature before reconstitution, and is compatible with most other advanced cardiac life support medications. Because of clinical equivalency and its logistical advantages, tenecteplase should be evaluated as an alternative to other thrombolytics in future trials involving cardiac arrest.

Aged↗

PubMed2004

Geriatric all-terrain vehicle trauma.

More than 300 all-terrain vehicle (ATV) trauma deaths occur annually. Most experience to date focuses on the pediatric trauma. However, senior citizens constitute the fastest growing segment of ATV enthusiasts. We queried our trauma registry from January 1988 to December 2002 and found 200 total ATV accidents. There were 8 patients over age 60. We compared geriatric and nongeriatric riders for presentation and outcome data. The anatomic distribution of injury was similar. Younger patients were more likely to have used ethanol or drugs. Tachypnea and hypotension were generally absent at presentation. The geriatric patients had worse predictive physiologic scores. Clinical outcomes for the geriatric group trended toward longer hospital stays, and they had significantly worse functional outcomes. The geriatric group nonsignificantly trended toward a higher mortality (12.5% vs 3.45%). Our study reflects the recent national trend toward a dramatic rise in geriatric ATV-related trauma. We recommend that geriatric ATV safety programs be instituted.

Accidents, Traffic↗

PubMed2002

Bystander cricothyroidotomy performed with an improvised airway.

OBJECTIVE: We report a roadside cricothyroidotomy successfully performed with only a pocketknife and the drinking straw from a sports bottle. Our study compared the adequacy of standard medical airway devices with some readily available nonmedical items that might be used as temporary tracheostomy tubes (TT). METHODS: We compared the airway resistances (Raw) of two standard cricothyroidotomy airway devices against the barrel from a ballpoint pen and two sports bottle straws. RESULTS: There was no statistically significant difference in Raw between the straws and standard airway devices. However, the pen barrel had much higher Raw. CONCLUSION: This is the first study to compare available nonmedical items that might be used as temporary TTs for bystander cricothyroidotomy. Two types of straws found on sports bottles had relatively low Raw compared with standard TTs. However, the barrel from a ballpoint pen had a much higher Raw and is an unacceptable choice.

Analysis of Variance↗