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C Chipman

Publications and source records attributed to C Chipman.

8 recordsLinked to original sources

Before the shift.

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Adaptation, Psychological↗

Early management of cervical spine injuries.

At the scene of an accident with possible injury to the cervical spine, management should focus on life support and prevention of further injury. On arrival of the patient in the emergency department, three standard x-ray films should be obtained in search of the abnormalities in soft tissues, alignment, and joints that indicate cervical spine injury and a thorough neurologic assessment should be performed. The potential of cord injuries to deteriorate makes careful monitoring of blood gases, urine output, and blood pressure imperative during this period. Early therapy with steroids and mannitol seems to minimize neurologic deterioration.

Adolescent↗

Criteria for cessation of CPR in the emergency department.

Specific criteria have been proposed for the cessation of cardiopulmonary resuscitation (CPR) in the emergency department. Using these criteria and others, we developed a survey which was completed by 78 physicians practicing emergency medicine. The physicians surveyed did not make decisions to cease CPR that were consistent with any such criteria which might guide them in clinical decision making. In this survey, the type of residency training, the size of city in which the physician practiced, and the number of years an individual had practiced emergency medicine significantly correlated with how he made the decision to cease CPR. Based on a review of the current literature, and due to the fact that considerable and variable ethical and psychological factors weigh in each clinical circumstance, the authors recommend that no criteria be followed for ceasing CPR.

Adult↗

Intraoperative recording of specialized atrioventricular conduction tissue electrograms in 47 patients.

Intraoperative mapping of the specialized atrioventricular conduction system was performed in 47 patients during cardiac surgery. Specialized conduction tissue electrograms were identified in 37, and atrioventricular conduction preserved in 92%. Specialized conduction tissue was identified in 27 patients with atrioventricular canal defect: complete heart block was avoided in 25. Conduction tissue was located in six of 12 patients with complex transpositions; atrioventricular conduction was preserved in all six. Other lesions in which the technique was useful were Ebstein's anomaly and single atrium. Limitations to the technique are 1) deep hypothermia and circulatory arrest; 2) interruption in atrioventricular conduction during mapping; 3) inadequate exposure and access to probable sites of conduction tissue; 4) variation of size and spatial relations of individual malformations; and 5) limited time for identification of unusually located conduction tissue. Indications for use of this technique include patients with both forms of atrioventricular canal, complex transpositions, atrioventricular discordance, single ventricle and single atrium.

Adolescent↗