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C L Emerman

Publications and source records attributed to C L Emerman.

66 records · Page 4Linked to original sources
PubMed1988

A comparison of venous blood gases during cardiac arrest.

Previous reports have advocated the use of mixed venous blood gases to estimate arterial pH and as a reflection of tissue acid-based balance. However, true mixed venous samples are difficult to obtain during cardiac arrest as they require a pulmonary artery catheter. The purpose of this study was to determine whether central or femoral venous samples could be used in place of pulmonary artery samples. Blood gases from these sites were drawn at intervals during experimental cardiac arrest in dogs. The PO2, PCO2, and pH from the pulmonary artery samples were strongly correlated with those from the central venous (r = .93, .99, and .99, respectively) and from the femoral venous samples (r = .73, .93, and .97, respectively). There were no significant differences in the pulmonary artery, central, or femoral venous gases. This animal model suggests that femoral and central venous samples mirror true mixed venous blood gases from the pulmonary artery and could be used in their place.

Animals↗
PubMed1988

Effect of injection site on circulation times during cardiac arrest.

Cardiopulmonary resuscitation requires effective, prompt drug administration. In order to analyze Advanced Cardiac Life Support (ACLS) recommendations for site of drug administration, we studied dye circulation times after central, femoral, and peripheral venous injection during both closed and open chest CPR using a canine arrest model. Measurements of circulation times were made after injection of indocyanine green dye at femoral, central, and peripheral venous sites. Circulation times during closed chest CPR were 62.7 +/- 19.6 sec after central injection, 86.6 +/- 23.5 sec after femoral injection, and 93.6 +/- 17.9 sec after peripheral injection (p less than .001). During closed chest CPR, peak dye concentration after central injection was significantly higher than that after peripheral injection (4.0 +/- 1.3 vs. 3.1 +/- 0.8 mg/L, p less than .01). Circulation times were significantly shorter during open chest CPR with times again shortest after central injection. This animal model suggests that prompt drug delivery during CPR is enhanced by central venous injection of medication. There appears to be no advantage in femoral over peripheral injection.

Animals↗
PubMed1987

Level of consciousness as a predictor of complications following tricyclic overdose.

In order to determine whether patients at low risk for complications following tricyclic antidepressant (TCA) overdose can be identified, we analyzed the records of all admissions for TCA overdose from 1975 to 1985. Of the 92 patients reviewed, 37 had serious complications including hypoventilation, loss of protective airway reflexes, seizures, hypotension, hemodynamically significant arrhythmias, or death. Patients with complications had increased heart rate, depressed level of consciousness, depressed Glasgow Coma Scale, and prolonged QRS interval, as compared to patients without complications. All 37 patients with serious complications required intubation in the emergency department. A Glasgow Coma Scale of less than 8 was the most sensitive predictor of serious complications (sensitivity = .86; specificity = .89). This was significantly better than the QRS interval (QRS greater than or equal to 100 msec; sensitivity = 59; specificity = .76). We conclude that level of consciousness is a better predictor of risk of complications and need for ICU admission than the QRS interval. Patients who are responsive to verbal stimuli on leaving the ED are at very low risk of developing complications.

Adolescent↗
PubMed1986

Ventricular arrhythmias during treatment for acute asthma.

A double-blind, randomized study was performed to determine the occurrence of ventricular arrhythmias in acute asthma patients treated with epinephrine, aminophylline, or both in combination. Sixty patients were studied with Holter monitoring during the 90-minute study period. There was no statistical difference among the study groups in frequency or grade of ventricular arrhythmia. Combination treatment of acute asthma with these drugs is as safe as treatment with either alone.

Adult↗
PubMed1984

Verapamil in the treatment of asystolic and pulseless idioventricular rhythm cardiopulmonary arrests: a preliminary report.

A randomized, double-blinded study was conducted to evaluate the effectiveness of the calcium antagonist verapamil in patients in cardiopulmonary arrest with asystole or pulseless idioventricular rhythm (PIVR). Twenty-one such patients presenting to the emergency department received either verapamil (10 mg) or normal saline placebo in an intravenous bolus as initial therapy. They were then treated according to standard American Heart Association guidelines with the exception that calcium was not used. If these rhythms persisted after ten minutes, a second bolus of verapamil or saline was given. Resuscitation was successful in two of ten patients (20%) receiving verapamil and in one of 11 patients (9%) receiving placebo. This similar outcome (P = .462) in this small series suggests that verapamil may not add to successful resuscitation in these patients. Additional studies are needed to define the role of calcium and its antagonists in the treatment of asystole and PIVR.

Aged↗
PubMed1983

Theophylline concentrations in the emergency treatment of acute bronchial asthma.

Ninety-three patients presenting with acute asthma to the emergency department were studied to determine theophylline levels and their relationship to airway obstruction, history of prior medication use, and side effects of treatment. The mean pretreatment theophylline level was 6.4 micrograms/ml. Patients on long-acting preparations had significantly higher levels than those on short-acting medications (p less than 0.05). The mean post-treatment theophylline level was 16.7 micrograms/ml. Twenty-three patients had toxic levels post-treatment but none of these had a major adverse reaction. Twenty of these patients had been taking long-acting preparations. Fifty percent of the patients with symptoms of gastrointestinal toxicity had theophylline levels below 15 micrograms/ml. There was no correlation between the theophylline level or change in level and the degree of airway obstruction as measured by pulmonary function testing. Clinical findings are not reliable predictors of theophylline levels. Patients taking long-acting theophylline products should receive a lowered loading dose.

Acute Disease↗
PubMedDate not supplied

Successful use of nasal BiPAP in three patients previously requiring intubation and mechanical ventilation.

Noninvasive mask ventilation may be used to treat patients with impending respiratory failure. In this case series, three patients with severe chronic obstructive pulmonary disease, who required mechanical ventilation in the past, were successfully treated with nasal bi-level positive airway pressure (BiPAP). All patients tolerated BiPAP well without complications. Therefore, nasal BiPAP may be considered a treatment option for patients with severe COPD who have previously required intubation and mechanical ventilation.

APACHE↗
PubMedDate not supplied

A pilot study of steroid therapy after emergency department treatment of acute asthma: is a taper needed?

The purpose of this study was to determine if there is a difference in early relapse rates between patients receiving an 8-day course of 40 mg/day prednisone and those receiving an 8-day tapering course of prednisone. Furthermore, we wished to determine if one regimen is superior to the other for minimizing adrenal suppression. This was a prospective, randomized, double blind clinical trial conducted in an urban, university-affiliated Level 1 trauma center. All asthmatic patients with exacerbation who were judged well enough for discharge home from the emergency department (ED) were eligible for participation. Patients with a history of chronic obstructive pulmonary disease, congestive heart failure, pneumonia, pneumothorax, or other pulmonary process, and asthmatics already using inhaled or oral steroids within 2 weeks of admission to the ED were excluded. Before treatment, a cosyntropin stimulation test was administered to all asthmatics admitted to the ED. All patients treated in the ED then received three doses of aerosolized albuterol, 60 mg of i.v. methylprednisolone, and oxygen. FEV1 was measured before treatment, after each treatment, and 1 h after the third aerosol administration. Patients were then sent home with either an 8-day course of 40 mg/day prednisone or an 8-day tapering course of prednisone (tapering from 40 mg to 0 mg). Patients were asked to return on day 12 for another cosyntropin stimulation test and pulmonary function testing and on day 21 for pulmonary function testing only. Fifteen patients participated: seven received a nontapering dose of prednisone and eight received a tapering dose of prednisone. There were no differences in the FEV1 percent predicted, the incidence of relapse, or the incidence of adrenal suppression between the two groups. In our small study, we found no difference in relapse rate between asthmatics receiving an 8-day tapering dose of prednisone and those receiving 40 mg/day prednisone upon discharge from the ED. Furthermore, no patients had evidence of adrenal suppression from either dosing regimen.

Acute Disease↗
PubMedDate not supplied

Bioimpedance monitoring: better than chest x-ray for predicting abnormal pulmonary fluid?

Bioimpedance monitoring may aid in treating heart failure. Mean thoracic electrical impedance (Zo) is inversely proportional to thoracic fluid volume and may offer greater sensitivity for detecting thoracic fluid. OBJECTIVE. Compare bioimpedance monitoring thoracic fluid detection to that of chest x-ray. METHOD. Prospective convenience sample. SETTING. 1000 bed teaching hospital. PARTICIPANTS. Patients with suspected heart failure and shortness of breath. A single blinded radiologist interpreted chest x-rays as: normal, cardiomegaly, or abnormal pulmonary fluid. STATISTICS. General linear model with post hoc Bon Ferroni pairwise comparisons. RESULTS. 131 patients, mean age 66.8 years, 64.3% male, with an initial mean Zo=18 ohms. There was a significant difference (p<0.0002) between patients with cardiomegaly (Zo=17.5+/-5.5) or abnormal pulmonary fluid on chest x-ray (Zo=17.2+/-4.2) compared to normals (Zo=23.4+/-5.4). There was no difference between cardiomegaly and abnormal pulmonary fluid patients. CONCLUSION. Bioimpedance measurement may detect pulmonary fluid not apparent on chest radiograph. (c)2000 by CHF, Inc.

Journal Article↗
PubMedDate not supplied

Stress levels in EMS personnel: a longitudinal study with work-schedule modification.

OBJECTIVE: To determine if stress levels of emergency medical services (EMS) personnel can be reduced by adjusting work schedules to personnel preferences. METHODS: A prospective, longitudinal, cohort study with a work-schedule modification intervention was performed. All EMS personnel employed by the City of Cleveland EMS were eligible for participation. EMS employees voluntarily completed an abbreviated medical personnel stress survey (MPSS-R), a 20- question validated stress-assessment tool, in September 1989, February 1991, and September 1991. A new scheduling pattern was introduced March 1991. At that time, 27 EMS employees volunteered to work the new schedule (12 hours/ shift: 3 days on/2 days off/2 days on/3 days off). The remaining 109 EMS employees remained on the old schedule (8 hours/shift: 6 days on/2 days off). RESULTS: Mean MPSS-R stress scores increased significantly from September 1990 (61.9 +/- 7.87) to September 1991 (65.08 +/- 7.23) (p < 0.05). In September 1991, mean stress scores of EMS personnel working the new schedule (64.39 +/- 7.82) were not significantly lower than stress scores of EMS personnel working the old schedule (65.25 +/- 7.10). CONCLUSION: Stress in EMS personnel increased despite a new schedule pattern designed to accommodate the preferences of EMS personnel.

Adult↗
PubMedDate not supplied

Stress levels in EMS personnel: a national survey.

OBJECTIVE: The purpose of this study was to evaluate stress levels in emergency medical services personnel across the United States. DESIGN: Confidential, 20-question survey tool, Medical Personnel Stress Survey--Abbreviated (MPSS-R). A total score of 50 indicates average stress levels. A score of 12.5 on the subset measurements of somatic distress, job dissatisfaction, organizational stress, and negative attitudes towards patients indicates average levels of stress. Data were analyzed using ANOVA and t-test. INTERVENTIONS: None. RESULTS: A total of 658 of 3,000 emergency medical technicians (EMTs) (22%) completed the survey. The mean value of 69.3 +/- 6.3 for the total stress scores was very high. Mean values for the subset scores were: somatic distress = 19.6 +/- 3.3; organizational stress = 17.3 +/- 2.4; job dissatisfaction = 17.0 +/- 2.6; negative attitudes towards patients = 15.5 +/- 2.3. Characteristics predicting higher stress were EMT-basic (A) licensure, basic life support (BLS) only service provider, volunteer status, new employee working in a small EMS organization, and providing service to a small town. CONCLUSION: Stress levels in EMS personnel were very high, were manifested primarily as somatic distress, secondarily as organizational stress and job dissatisfaction, and lastly as negative patient attitudes. Stress levels and subset manifestations of occupational stress among EMS personnel varied depending on gender, marital status, age, level of training and function, on salaried or volunteer status, length of time as an EMT, and size of the organization, city, and population served. Care should be taken to address stresses peculiar to individual EMS system needs.

Adult↗