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Biomedical subjects

C R Berryman

Publications and source records attributed to C R Berryman.

4 recordsLinked to original sources

Computer-based videotape analysis of trauma resuscitations for quality assurance and clinical research.

PURPOSE: To automate time (and motion) studies of major trauma resuscitations. TECHNIQUES: We modified an existing time-motion study technique based on time-encoded videotaping for medical imaging workstation human factors analysis. Videotapes were recorded of the trauma room during normal clinical activity using an unobtrusive mounted camera. The videotapes are displayed through a customized interface using a Macintosh-based display system. Within this platform, the time-motion study module allows flexible task definition, multiple concordant task assignment, and various summary result presentations. We established an expert panel of two traumatologists, two emergency radiologists, and two time-motion study experts. The expert panel prospectively and uniquely defined important recognizable procedural and cognitive tasks and personnel (MD, RN, EMT, RT, etc.) involved in trauma resuscitation based on pilot recordings and collective experience. These task functions were used to define a menu in the time-motion analysis software. During retrospective videotape review, the beginning and ending times of each task performed were recorded by electronically highlighting each defined individual and task. The summary results can be displayed in list, tabular, or graphic form by individuals, personnel classifications, or tasks.

Clinical Protocols↗

Interposed abdominal compression-CPR in human subjects.

Standard cardiopulmonary resuscitation (CPR) has been thought to produce approximately 30% of the usual resting cardiac output. Further increase of blood flow to vital organs may increase chances of resuscitation and decrease likelihood of permanent, residual central nervous system or cardiac damage. Various methods have been promoted, most requiring equipment not available to bystanders and time to initiate once advanced cardiac life support (ACLS) providers have necessary equipment at hand. Interposed abdominal compression-CPR (IAC-CPR), application of manual abdominal pressure during the release phase of chest compression in otherwise standard CPR, has been demonstrated in dogs to increase diastolic blood pressure by 100% and cardiac output by 75%. We measured systolic and mean arterial pressure (MAP) in a group of six cardiac arrest patients after resuscitation was deemed unsuccessful by the physician directing CPR. We alternated periods of CPR versus IAC-CPR measuring femoral and radial or brachial pressures in six subjects, and found a 50% increase in MAP (from 26 to 39 mm Hg). Central venous pressures (CVP) were measured in one subject and, using MAP minus mean CVP to determine mean perfusion pressure, we found a 37% increase (from 19 mm Hg to 26 mm Hg). We propose that IAC-CPR may be a significant improvement in basic CPR if these studies are reproducible in resuscitable patients.

Adult↗

Spectrum of Vibrio infections in a Gulf Coast community.

Infection with Vibrio species was diagnosed in 23 patients over a 10-year period in a Gulf Coast community. Species isolated were Vibrio vulnificus, V. cholerae, V. parahaemolyticus, and V. alginolyticus. Clinical presentations included diarrhea, wound infection, and bacteremia. Gastrointestinal tract infection was infrequently diagnosed, despite the routine use of stool culture media appropriate for vibrio isolation. Bacteremic infections were severe and occurred only in patients with underlying diseases. Wound infections were complicated by tissue necrosis and required surgical debridement. In patients with underlying diseases, soft tissue infections often progressed to fatal septicemias.

Adolescent↗