Biomedical subjects
C R Easter
Publications and source records attributed to C R Easter.
Clinical forensics for perioperative nurses.
Perioperative nurses frequently care for victims and suspected perpetrators of violent crimes. Nurses often are the first health care providers to assess the trauma patient and collect crucial evidence for future legal action. Informational evidence includes observations about patients' behavior and appearance and documentation of their comments. Nurses also must protect the chain of evidence so that evidence can be admissible in court. To function in this role, perioperative nurses must understand the concepts of clinical forensics, which is the application of the principles and practices of forensic science to questions of law in the investigation of violent crime.
Treatment of prehospital refractory ventricular fibrillation with bretylium tosylate.
Among 218 patients treated for prehospital arrest during an eight-month baseline period prior to addition of bretylium tosylate to the paramedic protocol in Columbus, 16 (7.3%) were seen with refractory ventricular fibrillation (RVF). These patients failed to respond to multiple countershocks, lidocaine, bicarbonate and epinephrine, and either were transported in arrest during cardiopulmonary resuscitation (CPR)(14) or were pronounced dead at the scene (2). A single patient was eventually resuscitated in and discharged from the hospital. During the subsequent 16 1/2-month experience with bretylium used only for prehospital RVF, 421 patients with prehospital arrest were seen, 35 of whom (8.3%) had RVF. All but five patients were defibrillated successfully, and 14 (40%) were converted to a rhythm sufficient to obviate CPR during transportation. Eleven patients (31%) survived to be admitted to the hospital, and eight of 35 (23% vs 1/16 or 6.2% above, P less than .05) were discharged and remained well three to 17 months later. Bretylium tosylate may provide life-saving therapy for refractory prehospital ventricular fibrillation so that survival from an almost uniformly fatal condition is improved. While patients with persistent arrest generally should be transported to the hospital, such patients should not be subjected to the difficulties of CPR in transit unless they are first given bretylium if RVF is present.