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Biomedical subjects

D G Hankins

Publications and source records attributed to D G Hankins.

At least 19 recordsLinked to original sources
PubMed2001

Patient outcomes following defibrillation with a low energy biphasic truncated exponential waveform in out-of-hospital cardiac arrest.

PRIMARY OBJECTIVE: To determine the outcome of patients with out-of-hospital cardiac arrest and ventricular fibrillation as the presenting rhythm while using automated external defibrillators (AEDs) that delivered non-escalating, impedance-compensated low-energy (150 J) shocks. MATERIALS AND METHODS: AEDs delivering low-energy biphasic truncated exponential (BTE) shocks were employed in an emergency medical services (EMS) system in which first-arriving personnel - police, firefighters or paramedics - delivered the initial shocks. Patients were classified according to their response to shocks: restoration of sustained spontaneous circulation (ROSC) without need for epinephrine and other advanced life support (ALS) interventions; and ALS, those requiring epinephrine in all instances. The primary end-point was neurologically-intact discharge survival. Secondary end-points were ROSC with shocks only and the call-to-shock time interval. RESULTS: Of 42 patients with VF arrest treated with BTE shocks, 35 were bystander-witnessed. Of these 35, 14 (38%) regained a sustained ROSC on-scene with shocks only, needing no epinephrine for ROSC. All 14 survived to discharge home. Of the remaining 21 patients needing ALS intervention, only two (9.5%) survived to discharge. Overall, 16/35 patients (46%) survived to discharge home, an outcome comparable to our experience with patients treated with escalating high-energy monophasic waveform shocks. CONCLUSIONS: Low-energy (150 J) non-escalating biphasic truncated exponential waveform shocks terminate VF in out-of-hospital cardiac arrest with high efficacy; patient outcome is comparable with that observed with escalating high-energy monophasic shocks. Low-energy shocks, in addition to high efficacy, may confer the advantage of less shock-induced myocardial dysfunction, though this will be difficult to define in the clinical circumstance of long-duration VF provoked by a pre-existing diseased myocardial substrate.

Aged↗
PubMed1998

Seven years' experience with early defibrillation by police and paramedics in an emergency medical services system.

PRIMARY OBJECTIVE: To assess the outcome of patients with out-of-hospital cardiac arrest with ventricular fibrillation as the presenting rhythm in an emergency medical services system utilizing a combined police/paramedic response to provide early defibrillation. MATERIALS AND METHODS: Police and paramedics were dispatched from law enforcement and ambulance communications centers, respectively. First-arriving personnel delivered initial shocks, all using automated external defibrillators. Patients were classified according to response to initial shocks: restoration of pulses with shocks only or in need of advanced life support, including epinephrine. Discharge survival was defined as return to home without disabling neurologic injury. RESULTS: Over the 7-year period of study 131 patients presented with ventricular fibrillation: 58 were first treated by police and 73 by paramedics. Restoration of pulses with shocks only and discharge survival were not different in police and paramedic groups, with overall survival of 40% (53 of 131 patients). Among the survivors, 19% (18/95 patients) obtained a spontaneous circulation only after administration of epinephrine and other ALS interventions. CONCLUSION: Both restoration of a functional circulation, without need for advanced life support interventions, and discharge survival without neurologic disability are very dependent upon the rapidity with which defibrillation is accomplished, regardless of who delivers the shocks. In addition, a smaller but significant number of patients who require ALS interventions, including epinephrine, for restoration of a spontaneous circulation survive to discharge. Short time differences, on the order of 1 min, are significant determinants of both immediate response to shocks and discharge survival.

Adolescent↗
PubMed1996

High discharge survival rate after out-of-hospital ventricular fibrillation with rapid defibrillation by police and paramedics.

STUDY OBJECTIVE: To assess outcome in patients with ventricular fibrillation (VF) treated by defibrillator-equipped police and emergency medical technician-paramedics in an advanced life support (ALS) emergency medical services (EMS) system. METHODS: We carried out a retrospective observational outcome study of all consecutive adult patients with atraumatic cardiac arrest treated from November 1990 through July 1995. The study was carried out in a city with a population of 76,865 in an area of 32.6 square miles. Central 911 dispatched police and an ALS ambulance simultaneously. Accurate intervals were obtained with the synchronization of all defibrillator clocks with the 911 dispatch clock. The personnel who arrived first delivered the initial shock. After shocks delivered by police, paramedics provided additional treatment if needed. Main outcome measures were time elapsed before delivery of the first shock, restoration of spontaneous circulation (ROSC), and survival to discharge home. RESULTS: Of 84 patients, 31 (37%) were first shocked by police. Thirteen of the 31 demonstrated ROSC, without need for ALS treatment. All 13 survived to discharge. The other 18 patients required ALS; 5 (27.7%) survived. Among the 53 patients first shocked by paramedics, 15 had ROSC after shocks only, and 14 survived. The other 38 needed ALS treatment; 9 survived. Call-to-shock time for all patients was less in the police group than in the paramedic group (5.6 versus 6.3 minutes, P = .038). For all patients, call-to-shock time was less in those with ROSC after shocks only than in those who needed ALS (5.4 versus 6.3 minutes, P = .011). Survival to discharge was 49% (41 of 84), with 18 of 31 (58%) in the police group and 23 of 53 (43%) in the paramedic group. Call-to-shock time for survivors was 5.8 minutes; it was 6.4 minutes for the nonsurvivors (P = .020). Neither ROSC nor discharge survival was significantly different between police and paramedic-shocked patients. ROSC after initial shock and call-to-shock time were major determinants of survival, whether the first shocks were administered by police or by paramedics. With ROSC after shocks only, 27 of 28 (96%) survived, whereas 14 of 56 (25%) needing ALS survived (P < .001). CONCLUSION: A high discharge-to-home survival rate was obtained with early defibrillation by both police and paramedics. When shocks resulted in ROSC, the overwhelming majority of patients survived (96%). Even brief time decreases (eg. 1 minute) in call-to-shock time increase the likelihood of ROSC from shocks only, with a consequent decrease in the need for ALS intervention. Short call-to-shock time and ROSC response to shocks only are major determinants of a high rate of survival after VF.

Adult↗
PubMed1996

Evaluation of the i-STAT portable clinical analyzer for use in a helicopter.

We evaluated the performance of the i-STAT Portable Clinical Analyzer (PCA) for use in a helicopter with the analyses performed by the flight nurses. Imprecision and initial split-sample comparative studies were performed in the Hospital Laboratory and Clinical Chemistry Laboratory. Day-to day imprecision (CV) ranged from 0.5 to 6.7% in the clinical laboratories and 0.5 to 5.3% in the helicopter with urea nitrogen and glucose determinations giving the highest values. Comparison studies between the PCA and the Kodak Ektachem E700 and the Beckman Astra 8 gave acceptable results, although urea nitrogen did show a bias in the high range (mean difference 4.91 and 3.69 mmol/L respectively). It was not considered medically significant for the anticipated patient population of the PCA in our hospitals. Comparison studies of patient specimens between the PCA in the helicopter and the clinical laboratories showed no significant differences, with the exception of glucose. Lower glucose values were obtained in the laboratory due to the time lag between specimen collection in the helicopter and analysis in the laboratory.

Aircraft↗
PubMed1995

Airborne and rescue point-of-care testing.

The prehospital environment has not been studied for point-of-care testing. Therefore, the authors' helicopter program evaluated the performance of the i-STAT Portable Clinical Analyzer, a rapid point-of-care, hand-held instrument. The primary aim of the study was to determine if the i-STAT Portable Clinical Analyzer could be used in the field to assess patient status in flight, and to allow the flight crew to intervene immediately, thus delivering a more stable patient to the emergency room. Imprecision and initial split-sample comparative studies with the Portable Clinical Analyzer were completed in the hospital satellite laboratory and clinical chemistry laboratory. Comparison studies were performed on patient samples drawn and analyzed in the helicopter and subsequently analyzed in the satellite and clinical chemistry laboratories. The only significant differences observed were with glucose. The glucose discrepancies were probably due to the time delay between collection of the specimen in the helicopter and subsequent analysis in the laboratory. Following this initial validation, the i-STAT Portable Clinical Analyzer was used on 81 patients transported by the flight crew. The tests performed in the helicopter include sodium, potassium, glucose, and hematocrit/hemoglobin concentrations. Fifteen (18.5%) of the patients were treated with transfusions, glucose, or insulin based on the Portable Clinical Analyzer results. Other identified needs include blood gas analysis (in process) and use of point-of-care testing in the fixed-wing environment.

Air Ambulances↗
PubMed1990

Thoracic aortography following blunt chest trauma.

The records of 314 patients who suffered blunt chest trauma and underwent thoracic aortography between 1968 and 1986 were retrospectively reviewed. The patients ranged in age from 7 to 84 years (mean, 37.7 years). There were 255 male and 59 female patients. The majority of injuries were the result of motor vehicle accidents. The most common indication for aortography was a widened mediastinum on chest roentgenogram (83.4%). The aortogram was positive for cardiovascular injury in 19.7% of cases. There were 47 patients with aortic rupture, 15 with subclavian artery disruption, and 1 with traumatic aortic insufficiency. Complications occurred in 1.7% of patients. Two patients sustained groin hematomas and one patient suffered an intimal tear of the ascending aorta from the angiographic catheter. None of the complications required treatment. Aberrant origin of the arch vessels occurred in 0.96% of patients, and ductus diverticulum occurred in 0.64%. There were two false-positive and no false-negative aortograms. It was concluded that thoracic aortography after trauma is accurate and safe.

Adolescent↗
PubMed1987

Profound acidosis caused by isoniazid ingestion.

Isoniazid (INH) is the cause of one of the most common serious drug overdoses and can cause severe metabolic acidosis. We report a case of INH overdose that is most notable because the patient survived without apparent sequelae after experiencing an extremely low pH level (6.49). This is the lowest reported pH level with patient survival. Toxicity and pharmacology of INH and various aspects of metabolic acidosis are discussed.

Acidosis, Lactic↗
PubMed1987

Hepatitis B vaccine and hepatitis B markers: cost effectiveness of screening prehospital personnel.

The purpose of this study was to evaluate the cost effectiveness of screening emergency medical technicians (EMTs) and paramedical personnel prior to administering hepatitis B vaccine. Hepatitis B screening and Heptavax vaccine were offered to 259 basic EMTs and paramedics. Of the 259 individuals, 62 refused screening, and six who had already received hepatitis B vaccine were excluded from the study. The screening was not continued after the results of the first 174 tests returned negative. All 191 participants were vaccinated. No hepatitis B surface antigen carriers and only three individuals positive for hepatitis B surface antibody were found among those screened. This study corroborates the Centers for Disease Control guidelines of cost effectiveness in screening prehospital health care workers.

Allied Health Personnel↗
PubMed1986

Controversies in resuscitation.

Many controversies, only a few of which have been discussed here, are now raging in the field of resuscitation. Much is expected to change in the next five to ten years. The American Heart Association is now considering changes for its new advanced cardiac life support course, which should be ready this year. The course will not include some of the possible changes mentioned in this article, because too few studies have been done. Physicians and other rescuers should abide by the guidelines of the American Heart Association as a standard of practice because its recommendations are the result of the best possible consensus. Over the next several years, many exciting changes in resuscitation will occur and may lead to improved survival rates and quality.

Calcium↗
PubMed1984

Ovarian ectopic pregnancy.

We present the case of a 27-year-old woman with left lower quadrant pain, tenderness, and rebound tenderness. Culdocentesis demonstrated non-clotting blood, and exploratory laparotomy showed an ovarian ectopic pregnancy. A wedge resection of the ovary was accomplished and the patient recovered completely. Ovarian ectopic pregnancy is an uncommon presentation of ectopic pregnancy.

Adult↗
PubMed1978

Pulmonary toxicity recurring after a six week course of busulfan therapy and after subsequent therapy with uracil mustard.

A growing number of drugs, including a number of alkylating agents, have been implicated as the cause of pulmonary diseases. A patient with chronic myelogenous leukemia presented with typical cytology, biopsy, and roentgenologic findings of lung toxicity after only six weeks of therapy with busulfan. There was subsequent clearing. A similar roentgenologic change also occurred after administration of uracil mustard. This has not been reported previously.

Busulfan↗
PubMedDate not supplied

Complication rates for the esophageal obturator airway and endotracheal tube in the prehospital setting.

PURPOSE: The purpose of this study was to determine the complication rates associated with the use of the endotracheal tube (ET) and the use of the esophageal obturator airway/esophageal gastric tube airway (EOA/EGTA) during the treatment of patients with prehospital cardiac arrest. METHODS: A descriptive, quasi-experimental study of 509 consecutive adults, cardiac arrest patients was conducted. Patients were examined prospectively for airway intervention type and complications. Some patients were examined at their final destinations (field, morgue, funeral home), while other patients were examined by EMS providers in the field when airway adjuncts were switched. Also, airways were evaluated for complications by emergency physicians at destination emergency departments. RESULTS: The airway in use at the time of examination was the esophageal obturator airway (EOA) or esophageal gastric tube airway (EGTA) in 208 patients (40.1%); the ET (endotracheal tube) in 232 patients (45.6%); and an oral or nasopharyngeal airway in 47 patients (9.2%). Twenty-two patients (4.3%) had both an EOA/EGTA and an ET tube in place at the time of the examination. The survival rates were similar between the EOA/EGTA and the ET groups (28% and 32%, respectively). The complication rates overall also were similar, but the serious or potentially lethal complication rate was 3.3 times more common with the use of the EOA/EGTA than with the ET tube (8.7% versus 2.6%, respectively). CONCLUSIONS: The complication rate for the EOA/EGTA is unacceptably high, and careful thought must be given to its continued use.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Spinal immobilization in the field: clinical clearance criteria and implementation.

Awareness of the health and financial repercussions of unnecessary immobilization has made cervical spinal immobilization controversial in out-of-hospital care. Clinical criteria for clearance of the cervical spine in the hospital based on mechanism of injury have been supported by many trauma centers. However, implementation of clinical criteria for cervical spinal clearance in out-of-hospital settings is not as well validated by multicenter studies or accepted by many emergency departments. This consensus group recommends that clinical criteria to determine "low-risk" patients be available for use by emergency medical services providers in out-of-hospital settings; however, training, audits, quality management, integration into the medical community, and extent of program implementation should be decided based on individual emergency medical services systems.

Age Factors↗
PubMedDate not supplied

Public-access defibrillation.

This paper provides a general overview of the current status of public-access defibrillation (PAD). The objectives are to describe the rationale for PAD, to define different levels of PAD as enumerated by the American Heart Association AED Task Force, to review the development of PAD over the past decade, and to discuss the cost-benefit of PAD, mainly from models and a few small implementations throughout the country. A prospective, randomized, controlled clinical trial (the Public Access Defibrillation Phase I Trial) has been designed to compare nontraditional targeted bystander CPR using AEDs with that not using AEDs. It is expected that the trial will resolve many of the uncertainties about the benefits of PAD.

Allied Health Personnel↗