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Biomedical subjects

E E Harrison

Publications and source records attributed to E E Harrison.

At least 19 recordsLinked to original sources
PubMed1999

Effects of intramuscular administration of low doses of medetomidine and medetomidine-butorphanol in middle-aged and old dogs.

OBJECTIVE: To determine effects of low doses of medetomidine administered with and without butorphanol and glycopyrrolate to middle-aged and old dogs. DESIGN: Prospective randomized clinical trial. ANIMALS: 88 healthy dogs > or = 5 years old. PROCEDURE: Dogs were assigned randomly to receive medetomidine (2, 5, or 10 micrograms/kg [0.9, 2.3, or 4.6 micrograms/lb] of body weight, i.m.) alone or with glycopyrrolate (0.01 mg/kg [0.005 mg/lb], s.c.), medetomidine (10 micrograms/kg) and butorphanol (0.2 mg/kg [0.1 mg/lb], i.m.), or medetomidine (10 micrograms/kg), butorphanol (0.2 mg/kg), and glycopyrrolate (0.01 mg/kg). Anesthesia was induced with thiopental sodium and maintained with isoflurane. Degree of sedation and analgesia were determined before and after medetomidine administration. Respiratory rate, heart rate, and mean arterial blood pressure were determined 10 and 30 minutes after medetomidine administration. Adverse effects and amounts of thiopental and isoflurane used were recorded. RESULTS: Sedation increased after medetomidine administration in 79 of 88 dogs, but decreased in 7 dogs that received 2 or 5 micrograms of medetomidine/kg. Mean postsedation analgesia score and amounts of thiopental and isoflurane used were less in dogs that received medetomidine and butorphanol, compared with other groups. Respiratory rate, heart rate, and blood pressure were not different among groups. Significantly more adverse effects developed in dogs that did not receive glycopyrrolate. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of medetomidine (10 micrograms/kg, i.m.) and butorphanol (0.2 mg/kg, i.m.) induced sedation and analgesia and reduced amounts of thiopental and isoflurane required for anesthesia in middle-aged and old dogs. Glycopyrrolate decreased frequency of medetomidine-associated adverse effects.

Adjuvants, Anesthesia↗
PubMed1984

Use of calcium in electromechanical dissociation.

Calcium is recommended by American Heart Association standards for the resuscitation of patients with electromechanical dissociation (EMD). Until recently, only anecdotal case reports were offered to support this recommendation. Recent studies examining the question of whether calcium is useful in resuscitating hearts in EMD are reviewed.

Calcium Chloride↗
PubMed1983

The use of bretylium in prehospital ventricular fibrillation.

Bretylium tosylate is recommended by the American Heart Association Standards for Advanced Cardiac Life Support for refractory ventricular fibrillation after countershock, sodium bicarbonate, and epinephrine. According to this protocol, paramedics gave five to six milligrams per kilogram of intravenous bretylium by bolus in 96 patients with refractory fibrillation over a 24-month period. A positive response was defined as the presence of a palpable pulse following bretylium and countershock. Thirty-five percent of patients (34/96) responded following bretylium. Twenty-one percent (20/96) responded only temporarily with a rhythm and pulse. Fifteen percent (14/96) maintained a stable rhythm and vital signs on admission to the hospital, but only five patients, 5% of the total population, (5/96), were eventually discharged home. Clinical variables were similar in non-responders, temporary responders, and those admitted, but the times from the onset of Advanced Cardiac Life Support to receiving bretylium were 23.5 min, 20.3 min, and 14.3 min respectively. We conclude that about one-third of patients in refractory ventricular fibrillation respond following bretylium and countershock and that earlier bretylium use may give better results.

Bretylium Compounds↗
PubMed1983

The use of calcium in cardiac resuscitation.

All records of cardiac arrest patients presenting to the Tampa EMS system for the 24-month period of January, 1980, through December, 1982, were reviewed. Paramedics were given direct orders or standing orders to administer calcium intravenously or intracardiac in patients in ventricular fibrillation, asystole, or electromechanical dissociation. Of the 480 patients receiving calcium for the above conditions, only patients with electromechanical dissociation responded to calcium. Twenty-seven EMD patients responded positively with the immediate return of blood pressure and pulse. Fourteen of these patients arrived at the emergency department with stable vital signs; there were three long-term survivors. Adverse rhythm or rate changes were not noted following calcium use, and arrhythmias associated with digitalis excess were not seen in a small group of patients taking digoxin. Although long-term survivors are limited in this group of patients, positive hemodynamic responses were seen following calcium chloride administration in 10% of EMD patients and not at all in patients with asystole or ventricular fibrillation.

Calcium Chloride↗
PubMed1983

Characteristics of left ventricular thrombus resulting in perioperative embolism. A complication of coronary artery bypass grafting.

A review of perioperative complications of cardiac procedures at Tampa General Hospital revealed a distinct preoperative finding in several patients having embolism after coronary artery bypass grafting (CABG). From a total of over 10,000 cardiac catheterization procedures, four patients had ventricular wall motion abnormalities with discrete, mobile, pedunculated filling defects noted during ventriculography. Three of these patients eventually underwent CABG, and each had a postoperative embolic episode. A similar catheterization finding was noted in a fourth patient, who later had an embolic event. Thus, even in the absence of a discrete aneurysm, this observation suggests the need for an aggressive surgical approach to CABG patients with these ventricular filling defects.

Aged↗
PubMed1981

Prehospital administration of nitrous oxide for control of pain.

The effects of 50% nitrous oxide and 50% oxygen and of 30% nitrous oxide and 70% oxygen were evaluated in 88 patients with significant pain while in the prehospital setting. Under the telemetry physicians' supervision, EMT-Ps directed patients in the technique of self-administration of the analgesic gas. Fifty percent (36/72) reported complete or almost complete amelioration of pain; all but 15% (11/72) reported some degree of relief. No patients experienced clinically deleterious side effects, although 48% (41/85) reported side effects, of which 90% were mild. The analgesic properties, lack of complications, quick onset and short duration of action, and acceptance by patients, physicians, and paramedics make N2O a nearly ideal analgesic agent for advanced life support use in the prehospital relief of significant pain.

Adolescent↗
PubMed1981

Lidocaine in prehospital countershock refractory ventricular fibrillation.

Drug management of out-of-hospital countershock refractory ventricular fibrillation was evaluated by including 100 mg lidocaine bolus intravenously as the only anti-arrhythmic option in a protocol for use by paramedics. One hundred sixteen patients entered the study by failing to convert from ventricular fibrillation after the sequence of countershock, sodium bicarbonate, and repeat countershock. Sixty-two patients (53%) received lidocaine during the course of attempted resuscitation (Group I); 54 patients (47%) did not receive lidocaine (Group II). The two groups did not have significant differences in response times, patient profiles, or the use of other drugs or procedures. In Group I, 28 patients (45%) remained in ventricular fibrillation on arrival at the hospital, 15 (24%) were admitted to the CCU, and seven (11%) were ultimately discharged. In Group II, 25 patients (46%) remained in ventricular fibrillation on arrival at the hospital, eight (17%) survived to be admitted to the hospital, and one (2%) was ultimately discharged. The ability to convert ventricular fibrillation and the number of short- and long-term survivors did not differ significantly between the two groups. We conclude that a well-documented, controlled study of prehospital drug management of ventricular fibrillation is possible, and that further clinical evaluation of drug use in countershock refractory ventricular fibrillation is needed.

Anti-Arrhythmia Agents↗
PubMed1980

Esophageal perforation following use of the esophageal obturator airway.

Four cases of esophageal rupture associated with the use of the esophageal obturator airway are presented and added to the fifteen cases already in the literature. The incidence of this complication may be greater than previously suspected since a systematic search for this complication has not been made in cardiac arrest patients. The mechanism of rupture of the occluded esophagus may be similar to that seen in postemetic rupture. Endotracheal intubation remains the procedure of choice in airway control of cardiac arrest patients, although the modified esophageal obturator airway with gastric tube may prevent the occurrence of esophageal rupture by allowing decompression of the esophagus.

Aged↗
PubMed1979

Echocardiographic incidence of pericardial effusion in patients resuscitated by emergency medical technicians.

The incidence of echocardiographically determined pericardial effusion was assessed in the early postmanual cardiopulmonary resuscitation (CPR) period in a group of patients resuscitated by advanced emergency medical technicians (EMT-P) from the Rescue Division of the Tampa Fire Department. The survival rate from out-of-hospital sudden death is comparable to that reported in other series. Twenty-six survivors of out-of-hospital sudden death had echocardiograms performed an average of 2.5 days (range 0-10) postCPR to determine the amount of pericardial effusion. Eight of the 26 (31%) patients had received intracardiac drugs during CPR administered by the EMT-Ps when physician-directed by radio. Of the 26, three (12%) were found to have very minimal pericardial effusions; all deemed insignificant. All three had alternate explanations for physiological or pathological causes of their effusions. One had received intracardiac drugs, but the pericardial effusion could be explained by congestive cardiomyopathy. Another had congestive cardiomyopathy, and the third had sustained a severe steering wheel injury to the chest. Thus, manual CPR with or without the use of intracardiac drugs does not appear to cause significant pericardial effusions in survivors of sudden cardiac death.

Adult↗
PubMed1978

Paramedic use of intracardiac medications in prehospital sudden cardiac death.

The intracardiac administration of medications in cardiac arrest is advocated when an intravenous route cannot be established. Although warnings of complications of this mode of therapy are reiterated throughout the literature, their careful documentation is lacking. Paramedics were trained to administer intracardiac medications, under strict criteria, in patients with prehospital sudden cardiac death. Long-term survivors who received intracardiac medications from paramedics were compared to a control group resuscitated by paramedics with intravenous medications alone. By far, the patients who received intracardiac medications were more nearly refractory to resuscitation because of the criteria for intracardiac medication use. Potential complications of the intracardiac route were identified and sought. However, complications were no more common in this group of patients than in the control group. Paramedics can successfully administer intracardiac medications when indicated.

Allied Health Personnel↗
PubMed1977

Coexisting right and left hypertrophic subvalvular stenosis and fixed left ventricular outflow obstruction due to aortic valve stenosis.

A case of fixed left ventricular outflow tract obstruction due to aortic valve stenosis coexisting with right- and left-sided subvalvular hypertrophic stenosis is documented with hemodynamic data, angiograms, echocardiograms and findings at surgery. Histologic examination of the septal muscle with light and electron microscopy revealed hypertrophy of the muscle but none of the characteristics of idiopathic hypertrophic subaortic stenosis. Septal hypertrophy with subvalvular obstruction can occur secondary to left ventricular pressure overload due to fixed left ventricular outflow tract obstruction and is not always the chance occurrence of two separate diseases.

Aged↗
PubMed1977

Valve replacement in patients over 70 years.

From July, 1972, to April, 1976, 54 consecutive patients over the age of 70 years underwent valve replacement at Tampa General Hospital. Twenty-one patients had isolated aortic valve replacement (Group 1), 14 had isolated mitral valve replacement (Group 2), and 19 had combined procedures that included at least 1 valve replacement (Group 3). There was 1 operative death (in Group 1), and another patient (Group 3) died three weeks post-operatively, resulting in an early mortality of 3.7%. Follow-up of the 52 hospital survivors from one to forty-one months reveals 2 additional deaths for a late mortality of 3.8%. Cardiac status improved noticeably in the surviving 50 patients. The data suggests that with current techniques, complex intracardiac procedures can be performed safely with acceptable operative mortality and a satisfactory prognostic outlook in elderly patients.

Age Factors↗
PubMed1977

Onset of Prinzmetal's angina two years following sudden death syndrome survival.

A patient who was resuscitated after an episode of ventricular fibrillation without myocardial infarction outside the hospital developed angina for the first time two years later. Although the clinical pattern did not fulfill all of the criteria of Prinzmetal's variant angina and was found to correspond with episodes of ventricular tachycardia, we feel that Prinzmetal's angina can be implicated as the mechanism of previos ventricular fibrillation. During the patient's second hospitalization, angiography demonstrated a single, moderately stenotic, right coronary lesion which was bypassed. Immediately postoperatively, the patient developed ventricular fibrillation requiring more than two hours of cardiopulmonary resuscitation. Six months after bypass surgery, she experienced an inferior wall myocardial infarction. She is presently asymptomatic with normal heart size.

Angina Pectoris↗