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Biomedical subjects

G M Vilke

Publications and source records attributed to G M Vilke.

At least 19 recordsLinked to original sources
PubMed2001

Effect of surgical cricothyrotomy on the unstable cervical spine in a cadaver model of intubation.

Cricothyrotomy is indicated for patients who require an immediate airway and in whom orotracheal or nasotracheal intubation is unsuccessful or contraindicated. Cricothyrotomy is considered safe with cervical spine (c-spine) injury; however, the amount of c-spine movement that occurs during the procedure has not been determined. In this experimental study, an established cadaver model of c-spine injury was used to quantify movement during cricothyrotomy. A complete C5--6 transection was performed by using an osteotome on 13 fresh-frozen cadavers. Standard open cricothyrotomy was performed on each cadaver, with c-spine images recorded in real time on fluoroscopy, then transferred to video and Kodachrome still images. Outcome measures included movement across the C5--6 site with regard to angulation expressed in degrees of rotation and linear measures of axial distraction and anterior-posterior (AP) displacement expressed as a proportion of C5 body width. Data were analyzed by using descriptive statistics to determine mean change from baseline in each of three planes of movement. Significance was assumed if 95% confidence intervals did not include zero. A significant amount of movement was observed with regard to AP displacement (6.3% of C5 width) and axial distraction (-4.5% of C5 width, indicating narrowing of the intervertebral space). These correspond to 1--2 mm AP displacement and less than 1 mm axial compression. No significant angular displacement was observed. In conclusion, cricothyrotomy results in a small but significant amount of movement across an unstable c-spine injury in a cadaver model. This degree of movement is less than the threshold for clinical significance.

Cadaver↗
PubMed2001

Exercise-associated hyponatremia in marathon runners: a two-year experience.

This study was conducted to better define the pathophysiology, risk factors, and therapeutic approach to exercise-associated hyponatremia. Medical records from all participants in the 1998 Suzuki Rock 'N' Roll Marathon who presented to 14 Emergency Departments (EDs) were retrospectively reviewed to identify risk factors for the development of hyponatremia. Hyponatremic patients were compared to other runners with regard to race time and to other marathon participants seen in the ED with regard to gender, clinical signs of dehydration, and use of nonsteroidal anti-inflammatory drugs (NSAIDs). An original treatment algorithm incorporating the early use of hypertonic saline (HTS) was evaluated prospectively in our own ED for participants in the 1999 marathon to evaluate improvements in sodium correction rate and incidence of complications. A total of 26 patients from the 1998 and 1999 marathons were hyponatremic [serum sodium (SNa) < or =135 mEq/L] including 15 with severe hyponatremia (SNa < or = 125 mEq/L). Three developed seizures and required intubation and admission to an intensive care unit. Hyponatremic patients were more likely to be female, use NSAIDS, and have slower finishing times. Hyponatremic runners reported drinking "as much as possible" during and after the race and were less likely to have clinical signs of dehydration. An inverse relationship between initial SNa and time of presentation was observed, with late presentation predicting lower SNa values. The use of HTS in selected 1999 patients resulted in faster SNa correction times and fewer complications than observed for 1998 patients. It is concluded that the development of exercise-associated hyponatremia is associated with excessive fluid consumption during and after extreme athletic events. Additional risk factors include female gender, slower race times, and NSAID use. The use of HTS in selected patients seems to be safe and efficacious.

Adult↗
PubMed2001

The prehospital electrocardiogram.

Although widely used in Europe, the prehospital 12-lead electrocardiogram (EKG) has seen only limited use in this country. Reported benefits of the 12-lead EKG include shortening the door-to-needle time, accelerating the initiation of reperfusion therapy, and overall improving the prehospital and hospital management and outcome of patients with acute myocardial infarction. The field EKG also provides the basis for prehospital fibrinolysis. Concerns still exist, however, regarding the best means of providing real-time field interpretation of the prehospital EKG and the potential for inappropriate field time delay, triage, and treatment of patients. Moreover, questions remain about the overall clinical and cost benefit of expanding this resource universally. The following article reviews the role of prehospital EKG in caring for patients with acute coronary syndromes.

Electrocardiography↗
PubMed2001

Estimation of pediatric patient weight by EMT-PS.

To determine paramedics' experience, comfort, and accuracy in the estimation of pediatric weights, paramedics were surveyed regarding their experience and training in estimating pediatric weights and then were presented with four children and asked to estimate their weights and to calculate the first round of i.v. epinephrine dose for asystole according to protocol. Twenty paramedics participated, with 55% stating they were uncomfortable on pediatric calls; 15 of 20 (75%) stated they were uncomfortable estimating children's weights. The majority of estimations were within 50% of the actual weights. Based on weight estimations, the epinephrine doses were calculated correctly in 88% of all cases. In 10% of cases, the epinephrine dose was incorrect by a factor of 10 times the appropriate dose. The weight range using the Broselow tape was determined correctly by all participants, with 95% correctly reporting the correct dose of epinephrine. Overall, paramedics were accurate in estimating pediatric weights, and use of the Broselow tape improved the precision of these estimations.

Attitude of Health Personnel↗
PubMed2001

Electrocardiographic manifestations: pulmonary embolism.

The electrocardiographic findings associated with pulmonary embolism have been well described in the medical literature for over 50 years. These abnormalities include changes in rhythm, QRS axis, and morphology, particularly in the QRS and T waves. Such findings may reflect hemodynamic changes, such as right heart strain, as well as myocardial ischemia associated with the disease. Although certain findings may correlate with the severity of pulmonary embolism, the overall utility of the electrocardiogram is limited due to the variable presence, frequency, and transient nature of most of the abnormalities associated with the disease.

Aged↗
PubMed2000

Use of a complete neurological examination to screen for significant intracranial abnormalities in minor head injury.

Indications for head computed tomography (CT) scans are unclear in patients with nonpenetrating head injury and Glasgow Coma Scale (GCS) scores of 15. We performed a prospective study to determine if significant intracranial injury could be excluded in patients with GCS-15 and a normal complete neurological examination. A prospective trial of clinically sober adult patients with GCS = 15 on emergency department (ED) presentation after closed head injury with loss of consciousness or amnesia was conducted from May 1996 through April 1997. All subjects underwent a standardized neurological examination including mental status evaluation, and assessment of motor, sensory, cerebellar and reflex function before CT scan. During the study period, 58 patients met inclusion criteria. Fifty-five patients (95%) had normal CT scans and 23 (42%) had focal neurological abnormalities. Three patients (5%) had CT scan findings of acute intracranial injury, two of whom had normal neurological examinations. One patient had an acute subdural hematoma requiring emergent surgical decompression; the other had both an epidural hematoma and pneumocephalus that did not require surgery. Significant brain injury and need for CT scanning cannot be excluded in patients with minor head injury despite a GCS = 15 and normal complete neurological examination on presentation.

Adolescent↗
PubMed2000

Amoebic abscess.

Explore the source record for details and available documents.

Abdominal Pain↗
PubMed2000

Safety and efficacy of the Rapid Four-Step Technique for cricothyrotomy using a Bair Claw.

The Rapid Four-Step Technique (RFST) has been demonstrated to be faster than standard open crico thyrotomy technique, but may have a higher incidence of cricoid injury with tracheal hook traction applied caudad. The "Bair Claw" is a novel device that may help eliminate these complications. This randomized, experimental trial used a fresh-frozen cadaver model of cricothyrotomy to compare speed and safety between RFST using a Bair Claw and standard open technique. Outcome measures included time to definitive airway, size of largest endotracheal (ET) tube able to be passed, and incidence of complications. We observed that RFST using a Bair Claw was significantly faster than standard open technique. There was no significant difference with regard to size of ET tube able to be passed with RFST using a Bair Claw versus standard open technique, and there was no damage to trachea or larynx observed with either technique. We concluded that RFST using a Bair Claw is faster and appears to be equally safe when compared to standard open technique in a fresh-frozen cadaver model of cricothyrotomy. The two techniques were equal with regard to maximal ET tube size.

Cadaver↗
PubMed2000

Rapid sequence intubation in the field versus hospital in trauma patients.

We conducted a retrospective review of all adult trauma patients who underwent prehospital field rapid sequence intubation (RSI) by aeromedical crews from 1988 through 1995 and compared them to all trauma patients who arrived by ground transportation and underwent RSI in the trauma suite from 1992 through 1995 at a University hospital. Of the 47 field RSI patients, 46 (97.9%) were successfully intubated, whereas 263 of the 267 (98.5%) hospital RSI patients were successfully intubated. There were no statistical differences in success rates, number of attempts, or immediate intubation events in the procedure between the two groups. There were no differences in delayed events with the exception of pneumonia, which occurred more frequently in the field RSI group (28% vs. 6%, respectively). We performed a subgroup analysis on isolated head injury patients to evaluate outcome. There was no difference in total hospital days, length of ICU stay, mortality or final disposition in the two head injury groups. Though this study is limited by small sample size, we conclude that field RSI is equally successful and safe as hospital RSI.

Adult↗
PubMed2000

Emergency department patient knowledge of medications.

Therapeutic decisions made by Emergency Physicians are often influenced by which prescribed medications are being taken by patients. We sought to assess Emergency Department (ED) patients' knowledge of their medications by using a survey. A convenience sample of adult ED patients was surveyed verbally by a research assistant. Two-hundred patients were enrolled. Only 48% of patients could recall or produce a list or the actual bottles of all of their medications, 39% knew the times they take their medications, and only 24% knew all the dosages. Seventeen percent brought a list or the actual medication bottles with them to the ED. Patients who had a primary care physician knew all their medications 51% of the time, compared to 43% who did not have a physician. Fifty-one percent of insured patients compared to 38% of non-insured patients could identify all of their medications. Although knowledge of medications is often critical for decision making in the ED, a significant number of patients are unable to provide this information.

Adult↗
PubMed2000

Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation.

STUDY OBJECTIVE: Orotracheal intubation (OTI) is commonly used to establish a definitive airway in major trauma victims, with several different cervical spine immobilization techniques and laryngoscope blade types used. This experimental, randomized, crossover trial evaluated the effects of manual in-line stabilization and cervical collar immobilization and 3 different laryngoscope blades on cervical spine movement during OTI in a cadaver model of cervical spine injury. METHODS: A complete C5-C6 transection was performed by using an osteotome on 14 fresh-frozen cadavers. OTI was performed in a randomized crossover fashion by using both immobilization techniques and each of 3 laryngoscope blades: the Miller straight blade, the Macintosh curved blade, and the Corazelli-London-McCoy hinged blade. Intubations were recorded in real time on fluoroscopy and then transferred to video and color still images. Outcome measures included movement across C5-C6 with regard to angulation expressed in degrees of rotation and axial distraction and anteroposterior displacement with values expressed as a proportion of C5 body width. Cormack-Lehane visualization grades were also recorded as a secondary outcome measure. Data were analyzed by using multivariate analysis of variance to test for differences between immobilization techniques and between laryngoscope blades and to detect for interactions. Significance was assumed for P values of less than.05. RESULTS: Manual in-line stabilization resulted in significantly less movement than cervical collar immobilization during OTI with regard to anteroposterior displacement. Use of the Miller straight blade resulted in significantly less movement than each of the other 2 blades with regard to axial distraction. The Cormack-Lehane grade was significantly better with manual in-line stabilization versus cervical collar immobilization; no differences were observed between blades. CONCLUSION: Manual in-line stabilization results in less cervical subluxation and allows better vocal cord visualization during OTI in a cadaver model of cervical spine injury. The Miller laryngoscope blade allowed less axial distraction than the Macintosh or Corzelli-London-McCoy blades. The clinical significance of this degree of movement is unclear.

Cadaver↗
PubMed2000

Spirometry in normal subjects in sitting, prone, and supine positions.

OBJECTIVE: Determine whether pulmonary function testing is affected by patient positioning. METHODS: In a descriptive study with measurements made in a sequential but randomized order at a university-based pulmonary function laboratory, 20 healthy men, ages 18-50 years, were evaluated with spirometric assessment of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and maximum voluntary ventilation (MVV) in the sitting, supine, and prone positions. Subjects were excluded for body mass index (BMI) > 30 kg/m2 or abnormal baseline spirometry. RESULTS: Comparing sitting to supine and prone positions, there was a statistically significant decline in the spirometry values (reported as percent of predicted normal +/- standard error of the mean). FVC was 102% +/- 4% while sitting, 95% +/- 4% while supine, and 94% +/- 4% while prone. FEV1 was 104% +/- 3% while sitting, 96% +/- 3% while supine, and 94% +/- 3% while prone. MVV was 115% +/- 4% while sitting, 102% +/- 4% while supine, and 97% +/- 3% prone. CONCLUSION: In healthy men with BMI < 30 kg/m2, changing from the sitting to supine or prone position results in statistically significant change in respiratory pattern. However, all spirometry values in each position were normal by American Thoracic Society definitions.

Adolescent↗
PubMed1998

Postpartum coronary artery dissection.

A 34-year-old woman presented to the emergency department 12 weeks postpartum with chest pain. An ECG indicated an acute myocardial infarction. The patient underwent cardiac catheterization with findings suggestive of coronary artery dissection later confirmed on intravascular ultrasonography. She underwent emergency coronary artery bypass grafting and has subsequently done well.

Adult↗
PubMed1998

Outcome study of prehospital patients signed out against medical advice by field paramedics.

STUDY OBJECTIVE: To describe the incidence and demographic data of prehospital patients who contact paramedics by way of the 911 system, refuse transport against medical advice (AMA), then call 911 and are subsequently reevaluated by paramedics in the following 48 hours. METHODS: We conducted a retrospective observational review of records using the San Diego County Quality Assurance Network database for prehospital providers. All paramedic 911 responses that made base hospital contact over a 3-month period were reviewed to identify patients who signed out AMA. The main outcome measure was to identify patients who signed out AMA and then called 911 again within 48 hours. The demographics, complaints, treatments, and dispositions of these patients are described. RESULTS: Of 6,512 total 911 responses reviewed, 443 (7%) involved patients who signed out AMA. Of these patients, 156 cases (35.2%) were listed as trauma and 287 (64.8%) were medical, with cardiac chest pain, seizure, and respiratory distress/shortness of breath the most frequently noted medical subcategories. Fifty-one (11.5%) such patients received treatment; 34 received dextrose, 12 naloxone, 4 albuterol, and 1 a splint. Patient names were available in 5,515, of the total 6,512 responses and 431 of the 443 AMA cases, permitting computer searching of reevaluations by paramedics. Of the 431 AMA patients for whom a name was available, 10 (2%) called 911 again within 48 hours. All 10 callbacks were made for a related chief compliant, and all 10 of these patients were transported (4 admitted to hospital, 1 died en route, 1 transferred to another facility, 4 discharged from the ED). Of these 10 patients, 7 (70%) were older than 65 years, compared with 17% of all AMA patients older than 65 years. CONCLUSION: On the basis of our findings, patients over the age of 65 years have a propensity to recontact paramedics and should be aggressively encouraged to seek emergency medical treatment. Future prospective studies should be mounted to examine at patient outcome and to assess why patients sign out AMA after making contact with paramedics.

Adolescent↗
PubMed1998

Reexamination of custody restraint position and positional asphyxia.

The use of the hogtie restraint (also known as hobble or prone maximal restraint) by law enforcement and prehospital personnel has come under scrutiny because of reports of sudden deaths in persons placed in this restraint position. Some contend that this body position restricts chest and abdominal movement to the point that individuals are at risk for hypoventilatory respiratory compromise and "positional" asphyxiation. We review case reports of custody deaths in subjects placed in the hogtie position, as well as related medical literature regarding positional asphyxia. We also review the current research findings from human physiology studies that have investigated the effects of the hogtie position on respiratory and pulmonary function. We conclude that the hogtie restraint position by itself does not cause respiratory compromise to the point of asphyxiation and that other factors are responsible for the sudden deaths of individuals placed in this position.

Asphyxia↗
PubMed1997

Restraint position and positional asphyxia.

STUDY OBJECTIVE: To determine whether the "hobble" or "hog-tie" restraint position results in clinically relevant respiratory dysfunction. METHODS: This was an experimental, crossover, controlled trial at a university-based pulmonary function laboratory involving 15 healthy men ages 18 through 40 years. Subjects were excluded for a positive urine toxicology screen, body mass index (BMI) greater than 30 kg/m2, or abnormal screening pulmonary function testing (PFT). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and maximal voluntary ventilation (MVV) were obtained with subjects in the sitting, supine, prone, and restraint positions. After a 4-minute exercise period, subjects rested in the sitting position while pulse, oxygen saturation, and arterial blood gases were monitored. The subjects repeated the exercise, then were placed in the restraint position with similar monitoring. RESULTS: There was a small, statistically significant decline in the mean FVC (from 5.31 +/- 1.01 L [101% +/- 10.5% of predicted] to 4.60 +/- .84 L [88% +/- 8.8% of predicted]), mean FEV1 (from 4.31 +/- .53 L [103% +/- 8.4%] to 3.70 +/- .45 L [89% +/- 7.7%]), and mean MVV (from 165.5 +/- 24.5 L/minute [111% +/- 17.3%] to 131.1 +/- 20.7 L/minute [88% +/- 16.6%]), comparing sitting with restraint position (all, P < .001). There was no evidence of hypoxia (mean oxygen tension [PO2] less than 95 mm Hg or co-oximetry less than 96%) in either position. The mean carbon dioxide tension (PCO2) for both groups was not different after 15 minutes of rest in the sitting versus the restraint position. There was no significant difference in heart rate recovery or oxygen saturation as measured by co-oximetry and pulse oximetry. CONCLUSION: In our study population of healthy subjects, the restraint position resulted in a restrictive pulmonary function pattern but did not result in clinically relevant changes in oxygenation or ventilation.

Adolescent↗