PubMed Health⌕ Search

Biomedical subjects

G Tulli

Publications and source records attributed to G Tulli.

At least 55 records · Page 3Linked to original sources
PubMed1989

[Operative central unit for coordinating the emergencies-urgencies department. Proposal for a mini-unit to solve the problems caused by the relation between volunteer associations and the public structure].

One of the most important problems, of very difficult solution, in organizing an A/E department is to co-ordinate the emergency in the field. This peculiar task is carried on by an operative central station, the core of an A/E Dept. The organizer in Arezzo try to find out the efficiency and a cost benefit ratio of this central station and try to jump over an historical hindrance to operate by mutual consent with voluntary service. This seems to be possible with the technological development of telephone system and broadcast system. Staff, technical qualifications, connections, reception, modulation, sorting out of different calls are discussed in conjunction with problems of health education concerning the operative central station that coordinates A/E Dept in Arezzo.

Emergency Medical Service Communication Systems↗
PubMed1989

[Multiple organ failure syndrome in infection caused by ictero-hemorragic Leptospira. Description of a clinical case].

A 53 years old fisherman was admitted to General Intensive Care Unit in Arezzo with signs and symptoms of Weil disease. An early acute respiratory failure developed. Radiological and haemodynamic findings confirmed a diagnosis of ARDS. The patient developed a severe jaundice, acute renal failure and ARDS (MOF multiple organs failure). To support different failures of the organs, CMV (continuous mandatory ventilation: CPPV with PEEP max 10 cm H2; IRV max 2:1) and AMV (assisted mandatory ventilation: Pressure Support Ventilation), haemofiltration, haemoperfusion and plasmapheresis were simultaneously used, that got better and better renal and respiratory performances. Haemodynamic worsening by PEEP during extracorporeal treatment was overcome by PSV very useful new ventilatory procedure even during weaning period. The patient treated in such manner survived without important disabilities. This care confirms that ARDS (non cardiogenic edema) and MOF can develop during Icterohaemorrhagic Leptospirosis.

Acute Kidney Injury↗
PubMed1989

[Survey carried out by land of the intervention time for territorial health care].

While organizing the Catchment area of A/E Department in Arezzo, a recording of intervention time of prehospital care system (primary transport) was made by land. The analysis recorded that one third of the field on the Catchment area of the A/E Dept was in a red dangerous zone reachable in 15 minutes and more. Such analysis confirmed the importance of local operation bonds all for a correct redistribution of ambulances in the Catchment area and a rational choice of vans and staff suitable for an advanced life support only where and when really necessary.

Ambulances↗
PubMedDate not supplied

Critical points for sepsis management at the patient bedside.

Following an interpretative philosophy, dyna-mic and faithful to the complexity theory, a clinical pathway is outlined close to the reality, at the patient bedside, that is comprehensive of the diagnostic process in its temporal dynamism, of the therapeutic process in its specificity (antibiotic therapy, surgical souce control), in the use of organs supportive therapy (haemodynamic, respiratory, renal, etc.) and in the use of adjunctive and immunomodulatory therapies (APC, AT, etc.). The importance of the contextual activation of microbiological, immunological and coagulative monitorings is underlined. Through a critical review of the more recent literature, a strict relationship, in sepsis and septic shock, between inflammation and coagulation is described, that allowed the activated protein C (drotrecogin alpha activated) success, in terms of reduction of the absolute and relative mortality. This therapeutic success is contextualized into two other important therapeutic successes, recently obtained in severe sepsis and septic shock, based on the medical evidence, one using low doses of corticosteroids and the other using the early (6 h) goal directed haemodynamic therapy to restore a balance between oxygen delivery and oxygen demand. Once systemic inflammation is complicated by organ failure, there are few options. Treatment with activated protein C lowers the risk of death but is associated with an increased risk of bleeding and is likely to be expensive. The strategies described by the groups of Rivers and Annane offer the opportunity for good therapeutic results, by preventing the progression or even the development of sepsis and its complications: septic shock and multiple organ dysfunction.

Blood Coagulation↗
PubMedDate not supplied

[The estimation of p50 by the algorithm proposed by Siggard-Andersen. Its experimental assessment in critical patients].

STUDY OBJECTIVE: To determine the ability of O. Siggaard-Andersen algorithm in the estimation of the "in vivo" p50 and standard p50 values from a single blood sample with sO2% less than or equal to 97. DESIGN: comparison between measured and calculated standard p50 values. SETTING: Intensive care unit. PATIENTS: thirteen cardio-pulmonary critical ill patients. Mean age of seventy-four years (range 53-84 years). MEASUREMENT: The experimental measurement of p50 standard (p50st sper) was performed tonometering the venous blood samples (60 specimens) using an IL-237 tonometer at 37 degrees C, with two different gas mixtures to obtain pCO2 at 5.33 kPa (DS = 0.06), and pO2 at levels to achieve sO2% values close to 50%. The gases's complete equilibration was not deemed important. The pO2 values were corrected to a pH of 7.40 using a Bohr factor = -0.48 and the p50 was taken by simple interpolation of points on the sO2%/pO2 diagram. Calculated standard p50 (p50st calc) and calculated "in vivo" p50 on the venous specimens (No. 60) and the correspondent arterial specimens with sO2% less than or equal to 97 (No. 40) were obtained by Siggaard-Andersen's computerized algorithm. Blood specimen analysis was performed by means of an ABL3 Radiometer gas analyzer and an OSM3 Radiometer oximeter. Statistical analysis was made by Anova test for liner regression. RESULTS: There was excellent correlation between the 60 experimental p50st determined by Siggaard-Andersen's oxygen dissociation curve on the same blood samples. The regression equation was: p50st sper = -0.79 + 1.21 x p50st calc, r = 0.90, R2 = 81.1%; with F = 249.5 and less than 10(-5). No good correlation was found between p50st and standards p50 calculated on arterial specimens (p50st calc art): p50 = 1.38 + 0.52 x p50st calc art, r = 0.52, R2 = 26.6%, F = 14 e P less than 10(-3). Regression of in vivo P50 calculated on correspondent venous samples (p50 ven) was: p50 ven = 0.79 = 0.77 x p50 art, r = 0.93, R2 = 87.2%, F = 256 and P less than 10(-5). CONCLUSION: Our results suggest that the curve describes the curve also at high saturation when it is not longer linear. Accurate measurement (including dishemoglobin percentage) and sO2% less than or equal to 97 are necessary. We did not perform experimental measurements of "in vivo" p50 but we postulate that as the p50st was well calculated so too would be the p50 "in vivo" at 37 degrees C.

Aged↗
PubMedDate not supplied

[ARDS in MOFS (multiple organ failure syndrome). How to direct the therapy? A case report of MOFS in AIDS].

A young AIDS patient was admitted to the Intensive Therapy ward of our hospital with ARDS. The case raised the question of how medical and nursing personnel should face the problem of "suitable treatment for a terminally ill patient". Therapy was based on invasive methods such as mechanical ventilation and the insertion of catheters to monitor vital parameters. The evolution of ARDS in MOFS revealed the difficulty of sustaining vital parameters and avoiding pluriorganic damage.

Acquired Immunodeficiency Syndrome↗