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Biomedical subjects

J Schofferman

Publications and source records attributed to J Schofferman.

26 records · Page 2Linked to original sources
PubMed1977

Factors in successful resuscitation by paramedics.

The out-of-hospital reports of 2152 consecutive paramedic fire rescue responses were reviewed. Examination of emergency department records and outcome was conducted in all cardiopulmonary arrests (120), major trauma (59) or nontraumatic hemorrhage (9) and one half (95 of 199 patients) with chest pain or possible myocardial infarction. Predominant age was 50 to 70 (66%) and men outnumbered women by four to one. At the scene arrival was under five minutes in over 70% of the cases. Thirty of the 120 patients with cardiopulmonary arrest (12 occurred after paramedic arrival) responded to initial cardiopulmonary resuscitation, 24 patients entered the coronary care unit, and 16 were discharged alive. Ventricular fibrillation (50) and asystole (40) were the documented rhythms. All survivors had ventricular fibrillation. Evaluation of the trauma and nontraumatic blood loss victims indicated that, after the paramedic places an intravenous line, the paramedic role is less well defined. Mean transportation time was 36 (trauma) and 38 (hemorrhage) minutes to the hospital.

Adult↗
PubMed1977

Use of the telephone for short-term follow-up.

We have instituted a telephone appointment system (TAS) to follow patients with well-defined relatively minor problems. The patient is asked to call a special phone number at a specified date and time to obtain test results or information. A senior physician reviews each chart beforehand and indicates in lay terms, the information to be given to the patient by the clerk. Initial contact was made with 235 (58%) of the 404 scheduled telephone appointments reviewed during a four-week period. Physician data review time averaged one minute per chart and two full-time clerks were required. Although no improvement in patient compliance was found, significant savings of patient, physician, and nursing time are obvious. Additional advantages include decreased total patient load and the opportunity for senior physicians to assess the quality of care and provide feedback to the emergency department house officers.

Aftercare↗
PubMed1976

Upper airway obstruction.

A large number of diseases may present with respiratory distress. In adults, upper airway obstruction (UAO) is relatively rare. Consequently, UAO may initially be overlooked in the differential diagnosis of the dyspneic patient. Because it may progress rapidly, delays or errors in diagnosis can be critical. During an eight-month period in one emergency department, seven adult patients with potentially life-threatening diseases of the upper airway were seen. To reacquaint physicians with the syndrome of mechanical obstruction of large airways, several illustrative cases are presented and the syndrome is discussed.

Adult↗
PubMed1976

Arterial blood gases in acute pulmonary edema.

Arterial blood gas and pH measurements in 82 patients with acute pulmonary edema of cardiogenic origin entering the emergency department varied widely and were unpredictable using clinical examination. The mean arterial oxygen tension (PaO2) measured in 71 patients breathing room air was 59 mm Hg. Fourteen of the 82 patients were acidemic; 35, alkalemic and 33 had a pH in the normal range. The acidemic group had markedly lower PaO2, all under 60 mm Hg. Oxygen and furosemide were used in all cases and effectively corrected the hypoxia and reduced pulmonary congestion. Other drugs used included aminophylline (14 patients), morphine sulfate (9 patients) and digoxin (3 patients). Five of the nine patients who received morphine were hypercarbic initially but the CO2 retention did not worsen. No patient died during the initial 48 hours. This study reiterates the importance of directing therapy at ventilatory and cardiac abnormalities and points out the value of arterial blood gas monitoring to assess the initial status, monitor the patient's course, and to select drug therapy.

Acidosis↗
PubMed1976

The esophageal obturator airway. A clinical evaluation.

The esophageal obturator airway (EOA) has been considered a useful ventilatory technique for cardiopulmonary resuscitation, but quantitative analysis of its clinical effectiveness is not available. We evaluated the EOA in 18 patients who had suffered prehospital cardiac arrest and who were resuscitated by mobile intensive care unit paramedics employing an EOA. Arterial blood gas determinations were obtained during ventilation with the EOA and then repeated after endotracheal intubation. Arterial oxygen tension (PaO2) greater than 64 mm Hg was achieved in 11 of 12 patients who had been converted to supraventricular rhythm, despite varying inspired oxygen concentrations. A PaO2 greater than 77 mm Hg was achieved in three of six patients still requiring external cardiac massage. There was little or no improvement in oxygenation after endotracheal intubation, implying that the failures to oxygenate were not due to the EOA. We conclude that the EOA is a useful adjunct during cardiopulmonary resuscitation when endotracheal intubation is not feasible.

Adult↗