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Biomedical subjects

M B Heller

Publications and source records attributed to M B Heller.

At least 19 recordsLinked to original sources
PubMed1992

Emergency management of acute pain. New options and strategies.

Emergency physicians often encounter patients in pain and may also have to cope with other problems (eg, alcohol intoxication, a patient's stubborn will to drive after the emergency department visit, narcotic "allergy"). Novel approaches can be used to treat these patients. Dr Heller discusses such approaches, including measures for treating patients with drug-seeking behavior (eg, use of nonnarcotic parenteral agents), and describes treatment options for patients with such specific conditions as hypotension, chest pain, and renal colic.

Acute Disease↗
PubMed1992

Ultrasonography in emergency medicine.

The use of ultrasonography in emergency medicine is an area of rapid growth and controversy. This article reviews the current and future applications of emergency ultrasonography with particular emphasis on the role of bedside scanning by the emergency practitioner. Abdominal, pelvic, and cardiac ultrasonographic applications are reviewed, as are the uses of ultrasonography as an adjunct to the performance of procedures in the Emergency Department.

Abdomen, Acute↗
PubMed1991

Confirmation of endotracheal tube placement: a miniaturized infrared qualitative CO2 detector.

STUDY OBJECTIVES: A miniaturized, infrared, solid-state, end-tidal CO2 detector was used to confirm emergency endotracheal tube (ETT) placement. DESIGN: This prospective, clinical study used a miniature, infrared, solid-state end-tidal CO2 detector to confirm ETT placement in an acute setting. SETTING: The ICU, emergency department, and hospital floor. TYPE OF PARTICIPANTS: There were 88 consecutive adult patients requiring 100 emergency intubations. MEASUREMENTS AND MAIN RESULTS: The indication for airway intervention was considered urgent in 79% and under arrest conditions in 21%. The mean number of intubation attempts was 1.83 (range, one to five) with difficulty of intubation of 6.48 and confirmation of 7.75, on a linear scale from 0 (lowest) to 10 (highest). Determination of ETT position revealed intratracheal intubation in 96% and esophageal intubation in 4%. Placement was confirmed by direct visualization or radiography in all cases. Sensitivity and specificity for ETT localization was 100% (P less than .0001). CONCLUSION: This hand-held infrared capnometer reliably confirms ETT placement under emergency conditions.

Carbon Dioxide↗
PubMed1991

Verification of endotracheal tube placement with colorimetric end-tidal CO2 detection.

STUDY OBJECTIVE: To determine the ability of a disposable colorimetric CO2 detector to accurately confirm or refute endotracheal tube placement. DESIGN: Two hundred fifty prospective emergency intubations. SETTING: Emergency intubations performed in the emergency department, helicopter, and prehospital ground environment. TYPE OF PARTICIPANTS: Intubations were performed by emergency medicine residents, paramedics, and flight nurses. INTERVENTIONS: The FEF CO2 detector was applied after 250 emergency intubations. Notation of color change indicating intratracheal placement was recorded in each case. Confirmation of refutation of the detector's results was determined subsequently through traditional methods. RESULTS: The sensitivity for confirmation of endotracheal intubation in the 137 patients with a palpable pulse was 100%. However, only 76 of 103 patients (sensitivity, 72%) in cardiac arrest had endotracheal intubation confirmed by color change. The device was uniformly specific for tracheal intubation in 73 arrested patients in whom a color change was noted (100%). There was one instance (of a total of seven misintubations) in which a positive color change was noted, but the tube was not intratracheal (specificity, 86%). Overall sensitivity for tracheal intubation was 88% (95% confidence limits; range, 0.83 to 0.92), and specificity for tracheal intubation was 92% (95% confidence limits; range, 0.62 to 0.99). CONCLUSION: The FEF colorimetric detector reliably detects intratracheal placement in the nonarrested patient. Its use in prolonged cardiac arrest merits further study.

Breath Tests↗
PubMed1991

Use of portable ultrasound to assist urine collection by suprapubic aspiration.

STUDY OBJECTIVE: To determine whether portable ultrasound can improve the success rate of suprapubic aspiration (SPA). DESIGN: Patients were randomly assigned to either ultrasound or no ultrasound groups. In the ultrasound group, patients underwent SPA if ultrasound revealed urine in the bladder: if no urine was present, patients underwent catheterization instead of SPA. In the no-ultrasound group, SPA was attempted without ultrasound. All unsuccessful SPAs were followed by catheterization and measurement of urine volume. SETTING: Children's hospital-based pediatric emergency department. PARTICIPANTS: Children less than 2 years old who required SPA. INTERVENTIONS: Ultrasound versus no ultrasound. RESULTS: Thirty-five patients were randomized to the ultrasound group, and 31 were randomized to the no-ultrasound group. SPA was successful in 79% of attempts in the ultrasound group compared with 52% in the no-ultrasound group (P = .04). The sensitivity and specificity of ultrasound were 90% and 86%, respectively. CONCLUSION: Portable ultrasound can significantly improve the success rate of SPA and limit nonproductive attempts at SPA.

Cost-Benefit Analysis↗
PubMed1990

Prehospital use of nifedipine for severe hypertension.

The prehospital management of severe hypertension is limited by a paucity of pharmacologic agents suitable for field use. This prospective study was designed to test the safety and efficacy of intraoral nifedipine therapy in 50 patients with severe hypertension being transported by an urban emergency medical service system. Ten milligrams of nifedipine were administered. Serial blood pressure determinations were obtained at 3, 5, 10, and 15 minutes and patients were observed for possible side effects. A marked effect on systolic blood pressure (SP), diastolic blood pressure (DP), and mean arterial pressure (MAP) was evident and was statistically significant in all three categories by 3 minutes. MAP decreased from 169 to 129 mm Hg (delta MAP of 40 mm Hg) at 15 minutes with parallel changes in the SP (55 mm Hg) and delta DP (32 mm Hg). These changes were highly significant (P less than .01) when compared with those of 50 historical controls. No evidence of severe adverse effects were noted. Nifedipine appears to be a promising agent for the prehospital treatment of severe hypertension, but its proper role is not yet defined.

Administration, Oral↗
PubMed1990

The safety of prehospital naloxone administration by paramedics.

We performed a retrospective review to investigate the safety of prehospital naloxone administration by paramedics as part of a protocol for all patients presenting with an acutely depressed level of consciousness (LOC). The prevalence of naloxone-induced vomiting, seizures, hypotension, hypertension, and cardiac arrest was sought from the prehospital records of 813 patients treated during a 12-month period. The mean age of the treated patients was 42.4 +/- 9.7 years. The initial dose of naloxone was 0.4 to 0.8 mg, and the mean total dose was 0.9 +/- 0.6 mg. No patients lost a pulse within ten minutes of receiving naloxone. Two patients (0.2%) experienced a significant drop in systolic blood pressure, and one patient (0.1%) demonstrated a significant rise in systolic blood pressure within five minutes of naloxone administration. Vomiting occurred in two patients (0.2%), and one patient (0.1%) suffered a tonic-clonic seizure within five minutes of naloxone administration. Of the 813 patients treated, 60 patients (7.4%: mean age, 32.3 +/- 6.7 years) were judged to have an improved LOC after naloxone, with 27 (3.3%) regaining a normal LOC. We conclude that in the above doses, naloxone is safe as part of prehospital protocols for paramedics treating patients with an acutely depressed LOC. However, the vast majority of patients treated empirically with naloxone in the field demonstrated no benefit.

Adult↗
PubMed1990

Intravenous verapamil in the prehospital treatment of paroxysmal supraventricular tachycardia.

The prehospital treatment of paroxysmal supraventricular tachycardia (PSVT) with verapamil alone or in comparison with other interventions has not been studied. A sequential protocol consisting of Valsalva maneuver, ice packs, pneumatic antishock garment inflation, and verapamil 0.5 mg IV was implemented in an urban emergency medical services system after appropriate paramedic education. On-line physician discretion could alter the protocol in specific clinical situations. Inclusion criteria required a narrow-complex regular tachycardia at a rate of between 150 and 250. Of 43 patients identified, the protocol was applied sequentially in 26 (60%) and with valid physician discretion in 15 patients (35%) (due to hypotension, chest pain, or dyspnea). Conversion to a more stable rhythm occurred in 25 patients (59%). Of these, all but one achieved a sinus mechanism. The Valsalva maneuver and ice pack application were ineffective in achieving rhythm conversion, being successful in only two of 33 (6%), one of 31 (3%), and four of 24 (17%) attempts, respectively (P greater than .05). Verapamil, however, was significantly more effective (18 of 24 attempts, 75%) than any of the other interventions either singly (P less than .01) or in combination (P less than .0001). No clinically important adverse effects occurred with any intervention, but application of the protocol increased mean on-scene time to 30.6 minutes. We conclude that verapamil is an effective agent for the prehospital termination of PSVT but that careful on-line physician supervision and a system for confirming rhythm identification are both essential.

Adolescent↗
PubMed1990

Open-chest cardiac massage. The possible rebirth of an old procedure.

Open-chest cardiac massage was widely and successfully used for many decades before its virtual abandonment 25 years ago. Both experimental evidence and basic physiologic evidence indicate that it has many advantages over closed-chest massage (especially increased cardiac output). Both resuscitation techniques have specific and unique advantages and disadvantages: They are not mutually exclusive. However, significant increases in rates of survival after cardiac arrest cannot be expected with variations of closed-chest cardiac massage and standard advanced life support services. Therefore, physicians must be willing to support controlled human studies that can definitively determine the proper role of each in resuscitation after cardiac arrest.

Animals↗
PubMed1989

An analysis of clinical toxicology urine specimens using the KDI Quik test.

The KDI Quik test is a rapid qualitative method for detecting narcotics, cocaine, PCP, and amphetamines in urine. The accuracy of this test was evaluated by testing 106 clinical toxicology urine specimens. Three investigators independently reviewed the test results and compared them to results of standard toxicological analyses. Of 83 samples found positive by the reference technique, only 70 were correctly identified as positive on the Quik test; only nine of 23 truly negative controls were correctly identified as negative by the Quik test. The overall sensitivity of the test was 84.7% while the specificity was 39.1%. As inaccuracies of this degree could result in frequent clinical error, use of the Quik test is not recommended.

Amphetamines↗