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Biomedical subjects

M C Dolan

Publications and source records attributed to M C Dolan.

7 recordsLinked to original sources
PubMed1989

Evaluation of the validity of the Done nomogram in the management of acute salicylate intoxication.

To evaluate the validity of the Done nomogram in the management of acute adult salicylate intoxications, a retrospective review of cases at our institution was performed. The degree of severity (ie, asymptomatic, mild, moderate, or severe) as determined by plotting the serum concentration and time on the nomogram for 55 acute salicylate intoxications was compared with the degree of severity decided on by three experienced emergency physicians who based their decision on the clinical presentation of the cases and the original criteria devised by Done for each category of severity. Discordant classifications between the nomogram and the physicians provided a basis on which a predictive index for the nomogram and various subsets of cases could be determined. The calculated predictive index for the nomogram was 0.42, with the highest predictive index of 0.79 in the mild salicylate category. The nomogram tends to overpredict the severity of intoxication in the moderate and severe categories. There was no significant difference between predictive indexes of mixed versus nonmixed or enteric-coated acetylsalicylic acid versus plain acetylsalicylic acid cases, although the nomogram had a higher predictive index when used for concentrations drawn six to 12 hours after ingestion (P less than .01, Fisher's exact test). Decisions on management of an acute salicylate overdose should be based on clinical presentation and good judgment as well as the serum salicylate concentration in relation to the time of ingestion.

Adult↗
PubMed1989

Prehospital blind nasotracheal intubation by paramedics.

Blind nasotracheal intubation attempts by paramedics in the field were prospectively reviewed. In particular, we analyzed the frequency, success rate, complication rate, frequency of performance by each paramedic, indications, and patient outcome. Blind nasotracheal intubation was attempted in 324 patients and successful in 231. The average success rate for medical patients was 72.2% (195 of 270 attempts) and for trauma patients was 66.7% (36 of 54 attempts). This difference was not significant (P greater than .05). Even with 59.8% of the 82 participating paramedics attempting blind nasotracheal intubation less than four times over the 19-month study period, the average success rate was 71.3%. There was a significant increase in success when blind nasotracheal intubation was attempted more than three times during the study period (P less than .005). Major complications occurred in 0.9% (three) of the patients. The overall complication rate was 13% (42). The incidence of complications tended to decline with increasing paramedic frequency but did not reach statistical significance (P greater than .05). Blind nasotracheal intubation is a safe initial field airway approach in spontaneously breathing patients in whom there are no contraindications. Even with a low frequency of performance, success and complication rates are acceptable.

Allied Health Personnel↗
PubMed1987

Carboxyhemoglobin levels in patients with flu-like symptoms.

Subacute carbon monoxide poisoning is commonly misdiagnosed as an influenza-like viral illness. All patients presenting to the triage nurse at University Hospital with flu-like symptoms during February 1985 were asked to give blood samples for carboxyhemoglobin determination. Fifty-five patients (10% of those eligible) with headache, dizziness, nausea, vomiting, diarrhea, weakness, general malaise, or shortness of breath were enrolled in the study. Carboxyhemoglobin levels ranged from 0 to 21%. Thirteen patients (23.6%) of this self-selected subgroup had carboxyhemoglobin levels greater than or equal to 10%. There was no statistically significant difference in carboxyhemoglobin levels between smokers and nonsmokers. More patients using wood heat had elevated carboxyhemoglobin levels than patients using any other form of heating (P less than .05). No patient with a carboxyhemoglobin level greater than or equal to 10% was diagnosed as having subacute CO poisoning by emergency physicians. Physicians must seek out the possibility of CO toxicity in patients with flu-like illness, particularly in inner-city populations during the heating months. Fundoscopy and COHb levels may be useful in selected cases to correctly diagnose patients and avoid a return to a hazardous environment with potentially fatal consequences.

Adolescent↗
PubMed1987

Canine von Willebrand factor expresses a multimeric composition similar to human von Willebrand factor.

Canine von Willebrand factor (vWf) was compared to human vWf. Antisera raised against human vWf or canine vWf cross-reacted with both heterologous proteins and reactions of partial identity were seen using crossed immunoelectrophoresis. Similar patterns of multimerization were obtained for vWf from both canine and human sources using the enzyme-linked immunoelectrotransfer blot method. However, the canine protein displayed an altered electrophoretic mobility. The molecular weight of the vWf monomer was estimated by SDS-PAGE and found to be indistinguishable from that of human vWf monomer. Canine vWf is decreased in animals with clinically evident hypothyroidism and in heterozygous "carriers" of von Willebrand's disease (vWd) that display no clinical symptoms of vWd. Results expand the concept that von Willebrand's disease in dogs may be a useful model for study of vWd in humans, and that immunochemical methods established for studies of human vWf appear appropriate for studies of canine vWf.

Animals↗
PubMed1985

Carbon monoxide poisoning.

Carbon monoxide poisoning is a significant cause of illness and death. Its protean symptoms probably lead to a gross underestimation of its true incidence. Low levels of carbon monoxide aggravate chronic cardiopulmonary problems, and high levels are associated with cardiac arrhythmias and cerebral edema. Patients who survive acute poisoning are at risk of delayed neurologic sequelae. The measurement of carboxyhemoglobin levels does not reveal the tissue levels of carbon monoxide but is useful in determining therapy. Treatment includes the monitoring and management of cardiac arrhythmias and oxygenation. Hyperbaric oxygenation is beneficial, but there are currently no definite criteria for its use.

Carbon Monoxide Poisoning↗