PubMed Health⌕ Search

Biomedical subjects

M Eckstein

Publications and source records attributed to M Eckstein.

At least 19 recordsLinked to original sources
PubMed2001

Implementation of standing field treatment protocols in an urban EMS system.

The objective was to describe our experience with implementation of standing field treatment protocols (SFTP) in a large, urban EMS system. A prospective, consecutive observational study examining the first 21 days of implementation of SFTPs in the City of Los Angeles, California. SFTPs were developed for 7 medical chief complaints and all major trauma patients. There were 13,586 EMS incidents, of which 4,037 (30%) received ALS treatment. SFTPs were used on 2,177 of these incidents, representing 54% of all ALS runs and 16% of all EMS incidents. The most frequently used SFTPs were for altered level of consciousness (29%), and chest pain (25%). The most common errors found were failure to document reassessment of the patient after each medication administration (45% fallout rate), and failure to document and attach a copy of the ECG to the EMS report (40%). The mean fallout rate for failure to establish or attempt IV access, administer oxygen, or provide cardiac monitoring was 7%. Out of 1,450 incidents with outcome data provided by the receiving hospitals, only 3 cases (2%) involved incorrect treatment, with an additional 2 involving the unnecessary use of lidocaine. None of these instances resulted in adverse effects or complications. SFTPs were integrated into a large EMS system with few procedural errors or adverse outcomes.

Adult↗
PubMed2001

Termination of resuscitative efforts: medical futility for the trauma patient.

Despite years of research on the resuscitation of the patient with critical traumatic injuries, controversy remains surrounding the criteria to waive initiation of resuscitation in the pre-hospital setting or to terminate such efforts in the emergency department. The decision to initiate or continue resuscitation on moribund trauma patients is associated with considerable costs. Ambulance transport using lights and sirens carries potential risk. Emergency department thoracotomy, with exposure to high risk bodily fluids, involvement of numerous staff, and usage precious blood products, is a procedure that has fewer and fewer indications. This review presents guidelines to help determine when to initiate resuscitation for the critically injured trauma patient and when to cease these efforts in the emergency department. Since there are economic, societal, and ethical implications, each system should establish their own criteria, using these guidelines as a basis.

Cardiopulmonary Resuscitation↗
PubMed2001

Heart-to-heart talk. Roundtable discussion.

This past August the American Heart Association (AHA) released a major revision of its recommendations for emergency cardiovascular care (ECC). The 2000 guidelines simplify CPR techniques for the layperson and strongly promote the use of community early defibrillation. What repercussions can we expect from these changes? We asked five experts to join a roundtable discussion of the BLS aspects of these new guidelines. Their conversation follows.

Cardiopulmonary Resuscitation↗
PubMed2000

Spatial covert attention increases contrast sensitivity across the CSF: support for signal enhancement.

This study is the first to report the benefits of spatial covert attention on contrast sensitivity in a wide range of spatial frequencies when a target alone was presented in the absence of a local post-mask. We used a peripheral precue (a small circle indicating the target location) to explore the effects of covert spatial attention on contrast sensitivity as assessed by orientation discrimination (Experiments 1-4), detection (Experiments 2 and 3) and localization (Experiment 3) tasks. In all four experiments the target (a Gabor patch ranging in spatial frequency from 0.5 to 10 cpd) was presented alone in one of eight possible locations equidistant from fixation. Contrast sensitivity was consistently higher for peripherally- than for neutrally-cued trials, even though we eliminated variables (distracters, global masks, local masks, and location uncertainty) that are known to contribute to an external noise reduction explanation of attention. When observers were presented with vertical and horizontal Gabor patches an external noise reduction signal detection model accounted for the cueing benefit in a discrimination task (Experiment 1). However, such a model could not account for this benefit when location uncertainty was reduced, either by: (a) Increasing overall performance level (Experiment 2); (b) increasing stimulus contrast to enable fine discriminations of slightly tilted suprathreshold stimuli (Experiment 3); and (c) presenting a local post-mask (Experiment 4). Given that attentional benefits occurred under conditions that exclude all variables predicted by the external noise reduction model, these results support the signal enhancement model of attention.

Attention↗
PubMed2000

Laser-induced chorioretinal venous anastomosis for non-ischaemic hemi-central vein occlusion.

PURPOSE: To assess the effectiveness and complications of laser-induced chorioretinal venous anastomosis performed on eyes with non-ischaemic hemi-central retinal vein occlusions (hemi-CRVO). METHODS: Fourteen eyes with a hemi-CRVO which reduced the visual acuity to 6/24 or less were treated with argon laser photocoagulation in an attempt to create a chorioretinal venous anastomosis between a retinal vein and the choroidal circulation. RESULTS: Laser anastomoses were successfully created in six eyes (43%) and required a mean of 1.8 attempts in each eye. Of the eyes that developed an anastomosis, four had significant visual improvement. The distal retinal venous segment closed off in five eyes and these had prophylactic segmental argon pan-retinal photocoagulation performed. Two eyes had localized fibrovascular proliferation. No permanent vision-threatening complications were observed in any of the 14 eyes over the follow-up period. CONCLUSIONS: Successful anastomosis between the retinal and choroidal circulation in eyes with hemi-vein occlusions may reduce macular oedema and improve vision. Complications of the technique are significant and a randomized clinical trial is due to commence which may clarify the suitability of this treatment.

Aged↗
PubMed2000

Effect of prehospital advanced life support on outcomes of major trauma patients.

OBJECTIVE: Determine whether prehospital advanced life support (ALS) improves the survival of major trauma patients and whether it is associated with longer on-scene times. METHODS: A 36-month retrospective study of all major trauma patients who received either prehospital bag-valve-mask (BVM) or endotracheal intubation (ETI) and were transported by paramedics to our Level I trauma center. Logistic regression analysis determined the association of prehospital ALS with patient survival. RESULTS: Of 9,451 major trauma patients, 496 (5.3%) had either BVM or ETI. Eighty-one percent received BVM, with a mean Injury Severity Score of 29 and a mortality rate of 67%; 93 patients (19%) underwent successful ETI, with a mean Injury Severity Score of 35 and a mortality rate of 93%. Adjusted survival for patients who had BVM was 5.3 times more likely than for patients who had ETI (95% confidence interval, 2.3-14.2, p = 0.00). Survival among patients who received intravenous fluids was 3.9 times more likely than those who did not (p = not significant). Average on-scene times for patients who had ETI or intravenous fluids were not significantly longer than those who had BVM or no intravenous fluids. CONCLUSION: ALS procedures can be performed by paramedics on major trauma patients without prolonging on-scene time, but they do not seem to improve survival.

Adolescent↗
PubMed2000

Simulating coronary arteries in x-ray angiograms.

Clinical validation of quantitative coronary angiography (QCA) algorithms is difficult due to the lack of a simple alternative method for accurately measuring in vivo vessel dimensions. We address this problem by embedding simulated coronary artery segments with known geometry in clinical angiograms. Our vessel model accounts for the profile of the vessel, x-ray attenuation in the original background, and noise in the imaging system. We have compared diameter measurements of our computer simulated arteries with measurements of an x-ray Telescopic-Shaped Phantom (XTSP) with the same diameters. The results show that for both uniform and anthropomorphic backgrounds there is good agreement in the measured diameters of XTSP compared to the simulated arteries (Pearson's correlation coefficient 0.99). In addition, the difference in accuracy and precision of the true diameter measures compared to the XTSP and simulated artery diameters was small (mean absolute error across all diameters was < or = 0.11 mm +/- 0.09 mm).

Algorithms↗
PubMed2000

Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS).

BACKGROUND AND PURPOSE: Reliable identification of stroke patients in the field by prehospital personnel could expedite delivery of acute stroke therapy. The Los Angeles Prehospital Stroke Screen (LAPSS) is a 1-page instrument designed to allow prehospital personnel to rapidly identify acute stroke patients in the field. We performed a prospective, in-the-field validation study of the LAPSS. METHODS: Paramedics assigned to 3 University of California at Los Angeles-based advanced life support units were trained and certified in use of the LAPSS. Over 7 months, paramedics completed the LAPSS on noncomatose, nontrauma patients with complaints suggestive of neurological disease. LAPSS form stroke identification results were compared with emergency department and final hospital discharge diagnoses. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and likelihood ratios were calculated for LAPSS identification of ischemic stroke, currently symptomatic transient ischemic attack, and intracerebral hemorrhage. RESULTS: Of a total of 1298 runs, 34% were for nontraumatic, noncomatose neurologically relevant complaints. Thirty-six of these patients (3% of all transports) had a final diagnosis of acute symptomatic cerebrovascular disease (21 ischemic strokes, 7 transient ischemic attacks, and 8 intracerebral hemorrhages). LAPSS forms were completed on 206 patients. Paramedic performance when completing the LAPSS demonstrated sensitivity of 91% (95% CI, 76% to 98%), specificity of 97% (95% CI, 93% to 99%), positive predictive value of 86% (95% CI, 70% to 95%), and negative predictive value of 98% (95% CI, 95% to 99%). With correction for the 4 documentation errors, positive predictive value increased to 97% (95% CI, 84% to 99%). CONCLUSIONS: The LAPSS allows prehospital personnel to identify patients with acute cerebral ischemia and intracerebral hemorrhage with a high degree of sensitivity and specificity.

Aged↗
PubMed1999

The maintenance of apparent luminance of an object.

Results from luminance discriminations with objects defined by apparent motion suggest an object-specific temporal integration of luminance. Further experiments suggested that this integration is weighted to favor the initial display of an object and involves the percept of surface reflectance (lightness). These results are consistent with the object-file metaphor suggested by D. Kahneman, A. Treisman, and B. Gibbs (1992), in which an object's perceived initial surface reflectance is assigned and maintained in an object file. A strategy is proposed in which the intrinsic properties of an object are assumed not to change over time. As intrinsic properties are generally invariant and possibly difficult to compute, this strategy would have the advantage of relatively high accuracy at relatively low computational cost.

Adult↗
PubMed1999

The effect of a quality improvement program on paramedic on-scene times for patients with penetrating trauma.

OBJECTIVE: To decrease paramedic on-scene times (OSTs) for major trauma patients through a focused quality improvement (QI) program. METHODS: A prospective study was conducted from 1993 through 1997 to determine the impact of a QI program on paramedic OSTs. All penetrating trauma patients transported by paramedics to Los Angeles County/USC Medical Center, a Level-1 trauma center, were included, and all cases with OSTs > 20 minutes were reviewed in detail for extenuating circumstances. Cases including multiple victims or unsecured scenes were considered "acceptable deviations." All others were considered "fallouts," which prompted extensive review with the paramedics and their field supervisors. RESULTS: Prior to the inception of the QI project there was a 4.1% fallout rate of penetrating trauma patients with OSTs > 20 minutes. This fallout rate fell to 1.5% in 1997 (p < 0.01). Mortality rates among these fallouts decreased from 5.1% to 0.8% during the study period (p < 0.01). CONCLUSIONS: An intensive QI program can have a significant, positive impact on paramedic OSTs among patients with penetrating trauma.

Emergency Medical Services↗
PubMed1999

Out-of-hospital and emergency department management of epidemic scombroid poisoning.

OBJECTIVE: To report two epidemic outbreaks of scombroid food poisoning and their emergency medical services (EMS) response and emergency department (ED) treatment, analyzing the impact of early physician involvement and on-line medical control. METHODS: Retrospective case series of two multiple-casualty incidents (MCIs) involving scombroid food poisoning. RESULTS: A total 57 patients were treated from two separate incidents, with 30 patients transported to area hospitals. One patient required treatment with a cardiac medication in the field and another patient eventually required hospital admission. On-scene medical control (incident 1) and early identification of the index case (incident 2) were instrumental to out-of-hospital care interventions and conservation of resources. Patient triage, field treatment, and hospital transport were expedited, with some patients treated and released from the scene. CONCLUSIONS: Immediate diagnosis of a food-borne illness in the out-of-hospital setting allows rapid treatment at the scene and allows for the efficient transport of multiple patients to a single receiving facility. EMS medical directors should be able to immediately respond to such incidents to make presumptive diagnoses and accurately direct patient care. When this is not possible, early identification of the index case facilitates early diagnosis and treatment.

Adult↗
PubMed1999

Randomised clinical trial of lensectomy versus lens aspiration and primary capsulotomy for children with bilateral cataract in south India.

AIMS: The primary objective was to determine which surgical technique gave the best long term visual outcome for infants and young children with bilateral symmetrical cataract in south India. Secondary objectives were to assess complications and the need for further surgical intervention. METHODS: A randomised controlled clinical trial was undertaken. 65 children under 10 years old with bilateral cataract had one eye treated by lensectomy and the other by aspiration with primary capsulotomy. RESULTS: 56 children (86%) with a mean age at surgery of 53 months were reviewed 3 years after surgery. The overall binocular acuity was 6/18 or better in 57.1% and 6/60 or better in 94.6%. There was no difference in visual acuity between the matched pairs of eyes undergoing aspiration or lensectomy at the third year of follow up (p=0.57). Aspiration eyes were more likely to require a secondary procedure to restore vision than lensectomy eyes (66.1% v 1.8%). CONCLUSION: Aspiration with primary capsulotomy gives an acceptable visual outcome in this part of India providing that there is good follow up to manage capsule opacification. If secondary intervention is not possible owing to poor compliance with follow up, then lensectomy is likely to give better long term visual rehabilitation providing there is good maintenance and technical support for the lensectomy equipment.

Amblyopia↗
PubMed1998

Reappraising the prehospital care of the patient with major trauma.

Recent research efforts have demonstrated that many long-standing practices for the prehospital resuscitation of trauma patients may be inappropriate, particularly in certain circumstances. Traditional practices, such as application of antishock garments and IV fluid administration, may even be detrimental in certain patients with uncontrolled bleeding. Endotracheal intubation, although potentially capable of prolonging a patient's ability to tolerate circulatory arrest, may be harmful if overzealous ventilation further compromises cardiac output in such severe hemodynamic instability. If these procedures delay patient transport, any benefit they may offer could be outweighed by delaying definitive care. To improve current systems of trauma care, future trauma research must address the different mechanisms of injury, the anatomic areas involved, and the physiologic staging in a given patient.

Emergency Treatment↗
PubMed1998

Lethal abdominal gunshot wounds at a level I trauma center: analysis of TRISS (Revised Trauma Score and Injury Severity Score) fallouts.

BACKGROUND: The TRISS methodology (composite index of the Revised Trauma Score and the Injury Severity Score) has become widely used by trauma centers to assess quality of care. The American College of Surgeons recommends including negative TRISS fallouts (fatally injured patients predicted to survive by the TRISS methodology) as a filter to select patients for peer review. The purpose of this study was to analyze the TRISS fallouts among patients with lethal abdominal gunshot wounds admitted to a level I trauma center. STUDY DESIGN: All patients categorized as TRISS fallouts admitted from January 1995 through December 1996 were analyzed. RESULTS: During the study period, 848 patients with abdominal gunshot wounds were admitted. Of the 108 patients with any sign of life on admission who subsequently died, 39 (36%) were TRISS fallouts. The patients were largely young (mean age, 29 years) and male (87%), received rapid transport (mean scene time, 11 minutes), and had an attending-led trauma-team response (<5 minutes, 87%). Major vascular (80%) and multiple intraabdominal injuries (90%) predominated. The mean Penetrating Abdominal Trauma Index was 40.3. The mean TRISS probability of survival was 89%. The peer-review process deemed the deaths to be nonpreventable in 38 patients (97%) and potentially preventable in one patient (3%). CONCLUSIONS: "TRISS fallouts" were predominantly patients who died despite receiving rapid prehospital transport, rapid senior-level trauma-team response, and surgical intervention for a serious complex of injuries. We conclude that without regional adjustment of coefficients used to predict the probability of survival, the TRISS methodology is of limited use in patients with abdominal gunshot wounds.

Abdominal Injuries↗
PubMed1998

Surgical removal of non-age-related subfoveal choroidal neovascular membranes.

PURPOSE: To assess anatomical and visual results following the surgical removal of non-age-related subfoveal choroidal neovascular membranes. METHODS: A retrospective study was carried out of 31 consecutive patients undergoing vitrectomy, parafoveal retinotomy and removal of subfoveal choroidal neovascular membranes that were either idiopathic or associated with multifocal choroiditis, high myopia, trauma or angioid streaks. RESULTS: Visual acuity improved or remained the same in 25 eyes (81%) after a mean follow-up of 10.1 months (range 3-37 months). visual acuity improved by more than 2 lines of Snellen acuity in 5 eyes (16%) and decreased by more than 2 lines in 2 eyes (6%). There was no significant association between the final visual outcome and length of symptoms prior to surgery or pre-operative visual acuity. Atrophy of the retinal pigment epithelium and older age were associated with poor outcome. Membranes recurred in 11 eyes (35%), and eyes with subfoveal blood prior to surgery were more likely to have recurrent membranes. CONCLUSIONS: The results of surgical removal of non-age-related subfoveal neovascular membranes have been encouraging, but further studies of long-term outcome and of the natural history of individual conditions are required.

Adolescent↗