PubMed Health⌕ Search

Biomedical subjects

M G Goetting

Publications and source records attributed to M G Goetting.

At least 37 records · Page 2Linked to original sources
PubMed1991

Treatment of acute hypoxemic respiratory failure caused by chlorine exposure.

Chlorine inhalation may rapidly cause pulmonary edema, leading to acute hypoxemic respiratory failure. We report a 12 year old with acute respiratory failure from inhalation injury after he accidentally dropped chlorine tablets into a swimming pool. Supplemental oxygen alone failed to provide adequate arterial oxygenation. We administered positive end expiratory pressure (PEEP) in the emergency department, resulting in markedly improved oxygenation. Early institution of PEEP should be considered in patients with chlorine poisoning when supplemental oxygen alone is insufficient.

Child↗
PubMed1991

Regional cerebrovascular oxygen saturation measured by optical spectroscopy in humans.

Regional cerebrovascular oxygen saturation, a quantitative measure of hemoglobin saturation in the combined arterial, venous, and microcirculatory compartments of the brain, can be measured noninvasively with near infrared spectroscopy. We assessed the sensitivity of this aggregate saturation to cerebral hypoxia during transient cerebral hypoxic hypoxia in seven human subjects. Regional cerebrovascular oxygen saturation measured over the middle frontal gyrus and analog electroencephalogram were recorded. We compared the time to achieve two end points: the earliest paroxysmal burst of theta-delta background slowing and a cerebrovascular oxygen saturation of less than 55%. Saturation fell below 55% prior to the electroencephalographic change (p less than 0.05). In a related effort, we also compared spectroscopically measured regional cerebrovascular oxygen saturation with an estimate of this value calculated from arterial and cerebral mixed venous saturation in nine patients. A positive linear relation (n = 68, R2 = 0.55, s = 4.2) was noted.

Adult↗
PubMed1990

Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation.

Coronary perfusion pressure (CPP), the aortic-to-right atrial pressure gradient during the relaxation phase of cardiopulmonary resuscitation, was measured in 100 patients with cardiac arrest. Coronary perfusion pressure and other variables were compared in patients with and without return of spontaneous circulation (ROSC). Twenty-four patients had ROSC. Initial CPP (mean +/- SD) was 1.6 +/- 8.5 mm Hg in patients without ROSC and 13.4 +/- 8.5 mm Hg in those with ROSC. The maximal CPP measured was 8.4 +/- 10.0 mm Hg in those without ROSC and 25.6 +/- 7.7 mm Hg in those with ROSC. Differences were also found for the maximal aortic relaxation pressure, the compression-phase aortic-to-right atrial gradient, and the arterial PO2. No patient with an initial CPP less than 0 mm Hg had ROSC. Only patients with maximal CPPs of 15 mm Hg or more had ROSC, and the fraction of patients with ROSC increased as the maximal CPP increased. A CPP above 15 mm Hg did not guarantee ROSC, however, as 18 patients whose CPPs were 15 mm Hg or greater did not resuscitate. Of variables measured, maximal CPP was most predictive of ROSC, and all CPP measurements were more predictive than was aortic pressure alone. The study substantiates animal data that indicate the importance of CPP during cardiopulmonary resuscitation.

Aorta↗
PubMed1990

Jugular bulb catheterization: experience with 123 patients.

Jugular bulb catheterization (JBC) provides cerebral venous access for titration of brain-specific therapy. Little has been written about the catheterization procedure. We prospectively studied the time, number of punctures, success rate, and complications during JBC for a 24-month period in our ICUs. One hundred twenty-three patients (mean age 6.7 yr, range 12 hours to 21 yr) underwent JBC. Procedure time was 15.6 +/- 5.0 (SD) min. Median number of skin punctures was two. All but four were successful on first attempt. Three of the remaining were catheterized on second attempt. Inadvertent carotid puncture occurred in 3%. No other significant complications were noted. Radiography confirmed proper position in 97%. Duration of indwelling venous catheters was 2.5 +/- 1.6 days. All catheters functioned well until removal. We conclude that our technique of JBC is safe and highly successful. It compares favorably with previous, smaller series and with standard anterograde internal jugular catheterization in both children and adults.

Brain↗
PubMed1990

Passive inhalation of cocaine by infants.

Cocaine abuse has increased greatly in recent years, creating important medical, legal, and social problems. Urine drug testing is used to diagnose cocaine ingestion. The presence of the cocaine metabolite benzoylecgonine (BZ) is commonly believed to be proof of recent cocaine intoxication. However, oral ingestion of even a minute quantity of cocaine can result in a positive test result. BZ was detected in the urine of four nonbreast-fed infants aged 6 weeks to 14 months who were admitted with diagnoses unrelated to cocaine poisoning. These infants were exposed to cocaine by passive inhalation of vapors generated by adult caretakers smoking "crack" cocaine. Two of the infants were retested 12 hours later and had no detectable BZ, strongly suggesting ingestion of a subpharmacologic amount of cocaine. Because passive inhalation of cocaine can produce measurable urine BZ concentrations, a positive urine screen does not necessarily indicate poisoning or intentional administration of the substance and therefore is not proof of child abuse or neglect.

Cocaine↗
PubMed1989

High dose epinephrine in refractory pediatric cardiac arrest.

Cardiac arrest has a poor prognosis, regardless of age group. Children who fail to respond to two standard doses of epinephrine (0.01 mg/kg) rarely survive to hospital discharge, and most die without the return of spontaneous circulation (ROSC). We treated seven consecutive children in cardiac arrest with high dose epinephrine (0.2 mg/kg) after failure to respond to two standard doses. Six had prompt and sustained ROSC. By comparison, in the previous 20 consecutive pediatric patients with cardiac arrest in which there was no response to two standard doses of epinephrine, none had ROSC. Previous animal data as well as anecdotal human experience suggest that the standard epinephrine dose (0.01 mg/kg) may be much too low.

Adolescent↗
PubMed1989

Simultaneous aortic, jugular bulb, and right atrial pressures during cardiopulmonary resuscitation in humans. Insights into mechanisms.

Pressure gradients across and between the head and chest were studied during mechanical cardiopulmonary resuscitation (CPR) in 22 humans. Patients in medical cardiac arrest, managed by ACLS guidelines, underwent placement of aortic arch (Ao), jugular venous bulb (JVB), and right atrial (RA) catheters. Simultaneous pressures were measured, and intercatheter gradients were calculated. The JVB to RA pressure difference is the gradient between the cervical and central venous circulations. It was negative when averaged throughout the CPR cycle and was more negative during compression than relaxation, -19 +/- 12 and -2 +/- 6 mm Hg, respectively. This indicates that the intrathoracic pressure rise was not transmitted to the jugular venous system, supporting the concept of a competent jugular valve mechanism during CPR. It is consistent with the thoracic pump model of cerebral perfusion. JVB to RA was positive only during early relaxation, allowing blood return from the head. The Ao to JVB gradient, although not equal to cerebral perfusion pressure, is the maximum potential pressure gradient for blood flow across the cerebral vasculature. It was positive throughout CPR, 25 +/- 17 during compression, and 9 +/- 10 mm Hg during relaxation. The Ao to RA gradient during the relaxation phase is CPR coronary perfusion pressure. In most patients, it was minimally positive in both phases of the CPR cycle: 7 +/- 14 in compression and 7 +/- 9 mm Hg during relaxation. This appears to be inadequate in providing sufficient blood flow to meet the metabolic needs of the myocardium. Four patients had larger gradients during compression suggestive of cardiac compression.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

Massive hemorrhage into intracranial neurinomas.

Massive bleeding into an intracranial neurinoma is a rare event. The 12th case of this particular occurrence, which was precipitated by weight lifting, is described and a review of the literature is presented. Risk factors for bleeding appear to be tumor size and vascularity. Presenting symptomatology is abrupt and includes headache, nausea, vomiting, and depressed consciousness. Preexisting symptoms referrable to and marked dysfunction of the cranial nerve of origin are present. Deficits of neighboring cranial nerves are frequent. Computed tomography demonstrates the hemorrhages and the tumors. Mild head injury and physical exertion were precipitating factors in two cases. One-fourth of the patients died, while the others made good recoveries.

Adult↗
PubMed1987

Status epilepticus during labor. A case report.

Epileptic seizures during labor are seen rarely. A patient in labor had a 70-minute tonic-clonic convulsion. Maternal acid-base status and oxygenation remained normal. Fetal monitoring showed no evidence of distress. This case suggests that fetal bradycardia during maternal seizures is due to hypoxia and acidosis, not to other factors.

Adult↗
PubMed1985

Neurotoxicity of meperidine.

Meperidine neurotoxicity manifests as shakiness, tremors, myoclonus, and seizures. It is generally seen with repeated parenteral use. We report a case of meperidine neurotoxicity from oral use by an otherwise healthy woman. The pharmacology and clinical implications are discussed.

Administration, Oral↗