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Biomedical subjects

M H Cook

Publications and source records attributed to M H Cook.

14 recordsLinked to original sources
PubMed1995

Protamine use during peripheral vascular surgery: a prospective randomized trial.

PURPOSE: One hundred twenty patients undergoing aortic reconstruction (40), infrainguinal bypass (49), and carotid endarterectomy (31) were prospectively enrolled into a double-blind randomized trial to investigate the utility of routine heparin reversal with protamine. METHODS: All patients underwent systemic heparinization with 90 U/kg body weight during operation and after revascularization were randomized to receive either protamine or saline solution for heparin reversal. Blood loss was measured throughout the surgical procedure, and indexes of coagulation and the requirement for blood and blood products were documented during operation and the first 24 hours after operation. RESULTS: Plasma heparin concentration, partial thromboplastin time, and activated clotting time were significantly higher (p < 0.05) in those receiving saline solution at 20 minutes and 1 hour after administration. Total surgical blood loss was not significantly different between study groups. No significant differences were found in blood product requirement, intravenous fluid administered, hematocrit, or wound hematomas between groups at 24 hours. In addition, no difference was seen in the surgeon's subjective intraoperative assessment of hemostasis after administration of either study drug. Furthermore, after study drug administration protamine was associated with a deleterious effect on subsequent intraoperative blood loss (318 +/- 33 ml vs 195 +/- 18 ml, p < 0.05). CONCLUSIONS: Although protamine effectively reverses heparin anticoagulation, its routine use after elective peripheral vascular surgical reconstruction does not appear to provide any clinical benefit.

Aged↗
PubMed1988

A new device for emergency percutaneous transtracheal ventilation in partial and complete airway obstruction.

Several methods of percutaneous transtracheal ventilation have been described for the immediate relief of upper airway obstruction when conventional methods fail. This study was conducted to determine whether a single percutaneously placed catheter introducer (Arrow Emergency Infusion Device [EID]) could provide access adequate for percutaneous transtracheal ventilation with standard ventilatory modalities in an obstructed airway. Ten mongrel dogs were anesthetized, intubated, and monitored (for pulse, blood pressure, ECG, and arterial blood gases). The endotracheal tube was occluded. When the dogs became hypoxic and hypercarbic, the Arrow EIDs were inserted transtracheally and the dogs were ventilated with either a Bear 1 Adult Ventilator or a Mapleson D system. Percutaneous transtracheal ventilation by the Arrow EID adequately ventilated dogs with controlled partial (95%) or complete airway obstruction from hypoxic and hypercarbic states. The ease of insertion, decreased associated complications, ability to ventilate with easily available devices, and use with complete airway obstruction make the EID an effective device for transtracheal ventilation.

Airway Obstruction↗
PubMed1986

Reserving nursing home beds: evaluating the feasibility for the hospital and long-term care facility. Are they a legal alternative?

As well as the economic incentives of bed reserve agreements, hospitals and long-term care facilities must consider the legal implications. Although carefully structured bed reserve agreements will be recognized by HCFA as legal in most cases, the agency says poorly crafted ones can invite loss of Medicare provider status. In addition, Medicaid law and state statutes contain certain provisions where legal advice should be sought to verify that a particular type of "arrangement" will be acceptable. However, if proper caution is used, most arrangements will encounter no legal difficulties.

Centers for Medicare and Medicaid Services, U.S.↗