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Biomedical subjects

M H Keelan

Publications and source records attributed to M H Keelan.

10 recordsLinked to original sources
PubMed1992

Milwaukee Prehospital Chest Pain Project--phase I: feasibility and accuracy of prehospital thrombolytic candidate selection.

This study prospectively determined the feasibility and accuracy of prehospital thrombolytic therapy candidate selection by base station emergency physicians. During a 6-month period, paramedics acquired and transmitted prehospital 12-lead electrocardiograms (ECGs) and then applied a thrombolytic therapy contraindication checklist. Emergency physicians interpreted prehospital ECGs and prospectively selected candidates for thrombolytic therapy. A safety committee of cardiologists reviewed prehospital ECGs, checklists and hospital records to determine accuracy independently. Six hundred-eighty stable adult prehospital patients with a chief complaint of nontraumatic chest pain were initially evaluated. Two hundred forty-one patients were excluded because of (1) unsuccessful electrocardiographic transmission (149), (2) transport to nonparticipating facilities (72), and (3) unavailable medical records (20). No prehospital thrombolytic therapy was administered in this study. Of 439 cases, 91 (21%) had the final diagnosis of acute myocardial infarction, 38 (8.7%) had diagnostic prehospital ECGs, and 12 (2.7%) were selected by emergency physicians as candidates for thrombolytic therapy. Seventy percent of patients with myocardial infarction had checklist exclusions for thrombolytic therapy. Prehospital evaluation increased mean scene time (paramedic arrival on scene to scene departure) by 4 minutes. The median time from chest pain onset to paramedic arrival in patients with myocardial infarction was 60 minutes. The estimated average time saved if prehospital thrombolytic therapy had been available was 101 +/- 81 minutes. The safety committee concluded that acceptable accuracy of emergency physician prehospital electrocardiographic interpretation, checklist and case selection was achieved. It is concluded that emergency physicians can accurately identify candidates for prehospital thrombolytic therapy.

Adult↗
PubMed1979

Mitral valve prolapse in the elderly.

This study included 40 patients over 60 years of age with echocardiographic findings of mitral valve prolapse (MVP). Most of these patients were unaware of any cardiac disorder until the time of echocardiography. In the majority, the clinical manifestations were benign, and the duration of symptoms variable. Congestive heart failure (CHF) was noted in 10 patients (25 percent) who were unaware of having any cardiac disorders until the onset of their symptoms. In 5 patients (4 with CHF and 1 with endocarditis), surgical replacement of the prolapsed mitral valve was necessary. Endocarditis was present in 4 patients (10 percent), none of whom had been instructed in the prophylactic use of antibiotics. The physician's awareness of mitral valve prolapse in the elderly patient is important, since the disorder may not be as benign in aged patients as in younger ones, and life-threatening complications may occur.

Aged↗
PubMed1978

Ovarian (corpus luteum) hemorrhage during anticoagulation therapy.

Corpus luteum hemorrhage is a complication of long-term anticoagulant therapy that has rarely been reported in the literature. Within 16 months, we saw six cases in which young women taking anticoagulants to prevent clotting of prosthetic heart valves suffered corpus luteum hemorrhages. Diagnosis was difficult and delayed. Medication stopped the bleeding in three patients; bilateral salpingo-oophorectomy was necessary in the remaining three. Our patients had great difficulty controlling their anticoagulant therapy and had histories of previous bleeding episodes. We believe corpus luteum hemorrhage may become more common as more premenopausal women undergo cardiac valvular surgery.

Adult↗
PubMed1977

Preformed catheters for simplified transbrachial coronary arteriography.

The experience in 700 patients of transbrachial selective coronary arteriography using a preformed catheter is described. The excellent plastic memory of torque control of the polyurethane catheter combined with the characteristic gentle curve permit rapid and easy intubation of the coronary arteries. The so-called "difficult" cases encountered with the classic Sones technique have been catheterized with ease employing the technique described in this report. The exceptionally low complication rate (no deaths), abbreviated catheterization time, a success rate of 99.2%, and the high quality cine angiographic films make this technique a highly useful and effective method of transbrachial coronary arteriography.

Brachial Artery↗
PubMed1977

Management of sudden coronary death.

Twenty-three survivors of out-of-hospital sudden coronary death (SCD) have been followed subsequent to initial hospitalization, cardiac catheterization and coronary angiography, and ultimate coronary revascularization (11 patients) or medical treatment (12 patients). All were treated at the Milwaukee County Medical Center. History of previous myocardial infarction (10 patients) and predominance of triple coronary artery disease (20 patients) with associated ventricular dysfunction (21 patients) demonstrated advanced coronary disease in both groups. Selection for revascularization (mean, 3 grafts per patient) was not randomized, but was based on precarious coronary anatomy and was reinforced by post-SCD ventricular dysrhythmias and angina. During an average follow-up of 13 months, there were 2 perioperative surgical deaths (1 recurrent SCD) and 3 medical deaths (2 recurrent SCDs), giving a mortality rate of 22%. This is an improvement over reported post-SCD natural history and may support a policy of offering revascularization to all SCD patients who have precarious coronary anatomy.

Adult↗
PubMed1977

Multiple cardiac injuries secondary to a single stab wound.

A case of multiple cardiac injuries secondary to a single stab wound is described. The extent of the injury was not fully appreciated at the initial surgical intervention and typical clinical manifestations were delayed in appearance. Cardiac catheterization was necessary to confirm the correct diagnosis. After the correct diagnosis was made, surgical repair was successfully performed.

Adult↗
PubMed1976

Problems with balloon-tipped stylet pacemaker catheters.

Balloon-tipped stylet pacemaker catheters have two intraluminal stylet-related limitations that warrant extreme caution in their use. The first limitation involves manipulation of the stylet inside the catheter and appears to be a consequence of the angulation made by the catheter in the right atrium; the second limitation is a complication involving actual in vivo fracture of the stylet and is presumably related to tapering of the stylet at a point of stress in the right atrium. Although these pacemaker catheters have distinct advantages, the problem arising from their use cannot be ignored. Until modification can be made to resolve these problems, this catheter must be used with extreme caution.

Aged↗