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Biomedical subjects

M Helm

Publications and source records attributed to M Helm.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Blood coagulation parameters as prognostic factors in multiple trauma: can clinical values be an early diagnostic aid?].

INTRODUCTION: Polytraumatized patients develop complex changes in blood coagulation and fibrinolysis even before their arrival at the emergency room (ER). Hemostaseological parameters (i.e. antithrombine 3, alpha-2-antiplasmine, D-dimers) obtained upon admission however, permit advance differentiation of later mortality vs. survival and of possible future secondary organ failure with varying specification. OBJECTIVES: Which clinical findings enable to identify such patients early in the ER even when no specialized hemostaseological laboratory is available? MATERIAL AND METHODS: a) Prospective study of 40 polytraumatized adults upon arrival at the hospital; b) Blood sampling at the earliest possible time during takeover in the ER; c) Injury Severity Score (ISS) for descriptive purposes; d) Evaluation of the prehospital emergency physician's records in regard to respiratory therapy, fluid resuscitation, and arterial blood pressure; e) Statistics; Wilcoxon test, Spearman correlation coefficient. RESULTS: All 40 patients (m:f = 28:12; mean age: 36 (SD: 16.6) years; mean ISS: 34.7 (SD: 11.4)) displayed advanced disseminated intravascular coagulation with secondary hyperfibrinolysis upon arrival in the ER. The amount of deviation from the hemostaseological norm could not be derived from either the correlation of the typical activated parameters of coagulation of fibrinolysis with the ISS or the analysis of the separate injuries. On the other hand the subgroup of patients displaying a systolic blood pressure of less than 100 mmHg at the site of the accident or upon arrival at the ER all had significantly lower antithrombine 3, protein C, and alpha-2-antiplasmine activities as well as increased concentrations of specific reaction products resulting from activated coagulation (thrombine-antithrombine 3-complex) and of fibrinolysis (D-dimers). CONCLUSION: In our study patients with multiple injuries displaying a systolic blood pressure of less than 100 mmHg either at the scene of the accident or upon arrival in the ER showed coagulation values which by other investigators were regarded as a sign of potential secondary organ failure or death.

Adult↗
PubMed1994

[Recommendations for emergency strategies in crush trauma].

In a retrospective study conducted from 1.1. 1988-31.12.1991, we at our rescue helicopter station "Christoph 22" identified the special circumstances, which arise for the trauma anaesthesiologist during prehospital treatment of entrapped trauma patients. During the time frame of our study, we observed a continuous increase of patients suffering an entrapment trauma (from 8.3% to 15.9%). Motor vehicle accidents were the primary cause of entrapment (78.4%). Patients with an entrapment trauma in comparison to those without, to a much higher degree suffered more severe injuries (proportion of multi-system trauma: 49.4% versus 26%). Upon arrival of the trauma anaesthesiologist at the scene, the vital functions in the majority of the cases were already disturbed and unstable. The emergency medical measures required at the emergency scene therefore had to be timely and to the point and taken in close coordination with the technical rescue team. The proven procedures which we apply in such cases will be illustrated. Hospital of preference should, if possible, always be a trauma center.

Accidents, Traffic↗
PubMed1993

[Pulse oximetry in the air rescue service. 1: Quantitative detection of interfering factors on the method].

The introduction of pulse oximetric monitoring in prehospital emergency medicine considerably contributed to emergency patients' safety, stability and protection. As inherent in any method of measurement, certain factors can interfere with it and limit its practical application. The emergency helicopter service at Ulm, in a prospective study involving 400 patients, systematically collected data on these limiting factors and evaluated them. The index "S" was established to quantify the time lost due to malfunctioning. Within the study group, the index average was S = 0.269, that is 26.9% of measurement time was subject to interference. The major cause was motion artifacts (68%) sensor probe dislocation (15%), low perfusion (14%) and radiation (3%). Regarding the volume of time lost due to specific interfering factors, motion artifacts (61.8%) and low perfusion (25.5%) were dominant, followed by sensor probe dislocation (10.3%) and radiation (2.4%). Interference therefore, both in time and frequency was primarily due to motion artifacts and low perfusion. The conclusions from this study led to the evaluation of two methods by which the interfering factors could be reduced: 1. ECG-synchronisation of the pulse oximetric signal; 2. The use of adhesive sensors.--The degree of increase in pulse oximetric measurement stability achieved by these two methods will be investigated in part 2 of this study.

Aircraft↗
PubMed1993

[Pulse oximetry in the air rescue service. 2: Methods of increasing the stability of pulse oximetry measurements--ECG-synchronized pulse oximetry and adhesive sensors].

Pulse oximetric monitoring in air rescue service (rescue helicopter) is primarily influenced by motion artifacts (especially those of a passive nature), by low perfusion and by the problem of probe dislocation. In a prospective study involving 162 unselected emergency patients treated by the medical team of the emergency helicopter service "Christoph 22" (Ulm), we studied the possibility of reducing these adverse factors by applying available state-of-the-art technology, such as ECG-synchronization and adhesive probes. By applying the thus modified methods of monitoring, the interference factor was reduced to S = 0.056, that is only 5.6% of measurement time was adversely effected. The increase in measurement stability resulted from the reduction in number of described artifacts (motion artifacts and low perfusion), as well as from the reduction in duration of interfered measurement time. ECG-synchronization very effectively influenced the passive motion artifacts. Their frequency was reduced by the factor 8.2, respectively 42. An effective reduction in number of probe dislocations can be achieved by applying adhesive probes. The high costs of such probes presently limits their application. Radiation can be eliminated by redesigning the probe. ECG-synchronization of pulse oximetric signal has proved to be a method to reduce the artifacts frequently experienced in air rescue and has considerably contributed to the increase of emergency patient safety.

Aircraft↗
PubMed1993

[Management of the patient with craniocerebral injuries at the accident site and clinic admission].

Between January 1991 and December 1992, there were 686 rescue operations involving patients with craniocerebral trauma in the catchment area of Ulm. There were 376 patients who had to be graded as seriously injured according to the NACA classification. In 178 cases there was a severe craniocerebral trauma, and 131 of these patients were admitted to the traumatology department of the University of Ulm. The pattern of injuries was analysed; multiple injuries were found in 63 patients, with injuries to the extremities and the thorax being most-frequent. The primary preclinical treatment for patients with craniocerebral trauma is demonstrated; the indications for intubation and artificial respiration are discussed, and also the selection of drugs. Diagnostic procedures and immediate treatment must initially be directed at securing vital functions. Treatment of life-threatening haemorrhage has priority over neurosurgical diagnosis and therapy. The urgent indications for neurosurgical intervention are: space-occupying intracranial bleeding, open craniocerebral traumas, and space-occupying depressed fractures.

Brain Injuries↗
PubMed1992

[Hemostatic disorders following polytrauma--the role of physiologic coagulation inhibitors during the preclinical phase].

Coagulation changes due to polytrauma are considered to be an important determinant for the outcome. In this context, physiological inhibitors of activated coagulation are highlighted with special reference to antithrombin-III (AT-III). Blood samples of 20 randomly selected adults with polytrauma (Injury Severity Score mean = 36.7 +/- 8.6) were investigated. To investigate the very early onset of coagulation changes, samples were taken as early as possible at the site of emergency (mean = 18.3 +/- 5.5 min. after trauma) as well as at hospital admission (mean = 78.0 +/- 10.4 min.). By means of a specially designed "mini-lab", basic processing of the samples harvested (centrifugation, pipetting, freezing) was done on the spot to obtain haemostaseological results that agree as closely as possible with the subsequent analyses. Due to the activation of intravascular coagulation as well as the consumption of physiological inhibitors, comprehensive coagulation disturbances become obvious at the time of hospital admission. These are intensified by haemodilution as a consequence of high-dose fluid replacement. However, significantly elevated levels of specific coagulation reaction products (thrombin-antithrombin-III-complex) give evidence of the consumption of inhibitory potential exceeding haemodilution.

Adult↗
PubMed1992

[Disorders of hemostasis after polytrauma. On the extent of intrinsic fibrinolytic activity in the preclinical phase].

Coagulation disorders are of utmost importance in emergency surgery as well as for secondary organ failure of polytraumatized patients. In order to get hold of the early onset of these disorders, blood samples were harvested from 20 randomly selected patients (Injury Severity Score mean = 36.7 +/- 10.5) on the scene of emergency (mean = 18 [10-29] min after trauma) and at the time of hospital admission (mean = 78 [58-98] min after trauma). In addition to the activation of intravascular coagulation and the consumption of physiological inhibitors, high amounts (10- to 50-fold above normal) of degradation products (FgDP, FbDP, TDP, D-dimers) are present on the scene, already. The influence of hemodilution due to high-volume resuscitation is discussed.

Adolescent↗
PubMed1991

[Respiratory disorders in trauma patients. Pulse oximetry as an extension of prehospital diagnostic and therapeutic possibilities].

The early diagnosis and adequate treatment of respiratory complications in trauma cases has a decisive influence upon the patients' posttraumatic development. Pulse oximetry enables us to evaluate and monitor the prehospital respiratory situation objectively for the first time. Within a prospective study conducted from October 1988 to October 1989 in 336 unselected, primarily traumatized, emergency patients rescued by our "SAR Ulm 75" helicopter team, to determine the possibilities and limitations of this method, we maintained continuous pulse oximetric monitoring in all cases. The practical applicability and functional stability of the pulse oximeters used were adequate. On-the-spot intubation was necessary in 45% of the patients (or they were intubated prior to our taking over). Oxygen inhalation by nasal cannula was needed in 55%. While not being decisive for immediate intubation, monitoring with a pulse oximeter does play an essential role in controlling respiratory therapy. In 32% of our cases, pulse oximetric monitoring permitted early adjustment of the respiratory therapy to meet the patients requirements. This method is of special value in disclosing life-threatening respiratory complications (9.3%) i.e., valve pneumothorax. Within a group with a high percentage of multiple traumas (27%) and thorax traumas (39%), this was of enormous assistance in the differential diagnosis. Level and rate of increase of oxygen saturation can be an indication of the severity of a thorax trauma. The limitations of pulse oximetric monitoring, especially those resulting from low peripheral perfusion in trauma cases (7 patients), are fairly rare.

Adult↗