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Biomedical subjects

M K Copass

Publications and source records attributed to M K Copass.

At least 37 records · Page 2Linked to original sources
PubMed1992

A descriptive study of trauma, alcohol, and alcoholism in young adults.

Young adults, 18-20 years of age, admitted to a trauma center via the emergency department, were studied to determine if they had been drinking prior to their injury event. The prevalence of self-reported chronic alcohol problems was examined using the short Michigan Alcohol Screening Test (SMAST). Of the 319 subjects, 131 (41%) tested positive for alcohol, including about one-half of those with intentional injuries and 38% with unintentional injuries. Approximately 22% had blood alcohol concentrations of 100 mg/dL or more, indicating they were legally intoxicated at the time of their injury. Of study subjects who completed the SMAST, 49% attained scores suggesting potential or probable alcoholism, and 20% had already sought some type of treatment, despite their young age. Health-care practices and policies related to these findings include routine screening of trauma patients for alcohol abuse and integration of chemical dependency intervention services with trauma care.

Adolescent↗
PubMed1992

The effects of alcohol intoxication on the initial treatment and hospital course of patients with acute brain injury.

The effect of alcohol intoxication at the time of injury on hospital outcome was evaluated in 520 adult patients diagnosed with brain injury who were admitted to the emergency department of Harborview Medical Center. Data were collected for each subject's status from field intervention through hospitalization. Serum alcohol levels were measured from blood drawn in the emergency room, and the subjects were stratified into two groups: intoxicated (> or = 100 mg/dL, n = 191) and nonintoxicated (< 100 mg/dL, n = 329). Compared with subjects who were not intoxicated, intoxicated patients were more likely to be intubated in the field or emergency department (relative risk [RR] = 1.3, 95% confidence interval [CI] = 1.1-1.5), require placement of an intracranial pressure bolt (RR = 1.4, 95% CI = 1.1-1.8), develop respiratory distress requiring ventilatory assistance during hospitalization (RR = 1.8, 95% CI = 1.0-3.3), or develop pneumonia (RR = 1.4, 95% CI = 0.9-2.2). The similarities in the clinical presentation of patients with acute brain injury and those who are intoxicated appear to influence prehospital care and also suggest that a more objective assessment of cerebral injury than provided by clinical diagnostic measures alone is required, thus accounting for the elevated likelihood of intracranial pressure monitoring in intoxicated trauma patients.

Adolescent↗
PubMed1992

Community-based interventions for sudden cardiac death. Impact, limitations, and changes.

Since 1970, Seattle Fire Department paramedics have treated 5,120 victims of out-of-hospital ventricular fibrillation (VF). During the past decade, there was an impressive decline in the annual incidence of VF, probably reflecting a general reduction in age-adjusted mortality attributed to coronary heart disease. Since 1975, annual survival rates to hospital discharge fluctuated between 24% and 33%, averaging 28.9%. In spite of continuing efforts to improve basic and advanced life support, survival rates have not risen concomitantly. Since the early 1970s, average ages of victims have increased from 63.4 to 66.1 years (p less than 0.0001). Additionally, in survivors of VF arrest, habitual cigarette smoking has become much less frequent (48% versus 31%, p less than 0.0001). Longevity of VF survivors has improved in recent years, with 1- and 5-year survival rates increasing from 74% and 44%, respectively, for those resuscitated during 1970-1975 to 83% and 57%, respectively, for those resuscitated during 1982-1987 (p less than 0.0001). It is likely that medical or surgical therapy and improved hygienic measures have contributed to the better outcomes. The vast majority of resuscitated victims have not had symptomatic ventricular arrhythmias before VF. Accordingly, current efforts to control such arrhythmias will not have an important impact on the community incidence of sudden cardiac death. Successful strategies for further containment will likely be those that address the problem of coronary atherogenesis, although medical and surgical therapies may also have a role. Additionally, it is timely to evaluate the widespread use of automated defibrillators by persons other than emergency medical technicians or paramedics.

Community Health Services↗
PubMed1991

Reappraisal of emergency room thoracotomy in a changing environment.

The efficacy of resuscitative emergency room thoracotomy (ERT), particularly in blunt injury, has been questioned. Wide application of the procedure may not be cost effective. The risk of exposure and lethal infection to medical personnel during ERT is considerable. For the past decade, the policy at this institution has been to perform ERT on all moribund patients sustaining penetrating torso injury and all patients sustaining blunt injury with any evidence of cardiac electrical activity. To evaluate whether such a liberal policy is currently justified, the charts of all patients undergoing ERT over a 4-year period were reviewed. One hundred twelve patients underwent ERT; 24 (21%) sustained penetrating injury, 88 (79%) blunt injury. The overall survival rate was 1.8%. Penetrating injury had a 4.2% survival and blunt injury 1.1%. No patients with CPR initiated at the scene and required throughout transport survived. In those patients with both blood pressure and spontaneous respirations present in the field, survival rate was 11.8%. Survival rate in patients manifesting sinus rhythm or ventricular fibrillation upon arrival at the ER was 6.4%. No survivors were noted among patients coming to the hospital with an idioventricular rhythm or asystole. The total hospital charges for patients undergoing ERT exceeded reimbursement by $59,565. Screening for HIV and hepatitis could be documented in only two patients; both were negative. Liberal performance of ERT has dismal results, incurs monetary loss, and affords a greater potential for exposure to lethal infection. Emergency room thoracotomy is justified only when vital signs or a resuscitatible cardiac rhythm are present in the field or ER and deteriorate shortly before thoracotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Traumatic scapulothoracic dissociation: case report.

A 23-year-old man suffered traumatic scapulothoracic dissociation (TSD) in a car-vs.-bicyclist accident. TSD is a devastating forequarter injury characterized by brachial plexus damage, major upper extremity musculoskeletal disruption, and exsanguinating hemorrhage: our patient survived a hematocrit of 7. Prompt recognition and aggressive management of TSD's multiple injuries are crucial.

Accidents, Traffic↗
PubMed1990

Sexually transmitted diseases in victims of rape.

The risk of acquiring a sexually transmitted disease as a result of rape is not known, in part because it is difficult to ascertain whether infections were present before the assault or acquired during it. To investigate this question, we examined female victims of rape within 72 hours of the assault and again at least one week after the assault. Of the 204 girls and women initially examined within 72 hours of the rape, 88 (43 percent) were found to have at least one sexually transmitted disease. These diseases included infections caused by Neisseria gonorrhoeae (6 percent of those tested), cytomegalovirus (8 percent), Chlamydia trachomatis (10 percent), Trichomonas vaginalis (15 percent), herpes simplex virus (2 percent), Treponema pallidum (1 percent), and the human immunodeficiency virus type 1 (HIV-1; 1 percent) and bacterial vaginosis (34 percent). Among the 109 patients (53 percent) who returned for at least one follow-up visit (excluding those who were found to be infected at the first visit or who were treated prophylactically), the incidence of new disease was as follows: gonorrhea, 4 percent (3 of 71); chlamydial infection, 2 percent (1 of 65); trichomoniasis, 12 percent (10 of 81); and bacterial vaginosis, 19 percent (15 of 77). There were no new infections with herpes simplex virus, cytomegalovirus, Trep. pallidum, or HIV-1, but follow-up serologic testing was performed in only 26 percent of the patients. On the basis of our assumptions that most venereal infections present within 72 hours of a rape were preexisting and that new infections identified 1 to 20 weeks later were acquired during the assault, we conclude that the prevalence of preexisting sexually transmitted diseases is high in victims of rape and that they have a lower but substantial additional risk of acquiring such diseases as a result of the assault.

Adolescent↗
PubMed1990

Myocardial Infarction Triage and Intervention Project--phase I: patient characteristics and feasibility of prehospital initiation of thrombolytic therapy.

Prehospital initiation of thrombolytic therapy by paramedics, if both feasible and safe, could considerably reduce the time to treatment and possibly decrease the extent of myocardial necrosis in patients with acute coronary thrombosis. Preliminary to a trial of such a treatment strategy, paramedics evaluated the characteristics of 2,472 patients with chest pain of presumed cardiac origin; 677 (27%) had suitable clinical findings consistent with possible acute myocardial infarction and no apparent risk of complication for potential thrombolytic drug treatment. Electrocardiograms (ECGs) of 522 of the 677 patients were transmitted by cellular telephone to a base station physician; 107 (21%) of the tracings showed evidence of ST segment elevation. Of the total 2,472 patients, 453 developed evidence of acute myocardial infarction in the hospital; 163 (36%) of the 453 had met the strict prehospital screening history and examination criteria and 105 (23.9%) showed ST elevation on the ECG and, thus, would have been suitable candidates for prehospital thrombolytic treatment if it had been available. The average time from the onset of chest pain to prehospital diagnosis was 72 +/- 52 min (median 52); this was 73 +/- 44 min (median 62) earlier than the time when thrombolytic treatment was later started in the hospital. Paramedic selection of appropriate patients for potential prehospital initiation of thrombolytic treatment is feasible with use of a directed checklist and cellular-transmitted ECG and saves time. This strategy may reduce the extent and complications of infarction compared with results that can be achieved in a hospital setting.

Adult↗
PubMed1990

Critical care air transportation of the severely injured: does long distance transport adversely affect survival?

Civilian aeromedical transportation systems, both fixed and rotary wing, have proliferated since the middle 1970s. However, outcome data substantiating the benefit of these services have been slow in coming. From February 22, 1982, through March 5, 1984, Airlift Northwest transported 118 trauma patients (aged 15 years and older) an average distance of 340 miles (range, 100 to 800 miles) with fixed-wing aircraft. The in-hospital mortality for this group was 19% compared with 18% for a comparable group of trauma patients who were ground-transported from within the city limits of Seattle, Washington. The two groups did not differ significantly in age, Injury Severity Score, or Glasgow Coma Score. These results suggest that some part of the clinical benefit of a regional trauma center may be extended up to 800 miles with no increase in transport-related mortality.

Adolescent↗
PubMed1990

Neurologic consequences of electrical burns.

Permanent neurologic damage following major electric injury is a dreaded and often discussed complication. The incidence, severity, and sequelae are not clear from the literature. Therefore we reviewed the charts of 90 consecutive patients admitted to the University of Washington Burn Center between 1980 and 1986 looking at neurologic consequences. Electric injuries accounted for 4% of 2,305 admissions. The mean age was 31 +/- 13 years, total body surface area involved (TBSA), 6 +/- 11%, and length of stay, 13 +/- 20 days. There were 82 males and eight females. There were four deaths, for a mortality rate of 4%. Fourteen patients had 18 amputations. Twenty-two patients sustained low-voltage injury; 50% had immediate neurologic symptoms which resolved in nine of 11 patients. Eleven patients (50%) were asymptomatic. Sixty-four patients sustained high-voltage injury and 33% were asymptomatic. Forty-three patients (67%) had immediate central and/or peripheral neurologic symptoms. Loss of consciousness accounted for the largest fraction of CNS sequelae in the high-voltage group (45%). Twenty-three patients (79%) recovered consciousness before arrival at the hospital. Six patients remained comatose, three died, and three awoke but had neurologic sequelae. Twenty-two patients in the high-voltage group had one or more acute peripheral neuropathies. Sixty-four per cent of these neuropathies resolved or improved. Five patients had transient initial paralysis, but there were no delayed spinal cord symptoms. Eleven patients developed one or more delayed peripheral neuropathies. Half of these delayed neuropathies resolved or improved.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

Effect of epinephrine and lidocaine therapy on outcome after cardiac arrest due to ventricular fibrillation.

One hundred ninety-nine patients with out-of-hospital cardiac arrest persisted in ventricular fibrillation after the first defibrillation attempt and were then randomly assigned to receive either epinephrine or lidocaine before the next two shocks. The resulting electrocardiographic rhythms and outcomes for each group of patients were compared for each group and also compared with results during the prior 2 years, a period when similar patients primarily received sodium bicarbonate as initial adjunctive therapy. Asystole occurred after defibrillation with threefold frequency after repeated injection of lidocaine (15 of 59, 25%) compared with patients treated with epinephrine (four of 55, 7%) (p less than 0.02). There was no difference in the proportion of patients resuscitated after treatment with either lidocaine or epinephrine (51 of 106, 48% vs. 50 of 93, 54%) and in the proportion surviving (18, 19% vs. 21, 20%), respectively. Resuscitation (64% vs. 50%, p less than 0.005) but not survival rates (24% vs. 20%) were higher during the prior 2-year period in which initial adjunctive drug treatment for persistent ventricular fibrillation primarily consisted of a continuous infusion of sodium bicarbonate. The negative effect of lidocaine or epinephrine treatment was explained in part by their influence on delaying subsequent defibrillation attempts. Survival rates were highest (30%) in a subset of patients who received no drug therapy between shocks. We conclude that currently recommended doses of epinephrine and lidocaine are not useful for improving outcome in patients who persist in ventricular fibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)

Bicarbonates↗
PubMed1990

Outcome and predictors of outcome in pediatric submersion victims receiving prehospital care in King County, Washington.

Predictors of outcome in pediatric submersion victims treated by Seattle and King County's prehospital emergency services were studied. Victims less than 20 years old were identified from hospital admissions and paramedic and medical examiners' reports. The proportion of fatal or severe outcomes in patients were compared with various risk factors. Of 135 patients, 45 died and 5 had severe neurologic impairment. A subset of 38 victims found in cardiopulmonary arrest had a 32% survival rate, with 67% of survivors unimpaired or only mildly impaired. The two risk factors that occurred most commonly in victims who died or were severely impaired were submersion duration greater than 9 minutes (28 patients) and cardiopulmonary resuscitation duration longer than 25 minutes (20 patients). Both factors were ascertained in the prehospital phase of care. Submersion duration was associated with a steadily increasing risk of severe or fatal outcomes: 10% risk (7/67) for 0 to 5 minutes, 56% risk (5/9) for 6 to 9 minutes, 88% risk (21/25) for 10 to 25 minutes, 100% risk (4/4) for greater than 25 minutes. None of 20 children receiving greater than 25 minutes of cardiopulmonary resuscitation escaped death or severe neurologic impairment. Our rates for saving all victims, particularly victims in cardiopulmonary arrest, are considerably higher than has been reported before the children. Prompt prehospital advanced cardiac life support is the most effective means of medical intervention for the pediatric submersion victim. Prehospital information provided the most valuable predictors of outcome.

Adolescent↗
PubMed1989

Evaluation of potentially preventable deaths among pedestrian and bicyclist fatalities.

The prehospital, emergency department, and in-hospital care of 84 patients who died following a pedestrian- or bicycle-motor vehicle collision in a four-county area was retrospectively reviewed using a systematic, detailed scoring system. The purpose of the study was to examine the effectiveness of an advanced paramedic-regionalized trauma care system and to examine the usefulness of a systematic evaluation tool in identifying preventable and possibly preventable deaths. Among the 84 deaths, one was judged to be preventable and 18 possibly preventable. The one preventable death occurred in the emergency department, while the possibly preventable deaths more commonly occurred after 48 hours and were due to central nervous system injury, sepsis, and multiple organ failure. Prolonged prehospital and emergency department time and failure to establish an airway were the most common problems identified as contributing to fatal outcome. The use of explicit criteria was demonstrated to be an effective addition to the analysis of trauma care systems.

Accidents, Traffic↗
PubMed1989

Hemodynamic effects of external cardiac massage in trauma shock.

The effectiveness of closed chest cardiopulmonary resuscitation (CCCPR) in maintaining cardiac output has been well studied in cardiac arrest. Trauma surgeons most often encounter shock secondary to hypovolemia or cardiac tamponade, and the effectiveness of CCCPR in that setting has not been established. To determine the hemodynamic effects of external massage in profound shock, hypotension was induced in baboons. Pressures obtained with external massage were compared to spontaneous intra-arterial pressures before compression. Although external massage increased systolic pressures in both tamponade and hypovolemia, diastolic pressures were consistently decreased. We conclude that CCCPR does not augment arterial pressure in the clinical situations associated with decreased LVEDV and is unlikely to provide organ perfusion for trauma victims.

Animals↗
PubMed1988

Use of the automatic external defibrillator in the management of out-of-hospital cardiac arrest.

The automatic external defibrillator is a simple device that can be used by nonprofessional rescuers to treat cardiac arrest. In 1287 consecutive patients with out-of-hospital cardiac arrest, we assessed the results of initial treatment with this device by firefighters who arrived first at the scene, as compared with the results of standard defibrillation administered by paramedics who arrived slightly after the firefighters. Of 276 patients who were initially treated by firefighters using the automatic defibrillator, 84 (30 percent) survived to hospital discharge (expected rate according to a logistic model, 17 percent; P less than 0.001), as compared with 44 (19 percent) of 228 patients when fire-fighters delivered only basic cardiopulmonary resuscitation and the first defibrillation was performed after the arrival of the paramedic team. Few patients with conditions other than ventricular fibrillation survived. In a multivariate analysis of characteristics that influenced survival after ventricular fibrillation, a better survival rate was related to a witnessed collapse (odds ratio, 3.9; 95 percent confidence interval, 2.0 to 7.6), younger age (odds ratio, 1.2; 95 percent confidence interval, 1.0 to 1.4), the presence of "coarse" (higher-amplitude) fibrillation (odds ratio, 4.2; 95 percent confidence interval, 1.6 to 11.0), a shorter response time for paramedics (odds ratio, 1.4; 95 percent confidence interval, 1.0 to 2.1), and initial treatment by firefighters using an automatic external defibrillator (odds ratio, 1.8; 95 percent confidence interval, 1.1 to 2.9). These findings support the widespread use of the automatic external defibrillator as an important part of the treatment of out-of-hospital cardiac arrest, although the overall impact of the use of this device on community survival rates is still uncertain.

Aged↗
PubMed1988

Utilization and yield of drug screening in the emergency department.

Emergency qualitative tests for drugs are commonly ordered during evaluation of cases of suspected drug overdose. We prospectively compared the utilization and yield of drug screens based on urine and of identical tests of gastric contents under actual clinical conditions in a busy metropolitan emergency department. During the 4.5-month study period, physicians ordered drug screening in 405 of 582 (70%) study cases. Screens of both types of body fluid were ordered in only 95 cases (16%), suggesting study physicians regarded these tests to be functionally equivalent. Drug screens of gastric fluid were favored in cases involving acute ingestion and in medically complicated cases requiring gastric lavage. Urine drug screens were favored in clinically stable cases with primarily thought or behavior disorders. In the 95 cases for which both drug screens were ordered, gastric screens in 18 cases detected 20 drugs not detected by urine drug screening. Urine screening, on the other hand, identified 74 drugs not found on gastric screening in 48 cases. Gastric drug screening also performed poorly in comparison to quantitative serum drug levels. Seventeen false-positive urine or gastric screens were noted as well. Despite significant technical limitations, physicians frequently order drug screens in our emergency department. Qualitative drug screening of gastric fluid may prove useful in cases involving acute ingestion, but samples of urine and serum must also be submitted for analysis if optimal test performance is to be achieved.

Acute Disease↗
PubMed1988

Risk factors for urethral injuries in men with traumatic pelvic fractures.

Urethral injuries are commonly associated with pelvic fractures. The prompt recognition and appropriate management of these injuries may significantly impact subsequent morbidity, yet few studies have addressed the identification of the risk factors for urethral injury in men with pelvic fractures. We reviewed retrospectively the records of 405 men with pelvic fractures seen at our medical center, including 21 (5 per cent) with urethral injuries. Of the 21 men 14 (67 per cent) had fractures involving a pubic ramus and a sacroiliac joint, and 12 (57 per cent) had no physical signs (blood at the urethral meatus, perineal hematoma or a high-riding prostate) that would suggest a urethral injury. The likelihood for the presence of physical signs is directly related to the interval since injury. We believe that men with the combination of rami fractures and sacroiliac disruption should undergo retrograde urethrograms before urethral instrumentation, and that physical signs are unreliable indications for urethral injuries, especially soon after the injury.

Fractures, Bone↗
PubMed1988

Air transport following surgical stabilization: an extension of regionalized trauma care.

A 30-month retrospective review was performed of all trauma patients initially evaluated and operatively stabilized at Level III hospitals, with subsequent specialized air transport within 48 hours of injury to the regional Level I trauma center in Seattle. Nineteen patients were identified, with a mean ISS of 44 (range, 20-66). Mean transport time and distance were 2.4 hours and 456 miles, respectively. The estimated average ground transport time for the same patients was 23.8 hours. No deaths occurred during transport, and the overall survival rate was 58%. Transport charges averaged $4,162, which was 14% of the complete hospitalization cost. We conclude that: 1) patient survival after air transport was no different than that predicted for trauma victims with immediate access to a trauma center; 2) postoperative hemodynamic instability predicted a poor outcome; 3) the higher cost of air relative to ground transport is outweighed by significant time savings in these critically injured patients; and 4) air transport following operative stabilization represents an extension of regionalized trauma care to the isolated areas of Washington and Alaska.

Adolescent↗