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Biomedical subjects

M K Copass

Publications and source records attributed to M K Copass.

68 records · Page 4Linked to original sources
PubMed1982

Ventricular defibrillation -- a comparative trial using 175-J and 320-J shocks.

We compared the effects of initial electrical shocks using 175 and 320 J (joules) in 249 patients with ventricular fibrillation. Survival was unrelated to the energy level used for defibrillation. Reversion to an organized rhythm occurred in a similar proportion of both treatment groups after one or two shocks. The rhythm identified after the first shock was related to outcome (the survival rate was 42 per cent in patients with supraventricular rhythm, 30 per cent in persistent ventricular fibrillation, 26 per cent in idioventricular rhythm, and 14 per cent in asystole; P less than 0.02). Fibrillation recurred in 68 per cent of patients who had been initially defibrillated to an organized rhythm. Repeated shocks at the higher energy level resulted in a higher incidence of atrioventricular block after defibrillation (24 per cent of patients receiving 320 J and 9 per cent of those receiving shocks of lower energy; P less than 0.005). Patients who survived required fewer shocks than patients who later died in the hospital (2.6 shocks as compared with 3.6; P less than 0.005). We conclude that initial defibrillatory shocks using 175 J are as safe and effective as shocks of nearly twice that energy level.

Electric Countershock↗
PubMed1982

Persistent neuropsychological sequelae of toxic shock syndrome.

Twelve women, aged 16 to 29 years, were interviewed and examined for possible neuropsychological sequelae 2 to 12 months after they recovered from toxic shock syndrome. Six of the 12 women had symptoms such as difficulty concentrating, headache, recent memory lapses, inability to compute, and loss of other higher integrative functions. Eight patients were found to have electroencephalographic abnormalities. All six symptomatic patients but no asymptomatic patients had abnormal neurologic findings. Abnormalities such as impaired memory and calculation and poorly sustained concentration were found in five of six symptomatic patients but in no asymptomatic patient. Six control subjects, all asymptomatic women aged 17 to 29 years, were interviewed and examined 2 to 12 months after they recovered from postpartum endometritis; these subjects were normal in all parameters tested. A direct effect of the staphylococcal toxin on the central nervous system may be the cause of these sequelae.

Adolescent↗
PubMed1981

Comparison of bretylium tosylate and lidocaine in management of out of hospital ventricular fibrillation: a randomized clinical trial.

Bretylium tosylate was compared with lidocaine hydrochloride as initial drug therapy in 146 victims of out of hospital ventricular fibrillation in a randomized blinded trial. An organized rhythm was achieved in 89 and 93 percent and a stable perfusing rhythm in 58 and 60 percent of the patients who received bretylium and lidocaine, respectively. After initiation of advanced life support, an organized rhythm was first established after an average of 10.4 minutes and 10.6 minutes in the two respective groups, requiring an average of 2.8 defibrillatory shocks in those who received bretylium and 2.4 in the lidocaine-treated patients. Comparable numbers of patients were discharged from the hospital: 34 percent of those given bretylium and 26 percent of the patients whose initial therapy was lidocaine. No instance of chemical defibrillation was observed with either drug. In this study, bretylium afforded neither significant advantage nor disadvantage compared with lidocaine in the initial management of ventricular fibrillation.

Bretylium Compounds↗
PubMed1981

Role of emergency thoracotomy in the resuscitation of moribund trauma victims: 100 consecutive cases.

(1) Emergency thoracotomy can be a lifesaving procedure in critically injured patients who present with no detectable pulse or blood pressure. (2) Emergency thoracotomy is nonproductive if cardiac electrical activity is absent. (3) Best results are achieved in patients with chest injuries and the worst results in those with isolated blunt abdominal injury. (4) Survival was better if patient was taken directly to the operating room with ongoing cardiopulmonary resuscitation. (5) Prehospital airway control, volume resuscitation and cardiopulmonary resuscitation play a significant role in improving the outcome in traumatized patients who undergo emergency thoracotomy.

Emergency Medical Services↗
PubMed1981

The role of helmets in reducing head injuries from motorcycle accidents: a political or medical issue?

The cases of 311 motorcycle accident victims who were seen at a major trauma center over 17 months were reviewed. The types and severity of injuries were standardized according to the Injury Severity Score (ISS) for motor vehicle accidents. Victims were categorized into groups: helmet or no helmet and major, minor or no head injury. Major injury was defined as a 3 on the Abbreviated Injury Scale for "head" (loss of consciousness for at least 15 minutes with or without skull fracture and with or without neurological deficit). THE FOLLOWING CONCLUSIONS ARE DRAWN: (1) The death rate for those with and without helmets was not significantly different, (2) the victims of fatal accidents had identical total ISS scores regardless of the presence of helmets, (3) the chance of sustaining a severe head injury was significantly higher in the no helmet group and (4) the incidence of long-term neurological defect was three times greater in the no helmet group.

Accidents, Traffic↗
PubMed1980

Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians.

The survival rate for patients with out-of-hospital cardiac arrest is low in communities where emergency service is provided solely by emergency medical technicians. We trained such technicians in a suburban community of 79,000 to recognize and treat out-of-hospital ventricular fibrillation with up to three defibrillatory shocks without the use of medications or special airway protection. Outcomes from cardiac arrest due to underlying heart disease were determined during two periods: two years with standard care by emergency medical technicians and one year with defibrillator-trained technicians. During the period with standard care, four of 100 patients with cardiac arrest were resuscitated and discharged alive from the hospital, as compared with 10 of 54 patients during the period with defibrillator-trained technicians (P less than 0.01). In 12 of 38 patients with ventricular fibrillation, a stable perfusing cardiac rhythm followed defibrillatory shocks given by defibrillator technicians. The enhanced survival after cardiac arrest is encouraging, and further trials of defibrillation by emergency medical technicians are warranted.

Aged↗
PubMed1980

Management of out-of-hospital cardiac arrest. Failure of basic emergency medical technician services.

Survival after out-of-hospital cardiac arrest treated by emergency medical technicians (EMTs) with basic life support was studied in four communities with a combined population of 380,000. During a two-year period, 18 (6%) of 321 patients with cardiac arrest were resuscitated and ultimately discharged from the hospital. This figure is compared with 55 (22%) of 253 discharged in adjacent suburban communities with paramedic services. The evident factor accounting for the difference in survival rates was the time from collapse to receiving definitive care (advanced cardiac life support)--26 minutes in the EMT area compared to 7.8 minutes in the paramedic area.

Aged↗
PubMed1978

Acute and chronic progressive encephalopathy due to gasoline sniffing.

Acute encephalopathy caused by gasoline sniffing is well recognized, but has been thought to be completely reversible. We report a patient who developed a progressive encephalopathy characterized by ataxia, tremor and dementia following repeated, deliberate gasoline inhalation. Blood and urine lead levels were consistently elevated and at autopsy, the formalin-fixed brain lead content was between 5200 and 6500 micrograms/100 gm of tissue. This case shows that repeated gasoline sniffing can result in irreversible encephalopathy and that both the acute and chronic encephalopathy probably result from organic lead intoxication and not from the gasoline itself.

Adult↗
PubMedDate not supplied

Does age affect outcomes of out-of-hospital cardiopulmonary resuscitation?

We examined the relation between age and outcomes in patients treated for out-of-hospital cardiac arrest in Seattle, Wash. Considering all out-of-hospital cardiac arrests treated by paramedics over a recent 5-year period, 386 (27%) of 1405 consecutive patients aged 70 years or older were resuscitated and admitted to a hospital vs 474 (29%) of 1624 younger patients; 140 elderly patients (10%) were discharged alive vs 223 younger patients (14%). Of the 140 elderly patients, 112 went home and 28 went to a nursing home. Considering only patients whose initial rhythms were ventricular fibrillation, the percent of patients discharged alive was substantially higher: 120 (24%) of 493 for elderly patients and 194 (30%) of 639 for younger patients. Elderly patients can benefit from attempted resuscitation from out-of-hospital cardiac arrest.

Adult↗