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Biomedical subjects

N M Nelson

Publications and source records attributed to N M Nelson.

At least 19 recordsLinked to original sources
PubMed1985

Impact of improved emergency medical services and emergency trauma care on the reduction in mortality from trauma.

From 1972 to 1982 there was a 23.9% decline in the number of deaths due to trauma in Nebraska. During this time, an improved emergency medical services (EMS) system was being implemented, including training of EMT's and paramedics, physician education in advanced trauma life support (ATLS), establishment of three helicopter transport services, and designation of trauma centers in the two most populous (of six) EMS regions. Highway safety programs alone could not account for the decline in trauma deaths, since there was almost as great a fall in nonvehicular (21.4%) as vehicular (26.4%) trauma deaths. The much larger decline in prehospital (28.3%) than in-hospital (17.3%) trauma deaths suggested a relationship between the improving EMS system and decreased mortality from trauma. We found that growth of the EMS system, as measured by the cumulative number of EMT's trained, correlated strongly with the decline in prehospital (r = 0.95; p less than 0.001), in-hospital (r = 0.84; p less than 0.001), total (r = 0.95; p less than 0.001), vehicular (r = 0.86; p less than 0.001), and nonvehicular (r = 0.93; p less than 0.001) trauma deaths. Our findings suggest that improvements in the statewide EMS system along with better hospital care have caused a significant decline in the number of trauma deaths over a 14-year period.

Accidents, Traffic↗
PubMed1984

Limitation on effectiveness of rapid defibrillation by emergency medical technicians in a rural setting.

First-responding emergency medical technicians (EMTs) trained to defibrillate have been shown to increase survival from prehospital ventricular fibrillation (VF) almost fourfold in Washington's King County. Using Nebraska ambulance rescue run data from 1982 and published information relating ambulance response time to the likelihood that a patient would be in VF, we constructed a model to analyze the difference in expected results for EMT defibrillation among communities of varying population. The model predicts that EMTs in urban Nebraska (mean population 242,000) will use the defibrillator once every six weeks. EMTs in intermediate cities (mean population 22,300) will defibrillate once a year. In rural Nebraska (mean population 1,500), the defibrillator will be used once every 5.6 years. Despite these figures, the model predicts relatively low cost per life saved (ranging from $566 in urban areas to $4,785 in rural Nebraska). The major problem with EMT defibrillation in rural areas is maintenance of skills and continuing education.

Education, Continuing↗
PubMed1981

Observations on the behavioral state of newborn infants during the first hour of life. A comparison of infants delivered by the Leboyer and conventional methods.

Minute-by-minute observations are reported on the behavioral state during the first hour of life of 18 term infants delivered by the Leboyer (L) method and 18 by the conventional (C) method. The mothers were unmedicated and only two women in each group received epidural anesthetics. All deliveries were spontaneous and the infants were healthy. The behavioural states of both groups of infants were very similar, with the infants spending approximately 60% of the first hour in the quiet-alert state (median time: L = 41.5 C = 35.0 minutes) and only 10% of the time in the irritable-crying state. ALthough there were some individual differences, both groups of infants spent the second 30 minutes of the first hour predominantly in the quiet-alert state. The clinical relevance of these observations is that the first hour of life can be used to advantage in promoting parent-infant interaction.

Adult↗
PubMed1980

A randomized clinical trial of the Leboyer approach to childbirth.

To examine the effects of the Leboyer method of delivery, we randomly assigned 56 women to either a Leboyer or a conventional delivery and used a variety of clinical and behavioral measures to assess the outcome in mother and child. No differences were noted in maternal or newborn morbidity, in infant behavior in the first hour of life, at 24 or 72 hours post partum, or at eight months of age; or in maternal perceptions of her infant and the experience of giving birth, except that eight months after delivery, mothers who had used the Leboyer method were more likely to say that the event had influenced their child's behavior (P = 0.05). Women who expected a Leboyer delivery had shorter active labors (P = 0.03), suggesting that psychologic factors (expectations) influence physical outcomes in perinatal medicine. Our results suggest that the Leboyer procedure has no advantage over a gentle, conventional delivery in influencing infant and maternal outcomes.

Behavior↗
PubMed1971

Endogenous production of carbon monoxide in normal and erythroblastotic newborn infants.

The endogenous production of carbon monoxide ( V(CO)) in newborn infants was measured by serial determinations of blood carboxyhemoglobin during rebreathing in a closed system. Mean V(CO) in nine full-term infants was 13.7 +/-3.6 mul CO/kg per hr (SD), and in four erythroblastotic infants V(CO) ranged from 37 to 154 mul CO/kg per hr preceding exchange transfusion. Mean red cell life-span (MLS) and total bilirubin production were calculated from V(CO). MLS in normal newborns was 88 +/-15 days (SD), and bilirubin production was 8.5 +/-2.3 mg/kg per 24 hr. This is more than twice the amount of bilirubin normally produced in the adult per kilogram of body weight. Normal infants achieved a net excretion of bilirubin of at least 5.6 +/-2.3 mg/kg per 24 hr (SD) as calculated from the bilirubin production and the measured rise in serum bilirubin concentration.The measurement of V(CO) should prove valuable in the study of red blood cell survival and bilirubin metabolism in the newborn infant.

Bilirubin↗