PubMed Health⌕ Search

Biomedical subjects

O N Gofrit

Publications and source records attributed to O N Gofrit.

30 records · Page 2Linked to original sources
PubMed1997

Prehospital cricothyroidotomy by physicians.

To evaluate cricothyroidotomy in the field and the influence of physicians' medical specialty or previous experience on the success rate of this procedure, a retrospective study was conducted. Between October 1991 and April 1995, 29 cricothyroidotomies were performed in the prehospital setting in Israel. Twenty-six (89.6%) cricothyroidotomies were successfully performed. There was no evidence of higher success rate when the performers were surgeons, anesthesiologists, or intensive care specialists (100% success), compared to that of all other specialties (83.33%). All physicians had successfully completed the Advanced Trauma Life Support (ATLS) course, but only three had previously performed cricothyroidotomy. Acute complications included failure to establish an airway in 3 cases, minor bleeding in 2 cases, and an air leak around the cannula in 1 patient. These results show that following brief training (eg, the ATLS course) physicians are capable of performing emergency cricothyroidotomy in the field with a high success rate and minimal complications, regardless of medical specialty.

Adult↗
PubMed1997

Interhospital patient transfer: a quality improvement indicator for prehospital triage in mass casualties.

The need for interhospital patient transfer after mass casualties may be a consequence of triage errors. Indications for interhospital patient transfer following seven suicidal bus bombings in Israel were reviewed to identify possible errors in triage at the scene. Medical records of victims arriving to hospitals were analyzed for age, injury description, injury Severity Score (ISS), and indication and destination of interhospital transfer. A total of 473 victims were involved, 74 of whom died at the scene (15.6%). Mean victim age was 29 +/- 16 (SD) years. Interhospital transfer was necessary for 29 patients. Indications for transfer included (1) mandatory lifesaving procedures on route to trauma center (n = 14), (2) underdiagnosis at the scene (n = 1), (3) insufficient local resources (n = 9), and (4) triage-related errors (n = 5). The ratio between interhospital transfer due to triage errors and the victim population who may need to be transferred is suggested as quality assurance (QA/QI) indicator for triage.

Adolescent↗
PubMed1997

The trimodal death distribution of trauma victims: military experience from the Lebanon War.

INTRODUCTION: Mortality in war is traditionally divided into two categories: killed in action and died of wounds. Mortality in civilian trauma is generally divided into three categories: immediate death (50%), early death (30%), and late death (20%). Can we identify a trimodal death distribution among war victims? METHODS: We analyzed data for casualties in the Lebanon War from June 6 to September 20, 1982. During this period a total of 1,950 soldiers were injured; 351 (18%) of them died. Time of injury and time of death of the victims was determined from real-time recordings during the battle and from hospital files. RESULTS: Analyzing the time of death revealed that 329 of the soldiers (93.7%) died within the first hour after injury, 7 soldiers died 1 to 4 hours after injury (2%), and 15 soldiers died 24 hours to 75 days after injury (4.3%). The most common causes of death during the first hour after injury were central nervous system (CNS) injuries 31%, exsanguination 30%, incineration 21%, and combined CNS injury and exsanguination 10.9%. Exsanguination was the leading cause of death 1 to 4 hours after injury (86%). CNS injury was the most common cause of late death (60%). Only 1.1% of the soldiers who reached the hospital alive died of their wounds. CONCLUSIONS: A trimodal mortality distribution with different causes of death in each peak can be identified in the mortality pattern of Israeli soldiers during the Lebanon War. The relative height of the different peaks and the causes of death in the third peak are different from those found in civilian trauma. We believe that prompt medical treatment and expeditious evacuation from the battle zone led to a very low death rate among the wounded soldiers who had reached the hospital alive. The same factors may have increased the relative portion of CNS injuries as a cause of late death.

Cause of Death↗
PubMed1997

Intravenous line diameter: is bigger really better?

OBJECTIVE: To determine whether the size of an intravenous catheter influences the cannulation success rate and procedure duration among military medics. METHODS: According to a prospective, randomized, controlled crossover study design, 114 military medic cadets were paired and inserted 14-gauge (14G) and 16G intravenous catheters into veins in the antecubital fossa. Success rate and procedure duration were determined. RESULTS: The overall success rate for 14G and 16G catheters was 80 and 86%, respectively. Average procedure duration was 33 +/- 14.7 and 35.2 +/- 14.9 seconds, respectively. No significant differences were found in either success rate or procedure duration between the examined catheter sizes. CONCLUSION: Successful intravenous cannulation was unaffected by catheter size. Therefore, 14G intravenous catheters are recommended for use by military medics on the battlefield.

Adult↗
PubMed1997

Penile intracorporeal infusion--possible access to the systemic circulation. Pressure flow studies in dogs and humans.

OBJECTIVE: To assess penile intracorporeal infusion as a simple alternative method of intravenous access during the initial phase of fluid resuscitation in male patients. DESIGN: Laboratory pressure flow studies in dogs and in humans. SUBJECTS: 5 male mongrel dogs, and 10 male patients who were being investigated for psychogenic impotence (n = 5) or organic impotence (n = 5). INTERVENTIONS: Dogs- two 19G needles were inserted into the canine corpora cavernosa, one for fluid infusion, and the other for cavernosal pressure monitoring. Ringer's lactate solution was infused into the corpora cavernosa, through an infusion pump. The dogs were then bled until systolic blood pressure reached 60 mmHg, and resuscitated by transfusion of autologous blood into the corpora cavernosa. HUMANS: Ringer's lactate solution was infused into a corpus cavernosum through a 19G scalp vein needle. Pressure monitoring was done through another 19 G needle. MAIN OUTCOME MEASURE: Fluid flow rates and in humans time taken to insert an intracorporeal needle. RESULTS: Mean (SD) infusion rate through the canine corpora was 110 (22) ml/minute for Ringer's lactate solution and 109 (18) ml/minute for autologous blood. Mean infusion rate into the human corpora was 89.7 (12) ml/minute in the psychogenic impotent patients, and 88.2 (9) ml/minute in the organic impotent patients. Mean time taken to insert the needle was 15 (7) sec. CONCLUSIONS: An intracorporeal infusion line can be established in a short period of time and adequate quantities of fluids can be infused through the human and canine corpora cavernosa.

Animals↗
PubMed1996

Accurate anatomical location of war injuries: analysis of the Lebanon war fatal casualties and the proposition of new principles for the design of military personal armour system.

In this study we present a new approach to the design of the military personal armour system (MPAS). This approach is based on a computerized analysis of the exact anatomical location of 405 penetrating war injuries (290 shrapnel and 115 bullet injuries) in 164 soldiers killed in the Lebanon war. All the penetrating injuries (hits) were plotted on a computerized image of the human body. About 90 per cent of all hits were to the front of the body; 55 per cent of all hits were to the left side. About 45 per cent of all hits were to the torso, which is slightly more than the torso's proportion of total body-surface area (36 per cent). Of all hits to the torso, 64 per cent of the shrapnel hits and 73.3 per cent of the bullet hits were limited to the front mid torso (T4 to T9). The head at the level of the helmet received 9 per cent of all hits, most of which were over the frontal bones (72.4 per cent). The body part with the greatest density of penetrating injuries was the face, with 22.2 per cent of all penetrating wounds, and in particular the mid face, from the level of the lips to the level of the zygomatic bones, was especially vulnerable, sustaining 10 per cent of all the penetrating wounds. These findings suggest several possible modifications in the standard MPAS: an additional protective device over the front mid torso may be incorporated; the face may be protected by a transparent and lightweight face-shield; a horizontal margin added to the standard helmet may protect the upper face from missiles from above; a chin cover may protect the lower face.

Blast Injuries↗
PubMed1996

Blast injuries: bus versus open-air bombings--a comparative study of injuries in survivors of open-air versus confined-space explosions.

OBJECTIVES: To compare injury patterns resulting from explosions in the open air versus within confined spaces. METHODS: Medical charts of 297 victims of four bombing events were analyzed. Two explosions occurred in the open air and two inside buses. Similar explosive devices were applied in all four incidents. The incidence of primary blast injuries, significant penetrating trauma (Abbreviated Injury Scale score > or = 2), burns, Injury Severity Score, Revised Trauma Score, and mortality were compared between the two populations. RESULTS: A total of 204 casualties were involved in open-air bombings, 15 of whom died (7.8%). Ninety-three victims were involved in bus bombings, 46 of whom died (49%). The difference in mortality rate was highly significant, p < 0.00001. Primary blast injuries were observed in 25 and 31 victims (34.2% and 77.5% of admitted victims), respectively (p = 0.00003). Median Injury Severity Score was 4 versus 18, respectively (p < 0.0001). CONCLUSION: Explosions in confined spaces are associated with a higher incidence of primary blast injuries, with more severe injuries and with a higher mortality rate in comparison with explosions in the open air.

Adolescent↗
PubMed1996

Traumatic arm amputation, an uncommon parachuting injury.

Parachuting is a unique method of deploying troops. Accidents in parachuting are common, but usually carry minimal risk for severe injury. Most accidents occur during landing and injuries often affect the lower limbs and spine. Traumatic amputation of a limb is an extremely rare event in parachuting. We present a case of a parachutist who suffered a traumatic amputation of the left hand during jumping off the plane.

Accidents, Aviation↗
PubMed1996

Functional antagonistic activity of Rec 15/2739, a novel alpha-1 antagonist selective for the lower urinary tract, on noradrenaline-induced contraction of human prostate and mesenteric artery.

The aim of this study was to compare with known reference standards the functional in vitro alpha-1 antagonistic activity of Rec 15/2739 on noradrenaline-induced contractions of human prostate and mesenteric artery. We also characterized these tissues with regard to the alpha-1 adrenoceptor subtypes present. Comparing the apparent pKB values revealed Rec 15/2739 to be one of the most potent compounds action on the prostate. Its potency was slightly lower than that of tamsulosin and was higher than the potencies of prazosin, terazosin and 5-methylurapidil. On the mesenteric artery, tamsulosin was the most potent compound. Comparing the results from the functional studies with those obtained from radioreceptor binding studies, we found that the potency (pKB value) in inhibiting the contraction of prostatic tissue showed a close and significant correlation with the affinity for native and recombinant alpha-1A adrenoceptors. No significant correlation was found with affinity for either the native or the recombinant alpha-1B adrenoceptor subtype, or for recombinant alpha-1d receptors. Similar results were obtained for mesenteric artery. In order to characterize further the alpha-1 adrenoceptor subtypes present in the examined tissues, we investigated the functional effects of chloroethylclonidine, an alpha-1B-D subtypes selective alpha-1 adrenoceptor irreversible antagonist, and those of nifedipine, which antagonizes the extracellular calcium influx primarily mediated by alpha-1A adrenoceptor stimulation. The results indicate the presence of both chloroethylclonidine-sensitive and -insensitive alpha-1 adrenoceptor subtypes in the human prostate, whereas in mesenteric artery the alpha-1A subtype seems to be present exclusively. The possibility that the functionally relevant alpha-1 adrenoceptor subtype could be classified as alpha-1L in both tissues shoul also be considered.

Adrenergic alpha-1 Receptor Antagonists↗
PubMedDate not supplied

High-resolution ultrasonography: highly sensitive, specific technique for preoperative localization of parathyroid adenoma in the absence of multinodular thyroid disease.

The objective of this prospective study was to evaluate the role of preoperative ultrasonography (US) for parathyroid lesion localization in patients with primary hyperparathyroidism (PHPT) prior to initial surgery. Fifty-two consecutive patients with PHPT, diagnosed in our institution within a period of 2 years, were referred for preoperative US and subsequently for bilateral surgical neck exploration. The combination of a confirmatory pathologic report and normalization of blood calcium concentration for a period of at least 3 months was considered an operative success. In 50 patients (96.2%) a single parathyroid adenoma was excised, and in one patient (1.9%) hyperplasia of three glands was found at surgery. In the one surgical failure, no parathyroid pathology was identified in the neck; therefore the operative success in this series was 98%. The sensitivity of preoperative US was 83% with a specificity of 100%. In the absence of thyroid multinodular disease (MND), the sensitivity of preoperative US increased to 90%, whereas in patients with MND the sensitivity was only 64%. Our findings support the notion that patients with PHPT should be investigated with US before initial surgery. Bilateral surgical exploration is warranted in patients with MND. In the absence of such thyroid pathology, an US finding positive for adenoma should allow the surgeon to perform unilateral neck exploration only, with consequent reduction of operation time and postoperative complications.

Adenoma↗
PubMedDate not supplied

The efficacy of integrating "smart simulated casualties" in hospital disaster drills.

INTRODUCTION: Full-scale disaster drills are complex, expensive, and may involve hundreds or thousands of people. However, even when carefully planned, they often fail to manifest the details of medical care given to the casualties during the drill. OBJECTIVE: To assess the feasibility of integrating physicians among the simulated casualties of a hospital disaster drill. METHODS: A total of 178 physicians graduating an Advanced Trauma Life Support (ATLS) course participated in eight hospital disaster drills during 1994 as "Smart Victims." The participants were given cards with descriptions of their injury and detailed instructions on how to manipulate their medical condition according to the medical care provided in the hospital. They also were given coded questionnaires to fill out during the process of the drill. Conclusions were drawn from analysis of the questionnaires and from a roundtable discussion following each drill. RESULTS: The "smart casualties" made comments on the following topics: 1) triage (over-triage in 9%, and under-triage in 4%); 2) treatment sites; 3) medical equipment usage (i.e., shortage of ventilators and splinting devices); 4) medical knowledge and care rendered by the hospital staff; 5) evacuation and escorting of the wounded; 6) management of patients with post-traumatic stress disorder; and 7) medical documentation. Their comments contributed valuable information on the quality of medical care and organization, and identified obstacles that otherwise would have been overlooked. The "smart casualties" were very cooperative and indicated that their participation in the drill contributed to their understanding of disaster situations in hospitals. CONCLUSION: Integrating physicians among the simulated casualties in a hospital disaster drill may contribute to achieving the objectives of hospital disaster drills and add to disaster management education of the simulated casualty physicians.

Adult↗