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Biomedical subjects

P J Baskett

Publications and source records attributed to P J Baskett.

At least 19 recordsLinked to original sources
PubMed1998

The incidence of regurgitation during cardiopulmonary resuscitation: a comparison between the bag valve mask and laryngeal mask airway.

The risk of gastric regurgitation and subsequent pulmonary aspiration is a recognised complication of cardiac arrest--a risk which may be further increased by the resuscitative procedure itself. The purpose of this study was to compare the incidence of gastric regurgitation between the bag valve mask (BVM) and laryngeal mask airway (LMA). The resuscitation data collection forms of 996 patients who underwent in-hospital cardiopulmonary resuscitation over a 3.5 year period were reviewed. Of these, 199 patients were excluded from the study because there was no airway management involving a BVM or LMA. The incidence and timing of regurgitation was studied in the remaining 797 patients. Regurgitation was recorded to have occurred at some stage in 180 of these patients (22.6%). However, 84 regurgitated prior to CPR (46.7% of those patients who regurgitated). These patients were excluded from further analysis as regurgitation could not have been affected by any form of ventilation. Of the remaining 713 patients, BVM ventilation was used in 636 cases. In 170 of these the LMA was also used following the BVM. Where the patient was ventilated with the BVM alone or BVM followed by ETT the incidence of regurgitation during CPR was 12.4%. The LMA was used during resuscitation in 256 cases of which 170 had BVM ventilation prior to the LMA. Where the patient was ventilated with the LMA alone or LMA followed by ETT the incidence of regurgitation during CPR was 3.5%. The study confirms experience reported in earlier studies that when an LMA is used as a first line airway device, regurgitation is relatively uncommon.

Cardiopulmonary Resuscitation↗
PubMed1998

The intubating laryngeal mask. Use in failed and difficult intubation.

The use of the intubating laryngeal mask in three patients is described. In two patients for whom tracheal intubation using traditional techniques had failed, the intubating laryngeal mask was used to achieve successful tracheal intubation. The trachea of one of these patients was subsequently re-intubated for a second procedure using the same technique. A third patient with a cervical spine fracture whose trachea was electively intubated using the intubating laryngeal mask is also presented.

Aged↗
PubMed1997

Resuscitation.

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Anesthesiology↗
PubMed1994

Immediate management of the airway during cardiopulmonary resuscitation in a hospital without a resident anaesthesiologist.

The effect of withdrawing the resident anaesthesiologist from the cardiopulmonary resuscitation (CPR) team was audited over a 1-year period in a 407-bed hospital in which nurses had been trained in the use of the laryngeal mask airway (LMA) as a first response airway in CPR. The data were compared to those of the previous year, which are shown in parentheses. During the audit period, there were 115 (79) calls to 115 (79) patients; the immediate airway was secured using a mask bag valve assembly in 75 (49) episodes, the Laerdal pocket mask in 2 (2) episodes, the LMA in 64 (2) and the endotracheal tube in 20 (57). Return of spontaneous circulation occurred in 61% (36%). There were no instances of failure to maintain the immediate airway during the audit period. Initial results suggest that an anaesthesiologist may not be essential for the provision of an immediate airway in patients requiring CPR.

Airway Obstruction↗
PubMed1993

Ethics in cardiopulmonary resuscitation.

There is a minority of patients in whom resuscitation is inappropriate. It is important to identify such patients beforehand and communicate the decision not to attempt resuscitation to the would-be first responders. In the absence of the patient's expressed wishes, any decision not to attempt resuscitation must be made by the senior doctor in charge. This doctor will take into account a number of factors and, when appropriate, consult with medical and nursing colleagues relatives, etc. before making such a decision. There are many factors influencing the decision to terminate resuscitation once it has been started. These are listed and discussed. Legal aspects are addressed and indications are made of the expected performance of lay and professional rescuers working under a variety of circumstances. The various definitions of death are described in the light of modern medical practice and the possibility of organ transplantation. There is an increasing fear of infection hazards to the rescuer during mouth to mouth ventilation. The risks are discussed and the use of protective devices is encouraged if they are immediately available. Finally, guidelines for hospital ethical CPR policy are outlined in the hope that they will be considered for adoption on a national and international scale.

Brain Death↗
PubMed1992

A new chart to assist with advanced trauma life support.

Many studies have drawn attention to deficiencies in the management of major trauma, both in the UK and elsewhere. One area that has received little attention is the documentation of such cases in the Emergency Room. When outcome may be sub-optimal, documentation assumes greater importance if advances are to be made in the organisation of trauma care. Based upon the American College of Surgeons Advanced Trauma Life Support (ATLS) protocols, the authors have designed a document that records dynamically what happens to the multiply injured victim on arrival in the Emergency Room. It unifies the recording of vital signs, whilst acting as an assessment and resuscitation template. By ensuring no life-threatening illness is missed it is likely to improve patient survival. The document can act as a basis for teaching and a medico-legal record, whilst providing the necessary data for quality assurance and outcome audit.

Clinical Protocols↗
PubMed1991

Disaster management. Organizations and academic perspective.

The world has to cope with the results of an increasing number of disasters. If the planning and preparation for these disasters are to be effective, then national and international organizations are necessary to integrate the sources of advice and relief. Studies of disaster management have consistently highlighted coordination of resources as an essential element of effective response. These organizations, both governmental and voluntary, aim to do just that, and awareness of them and their work will add support.

Aircraft↗
PubMed1991

Trauma anesthesia for disasters. Anything, anytime, anywhere.

Field anesthesia can be practiced safely and effectively but requires special training to acquire familiarity with the techniques. Because field anesthesia may be required even in sophisticated countries for entrapment situations, skill should be maintained by practicing the appropriate techniques on a regular basis. Field anesthetic techniques are not second rate methods; they are just different. Although improvisation in the disaster situation has merit, it is not the place for experimenting with new and untried techniques.

Anesthesia↗