PubMed Health⌕ Search

Biomedical subjects

P S Clark

Publications and source records attributed to P S Clark.

18 recordsLinked to original sources
PubMed1993

Survival in the elderly after out-of-hospital cardiac arrest.

OBJECTIVES: To evaluate the survival prognosis for the elderly (> or = 70 yrs of age) after out-of-hospital cardiac arrest in a large urban center, and to identify any specific differences in survival factors relative to those adults < 70 yrs of age. DESIGN: The study was a prospective, inception cohort study. SETTING: An urban population of approximately 2,000,000, served by one centralized municipal emergency medical services system. PATIENTS: All 986 adult victims (367 elderly and 619 younger patients) of primary cardiac arrest attended by the emergency medical services system over a 12-month period. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: All victims of out-of-hospital cardiac arrest occurring within a single, large, urban municipality were studied over a 12-month period. Each event was analyzed for age, sex, witnesses, bystander cardiopulmonary resuscitation, presenting electrocardiographic rhythm, paramedic response time, scene time, return of spontaneous circulation (pulses), and electrocardiographic rhythm on hospital arrival. Outcomes evaluated included inhospital admission (resuscitation) and successful discharge from the hospital (survival). Patients were followed until death or discharge from the hospital. Of 367 elderly cardiac arrest victims, 81 (22%) patients were successfully resuscitated and 24 (7%) patients survived. However, of 119 (32% of all elderly patients) patients who presented with ventricular fibrillation/tachycardia, 48 (40%) patients were resuscitated and 17 (14%) patients survived. These 17 patients with ventricular fibrillation/tachycardia accounted for 71% of all elderly survivors. During the same study period, there were 619 adult primary cardiac arrest victims < 70 yrs of age, 160 (26%) of whom were resuscitated and 73 (12%) of whom survived. Among the younger patients, 296 (48%) patients presented with ventricular fibrillation/tachycardia, of whom 110 (37%) were resuscitated and of whom 60 patients (20%) survived. Within the context of this study, survival rates for younger and older ventricular fibrillation/tachycardia patients were not significantly different. Also, among survivors, there were no other major differences in terms of established survival determinants. CONCLUSIONS: Survival chances for the elderly after out-of-hospital cardiac arrest are not bleak, and are reasonable if ventricular fibrillation/tachycardia is the presenting rhythm. Survival determinants are similar for younger and older adults.

Age Factors↗
PubMed1993

Cardiac arrest presenting with rhythms other than ventricular fibrillation: contribution of resuscitative efforts toward total survivorship.

OBJECTIVE: The medical literature portrays a bleak prognosis for out-of-hospital cardiac arrest cases presenting with asystole, idioventricular rhythms with pulselessness, or primary electromechanical dissociation. In view of evolving philosophies to waive resuscitation attempts in such cases, we sought to delineate the actual contribution toward overall survivorship that is provided by resuscitation efforts for patients who have these electrocardiographic presentations. DESIGN: A prospective outcome study which analyzed all out-of-hospital cardiac arrest cases in a large city for a 2-yr period in terms of presenting electrocardiogram, age, sex, presence and status of witnesses, performance of bystander cardiopulmonary resuscitation, and survival to successful hospital discharge. SETTING: A large urban municipality (population, two million) served by a single, centralized emergency medical services program. PATIENTS: Excluding cases associated with trauma, drugs, airway obstruction, submersion or primary respiratory illness, 2,404 consecutive adult out-of-hospital cardiac arrest patients were studied. INTERVENTIONS: Standard advanced cardiac life support. MEASUREMENTS AND MAIN RESULTS: Although survival "rates" of patients with asystole, idioventricular rhythms with pulselessness, and electromechanical dissociation were low (1.6%, 4.7% and 6.9%, respectively), 22.2% of the 193 total survivors (confidence interval: +5.9%) initially presented with one of these electrocardiographic rhythms (14 asystole, 18 idioventricular rhythms with pulselessness, 10 electromechanical dissociation, plus one other). CONCLUSIONS: Despite poor survival "rates," resuscitative efforts for patients presenting with asystole, electromechanical dissociation, and idioventricular rhythms with pulselessness all contribute significantly toward a community's total survivorship from out-of-hospital cardiac arrest. Initial, aggressive attempts at resuscitation still should be emphasized in such patients.

Accelerated Idioventricular Rhythm↗
PubMed1992

Acute renal failure and glomerulopathy caused by nonsteroidal anti-inflammatory drugs.

Nonsteroidal anti-inflammatory drugs are now one of the most common causes of acute renal failure (ARF). To define more clearly the magnitude of the problem, we reviewed all cases of ARF in the Reno (Nev) area from 1972 through 1986. Twenty-seven cases of ARF and seven cases of glomerulopathy were identified, primarily during the last 5 years of the study period. Twenty-three of the cases of ARF and six of the cases of glomerulopathy cleared an average of 23 and 118 days, respectively, after treatment with the nonsteroidal anti-inflammatory drug was stopped. Two cases of ARF persisted, and two patients died. Proteinuria, hematuria, and casts were prominent in both ARF and glomerulopathy but were more pronounced in the glomerulopathies. The treatment of choice is to stop the use of the nonsteroidal anti-inflammatory drug. The role of steroids has not been evaluated.

Acute Kidney Injury↗
PubMed1971

Complications of smallpox vaccination, 1968. Results of a statewide survey in Alaska.

A survey was made to determine the incidence in Alaska of complications of smallpox vaccination during 1968. Of the 206 medical personnel responding to the questionnaire, 20 (or 9.7 percent) observed a complication. Twenty-six complications were reported, 20 of which occurred in primary vaccinees. Accidental implantation was the most common complication, but two cases of eczema vaccinatum and two of generalized vaccinia were observed. There were no deaths or cases of postvaccinial encephalitis or vaccinia necrosum. Of the 26 complications, 19 were theoretically preventable.

Adolescent↗
PubMedDate not supplied

Distinct criteria for termination of resuscitation in the out-of-hospital setting.

OBJECTIVE: To identify distinct criteria for appropriate on-scene termination of resuscitation efforts for out-of-hospital cardiac arrest when on-scene interventions fail to restore spontaneous circulation. DESIGN: For 18 months, all out-of-hospital cardiac arrests were evaluated prospectively for survival to hospital discharge and for all established survival predictors including age, gender, presenting cardiac rhythm, whether it was a witnessed event, performance of basic cardiopulmonary resuscitation by bystanders, and interval to paramedic arrival and return of spontaneous circulation (ROSC). SETTING: A large municipality with a single, centralized emergency medical services program. PATIENTS: All normothermic adults treated for out-of-hospital, unmonitored, primary cardiac arrest. INTERVENTIONS: Standard advanced cardiac life support provided at the scene by paramedics. MAIN OUTCOME MEASURES: The number and circumstances of patients achieving survival to hospital discharge following failure to achieve on-scene ROSC. RESULTS: Of 1461 consecutive primary cardiac arrests, 139 were monitored (paramedic witnessed), including 59 that occurred en route to the hospital. Of the 1322 unmonitored patients, 370 achieved ROSC at the scene. Only six (0.6%) of the 952 who did not achieve ROSC at the scene survived, and all six were readily identifiable as having persistent ventricular fibrillation. Excluding those patients with persistent ventricular fibrillation, all survivors achieved ROSC within 25 minutes after paramedic arrival. CONCLUSIONS: Excluding patients with persistent ventricular fibrillation, resuscitative efforts can be terminated at the scene when normothermic adults with unmonitored, out-of-hospital, primary cardiac arrest do not regain spontaneous circulation within 25 minutes following standard advanced cardiac life support. These criteria should now be validated in several large centers with high survival rates.

Aged↗