Biomedical subjects

R H Carmona

Publications and source records attributed to R H Carmona.

6 recordsLinked to original sources

PubMed1994

Tactical emergency medical services: an emerging subspecialty of emergency medicine.

Law enforcement agencies are recognizing the need to have emergency medical care available at the scene of any incident involving tactical operations. The potentially volatile and dangerous atmosphere surrounding tactical operations is conducive to severe injury to officers, hostages, suspects, and bystanders. This mandates the immediate availability of basic and advanced life support services. However, a purely traditional approach to emergency medical services in the tactical environment may not be feasible and may expose prehospital personnel to greater danger. It also may disrupt the law enforcement mission. These factors mandate a different set of field assessment and treatment priorities. To meet these needs, selected prehospital personnel and emergency physicians train to work with and support special weapons and tactics teams.

Civil Disorders↗

PubMed1985

Myocardial dysfunction in septic shock.

Myocardial depression is a major but poorly understood component of septic shock. This study investigates the morphologic and biochemical abnormalities associated with septic shock. Myocardial cells are incubated in normal and septic plasma in a nutrient-, oxygen-, pH-, electrolyte-, and temperature-controlled environment. Cells and media are tested for basal- and epinephrine-stimulated cyclic adenosine monophosphate (cAMP), lactic dehydrogenase (LDH), and creatine kinase. Electron microscopic studies are done at the end of incubation. Septic LDH and creatine kinase levels in the media are increased substantially, and septic cAMP levels are reduced significantly. Septic cells beat irregularly and arrest along with exhibiting abnormal electron microscopic structure. Septic myocardial dysfunction occurs independently of previously postulated causes that are controlled for in this experiment and therefore may be due to endogenously produced or accumulated toxic factor(s).

Animals↗

PubMed1984

The role of prostacyclin and thromboxane in sepsis and septic shock.

Prostacyclin, or prostaglandin I2 (PGI2), and thromboxane A2 (TXA2) are potent, endogenously produced, vasoactive substances that have been implicated as mediators in the pathophysiologic nature of septic shock. We investigated the contribution and production of PGI2 and TXA2 in sepsis and septic shock, using an intact rabbit model and an in vitro rabbit isolated cardiac perfusion model. Continuous hemodynamic monitoring of both experimental models, along with serial radioimmunoassays of the metabolites of PGI2 and TXA2, indicated that myocardial depression is a common finding in subjects with septic shock and that septic shock causes a suppression of PGI2 production while augmenting TXA2 production. In addition, PGI2 and TXA2 were mediators of some cardiovascular changes in septic shock but were themselves not the toxic factor(s) responsible for the associated myocardial depression.

Animals↗

PubMed1984

Oriental cholangitis.

Oriental cholangitis is a poorly understood syndrome consisting of intrahepatic pigment stone formation with chronically recurrent exacerbations and remissions. Endemic to Asia, it is being encountered more frequently in the United States due to increased immigration of asians. Twenty-one patients with oriental cholangitis (9 men and 12 women), 19 to 84 years of age, all of whom immigrated from asian countries, were treated between 1970 and 1983. All had histories of episodic abdominal pain, most with jaundice, chills, and fever. Laboratory results were nonspecific but frequently included leukocytosis and hyperbilirubinemia. All patients were operated on with 15 having cholecystectomy, common duct exploration, and a bilioenteric anastomosis. E. coli was cultured from specimens obtained from the biliary tracts of all patients, and 13 patients had more than one organism. Four patients had a previous history of parasitic infection, and four different patients had parasites identified in the biliary tract intraoperatively. Early recognition and appropriate operation will decrease morbidity and mortality.

Adult↗

PubMed1984

The role of packing and planned reoperation in severe hepatic trauma.

Liver lacerations are the most common intra-abdominal injury that leads to death, and control of hemorrhage remains the primary problem in lowering mortality from severe hepatic trauma. We retrospectively reviewed operative trauma cases in which liver packing and planned reoperation were used as temporizing measures in hemodynamically unstable patients. These cases were compared to patients closely matched for age, sex, type of trauma, and associated injuries but who did not undergo liver packing and planned reoperation. Preliminary data support our contention that liver packing and planned reoperation is a valuable adjunct for the management of hemorrhage from severe hepatic injury without incurring increased morbidity or mortality. This technique is useful for the experienced trauma surgeon to arrest hemorrhage and gain hemodynamic stability before attempting definitive care and for the community hospital surgeons who after gaining hemodynamic control would like to transfer the patient to a tertiary care facility.

Adolescent↗

PubMed1982

Morbidity and mortality in hepatic trauma. A 5 year study.

The records of 443 cases of liver trauma operated on at San Francisco General Hospital from 1976 to 1981 were reviewed. Forty-two percent of the injuries were due to blunt trauma, 32 percent to stabbings, and 26 percent to gunshot wounds. Seventy-two percent of the patients were treated by simple repair and only 8 percent of patients had to undergo major resection. Infections and pulmonary problems were the most common complications, and the overall morbidity was 38 percent. Associated injuries occurred in 84 percent of patients. Our overall mortality was 9 percent; mortality for blunt trauma was 14 percent, for gunshot wounds 8 percent, and for stab wounds 2.8 percent. Most deaths were intraoperative (58 percent), with the primary cause of death being exsanguination. Multiple organ failure accounted for most of the postoperative deaths. Our 5 years study and comparison with previous studies reaffirms our belief in a conservative approach to the traumatized patient with liver injury. Utilizing the aforementioned principles, we have managed to show a continual decrease in mortality in spite of treating a more severely traumatized group of patients. We believe that continued improvement in mortality and morbidity is possible through the prevention of trauma, adherence to our basic guidelines, and the implementation of new technological advances now on the horizon.

Adolescent↗