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Biomedical subjects

R J Wilder

Publications and source records attributed to R J Wilder.

16 recordsLinked to original sources
PubMed1991

Coming of age.

Explore the source record for details and available documents.

Baltimore↗
PubMed1987

Shoulder pain and pneumoperitoneum following a diving accident.

We present the case of a diver who experienced the acute onset of shoulder pain after a rapid ascent. It was determined that the patient had decompression sickness ("the bends") of the right shoulder and pulmonary barotrauma resulting in secondary pneumoperitoneum. He underwent decompression, with prompt resolution of symptoms. Of the 14 cases of isolated pneumoperitoneum due to barotrauma reported in the world literature, three were due to gastric rupture. Shoulder pain in association with pneumoperitoneum may be due to diaphragmatic irritation or may be an isolated symptom of decompression sickness. Correctly determining the etiology of these findings is crucial to the appropriate management of the patient.

Adult↗
PubMed1985

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion.

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.

Analysis of Variance↗
PubMed1983

Venous return in hemorrhagic shock after application of military anti-shock trousers.

UNLABELLED: The effect of Military Anti-Shock Trousers (MAST) on inferior vena cava blood flow was studied during graded hypovolemia using a pump reservoir system and an in-line electromagnetic flowprobe. During hemorrhagic shock MAST inflation increased cardiac output 25.4% ( CONTROL: 0.92 +/- 0.09 l/min) and arterial pressure 50% ( CONTROL: 60 +/- 2 mmHg). The so-called "autotransfusion" effect due to blood displacement from the lower part of the body into the central circulation was found to be only 4.3 +/- 0.6 ml/kg, a volume much less than previously estimated in the literature. We conclude that MAST inflation reliably improves cardiac output and systemic blood pressure above the diaphragm in dogs subjected to hemorrhagic shock. This effect is mainly due to a diversion of the cardiac output to the upper half of the body due to impedance of flow to the abdomen and lower extremities, rather than to a significant volume shift constituting an autotransfusion of blood from the lower part of the body.

Animals↗
PubMed1981

MAST augmentation of external cardiac compression: role of changing intrapleural pressure.

Ventricular fibrillation was induced in nine dogs weighing 18 to 22 kg. CPR was performed with a mechanical chest compressor. Mean carotid flow during CPR was 7.9 +/- 1.5 ml/min. After MAST inflation to 100 mm Hg, the flow increased to 15.7 +/- 3.7 ml/min. Intrathoracic aortic systolic pressure was also significantly increased from 65 +/- 7 to 73 +/- 8 mm Hg. When the thorax was vented with chest tubes bilaterally, no change in carotid flow or arterial pressure was noted on closing or opening the chest tubes. One liver laceration and two gallbladder contusions were noted at autopsy. MAST inflation apparently augments carotid flow an systolic pressure. Variations in intrapleural pressure do not seem to have a significant influence on CPR.

Animals↗