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Biomedical subjects

T J Coats

Publications and source records attributed to T J Coats.

At least 19 recordsLinked to original sources
PubMed2006

Does calcium cause the different effects of Gelofusine and Haemaccel on coagulation?

BACKGROUND: Gelofusine (which does not contain calcium) has a greater effect on coagulation than Haemaccel (which contains 6.25 mmol/l of calcium). This in vitro study was performed to assess whether calcium might be the cause of the different effects on coagulation. METHODS: Three solutions were compared; (a) Gelofusine, (b) Gelofusine with calcium added to 6.25 mmol/l, and (c) Haemaccel. Thromboelastography (Sonoclot) was used to examine whole blood coagulation, with time to peak clot weight as the primary outcome measure. RESULTS: There was no significant difference between the Gelofusine containing solutions. Both Gelofusine solutions gave a greater impairment of coagulation than the Haemaccel solution. CONCLUSIONS: The different effect of Gelofusine on coagulation compared with Haemaccel does not seem to be related to the different calcium contents of the solutions.

Blood Coagulation↗
PubMed2006

The effects of commonly used resuscitation fluids on whole blood coagulation.

OBJECTIVES: Evidence on the effect of crystalloid and colloid resuscitation fluids on coagulation is confusing, with contradictory results from previous studies. This study was performed to test the effect on whole blood coagulation of a range of resuscitation fluids in vitro using a single method at a single dilution. METHODS: Seven resuscitation fluids were tested in vitro at a dilution of 40%. Whole blood coagulation was measured using a Sonoclot analyser. RESULTS: A crystalloid/colloid split of effect on coagulation in vitro was not seen. The time to clot formation with Gelofusine, dextran and hydroxyethyl starch was a greatly increased, whereas saline and Haemaccel had little effect, or were slightly procoagulant. CONCLUSIONS: Some resuscitation fluids have a profound effect on coagulation. The confusion in the literature may result from the effect on coagulation being both fluid and dilution dependent, with no simple crystalloid/colloid split.

Blood Coagulation↗
PubMed2006

Impairment of coagulation by commonly used resuscitation fluids in human volunteers.

BACKGROUND: This study compared the effects of two commonly used resuscitation fluids on whole blood coagulation. METHODS: 1000 ml of two resuscitation fluids each (saline and Gelofusine) were given to eight volunteers in a crossover design with a 2-week washout period. The effect on whole blood coagulation was assessed using the Sonoclot analyzer, a conventional coagulation screen and coagulation markers. RESULTS: No significant effect was found on whole blood coagulation by giving saline (time to peak clot increased by a mean of 106 s; (95% confidence interval (CI) -140 to 354), whereas Gelofusine delayed the time to peak by a mean of 845 s (95% CI 435 to 1255). By contrast, there was no change in the conventional coagulation screen with either fluid. CONCLUSION: It was concluded that some resuscitation fluids have an effect on clot formation that is not shown by the conventional coagulation screen, but is disclosed only if the whole coagulation process is studied.

Blood Coagulation↗
PubMed2006

High quality acute care for the severely injured is not consistently available in England, Wales and Northern Ireland: report of a survey by the Trauma Committee, The Royal College of Surgeons of England.

INTRODUCTION: A survey was undertaken to determine the extent to which acute hospitals in England, Wales and Northern Ireland were meeting the acute trauma management standards published in 2000 by The Royal College of Surgeons of England and the British Orthopaedic Association. METHODS: A questionnaire comprising 72 questions in 16 categories of management was distributed in July 2003 to all eligible hospitals via the link network of the British Orthopaedic Association. Data were collected over a 3-month period. RESULTS: Of 213 eligible hospitals, 161 (76%) responded. In every category of acute care, failure to meet the standards was reported. Only 34 (21%) hospitals met all the 13 indicative standards that were considered pivotal to good trauma care, but all hospitals met at least 7 of these standards. Failures were usually in the organisation of services rather than a lack of resources, with the exception of the inadequate capacity for admission to specialist neurosurgery units. A minority of hospitals reported an inability to provide emergency airway control or insertion of chest tube. The data have not been verified and deficiencies in reporting cannot be excluded. CONCLUSIONS: The findings of this survey suggest that high quality care for the severely injured is not available consistently across England, Wales and Northern Ireland, and appear to justify concerns about the ability of the NHS to deal effectively with the current trauma workload and the consequences of a major incident.

Health Services Accessibility↗
PubMed2004

Does a single bolus thrombolytic reduce door to needle time in a district general hospital?

OBJECTIVES: To answer the question "In patients presenting with ST elevation acute myocardial infarction (STEMI) and no contraindication to thrombolysis, does the introduction of Tenecteplase reduce door to needle times?" METHODS: Firstly, an observational study was performed to compare the time taken to prepare standard thrombolytic therapy with Tenecteplase. Secondly, door to needle times were compared before and after the introduction of Tenecteplase. The study was powered to be 80% sure of finding a change of 10% in the number of patients meeting the national service framework standard of a 30 minute door to needle time. RESULTS: Tenecteplase takes 10.5 minutes less time to prepare than standard treatment (p value <0.001). After the introduction of Tenecteplase the percentage of patients receiving thrombolysis in 30 minutes increased from 58% to 76% (p value <0.01) CONCLUSION: Tenecteplase is quicker to prepare than standard therapy, resulting in a significant improvement in performance against the national service framework target.

Emergencies↗
PubMed2003

[Resuscitative transverse thoracotomy].

The technique of resuscitative transverse thoracotomy is for use in case of circulatory arrest in the trauma patient. This technique, performed after orotracheal intubation, is initiated by a 5th intercostal space thoracostomy in each mid-axillary line. If the circulatory arrest is not caused by a tension pneumothorax, bilateral thoracotomies in the 5th intercostal spaces with transverse transsection of the sternum is performed. Middle vertical incision of the pericardium allows the evacuation of a cardiac tamponade. This wide surgical access has proved simple to perform, even by non experienced operators. It allows digital control of a heart wound, cross-clamping of the thoracic descending aorta or of pulmonary hilum, rapid perfusion of warm fluids through the right auricle and the performance of bimanual internal cardiac massage.

Heart Arrest↗
PubMed2002

Recognition of ST elevation by paramedics.

OBJECTIVE: To define the ability of UK paramedics to recognise ST segment elevation using a prehospital 12 lead electrocardiogram (ECG). METHODS: Analysis of the diagnostic ability of seven paramedics 12 months after a two day training course, using interpretation of a 12 lead ECG by two cardiologists as the criterion standard. Comparison of paramedic and A&E SHO diagnosis to determine accuracy, specificity, sensitivity, negative predictive value, and positive predictive value of paramedic interpretation. RESULTS: Paramedics showed a median accuracy of 0.95 (95% CI 0.88 to 0.98), a specificity of 0.91 (95% CI 0.53 to 1.0), a sensitivity of 0.97 (95% CI 0.94 to 0.99), a NPV of 0.77 (95% CI 0.62 to 0.92) and a PPV of 0.99 (95% CI 0.92 to 1.0). This was not significantly different from a group of experienced A&E SHOs. CONCLUSIONS: UK paramedics can recognise ST elevation using a 12 lead ECG. Radio transmission of an ECG may not be necessary to pre-alert the hospital.

Clinical Competence↗
PubMed2002

The effect of gel burns dressings on skin temperature.

OBJECTIVES: This study was designed to investigate the effect on skin temperature of different methods of use of a hydrogel dressing. METHODS: Twelve volunteers had temperature measured under a hydrogel dressing with different combinations of air movement and bandaging. RESULTS: A large drop in skin temperature was only achieved when the dressing was left exposed with air movement over the surface of the dressing. CONCLUSIONS: A temperature that gives effective analgesia is not reached if the dressing is used in accordance with the manufacturer's instructions (covered with an insulating layer). This explains the authors' observation that paramedics and patients often leave these dressings uncovered.

Burns↗
PubMed2002

Early increases in blood lactate following injury.

Current pre-hospital trauma triage systems are based mainly on physiological parameters, but in compensated shock injury severity may not be immediately obvious, as the physiological parameters remain normal for some time. Serum lactate, measured in hospital, is known to be a predictor of injury severity and outcome. The technology for easy field lactate measurement has recently become available. We found that capillary lactate is elevated in trauma patients in the early phase of the response to injury. There is a moderate correlation (R2 = 0.44) between early lactate levels and injury severity, in patients who might otherwise be difficult to triage.

Adult↗
PubMed2001

Prehospital resuscitative thoracotomy for cardiac arrest after penetrating trauma: rationale and case series.

OBJECTIVE: The purpose of this study is to present the rationale for an algorithm that describes the place of resuscitative thoracotomy in the prehospital management of a patient with penetrating chest injury, and to review a 6-year experience using this algorithm. METHODS: This study was a retrospective review of all cases where a prehospital thoracotomy was performed by the medical teams of the London Helicopter Emergency Medical Service. RESULTS: Thirty-nine prehospital thoracotomies were performed. Four (10%) patients survived, one with long-term disability. Factors associated with survival were stab wound, single cardiac wound, cardiac tamponade, and loss of pulse in the presence of an experienced prehospital doctor. CONCLUSION: Current evidence suggests that patients who suffer a cardiac arrest more than 10 minutes away from emergency room thoracotomy are very unlikely to survive. Prehospital thoracotomy is associated with a small number of survivors. This intervention should be considered if there is an appropriately experienced, trained, and equipped doctor present, who is acting within a trauma system with ongoing training and quality assurance.

Adolescent↗
PubMed2001

Comparison of artificial intelligence techniques with UKTRISS for estimating probability of survival after trauma. UK Trauma and Injury Severity Score.

BACKGROUND: The development of TRISS was principally a search for variables that correlated with outcome. It is not known, however, if linear statistical models provide optimal results. Artificial intelligence techniques can answer this question and also determine the most important predictor variables. METHODS: An artificial neural network, using 16 anatomic and physiologic predictor variables, was compared with the latest United Kingdom version of TRISS model. RESULTS: Both methods were 89.6% correct, but TRISS was significantly better by the area under the receiver operating characteristic curve (0.941 vs. 0.921, p < 0.001). The artificial neural network, however, was better calibrated to the test data (Hosmer-Lemeshow statistic, 58.3 vs. 105.4). Head injury, age, and chest injury were the most important predictors by linear or nonlinear methods, whereas respiration rate, heart rate, and systolic blood pressure were underused. CONCLUSION: Prediction using linear statistics is adequate but not optimal. Only half the predictors have important predictive value, fewer still when using linear classification. The strongest predictors swamp any nonlinearity observed in other variables.

Artificial Intelligence↗
PubMed2001

Prehospital rapid sequence induction by emergency physicians: is it safe?

OBJECTIVES: To determine if there were differences in practice or intubation mishap rate between anaesthetists and accident and emergency physicians performing rapid sequence induction of anaesthesia (RSI) in the prehospital setting. METHODS: All patients who underwent RSI by a Helicopter Emergency Medical Service (HEMS) doctor from 1 May 1997 to 30 April 1999 were studied by retrospective analysis of in-flight run sheets. Intubation mishaps were classified as repeat attempts at intubation, repeat drug administration and failed intubation. RESULTS: RSI was performed on 359 patients by 10 anaesthetists (202 patients) and nine emergency physicians (157 patients). Emergency physicians recorded a larger number of patients as having Cormack and Lehane grade 3 or 4 laryngoscopy than anaesthetists (p<0.0001) but were less likely to use a gum elastic bougie to assist intubation (p=0.024). Patients treated by emergency physicians did not have a significantly different pulse, blood pressure, oxygen saturation or end tidal CO2 to patients treated by anaesthetists at any time after intubation. Emergency physicians were more likely to anaesthetise patients with a Glasgow Coma Score >12 than anaesthetists (p=0.003). There were two failed intubations (1%) in the anaesthetist group and four (2.5%) in the emergency physician group. Repeat attempts at intubation and repeat drug administration occurred in <2% of each group. CONCLUSIONS: RSI performed by emergency physicians was not associated with a significantly higher failure rate or an increased number of intubation mishaps than RSI performed by anaesthetists. Emergency physicians were able to safely administer sedative and neuromuscular blocking drugs in the prehospital situation. It is suggested that emergency physicians can safely perform rapid sequence induction of anaesthesia and intubation.

Adult↗