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Biomedical subjects

T Wisborg

Publications and source records attributed to T Wisborg.

At least 19 recordsLinked to original sources
PubMed1992

[Prevention of acute renal failure in muscular injuries].

Rhabdomyolysis may be caused by sustained, continuous pressure to skeletal muscle. The syndrome is characterized by hypovolemia, hyperkalemia and release of excessive amounts of myoglobin to the circulation. If untreated, the syndrome becomes complicated by potentially fatal acute renal failure. Two case reports are presented which illustrate the importance of early and aggressive fluid substitution where forced alkaline diuresis seemed to prevent life threatening renal complications.

Acute Kidney Injury↗
PubMed1992

[Semiautomated defibrillator. Experiences with the use in ambulances in a rural district].

Early defibrillation has been shown to be the single most effective intervention in resuscitation from sudden cardiac death. The new semi-automated defibrillators are safe and easy to use and are effective and precise instruments for interpreting cardiac rhythm. In our rural area, ambulance staff received six hours training in the use of a semi-automated defibrillator (Heartstart 2000, Laerdal Medical) before the apparatus was installed in the ambulance. During the first year after installation, eight cases of cardiac arrest were treated by the ambulance staff. Four patients received defibrillation, two of whom were resuscitated successfully. Increased local interest in treatment of cardiac arrest, including increased awareness of the need to provide early resuscitation, has strengthened the chain of response, where the procurement of a semi-automated defibrillator represents a link that seems to have improved the prognosis for patients with cardiac arrest in our district.

Aged↗
PubMed1991

Percutaneous placement of permanent central venous catheters: experience with 200 catheters.

The prospective registration of 200 percutaneous placements of permanent central venous catheters (Hickman catheters and subcutaneous infusion ports) was conducted in 172 patients aged 3 months-95 years. The insertions were reviewed to assess whether certain groups of patients or physicians were associated with more complications than others. Complications occurred in 16 patients (8.0%), of which 12 were arterial punctures. Two attempts (1%) at catheter placement failed. None of the complications required treatment. Of the catheter placements, 70% were performed by one of the three authors, and the rest by seven other experienced anesthesiologists. The complication rates were not different between the two groups. Nor was the complication rate significantly higher in small children. Percutaneous placement of permanent central venous catheters thus proved to be a safe and reliable technique, even in small children. The method is easily learnt by physicians experienced in central venous catheterization. Using this method, permanent venous access may be offered to a large number of patients.

Adolescent↗
PubMed1991

Crush injuries in arctic off-shore fisheries: initial treatment to prevent acute renal failure.

Rhabdomylosis following crush injuries represents an occupational hazard in the off-shore fisheries. In northern countries this can be complicated by hypothermia and a long transport time to the nearest hospital. If treatment is delayed, what is initially a local limb injury can result in a potentially life threatening acute renal failure as a result of the nephrotoxic effects of the various intracellular muscle components released into the circulation. Therefore early and aggressive fluid treatment in the field, and during the transport of crush injury victims is very important. Forced alkaline diuresis is the main prophylaxis against hyperkalemia and acute myoglobinuric renal failure. A case history which demonstrates some of the aspects and challenges in the treatment of crush injuries is presented.

Accidents, Occupational↗
PubMed1991

Anesthesiologist-manned helicopters and regionalized extracorporeal circulation facilities: a unique chance in deep hypothermia.

Norway has nine light ambulance helicopters, four heavy sea rescue helicopters and seven ambulance air planes in 24-hours duty spread all over the country. Most are manned with anesthesiologists. Five regional hospitals in all parts of the country, offer facilities for extracorporeal circulation. A case in which a 33 year old woman was found hypothermic at 21 degrees C is presented. She developed ventricular fibrillation at the time of her rescue. She was intubated and received chest compression for 70 minutes until she was rewarmed by extracorporeal circulation. She was discharged without signs of cerebral damage. The decision to bypass less advanced hospitals en route to the regional hospital proved correct in this case, and is suggested as standard procedure in deep hypothermic patients.

Adult↗
PubMed1991

[Exchange transfusion in cases of falciparum malaria].

Malaria is diagnosed in 50-70 patients each year in Norway. Severe malarial infection with cerebral involvement as well as hypoglycaemia, circulatory collapse and renal failure is often difficult to diagnose since the condition is only rarely seen in Scandinavia. This report describes a 49 year old seaman, who was admitted to hospital with a clinical picture of sepsis with multiorgan involvement including cerebral affection. Subsequently, it turned out that the patient had a severe infection with Plasmodium falciparum, involving more than 50 per cent of the red blood cells. Despite being comatose for one week with repeated attacks of grand mal type, and requiring 11 days mechanical ventilation plus dialysis for 4 weeks, he recovered uneventfully and was dismissed from hospital with only minor neurological sequelae. Even severe malaria with cerebral involvement can result in full restitution if the diagnosis is made early and exchange transfusion plus treatment with relevant drugs are instituted promptly.

Animals↗
PubMed1991

[Intra-osseous infusion--a simple, rapid and lifesaving method].

One of the major challenges in the initial treatment of critically ill or injured patients is the establishment of a well functioning intravenous access. This can be very difficult in patients with circulatory collapse, and almost impossible in infants. Central venous cannulation is time-consuming and requires skill. Nor can intratracheal and rectal administration of drugs and fluids fully replace the intravascular route. In such situations the old but forgotten technique of intraosseous infusion represents an elegant and easy way of gaining rapid intravascular access. The method is simple, safe and almost foolproof, and can easily be performed under field conditions, e.g. by paramedical personnel. Very few contra indications exist, and the success rate even by untrained personnel is high. In this review the physiological aspects and the technique itself is discussed and illustrated by case reports.

Aged↗
PubMed1991

[The laryngeal mask: a new tool for creating a free airway].

The laryngeal mask airway represents a new concept in airway management of anesthetised patients. It is inserted without any instruments and is very easy to use, even for unskilled personnel. It reduces the problem of waste gas pollution in the operating theater, and it leaves the hands of the anaesthetist free for record keeping and monitoring. It is well tolerated by the patients. In this article the technique is presented together with indications and limitations. Based on our experience we find the laryngeal mask airway an excellent alternative to the face mask, even in procedures of short duration.

Anesthesia, Inhalation↗
PubMed1990

[Resuscitation].

Explore the source record for details and available documents.

Humans↗
PubMed1990

[Instruction and training in emergency care procedures of recently deceased patients].

The need for medical personnel to be able to perform certain emergency medical procedures, such as endotracheal intubation, intravascular acess, defibrillation, and tracheotomy cannot be questioned. However, it is difficult to practise these techniques on patients and mannequins. Using newly deceased persons is an alternative which allows the procedures to be performed under nearly realistic circumstances, but this educational approach could raise certain ethical objections among staff who are not adequately informed about the educational objectives. A survey of the ten largest Norwegian hospitals revealed that only two had adopted this practice. The rest had considered it, but had decided not to start this routine. None of the hospitals had refrained from it after thoroughly analysing the ethical issues involved. Six hospitals used cadavers for other instruction. The practice represents a unique opportunity for training, and the ethical implications are justifiable provided that the training is conducted with respect and compassion for the deceased.

Education, Medical↗
PubMed1990

Health workers and the human immunodeficiency virus: knowledge, ignorance and behaviour.

The attitude of health personnel towards the human immunodeficiency virus (HIV) has a great influence on public opinion. Thus appropriate knowledge about HIV and its routes of transmission, plus safe and professional behaviour are crucial. A survey of 359 Norwegian health workers (75% response) revealed that factual knowledge was good. Fear of occupational transmission was substantial, but was not reflected in behaviour: 25-50% of the personnel reported not using gloves when exposed to blood. No relationship was found between knowledge and behaviour. A majority (79%) of the sample held the view that every hospital patient should be routinely tested on admission. Seventy-four per cent advocated preoperative screening, with special precautions if the results are positive. Knowledge did not seem to influence these attitudes. It is concluded that the behaviour of health personnel in relation to occupational risks is unrelated to factual knowledge, and further studies are needed to uncover behavioral determinants.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Paediatric anaesthesia in a developing country.

A suitable anaesthetic technique was needed for oral surgery in infants in a developing country. As an air compressor was present, and oxygen accessible, a continuous flow technique was chosen. Two Boyle's machines--useless due to lack of soda lime and nitrous oxide--were converted without increasing susceptibility to technical and supplemental deficiencies. The challenge to simplify techniques without reducing patient safety is discussed, and the solutions in an Ethiopian hospital are presented.

Anesthesia↗