Biomedical subjects

V F Ginger

Publications and source records attributed to V F Ginger.

4 recordsLinked to original sources

PubMed1995

Older nursing home residents have a cardiac arrest survival rate similar to that of older persons living in the community.

OBJECTIVE: To determine the survival rates of older nursing home residents after cardiopulmonary resuscitation (CPR) and to compare it with that of older persons who experienced cardiac arrest in an outpatient setting. To identify patient characteristics, arrest characteristics, and effort characteristics that are associated with higher survival rates. DESIGN: Retrospective review of emergency medical service charts and hospital medical records of a cohort of older nursing home residents (n = 114) after cardiopulmonary resuscitation and a matched cohort of community-residing older persons (n = 228) matched on age, gender, and year of cardiac arrest. SETTING: A large metropolitan city served by a tiered emergency medical service. MEASUREMENTS: Independent variables related to patient, cardiac arrest, and resuscitation effort characteristics. Dependent variables were defined as immediate survival after cardiopulmonary resuscitation and survival status at discharge. RESULTS: The mean age of nursing home residents was 80.3 years; 62.3% were females. The majority of cardiac arrests for both groups were unwitnessed (67%) and had agonal rhythms (asystole and electromechanical dissociation). Emergency medical service efforts were similar for the two cohorts. Among nursing home residents, 26.3% had a return of blood pressure for more than 5 minutes, 70.2% were pronounced dead in the emergency room, and 10.5% were discharged from hospitals alive. In the matched community-residing subjects, 22.7% had a return of blood pressure, 78.1% were pronounced dead in the emergency room, and 9.2% were discharged alive. Between-group comparisons of these variables revealed no significant differences even though our sample size was adequate. CONCLUSIONS: We conclude that survival after cardiac arrest of older persons residing in nursing homes is low; however, with an appropriate CPR/DNR selection process and an effective emergency medical system, survival of certain groups of nursing home residents following cardiac arrest could be comparable to that of community residing older persons. Despite the reasonably good survival rates for older persons seen above, our analyses indicated that patients who have unwitnessed arrests are not likely to survive to discharge and that patients with initial rhythms such as asystole or electromechanical dissociation rarely survive. These data suggest that patients who have an unwitnessed arrest in the nursing home should not receive resuscitation attempts, and in those patients for whom paramedics are called, resuscitation efforts should not proceed any further if their original rhythm is asystole or electromechanical dissociation. Thus, modification in nursing home policies regarding CPR efforts is needed.

Aged↗

PubMed1994

Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries.

BACKGROUND: Fluid resuscitation may be detrimental when given before bleeding is controlled in patients with trauma. The purpose of this study was to determine the effects of delaying fluid resuscitation until the time of operative intervention in hypotensive patients with penetrating injuries to the torso. METHODS: We conducted a prospective trial comparing immediate and delayed fluid resuscitation in 598 adults with penetrating torso injuries who presented with a pre-hospital systolic blood pressure of < or = 90 mm Hg. The study setting was a city with a single centralized system of pre-hospital emergency care and a single receiving facility for patients with major trauma. Patients assigned to the immediate-resuscitation group received standard fluid resuscitation before they reached the hospital and in the trauma center, and those assigned to the delayed-resuscitation group received intravenous cannulation but no fluid resuscitation until they reached the operating room. RESULTS: Among the 289 patients who received delayed fluid resuscitation, 203 (70 percent) survived and were discharged from the hospital, as compared with 193 of the 309 patients (62 percent) who received immediate fluid resuscitation (P = 0.04). The mean estimated intraoperative blood loss was similar in the two groups. Among the 238 patients in the delayed-resuscitation group who survived to the postoperative period, 55 (23 percent) had one or more complications (adult respiratory distress syndrome, sepsis syndrome, acute renal failure, coagulopathy, wound infection, and pneumonia), as compared with 69 of the 227 patients (30 percent) in the immediate-resuscitation group (P = 0.08). The duration of hospitalization was shorter in the delayed-resuscitation group. CONCLUSIONS: For hypotensive patients with penetrating torso injuries, delay of aggressive fluid resuscitation until operative intervention improves the outcome.

Abdominal Injuries↗

PubMed1993

Emergency medical services priority dispatch.

STUDY OBJECTIVE: To test the ability of a locally designed priority dispatch system to safely exclude the need for advanced life support (ALS). DESIGN: Retrospective review of emergency medical services (EMS) incident records to determine how often the lone dispatch of basic life support (BLS) units, staffed with basic emergency medical technicians, subsequently required or involved ALS care. SETTING: A large centralized municipal EMS system with a tiered ALS/BLS ambulance response. All BLS units carry automated defibrillators. MEASUREMENTS: Consecutive EMS records (35,075) were reviewed by computerized search for ALS procedures. Records indicating ALS procedures were tabulated and then manually reviewed for the nature of and probable indication for the ALS intervention. INTERVENTION: Brief sequences of computer-stored questions that help dispatchers identify (or exclude) signs and symptoms indicating the need for ALS. RESULTS: The dispatch triage system spared ALS units from initial dispatch in 14,100 of the EMS incidents (40.2%), increasing their availability and use for more serious calls. Among these 14,100 cases, only 41 patients (0.3%) later received drugs such as nitroglycerin and naloxone; another 27 patients (0.2%) received resuscitative interventions such as epinephrine or defibrillation. Furthermore, on closer analysis, the immediate presence of a paramedic might have provided a true potential for advantage in outcome for only five or six patients (less than 0.04 of the 14,100 BLS dispatches). Meanwhile, many important operational, fiscal, and cost-effective patient care benefits were realized with this system. CONCLUSION: A computer-aided dispatch triage algorithm can facilitate improvements in both EMS system operations and prehospital patient care by safely and reliably identifying EMS incidents requiring only BLS.

Algorithms↗

PubMed1992

Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device.

STUDY OBJECTIVES: To evaluate continuous, semiquantitative end-tidal carbon dioxide (ETCO2) monitoring in the prehospital and emergency department setting for confirming proper endotracheal tube placement and assessing prognosis and blood flow during CPR. TYPE OF PARTICIPANTS: Adult patients were included if an endotracheal tube was inserted by prehospital care providers or emergency physicians for cardiac arrest, respiratory arrest, respiratory insufficiency, or airway protection. DESIGN AND INTERVENTIONS: A small, portable, colorimetric ETCO2 detector was attached to the endotracheal tube immediately after each attempted endotracheal tube insertion. The color of the detector membrane was noted at the seventh breath following intubation. The color also was noted and recorded if there was return of spontaneous circulation (defined as a palpable pulse) immediately prior to and following conversion from manual to mechanical CPR. Survival to hospital admission was used as an end point to assess the prognostic value of the initial ETCO2 reading. MAIN RESULTS: A total of 227 patients (144 with cardiopulmonary arrest) were studied. In the 83 patients intubated but not in cardiopulmonary arrest, a reading on the ETCO2 detector signifying more than 0.5% ETCO2 was 100% sensitive and 93% specific in detecting proper endotracheal tube placement (100% specific with the endotracheal tube cuff inflated). In cardiac arrest patients, a longer period of estimated arrest appeared to be associated with a lower ETCO2 detector reading. A reading signifying more than 0.5% ETCO2 was 69% sensitive and 100% specific in detecting proper endotracheal tube placement. After proper endotracheal tube placement, all cardiac arrest patients who survived to hospital admission had an initial ETCO2 measurement signifying more than 0.5% ETCO2. Return of spontaneous circulation was usually accompanied by an improved ETCO2 value. Mechanical CPR always produced an ETCO2 value that was as high or higher than that produced by manual CPR. CONCLUSION: The colorimetric ETCO2 device is highly accurate for confirming endotracheal tube position in nonarrest patients. CONCLUSION: The colorimetric ETCO2 device is highly accurate for confirming endotracheal tube position in nonarrest patients. In cardiac arrest patients, a reading signifying more than 0.5% ETCO2 confirms correct endotracheal tube placement, while a value signifying less than 0.5% ETCO2 during resuscitation suggests that something is wrong (eg. esophageal intubation, inadequate circulatory flow, prolonged down-time interval, hypothermia, or significant ventilation/perfusion mismatch).

Adult↗