Etomidate-induced hypoglycaemia.
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Adolescent↗
Biomedical subjects
W E Rhoden
Publications and source records attributed to W E Rhoden.
Acute and chronic performance of a steroid eluting electrode for ventricular pacing.
Studies have demonstrated consistently low stimulation thresholds in the first months following implantation of steroid eluting electrodes. There have been no reported cases of exit block. There is little information on the long-term performance of these leads. Data were collected on 15 patients in whom Medtronic steroid eluting leads (5023 and 4003) had been implanted in 1987. Stimulation thresholds were measured at implantation and at weeks 1, 2, 3, 4, 5, 6 and 12. Stimulation threshold, lead impedance and sensing thresholds were monitored periodically for 3 yr using the telemetered function of the pulse generator. Three-month follow-up was obtained in all the patients and 3-yr follow-up in 10. Stimulation thresholds remained low throughout the follow-up period in all but one patient who developed exit block necessitating the replacement of the pacing system. In the remaining patients there was a significant increase in mean stimulation threshold from implantation to week 1 (mean stimulation threshold at implantation = 0.106 ms, mean ST at week 1 = 0.182 ms; p = 0.05), and also a gradual increase in the stimulation threshold over the first 2 yr of follow up (mean stimulation threshold 1 week = 0.182 ms, mean stimulation threshold months 13-24 = 0.243 ms; p = 0.05). Lead impedance showed no significant change over the follow-up period (mean change in impedance = 4.3 omega, SD 163.2, p = 0.97). Unlike many conventional electrodes, steroid eluting leads show no early peak in stimulation threshold but exit block can occur. Stimulation thresholds show a small but significant rise over time.
Atrial Fibrillation↗
An audit of drug usage for in-hospital cardiopulmonary resuscitation.
The objective of this study was to assess the changes in outcome of cardiac arrest due to ventricular fibrillation, asystole and electromechanical dissociation in relation to the changing guidelines for drug therapy set by the U.K. Resuscitation Council. It was a retrospective study of 667 resuscitation records for the years 1982, 1986, 1988, 1989, 1990 and 1991. It took place in a large district general hospital with a regional cardio-thoracic centre. We have audited the asystolic cardiac arrests (N = 271) which occurred outside the cardiac care unit (CCU). Adrenaline (intravenous 1 mg) is now the first line drug followed by atropine at an increased dose (2 mg intravenously); calcium is no longer recommended and sodium bicarbonate should be reserved for cases in which an acidosis has been documented. Atropine use has increased over the 9-year period. Bicarbonate use did not change from 1982 to 1986 but fell progressively to no use at all in 1991. Calcium use has declined since 1982. Adrenaline use has remained unchanged. Survival from asystolic arrests (hospital discharge) has remained unchanged at 0-5.5%. Asystole as a primary event in the CCU was uncommon (N = 17) and no patient was discharged. Over the same period, 60% of patients (N = 92) with a cardiac arrest on CCU due to ventricular fibrillation (VF) were discharged and 55% were alive after 6 months. For VF on the wards (N = 192), only 20% of patients were discharged from hospital. A similar proportion was successful for each year.(ABSTRACT TRUNCATED AT 250 WORDS)
Atropine↗
Fast-tracking of myocardial infarction by paramedics.
OBJECTIVE: To study the effectiveness of a fast-track method of admitting patients with myocardial infarction directly to the coronary care unit (CCU). STUDY DESIGN: Ambulance paramedic staff were trained and provided with a Life Pak XI Monitor/Defibrillator which can obtain a 12-lead electrocardiogram. When a diagnosis of acute myocardial infarction was made by the paramedics, the CCU was informed and the patient was directly transferred to the CCU, bypassing the accident and emergency (A&E) department. The appropriateness of admission to the CCU was assessed against set criteria. The time from call for help to the administration of thrombolytic therapy (thrombolysis time) in patients directly admitted to the CCU was compared with that in another group of patients with definite myocardial infarction who were admitted through the A&E department over the same period of time. RESULTS: Twenty-five patients were fast-tracked to the CCU. Diagnosis of myocardial infarction was confirmed on admission in 14. Thirteen were treated with thrombolysis as there were no contra-indications; of the other 11 patients, seven were diagnosed as angina, one had complete heart block, one had haemodynamically significant atrial fibrillation and two had non-cardiac chest pain. The average time from call for help to thrombolysis in this group was 82 +/- 32 minutes. This was significantly shorter (p < 0.02) than in the patients who were admitted through A&E, in whom the average time from call for help to thrombolysis was 112 +/- 35 minutes. Twenty-one of 25 fast-tracked patients fulfilled the criteria for CCU admission. CONCLUSION: The majority of fast-trackings are appropriate and will result in quicker administration of thrombolysis in hospitals where the facility for thrombolysis does not exist in the A&E department.
Chest Pain↗