PubMed Health⌕ Search

Biomedical subjects

W F Rutherford

Publications and source records attributed to W F Rutherford.

11 recordsLinked to original sources
PubMed1992

Report of nitropatch explosions complicating defibrillation.

Reports of complications associated with the use of electrical defibrillators have been relatively rare. In two patients, defibrillation performed over a nitroglycerin skin patch resulted in electrical arcing with a resultant flash of light and thermal injuries. Skin burns as a complication of defibrillation over nitropatches has not been previously reported. Such burn injuries respond to standard therapeutic measures. Healthcare professionals who may perform defibrillation should be aware of this potential complication.

Administration, Cutaneous↗
PubMed1992

Spontaneous pneumomediastinum: clinical and natural history.

STUDY OBJECTIVE: To evaluate the clinical characteristics and natural history of patients presenting with spontaneous pneumomediastinum. DESIGN: A retrospective case series was conducted to identify patients diagnosed with spontaneous pneumomediastinum. ICD-9 discharge codes were used for 1984 to 1990 at two institutions, and emergency department records of a third hospital were reviewed for 1981 to 1986. Clinical features, interventions, complications, setting, etiology, symptoms, and length of hospital stay were recorded. SETTING: Three university tertiary care hospitals. PARTICIPANTS: All ED patients more than 12 years old with a diagnosis of spontaneous pneumomediastinum. INTERVENTIONS: None. RESULTS: Seventeen cases were identified. Age range was 15 to 41 years (mean, 25 years). Presenting symptoms were chest pain in eight (47%), dyspnea in three (18%), both symptoms in three (18%), and neither in three (18%). Three patients complained only of throat discomfort. Nine (52%) had a Hamman's crunch, 11 (65%) had subcutaneous emphysema, and two (11%) had a small pneumothorax. Five (29%) were smokers, and five (29%) had normal esophograms. Thirteen of 17 (76%) cases were associated with illicit inhalation drug use. Twelve cases (70%) had history of a "Valsalva-type" maneuver. All but three were admitted to a hospital, with a mean stay of 2.5 days (range, one to six). No patient suffered complications or required interventions for spontaneous pneumomediastinum. Specifically, no patient developed a subsequent pneumothorax or airway compromise. The three patients not admitted were followed up by telephone contact. All did well with rapid resolution of their symptoms. CONCLUSION: Most spontaneous pneumomediastinum cases occur in the setting of inhalational drug use. One hundred percent of patients will have a symptom directly related to the spontaneous pneumomediastinum, with 82% presenting with either dyspnea or chest pain. Most (88%) will present with either subcutaneous emphysema or a Hamman's crunch on examination. Simple spontaneous pneumomediastinum has a very benign course and does not require hospitalization. Serial radiographs, likewise, did not change the medical management of spontaneous pneumomediastinum.

Administration, Inhalation↗
PubMed1991

Drug-induced supraventricular tachycardia: a case report of fluoxetine.

We report the occurrence of supraventricular tachycardia and hypotension in a 54-year-old woman after maintenance therapy with fluoxetine. Although cases of tachycardia and palpitations have been reported, supraventricular tachycardia and hypotension have not been directly attributed to fluoxetine.

Electrocardiography↗
PubMed1990

Assessment of intravenous fenoldopam mesylate in the management of severe systemic hypertension.

To evaluate the acute BP response to iv fenoldopam mesylate (FNP), 14 patients with severe hypertension (diastolic BP 120 to 170 mm Hg) were studied in an open-label trial. Initial infusion rate of FNP was 0.1 microgram/kg.min. Titration to diastolic BP goal (95 to 110 mm Hg) was followed by a constant infusion phase (greater than or equal to 6 h), a detitration phase (2 h), and a postinfusion phase. FNP reduced BP by 27/29 mm Hg (p less than .001) with no significant effect on heart rate. Maintenance of the BP effect was noted through the 6 h of constant rate infusion. Mild, transient vasodilating-associated adverse effects were noted with FNP. We conclude that FNP is an effective, well-tolerated iv antihypertensive agent for acute BP reduction in a severely hypertensive population.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMed1990

Hyperventilation-induced reduction in cerebral blood flow: assessment by positron emission tomography.

The use of positron emission tomography (PET) has been well documented as a relatively noninvasive method of measuring cerebral blood flow (CBF), both globally and regionally. The utility of readily detecting alterations in CBF is apparent, particularly when applied to the evaluation of therapeutic interventions thought to influence CBF. We report the effects of hypocapnia, an experimental condition of known cerebral vasoconstriction, in ten normal volunteers. Subjects had brain blood flow evaluated utilizing H215O as the positron emitter before and after approximately five minutes of hyperventilation. Baseline CBF was measured as a mean +/- SD of 61.2 +/- 16.3 mL/min/100 g of tissue. Mean baseline arterial blood gas values were PaO2 107.4 +/- 14 mm Hg, PaCO2 37.7 +/- 0.89 mm Hg, and pH 7.39 (calculated from mean [H+]). Post hyperventilation, global CBF was measured as 31.1 +/- 10.8 mL/min/100 g. Mean arterial blood gas values were PaO2 141.7 +/- 21 mm Hg, PaCO2 19.7 +/- 5 mm Hg, and pH 7.63 (calculated from mean [H+]). CBF decreased by a mean of 49.5 +/- 11 percent. Data analysis using the Student's t-test showed a significant change over baseline in PaCO2 (p less than 0.001) and CBF (p less than 0.001), in the hyperventilated state. Correlations were noted between the decrease in CBF and change in PaCO2 (r = 0.81) as well as between hyperventilation PaCO2 and the change in CBF (r = 0.97). We conclude that, as measured by PET, CBF decreases significantly during a state of artificial hyperventilation to a degree consistent with results seen using other methods. PET appears to be a valuable tool in the assessment of interventions that could influence CBF.

Cerebrovascular Circulation↗
PubMed1989

Prediction of changing cerebral blood flow by use of the conjunctival oxygen tension/arterial oxygen tension index.

Current methods of assessing cerebral blood flow (CBF) are limited in their ability to provide data at the bedside in a timely, inexpensive, and continuous fashion. Since the palpebral conjunctiva is perfused by branches of the internal carotid artery, perfusion of this tissue may reflect global CBF. Conjunctival oxygen tension (PcjO2), PaO2, PaCO2, and pH were measured in ten healthy subjects during normal ventilation and active hyperventilation. CBF was measured simultaneously using positron emission tomography. CBF decreased from an average of 64.3 +/- 15.1 ml x 100 g-1 x min-1 during baseline measurements to 33.2 +/- 8.4 ml x 100 g-1 x min-1 during hyperventilation. The ratio of PcjO2 to PaO2 (the PcjO2/PaO2 index) decreased from 0.53 +/- 0.07 to 0.35 +/- 0.09 in the same time period. The PcjO2/PaO2 index was significantly correlated with CBF (r = .78, p less than .001). We conclude that the PcjO2/PaO2 index may reflect the reduction in CBF induced by hyperventilation in normal humans, and should be investigated further as a method of assessing CBF in other settings which can result in globally reduced cerebral perfusion.

Adult↗
PubMed1989

Selective left endobronchial suctioning in the intubated patient.

Suctioning of secretions from the left endobronchial tree is frequently necessary but often difficult in intubated patients. We examined the effectiveness of a catheter designed expressly for this purpose. Special curved tip (Bronchitrac-L) suction catheters were fitted with thin, radiopaque tubing to facilitate x-ray visualization. Eight-one attempts at left endobronchial placement were made on 74 stable adult intensive care unit patients. The suction catheter was inserted into the oral endotracheal tube or tracheostomy tube just prior to an x-ray filming of the chest. In 15 of 66 patients, the tip of the oral endotracheal tube was too distal (less than 2 cm above the carina) to allow proper functioning of the catheter. Patients with a properly positioned oral endotracheal tube were analyzed separately and showed 56 percent of the catheters went to the left bronchus. When the head was turned to the left prior to placement, successful left bronchus placement occurred in 65 percent. When the catheter was placed through a tracheostomy tube, 100 percent went into the left bronchus (n = 15). There were no catheter-induced complications in this study. The curved tip catheter is an effective means of suctioning the left bronchial tree in patients with tracheostomy tubes. Its reliability in patients with oral endotracheal tubes is reduced but more effective than current methods.

Bronchi↗
PubMed1987

Deterioration of conjunctival PO2 after CPR.

An 82-year-old man was resuscitated following cardiac arrest suffered outside the hospital. Conjunctival oxygenation (PcjO2), as measured by a conjunctival PO2 monitor, increased in the immediate post-resuscitation period (60 min) and neurologic status improved. The PcjO2 steadily declined over the next three hours. During the period of declining PcjO2, the systolic blood pressure tended to remain stable (104 mm Hg +/- 18), the arterial PO2 (PaO2) was greater than or equal to 103 mm Hg, and the PcjO2/PaO2 ratio initially increased, while the PcjO2/arterial oxygen content (CaO2) ratio and neurologic status declined. The rise and subsequent fall of PcjO2 in this patient paralleled the neurologic status and may be consistent with the cerebral reperfusion/hypoperfusion phenomena observed in experimental preparations of resuscitation from circulatory arrest.

Aged↗
PubMedDate not supplied

High-dose versus standard-dose epinephrine treatment of cardiac arrest after failure of standard therapy.

STUDY OBJECTIVE: To assess the efficacy of high-dose epinephrine (HDE) compared with standard-dose epinephrine (SDE) in emergency department patients in cardiac arrest after SDE failed to improve asystole or ventricular fibrillation. DESIGN: Prospective, multicenter, blinded, controlled trial. SETTING: Eight academic center emergency departments. PATIENTS: One hundred forty patients treated for cardiac arrest. MEASUREMENTS AND MAIN RESULTS: Primary outcomes were either improvement in cardiac rhythm or return of spontaneous circulation (ROSC). Of the 140 patients enrolled, 78 received HDE and 62 received SDE. Of the 34 patients with ventricular fibrillation, 3 were resuscitated with HDE and 2 with SDE (p = 0.60). Of those with asystole, ROSC occurred in 12 of HDE and 5 of SDE recipients (p = 0.11). No patient had return of significant neurologic function and none survived to hospital discharge. Overall, there was no advantage to HDE after failure of SDE. CONCLUSION: Our results are similar to those of controlled clinical trials comparing HDE with SDE in cardiac arrest.

Adrenergic alpha-Agonists↗