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Emergency Treatment (emergency + treatment)

Distribution by Scientific Domains

Medical Sciences	86%
3 Other Domains	14%

Selected Abstracts

A retrospective study of treatment provided in the primary and secondary care services for children attending a dental hospital following complicated crown fracture in the permanent dentition

INTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2000
A. Maguire
Objectives. To investigate treatment provision in primary and secondary dental care following complicated crown fracture of permanent teeth. Design and methods. Retrospective observational survey of dental records of all patients attending a dental hospital trauma clinic during a 2-year period with complicated crown fracture. Results. Eighty children (70% male) aged 6,16 years (mean age 10·3 years) with 98 complicated crown fractures were identified. Of these children, 54% were seen for emergency treatment on the day of their injury, 75% within 48 h. Of the 98 injured teeth, 60% were seen initially in general dental practice but only 56% of these 59 cases were provided with emergency treatment in practice, the others being referred immediately to the trauma clinic for treatment. The main cause of fractures was transport, in particular, bicycles. Radiographs were available for 96 teeth; for the 43 open apex teeth, the definitive treatment was pulp capping (44% of cases) and pulpotomy (30%), with vitality maintained in five cases up to 4·8 years after trauma. The 53 closed apex cases were treated definitively with pulp capping (38%) and pulpectomy (36%) and six teeth had maintained their vitality up to 4·3 years after trauma. Sixty-seven per cent of the pulp caps and 47% of the 19 pulpotomies provided relied on a doubtful coronal seal. This was primarily due to the extensive use of a conventional glass ionomer cement as an emergency bandage. The use of an etched or bonded material at initial presentation extended the Median Survival Time for vitality in open apex teeth from 188 to 377 days and in closed apex teeth from 15 to 64 days. Conclusions. Emergency treatment of complicated crown fractures, particularly in primary care services is often inappropriate or inadequate with regard to emergency management of the exposed pulp and provision of a hermetic coronal seal. [source]

Emergency treatment of chemical and thermal eye burns

ACTA OPHTHALMOLOGICA, Issue 1 2002
Ralf Kuckelkorn
ABSTRACT. Chemical and thermal eye burns account for a small but significant fraction of ocular trauma. The speed at which initial irrigation of the eye begins, has the greatest influence on the prognosis and outcome of eye burns. Water is commonly recommended as an irrigation fluid. However, water is hypotonic to the corneal stroma. The osmolarity gradient causes an increased water influx into the cornea and the invasion of the corrosive substance into deeper corneal structures. We therefore recommend higher osmolarities for the initial rinsing to mobilize water and the dissolved corrosives out of the burnt tissue. Universal systems such as amphoteric solutions, which have an unspecific binding with bases and acids, provide a convenient solution for emergency neutralisation. Both conservative anti-inflammatory therapy and early surgical intervention are important to reduce the inflammatory response of the burnt tissue. In most severe eye burns, tenonplasty re-establishes the conjunctival surface and limbal vascularity and prevents anterior segment necrosis. [source]

Effects of severe dentoalveolar trauma on the quality-of-life of children and parents

DENTAL TRAUMATOLOGY, Issue 5 2009
Teresa D. Berger
Sample: A visual analogue scale (VAS) was used to assess the pain of injury and treatment for 27 individuals 8,20 years and their parents. The Child Oral Health Quality of Life (COHQoL) survey was used to assess the effects of dental injuries on the QoL of 23 children aged 8,14 and their parents. Results: Mean VAS scores revealed that all patients and parents perceived the pain of initial injury to be significantly greater than pain of splint removal (P , 0.05) and that pain decreased in a stepwise manner from injury through emergency treatment to splint removal. The COHQoL questionnaire demonstrated a profound and continuing effect on children and their parent's QoL following severe dental injury. The initial parental COHQoL score was significantly greater than the 12-month score (P , 0.05) in both 8,10 and 11-14- year-olds. The COHQoL results indicated a measurable reduction in the QoL of patients and parents was still present 12-months after the injuries. At the end of one-year children were still affected by the social and well-being aspects of the injury yet parents exclusively reported that one-year effects were limited to their children's oral symptoms and functional limitations. Conclusions: Severe dental injuries produce initial and ongoing pain. Detrimental effects on the QoL of both children and parents are still present at one-year and these long-term effects are different for children and parents. [source]

An audit of the time to initial treatment in avulsion injuries

DENTAL TRAUMATOLOGY, Issue 1 2009
Betul Kargul
Good outcome requires education of the general public and non-dental professionals. Aim:, Retrospective observational survey of case records of avulsion injuries attending a dental hospital trauma clinic. Method:, Data collected included: hospital number, date of birth, gender, source of patient's referral, date of trauma, number of avulsed teeth, place of initial presentation, storage, hours till initial presentation, and initial treatment. Results:, One hundred and twenty teeth with avulsion were identified in 75 children. The mean age of the patients was 9.8 years (SD = 2.3 years) at the time of trauma with avulsions recorded in 44 (58.7%) boys and in 31 (41.3%) girls. Only 51 (42.5%) teeth were stored in an appropriate medium before attendance at any site and only 48 (40%) of the teeth were seen within 1 h. 83.3% received emergency treatment at general hospital, 89.7% in dental practice and 92.9% at dental hospital. Conclusions:, A minority of avulsion injuries were seen within the first hour and a minority were in appropriate storage medium at presentation. Geographical location plays a huge role in the time taken to reach secondary care. However, improving public and non-dental professional knowledge about tooth storage in avulsion injuries is critical to long-term prognosis of the teeth. [source]

Dental trauma that require fixation in a children's hospital

DENTAL TRAUMATOLOGY, Issue 1 2008
Timothy Bruns
Complex injuries to permanent teeth and their periodontium require immediate repositioning and stabilization. Many of these emergencies are treated by pediatric dental residents at the Women and Children's Hospital of Buffalo, Buffalo, New York. The purpose of this study was to characterize these complex injuries of permanent teeth that require emergency treatment in a Children's Hospital. All of the cases of dental trauma which had involved permanent teeth and which had been treated with a splint in 2001 and 2002 were reviewed. There were 79 patients that were between 5 and 19 years of age with twice as many males (54) as females (25). The number of males increased from childhood (5,10 years) to early adolescence (11,15 years) and then decreased rapidly in late adolescence (16,19 years), whereas the number of females decreased steadily with age. Most of the incidents occurred during the summer months (72%), particularly in June and July (42%), and Fridays and Saturdays were the busiest days of the week. Most of the injuries were caused by organized and recreational sporting activities (39%) and accidental falls (33%), followed by interpersonal violence (15%) and a few motor vehicle accidents (7%). The 173 permanent tooth injuries were mostly luxations (62%) or avulsions (20%), with only a few fractures of the alveolar bone (5%) or tooth root (1%). Most of the displacements were lateral luxations (40%) or extrusions (18%) with only a few intrusions (3%). These injuries most commonly afflicted the maxillary central incisors (54%), followed by the maxillary laterals (18%) and mandibular centrals (17%). The emergency treatment that was provided at the Children's Hospital included replantation and repositioning, and the placement of a semi-rigid or flexible splint. [source]

Knowledge of oral health professionals of treatment of avulsed teeth

DENTAL TRAUMATOLOGY, Issue 6 2006
Nestor Cohenca
Abstract,,, The management and immediate treatment of an avulsed permanent tooth will determine the long-term survival of the tooth. The aim of this study was to evaluate the knowledge of oral health professionals on the new guidelines for emergency treatment of avulsed teeth. A 12-item questionnaire was distributed among general dentists, specialists, dental hygienists and dental assistants attending Continuing Education courses at the School of Dentistry, University of Southern California, between 2003 and 2004. This study reports only on the general practitioners who comprised 83% of the participants. The results revealed an uneven pattern of knowledge among them regarding the emergency management of an avulsed tooth. Statistically significant associations were related to the participants' previous dental trauma education and their age. In conclusion, there is a need to improve the knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth. [source]

A study into dentists' knowledge of the treatment of traumatic injuries to young permanent incisors

INTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2005
M. N. KOSTOPOULOU
Summary. Objective., The aims of this study were to evaluate dentists' knowledge of the emergency treatment of traumatic injuries to young permanent incisors, and to investigate barriers to treatment. Design., A closed-ended questionnaire was sent to 1023 general dental practitioners (GDPs) and community dental officers (CDOs) in West/North Yorkshire and Humberside, UK. Methods., The questionnaire comprised 17 questions. Six questions asked for general information about the participants (i.e. profession, age, gender, year of graduation, training or education on dental trauma, and willingness to provide emergency care), 10 were relevant to the emergency treatment of crown fractures, root fractures, luxation and avulsion injuries, and the last question queried any perceived barriers to treatment. Results., Seven hundred and twenty-four questionnaires were returned, a response rate of 71%, and these indicated that dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. The CDOs were significantly more knowledgeable than the GDPs, as were younger and more recently graduated dentists compared with older ones. The GDPs regarded the difficulty of treating children and the inadequate fees of the UK National Health Service as important barriers to treatment. Dentists who attended continuing dental education courses on dental traumatology had a more thorough knowledge than those who did not. Conclusion., Overall, the dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. Greater emphasis on undergraduate and postgraduate education in this area is indicated. [source]

A retrospective study of treatment provided in the primary and secondary care services for children attending a dental hospital following complicated crown fracture in the permanent dentition

Doctors as Good Samaritans: Some Empirical Evidence Concerning Emergency Medical Treatment in Britain

JOURNAL OF LAW AND SOCIETY, Issue 2 2003
Kevin Williams
This paper reports the results of the first survey of British doctors' attitudes towards the provision of emergency treatment outside the usual confines of a surgery or hospital. The experience and perceptions of NHS doctors practising in Sheffield concerning Good Samaritan behaviour are discussed against the background of the rather uncertain common law of medical rescue. The implications of the survey's findings for the direction of legal policy and the promotion of medical altruism are also considered. Despite the alleged deterioration in standards of social responsibility, the potentially fraught nature of such interventions, and the theoretical possibility of legal liability should any rescue attempt go badly, it seems that the overwhelming majority of doctors (in this survey, at least) are willing Samaritans. [source]

Good neurological recovery after cardiopulmonary resuscitation and thrombolysis in two old patients with pulmonary embolism

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009
F. CAVALLARO
The use of thrombolysis as an emergency treatment for cardiac arrest (CA) due to massive pulmonary embolism (MPE) has been described. However, there are no reports of successful treatment of MPE-associated CA in patients over 77 years of age. We report two cases of successful cardiopulmonary resuscitation for an MPE-associated CA in two very old women (87 and 86 years of age). In both cases, typical signs of MPE were documented using emergency echocardiography, which showed an acute right ventricle enlargement and a paradoxical movement of the interventricular septum. Emergency thrombolysis was administered during resuscitation, which lasted 45 and 21 min, respectively. Despite old age and prolonged resuscitation efforts, both patients had good neurological recovery and one of them was alive and neurologically intact 1 year later. Thrombolysis is a potentially useful therapy in MPE-associated CA. A good neurological outcome can be obtained even in very old patients and after prolonged resuscitation. [source]

Calixarene-entrapped nanoemulsion for uranium extraction from contaminated solutions

JOURNAL OF PHARMACEUTICAL SCIENCES, Issue 3 2010
Aurélie Spagnul
Abstract Accidental cutaneous contamination by actinides such as uranium occurring to nuclear power plant workers can lead to their dissemination in other tissues and induce severe damages. Until now, no specific emergency treatment for such contamination has been developed. The aim of the present work was to formulate a tricarboxylic calix[6]arene molecule, known to exhibit good affinity and selectivity for complexing uranium, within a topical delivery system for the treatment of skin contamination. Since calixarene was shown to reduce oil/water interfacial tension, we have designed an oil-in-water nanoemulsion, taking advantage of the small droplet size offering a high contact surface with the contaminated aqueous medium. Characterization of the calixarene nanoemulsion was performed by determination of the oily droplet size, zeta potential and pH, measured as a function of the calixarene concentration. The obtained results have confirmed the surface localization of calixarene molecules being potentially available to extract uranyl ions from an aqueous contaminated solution. In a preliminary experiments, the calixarene nanoemulsion was used for the removal of free uranium from an aqueous contaminated solution. Results showed that the calixarene nanoemulsion extracted up to 80,±,5% of uranium, which demonstrates the potential interest of this delivery system for uranium skin decontamination. © 2009 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 99: 1375,1383, 2010 [source]

Anaphylactic Reactions on the Beach: A Cause for Concern?

JOURNAL OF TRAVEL MEDICINE, Issue 2 2009
Alexander D. Karatzanis MD
Background The commonest causes of anaphylaxis include hymenoptera bites, high-risk food, exercise, and jellyfish bites and may often be encountered on the beach. Therefore, millions of visitors at popular touristic locations are exposed to increased risk of anaphylactic reactions every year. At least 35 cases of acute allergic reactions requiring medical attention took place on the beaches of Crete, Greece during the previous summer. Objective To evaluate the level of training of lifeguards working on the beaches of the island of Crete, Greece, with regard to emergency management of anaphylaxis as well as to assess the sufficiency of medical equipment that lifeguards possess to treat an anaphylactic reaction. Methods A questionnaire was prepared by the authors and administered to 50 lifeguards working on various beaches of Crete. Queries included the definition of anaphylaxis, proper medical treatment, and the existence or not and composition of an emergency kit with regard to the management of acute allergic reactions. Results Our series consisted of 50 lifeguards, 39 (78%) male and 11 female (22%). Although 41 (80%) lifeguards were aware of an acceptable definition of anaphylaxis, no one knew that epinephrine is the first-choice treatment, and 32 (60%) lifeguards replied that steroids should be used for emergency treatment. Additionally, no one possessed an emergency kit that would qualify for management of acute allergic reactions. Conclusions The beach should be considered as a high-risk place for the appearance of anaphylactic reactions. Lifeguards who would be the first trained personnel to encounter this condition should be sufficiently trained and equipped for emergency treatment. Our department is currently introducing a training program to local authorities for the proper training and equipping of lifeguards in the island of Crete. [source]

The safety of sublingual immunotherapy with one or multiple pollen allergens in children

ALLERGY, Issue 12 2008
F. Agostinis
Background:, Since the majority of allergic patients are polysensitized, it is often necessary to prescribe immunotherapy with multiple allergens. It is crucial to know if the administration of multiple allergens with sublingual immunotherapy (SLIT) increases the risk of side-effects in children. Methods:, Consecutive children with respiratory allergy because of pollens, receiving SLIT for multiple or single allergens were followed-up in a postmarketing survey. Inclusion criteria were those for prescribing SLIT according to guidelines. Parents recorded in a diary card the side-effects (eye symptoms, rhinitis/ear itching, asthma, oral itching/swelling, nausea, vomiting, abdominal pain, diarrhoea, urticaria, angioedema and anaphylaxis). The side-effects were graded as mild, moderate and severe. Results:, Four hundred and thirty-three children (285 male, age range 3,18 years) receiving SLIT were surveyed. Of them, 179 received a single extract, and 254 multiple allergens. The total number of doses given was 40 169 (17 143 with single allergen). Overall, 178 episodes were reported. Of them, 76 occurred with the single allergen (42.46% patients, 4.43/1000 doses) and 102 (40.3% patients, 4.42/1000 doses) with multiple allergens (P = NS). 165 episodes (92.5%) were mild and self-resolving and were equally distributed in the two groups. In 13 cases, the events were judged of moderate severity and medical advice was required. Three patients discontinued SLIT, despite the local side-effects being mild. No emergency treatment was required at all. Conclusion:, The use of multiple allergens for SLIT does not increase the rate of side-effects in children. [source]

Co-administration of salbutamol and fluticasone for emergency treatment of children with moderate acute asthma,

PEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 7 2005
Elizabeth Estrada-Reyes
This study aimed to compare the efficacy of nebulized therapy with salbutamol alone or in combination with fluticasone. In a randomized, double-blind clinical trial, 150 children with moderate acute asthma were randomly assigned to receive by nebulizations either (i) three doses of salbutamol 30 ,l/kg per dose, each dose administered every 15 min, (ii) three doses of salbutamol plus two doses of fluticasone 500 ,g/dose at 15 and 30 min after first dose of salbutamol, or (iii) three doses of salbutamol/fluticasone 500 ,g/dose, each combined dose administered every 15 min. Pulse oxymetry (SaO2), peak expiratory flow (PEF) and Wood et al. (Am J Dis Child, 123, 1972, 123) clinical scale were evaluated at baseline, 15, 30, 45, 60, 90 and 120 min after the first nebulization. Patients in the three groups significantly improved since 15 min after the first nebulization. We did not observe differences in the recovery of SaO2 and PEF among the three groups of treatment (p > 0.10). In group 3, children showed better clinical response at 120 min than the other two groups (p < 0.05). No significant adverse effects were observed with any treatment. To summarize, in children with acute moderate asthma, nebulized salbutamol at an accumulated dose of 90 ,l/kg plus fluticasone at an accumulated dose of 1500 ,g produced better clinical relief after 2 h. However, similar PEF and SaO2 responses were observed with salbutamol alone or in combination with different doses of fluticasone. [source]

GP guide to the assessment and management of croup

PRESCRIBER, Issue 16 2006
Sarah Brown MRCPCH
Croup is the commonest cause of acute airway obstruction in young children. Here the author describes its diagnosis and management in primary care and advises on when to admit for emergency treatment. Copyright © 2006 Wiley Interface Ltd [source]

Using Telemedicine to Avoid Transfer of Rural Emergency Department Patients

THE JOURNAL OF RURAL HEALTH, Issue 3 2001
Lanis L. Hicks Ph.D
ABSTRACT: Access to emergency treatment in rural areas can often mean the difference between life and death. Telemedicine technologies have the potential of providing earlier diagnosis and intervention, of saving lives and of avoiding unnecessary transfers from rural hospital emergency departments to urban hospitals. This study examined the hypothetical impact of telemedicine services on patients served by the emergency departments of two rural Missouri liospitals and the potential financial impact on the affected hospitals. Of the 246 patients transferred to the hub hospital from the two facilities during 1996, 161 medical records (65.4 percent) were analyzed. Using a conservative approach, only 12 of these cases were identified as potentially avoidable transfers with the use of telemedicine. Of these 12, 5 were admitted to the hub hospital after transfer. In addition to this conservative estimate of avoidable transfers based on current availability of resources in the rural hospitals, two more aggressive scenarios were developed, based on an assumption of increased service availability in the rural hospitals. Economic multipliers were used to estimate the financial impacts on communities in each scenario. This evaluation study demonstrates the potential value of telemedicine use in rural emergency departments to patients, rural hospitals and rural communities. [source]

Point-of-care reversal treatment in phenprocoumon-related intracerebral hemorrhage

ANNALS OF NEUROLOGY, Issue 6 2010
Timolaos Rizos MD
Objective Rapid reversal of the anticoagulatory effect of vitamin K antagonists represents the primary emergency treatment for oral anticoagulant-related intracerebral hemorrhage (OAC-ICH). Predicting the amount of prothrombin complex concentrate (PCC) needed to reverse OAC in individual patients is difficult, and repeated international normalized ratio (INR) measurements in central laboratories (CLs) are time-consuming. Accuracy and effectiveness of point-of-care INR coagulometers (POCs) for INR reversal in OAC-ICH have not been evaluated. Methods In phase 1, the agreement of emergency POC and CL INR measurements was determined. In phase 2, stepwise OAC reversal was performed with PCC using a predetermined dosing schedule. Concordance of POC and CL INR measurements during reversal and time gain due to POC were determined. Results In phase 1 (n = 165), Bland-Altman analysis showed close agreement between POCs and CLs (mean INR deviation 0.04). In phase 2 (n = 26), POCs caused a median initial net time gain of 24 minutes for the start of treatment with PCC. Median time for POC-documented complete OAC reversal was 28 minutes, compared with 120 minutes for CLs. Bland-Altman analysis between POCs and CLs revealed a mean INR deviation of 0.13 during stepwise PCC administration. POCs tended to slightly overestimate the INR, especially at higher INR levels. Remarkably, POC-guided reversal led to a median reduction of 30.5% of PCC dose compared with the a priori dose calculation. Hematomas enlarged in 20% of patients. Interpretation POC INR monitoring is a fast, effective, and economic means of PCC dose-titration in OAC-ICH. Larger studies examining the clinical efficacy of this procedure are warranted. ANN NEUROL 2010;67:788,793 [source]

Children's memory for emergency medical treatment after one year: the impact of individual difference variables on recall and suggestibility

APPLIED COGNITIVE PSYCHOLOGY, Issue 7 2001
Elaine Burgwyn-Bailes
This study explores the impact of individual difference variables on children's recall and suggestibility when they discuss a stressful personal experience. It was hypothesized that some differences in social factors, including child self concept and parenting style, would be associated with variations in the way children related their experiences. Participants were 24 3- to 7-year-old children who sustained facial lacerations requiring minor medical emergency treatment by a plastic surgeon. The children were interviewed about their surgeries on three occasions: a few days, 6 weeks and 1 year after the experience. A number of individual difference measures were administered to the children and their parents at the time of the first two interviews. The results support the hypothesis that there are individual difference variables that may help to explain some of the variability in children's recall and suggestibility. Younger children with poorer receptive language skills and children of more traditional parents recalled less total information about their surgeries after one year. Child traditionalism, achievement-motivation and social avoidance, as assessed by use of the Eder Self-View Questionnaire, made a difference in suggestibility at the initial interview, but not at subsequent memory assessments. The results are interpreted as suggesting that both the demand characteristics of the interview and the strength of the memory trace are important in understanding the effects of individual difference variables in memory performance. Implications for child testimony are discussed. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Emergency Use of Extracorporeal Membrane Oxygenation in Cardiopulmonary Failure

ARTIFICIAL ORGANS, Issue 9 2009
Matthias Arlt
Abstract Severe pulmonary and cardiopulmonary failure resistant to critical care treatment leads to hypoxemia and hypoxia-dependent organ failure. New treatment options for cardiopulmonary failure are necessary even for patients in outlying medical facilities. If these patients are in need of specialized center treatment, additional emergency medical service has to be carried out quick and safely. We describe our experiences with a pumpless extracorporeal lung assist (PECLA/iLA) for out-of-center emergency treatment of hypercapnic respiratory failure and the use of a newly developed hand-held extracorporeal membrane oxygenation (ECMO) system in cardiac, pulmonary, and cardiopulmonary failure (EMERGENCY-LIFE Support System, ELS System, MAQUET Cardiopulmonary AG, Hechingen, Germany). Between March 2000 and April 2009, we used the PECLA System (n = 20) and the ELS System (n = 33) in adult patients. Cannulation was employed using percutaneous vessel access. The new hand-held ELS System consists of a centrifugal pump and a membrane oxygenator, both mounted on a special holder system for storing on a standard patient gurney for air or ground ambulance transfer. Bedside cannulation processes were uneventful. The PECLA System resulted in sufficient CO2 removal. In all ECMO patients, oxygen delivery and systemic blood flow could be restored and vasopressor support was markedly down. Hospital survival rate in the PECLA group was 50%, and 61% in the ECMO group. Out-of-center emergency treatment of hypercapnic pulmonary failure with pumpless extracorporeal gas exchange and treatment of cardiac, pulmonary, and cardiopulmonary failure with this new hand-held ECMO device is safe and highlyeffective. Patient outcome in cardiopulmonary organ failure could be improved. [source]

Epinephrine for the treatment of anaphylaxis: do all 40 mg sublingual epinephrine tablet formulations with similar in vitro characteristics have the same bioavailability?

BIOPHARMACEUTICS AND DRUG DISPOSITION, Issue 9 2006
Mutasem M. Rawas-Qalaji
Abstract Epinephrine autoinjectors are underutilized in the first aid emergency treatment of anaphylaxis in the community; so non-invasive sublingual epinephrine administration is being proposed. In order to determine the effect of changing excipients on the bioavailability of sublingual epinephrine, four distinct fast-disintegrating epinephrine 40 mg tablet formulations, A, B, C and D, were manufactured using direct compression. All formulations were evaluated for tablet hardness (H), disintegration time (DT) and wetting time (WT). In a prospective 5-way crossover study, four sublingual formulations and epinephrine 0.3 mg i.m. as a control were tested sequentially in a validated rabbit model. Blood samples were collected before dosing and at intervals afterwards. Epinephrine plasma concentrations were measured using HPLC-EC. All tablet formulations met USP standards for weight variation and content uniformity, and resulted in similar mean H, DT and WT (n=6). The area under the curve (AUC), maximum concentration (Cmax) and time at which Cmax was achieved (Tmax) did not differ significantly after the sublingual administration of formulation A and epinephrine 0.3 mg i.m. The AUC after B, C and D were significantly lower (p<0.05) than after epinephrine 0.3 mg i.m. These results suggest that the selection of excipients used in these tablet formulations can affect the bioavailability of sublingually administered epinephrine. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Venous Pressure Regulation During Pulsatile Extracorporeal Life Support

ARTIFICIAL ORGANS, Issue 10 2008
Seong Wook Choi
Abstract During the use of pulsatile extracorporeal life support (pulsatile-ECLS), the patient's venous pressure near the inlet venous catheter tip must be monitored to maintain sufficient blood flow and to prevent vein collapse. However, direct measurement of the venous pressure and the estimate of suction using measured blood inflow and prepump pressure are not practical because of setup difficulties during emergency treatments and in cardiovascular operations. In this article, we describe a new method for estimating the venous pressure that can be implemented in the controller of the pulsatile-ECLS system, the T-PLS. It uses real-time measurement of the electric current and actuator motion. The current waveform of the T-PLS is used to determine the outflow amount and the volume remaining in the pulsatile pumps. Previously measured values of the pulsatile-ECLS compliance and the hemodynamic resistance along the inflow path are used to evaluate venous pressure with estimated blood flow. Estimated prepump pressure, inflow, and venous pressure were compared to the measured data in a series of in vitro experiments. The estimated venous pressure was used to avoid vein collapse and to increase the reliability in animal experiments. [source]

National Study of Emergency Department Visits for Acute Exacerbation of Chronic Obstructive Pulmonary Disease, 1993,2005

ACADEMIC EMERGENCY MEDICINE, Issue 12 2008
Chu-Lin Tsai MD
Abstract Objectives:, Little is known about recent trends in U.S. emergency department (ED) visits for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) or about ED management of AECOPD. This study aimed to describe the epidemiology of ED visits for AECOPD and to evaluate concordance with guideline-recommended care. Methods:, Data were obtained from National Hospital Ambulatory Medical Care Survey (NHAMCS). ED visits for AECOPD, during 1993 to 2005, were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Concordance with guideline recommendations was evaluated using process measures. Results:, Over the 13-year study period, there was an average annual 0.6 million ED visits for AECOPD, and the visit rates for AECOPD were consistently high (3.2 per 1,000 U.S. population; Ptrend = 0.13). The trends in the use of chest radiograph, pulse oximetry, or bronchodilator remained stable (all Ptrend > 0.5). By contrast, the use of systemic corticosteroids increased from 29% in 1993,1994 to 60% in 2005, antibiotics increased from 14% to 42%, and methylxanthines decreased from 15% to <1% (all Ptrend < 0.001). Multivariable analysis showed patients in the South (vs. the Northeast) were less likely to receive systemic corticosteroids (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.4 to 0.9). Conclusions:, The high burden of ED visits for AECOPD persisted. Overall concordance with guideline-recommended care for AECOPD was moderate, and some emergency treatments had improved over time. [source]