Field triage for on-scene helicopter transport

This prospective study evaluated the use of basic vital signs, two mechanisms of injury, and time-distance factors as field triage criteria for on-scene helicopter transport of 130 patients to a trauma center serving a rural area. The vital signs criteria included any one or more of the following: level of consciousness (LOC) less than or equal to unresponsive to verbal stimulation; respiration rate (RR) less than or equal to 10 or greater than or equal to 30; systolic blood pressure (BP) less than or equal to 90; pulse (P) less than or equal to 60 or greater than or equal to 120. The flight crew recorded vital signs taken by the first responder capable of basic assessment. Entrapment and associated fatalities in motor vehicular accidents were recorded and flight logistics were examined. The presence of one or more abnormal signs identified a group of seriously injured trauma patients (mean Injury Severity Score = 29.1) with 24% mortality compared to a predicted mortality of 32% (p less than 0.02). Unresponsiveness to verbal stimulation in the field was the single most predictive criterion, yielding sensitivity of 93% and specificity of 85%. Time-distance criteria were helpful to determine helicopter use.

MRI simulator for instruction in pulse-sequence selection

An ordinary desk-top microcomputer was programmed to simulate MR images for specified spin-echo pulse sequences. Model pixel maps of proton density and T1 and T2 relaxation times were made from published estimated values for regions of the human head, neck, and spine. Images were generated and displayed from the model maps and user-specified pulse-sequence parameters in less than 30 sec/image. Models for various pathologic conditions, including calcification, subacute hemorrhage, porencephaly, lipoma, and multiple sclerosis, were superimposed on the images of normal anatomy to create unknown cases. Simulated images can easily demonstrate the effect of pulse-sequence selection on the contrast of normal structures and pathologic conditions. Use of simulated images is an excellent technique for gaining experience in pulse-sequence selection. Low-cost microcomputers can provide adequate image detail and reasonable image display time of synthetic MR images for teaching purposes.

Colonoscopy following intraoperative lavage in the management of severe colonic bleeding

Intraoperative lavage of the colon through a catheter inserted into the caecum provides a rapid means of cleansing the bowel of blood and clots to enable thorough colonoscopy in cases of severe colonic bleeding. This permits diagnosis of the site and cause of haemorrhage in those cases in which neither arteriography, conventional colonoscopy, nor laparotomy alone are helpful. Four cases are presented in which the technique of colonoscopy following intraoperative lavage allowed diagnosis and treatment in massive large bowel bleeding.

Enderley group

Images

Ocular pneumoplethysmography in head-injured patients

Severe head injury is frequently associated with multiple trauma. In the comatose patient, endotracheal intubation and ventilator support are often required, if there is associated dyssynchronous spontaneous effort. The latter is managed with therapeutic (drug) paralysis. An elaborate life-support and monitoring system coupled with controlled paralysis limits the mobility of the patient for diagnostic procedures, and a continuing reevaluation of neurological status is difficult. Under these circumstances the ocular pneumoplethysmograph provides a simple rapid noninvasive assessment of ocular blood flow, and this reflects cerebral blood flow and alterations in brain compliance. Alterations in the therapeutic regimen can be based on these observations.

Gastric emptying after intestinal resection in Crohn's disease

Gastric emptying, using a liquid meal labelled with 99Tcm DTPA was studied in 6 patients with Crohn's disease who had diarrhoea following resection of the small intestine. Results were compared with those obtained in 6 normal subjects and 6 patients who had classic dumping symptoms following gastric surgery. The rate of gastric emptying of patients with Crohn's disease was similar to that of normal subjects, and differed markedly from gastric emptying in patients with the dumping syndrome (P less than 0 . 001). Diarrhoea in patients with Crohn's disease who have undergone intestinal resection is not due to rapid gastric emptying and would therefore be unlikely to respond to therapeutic measures designed to improve similar symptoms in patients who have the dumping syndrome.

Complications of posterior fossa craniotomy

The nurse, as primary and continuous accessor of the patient, must have a thorough knowledge of complications related to posterior fossa surgery. Continuous evaluation of neuro status will alert her to any changes. These changes can occur quickly and require immediate intervention to prevent life-threatening situations. Attentive nursing care, both physiological and psychological, with utilization of other health care team members (social service, mental health counselors, physical and occupational therapy) can ensure a more secure recuperative period.

The demonstration of sialic acid in kidney stone matrix

1. The organic matrices of 12 kidney stones containing calcium and two composed of uric acid were solubilized, with ethylenediaminetetra-acetate for the former and sodium hydroxide for the latter. 2. The solubilized matrices and residual fine particulate material were examined for sialic acid by the thiobarbituric acid method. 3. Sialic acid was found in every stone in either the soluble and/or insoluble material. 4. The identity of sialic acid was confirmed by the absorption spectrum of the colour produced and by its release from the protein by neuraminidase. 5. The presence of sialic acid in all stones despite widely varying composition suggests that it may be passively deposited.

Infrared spectrometer for Voyager

The Voyager IR investigation uses a Michelson interferometer with a 4.3-cm(-1) spectral resolution in the 80-2500-cm(-1) range and a single-channel radiometer for the visible and near-IR, 5000-30,000-cm(-1). Both devices share a Cassegrain telescope with a 50-cm diam primary mirror and a 0.25 degrees field of view. Design, calibration, and performance are discussed along with a sample spectrum of Jupiter.

Sublethal stress in Escherichia coli: a function of salinity

Sublethal stress in Escherichia coli was detected in various test media after exposure (in vitro) to seawater of various salinites. Stress was measured with an electrochemical detection technique and a beta-galactosidase assay. Test media included EC medium, medium A-1, and tryptic soy broth modified to contain lactose for beta-galactosidase assay experiments. Stress was defined as the difference between a predicted electrochemical response time calculated for unstarved cells from a standard curve and the observed electrochemical response time for cells starved in seawater. The higher the salinity, the greater the stress for all test media examined. Stress was most pronounced in EC and was attributed primarily to initial die-off of starved cells exposed to the test medium at the elevated temperature of 44.5 degrees C. Lag time and growth rates in test media were not significantly affected by salinity. beta-Galactosidase specific activity, assayed in starved cells after transfer to an induction medium at 44.5 degrees C for 150 min, was inversely related to the salinity of the starved cell suspension. The consequences of these observations with respect to coliform enumeration methods are discussed.