Can cardiac sonography and capnography be used independently and in combination to predict resuscitation outcomes?

OBJECTIVE: To measure the ability of cardiac sonography and capnography to predict survival of cardiac arrest patients in the emergency department (ED). METHODS: Nonconsecutive cardiac arrest patients prospectively underwent either cardiac ultrasonography alone or in conjunction with capnography during cardiopulmonary resuscitation at two community hospital EDs with emergency medicine residency programs. Cardiac ultrasonography was carried out using the subxiphoid view during pauses for central pulse evaluation and end-tidal carbon dioxide (ETCO(2)) levels were monitored by a mainstream capnograph. A post-resuscitation data collection form was completed by each of the participating clinicians in order to assess their impressions of the facility of performance and benefit of cardiac sonography during nontraumatic cardiac resuscitation. RESULTS: One hundred two patients were enrolled over a 12-month period. All patients underwent cardiac sonographic evaluation, ranging from one to five scans, during the cardiac resuscitation. Fifty-three patients also had capnography measurements recorded. The presence of sonographically identified cardiac activity at any point during the resuscitation was associated with survival to hospital admission, 11/41 or 27%, in contrast to those without cardiac activity, 2/61 or 3% (p < 0.001). Higher median ETCO(2) levels, 35 torr, were associated with improved chances of survival than the median ETCO(2) levels for nonsurvivors, 13.7 torr (p < 0.01). The multivariate logistic regression model, which evaluated the combination of cardiac ultrasonography and capnography, was able to correctly classify 92.4% of the subjects; however, of the two diagnostic tests, only capnography was a significant predictor of survival. The stepwise logistic regression model, summarized by the area under the receiver operator curve of 0.9, furthermore demonstrated that capnography is an outstanding predictor of survival. CONCLUSIONS: Both the sonographic detection of cardiac activity and ETCO(2) levels higher than 16 torr were significantly associated with survival from ED resuscitation; however, logistic regression analysis demonstrated that prediction of survival using capnography was not enhanced by the addition of cardiac sonography.

Fast education: a comparison of teaching models for trauma sonography.

This study's objective was to evaluate the peritoneal dialysis and mannequin simulator models for the hands-on portion of a 4-h focused abdominal sonography for trauma (FAST) course. After an introductory lecture about trauma sonography and practice on normal models, trainees were assigned randomly to two groups. They practiced FAST on one of the two simulator models. After the didactic and hands-on portions of the seminar, FAST interpretation testing revealed mean scores of 82% and 78% for the peritoneal dialysis and mannequin simulator groups, respectively (p = 0.95). Post-course surveys demonstrated mean satisfaction scores for peritoneal dialysis and mannequin simulator models of 3.85 and 3.25, respectively, on a 4-point Likert scale (p = 0.317). A FAST educational seminar, which provides both didactic and hands-on instruction, can be completed in 4 h; the hands-on instruction phase can incorporate both normal models and abnormal simulation models, such as the peritoneal dialysis model and the multimedia mannequin simulator.

Bradykinin stimulates phospholipase D in PC12 cells by a mechanism which is independent of increases in intracellular Ca2+.

These experiments were designed to learn the role of bradykinin induced changes in intracellular Ca2+ in the activation of phospholipase D activity in PC12 cells. Ionomycin at a concentration of 0.1 microM caused an increase in intracellular Ca2+ comparable to bradykinin, but had no effect on phospholipase D activity. Carbachol, ATP, and thapsigargin also increased intracellular Ca2+ but had no effect on phospholipase D activity. Increases in intracellular Ca2+ may be a necessary but not a sufficient factor in the activation of phospholipase D. To investigate this issue, the bradykinin induced increase in intracellular Ca2+ was blocked by preincubating the cells in Ca(2+)-free media plus EGTA or in media containing the intracellular Ca2+ chelator BAPTA/AM. These preincubations completely blocked the bradykinin induced increase in intracellular Ca2+ but only attenuated the bradykinin mediated activation of phospholipase D. Physiological increases in intracellular Ca2+ apparently do not mediate the effect of bradykinin on phospholipase D.

Increased levels of methylated intermediates of phosphatidylcholine lead to enhanced phospholipase D activity.

Previous work from this laboratory and others has shown that neurotransmitters can activate phospholipase D. Unlike the phospholipase C that specifically hydrolyzes inositol-containing phospholipids, phospholipase D in neuronal tissue specifically hydrolyzes phosphatidylcholine. One route for the synthesis of phosphatidylcholine, is via methylation of phosphatidylethanolamine. Using an in vitro assay, we have previously shown that methylated intermediates are also good substrates for phospholipase D (1). In this manuscript we demonstrate that these intermediates are also substrates in the intact PC12 cells. Cells incubated with methyl and dimethylethanolamine incorporate more [3H]palmitic acid into the corresponding phospholipid, phosphatidyl-N-methylethanolamine and phosphatidyl-N,N-dimethylethanolamine. In these cells bradykinin causes a greater increase in [3H]phosphatidylethanol production. Elevated levels of [3H]phosphatidylcholine do not enhance bradykinin-stimulated [3H]phosphatidylethanol production, therefore, this effect is specific for the methylated intermediates. Finally, this effect is not due to some generalized enhancement of receptor coupling because incubation of the cells with methylethanolamine does not lead to an increase in bradykinin stimulated inositol phosphate production.

[Effects of prolonged work on "deep-sea" fishermen: influence of blood cortisol, prolactinemia and urinary catecholamines]. / Effetti del lavoro prolungato sui pescatori "d'altura": influenza sulla cortisolemia, prolattinemia e catecolamine urinarie.

Effects of persistent overwork on the deep-sea fishermen: influence on serum cortisol and prolactin, and on urinary catecholamine levels. Variations in serum prolactin and cortisol levels and in urinary catecholamines levels were studied in fishermen exposed to a persistent overwork period of deep-sea fishing. Results indicate that prolactin was rapidly modified. In fact, the serum prolactin levels already increased on the first day and maximum levels were observed on the fifth day. On the contrary, the physiological rise and fall in the serum levels of cortisol were scarcely influenced on the first day while on the fifth day increased in the morning and fell in the evening in a very significant manner. No significant variation in urinary catecholamine levels was observed at the end of fifth day. These results suggest that, unlike for prolactin, the effects of stress on serum levels of cortisol are complex and, under our conditions, could be due, at least in part, to the duration of the stress and to the functional moment of pituitary-adrenal axis.