Jay L Falk

Publications of Jay L Falk

• Capnogram shape in obstructive lung disease.

  Authors: Baruch Krauss, Aaron Deykin, Alexander Lam, Joan J Ryoo, David R Hampton, Paul W Schmitt, Jay L Falk

  Anesthesia and analgesia. 04/2005; 100(3):884-8, table of contents.

  Small, preliminary studies have suggested that capnograms of obstructive lung disease (OD) exhibit a characteristic shape and that this shape may be correlated to changes in forced expiratory volumeSmall, preliminary studies have suggested that capnograms of obstructive lung disease (OD) exhibit a characteristic shape and that this shape may be correlated to changes in forced expiratory volume in 1 s (FEV(1)). We evaluated the association between capnograms and spirometry from subjects with OD with normal and restrictive lung disease (RD) subjects. The study was conducted in a prospective, nonrandomized manner using a convenience sample of 262 subjects presenting to a pulmonary function laboratory. Capnograms were recorded before pulmonary function testing. Subjects with OD had capnograms that were significantly different from normal and RD subjects. These differences were progressive, increasing with disease severity. The average take-off angle of the ascending phase for severe OD was 7.2 degrees less (95% confidence interval [CI]: 4.0, 10.4) than for normals. The average alveolar plateau elevation angle was 0.8 degrees more (95% CI: 0.14, 1.4) for moderate OD than for normals, whereas the average elevation angle was 3.6 degrees more (95% CI: 2.9, 4.3) for severe OD than for normals. Differences between OD capnograms and normal and RD capnograms, correlating to changes in FEV(1), were sufficiently large enough to suggest that the capnogram could be used to discriminate between OD and normal.

• Prehospital fluid resuscitation of the patient with major trauma.

  Authors: Paul E Pepe, Vincent N Mosesso, Jay L Falk

  Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. 6(1):81-91.

  The most appropriate prehospital approach to resuscitative fluid interventions for trauma patients involves: determining the mechanism of injury (i.e., blunt versus penetrating versus thermalThe most appropriate prehospital approach to resuscitative fluid interventions for trauma patients involves: determining the mechanism of injury (i.e., blunt versus penetrating versus thermal injury); identifying anatomic involvement (i.e., truncal versus isolated head injury versus isolated extremity injury); and staging the condition (i.e., hemodynamic stability versus instability versus moribund state). Based on available data, the liberal use of fluid infusions for presumed uncontrolled internal hemorrhage, such as that usually occurring after penetrating abdominal and thoracic injuries, is no longer advised. Although some infusion might be appropriate in patients with extremely severe hemorrhage (i.e., no palpable blood pressure, unconscious), the priority in such patients is rapid evacuation to definitive surgical intervention, with airway control and intravenous access provided en route. The data are less clear for patients with blunt injuries, particularly those with closed head injury. Most researchers would still recommend that patients with isolated extremity and head injuries, either blunt or penetrating, are candidates for immediate support of blood pressure through fluid infusions. However, the addition of potential intra-abdominal, intrapelvic, or intrathoracic injuries with uncontrolled hemorrhage confounds the decision-making process. Although conventional wisdom has been to provide aggressive blood pressure support under these circumstances through judicious use of isotonic, or perhaps hypertonic, fluid resuscitation, recent experimental data challenge even this philosophy. Use of new blood substitutes might help to resolve some of these issues by providing oxygen delivery with limited volume in the face of uncontrolled hemorrhage.