摘要:

Blood gas values were obtained from Swan-Ganz pulmonary artery catheters in 25 patients with acute pulmonary failure, with the objective of evaluating the possibility of contamination with “arterialized” blood and examining the mechanism by which this might happen. Blood oxygen content increased significantly from the main to a segmental pulmonary artery, proportional to the withdrawal rate of the sample. At 3 ml/min, distal contents ranged from 100 to 116% of proximal values (p > 0.01). At 23 ml/min the range was 100–140% of proximal values (p > 0.001). Sampling of blood from a Swan-Ganz catheter in the usual position for “wedge” pressure measurement, but with balloon deflated, may lead to large errors in calculation of cardiac output by the Fick method and in calculation of intrapulmonary shunt fraction.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

With the thermodilution technique, repeated determination of cardiac index (CI) has become a rapid, easily accomplished, safe procedure. We paired 77 CI determinations measured by direct Fick and thermodilution techniques in 21 patients who underwent myocardial revascularization. Commercially available thermistor-tipped catheters and a cardiac output computer were used to determine CI according to the manufacturer's instructions. Oxygen consumption and arterial-venous oxygen content differences were measured directly to determine CI by the Fick method. Comparisons were made during mechanical ventilation with and without positive end-expiratory pressure (PEEP) and during spontaneous ventilation with and without PEEP. Cardiac indices measured by the two techniques were within ±0.5 L/min/m2of each other only 76% of the time and within ±1.0 L/min/m296% of the time, if CI ≥ 4.0 L/min/m2were omitted. Ventilatory pattern had no apparent effect on results.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Four heroin-overdosed patients presented with coma, elevated serum enzymes (creatine phosphokinase (CPK) and serum glutamic oxaloacetic transaminase (SGOT)), and increased levels of plasma free hemoglobin. In two patients marked myoglobinuria was also detected. The plasma free hemoglobin re-turned to normal levels by the 3rd hospital day. Since coma may eventuate in compression of muscles, we suggest that the disruption of erythrocytes occurs as they traverse these ischemic areas.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The problem-oriented approach to the medical record has aroused a long overdue interest in the structuring of the medical case file. Clinical information in the traditional record is source-structured and time-sequenced, whereas the problem-oriented system differs by being a problem-structured record retaining still a chronologic sequence. We have found that in acute illness the multiplicity of interacting pathophysiologic processes makes premature application of the problem-oriented approach cumbersome and unwieldy. The formulation of the problem list at an early stage often led to the reduplication of problems, creating disorder in the clinical picture rather than serving to clarify it. Some used the simple cataloguing of events and data as a substitute for clinical judgment and decision making, focusing more upon style rather than content of the medical record. By using a rigid physiologic system-structured “problem” list and a modification of the SOAP (Subjective, Objective, Assessment, Plan) subdivision, we have improved the documentation of our intensive care patients. The summary of the patient's stay in the intensive care unit is structured with active and inactive problems, this summary to be further used as the permanent problem list.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Good results of the emergency management trauma victims depend on recognition of serious injures and rapid, effective treatment as well as anticipation and prevention of complications. The most spectacular injury is not always the most urgent and life threatening. Based on priorities of management, care recommended to improve mortality and morbidity statistics. Suggestions for effective treatment of rapid) lethal lesions and preparations for transporting seriously injured patients are also outlined.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

This paper presents the need for and offers a solution to the problem of factitial tongue and other intra-oral injuries in comatose and decerebrate patients. The neurophysiology of jaw movement in the comatose patient is the basis for the design of an intraoral prosthesis which in two patients has prevented discoordinate mandibular chewing movements and facilitated healing of preexisting factitial lesions. The authors delineate in detail the fabrication, insertion, and maintenance of this protective prosthesis and emphasize the need for joint effort between the intensive care, neurosurgical, and oral surgical teams.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

We have utilized new methods of dialyzer-augmented whole blood and plasma exchange transfusion in the treatment of hepatic coma. The method employs the. new fast flow Buselmeier shunt so that the exchange can be done from a peripheral radial artery shunt site rather than a shunt site in a more major vessel, such as the brachial artery. The method employs in-line dialysis of citrated (CPD) blood or plasma to normalize pH, electrolytes, and blood sugar while infusion heparinization decreases heparin requirements. The application of a single roller pump to the administration and withdrawal lines (placed in opposite directions) helps equalize inflow and outflow where whole blood ex-change is done while identical opposing pumps accomplish the same with plasma exchange. The administration of albumin and metaraminol bitartate prevents hypotension due to fluid shifts or compartmental venous dilatation. A closed circuit which does not require disconnection throughout the 30− 60-minute whole blood exchange or the 21/2-hour plasma exchange de-creases the risk of septic contamination to both medical staff and patients.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID