Ugeskrift for laeger
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Ugeskrift for laeger · Feb 1991
Review[Blood transfusion and Jehovah's witnesses. Ethical and medicolegal aspects].
Jehovah's witnesses refuse transfusion of blood and blood products on the basis of religious convictions even when transfusion is considered necessary to save life. Medical treatment of these patients presents an ethical challenge for the physicians. The legal aspects of either administering blood to or withholding necessary blood transfusion from a Jehovah's witness are not clarified. ⋯ Final clarification of the patients' rights and the physicians' legal status could be obtained by an amendment to the existing Practice of Medicine Acts as proposed in the report (1184) from the Danish Ministry of Justice. The ethical aspects of administering blood to or withholding blood from these patients are also complex. It is recommended to determine one's own attitude individually and to inform the patient about this before an operation.
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Ugeskrift for laeger · Jan 1991
Case Reports[Retroperitoneal complications after lumbar disk prolapse surgery].
Injury to retroperitoneal vascular structures secondary to lumbar disc surgery is a rare but serious complication. In some cases early recognition and surgical intervention is of vital importance. Vascular injuries may be classified in in the following manner. 1. ⋯ False aneurysm. Based on a review of the literature and three case reports, the anatomy is reviewed. The diagnosis, clinical pictures and the vascular reconstruction are discussed.
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A case of toxic reaction to bupivacaine which was administered epidurally to a pregnant woman is presented. The test dosage and the aspiration test are discussed. The value of fractionated administration of bupivacaine is emphasized.
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Ugeskrift for laeger · Jan 1991
Review Comparative Study[Methods for ensuring correct tracheal intubation. A review].
To confirm correct intubation of the trachea, the literature mentions the following methods: Auscultation of thorax, the sensation of normal ventilation, gastric and thorax movement, condensation of water vapor in the tube lumen, external palpation on the patient's neck of the tube and the cuff, tactile palpation through the patient's mouth of the tube, x-ray of thorax and detection of hemoglobin oxysaturation with pulse oximetry. These methods can be used, but cannot be recommended, because they are not reliable. The following methods are recommended in the literature as reliable: Repeated laryngoscopy when there are direct visualization of the vocal cords, fiberoptic bronchoscopy, suction on the tube with a 60-ml syringe, auscultation of the upper abdomen and lungs and end-tidal carbon dioxide measurement. For the daily routine, control, of the endotracheal tube placement, by auscultation over the epigastrium, then in the right and left axilla, and continuous measurement of carbon dioxide in the expired air are recommended.