Chest
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The contribution of the electrocardiogram to the clinical judgment used by the physician in the emergency room to determine the necessity for hospitalizing patients was evaluated. Thirty-five percent of all 1,578 patients with presumed myocardial infarction referred to the Chaim Sheba Medical Center, Tel Hashomer, Israel, for a one-year period had subsequently diagnosed myocardial infarctions. The ECG in the emergency room detected only 65 percent of these. ⋯ When the myocardial infarction was not evident on the ECG and the abnormalities on the tracings were identical for patients with subsequent myocardial infarctions and those without, again the physician made the right choice more often than the wrong. The follow-up ECG also attested to the good judgment of the physician in the emergency room. Of the emergency room ECGs of patients without subsequent myocardial infarctions who were admitted to the hospital, 17 percent showed myocardial infarction by follow-up, while this happened to only 2 percent of those denied admission.
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A 59-year-old white man had an extensive bronchogenic carcinoma of the right upper lobe. During the course of pneumonectomy, the patient died unexpectedly. ⋯ The cause of the air embolism and subsequent death was almost certainly related to positive-pressure ventilation, allowing entry of air into the systemic venous system through the broncho-azygous vein communication. Because of the clinical implications of this problem, the case is reported, and suggestions for management are offered.