Chest
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Case Reports
Gastroesophageal lacerations. A fatal complication of closed chest cardiopulmonary resuscitation.
A case of fatal gastrointestinal hemorrhage from gastric mucosal lacerations related to the closed chest cardiac compression of cardiopulmonary resuscitation is reported. Previous autopsy series suggest that gastroesophageal lacerations may occur in 12 percent of cases not surviving cardiopulmonary resuscitation (CPR). In the presence of increasing out-of-hospital and lay-initiated resuscitation, recognition of this complication of closed chest compression seems to be of particular importance. Attention to the technique of chest compression and ventilation, including early intubation and gastric decompression, may help to minimize the incidence of gastric mucosal laceration occurring during CPR.
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The ventricular volume and function changes induced by the addition of 12 cm H2O of positive end-expiratory pressure (PEEP) during mechanical ventilation were studied in 11 patients with the adult respiratory distress syndrome. Cardiac output was measured by thermodilution and ventricular ejection fraction by the multiple gated equilibrated cardiac blood pool scintigraphy. ⋯ On the basis of the relationship between stroke volume and ventricular end-diastolic volume, we conclude that reduction in preload was the major component of the decrease in cardiac output. After removal of PEEP, we observed a rebound phenomenon characterized by higher values for stroke volume and cardiac output than before the application of PEEP.
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Case Reports
Significant left main stenosis following asymptomatic dissection during coronary arteriography.
The natural history of minimally symptomatic or asymptomatic iatrogenic coronary dissection is not well-defined. While generally considered a serious and life-threatening complication of coronary arteriography, there have been some reported cases of spontaneous resolution without residuals. We describe a case demonstrating that coronary artery dissection, even when initially asymptomatic, may later progress and result in significant or complete coronary occlusion. The implications of this are discussed.