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Asthma in children has many special features which deserve consideration. This disease is probably underdiagnosed and is often undertreated. Vague, persistent respiratory symptoms, especially chronic cough, may often be due to asthma. ⋯ Nevertheless, many children with moderate or severe asthma will continue to be troubled by intermittent or chronic airway obstruction into adulthood, and they require long-term, anticipatory treatment programs. Comprehensive care will optimize the quality of life for the affected children and their families, and it will minimize the discomfort and restrictions to which some of them have been subjected unnecessarily. Asthma in childhood, especially when not well controlled, may constitute a risk factor for the development of chronic obstructive pulmonary disease in adulthood; however, this is as yet only suspected and not proved.
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We reviewed 94 cases of prehospital ventricular fibrillation (VF) to determine aspects of field response that predicted outcome. Only one of 37 patients (3 percent) failing to achieve rhythms other than VF or asystole after the first two defibrillations survived to hospital discharge compared to nine of 57 (16 percent) achieving organized rhythms by this point (p less than 0.05). ⋯ Thus, for prehospital VF, the best field response identifies potential survivors prior to hospital arrival. In addition, the frequent occurrence and potentially favorable outcome of an initially pulseless rhythm necessitates reevaluation of current therapy.
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A national survey of hospitals was conducted to evaluate the usage of lung expansion maneuvers in the prevention and management of postoperative atelectasis associated with abdominal and thoracic surgery. Equal numbers of hospitals were randomly selected from the nine American Hospital Association regions and from bed-size groups of 50 to 200 beds, 201 to 400 beds, and greater than 400 beds. ⋯ Objective measurements of tidal volume or inspiratory capacity as a guide to therapeutic decisions are performed more frequently in the western regions. Surgical statistics relative to the number of abdominal and surgical procedures done and the incidence of postoperative atelectasis are also presented.